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Biomedical subjects

J M Matta

Publications and source records attributed to J M Matta.

At least 37 records · Page 2Linked to original sources
PubMed1996

[New technique for a hip arthrodesis using an anterior approach and a ventral plate].

The authors present a new technique for fusion of the hip joint through an anterior approach (Smith-Petersen) with the use of a ventral plate and a lateral compression screw. The indications for fusion of the hip joint are discussed and some cases are presented. The advantages of this technique are that strong bone stock for fixation is used on the pelvic side, that the abductor muscles and vascularization of the femoral head are left intact, and that no external fixation (cast) is routinely used for after-treatment.

Adult↗
PubMed1996

Late reconstruction after pelvic ring injuries.

Pelvic malunions or nonunions are the result of inappropriate treatment of rotationally or linearly unstable injuries of the pelvic ring. Long-term sequelae such as chronic pain in the posterior pelvic ring, gait abnormalities, leg length discrepancy, sitting discomfort, neurological problems or impingement on the visceral organs may be secondary to the disturbed integrity of the pelvic ring. The late correction of the deformity is technically much more demanding than the treatment of acute pelvic ring injuries. Depending on the specific problem, osteotomies at the site of the deformity, excision of scar tissue and callus, release of ligaments, bone grafting, and an adapted technique of reduction and fixation may be required. Possible complications include nerve or vascular injuries, incomplete reduction of the deformity, failure to unite, incomplete pain relief, and infection. Prior to surgery, a careful clinical and radiological examination is mandatory to assess the relationship between the presenting anatomical deformity and the complaints of the patient. The final decision for surgery has to be made by the patient taking into account reasonable expectation and the potential complications associated with the corrective procedure.

Fracture Fixation↗
PubMed1996

Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury.

The results were reviewed for 259 patients who had open reduction and internal fixation of 262 displaced acetabular fractures within twenty-one days after the injury. Two hundred and fifty-five hips were followed for a mean of six years (range, two to fourteen years) after the injury; the remaining seven, which clearly had a poor result, were followed for less than two years. According to the classification of Letournel and Judet, associated fracture types accounted for 208 (79 per cent) of the fractures, with both-column fractures being the most common type (ninety-two hips; 35 per cent). Two hundred and fifty-eight hips were operated on with a single operative approach (Kocher-Langenbeck, ilioinguinal, or extended iliofemoral). The four remaining hips were operated on with a Kocher-Langenbeck as well as an ilioinguinal approach. The reduction was graded as anatomical in 185 hips (71 per cent). The rate of anatomical reduction decreased with increases in the complexity of the fracture, the age of the patient, and the interval between the injury and the reduction. The over-all clinical result was excellent for 104 hips (40 per cent), good for ninety-five (36 per cent), fair for twenty-one (8 per cent), and poor for forty-two (16 per cent). The clinical result was related closely to the radiographic result. The clinical result was adversely affected by associated injuries of the femoral head, an older age of the patient, and operative complications. It was positively affected by an anatomical reduction and postoperative congruity between the femoral head and the acetabular roof. Osteonecrosis of the femoral head was noted in eight hips (3 per cent), and progressive wear of the femoral head was seen in thirteen (5 per cent). Subsequent operations included a total replacement of seventeen hips (6 per cent), an arthrodesis in four (2 per cent), and excision of ectopic bone in twelve (5 per cent). These findings indicate that in many patients who have a complex acetabular fracture the hip joint can be preserved and post-traumatic osteoarthrosis can be avoided if an anatomical reduction is achieved. An increase in the rate of anatomical reduction and a decrease in the rate of operative complications should be the goals of surgeons who treat these fractures.

Acetabulum↗
PubMed1994

Operative treatment of acetabular fractures through the ilioinguinal approach. A 10-year perspective.

