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J D Zuckerman

Publications and source records attributed to J D Zuckerman.

At least 55 records · Page 3Linked to original sources
PubMed1998

Open surgical treatment of anterior glenohumeral instability: an historical perspective and review of the literature. Part I.

Anterior glenohumeral instability is an undesirable result of trauma to the shoulder. Several surgical treatments for this condition have been developed, beginning in the early years of the twentieth century. Although these procedures were usually popular at their inception, many of them have fallen out of favor as more information has been acquired concerning the long-term results and complications of their use. Often successful in preventing recurrent instability, these earlier procedures also often led to a loss of external rotation, and consequently, function. Newer procedures that aim to prevent recurrent instability while maintaining full range of motion and function have been devised. Part I of this paper presents a brief history of the treatment of glenohumeral instability and a review of the literature, including the Bankart and du Toit procedures. Part II, which will be published in the December 1998 issue, includes the Putti-Platt, Magnuson-Stack, Bristow, and newer procedures.

History, 20th Century↗
PubMed1998

Open surgical treatment of anterior glenohumeral instability: an historical perspective and review of the literature. Part II.

Anterior glenohumeral instability is an undesirable result of trauma to the shoulder. Several surgical treatments for this condition have been developed, beginning in the early years of the twentieth century. Although many of these procedures were popular at their inception, many of them have fallen out of favor as more information has been acquired concerning the long-term results and complications of their use. While often successful in preventing recurrent instability, these earlier procedures also often led to a loss of external rotation, and consequently, function. Newer procedures have been devised that aim to prevent recurrent instability while maintaining full range of motion and function. Part I of this paper, published in the November issue, presented a brief history of the treatment of glenohumeral instability and a review of the literature, including the Bankart and du Toit procedures. Part II includes the Putti-Platt, the Magnuson-Stack, the Bristow, and capsular shift procedures.

Female↗
PubMed1997

Pubic rami fracture: a benign pelvic injury?

OBJECTIVE: To present a consecutive series of older patients with pubic rami fractures and evaluate their long term functional outcome. STUDY DESIGN: Retrospective. METHODS: Sixty-three consecutive community-dwelling, ambulatory patients who sustained a public rami fracture and were treated at one hospital were reviewed. Fifty-two of sixty-three patients (83%) had radiographic evidence of pubic rami fracture at initial presentation; in the remaining eleven patients, the diagnosis of pubic rami fracture was made after additional imaging studies. Sixty patients (95%) required hospitalization for pain control and progressive mobilization. RESULTS: The hospital length of stay for the sixty admitted patients averaged fourteen days; patients who had three or more associated medical comorbidities or required use of a cane or walker for ambulation prior to fracture were more likely to have been hospitalized greater than two weeks. Thirty-eight patients were available for one year minimum follow-up; thirty-five of thirty-eight patients (92%) were living at home, 84% had no or mild complaints of hip/groin pain, 92% had returned to their prefracture ambulatory status, and 95% had returned to their performance function in activities of daily living. CONCLUSIONS: 1) Elderly patients with pubic rami fractures utilize substantial healthcare resources based upon length of stay and need for home care services; and 2) those patients who survive have a good prognosis with regard to long term pain relief and functional outcome.

Activities of Daily Living↗
PubMed1997

Hip fractures in the elderly: predictors of one year mortality.

OBJECTIVE: To determine the one year mortality following hip fracture in an ambulatory, community dwelling, cognitively intact elderly population and to examine the role of specific type, number, and severity of associated medical comorbidities. DESIGN: Prospective, consecutive. METHODS: Six hundred twelve elderly who sustained a non-pathologic hip fracture were followed. RESULTS: Twenty-four patients (4%) died during hospitalization; seventy-eight (12.7%) died within one year of fracture. The factors that were predictive of mortality, based on multivariate analysis, were patient age > 85 years, preinjury dependency in basic activities of daily living, a history of malignancy other than skin cancer, American Society of Anesthesiologists rating of operative risk 3 or 4, and the development of one or more in-hospital postoperative complications; all factors other than the development of an in-hospital complication were independent of treatment. CONCLUSION: These results indicate that efforts at reducing one year mortality after hip fracture should be directed at the prevention of postoperative complications.

