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Biomedical subjects

P G Spiegel

Publications and source records attributed to P G Spiegel.

At least 19 recordsLinked to original sources
PubMed1990

Tuberculous osteomyelitis masked by concomitant staphylococcal infection.

A systematic and easily reproduced bone protocol was used over a 14-month period to evaluate bone histologically and by mycobacterial culture in patients with chronic osteomyelitis. On examination of 140 bone specimens, we found four patients with unsuspected tuberculous osteomyelitis whose diagnosis was obscured by a concomitant staphylococcal osteomyelitis. Three of the patients had axial skeleton involvement, and one had disease of the femur. No patient had a history of a positive skin test or of tuberculous disease, and none had coexistent pulmonary disease. The underlying granulomatous infection was initially revealed in one patient by histologic examination of bone and in three others only by mycobacterial culture of bone. Concomitant osseous tuberculosis should be excluded in patients with staphylococcal osteomyelitis. Evaluation using a bone protocol with histologic study and culture on Löwenstein-Jensen medium is effective in diagnosing occult osseous tuberculosis.

Adult↗
PubMed1988

Fractures of the tibial pilon.

Fractures of the tibial pilon are difficult to manage because of their severity. They are the product of high-energy compression forces and too frequently result in comminution and impaction of the weight-bearing surface of the distal tibia. Other fractures involving the roof of the ankle joint may be called "pilon fractures," but have a better prognosis because the compressive force is coupled with torsional forces. Operative reduction with the application of stable fixation in a clinically proven sequence of steps may lead to a satisfactory outcome in approximately three fourths of the cases, but must be accomplished with a sound understanding of the anatomy of the ankle joint and the principles of stable internal fixation by a surgeon with good atraumatic technique.

Ankle Injuries↗
PubMed1987

Prevention of medical complications in orthopedic trauma.

In severely traumatized patients, morbidity and mortality can be reduced by early management of the skeletal injuries. However, prevention of the complications of shock, pulmonary distress syndrome, embolic phenomena, blood disorders, and immunologic, neuroendocrine, and metabolic problems have a very high priority in overall patient management.

Bone and Bones↗
PubMed1985

Autologous corticocancellous bone paste for long bone discontinuity defects: an experimental approach.

A number of materials have been used in treating long bone discontinuity defects, some with rewarding results and some without. These materials vary from autologous, allogenic, and xenogenic grafts, to bone implants. Other inorganic implants, such as plaster of Paris and gold, have been used, most inducing a strong inflammatory reaction. In this experiment, a paste of autologous corticocancellous bone particles was used to reconstitute discontinuity defects in long bones. The defects were healed to a solidified state within six months. This finding confirms our previous work; in membranous bone discontinuity defects, autologous corticocancellous bone gave best overall results either when used alone or with a template carrier for contouring purposes.

Animals↗
PubMed1985

A prospective, randomized study of the management of severe ankle fractures.

One hundred and thirty-eight patients with a closed grade-4 supination-external rotation or pronation-external rotation ankle fracture (Lauge-Hansen classification) who were seen in the emergency room of the University of Chicago Hospitals were entered into a randomized study of the results of various methods of treatment. Ninety-six patients with satisfactory initial closed reduction were randomized between continued closed treatment in a plaster cast and open reduction with rigid internal fixation according to the techniques of the Association for the Study of Internal Fixation (ASIF). Forty-two patients with unsatisfactory closed reduction were randomized between open reduction with internal fixation of only the medial malleolus and open reduction with rigid internal fixation according to the ASIF techniques. Of the 138 patients who were admitted to the study, only seventy-one (51 per cent) could be followed for an average of 3.5 years (a typical return rate of urban trauma centers). The outcomes were evaluated by a scoring system that included clinical, anatomical, and arthritis scores. Statistical analysis of the data showed that, of the patients with initial satisfactory closed reduction, the ones treated by open reduction and rigid internal fixation had significantly higher total scores, particularly the patients who were more than fifty years old and those with a medial malleolar fracture. The small number of patients with unsatisfactory closed reduction who were treated by one of the two types of open reduction and internal fixation and were available for follow-up precluded drawing any conclusions about the superiority of one method of internal fixation over the other in that group. The difference in the talocrural angle between the injured and normal sides was the only statistically significant radiographic indicator of a good prognosis.

Adolescent↗
PubMed1984

Triplane fractures of the distal tibial epiphysis.

Triplane distal tibial fractures can occur as two-, three-, or four-part fractures with or without a fibular fracture. Diagnosis of the particular anatomy of each fracture is ascertained by plain radiographs; if the fracture is displaced 2 mm or more on any view, anteroposterior and lateral tomograms and, if possible, a limited computerized tomography (CT) scan should be done. A plaster cast in situ for non-displaced fractures or closed reduction for displaced fractures should be attempted first by internal rotation and anterior movement of the fibular metaphyseal piece. Failure to obtain and/or maintain an adequate closed reduction (less than 2 mm displacement), determined by plain radiographs, is an indication for operative treatment. Operative treatment consists of screw fixation for the metaphyseal fragment alone in two-part fractures and both metaphyseal and epiphyseal screw fixation in three-part fractures. Associated fibular fractures may also require internal fixation. The prognosis is generally good if adequate reduction has been achieved by closed or open means.

