Search PubMed⌕ Search

Biomedical subjects

R K Beals

Publications and source records attributed to R K Beals.

At least 19 recordsLinked to original sources
PubMed1999

Fractures of the femur after hip replacement: the Oregon experience.

The article provides an analysis of 102 interventions in 93 periprosthetic fractures of the femur contributed by multiple surgeons predominately in community practice. The authors find that treatment of periprosthetic fracture of the femur is problematic. Success in terms of arthroplasty function and fracture treatment is difficult to achieve. Specific treatment recommendations are made based upon the success and failures of this survey.

Arthroplasty, Replacement, Hip↗
PubMed1997

Sponastrime dysplasia: diagnostic criteria based on five new and six previously published cases.

Sponastrime dysplasia is a dwarfing autosomal recessive bone dysplasia, the diagnosis of which is based on a combination of clinical and radiological features. The radiological features are more specific than the clinical ones. We have developed diagnostic radiological criteria based on information from our five cases and from six previously published ones.

Bone Diseases, Developmental↗
PubMed1996

Sponastrime dysplasia: five new cases and review of nine previously published cases.

Sponastrime dysplasia (SD) is a dwarfing autosomal recessive short-limb bone dysplasia. The diagnosis is established by a combination of clinical and radiological findings of which the radiological are the more specific. The current diagnostic criteria are ambiguous as demonstrated by the fact that, in our opinion, three of the five patients reported since the original article do not have this condition. Comparison of our five patients and the 9 published patients has led to development of more specific diagnostic criteria. Previously undescribed complications of this condition are subglottic stenosis and tracheo-broncho-malacia, developmental coxa vara, and avascular necrosis of the capital femoral epiphyses.

Adolescent↗
PubMed1996

Periprosthetic fractures of the femur. An analysis of 93 fractures.

A retrospective review of 93 periprosthetic fractures and 102 periprosthetic fracture treatments showed that the type of prosthesis (cemented, ingrowth, Austin-Moore) and the presence of preexisting stress risers play a role in determining where the fractures occur. The site of fracture and the prefracture interface influence treatment of periprosthetic fractures. This study suggests that fractures associated with a loose interface, cemented or cementless, are best treated by removal of the prosthesis, reduction of the fracture, and insertion of a long stemmed prosthesis with additional fixation as needed. Treatment of a periprosthetic fracture associated with a stable prosthesis depends on the site of fracture. Fractures proximal to the tip of a fixed prosthesis usually can be treated nonoperatively or with limited internal fixation. Fractures at the tip of the prosthesis may be managed by revision or internal fixation, and fractures below the prosthesis can be managed operatively or nonoperatively.

Accidental Falls↗
PubMed1996

Saline load test for penetration of periarticular lacerations.

We used a saline load test in 50 consecutive patients with periarticular lacerations suggestive of joint penetration. The surgeon had predicted on clinical grounds whether or not the laceration penetrated the joint. Joint penetration was demonstrated in 14 and was absent in 36. A comparison of the prediction and the test results showed that there were false-positive clinical results in 39% and false-negative in 43%. There were no complications from the use of the test. Our findings support the use of a saline load test in evaluating periarticular lacerations.

Bias↗
PubMed1995

Iliopsoas bursa imaging: efficacy in depicting abnormal iliopsoas tendon motion in patients with internal snapping hip syndrome.

PURPOSE: To evaluate the efficacy of both iliopsoas bursa imaging and therapeutic injections for determination of the cause of pain in patients with internal snapping hip syndrome. MATERIALS AND METHODS: Twelve patients underwent iliopsoas bursa imaging. One patient underwent the procedure bilaterally and five underwent repeated studies for a total of 21 studies. Eight patients also received therapeutic injections after bursa imaging. RESULTS: Abnormal motion of the iliopsoas musculotendinous unit that occurred synchronously with the snap was revealed in 15 of the 21 studies. Four studies revealed additional information that contributed to symptoms. Eight patients received therapeutic injections with relief of symptoms that ranged from 2 weeks to 2 years. CONCLUSION: Iliopsoas bursa imaging is a simple, rapid, and reproducible method with which abnormal iliopsoas tendon motion can be documented in patients with internal snapping hip syndrome and is also useful for diagnosis of other causes of atypical hip pain. Therapeutic injection into the iliopsoas bursa may delay or obviate surgery.