Aged↗
PubMed1997

Does blood transfusion increase the risk of infection after hip fracture?

OBJECTIVE: To determine whether allogeneic red blood cell transfusion is a predictor for developing an in-hospital postoperative urinary tract, respiratory, or wound infection. STUDY DESIGN: Prospective, consecutive. METHODS: Six hundred eighty-seven community-dwelling, ambulatory, geriatric hip fracture patients were prospectively followed; all patients had operative fracture treatment and received perioperative antibiotics. RESULTS: Sixty-eight patients had a culture-positive infection before operative treatment. One hundred thirty-four of the remaining 619 patients (21.6%) developed a postoperative infection, primarily a urinary tract infection. The infection rate was 26.8% in transfused patients compared with 14.9% in nontransfused patients (p = 0.001). When stratifying by the type of infection, only the risk of urinary tract infection was statistically significant (p = 0.001). After controlling for the effect of patient age, sex, number of preinjury medical comorbidities, American Society of Anesthesiologists (ASA) rating of operative risk, fracture type, surgical delay, type of surgery, type of anesthesia, operative time, and blood loss, the relationship between allogeneic red blood cell transfusion and postoperative urinal tract infection remained statistically significant. CONCLUSIONS: Geriatric hip fracture patients who receive allogeneic red blood cell transfusions are at higher risk for developing a postoperative urinary tract infection than are those patients who are not transfused.

Aged↗
PubMed1997

Salter-Harris type III fracture-dislocation of the proximal humerus.

Salter-Harris type III fractures of the proximal humerus are rare injuries. We report a Salter-Harris type III anterior fracture-dislocation of the proximal humerus in a 10-year-old boy that was open reduced and internally stabilized. A bone scan performed during the initial hospitalization and at 2-year follow-up revealed devascularization and subsequent revascularization of the humeral head. At 2-year follow-up, the patient had full motion of the shoulder, no pain, and arm strength equal to that of the contralateral side. Four cases of Salter-Harris type III fractures of the proximal humerus have been previously reported; good early clinical outcomes were obtained in all. Despite devascularization of the epiphyseal fragment, excellent clinical outcomes may result.

Child↗
PubMed1997

Functional outcome after minimally displaced fractures of the proximal part of the humerus.

One hundred and four patients who had a minimally displaced fracture of the proximal part of the humerus (a so-called one-part fracture) were managed with a standardized therapy regimen and followed for more than one year. The clinical outcome was assessed on the basis of pain, function, and the range of motion of the shoulder. The duration of follow-up averaged forty-one months (range, twelve to 117 months). All fractures united without additional displacement. Eighty patients (77 per cent) had a good or excellent result, fourteen (13 per cent) had a fair result, and ten (10 per cent) had a poor result. Ninety four patients (90 per cent) had either no or mild pain in the shoulder, eight (8 per cent) had moderate pain, and two (2 per cent) had severe pain. Functional recovery averaged 94 per cent; forty-eight patients (46 per cent) had 100 per cent functional recovery. At the time of the most recent follow-up, forward elevation of the injured shoulder averaged 89 per cent; external rotation, 87 per cent; and internal rotation, 88 per cent that of the uninjured shoulder. The percentage of good and excellent results was significantly greater (p < 0.01) and external rotation was significantly better (p < 0.01) at the time of the latest follow-up for the patients who had started supervised physical therapy less than fourteen days after the injury than for the patients who had started such therapy at fourteen days or later.

Activities of Daily Living↗
PubMed1997

Treatment of grade III acromioclavicular separations. Operative versus nonoperative management.

