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Biomedical subjects

M S Pinzur

Publications and source records attributed to M S Pinzur.

At least 73 records · Page 4Linked to original sources
PubMed1991

Preventing heel ulcers: a comparison of prophylactic body-support systems.

Five commercially available body-support systems used in the prevention of decubitus heel ulcers were objectively compared for their capacity to dissipate or decrease pressure concentration at the most prominent posterior aspect of the heel in bedridden, insensate patients. The Foot Drop Stop, a foam heel suspender, completely eliminated contact between the heel and the bed, and it was the most successful in decreasing pressure concentration. The space boot and foam heel protectors were far more successful than sheepskin rugs or polyester heel protectors, which provided little protection to the prominent heel.

Equipment and Supplies↗
PubMed1990

Torsional malunion of a femur fracture: diagnosis and treatment.

Angulatory malunion and overgrowth deformity following skeletal traction or hip spica treatment of pediatric femoral shaft fractures have been reported often. Torsional deformity following such fractures is less common. Accurate diagnostic measurement and the value of treatment are controversial issues. We present a case of symptomatic torsional deformity, describe a method for accurate calculation of the magnitude of the deformity, and discuss treatment guidelines.

Child↗
PubMed1990

Tips of the trade #26. Treatment of amputation residual limb ulcers with a hydroactive dressing and continued weight bearing.

This paper discusses treatment methods for amputation residual limb (stump) ulcers and infected or failed-amputation wounds. Local wound care and abstinence from prosthetic limb use and weight bearing have been found effective in the treatment of decubitus ulcers, as has the use of occlusive hydroactive dressings such as DuoDERM (ConvaTec, Princeton, NJ). DuoDERM application and prosthetic socket modification have been found useful for the treatment of decubitus ulcers in ambulatory patients. The techniques of, and benefits obtained from, DuoDERM therapy are explored; we conclude that the relief of local wound pressure and shear forces obtained with this therapy generally enhances ambulation capacity.

Amputation Stumps↗
PubMed1989

A safe, pre-fabricated, immediate postoperative prosthetic limb system for rehabilitation of below-knee amputations.

Thirty-eight below-knee amputees were treated with a commercially available pneumatic prosthetic limb system, applied immediately postoperatively, that would allow immediate weight bearing following lower extremity amputation. Thirty-four limbs were amputated for peripheral vascular insufficiency and four were amputated due to trauma. Weight bearing was initiated an average of 4.7 days following surgery and patients were discharged with a non-removable temporary prosthesis at an average of 8.9 days. Thirty-three healed and were uneventfully fit with standard below-knee prosthetic limbs. Three required revision to the above-knee level. In a controlled setting, early weight bearing in the peripheral vascular insufficiency patient can be initiated with a low risk of local wound complication.

Adult↗
PubMed1989

Complications following midfoot amputation in neuropathic and dysvascular feet.

A review of 64 midfoot amputations performed between 1980 and 1985 revealed that complications occurred in 42% of the series. These included early wound dehiscence and late re-ulceration after the patient began walking again. By providing aggressive management and appropriate local revisions, 84% of the original group's limbs were salvaged at a functionally significant level. These findings underscore the fact that midfoot amputation requires diligent immediate and long-term follow-up if an acceptable success rate is to be achieved.

Amputation, Surgical↗
PubMed1989

Axial loading studies of unstable intertrochanteric fractures of the femur.

An experimental four-part unstable intertrochanteric (IT) femoral fracture was created with either a large or small posteromedial fragment (PMF). Sixty-eight adult embalmed femoral anatomic specimens were fractured and subjected to axial loading after fixation. The maximum load prior to failure for femora from the same anatomic specimen was compared to differentiate between different methods of fixation. In the presence of the large PMF variation, anatomic reduction and fixation allowed the femur to resist an average maximum load 57% greater than identical fractures with the fragment excluded. Fixation of the small PMF increased construct strength by an average of 17% over no fixation. The PMF is the keystone to mechanical stability for IT fractures of the femur. When anatomic reduction is possible, its fixation becomes progressively more critical as its size increases.

Aged↗
PubMed1988

Brachioradialis to finger extensor tendon transfer to achieve hand opening in acquired spasticity.

Four patients with adult acquired spastic hemiplegic hand disorders had brachioradialis to extensor digitorum communis tendon transfer to establish motor balance and improve prehensile hand function. All of the patients had volitional control of the wrist and finger flexors without control of the finger extensors, producing a dynamic hand deformity in which the patients could initiate grasp without release. Dynamic electromyography in these patients revealed electrical activity of the brachioradialis muscle during active elbow extension, making a seemingly "out-of-phase" muscle available for "in-phase" tendon transfer. At follow-up, ranging from 26 to 36 months (average of 30.2 months), all four patients improved three functional levels. Translated to functional capacity all of the patients had no functional capacity before operation and good assistive prehension afterward.

Adult↗
PubMed1988

Limb salvage in infected lower extremity gangrene.

Four diabetic patients with gangrene of the forefoot and infection ascending above the ankle were treated with open amputation of the foot combined with open fasciotomy and debridement of the involved proximal muscle compartments. All four patients healed their wounds and returned to their premorbid community ambulation status. The management and indications in these unusual patients are discussed.

Adult↗
PubMed1988

Combined anteroposterior tibial tendon transfer in post-traumatic peroneal palsy.

