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Biomedical subjects

N D Reis

Publications and source records attributed to N D Reis.

At least 19 recordsLinked to original sources
PubMed2004

A three-dimensional classification for fractures of the proximal humerus.

Existing classifications of fractures of the head of the humerus are inadequate in terms of interobserver reliability and the predictability of the clinical outcome. From a combined study of 73 fracture specimens in museums and 84 CT-three-dimensional reconstructions in patients, we have devised a classification which appears to be more useful clinically. Common patterns of fracture and a plausible mechanism of injury were observed. In 3-D most proximal humeral fractures can be organised into five basic types. These correspond in some degree to the Codman/Neer classification, but differ significantly in regard to the more complex patterns of fracture. We observed a logical progression from simple to complex fractures. An interobserver reliability study was carried out which indicated the improved usefulness of this new 3-D concept in providing a common language among clinicians for classifying these injuries. When surgery is indicated, the 3-D concept is also invaluable in guiding the restitution of anatomy through either open or percutaneous means.

Cadaver↗
PubMed2003

Hyperbaric oxygen therapy as a treatment for stage-I avascular necrosis of the femoral head.

Avascular necrosis (AVN) of the head of the femur is a potentially crippling disease which mainly affects young adults. Although treatment by exposure to hyperbaric oxygen (HBO) is reported as being beneficial, there has been no study of its use in treated compared with untreated patients. We selected 12 patients who suffered from Steinberg stage-I AVN of the head of the femur (four bilateral) whose lesions were 4 mm or more thick and/or 12.5 mm or more long on MRI. Daily HBO therapy was given for 100 days to each patient. All smaller stage-I lesions and more advanced stages of AVN were excluded. These size criteria were chosen in order to compare outcomes with an identical size of lesion in an untreated group described earlier. Overall, 81% of patients who received HBO therapy showed a return to normal on MRI as compared with 17% in the untreated group. We therefore conclude that hyperbaric oxygen is effective in the treatment of stage-I AVN of the head of the femur.

Adult↗
PubMed1997

External fixation for severe open fractures of the humerus caused by missiles.

OBJECTIVE: To evaluate the use of external fixation of the humerus after missile injuries. DESIGN: Retrospective. SETTING: University medical center. PATIENTS: Twenty-six soldiers with twenty-six open Gustilo type III fractures. INTERVENTIONS: Immediate external fixation. MAIN OUTCOME MEASURES: Clinical, functional, social, and rehabilitation criteria were evaluated. RESULTS: Excellent in fourteen patients (61%), good in four (17%), fair in three (13%), and poor in two (9%). All fractures eventually healed. CONCLUSION: External fixation is the preferred initial treatment for stabilizing severe open missile fractures of the humerus. Its use, together with radical debridement of dead bone, has reduced the incidence of chronic infection and improved the prognosis of vascular repairs. As a result, the rate of morbidity and upper limb amputation has been reduced significantly, compared with our previous experience.

Adult↗
PubMed1995

Closure of an open high below-knee guillotine amputation wound using a skin-stretching device.

A skin-stretching device (SSD) which is designed to harness the viscoelastic properties of the skin using incremental traction is described. It has proved to be of value in securing closure, within 72 h, of an open high below-knee guillotine stump wound which did not heal during a period of 2 months after amputation. The skin-stretching device provided healthy, durable and sensate skin for stump coverage. Hospitalization time was shortened and an early post-surgical prosthetic fitting and ambulation was achieved.

Amputation Stumps↗
PubMed1993

Pyknodysostosis: imaging and laboratory observations.

Pyknodysostosis is a rare form of sclerosing bone dysplasia with autosomal recessive inheritance. Affected members of two families were assessed as follows: three patients underwent densitometry measurements and bone scans; four patients underwent magnetic resonance imaging (MRI) and an immunological investigation, as well as a detailed endocrinological and biochemical laboratory review. Densitometry measurements revealed values of up to 291% of age-matched normal controls; this increased bone density was mainly in the trabecular bone and not in the cortical bone. The MRI showed the cortex to be of normal thickness, whereas the increase in trabecular bone limited the space within the medullary canal. Bone scans and single photon emission computerized tomography in three patients showed an increased uptake of [99mTc]methylene diphosphonate of up to 538% of age-matched controls, which reflected the increased bone density. Monocyte function tests demonstrated a normal phagocytic capacity, but their killing activity was impaired. Interleukin-1 secretion was also impaired, which may point to the pathogenesis of the disease, in view of its function as an osteoclast activator and its role in bone resorption.

