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Biomedical subjects

M J Patzakis

Publications and source records attributed to M J Patzakis.

At least 37 records · Page 2Linked to original sources
PubMed1995

Acute hematogenous osteomyelitis. An unusual cause of compartment syndrome in a child.

Acute compartment syndrome of the leg developed in a 4-year-old child due to acute hematogenous osteomyelitis of the proximal fibula. Because of its unusual presentation, the diagnosis of osteomyelitis initially was missed. This report suggests that the diagnosis of acute hematogenous osteomyelitis of the proximal part of the fibula should be considered in young children who present with acute compartment syndrome of the leg and who have no history of recent surgery or trauma.

Acute Disease↗
PubMed1994

Comparison of the results of bacterial cultures from multiple sites in chronic osteomyelitis of long bones. A prospective study.

We evaluated the results of aerobic, anaerobic, and fungal cultures of specimens that had been obtained from multiple sites in thirty patients who had traumatic osteomyelitis with a sinus track. In each patient, we obtained specimens of material from the sinus track; specimens of purulent fluid, of soft tissue, and of bone obtained from curettage; and specimens from the bed of the involved bone. More than one organism grew on culture of the specimens from twenty-one of the patients; more than three organisms, from those of eleven patients; and ten organisms, from those of two patients. The same organisms grew on culture of the specimens from every site in only fourteen (47 per cent) of the thirty patients. We recommend that specimens of material from the sinus track; specimens of purulent material, of soft tissue, and of bone obtained from curettage; and specimens from the bed of the involved bone be obtained for culture before the treatment of chronic osteomyelitis with a draining sinus, so that as many of the infecting organisms as possible will be identified.

Bacteria, Aerobic↗
PubMed1993

Treatment of chronic osteomyelitis with muscle flaps.

This article discusses a study of 36 patients with chronic osteomyelitis that had local or free muscle flaps. Reconstruction of chronic osteomyelitis requires infection control and assessment of soft tissue and bone. In patients with osteomyelitis with an ununited fracture or nonunion, stabilization of the fracture is needed.

Adult↗
PubMed1993

Septopal beads and autogenous bone grafting for bone defects in patients with chronic osteomyelitis.

Thirty-five patients with chronic osteomyelitis were treated with autogenous bone grafts for bone defects. Of 35 patients, two were lost to follow-up evaluation. There were 27 men and six women. The age range was from 18 to 62 years (median age, 29 years). The bones included 22 tibias, nine femurs, and two ulnas. The size of the bone defects ranged from 2.5 x 15 cm (median defect, 2.5 x 6 cm). The length of infection ranged from two to 540 months (median, 31 months). Twenty patients had nonunions and 19 patients required soft-tissue muscle transfers. Patients were treated with systemic antibiotics and/or gentamicin (Septopal) antibiotic beads. Twelve patients were treated with Septopal beads. The range of follow-up evaluation was 24 to 68 months (median, 47 months). Thirty-one of 33 patients had one bone-graft procedure and two patients required two. The time from initial debridement and infection control to bone graft for patients not requiring soft-tissue muscle flaps was one to six weeks (median time, four weeks). For patients requiring soft-tissue muscle transfer, the range was six to nine weeks (median, six weeks). The median time to bone-graft incorporation was six months. All fractures united. Complications included two refractures from auto accidents in the immediate postoperative period, one partial muscle loss, one skin-graft loss, four pin tract draining sites, and two antibiotic-related skin rashes. There was one recurrent infection, and the infection arrest rate was 97%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

A comparison of gentamicin-impregnated polymethylmethacrylate bead implantation to conventional parenteral antibiotic therapy in infected total hip and knee arthroplasty.

A multicenter study of infected total knee and total hip arthroplasties was conducted from 1985 until 1990. Twenty-eight patients (22 total hip arthroplasties and six total knee arthroplasties) who had periprosthetic infections were treated according to a prospective, randomized protocol. After initial debridement for their infections, patients were randomized into one of the two following groups: Group I, debridement and the implantation of gentamicin-polymethylmethacrylate (PMMA) beads; and Group 2, debridement and conventional parenteral systemic antibiotic therapy. After initial treatment, the patients were then scheduled for a delayed reconstruction total joint arthroplasty. Of the 28 patients, 25 subsequently had delayed total arthroplasty, and if acrylic bone cement was used for fixation at the time of reimplantation, antibiotics were not added to the cement. The average follow-up period was three years (range, six months to 5.6 years). Infection recurred in two patients treated by debridement and the implantation of gentamicin-PMMA beads (15%) and in four patients treated with debridement and conventional systemic antibiotic therapy (30%). All recurrences occurred in patients who had infected total hip arthroplasties; none occurred in patients with total knee arthroplasties. The conditions that were common in patients with recurrent infection were (1) multiple previous surgeries, (2) host compromise and malnutrition, (3) extensive infection, and (4) inadequate debridement. The recurrence of infection was not statistically significantly more common in either treatment group. The outcome of treatment in patients with infected total joint arthroplasties using debridement, gentamicin-PMMA bead implantation,and a two-stage delayed reconstruction was similar to that of patients treated with debridement combined with conventional parenteral systemic arthroplasty and two-stage reconstruction.

