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Biomedical subjects

Steven J Morgan

Publications and source records attributed to Steven J Morgan.

17 recordsLinked to original sources
PubMed2006

Expandable intramedullary nailing for tibial and femoral fractures: a preliminary analysis of perioperative complications.

OBJECTIVE: To report the results of using the expandable nailing system in the treatment of femoral and tibial shaft fractures. DESIGN: Prospective, cohort series. SETTING: Two level-1 university trauma centers. PARTICIPANTS: Forty-eight patients with acute, traumatic diaphyseal fractures of the tibia or femur. INTERVENTION: Internal fixation of lower extremity long bone fractures using expandable intramedullary nailing. MAIN OUTCOME MEASUREMENTS: Perioperative complications and time to healing. RESULTS: Forty-nine long bone fractures were treated: 22 femoral fractures (OTA classification: 4 type A1, 6 A2, 7 A3, 1 B1, and 4 B2) and 27 tibial fractures (OTA classification: 4 type A1, 11 A2, 9 A3, 0 B1, and 3 B2). There were 13 open fractures and 37 closed fractures. Healing occurred in 37 (75%) fractures without additional interventions. There were 2 tibial delayed unions and 1 femoral and 1 tibial nonunion. Five tibial shaft fractures and 6 femoral fractures shortened by 1.0 cm or more postoperatively. In 3 tibias and 4 femurs, shortening occurred after fractures judged to be length-stable became unstable because of fracture propagation during nail expansion. Five tibias and 3 femurs were converted to standard locked nails because of shortening. The average time to healing, excluding nonunion, was 15 weeks in the tibia and 16 weeks in the femur. The expandable nail resulted in an unplanned reoperation in 12 cases (25%). CONCLUSION: We found a high complication rate because of shortening, which was independent of fracture classification. Consequently, we cannot recommend the use of an unlocked, expandable nail in diaphyseal fractures of the femur or tibia.

Female↗
PubMed2006

The deltoid muscle: an anatomic description of the deltoid insertion to the proximal humerus.

OBJECTIVE: This study was designed to describe the anatomic insertion point of the deltoid to the proximal humerus. DESIGN: Gross anatomic study. SETTING: Level one academic trauma center. PATIENTS: Cadaveric study. MAIN OUTCOME MEASUREMENTS: Bilateral humeri were stripped of soft tissue except the deltoid insertion point. The length of the humeri was recorded. The distance from the greater tuberosity to the proximal most aspect of the tendinous insertion point and the distal most tendinous attachment was measured. The humeri were cross-sectioned 5-mm distal to the proximal insertion point, 5-mm proximal to the distal insertion point, and midway between these 2 points. The circumferential proportion of humerus into which the tendon inserted at each point was recorded. RESULTS: The mean length of the deltoid insertion was 97 (range, 83-111) mm. The mean distance from the greater tuberosity to the proximal insertion point was 61 (range, 55-75) mm and to the distal insertion was 158 (range, 142-172) mm. The deltoid occupied on average: 8% of the humeral circumference 5 mm from the proximal insertion point, 39% at the mid point of the insertion, and 31% of the humeral circumference 5 mm from the distal insertion point. CONCLUSIONS: The deltoid insertion is long and broad. A 4.5-mm plate would result in detaching 13.5 mm of the insertion, leaving at least half of the original insertion attached to the humerus.

Bone Plates↗
PubMed2006

Syndesmosis fixation: a comparison of three and four cortices of screw fixation without hardware removal.