Posterior tibial tendon transfer to the dorsum of the foot for correction of traumatic paralytic peroneal palsy is a well-accepted treatment option. A careful review of the literature reveals that the results of treatment in this specific patient group are not always encouraging. This paper reports the results of a combined anteroposterior tibial tendon transfer in nine patients with traumatic paralytic peroneal palsy who initially used an ankle-foot orthosis to ambulate. Percutaneous tendo achillis lengthening to correct fixed ankle equinus was performed in six of the patients. At a minimal 24-mo follow-up (range, 24-56), all nine patients were brace free and subjectively felt that the surgery was successful. While the surgery was initially planned to provide an active "tenodesis" of the ankle to resist passive ankle equinus during swing phase of gait, walking electromyography revealed "retraining" of the transferred posterior tibial muscle to function as an active swing-phase ankle dorsiflexor muscle in seven of the nine patients.

Adult↗
PubMed1988

Salvage of infected or failed below-knee amputations with total contact casting and continued weight bearing.

Ten patients with infected or apparently failing below-knee amputations were treated with total contact casting and continued weight bearing ambulation with a commercially available temporary prosthesis. Amputation was performed for peripheral vascular insufficiency in all patients. Seven of the patients were diabetic, five being insulin dependent. All ten were treated as outpatients and proceeded to heal their wounds and continued to function as independent community ambulators during treatment. None of the patients required surgical revision and each was successfully fit with a permanent below-knee prosthesis.

Aged↗
PubMed1988

Early post-surgical prosthetic limb fitting in dysvascular below-knee amputees with a pre-fabricated temporary limb.

Two consecutive series of patients undergoing below-knee amputation for peripheral vascular insufficiency were compared relative to the length of acute-care hospitalization and rehabilitation. The residual limb control group was treated with soft-surgical dressings and non-weight bearing ambulation with referral to the amputee clinic when the residual limb wound was "ready." The residual limb experimental group was treated with rigid plaster (cast) dressings with early post-surgical prosthetic limb fitting and progressive weight bearing ambulation. Acute-care hospitalization following amputation surgery averaged 27.7 days in the control group, and 23.7 days in the treated group. Patients were either re-admitted or transferred to a rehabilitation unit where hospitalization averaged 42.9 days in the control group and 14.1 days in the treated group. This resulted in a cost savings of almost $15,000 per patient based on present hospital fees. The results of this study suggest that early post-surgical prosthetic limb fitting not only hastens recovery amputation, but can be safe and cost effective.

Adult↗
PubMed1988

Psychologic testing in amputation rehabilitation.

Sixty adult patients had psychologic testing following successful below- or above-knee amputation surgery. All were considered to be prosthetic candidates based on the evaluation of an experienced multidisciplinary rehabilitation team. Objective psychologic testing revealed that six (10%) had severe deficits in cognitive ability, eight (13%) had covert psychiatric illness, and three (5%) had both. A vigorous attempt at prosthetic limb fitting and gait training was made in every patient in an inpatient rehabilitation unit. Of the 17 patients (28%) who were determined to be poor candidates for prosthetic limb fitting and gait training based on objective psychologic testing, only four (6%) were capable of even minimal use of the prosthesis, and none approached their preamputation level of ambulation. Psychologic testing may play an important role in determining the rehabilitation potential of the dysvascular amputee.

Adult↗
PubMed1988

Selection of patients for through-the-knee amputation.

Forty-six adult patients had a through-the-knee amputation (disarticulation of the knee) in a four-year period. Thirty-four of the patients had peripheral vascular insufficiency and were judged to lack the potential for using a prosthesis functionally, although the evaluation indicated that they had the potential for healing of the wound at the below-the-knee level of amputation. At a minimum follow-up of one year, the amputation wound had healed in thirty of these patients, and no joint contracture had developed. Two patients died in the first postoperative month, and two had failure to heal and needed revision to an above-the-knee amputation. The remaining twelve patients who had a through-the-knee amputation were judged to be potentially able to use a prosthesis functionally, but they did not have the capacity for wound-healing at the below-the-knee level. Therefore, in these patients, a through-the-knee amputation was performed as an alternative to an above-the-knee amputation. The amputation wound healed in eight of these patients, but four (33 per cent) had failure to heal and needed subsequent revision to an above-the-knee amputation. All twelve patients were able to use a prosthesis. The through-the-knee amputation provides good muscular balance and has a low risk for the late development of joint contracture. The residual limb (stump) provides an excellent surface area for sitting balance and a lever-arm for transfer. In a patient who has the potential to use a prosthesis functionally, the residual limb allows direct load-transfer (end weight-bearing).(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1987

Flexible intramedullary nails for ipsilateral femoral and tibial fractures.

Between June 1981 and August 1983, six patients were treated with flexible intramedullary nails for both femoral and tibial fractures in six floating knees. All six patients were males averaging 26 years of age and all six were involved in motor vehicle accidents. Concomitant associated injuries were common. Two femoral and five tibial fractures were open. All fractures were stabilized within 24 hours of injury by closed intramedullary nailing with Ender nails. At final followup, there was one femoral and one tibial nonunion in the same patient. For the remaining patients, femoral union averaged 10.3 weeks and tibial union averaged 18 weeks. Five patients regained full motion at the hip, and four regained full motion at the knee and ankle. Four patients returned to their preinjury level of function; two were less active, one ambulating without the use of external assistive devices, and one using a cane.

Adult↗