The ilioinguinal surgical approach was found to be effective for treatment of 119 (about 33%) of the 373 acetabular fractures treated operatively by the author over a 10-year period. It is indicated for anterior wall, anterior column, associated anterior and posterior hemitransverse fractures, as well as certain both column and transverse fractures. The approach offers the advantages of a cosmetic incision, rapid recovery of muscle function, and minimal ectopic bone formation. Complications included 3% surgical wound infection, 2% iatrogenic nerve palsy, 1% significant ectopic bone, and 1% death from pulmonary embolus. Clinical results at a minimum of 1-year, and an average of 3-years' followup, were, excellent in 37%, good in 47%, fair in 14%, and poor in 2%. Two patients later required total hip arthroplasty for posttraumatic arthritis.

Acetabulum↗
PubMed1994

Prevention of deep vein thrombosis and pulmonary embolism in acetabular and pelvic fracture surgery.

In a prospective nonrandomized study, a protocol was examined for prophylaxis of deep venous thrombosis and pulmonary embolism in patients with operative treatment of acetabular and pelvic fractures. There were 197 patients in the study with 203 fractures, including 148 acetabular and 55 pelvic fractures. There were 2 cases of bilateral acetabular fractures and 4 cases with both acetabular and pelvic fractures. The protocol involved preoperative noninvasive screening of the lower extremities, intraoperative and postoperative use of mechanical antithrombotic devices, and chemical prophylaxis with warfarin for 3 weeks following removal of surgical drains. There were 11 cases (6%) of preoperative deep venous thrombosis detected. There were 6 cases of postoperative deep venous thrombosis and 2 cases of pulmonary embolism. The incidence of postoperative venous thrombosis and pulmonary embolism was 3% and 1%, respectively. The protocol was found to be effective for preoperative detection of venous thrombosis and prevention of deep venous thrombosis and pulmonary embolism in trauma patients with minimal bleeding complications and no morbidity from embolic disease.

Acetabulum↗
PubMed1994

Delayed reconstruction of acetabular fractures 21-120 days following injury.

A retrospective review was performed of 207 patients treated by delayed reconstruction of acetabular fracture between 21 and 120 days following injury. Nineteen patients were lost to followup. One hundred eighty seven patients had 188 fractures classified as follows; 35 posterior wall, 9 posterior column, 5 anterior wall, 4 anterior column, 13 transverse, 49 transverse/posterior wall, 21 T shape, 8 posterior column/posterior wall, 8 anterior column posterior hemitransverse, and 34 both column fractures. The average preoperative delay was 43 days. Followup averaged 6.5 years (range, 9 months-30 years). Overall good to excellent results were achieved in 65% of patients, fair in 9%, and poor in 26%. Good to excellent results by fracture type were; posterior wall (51%), posterior column (89%), anterior wall (60%), anterior column (100%), transverse (69%), transverse/posterior wall (59%), T shape (62%), posterior column/posterior wall (88%), anterior column/posterior hemitransverse (75%), and both column (72%). Heterotopic ossification developed in 49 of 168 patients without prophylactic treatment, in 6 of 12 treated prophylactically with diphosphonate, and in 2 of 27 receiving prophylactic indomethacin therapy. There were 20 postoperative sciatic nerve palsies, 3 immediate and 5 delayed infections, 5 cases of pulmonary embolism, and 26 cases of avascular necrosis. Delayed management of acetabular fractures increases the difficulty of operative treatment and may result in a significant reduction in good to excellent results. Simple anterior or posterior wall fractures, associated transverse + posterior wall fractures, and T shape fractures have an increased risk of failure when treated within this time period.

Acetabulum↗
PubMed1994

Surgical revision of malreduced acetabular fractures.

Early failure of open reduction and internal fixation of fractures of the acetabulum presents a treatment challenge even more difficult than that of the primary injury. This study evaluates the success of reoperation for 64 patients with surgical malreduction or secondary loss of reduction. In 36 patients (56%) the reconstruction achieved was within 2 mm of being anatomic as judged by plain radiography. Overall, 27 patients (42%) had excellent or good outcomes at an average 4.2 year followup. Delay to reoperation appeared to have an adverse affect on the result of surgery. At followup 57% of patients reoperated on within 3 weeks of injury were rated good or excellent. This figure dropped to 29% when the delay exceeded 12 weeks. These data do not compare favorably with results obtained in large series of singly operated fractures; however, they do indicate that it is possible to salvage a significant number of failed open reductions by reoperation.