BACKGROUND: Great variability exists in methods of stabilization for syndesmotic disruptions of the ankle. We hypothesized that syndesmotic screw fixation with 3.5-mm fully threaded cortical screws through either three or four cortices would have similar strength and rate of mechanical failure and that retention of screws after fracture healing would not result in adverse clinical symptoms. METHODS: In a prospective, surgeon-randomized study at a Level-one trauma center, 127 patients with syndesmotic disruptions were treated surgically. Seven patients were lost to followup, leaving 120 for review. Syndesmotic disruptions were stabilized with 3.5-mm fully threaded cortical screws placed through three or four cortices. Screws were removed only if symptomatic. Outcome criteria were screw failure, loss of reduction, and need for hardware removal. RESULTS: Fifty-nine patients received fixation through three cortices and 61 patients received fixation through four cortices. Mean follow-up was 150 days. In the group with stabilization through three cortices, hardware failure occurred in five patients (8%) and three had a loss of reduction. In the group with stabilization through four cortices, hardware failure occurred in four patients (7%); all were asymptomatic and did not require screw removal. There was no loss of reduction in that group. Comparing the two groups using binary logistic analysis, there was no difference in loss of reduction (p = 0.871), screw breakage (p = 0.689), or need for hardware removal (p = 0.731). CONCLUSION: The data suggest that either three or four cortices of fixation can be used when stabilizing syndesmotic injuries of the ankle. There was a trend towards higher loss of reduction in the group with tricortical fixation when weightbearing restrictions were not followed. Retention of the syndesmotic screws, even with mechanical failure, does not pose a clinical problem. Weightbearing can be allowed at 6 to 10 weeks without routine removal of screws.

Adult↗
PubMed2005

Pelvic fracture pattern does not always predict the need for urgent embolization.

BACKGROUND: The intimate relationship between the pelvis and related vasculature can lead to life-threatening arterial hemorrhage after blunt trauma. Unfortunately, hemorrhage related to pelvic fracture is often associated with other serious injuries, complicating clinical decision making. Previous clinical reviews have associated fracture geometry with arterial hemorrhage, specifically implicating those injuries with evidence of major ligamentous disruption (MLD). METHODS: We analyzed pelvic fractures for evidence of a relationship between MLD and the need for angiographic embolization. Our trauma registry was reviewed from 1996 to 2002; 283 patients with pelvic fractures arrived in the emergency department with a systolic blood pressure < or = 90 mmHg. MLD was defined as anteroposterior compression types II and III, lateral compression type III, combined mechanism, and vertical shear according to the Young-Burgess classification. RESULTS: Thirty-seven (13%) of the patients studied required angiographic embolization for control of pelvic hemorrhage. The pelvic fracture pattern (MLD vs. non-MLD) did not differ significantly between the embolized and nonembolized groups. The predictive value of other variables varied by gender. Age had a significant correlation with the need for embolization in women, whereas Injury Severity Score did not. Conversely, age had no predictive value for men, whereas Injury Severity Score had a significant correlation. CONCLUSION: The findings in this study suggest that pelvic fracture pattern does not consistently correlate with the patient's need for urgent embolization and should not be used as the sole determinant for angiography. Furthermore, variables such as age and gender should be further investigated, as they may potentially have a predictive value in this clinical setting.

Adult↗
PubMed2005

Be prepared.

Explore the source record for details and available documents.

Disaster Planning↗
PubMed2005

Clinical evaluation of a true percutaneous technique for antegrade femoral nailing.

From July 1997 to March 2001, 209 consecutive patients with 215 femoral shaft fractures amenable to antegrade femoral nailing were enrolled. A true percutaneous insertion technique was performed using a stab wound incision. One hundred ninety-seven (92%) fractures achieved primary union with anatomic or near anatomic alignment. Eighteen (8%) healing problems and two deep infections (1%) responded to repeat interventions. There was one iatrogenic complication related to an anterior starting point. External blood loss was minimal (generally <100 cc). Incisions averaged 16 mm and healed uneventfully. At one-year follow-up only 10% of patients had hip abductor pain. The percutaneous technique appears to be a safe and effective alternative to the standard technique. Hip pain at one year appears decreased compared to reports using a traditional approach.

Adolescent↗
PubMed2004

Advantages of submuscular bridge plating for complex pediatric femur fractures.