Adolescent↗
PubMed1992

Muscle microcirculatory impairment following acute compartment syndrome in the dog.

Visualization of the intramuscular microcirculation during and after compartmental syndrome was studied by microangiograms and histologic cross sections. A marked reduction in the circulation of the endomysial capillary network was found during compartment tamponade, whereas the perimysium arteriolar system was patent. Revascularization took place by formation of distorted blood vessels accompanied by intramuscular hematomas in muscles 7 and 14 days after the compartment insult. The cross sections show massive fibroblastic activity around blood vessels that caused concealed intramuscular pressure-ischemic contracture resulting in the foci of myofibrillar necrosis seen within normal muscle tissue. The muscle located in the tamponaded compartment profusely bleeds when it is touched, even though its viability is in doubt. The explanation for this clinical observation might be the abnormal intramuscular revascularization that was found in this work.

Acute Disease↗
PubMed1991

A philosophy of limb salvage in war: use of the fixateur externe.

Over the period 1973-1983, we treated by external fixation 110 severe grade three open or complicated fractures caused in war (minimum follow-up, 7 years). We present our data analyzed according to method, location, and type of fracture. The methods we have evolved over the years are described in detail: primary wound stabilization by fixateur externe; primary radical wound excision, repeated every 48 hours as required, including excision of dead bone; delayed primary vascular soft tissue cover; delayed primary or secondary skeletal and soft tissue reconstruction as dictated by local wound conditions; prophylactic antibiotics and intensive physiotherapy to the joints and muscles of the injured limb and as rapid an ambulation of the patient as possible. The advantages and limitations of external fixation are enumerated. It is possible to avoid the complications of pin tract infection and ring necroses, but care is required to avoid refracture after removal of the apparatus, since the quality of bone healing is not always good with the use of external fixation. External fixation has greatly facilitated the various methods for achieving delayed primary vascular soft tissue cover over severe open fractures, bringing about an improved prognosis; micro-vascular techniques hold great promise for wound cover and skeletal reconstruction. Similarly, the Ilizarov method of bone osteotaxis has opened up new vistas in the treatment of bone mass loss. The latter requires a sophisticated set-up which will not be available in most war zones. In spite of the advances in treatment and in the improved results achieved by modern techniques of wound stabilization, wound soft tissue cover, and bone and soft tissue reconstructions, the temptation to try to salvage useless limbs must be resisted. Amputation, judiciously adjudged and correctly timed, remains one of the most successful forms of treatment in these severe injuries, saving the casualty from a physical and spiritual via dolorosa. Enthusiasm for surgical endeavor must be well tempered with mature judgment and realistic clinical acumen.

Amputation, Surgical↗
PubMed1990

Anatomy of the extrinsic spinal muscles related to the deformities of scoliosis.

The spatial displacement of vertebrae in idiopathic scoliosis is not explicable by forces created by the muscles which act upon the spine only (intrinsic muscles). The trapezius and latissimus muscles are attached to the spinous processes and the upper limb. In keeping with Newton's third law, these muscles act on the spine as well as upon the upper extremity. The peculiarity of the vertebral anatomy, together with the direction of pull of these muscles, permits an explanation of the biomechanics of the development of 'idiopathic' scoliosis.

Biomechanical Phenomena↗
PubMed1989

[External fixation for open fractures of the femur].

32 cases of severe open fractures of the femur were treated by external fixation in 1 lateral plane with either the Wagner apparatus or the A.O. tubular system. 2/3 of the cases were war injuries and 1/3 were due to traffic accidents. In 1 case the broken limb was severely burned. In half the cases external fixation was changed for P.O.P. or internal fixation because of pin tract infection or delayed union. There were no non-unions or amputations, but 1 case had chronic post-traumatic osteomyelitis. We conclude that the method of choice for 3rd degree open fractures of the femur is external fixation. In the case of severe multitrauma and complex wounds with vascular injury or burns, external fixation is mandatory.

Femoral Fractures↗
PubMed1988

Osteochondritis dissecans of the dome of the talus. Computed tomography scanning in diagnosis and follow-up.

From 1977 through 1985, thirty-two patients were treated for osteochondritis dissecans of the dome of the talus. The diagnosis was established in two-thirds of the patients using ordinary roentgenograms, but it was established in all of them using computed tomography scans. After a mean length of follow-up of about five years, the results of surgical treatment were significantly better than those of conservative treatment. For twenty patients, computed tomography scans were superior to roentgenograms in showing healing of the lesion. We concluded that computed tomography is useful not only for diagnosis--that is, in determining the extent and precise location of the lesion--but also for follow-up.

Adolescent↗