Biomedical subjects

Robert D Zura

Publications and source records attributed to Robert D Zura.

6 recordsLinked to original sources

PubMed2006

Intramedullary fixation of fibular fractures with flexible titanium elastic nails: surgical technique and a case report.

Intramedullary fixation of fibular fractures has been reported in the literature. Its advantages include ease of fixation as well as minimal soft tissue disruption. Various implants have been described, including the Inyo nail and Rush rods. Several studies have examined their use in older people with osteoporotic bone as well as in instances where soft tissue preservation is of concern. To our knowledge, no technique has been described using flexible titanium elastic nails (TENS) (Synthes; Paoli, PA). We illustrate such a technique as well as a case report that demonstrates our experience. Insertion of flexible titanium elastic nails requires attention to detail with preservation of the peroneal tendons and their sheath. While such a construct cannot control rotation, it can preserve length as well as prevent varus and valgus displacement. Future endeavors could focus on the biomechanical principles of intramedullary fibular fixation with TENS nails.

Bone Nails↗

PubMed2006

Manufacturing imperfection of a locking plate screw hole: a case report.

Plate and screw fixation devices are essential in the orthopaedic surgical management of various fractures. Production of these devices has been nearly perfected, with few manufacturing defects reported. Assuming that all implants have been machined properly may cause a surgeon to overlook a manufacturing defect and may potentially result in a poor patient outcome. We report a case of the imperfect manufacturing of a less invasive stabilization system (LISS) plate screw hole. This resulted in a loss of fixation of a single locking screw to the plate in the treatment of a distal femoral fracture. Prompt recognition of the defect helped avoid a potential adverse outcome for the patient. When these issues arise, open dialogue with industry is crucial to promptly identify a solution and enhance patient care. This case highlights the manufacturing company's outstanding quality control and prompt solution of such an occurrence. It is the purpose of this report to raise surgeons' awareness of potential manufacturing problems with implants and prevent negative consequences as a result.

Bone Screws↗

PubMed2006

Current concepts in locked plating.

Approaches to internal fixation have become more biologic. Greater emphasis is placed on vascularity and soft tissue integrity. Locked plates, analogous to rigid internal fixators, can provide relative stability favorable to secondary fracture healing. If applied appropriately, they can avoid soft tissue compromise. The key to this new generation of plates is the locking mechanism of the screw to the plate, which provides angular stability and avoids compression of the plate to the periosteum. Favorable biomechanical and clinical results continue to expand the number of appropriate indications for use of locked plating devices, although exact indications for their use have yet to be precisely defined.

Biomechanical Phenomena↗

PubMed2005

Devastating injuries in healthcare workers: description of the crisis and legislative solution to the epidemic of back injury from patient lifting.

The purpose of this report is to describe a crisis in healthcare, disabling back injuries in US healthcare workers. In addition, outlined is the proven solution of safe, mechanized, patient lifting, which has been shown to prevent these injuries. A "Safe Patient Handling--No Manual Lift" policy must be immediately instituted throughout this country. Such a policy is essential to halt hazardous manual patient lifting, which promotes needless disability and loss of healthcare workers, pain and risk of severe injury to patients, and tremendous waste of financial resources to employers and workers' compensation insurance carriers. Healthcare workers consistently rank among top occupations with disabling back injuries, primarily from manually lifting patients. Back injury may be the single largest contributor to the nursing shortage. Reported injuries to certified nursing assistants are three to four times that of registered nurses. A national healthcare policy for "Safe Patient Handling--No Manual Lift" is urgently needed to address this crisis. Body mechanics training is ineffective in prevention of back injury with patient lifting. Mandated use of mechanical patient lift equipment has proven to prevent most back injury to nursing personnel and reduce pain and injury to patients associated with manual lifting. With the national epidemic of morbid obesity in our country, innovative devices are available for use in emergency medical systems and hospitals for patient lifting and transfer without injury to hospital personnel. The US healthcare industry has not voluntarily taken measures necessary to reduce patient handling injury by use of mechanical lift devices. US healthcare workers who suffer disabling work-related back injuries are limited to the fixed, and often inadequate, relief which they may obtain from workers' compensation. Under workers' compensation law, healthcare workers injured lifting patients may not sue their employer for not providing mechanical lift equipment. Discarding healthcare workers disabled by preventable back injuries is an abuse which legislators must remedy. In addition, Medicare reimbursement policies must also be updated to allow the disabled community to purchase electrically operated overhead ceiling lifts. The US lags far behind countries with legislated manual handling regulations and "No Lifting" nursing policies. England and Australia have had "No Lifting" nursing policies in place since 1996 and 1998, respectively. The National Occupational Research Agenda (NORA) recognized a model in 2003 for reduction of back injuries to nursing staff in US healthcare facilities. Also in 2003, the American Nurses Association called for elimination of manual patient handling because it is unsafe and causes musculoskeletal injuries to nurses. The first state legislation for safe patient handling passed both houses in California but was vetoed by the Governor in September 2004. California and other states are preparing to (re)introduce legislation in January 2005. A national, industry-specific policy is essential to quell the outflow of nursing personnel to disability from manual patient lifting.

Adult↗

PubMed2004

Unstable proximal extraarticular tibia fractures: a biomechanical evaluation of four methods of fixation.

OBJECTIVE: To compare the biomechanical stability of extraarticular proximal tibia fractures reconstructed using a double-plate construct, locking plate system, hybrid external fixator, and single lateral periarticular plate, all from the same manufacturer. DESIGN: Standardized proximal tibial fractures (AO classification 41-A3.2 and A3.3) in synthetic tibiae were stabilized using one of the four constructs. Load versus proximal fragment translation and rotation were monitored in each case. Fixation was evaluated for moderately unstable and completely unstable fractures simulated by wedge and gap osteotomies of the proximal femur. SETTING: Academic medical center biomechanical engineering laboratory. MAIN OUTCOME MEASUREMENTS: Proximal fragment axial displacement, varus rotation, and posterior rotation versus applied load for each of the constructs. RESULTS: The double-plate construct was significantly stiffer than all other constructs with regard to resistance to axial displacement, varus rotation, and posterior rotation for both types of unstable fractures. With regard to axial stiffness, the double-plate construct was statistically similar to an intact tibia for moderately stable fractures. The locking plate and the external fixator were similar for stabilization of moderately unstable fractures, whereas the locking plate and the periarticular plate were significantly stiffer than the external fixator construct for completely unstable fractures. CONCLUSION: For axial load applied to a wedge or gap osteotomy of the proximal tibia, the double-plate construct provided significantly more rigidity than the other constructs. The locking plate, periarticular plate, and hybrid external fixator tested provided similar rigidity for the wedge osteotomy, but for the gap osteotomy the external fixator could not support 600N without complete closure of the gap.

Biomechanical Phenomena↗

PubMed2003

Current treatment of gunshot wounds to the hip and pelvis.

Gunshot wounds to the pelvis can result in injuries to various organ systems. These injuries require the care of a multispecialty trauma team at a trauma center. Orthopaedic care includes wound treatment, fracture stabilization, and infection prophylaxis. Wound care is determined by the personality of the injury, and not solely based on the velocity of the missile. Antibiotic treatment usually is indicated for patients with gunshot wounds to the pelvis, but is controversial in patients with low-energy wounds. Fractures are treated based on their stability. Regional consideration of pelvic gunshot wounds includes injuries with associated abdominal viscus injury, intraarticular bullets, and retained bullets in the spinal canal.

Hip Injuries↗