Twenty-six patients with Grade III acromioclavicular joint separations were evaluated to determine the outcomes of nonoperative and operative management. Evaluation consisted of a detailed functional questionnaire, physical examination, and comprehensive isokinetic strength assessment. The patients were divided into two groups: operative (n = 16) and nonoperative (n = 10). Operative management consisted of coracoclavicular stabilization with heavy suture material and with nine of the sixteen patients treatment also consisted of coracoacromial ligament transfer and lateral clavicle resection. Nonoperative management consisted of short-term immobilization with early range of motion and rehabilitation. The two groups were similar in all characteristics except mean age: 30.7 years for the operative group and 49.6 years for the nonoperative group. Follow-up evaluation was performed an average of 32.9 months after either injury (nonoperative group) or surgery. Our results indicated that nonoperative management was superior to operative management with respect to time to return to work (0.8 months vs. 2.6 months), time to return to athletics (3.5 months vs. 6.4 months) and time of immobilization (2.7 weeks vs. 6.2 weeks). However, operative management was superior to nonoperative management in the following parameters: time to attain completely pain-free status, the patient's subjective impression of pain, range of motion, functional limitations, cosmesis, and long-term satisfaction. There were no significant differences between the two groups with respect to shoulder range of motion, manual muscle testing, or neurovascular findings. Isokinetic strength testing of the involved shoulder, expressed as a percentage of the uninvolved shoulder, showed no significant differences in peak torque, total work, or total power between the operative and nonoperative groups. However, comparison of the involved to the uninvolved extremity within each group did reveal a trend toward decreased peak torque, work, and power for abduction in the involved extremity regardless of the treatment used. These findings reached statistical significance only for power at the slower testing speed (60 degrees/sec). There was also a significant decrease in power in the involved extremity for external rotation at the faster speed (120 degrees/sec) in the nonoperative group. Finally, the absolute values for peak torque, work, and power were significantly greater for all motions tested in the operative group as compared to the nonoperative group. This may reflect the difference in age between the two groups. Based upon the patients studied, there are benefits to both nonoperative and operative methods of treatment of Grade III acromioclavicular separations. Recovery of strength did not differ between the two groups and therefore should be viewed as a less important factor in patient selection for operative versus nonoperative management. Careful patient selection should remain an important aspect of treatment for this controversial injury.

Acromioclavicular Joint↗
PubMed1996

Hip fracture.

Explore the source record for details and available documents.

Hip Fractures↗
PubMed1996

Development of a telemeterized shoulder prosthesis.

A telemeterized shoulder prosthesis was developed and tested, first in vitro and then in a cadaver implantation. The prototype prosthesis was instrumented with 3 strain gauges fixed within a hollow, tapered neck element whose output was used to determine the load vectors experimentally applied to the humeral head. Testing demonstrated accuracy of force measurement resolution to within 5% of actual applied forces. This design seems feasible for further investigations to develop a totally implantable telemeterized prosthesis.

Biomechanical Phenomena↗
PubMed1996

Patients with femoral neck and intertrochanteric fractures. Are they the same?

A prospective analysis was performed involving 680 geriatric patients with hip fractures to determine whether the demographic profile of patients with femoral neck fractures was similar to that of patients with intertrochanteric fractures. All patients were community dwelling, cognitively intact, previously ambulatory elderly with femoral neck or intertrochanteric fracture. Three hundred fifty-eight patients (52.6%) sustained a femoral neck fracture; 322 (47.4%), an intertrochanteric fracture. Patients with an intertrochanteric fracture were significantly older, more likely to be limited to home ambulation, and were more dependent regarding basic and instrumental activities of daily living. After stratification by gender and adjustment for age, these differences remained significant in women only. There were no differences in age, prefracture ambulatory ability, or dependence in activities of daily living in men with either type of fracture.

Activities of Daily Living↗
PubMed1996

Split fractures of the lateral tibial plateau: evaluation of three fixation methods.

A laboratory study was performed to compare the stability and ultimate strength of three standard fixation techniques for split-type lateral tibial plateau fractures. The three methods of fixation were (a) three 6.5-mm cancellous lag screws with washers; (b) two 6.5-mm cancellous lag screws with washers and an additional antiglide 4.5-mm cortical screw with washer; and (c) six-hole L-shaped buttress plate. Twelve pairs of embalmed mildly osteopenic lower extremities were used. Simulated split-type lateral tibial plateau fractures were created, reduced, and then instrumented in a matched pair design. The instrumented specimens were axially loaded to determine resistance to displacement, cyclically loaded to 10,000 cycles to determine dynamic stability, and then loaded to failure. There were no statistically significant differences found between resistance to displacement or failure strength as a function of either fragment size or sample bone density. On the basis of biomechanical stability, there appears to be no difference between the three fixation techniques tested. The results of this study suggest that use of an antiglide screw or buttress plate does not offer an advantage over lag screw fixation alone for the treatment of split type lateral tibial plateau fractures.

Biomechanical Phenomena↗