Search PubMed⌕ Search

Biomedical subjects

Kelly D Carmichael

Publications and source records attributed to Kelly D Carmichael.

At least 19 recordsLinked to original sources
PubMed2006

Posterior sternoclavicular epiphyseal fracture-dislocation with delayed diagnosis.

Posterior sternoclavicular joint dislocations and epiphyseal fractures are relatively rare injuries. We present a case report of a 16-year-old male who presented with a 10-day delay in diagnosis. The medial clavicular fragment was widely displaced and rested against the cervical vertebral body. Despite the degree of displacement, the patient had very few symptoms, and the diagnosis was not appreciated in the emergency department and became apparent at 10-day clinic follow-up. Treatment consisted of attempts at closed reduction, which were not successful. Open reduction was performed and the repair done with strong sutures. At 1-year follow-up the patient is doing well without any symptoms. A literature review consisting of anatomy, ossification patterns, classification systems, diagnosis and associated symptoms, imaging recommendations, treatment recommendations, outcomes, and complications is included.

Adolescent↗
PubMed2006

Biomechanical comparison of flexible intramedullary nailing versus crossed Kirschner wire fixation in a canine model of pediatric forearm fractures.

This study compares the biomechanical properties of crossed Kirschner wires with those of flexible intramedullary nails in a canine model. The Kirschner wire groups had greater anteroposterior, lateral, and torsional stiffness and force to failure rates in most of the bones tested. Bones fixated with flexible intramedullary nails could bend and recoil during failure testing. The bones fixated with Kirschner wires failed at smaller levels of displacement and frequently had hardware cut-out during failure testing. Flexible intramedullary nails have more recoil and do not induce new fracture lines, which may explain their clinical superiority to Kirschner wires despite providing less rigid fixation.

Animals↗
PubMed2006

Quality of reduction versus timing of surgical intervention for pediatric supracondylar humerus fractures.

Recent reports have shown that some displaced supracondylar humerus fractures can be treated in a delayed fashion the day following injury and complication rates will not be increased. This study determined if the quality of the reduction, as determined by restoration of Baumann's angle, is affected by surgical timing. Forty two patients ranging in age from 2 to 12 years were treated. Delayed intervention was defined as > 8 hours post-injury. Acute intervention occurred in 25 patients with a mean age of 5.5 years. Delayed intervention occurred in 17 patients with a mean age of 5.8 years. Baumann's angle was restored to within an average of 2.2 degrees of the contralateral elbow in the acute group and to within 1.2 degrees in the delayed group. Gartland type 2 fractures were more likely to be delayed in this retrospective study and these fractures showed better improvements in Baumann's angle restoration than did type 3 injuries when treated in a delayed fashion. In type 2 injuries and type 3 injuries without neurovascular compromise, delaying operations until the next morning will not compromise the quality of the reduction.

Child↗
PubMed2005

Relation of residency selection factors to subsequent orthopaedic in-training examination performance.

OBJECTIVES: Orthopaedic surgery remains one of the most competitive specialties, with more than a 99% match fill rate in the past several years. An oversupply of qualified applicants leads to intense competition for these residency spots, allowing program directors to be more selective in choosing their future residents. Although many previous studies have documented factors important to program directors in the admission process, less is known about how preselection factors correlate with subsequent performance in a residency program. METHODS: The relation of both demographic and academic factors with subsequent performance on the Orthopaedic In-Training Examination (OITE) were studied. These factors include United States Medical Licensing Examination (USMLE) step I scores, Alpha Omega Alpha (AOA) status, research publications, age entering residency, marital status, and medical school affiliation. RESULTS: In this study, the only statistically significant correlations to OITE scores were USMLE step I performance and marital status. Those residents who had previously scored above 220 on the USMLE step I had higher average OITE scores than those scoring below 220. Residents who were married also had higher average OITE scores. A trend with regard to AOA status also was found, with residents scoring slightly higher on the OITE if they were members of AOA. CONCLUSIONS: Few preresidency variables correlate to success during an orthopaedic residency.

Adult↗
PubMed2005

Cast abscess.

Explore the source record for details and available documents.

Abscess↗
PubMed2005

Effectiveness of ear protection in reducing anxiety during cast removal in children.

We studied the effect of wearing ear protection on 100 children undergoing cast removal. Pulse rate (PR) and mean arterial pressure (MAP) increases during cast removal were used as physiologic indicators of anxiety. One goal was to determine whether children of various ages are less anxious when wearing ear protection during cast removal. Another goal was to determine whether previous cast removal affects anxiety reactions. Results with children of all ages combined showed that PR increases were significantly lower for those who wore ear protection (P = .04). When wearing ear protection, children up to 6 years old had 9.7% lower PR increases, and 7- to 12-year-olds had 8.8% lower PR increases, but 13- to 17-year-olds had 4.5% higher PR increases. No differences were noted among the groups with respect to MAP increases. There were no significant differences between children who had a cast removed previously and children who were having a cast removed for the first time. Children younger than 13 seemed to benefit the most from wearing ear protection during cast removal.

Adolescent↗
PubMed2005

Rates of refracture associated with external fixation in pediatric femur fractures.