Acetabulum↗
PubMed1994

Heterotopic ossification following operative treatment of acetabular fracture. An analysis of risk factors.

A total of 237 patients with surgically treated acetabular fractures were analyzed to identify the risk factors predisposing to development of heterotopic ossification (HO) following operative treatment, and to evaluate both clinical significance of HO and the clinical outcome of operative excision of ectopic bone. All patients had a minimum of 1 year followup time. The degree of HO was determined from anteroposterior radiographs of the pelvis at the 1 year followup and was classified as Grade 0 or Grade 1 according to the amount of ectopic bone present. Forty patients (17%) who developed a moderate to severe amount of ectopic bone were classified as Grade 1. Nine who developed significant ectopic bone resulting in 20% or greater loss of hip motion underwent excision of the ectopic bone; all six available for followup showed an improvement in range of motion. A significant correlation was found between poor clinical results at the 1 year followup and Grade 1 ectopic bone formation (p < 0.001). Four factors found to highly correlate with Grade 1 ectopic bone formation were: (1) the iliofemoral surgical approach; (2) multiple (2 or more) operative findings; (3) T type fractures; and (4) the presence of associated injuries to the abdomen and chest.

Acetabulum↗
PubMed1993

Unrecognized posterior dislocation of the hip associated with transverse and T-type fractures of the acetabulum.

Five patients who had displaced transverse or T-type fractures of the acetabulum and who were transferred 3-5 days after their injury with an unrecognized posterior dislocation of the hip are reported. On the anteroposterior pelvis radiograph, central displacement of the acetabular fragment dominated the radiographic appearance; however, superior displacement of the femoral head with superimposition on the intact acetabular roof was a consistent finding. The typical radiographic findings of adduction and internal rotation of the femur were not present. Oblique views of the pelvis, and/or a computed tomography scan made the diagnosis obvious. Appropriate initial radiographic evaluation is imperative in all patients with acetabular fractures. Failure to recognize the posterior hip dislocation in this group of patients may have led to an increased incidence of avascular necrosis of the femoral head, nerve palsy, and femoral head articular cartilage damage. We recommend either closed reduction with the patient under anesthesia followed by skeletal traction and delayed open reduction/internal fixation, or immediate open reduction/internal fixation if the reduction is not stable.

Acetabulum↗
PubMed1993

The computerized tomography subchondral arc: a new method of assessing acetabular articular continuity after fracture (a preliminary report).

The criteria to treat acetabular fractures operatively versus nonoperatively continue to evolve. The technique of roof arc measurements was developed to identify the extent of superior acetabulum left intact after fracture. Computerized tomography (CT) of the superior 10 mm of the acetabular articular surface evaluates the area equivalent to roof arc measurements of 45 degrees. CT provides increased detail of the superior acetabulum involved with the fracture. Our current criteria for selecting cases for nonoperative treatment are as follows: 1. The acetabular articular surface is intact in the superior 10 mm of the joint on CT evaluation. (Fractures that enter the acetabular fossa, but not the articular surface in the superior 10 mm are included in this group.) 2. The femoral head remains congruent with the superior acetabulum out of traction on the anteroposterior and 45 degree oblique radiographic views of the pelvis. 3. When a posterior wall fracture is part of the injury pattern, a minimum of 50% of the posterior wall articular surface is intact at the most involved level as determined by CT.

Acetabulum↗
PubMed1989

Internal fixation of pelvic ring fractures.

The orthopedic care of unstable pelvic fractures requires reduction and stabilization in order to promote union in a satisfactory position and provide a satisfactory clinical result. The results of three treatment techniques, skeletal traction and/or pelvic sling, anterior frame external fixation, and internal fixation, were evaluated over a four-year period.

Adolescent↗
PubMed1988

Displaced acetabular fractures.

