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Biomedical subjects

K Tetsworth

Publications and source records attributed to K Tetsworth.

8 recordsLinked to original sources
PubMed2006

Comparison of delayed and primary wound closure in the treatment of open tibial fractures.

INTRODUCTION: Primary wound closure in the management of open tibial fractures has generally been discouraged. Several prior studies suggest that infections are not caused by the initial contamination, but are instead the result of organisms acquired in the hospital. Primary wound closure after adequate wound care and fracture stabilisation could therefore be considered a reasonable option. MATERIALS AND METHODS: We analysed 95 patients with open tibial fractures (Gustilo-Anderson type 1 to 3A) treated with primary fracture stabilisation and either delayed wound closure (group I) or primary wound closure (group II), with a minimum follow-up of 12 months. RESULTS: Group I included 46 patients with a mean age of 30.2 years (16-56), and a mean follow-up of 13.5 months (12-18). Group II included 49 patients with a mean age of 33.4 (18-69), and a mean follow up of 13.7 months (12-16). One infection developed in group I (2%), and two infections developed in group II (4%). This difference was not found to have any statistical significance. CONCLUSION: Our results support other recent reports that the infection rate is not increased following primary wound closure after thorough debridement of less severe open fractures. The length of stay following primary closure (group II) was significantly shorter, and that should result in substantially more cost effective care of these serious injuries. We conclude that primary wound closure is a safe option in properly selected cases. Prospective multi-centre studies are needed to further evaluate the safety and efficacy of this treatment alternative.

Adolescent↗
PubMed1999

Osteomyelitis debridement techniques.

Debridement of chronic osteomyelitis can be technically demanding and difficult. The surgical principles that govern treatment of osteomyelitis involve an atraumatic approach and complete removal of all devitalized tissue and foreign material. Despite recent advances in medical science, the quality of surgical debridement remains the most critical factor in the successful management of chronic orthopaedic infections. Important areas discussed include thorough preoperative evaluation, the surgical philosophy, soft tissue aspects, bone considerations, and dead space management.

Chronic Disease↗
PubMed1994

Malalignment and degenerative arthropathy.

The axial relationship of the joints of the lower extremity reflects both alignment and orientation. Static considerations are useful for preoperative planning and deformity correction, but dynamic considerations including compensatory gait may be more relevant clinically. Laboratory animal models have been developed that simulate the deleterious effect of malalignment on articular cartilage. Malalignment disturbs the normal transmission of force across the knee, and altered stress distribution related to deformity has been demonstrated in cadaver models using pressure-sensitive film. No prospective data are available to document the natural history of malalignment, but several retrospective studies suggest the clinical course is one of gradual progression resulting in degenerative arthropathy. The long-term follow-up of fractures is less definitive, and difficult to interpret considering the bias inherent in patient selection. Although direct clinical evidence of a cause-and-effect relationship between malalignment and arthrosis has not been possible, substantial evidence from the orthopedic literature supports this hypothesis.

Animals↗
PubMed1994

Deformity planning for frontal and sagittal plane corrective osteotomies.

The authors have developed a universal system of geometric deformity planning based on the mechanical or anatomic axes. The place where the axes intersect is the center of rotation angulation (CORA) of a deformity. Osteotomy level and type should be considered relative to the CORA to avoid creating secondary deformities. This type of planning is applicable to both frontal and sagittal plane deformities.

Bone Malalignment↗
PubMed1992

Mechanical axis deviation of the lower limbs. Preoperative planning of uniapical angular deformities of the tibia or femur.

Angular deformities of the tibia or femur in the frontal plane lead to mechanical axis deviation of the lower limb and malorientation of the joints above and below the level of deformity. Accurate correction of the malalignment and of the joint orientation is important for function and to prevent joint degeneration. An accurate yet simple method to determine the apex of deformity and the type of correction required is based on the joint reference lines of the hip, knee, and ankle, and the individual mechanical axis lines of each bone segment. If the osteotomy is performed at the level of the apex of the deformity, then the only correction needed is angulation. If the osteotomy is performed at a level proximal or distal to the apex, then translation in addition to angulation is necessary to accurately correct the deformity.

Femur↗
PubMed1992

Mechanical axis deviation of the lower limbs. Preoperative planning of multiapical frontal plane angular and bowing deformities of the femur and tibia.

Multiapical deformities complicate the process of preoperative planning. It is necessary to determine the level of each apex of deformity to plan accurate correction. The basic principles of mechanical axis realignment and joint orientation need to be preserved. Using the joint reference lines and mechanical axis of each bone segment, one can accurately determine the apex of each deformity. Bowing deformities are multiapical angular deformities. There are two types of bowing deformities: compensated and noncompensated. Typical examples of compensated bowing are the anterolateral and posteromedial bows of the tibia. A noncompensated bow is typical of the deformity seen in rickets.

Femur↗
PubMed1991

Percutaneous osteotomies. Osteotome and Gigli saw techniques.

Traditional methods of performing tibial and femoral corticotomies is discussed and then the modification using a percutaneous Gigli saw is explained. Advantages of the procedure are detailed, and numerous illustrations aid the reader.

Bone Lengthening↗