Adolescent↗
PubMed1994

Osteoarticular allograft reconstruction for recurrent post-traumatic dislocation of the hip.

A patient with post-traumatic mechanical instability associated with a significant posterior acetabular deficiency in the presence of an otherwise good articular surface was treated with an allograft reconstruction. The short-term result was good; at 10-month follow-up there was full range of motion with no clinical evidence of instability. This procedure may be indicated in rare instances of post-traumatic mechanical instability where insufficiency of the posterior acetabular wall is felt to be a significant factor.

Accidents, Traffic↗
PubMed1993

Resonant frequency analysis of the tibia as a measure of fracture healing.

The Resonant Frequency (RF) of the tibia is proportional to its stiffness. As a fractured tibia heals, its RF should increase. The RF was serially determined in 74 fractured tibias (205 examinations). These were subdivided by fracture location and fixation. Fast Fourier transform software generates the RF from data obtained with an instrumented impactor and accelerometer. The RF was normalized by expressing it as a ratio of the intact tibia. This ratio is called the tibial stiffness index (TSI). A 20 point tibial fracture score (TFS) quantitated the clinical and radiographic signs of healing. For each group the paired TSI and TFS were compared by regression analysis. Except for those fractures limited to the proximal fourth of the tibia, the TSI was found to correlate significantly (p = 0.0001) with the TFS. Fractures without fixation and those with unlocked, unreamed tibial nails showed very significant correlation of TSI with TFS (p = 0.0001). RF analysis was not useful in fractures with locked or reamed tibial nails. Examination of tibia with external fixation showed significant correlation (p = 0.02) of the TSI with the TFS.

Biophysical Phenomena↗
PubMed1993

Anomalies associated with vertebral malformations.

A review of 218 patients with congenital vertebral anomalies demonstrates that 61% of patients had associated abnormalities affecting seven systems. The type of vertebral anomaly did not predict the location or type of associated abnormality. The site of vertebral anomaly did correlate with the occurrence of some associated diagnoses. The most common abnormalities associated with vertebral malformation were cranial nerve palsy, radial hypoplasia, club feet, dislocated hip, Sprengel's deformity, imperforate anus, hemifacial microsomia, and renal and cardiac anomalies. Comprehensive evaluation of patients with vertebral anomalies will be enhanced by knowledge of the type and frequency of associated anomalies.

Abnormalities, Multiple↗
PubMed1993

The results of treatment of posttraumatic avascular necrosis of the femoral head in young adults: report of 31 patients.

A series of 31 adult patients less than 42 years of age who were treated for avascular necrosis (AVN) following a healed femoral neck fracture were followed for an average of 14.6 years, and the results of their treatment were analyzed. The average age at fracture was 26.3 years (range: 12.2 to 41.4 years). The mechanism of injury was a motor vehicle accident in 18 and a fall in 13. Sixteen patients had multiple injuries. The average time from fracture to diagnosis of AVN was 19.1 months. The management of AVN included one or a combination of the following: non-weightbearing ambulation, decompression and bone grafting, electrical stimulation, femoral osteotomy, cup arthroplasty, resurface arthroplasty, arthrodesis, hemiarthroplasty, and total hip arthroplasty (THA). The average number of hip operations after initial fracture treatment was 2.9 per patient (range: 0-7). Current follow-up was possible in 97% (30 out of 31) of the patients. THA was performed either primarily or following other treatment in 23 patients at an average age of 31.9 years (range: 16.9-55.3 years). The survivorship of these THAs was 89% at five years and 49% at ten years. Revisions have been done for aseptic loosening of cemented components with the exception of two infections and one loose metal-on-metal press-fit THA. The results of this study indicate that total hip arthroplasty has a high long-term failure rate in this population, and alternate treatment should be considered in order to improve the long-term results.

Adolescent↗
PubMed1993

Painful snapping hip in young adults.