Conventional treatments of pediatric femoral shaft fractures may result in an unacceptable rate of complications, especially in complex fractures. These fractures include high-energy injuries resulting in unstable fracture patterns, fractures in the proximal or distal third, and fractures occurring in large or multiply injured children. Our goal was to evaluate whether a minimally invasive submuscular bridge plating technique provides stability for early functional treatment (without protective casting or bracing) and predictable healing. Fifty-one patients with an average age of 10 years were studied. Sixty-seven percent had high-energy injuries and 55% had unstable fracture patterns. With an average followup of 14.2 months, all fractures united with excellent clinical results. Two (4%) significant complications occurred: fracture of one 3.5-mm LC-DCP Ti plate, and refracture of a pathologic fracture after early plate removal. Four patients (8%) had a leg-length discrepancy ranging from 23-mm short to 10-mm long. The average operative time was 106 minutes, with average fluoroscopy time of 84 seconds. Procedures were done by 15 surgeons in five university medical centers. This technique offers the advantage of adequate stability for early functional treatment and predictable healing with maintenance of length and alignment for all pediatric femoral shaft fractures.

Adolescent↗
PubMed2004

Symptoms of posttraumatic stress disorder after orthopaedic trauma.

BACKGROUND: The purpose of this study was to determine the prevalence of posttraumatic stress disorder among patients seen following an orthopaedic traumatic injury and to identify whether injury-related or demographic variables are associated with the disorder. METHODS: Five hundred and eighty patients who had sustained orthopaedic trauma completed a Revised Civilian Mississippi Scale for Posttraumatic Stress Disorder questionnaire. Demographic and injury data were collected to analyze potential variables associated with posttraumatic stress disorder. RESULTS: Two hundred and ninety-five respondents (51%) met the criteria for the diagnosis of posttraumatic stress disorder. Patients with posttraumatic stress disorder had significantly higher Injury Severity Scores (p = 0.04), a higher sum of Extremity Abbreviated Injury Scores (p = 0.05), and a longer duration since the injury than those without posttraumatic stress disorder (p < 0.01). However, none of these three variables demonstrated a good or excellent ability to discriminate between patients who had posttraumatic stress disorder and those who did not. The response to the item, "The emotional problems caused by the injury have been more difficult than the physical problems," was significantly associated with the presence of posttraumatic stress disorder (p < 0.0001) and showed a fair ability to identify patients with the disorder. CONCLUSIONS: Posttraumatic stress disorder is common after orthopaedic trauma. Patients who respond positively to the item, "The emotional problems caused by the injury have been more difficult than the physical problems," may meet diagnostic criteria for this disorder and should be evaluated further.

Adult↗
PubMed2003

Bilateral peroneal nerve palsy following emergent stabilization of a pelvic ring injury.

External noninvasive compressive devices are becoming popular for emergent stabilization of pelvic ring disruptions. The ease of application utilizing available materials such as sheets, the noninvasive nature of such measures, and perceived absence of complications has made this a popular stabilization modality. The authors report a case of bilateral peroneal nerve palsy related to the use of external compressive wraps in a patient with pelvic ring injury.

Accidents, Traffic↗
PubMed2003

Clinical effectiveness of the physical examination in diagnosis of posterior pelvic ring injuries.

OBJECTIVE: To determine if physical examination (PE) of the posterior pelvis in awake and alert trauma patients with known pelvic ring injuries can accurately predict a potentially unstable posterior ring injury and guide the use of computed tomography (CT) more effectively. DESIGN: Patients with pelvic fracture noted on anteroposterior (AP) pelvic radiographs were prospectively evaluated over a 21-month period. AP, inlet, and outlet radiographs as well as CT scans were obtained on all patients. SETTING: Level I trauma center. PATIENTS: Patients were excluded who had a Glasgow Coma Scale score less than or equal to 12, were unable to cooperate with a PE, were 12 years old or younger, or had concomitant acetabular fracture. INTERVENTION: A focused PE protocol with emphasis on the posterior pelvis, including posterior palpation of the sacrum and sacroiliac joint, AP and lateral iliac wing compression, active hip range of motion, and a digital rectal examination. If an individual PE parameter resulted in tenderness, it was considered positive. MAIN OUTCOME MEASUREMENTS: The 4 PE modalities were compared with CT scan results using sensitivity, specificity, negative predictive value, positive predictive value, likelihood ratio, and McNemar's test for discordant pairs. RESULTS: The study group included 66 patients. Of patients, 49 (74%) had posterior pelvic injury diagnosed by CT scan. Of the patients with positive posterior CT scan findings, 48 (98%) had pain with posterior palpation. Sensitivity and specificity were 0.98 and 0.94, and the likelihood ratio was 16.3. CONCLUSIONS: PE, specifically palpation of the posterior pelvis, in patients with pelvic fractures can accurately detect injuries of the posterior ring.

