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Biomedical subjects

L L Fleming

Publications and source records attributed to L L Fleming.

36 records · Page 2Linked to original sources
PubMed1983

Evaluation of acute knee injuries with sciatic/femoral nerve blocks.

A preliminary study of the applicability of sciatic and femoral regional nerve blocks in the evaluation of acute knee injuries was conducted. During the period from January 1980 to March 1981, 12 patients with acute knee injuries in whom clinical examination under local anesthesia was considered totally unreliable secondary to patient uncooperation or severe pain were examined at Grady Memorial Hospital. Each of these patients received regional anesthesia by sciatic/femoral nerve block. All patients obtained satisfactory relaxation and analgesia for complete evaluation, and 92% obtained total analgesia for the knee. A full range of motion was present in each patient after the block. No complications were encountered. A satisfactory block was obtained in one attempt in 96% of the patients. (One patient had a failed femoral nerve block, but a repeated block was successful).

Acute Disease↗
PubMed1983

Open fractures of the tibia treated by the Hoffmann external fixator.

In a prospective study 40 consecutive patients with open tibial fractures were treated by the Hoffmann external fixator; the follow-up period was 18 months. All fractures were irrigated, debrided, and fixed rigidly with the Vidal-Adrey modification of the Hoffmann device as soon as the patients' condition allowed. The wounds were left open, to be closed secondarily with skin grafts, muscle flaps, and other plastic surgical procedures. The 40 wounds were all classified as Gustilo's Type II or III in relation to soft tissue damage; 36 injuries were due to motor vehicle accidents and four to gunshot wounds. At the 18-month follow-up examination there had been five amputations and five nonunions had healed after bone grafting; in addition, five patients had persistent pin drainage. Pin site drainage (80%) was the most common problem, but most cleared after removal of the fixator and five after curettage of ring sequestra. There was a high number of associated surgical procedures (2.4% per patient) related to the open fracture. At the 18-month follow-up examination bony healing was noted in all patients.

Accidents, Traffic↗
PubMed1983

Open fractures of the tibia treated with the Lottes nail.

Of fifty consecutive open fractures of the mid-part of the shaft of the tibia that were treated from 1975 to 1980 with immediate intramedullary Lottes-nail fixation and with débridement and irrigation, with minimum periosteal disruption, all but one healed. The rate of infection was 6 per cent; of delayed union, 16 per cent; and of malunion, 4 per cent. One fracture, with arterial injury, resulted in amputation. The wounds were classified as Gustilo and Anderson Type I (24 per cent), II (12 per cent), or III (64 per cent). Seventy-six per cent of the patients had other fractures, and 38 per cent had a fracture of the ipsilateral femur. Sixty-four per cent of the fractures were segmental and 36 per cent were transverse with comminution.

Adolescent↗
PubMed1982

Fractures of the femoral shaft: a prospective study of closed intramedullary nailing, modified open intramedullary nailing, and cast-bracing.

One hundred twelve consecutive fractures of the femoral diaphysis were treated in a prospective study at Grady Memorial Hospital, a designated trauma center, during the three-year period 1978 through 1980. Fifty of these were treated by closed intramedullary nailing; all united. Of the rest, 20 were treated by modified open intramedullary nailing, and 42 by cast-bracing. Closed intramedullary nailing offered a significant reduction in hospitalization and healing times compared to the other two methods; however, the high cost of equipment, along with the added cost of reoperation to remove the nail, rendered cast-bracing economically superior. Fractures treated by modified open intramedullary nailing developed no infections, but these patients lost significantly more blood during operation than those treated by closed nailing. Because of the decreased hospitalization and healing times, we prefer the closed intramedullary nailing technic for use in selected femoral fractures treated during the acute phase by an experienced surgical team.

Adult↗
PubMed1982

Proximal femoral fractures following total hip arthroplasty.

Thirty-one postoperative fractures around the femoral component of previous total hip arthroplasties were reviewed retrospectively until healing occurred. This type of injury seemed to be associated with either high-velocity trauma or weakening of bony stock secondary to stress risers from prior surgery or loosening. These fractures were classified as Type A at the stem tip, Type B spiralling around the stem, and Type C comminuted around the stem. Type A fractures have a significant incidence of nonunion in the face of multiple previous proximal femoral surgeries, but, after healing, usually show no loosening. Type B fractures usually will heal without operative intervention but have a high incidence of associated eventual component loosening. Type C fractures need immediate surgery to allow mobilization of the elderly patient. When postfracture revision surgery with long-stem component or plating is required, the technical order of priority should be adequate bony apposition of fracture fragments, good cement technique at the proximal femur, bone grafting.