Adult↗
PubMed1991

Analysis of 61 cases of vertebral osteomyelitis.

Sixty-one cases of bacterial vertebral osteomyelitis from July 1969 to July 1979 were analyzed. The ages of the 49 men and 12 women ranged from 21 to 66 years. The portal of entry was hematogenous in 58 cases, gunshot wounds in two cases, and and adjacent retroperitoneal abscess in one case. Biopsy was performed in 60 patients. There were 15 complications related to the disease. Gram-negative rods were the predominant bacteria isolated. Blood culture was positive in 13 of the 26 (50%) patients tested. Eleven of the 13 (85%) organisms isolated from the blood cultures correlated with organisms recovered from biopsy specimens. Eleven of the patients had more than one disk level involved. Of the 61 patients, 29 went on to spontaneous fusion, 17 were lost to follow-up study, 11 failed to fuse, three had surgical fusion, and one patient died. Recommendations for diagnosis included the collection of blood cultures and radionuclide bone scans. Management recommendations included systemic antibiotics for at least three weeks and immobilization with either bed rest or spinal orthoses. Surgery was indicated if an abscess was present, neurologic complications occurred, instability became a factor, or the medical treatment failed.

Adult↗
PubMed1990

Clostridial myonecrosis.

The best treatment for gas gangrene is prevention by following the principles of thorough debridement, immediate effective parenteral antibiotic therapy, and delayed closure of open fractures.

Fractures, Open↗
PubMed1990

Peripheral teflon catheters. Potential source for bacterial contamination of orthopedic implants?

To detect low numbers of bacterial cells on Teflon catheters removed from peripheral veins, 74 catheter tips were incubated in thioglycollate media for up to ten days. Fifteen (20.3%) of the catheters were found to be culture-positive. Propionibacterium acnes was isolated from seven, Staphylococcus epidermidis from six, and Staphylococcus haemolyticus and Staphylococcus hominis from one each, all common skin organisms associated with infection of implants. An increase in documentation of bacterial contamination resulted from incubating greater than 72 hours; this allowed the slower-replicating Propionibacterium acnes to grow to detectable numbers. Because of these findings and those of others, attention is focused on the peripheral vein conduit as a potential source for hematogenous seeding of implants with bacterial cells. Changing peripheral catheters within 24 hours is recommended to reduce the constant risk of occult bacteremia.

Bacteria↗
PubMed1989

Wound site as a predictor of complications following deep nail punctures to the foot.

The site of injury, condition of the nail, and type of foot covering were compared in 36 inpatients and 34 outpatients with nail puncture wounds to the foot. Of the 36 inpatients, 34 (94%) had pyarthrosis, osteomyelitis, or both. The plantar surface of the foot was divided into 3 zones. Of the 36 inpatients, 35 (97%) had deep puncture wounds in zone 1. In contrast, only 6 of 34 (18%) outpatients had injury to this area. Tennis shoes were shown to predispose to infection with Pseudomonas aeruginosa. Based on our findings, an early hospital admission should be considered for all patients with deep puncture wounds located in zone 1 and for patients who give a history of bone penetration in zone 2 or 3 at the time of injury. All patients who meet the above criteria and who are not admitted to hospital should be observed closely.

Adolescent↗
PubMed1989

Factors influencing infection rate in open fracture wounds.

Seventy-seven infections in 1104 open fracture wounds were evaluated to identify those factors that predisposed to infection. Factors could be placed into three categories: (1) increased risk, (2) no effect, and (3) inconclusive. The single most important factor in reducing the infection rate was the early administration of antibiotics that provide antibacterial activity against both gram-positive and gram-negative microorganisms. In this study, surgical debridement was performed on all open fracture wounds.

Adolescent↗
PubMed1988

Ipsilateral diaphyseal femur fractures and knee ligament injuries.

