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Biomedical subjects

J Tracy Watson

Publications and source records attributed to J Tracy Watson.

13 recordsLinked to original sources
PubMed2006

Distraction osteogenesis.

The treatment of bone loss resulting from acute trauma has traditionally been a complex surgical problem. Numerous procedures have been devised to reconstitute bone stock, obtain fracture union, and provide a stable functional limb. Traditional internal bone transport has been used successfully for bony reconstruction for both acute and reconstructive bone loss. Potential complications are primarily related to the complexity of the external device, prolonged time in the frame, and nonunion of the docking and regenerate segments. Recent advances in fixator and pin design have reduced the complexity of these devices as well as the incidence of pin- and frame-related complications. Gradual shortening, rapid distraction using autodistractors, transporting over intramedullary devices, and using orthobiologic and adjuvant techniques to assist in the consolidation of regenerate and docking sites are now being combined to decrease the morbidity and excessive frame time required to complete these reconstructions.

Equipment Design↗
PubMed2004

The use of an injectable bone graft substitute in tibial metaphyseal fractures.

Eight consecutive patients with severely comminuted proximal or distal tibial metaphyseal fractures were surgically treated with a novel injectable, in situ hardening calcium sulfate material to provide temporary intraoperative structural support until instrumentation was appropriately placed. The calcium sulfate bone substitute was also used as a bone void filler to provide an osteoconductive environment following stabilization. Bone regrowth was observed in all patients and, in seven of the eight patients, 90%-100% bone formation was observed within 3 months. The bone substitute had almost completely resorbed by 3 months in all patients. One patient with extensive initial bone loss required a second bone graft. Although the patient sample size was small, the success rate of treating severely comminuted fractures was significantly better than in reports using only internal fixation. Injectable bone substitute for minimally invasive surgery to repair metaphyseal fractures.

Adult↗
PubMed2003

Calcium sulfate used as bone graft substitute in acetabular fracture fixation.

The purpose of this study was to determine the natural history of calcium sulfate pellets implanted during acetabular fracture surgery. The study group consisted of patients sustaining an acetabular fracture with intraarticular comminution or marginal impaction or both in whom calcium sulfate pellets were implanted in lieu of autologous bone graft. Between 1997 and 1999, 32 fractures were treated. Followup adequate to delineate pellet outcome, including radiographs and computed tomography, was obtained in 31 patients. Evaluation of plain radiographs showed that the calcium sulfate pellets became undifferentiated from the surrounding bone at an average of 7 weeks postoperatively. In no case was a residual bony deficit seen. Computed tomography analysis showed that in 22 patients, the pellets essentially had been (> 90%) replaced by bone and in four patients, the majority (> 50%-90%) of the pellets had been replaced by bone. However, in five patients, less than 50% of the pellets had been replaced by bone, including one showing no bony replacement. The common finding in patients with an extensive residual deficit was direct communication of the pellets with the joint space shown on the postoperative computed tomography scan. Patients with the best results had complete containment of the pellets within bone. Therefore, it seems that implanted calcium sulfate pellets in contact with joint synovial fluid are at risk for resorption without significant bony response. If calcium sulfate pellets are to be implanted in a periarticular location, complete bony containment is desirable. Evaluation of the periacetabular bony response requires computed tomography scans, as plain radiographs are inadequate for this purpose.

Acetabulum↗
PubMed2003

Identification of the optimal intercondylar starting point for retrograde femoral nailing: an anatomic study.