Adolescent↗
PubMed1983

Minimal internal and external fixation in the treatment of open tibial fractures.

The advantages of rigid internal fixation for open tibial fractures are well documented. There is also a large literature describing various forms of external fixation for open tibial shaft fractures. Because of the enthusiasm for internal and external fixation, the disadvantages and complications warrant new emphasis.

Biomechanical Phenomena↗
PubMed1982

Injuries to the knee ligaments with fractures of the femur.

Evaluation of twenty-four consecutive patients with fracture of the femoral shaft showed injuries of the ligaments of the ipsilateral knee in eight (33 per cent) of them. The history was always one of violent injury, but the examiner had to suspect that this combination of injuries had occurred simultaneously before a careful local physical examination elicited diagnostic signs. Then, pin stabilization of the distal part of the femur with stress radiographs of the knee yielded an early diagnosis. Late recognition of the combined injuries usually could be documented by radiographs of the femur and the knee in traction.

Adolescent↗
PubMed1980

Internal and external fixation of fractures in children.

We have illustrated instances in which open reduction with internal or external fixation should be used in the care of fractures in children. These methods should be used when closed reduction fails or in other circumstances in which they are the initial treatment of choice. At no time should the surgeon hesitate to utilize these operative options if they represent the best method of achieving the most functional end result in a pediatric fracture.

Child↗
PubMed1978

Tibial fractures involving the ankle in children. The so-called triplane epiphyseal fracture.

Triplane fractures of the distal end of the tibia in fifteen children (average age, thirteen years) represented 6 per cent of 237 consecutive epiphyseal fractures of the ankle. Thirteen children were treated by closed methods (including manipulation) and two had open reduction of the fractures. At an average of twenty-six months after injury, three of fourteen patients showed roentgenographic evidence of premature symmetrical epiphyseal closure with less than 0.5 centimeter of shortening and no angular deformity. Of twelve children examined clinically, three had a 5 to 10-degree external rotation deformity and one patient also had an articular incongruity due to inadequate reduction. In the five cases in which tomograms were used to the medial malleolus, and the anteromedial part of the epiphysis. The lateral fragment included the remainder of the epiphysis together with a piece of posterior metaphysis with attached fibula.

Adolescent↗
PubMed1978

Childhood leukemia presenting as a diaphyseal radiolucency.

A 41-month-old black child with a symtomatic diaphyseal destructive lesion of the femur, and a corresponding area of increased uptake on a technetium99m bone scan, had an upper respiratory tract infection. An open biopsy was performed because of an initial clinical diagnosis of osteomyelitis, histiocytosis X or a round cell sarcoma. The biopsy showed numerous blast cells compatible with acute lymphocytic leukemia. Acute leukemia should be included in the differential diagnosis of symptomatic diaphyseal destructive lesions in children. A peripheral blood smear should be carefully interpreted prior to any other invasive diagnostic tests.

Child, Preschool↗
PubMed1976

Acute carpal tunnel syndrome secondary to pseudogout: case report.

Acute carpal tunnel syndrome secondary to chondrocalcinosis seems not to have been previously reported. In a 75-year-old woman, with arthropathy and calcification of the triangular fibrocartilage of the wrist, hyperparathyroidism was suspected, but not proven. Hydroxyapatite and calcium pyrophosphate crystals were found together in the pathological specimen. The patient obtained complete relief from sectioning of the transverse carpal ligament.

Aged↗
PubMed1975

Fractures of the humeral shaft: a retrospective study of 240 adult fractures.

Of 240 humeral fractures, 60 per cent occurred in patients under 35 years old, 39 per cent of fractures being in the middle third of the shaft, 28 per cent were open with an infection rate of 4 per cent. Radial nerve palsy was present in 18 per cent; midshaft fractures accounting for 69 per cent, with 60 per cent of radial nerves recovering spontaneously; 24 per cent after 12 weeks post injury. One hundred and eleven fractures had documentation greater than 3 months. Closed treatment in 100 patients resulted in 5 non-unions and 15 delayed unions; 11 primary internal fixations resulted in 3 non-unions and 2 delayed unions. Subsequent operative procedures reduced the total non-union rate to 5 per cent with 1 per cent delayed union and 4 per cent unknown. Fractures of the humeral shaft that have not begun to unite at 6 to 10 weeks probably will go on to non-union unless the treatment plan is changed. Closed methods of immobilization, other than the sling and swathe, should be used in chronic brain syndrome patients to avoid compounding their fractures. Sixty-three patients with 64 fractures were evaluated in follow-up using Cave's AEF system (92% excellent and satisfactory results) and a modification of Neer's protocol for proximal humeral fractures, (87% excellent and satisfactory results). A functional evaluation on the Cybex machine, (torque through range of motion) gave a useful graphic end result.

Adult↗