Three hundred and nine consecutive patients with 320 diaphyseal femur fractures were retrospectively reviewed to determine the incidence of ligament injury in the ipsilateral knee. Ligamentous injuries were diagnosed if serious (Grades II and III) instability was apparent on admission, found at surgery for femoral stabilization, or disclosed on roentgenograms during closed management. Seventeen patients with unilateral shaft fractures of the femur had ipsilateral knee ligament injuries, or 5.3%. There was no relationship between specific ligament damage and the cause of the injury or level of fracture. Twelve patients were followed for an average of 34 months. Five patients lacked full extension and ten lacked full flexion. Two of seven patients with ligament repair and three of five patients without ligament repair had at least one unstable ligament. Better range of knee motion was obtained when both the femur and ligament injuries were surgically managed, but most (seven of 12) patients were disabled.

Adult↗
PubMed1987

Tibial plateau fractures: definition, demographics, treatment rationale, and long-term results of closed traction management or operative reduction.

Results of a decade of experience with 988 tibial plateau fractures are presented. Maximum plateau depression was measured on initial and follow-up x-ray studies, and knee instability was clinically evaluated to identify minor and major fractures as a guide to management. Demographic, treatment, and complication data were gathered prospectively in 753 fractures. Four hundred thirty-seven "major" tibial plateau fractures (44% of cases) were treated operatively; the remainder were treated by traction. Three hundred twenty patients who sustained only a plateau fracture were followed from 1 to 10 years, with an average of 3.7 years. Nonsurgical treatment included Buck's traction (89% of closed treatment cases) or a "knee exerciser" device utilizing skeletal traction in a Hodgson-Pearson apparatus. Early intermittent passive and active knee motion was encouraged. The complication rate of traction was 8%. The complication rate in operated patients was 19%, much of which was due to infection. Methods for objective and subjective scoring of both traction and operative results were developed and utilized. Results show that anatomic reduction of plateau fractures, in addition to early motion, is a major factor contributing to successful management of this potentially disabling injury.

Adolescent↗
PubMed1987

Surgical findings in clenched-fist injuries.

A total of 191 patients (representing 194 skin lacerations) hospitalized for clenched-fist injuries were evaluated for deep structure involvement. Tendon, joint, cartilage, and/or bone were damaged in 75%. Tendon involvement occurred in 28 of 138 (20.3%), joint capsule violation in 99 of 146 (67.8%), free articular cartilage fragments in 8 of 139 (5.8%) and articular-bone indentations in 23 of 139 (16.5%). All patients with clenched-fist lacerations or puncture wounds over joints should be treated by surgical debridement and exploration of the deep structures, including the joint, at the time they first seek medical care.

Adolescent↗
PubMed1986

Infection following intramedullary nailing of long bones. Diagnosis and management.

In 30 patients (23 femurs and 7 tibias) with infection of long bone fractures following intramedullary (IM) nailing, the follow-up study ranged from eight to 84 months (mean, 20 months). Six patients retained active infection at the time of follow-up examination. Ununited fractures were present in four and sequestra in two patients. Stabilization for fracture healing after irrigation and debridement with appropriate systemic antibiotic therapy was the critical factor in the orthopedic management of this series of patients.

Adult↗
PubMed1985

Results of compression-plating of closed Galeazzi fractures.

Diaphyseal fractures of the distal third of the radius that are associated with disruption of the distal radio-ulnar joint accounted for eighty-four (6.8 per cent) of 1236 fractures in the forearm that were treated during a five-year period at the Los Angeles County-University of Southern California Medical Center. Thirty-six closed Galeazzi fractures, twenty-eight in male and eight in female patients, were followed for 1.5 to seven years after treatment using standard AO-compression plates with four to seven holes. Complications included seven injuries to the sensory or dorsal interosseous branch of the radial nerve, two infections, two non-unions, two re-fractures after plate removal, and shortening of the radius of five millimeters in one patient. The complication rate was 39 per cent. The average grip strength at follow-up was 71 per cent of the calculated normal value. The loss of strength was not related to use of a volar or dorsal surgical approach, the patient's age, or a delay of surgery for more than ten days after injury. The average loss of grip strength in the seven upper extremities with restricted motion of the wrist and forearm was 48 per cent, compared with an average loss of 29 per cent in the whole group. Of the twelve patients who were operated on more than ten days after injury, six had loss of motion at follow-up, compared with three who had such a loss among the twenty-four patients who were operated on within ten days after injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

The mechanisms of action for beta-lactam antibiotics and inhibitors of bacterial protein synthesis.

The replication of bacteria, when unchecked, may lead to morbidity or mortality in a susceptible host. The majority of antimicrobial agents either modify or inhibit the synthesis of key substances and are reflected by morphologic, if not lethal, changes. Activity occurs during synthesis of the bacterial cell wall and synthesis of bacterial protein. These two events are described in terms of the local mechanism of action of different classes of antibiotics. The role of antibacterial agents in the replication of bacteria should be clearly understood before antibiotic therapy is administered.

Anti-Bacterial Agents↗