BACKGROUND: Retrograde nailing of femoral shaft fractures is an effective and increasingly more popular method of fracture fixation. However, concern remains regarding the effect of the intercondylar entry-portal location on knee function. METHODS: The optimal entry-portal location was identified in cadaver femurs. Approximating the clinical intraoperative situation, a threaded guidewire was inserted into each of 26 distal femur specimens and positioned in the center of the femoral shaft as determined by anteroposterior and lateral fluoroscopic imaging. Each guidewire was then overdrilled with a 12-mm cannulated drill bit. All entry-portal locations were recorded relative to the posterior cruciate ligament attachment and the intercondylar groove and mapped relative to the known patellofemoral contact area. RESULTS: The starting holes averaged 6.21 mm anterior to the posterior cruciate ligament attachment and 2.67 mm medial to the intercondylar groove. Overall, 100% of starting portals were located in safe areas relative to the patellofemoral contact area. CONCLUSION: In the vast majority of femurs, the optimal entry portal for retrograde femoral nailing (in line with the long axis of the femur) is located in the expected safe position, anterior to the posterior cruciate ligament insertion and slightly medial to center of the intercondylar groove. However, because of anatomic variability, the ideal starting position occasionally may be located in a patellofemoral contact area. Potential compromise of the patellofemoral contact area by the retrograde nail entry portal can and should be recognized before nailing, allowing the surgeon the option of altering the surgical technique.

Bone Nails↗
PubMed2003

Computed tomographic assessment of fractures of the posterior wall of the acetabulum after operative treatment.

BACKGROUND: The purpose of this study was to evaluate the results after operative treatment of fractures of the posterior wall of the acetabulum in relationship to the quality of the fracture reduction as assessed by postoperative two-dimensional computed tomography. METHODS: The functional results for sixty-seven patients who had open reduction and internal fixation of an unstable fracture of the posterior wall of the acetabulum and the findings of two-dimensional computed tomography performed postoperatively were analyzed. Sixty-one patients were followed for a mean of four years after the injury, and the remaining six patients who had poor early results necessitating reconstructive surgery were followed for less than two years. All patients were evaluated preoperatively and postoperatively with use of three standard plain radiographs (one anteroposterior and two Judet 45 degrees oblique pelvic radiographs) and a two-dimensional computed tomography scan. The functional outcome for the patients was evaluated with use of a modification of the clinical grading system described by Letournel and Judet. The radiographs were graded according to the criteria described by Matta. The two-dimensional computed tomography scans were used to determine fracture gap and offset measurements. RESULTS: The clinical outcome was graded as excellent in thirty-one patients (46%), very good in twenty (30%), good in eight (12%), and poor in eight (12%). The final radiographic results were graded as excellent in fifty-three hips (79%), good in four (6%), fair in three (5%), and poor in seven (10%). There was a strong association between clinical outcome and final radiographic grade. Fracture reductions were graded as anatomic in sixty-five and imperfect in two, as determined with use of plain radiography. However, postoperative computed tomography revealed an incongruency (offset) of >2 mm in eleven hips and fracture gaps of > or = 2 mm in fifty-two. Fracture gaps of > or = 10 mm in any dimension or a total gap area of > or = 35 mm(2) were associated with a poor result. The main risk factors for a poor result were a residual fracture gap width of > or = 10 mm and osteonecrosis of the femoral head. CONCLUSIONS: The degree of residual fracture displacement is detected more accurately on postoperative computed tomography scans than on plain radiographs. The accuracy of surgical reduction as assessed on postoperative computed tomography is highly predictive of the clinical outcome. LEVEL OF EVIDENCE: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.

Acetabulum↗
PubMed2003

Dynamic hip screw removal using a blade plate extraction device.

Dynamic hip screw implants are extracted by removing the side plate and compression screws. Occasionally, ingrown bone will prevent easy plate removal. A common solution is to use an osteotome as a levering device; however, the stress riser on the proximal femur caused by this maneuver could result in a catastrophic fracture. A blade plate extraction device fits into the dynamic hip screw side plate and allows relatively atraumatic removal of the implant, preventing the use of excessive force and decreasing the risk of an intraoperative fracture.

Bone Plates↗
PubMed2002

Hybrid external fixation for tibial plateau fractures: clinical and biomechanical correlation.

The biomechanical data support the use of tensioned wire fixation to stabilize complex fractures of the proximal tibia. The authors will show that the stability of a four-wire construct is comparable to the gold standard of dual plating internal fixation techniques. Using these techniques, many recent investigators have demonstrated improved clinical results, with average knee scores for most patients ranging from 85 to 90.