We conducted a small retrospective study of rates of early complications associated with external fixation of pediatric femur fractures and compared rates at our institution with those reported in the literature. In our series of 22 patients, early complications included 12 pin-track infections (54.5%), 2 cases of loss of reduction (9.1%), 1 pin-track abscess (4.5%), and 1 refracture (4.5%). Overall rates (ours combined with those reported by other investigators) were 4.7% (34/719) for refractures and 33.1% (224/677) for pin-track infections. Factors that correlated with refractures were open fracture, bilateral fracture, and longer time in fixator. Factors with inconclusive correlations were fracture pattern, dynamization status, fixator type, pin size, and number of pins.

Adolescent↗
PubMed2004

What attributes are necessary to be selected for an orthopaedic surgery residency position: perceptions of faculty and residents.

Orthopaedic surgery has an extremely competitive residency selection process. The authors discuss which attributes of an orthopaedic surgery residency applicant are the most important in obtaining a position. A comparison of applicants' opinions to those of faculty was also done. Anonymous questionnaires were filled out by orthopaedic surgery residency applicants and faculty orthopaedists at teaching institutions. The most important attributes to obtaining a residency were performance on a local rotation (externship), class rank, and interview performance according to faculty. Applicants thought performance on local rotation, United States Medical Licensing Examination Step 1 scores, and letters of recommendation were the three most important. Both groups ranked research participation, gender, and race as the three least important attributes.

Educational Measurement↗
PubMed2003

The angled buckle fracture in pediatrics: a frequently missed fracture.

Buckle (torus) fractures in childhood are very common, and most assume a typical configuration wherein the trabeculae across the fracture line are compressed and the corresponding cortex bulges outward (unilateral or bilateral). In other cases the fracture merely shows cortical angulation along one side of the bone and classical buckling is not present. These latter fractures frequently are subtle and easily overlooked. However, if one knows what they look like and where they are likely to occur, one is able to detect them with greater frequency and confidence. The purpose of this communication is to bring attention to this fracture, describe the mechanism by which it occurs, and indicate its most common sites.

Journal Article↗
PubMed2003

Lateral femoral condylar shearing fractures.

Lateral femoral condylar shearing fractures occur as the aftermath of acute patellar dislocation. The fracture fragment may be larger than originally appreciated on plain films. Diagnosis depends on identifying the fracture fragment somewhere within the knee joint, and the "donor site" on the lateral femoral condyle. Therefore, MRI or arthroscopy should be performed to identify the true size of the fracture fragment. The larger of these fragments may require surgical intervention with fixing of the fracture fragment onto the lateral condyle with screws. We present the radiographic and clinical findings in seven patients.

Journal Article↗
PubMed2003

Brachial plexus injury by nonviolent means in an adolescent baton twirler.

Brachial plexus injuries are usually the result of violent trauma, or they may be chronic and recurrent with thoracic outlet syndrome. The case presented is an acute, nonrecurrent injury sustained by minor trauma. The injury to the brachial plexus occurred while a 15-year-old girl reached overhead to catch a baton. The treatment was conservative, and the patient made an almost complete recovery.

Acute Disease↗
PubMedDate not supplied

Cast abscess: a case report.

This report describes a case in which a pediatric patient wounded his ankle when he stuck an object inside the cast while trying to scratch himself. The wound became infected and resulted in a limb-threatening abscess. Although most patients treated with casts do not have any significant problems, it is important to emphasize cast care instructions to young patients and their parents. In addition, it may be equally important to advise patients about safe methods to alleviate itching, such as blowing cool air under the cast. In this way, the risk of serious infectious complications can be minimized.

Abscess↗
PubMedDate not supplied

Recurrence rates of burn contracture ankle equinus and other foot deformities in children treated with Ilizarov fixation.

The purpose of this study was to determine recurrence rates of pediatric foot and ankle burn deformities treated with the Ilizarov method. A total of 19 patients with 29 foot and ankle deformities were studied. The most common deformity treated was equinus (23). Rocker-bottom and cavus foot deformities were each treated three times. The average age of the patient at the time of the burn injury was 3.2 years, and the average age at the time of fixation was 9.4 years. Equinus contractures averaged -34 degrees (34 degrees of plantarflexion) before surgery and +7 degrees (7 degrees of dorsiflexion) after treatment with the Ilizarov fixator. The recurrence rate for all 29 ankles and feet was 69% (20/29). The recurrence rate for equinus contractures was 74% (17/23). The average time to recurrence was 17.3 months. Only short-term follow-up was available on four of the six feet and ankles that did not recur. Deformity correction in burned feet and ankles is difficult to obtain by any means. The authors recommend using the Ilizarov method to obtain correction of moderate to severe foot and ankle deformities in pediatric burn patients, but the correction obtained is not stable and deformity will likely recur. Parents and patients should anticipate adjunctive nonoperative and operative procedures to keep their feet plantigrade as they grow. In young children, the possibility of having additional surgeries, including repeat Ilizarov procedures, should be discussed. Even older children should expect additional surgeries to prevent recurrent deformities.

Adolescent↗
PubMedDate not supplied

Proximal humerus fractures sustained during the use of restraints in adolescents.

Injuries to skeletally immature individuals sustained during restraints have been rarely documented. The authors report a series of five proximal humerus fractures in skeletally immature patients (average age 15.3 years) that occurred during restraint with handcuffs. A similar mechanism of injury was identified in all of the cases. All five injuries were Salter-Harris type I or II, and three of the five required operative intervention. At short-term follow-up, all patients are doing well without evidence of growth disturbances. To the authors' knowledge, this is a unique mechanism of injury that could be avoided with proper education.

Adolescent↗