Adult↗
PubMed1981

Radial nerve palsy at the elbow following venipuncture-case report.

A 29-year-old man sustained a radial nerve lesion when a blood bank technician attempted to cannulate the cephalic vein. Severe pain in the hand and fingers led to removal of the 16-gauge needle. A complete motor and sensory deficit occurred below the elbow. Electrical testing confirmed the neurologic lesion. Complete recovery took 3 months.

Adult↗
PubMed1981

Fractures of the tibia treated with Lottes nail fixation.

We have reviewed 60 consecutive cases, occurring in 57 patients, of intramedullary fixation of fractures of the midshaft of the tibia done over a ten-year period with the Lottes nail. Of 50 acute fractures, 38 were open fractures, nailed after adequate irrigation and debridement; the other 12 were closed fractures. The remaining ten cases were nonunions. All fractures healed with a rate of infection of 3.33% and a rate of malunion of 3.33%. Of the 50 patients with acute fracture, 29 had other fractures of long bones and 12 had ipsilateral fractures of the femur. The nailing facilitated their ambulation and care. All ten nonunions healed after nailing and bone grafting. Lottes nailing of tibial midshaft fractures is a simple procedure that gives stability, allows early weight-bearing with minimal shortening, and can be used in open fractures with minimal morbidity after adequate debridement.

Bone Nails↗
PubMed1981

Arthroscopy and arthrography of the knee: a comparison study.

Between 1975 and 1978, over 200 knee arthroscopies were performed at the Emory University Hospitals; the findings were totally correct in 91%. During the same period, arthrograms were performed on 79 different patients, 39 of whom had confirming arthrotomies. The arthrograms were totally correct in 38%. Fifteen totally incorrect arthrograms were reviewed without knowledge of the operative findings; 12 were considered by the radiologist to be technically acceptable for review. Of these, five correlated partially, but none completely, with findings at arthrotomy. We discuss the difficulty in arthrographic reading of lateral meniscus tears, anterior cruciate tears, and osteochondral loose bodies. We conclude that, although arthroscopy and arthrography can be complementary, arthrography must be used only with the best equipment and technic by a motivated, experienced, and enthusiastic radiologist.

Adolescent↗
PubMed1981

Calcaneal fractures: a good prognosis.

Calcaneal fractures at Grady Memorial Hospital were reviewed for the period of 1973 to 1980. Sixty-two of these fractures were available for follow-up. Treatment was with compression dressings, plaster, pin reduction or open reduction. Grading was by the previously published criteria of Allen and Lindsey. This paper identifies a positive correlation between facet reduction ad successful treatment results. Recommendations are made for fracture classification, surgical treatment and postoperative management.

Adult↗
PubMed1980

Clinical experience with a new casting tape.

Between October 1977 and 1978, 93 CutterCast casts were applied at the Veterans Administration Hospital in Atlanta, Georgia. The composition and application of this new casting system are described, and the performance of the 93 casts is evaluated in relation to ease of application, roentgenographic clarity, skin condition, patient comfort, and ease of removal. The advantages and disadvantages are discussed.

Adult↗
PubMedDate not supplied

Traumatic dislocations of the peroneal tendons.

Traumatic dislocation of the peroneal tendons is an often unrecognized injury which has been reported to occur most commonly during snow skiing. The strength of the peroneal retinaculum is exceeded during resistance to violent passive dorsiflexion or to inversion stress. Pain, swelling, and ecchymosis may hinder early diagnosis; however, intense retromalleolar pain on active eversion is a specific, highly suggestive finding. Fracture of a thin shell of the lateral malleolar cortex is diagnostic. In chronic cases, marked dislocation of the tendons is frequently demonstrable, with more than the usual degree of snapping. Surgical repair is advocated, using one of several procedures available. Most acute cases can be treated by simple repair of the torn or fractured structures. In chronic cases, or in acute cases with deficient structures predisposing to dislocation, it is necessary to reconstruct the peroneal retinaculum and/or deepen the peroneal groove. Longitudinal splitting of the peroneus brevis tendon was a new finding in this series.

Ankle Injuries↗
PubMedDate not supplied

Computerized tomography in the evaluation of peroneal tendon dislocation. A report of two cases.