Biomechanical Phenomena↗
PubMed2002

Ipsilateral femoral neck and shaft fractures: complications and their treatment.

An ipsilateral femoral neck fracture occurs in approximately 6% to 9% of all femoral shaft fractures. Despite this relatively common presentation, decision-making often is difficult. Furthermore, the risk for complications is greater in the treatment of this combination injury pattern than for single-level fractures. A retrospective review of the authors' large trauma database revealed 13 patients who had healing complications develop after their index surgical procedure. Six of the eight (75%) femoral neck nonunions occurring in these 13 patients developed after the use of a second generation, reconstruction-type intramedullary nail. Factors contributing to nonunion of the femoral shaft were the presence of an open fracture, use of an unreamed, small diameter intramedullary nail, and prolonged delay to weightbearing. The femoral neck nonunions healed after either valgus intertrochanteric osteotomy (seven patients) or compression hip screw fixation (one patient). The femoral shaft nonunion proved more difficult than expected to treat with some patients with femoral shaft nonunions requiring more than one operative procedure to achieve union. Lag screw fixation of the femoral neck fracture and reamed intramedullary nailing for shaft fracture stabilization were associated with the fewest complications. Therefore, this approach is recommended as the treatment of choice.

Adult↗
PubMed2002

Results of operative treatment of fractures of the posterior wall of the acetabulum.

BACKGROUND: The purpose of this study was to determine the clinical outcome in patients in whom a displaced fracture of the posterior wall of the acetabulum had been treated by open reduction and internal fixation. METHODS: One hundred patients who had had open reduction and internal fixation of an unstable unilateral fracture of the posterior wall of the acetabulum were studied. Ninety-four patients were assessed at a mean of five years (range, two to fourteen years) after the injury. Six patients with a poor result were followed for less than two years. The functional outcome was evaluated with use of the clinical grading system adopted by Letournel and Judet with incorporation of modifications by Matta. Patient, fracture, and radiographic variables were analyzed to identify possible associations with functional outcome. RESULTS: The reduction of the fracture, as determined with plain radiography, was graded as anatomic in ninety-seven patients and as imperfect in three. The clinical outcome at the time of final follow-up was graded as excellent in fifty-five patients, very good in twenty-five, good in nine, fair in one, and poor in ten. The radiographic result was excellent in eighty-one patients, good in five, fair in four, and poor in ten. There was a strong association between the clinical outcome and the final radiographic grade. Variables identified as risk factors for an unsatisfactory clinical result included a delay of greater than twelve hours before reduction of an associated hip dislocation, an age of fifty-five years or older at the time of injury, intra-articular comminution, and osteonecrosis. CONCLUSIONS: The uncomplicated radiographic appearance and relatively simple operative approach for fractures of the posterior acetabular wall belie the risk of poor results. Prompt reduction of an associated hip dislocation is imperative. Fractures in elderly patients and those with extensive comminution are more likely to have a poor clinical result. However, a high likelihood of a long-term good-to-excellent result can be expected following anatomic reduction and internal fixation of these fractures.

Acetabulum↗
PubMed1998

[Not Available].

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Journal Article↗
PubMedDate not supplied

Overview of biologics.

A variety of orthobiologic materials are available or under development to enhance the repair of bone fractures. These materials vary widely in their composition, mechanism of action, and clinical results. This article provides a brief review of the currently available bone grafting materials, which include autografts, allografts, conductive substrates, demineralized bone matrix, platelet gels, recombinant bone morphogenic proteins, and bone marrow aspirate injections.

Bone Matrix↗
PubMedDate not supplied

New horizons in orthopaedics: a rational discussion of biologics and bone graft substitutes.

Numerous inductive proteins, conductive substrates, and autogenous cellular concentration techniques have become clinically available as substitutes for autogenous bone graft. This review presents a critical analysis of their preclinical and clinical efficacy. In many instances, the widespread use of these materials must be questioned based on the limited clinical data available. A thorough knowledge of these materials is crucial for the surgeon to match the material to its defined indications.

Biocompatible Materials↗