The Council on Scientific Affairs of the California Medical Association presents the following inventory of items of progress in orthopedics. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, and scholars to stay abreast of these items of progress in orthopedics that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another. The items of progress listed below were selected by the Advisory Panel to the Section on Orthopedics of the California Medical Association, and the summaries were prepared under its direction.

Acetabulum↗
PubMed1992

The hip joint in Down's syndrome. A study of its structure and associated disease.

Clinical and roentgenographic examination of the hip was performed in 114 patients with Down's syndrome to study range of motion, roentgenographic anatomy, and incidence of hip pathology. The study found increased external rotation of the hip. Roentgenographic studies demonstrate that, in comparison with a normal acetabulum, the acetabulum of a patient with Down's syndrome is deep, more horizontally placed, and has increased anteversion. The proximal femur of a patient with Down's syndrome has a normal neck-shaft angle and a moderate increase in anteversion. Of the patients, 7.9% had some hip abnormality, including dysplasia, dislocation, avascular necrosis, or slipped capital femoral epiphysis.

Adolescent↗
PubMed1991

Partial calcanectomy for the treatment of osteomyelitis of the calcaneus.

Seven patients underwent partial calcanectomy for chronic osteomyelitis. An average of 20 months followup demonstrated no recurrences, 80% excellent, and 20% good results. Gait assessment, range of motion, and manual motor testing demonstrated minimal functional deficits and full return to preoperative activities. Partial calcanectomy for chronic osteomyelitis of the calcaneus is a simple procedure with low morbidity, rapid convalescence, and good functional results. The high success rate and patient acceptance define it as a well tolerated alternative to more complex procedures.

Adolescent↗
PubMed1991

Stress fractures of the anterior tibial diaphysis.

Stress fracture of the anterior tibial diaphysis is rare and occurs mostly in leaping athletes. Thirty-six of these fractures in 35 patients have been reported in the literature. These are combined with 15 similar fractures in our experience to provide combined data on 51 anterior tibial stress fractures. Comparison of the various treatments utilized disclosed that there is a high risk of complete fracture if affected patients are allowed full activity, and that treatment by rest alone allowed only 40% to return to full activity even after symptomatic improvement. The treatment recommended for these patients is excision of the fissure, transverse drilling at the fissure site, and cancellous bone grafting of the defect. In those patients who suffer a complete fracture, open reduction and internal fixation is superior to closed treatment.

Adolescent↗
PubMed1991

The treatment of ankle valgus by surface epiphysiodesis.

Progressive ankle valgus in childhood requiring surgical correction is usually because of paralytic disease or conditions that produce a short distal fibula such as multiple exostoses or both. Surface epiphysiodesis of the distal medial tibial physis was used to correct valgus deformity in ten ankles in seven patients. This procedure has been found to be a simple and effective method of treatment. Measurement of the degree of valgus and calculation of the remaining growth of the distal tibial physis are recommended to determine whether this procedure will be effective. It is most often indicated in the presence of moderate valgus in children aged 11 to 14 years.

Adolescent↗
PubMed1989

Role of revascularization to treat chronic nonhealing fractures in ischemic limbs.

The contribution of chronic limb ischemia to long-term nonunion of a lower extremity fracture was suggested in a single published case report from our group 13 years ago. We have since encountered three additional patients with nonunited lower extremity fractures occurring in limbs with arterial ischemia. In each of these four patients limb revascularization was undertaken in an effort to stimulate healing of the fracture. These patients had chronic (mean 6 months) nonunion of tibial (three) or femur (one) fractures associated with severe lower extremity ischemia (ankle/brachial index m = 0.33; range 0.24 to 0.5). All patients had histories of chronic lower extremity ischemia before the fracture (ischemic rest pain, 2; claudication, 2). All patients underwent angiography followed by lower extremity revascularization. Restoration of normal arterial supply to the fracture site was followed by healing of the fracture in all patients. To our knowledge, this represents the first reported series of patients undergoing elective limb revascularization to stimulate healing of the fracture. Widespread appreciation of this relationship by orthopedic surgeons may be of considerable clinical importance.

Aged↗