Dislocation or subluxation of a peroneal tendon is a relatively uncommon entity, and the diagnosis is rarely made at the time of initial injury. If untreated, chronic lateral instability and pain may develop which can be a diagnostic dilemma. These patients usually will have a history of frequent episodes of ankle instability and may be aware of a pop or snap just prior to the episode of instability. There is usually no significant anterior drawer or inversion laxity present on stress testing. Unfortunately, it is often difficult to passively or actively dislocate the involved peroneal tendon. Surgical treatment may have to be recommended on strong suspicion alone. Two patients with chronic lateral ankle pain underwent computerized tomography preoperatively and postoperatively. In addition, eight normal ankles were scanned for comparison. In the two cases of peroneal tendon dislocations presented, computerized tomography was found to be a very beneficial aid in making the diagnosis, and may be of significant value in those with suspected peroneal tendon subluxation/dislocations.

Adult↗
PubMedDate not supplied

The Cybex II evaluation of lateral ankle ligamentous reconstructions.

Chronic lateral ankle instability is a costly disability to the athlete. The Chrisman-Snook and Evans lateral ligamentous reconstructions are two procedures frequently performed to correct ligamentous instability. The entire peroneus brevis tendon is transected in the Evans procedure, thus sacrificing its eversion strength and power. The importance of preserving the eversion function of the peroneus brevis muscle is speculative, but may be of significance for good long-term results. The ankle eversion strength and power of 10 patients with Chrisman-Snook and 10 patients with Evans lateral ligamentous reconstructions were objectively evaluated with the Cybex II Isokinetic Dynamometer. The mean postoperative time to testing was 4.2 years. The uninvolved ankle was also tested and used as the normal strength of the patient. Twenty normal controls matched for age, sex, and physical activity were tested to assure maximum test reproducibility. The eversion strength was tested at several speeds, but torque values at speeds of 30 and 120 deg/sec were selected for analysis. At slow speeds, 30 deg/sec, and ankles that had Evans and Chrisman-Snook reconstruction were 4% and 7% weaker, respectively, than the contralateral normal ankles. At 120 deg/second the ankles were 8% and 9% weaker with the Evans and Chrisman-Snook reconstructions, respectively. A three factor analysis of variance with repeated measures on two of the factors was used to analyze the data.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

A review of lateral ankle ligamentous reconstructions.

We have performed on ongoing retrospective and prospective multi-institutional review of 50 patients who underwent 53 lateral ligamentous reconstructive procedures of the ankle. The point grading system used for postoperative evaluation of our patients allowed for classification of functional activity. The grading system included evaluation of the patient's return to preinjury activities and athletics, degree of pain, degree of swelling, number of recurrent sprains, and any disability that the patient incurred secondary to the tendon transfer. Preoperative and postoperative stress radiographs were obtained to evaluate the talar tilt angle. Of our 53 lateral ankle ligamentous reconstructions, we consider 45 to be excellent, with the patients returning to full activity and athletics. Our results show no statistically significant difference in long-term function among the five ligamentous repairs employed in this series (Pearson Chi-square test; chi 2 = 2.30, df = 4, P = 0.68). No correlation could be made between the long-term clinical response of the various procedures and the postoperative talar tilt angle. We conclude that lateral ligamentous reconstructive repairs of the ankle are indicated, and that good or excellent clinical results, greater than 91%, can be obtained with any of the five reconstructive procedures, performed correctly.

Adolescent↗
PubMedDate not supplied

Impingement exostoses of the talus and fibula secondary to an inversion sprain. A case report.

Impingement exostoses of the talus and fibula following an inversion sprain is an uncommon sequela to the initial injury. Although a high frequency of symptomatic tibial and talar impingement exostoses have been reported, changes on the lateral side of the ankle are more subtle with significant roentgenographic findings rarely seen. The authors present a rare case of impingement exostoses involving both the talus and fibula simultaneously. Arthroscopy visualized the tibiotalar and talomalleolar articulations. It revealed opposing exostoses of the talus and fibula, necessitating surgical resection. Arthroscopy is recommended for difficult diagnostic problems of the ankle and an awareness of the condition of post-traumatic impingement exostoses of the talus and fibula.

Ankle Injuries↗
PubMedDate not supplied

The tensile strength of the anterior talofibular ligament.

Cadaveric anterior talofibular ligaments, with their associated bone attachments, were tensile tested to destruction. The ligament ruptured by either bone avulsion from the talus or midsubstance failure. The values of tensile strength varied from 58 to 556 newtons with a mean strength of 206 newtons.

Adult↗