Adolescent↗
PubMed2002

Helmet availability at skiing and snowboarding rental shops. a survey of Colorado ski resort rental practices.

BACKGROUND: Many studies have determined that head injuries are serious and potentially life threatening in skiers and snowboarders. Helmets have proven to be effective in reducing the risk of head and brain injury in blunt trauma from bicycling, climbing, skiing, and snowboarding. The objective of this study was to evaluate the availability, cost, and prevelance of helmet rental to skiers and snowboarders at Colorado ski resorts. METHODS: A survey of rental shops based at Colorado ski areas was conducted during the 1998-1999 ski season. Surveys were mailed to 27 Colorado ski areas. The establishments surveyed were skiing/snowboarding rental shops owned, operated, or both by the resorts based at respective mountains. RESULTS: Nineteen of 26 responding Colorado ski resorts rented helmets, and helmet rental has been increasing in popularity. However, helmets were not considered as part of the standard rental package by any of the resorts, and only one resort offered a discount on helmet rental with a package. While 2% to 38% of skiers/snowboarders rented equipment, less than 1% to 8.6% of renters rented helmets. Subjectively, helmet rental was encouraged mostly for children. CONCLUSIONS: The data acquired should represent a reasonable picture of current helmet rental practices at Colorado ski areas. While helmet use is increasing, it has not yet become generally accepted.

Adolescent↗
PubMed2002

Prospective comparison of contrast-enhanced computed tomography versus magnetic resonance venography in the detection of occult deep pelvic vein thrombosis in patients with pelvic and acetabular fractures.

OBJECTIVE: To determine the rate of pelvic vein thrombosis following acetabular or pelvic fracture identified by enhanced computed tomography venography or magnetic resonance venography. DESIGN: Prospective evaluation of computed tomography venography and magnetic resonance venography in patients with pelvic and acetabular trauma as a screening tool for deep vein thrombosis. SETTING: Level I trauma center. RESULTS: Thirty patients with pelvic or acetabular fractures and who met the study criteria were prospectively screened with magnetic resonance venography and computed tomography venography to determine preoperative presence of pelvic venous thrombosis. Pelvic deep vein thrombosis was detected by computed tomography venography in two patients (7%) and by magnetic resonance venography in four patients (13%). Invasive selective pelvic venographies were performed on the five subjects who tested positive on either one or both screening tests. Only one computed tomography venography case was validated by invasive pelvic venography. The false-positive rate for computed tomography venography was 50%, and the false-positive rate for magnetic resonance venography was 100%. CONCLUSIONS: We cannot recommend the sole use of either computed tomography venography or magnetic resonance venography to screen and direct the treatment of asymptomatic thrombi in patients with fracture of the pelvic ring because of the high false positive rates. If these studies are used as screening tools, confirmation of the presence of thrombosis with selective venography should be performed prior to initiating invasive treatment with a vena cava filter. Clinical decisions based solely on one of these imaging techniques may result in inappropriate aggressive treatment due to the high false-positive rate.

Acetabulum↗
PubMedDate not supplied

Results and technique of unstable pediatric femoral fractures treated with submuscular bridge plating.

Twenty-seven patients underwent submuscular bridge plating for unstable pediatric femoral fractures with contraindications to fixation with flexible intramedullary nails. This report discusses the technique and results. A precontoured plate was tunneled proximally through a small distal incision in the subvastus plane to bridge the fracture. The plate was secured to the femur, with screws placed percutaneously proximal and distal to the fracture to reduce and stabilize the fracture. A retrospective review of radiographs and clinical follow-up was analyzed for postoperative alignment, any change in alignment or instrumentation failure, bony union, clinical exam, and complications. There were no intraoperative or postoperative complications. There has been no instrumentation failure or loss of reduction. Early callus was seen by 6 to 8 weeks and stable bony union by 12 weeks in all patients. Submuscular plating is a reasonable option for operative stabilization of comminuted and unstable pediatric femoral fractures.

Adolescent↗