Displaced acetabular fractures occur primarily in young adults involved in high energy trauma and can lead to disabling posttraumatic arthritis. An initial roentgenographic evaluation with accurate delineation of all fracture lines provides the key to decisions about whether to give closed or open treatment. When open treatment is indicated, a surgical approach can be chosen that will almost always lead to reduction without the necessity of a second approach. The authors have found that the Kocher-Langenbeck, ilioinguinal, and extended iliofemoral approaches are the most useful. A fracture table and specialized reduction instruments aid fracture reduction and fixation. Satisfactory operative reduction of the fracture is the factor that correlates best with a satisfactory clinical result. The rate of satisfactory operative reductions improved gradually over the first 50 operations of a prospective study of 121 displaced acetabular fractures. Overall, there were 80% satisfactory clinical results in this series. Complications included a 3% infection rate and a 5% incidence of nerve palsy. Open reduction and internal fixation are indicated for the majority of displaced fractures. However, closed treatment can produce satisfactory results in selected patients.

Acetabulum↗
PubMed1986

Fractures of the acetabulum. A retrospective analysis.

A roentgenographic analysis of 204 acetabular fractures is presented. In addition, 64 displaced fractures (43 treated surgically) are evaluated clinically and roentgenographically (average follow-up period, 3.7 years). Most fractures can be adequately evaluated from anteroposterior and oblique roentgenograms of the pelvis. The roentgenographic and clinical results correlate closely. Fractures must be reduced to a displacement of 3 mm or less, in addition to congruent reduction of the femoral head with the weight-bearing dome of the acetabulum, to achieve a satisfactory clinical result. Most displaced fractures involve the weight-bearing dome and require surgery. With an intact weight-bearing dome, nonoperative treatment is considered. Quantification of this dome with three measurements termed the medial, anterior, and posterior roof arc obtained from the standard roentgenograms is valuable in determination of appropriate treatment for displaced acetabular fractures.

Acetabulum↗
PubMed1986

Fractures of the acetabulum. Early results of a prospective study.

One hundred two patients with 105 displaced fractures of the acetabulum were treated for fractures involving at least one column of the acetabulum and displaced at least 5 mm (rim fractures were excluded). The patients were primarily young adults with multiple injuries secondary to motor-vehicle-associated trauma. Fractures were classified according to the classification of Letournel. The most common fractures were the complex associated types with 44 complete both column, 19 T-shaped, and 18 associated transverse and posterior wall. Seventeen fractures were treated closed, and 88 were treated operatively. Closed treatment with skeletal traction was undertaken if roof arc measurements demonstrated a satisfactory remaining acetabular dome following fracture and in some cases of apparent congruence following complete both column fractures. Fractures not meeting these criteria were operated upon through the Kocher-Langenbeck, extended iliofemoral, or ilioinguinal approach. Ninety percent of the operations produced a satisfactory reduction of the fracture (3 mm or less displacement). A follow-up study longer than one year was obtained for 50 fractures. Clinical results were 80% satisfactory overall. Operative complications included 3% infection, 5% nerve palsy, and 7% significant ectopic bone. Operative treatment can produce satisfactory fracture reductions and clinical results with an acceptably low complication rate.

Acetabulum↗
PubMed1986

Comminuted and rotationally unstable fractures of the femur treated with an interlocking nail.

One hundred twelve comminuted or rotationally unstable fractures of the femur were treated with the Grosse-Kempf interlocking nail. Two-thirds of the fractures had comminution involving more than 50% of the cortex. Of the 112 nailings, 82 were static and 30 dynamic. Clinical and radiographic fracture union occurred in 98% of cases; there were two nonunions. There were no instances of deep wound infection or osteomyelitis. Only two patients had a change of limb length greater than 1 cm. Angulation in any plane greater than 10 degrees was noted in three patients (2.5%). External rotation deformities occurred in eight patients (7.0%). The interlocking nail has expanded the indications for the use of closed intramedullary nailing in the treatment of complex fractures of the femur. The incidence of infection and nonunion is remarkably low. Immediate stability of the fracture allows for immediate mobilization of the patient, early rehabilitation of the limb, and a shorter hospital stay.

Adult↗
PubMed1986

Surgical management of acetabular fractures.

We have each experienced a significant learning phase for surgical treatment of these fractures. However, problems of articular reduction remain significant, particularly for complex fractures. It is our opinion that a certain degree of centralization of acetabulum fracture treatment--especially for the associated types--can lead to an improved standard of care overall.

Acetabulum↗