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Biomedical subjects

W W Brien

Publications and source records attributed to W W Brien.

At least 19 recordsLinked to original sources
PubMed1997

Reliability evaluation of classifying radial head fractures by the system of Mason.

Inter-observer and intra-observer reliability for classifying radial head fractures by the system of Mason was analyzed. Twenty-three cases of isolated radial head fractures and twenty-five sets of corresponding AP and lateral radiographs representing these fractures were assembled. The cases were reviewed and assessed independently according to the system of Mason by twenty practicing orthopedic surgeons. On two occasions, the inter-observer and intra-observer variation was analyzed by standard unweighted Kappa statistics. In both observations, complete agreement was seen in only 16% of the cases. Kappa statistic values indicated that 69% of the cases at first observation and 45% of the cases at second observation suggest moderate to poor agreement. Intra-observer agreement between the first and second observation was graded fair to poor in 60% of the cases. Individual observer consistency was, on average, only 78% (range 60% to 92%). The demonstrated wide degree of variation suggests that the Mason classification is unreliable.

Confidence Intervals↗
PubMed1995

The management of gunshot wounds to the femur.

This article is an overview of the management of femoral shaft fractures resulting from gunshot wounds. It deals with the initial patient evaluation, operative techniques of fracture stabilization and wound care, associated complications, and the postoperative rehabilitation of these complex fractures. The recommendations are based upon a large patient experience in an urban trauma center.

Bone Nails↗
PubMed1994

Hip joint arthrodesis utilizing anterior compression plate fixation.

Sixteen patients who had undergone hip arthrodesis utilizing an anteriorly placed compression plate were evaluated at an average of 4.5 years after surgery. The technique was designed to facilitate future conversion to a total hip arthroplasty by preserving the abductor musculature. Of the 11 patients who underwent primary fusions, 5 failed to unite (45%). Nonunion occurred in all five (100%) patients undergoing refusion for a failed surgical arthrodesis. The authors conclude that an anterior compression plate alone in patients with limited bone stock does not provide adequate fixation and predisposes the patient to failure of fixation and nonunion.

Adult↗
PubMed1994

Scaphoid fractures and scaphoid nonunion. Diagnosis and treatment.

Scaphoid nonunion can cause pain, loss of wrist motion, and loss of grip strength. Because initial roentgenograms are not always definitive, patients suspected of having a scaphoid fracture despite negative initial radiographs should undergo bone scan. Treatment of acute nondisplaced fracture of the scaphoid generally nonoperative, involving immobilization in a cast. Treatment of scaphoid nonunion is generally operative, and many procedures and their associated risks are reviewed. There is no consensus about the clinical implications of scaphoid malunion.

Adolescent↗
PubMed1994

The distal radioulnar joint following Galeazzi's fracture.

Fourteen patients underwent evaluation of the distal radioulnar joint following Galeazzi's fracture. Five of 12 patients who underwent a preoperative magnetic resonance imaging scan of the wrist had evidence of injury to the triangular fibrocartilage complex. These 5 patients also had abnormal intraoperative radiocarpal arthrograms. The amount of radial shortening in the injured forearm was measured prior to surgical treatment. Injury to the distal radioulnar joint appeared to be independent of the amount of radial shortening.

Adolescent↗
PubMed1993

Dislocation following THA: comparison of two acetabular component designs.

One hundred ninety-seven consecutive primary cemented total hip arthroplasties using 22 mm heads were evaluated for the rate of dislocation. All surgery was performed by one surgeon through a posterior approach. A Charnley type femoral component was used in each case. Patients were divided into three groups based on the acetabular component used. Group I had 60 Charnley HPW cups implanted between January 1985 and December 1986; group II had 70 Tibac cups implanted between January 1987 and August 1987; and group III had 67 Charnley HPW cups implanted between September 1987 and February 1988. The groups were similar with regards to age, sex, original diagnosis, and surgical technique. There was a total of 11 dislocations (5.6%), of which 8 (11.4%) occurred in group II (Tibac cup). Furthermore, 6 patients (3%) developed recurrent hip dislocations, 5 (7.1%) of which were from group II. Group II had a statistically significant increase in the dislocation rate (P < .05). The authors conclude that the dislocation rate with the 22 mm Tibac cup is unacceptably high and that the design of the Charnley cup affords greater stability to the artificial hip joint than the hemispherical design of the Tibac cup.

Adult↗
PubMed1993

Antibiotic impregnated bone cement in total hip arthroplasty. An in vivo comparison of the elution properties of tobramycin and vancomycin.

A prospective in vivo quantification was performed to measure the elution of tobramycin and vancomycin antibiotics from two commonly used bone cements. Forty patients were divided into four groups: Group I, tobramycin-Simplex; Group II, tobramycin-Palacos-R; Group III, vancomycin-Simplex; and Group IV, vancomycin-Palacos-R. Antibiotic levels were measured from hemovac wound drainage, urine, and serum and compared with control groups who received either intravenous tobramycin or vancomycin. There were no significant differences in daily mean tobramycin levels in hemovac samples between Groups I and II. Tobramycin hemovac levels from Groups I and II were significantly higher than the tobramycin control group. Similarly, no differences were seen in daily mean vancomycin levels of the hemovac samples between Group III and IV; however, the intravenous vancomycin control group had significantly higher levels in the hemovac fluid than Groups III or IV. Tobramycin in the hemovac fluid from Groups I and II was highly bioactive against the control organism. Vancomycin in the hemovac fluid from Groups III and IV had variable bioactivity against the control organism. In 30% of the cases, no vancomycin was detected in the hemovac fluid, and in these cases, the hemovac fluid had no effect on the control organism. Tobramycin elutes to give adequate local tissue levels and releases antibiotic effects when used in an antibiotic bone cement combination. Vancomycin has variable elution properties and is not a predictable additive for the bone cements tested.

Bone Cements↗
PubMed1992

Ipsilateral fractures of the femoral neck and shaft.

Thirty-three patients with ipsilateral intracapsular femoral neck and shaft fractures were treated with antegrade reamed intramedullary (IM) nails and cancellous screw fixation of the femoral neck. The shaft fractures were fixed prior to definitive neck stabilization. A "reversed" nail construct was used in 13 patients, a conventional interlocked nail was used in 6, and a reconstruction nail was used in the remaining 14. Thirty-one (94%) of the femoral shaft fractures healed primarily. In two patients, the shaft fracture failed to unite and was bone grafted and plated, respectively; the fractures subsequently healed. However, only 27 (82%) of the femoral neck fractures healed after initial fixation. In six patients (18%), a symptomatic varus nonunion developed, requiring a valgus osteotomy. Five of the six femoral neck non-unions and all of the osteotomy sites united; however, two of these patients later developed osteonecrosis of their femoral heads. Closed reamed antegrade IM nailing with supplemental screw fixation of ipsilateral femoral neck and shaft fractures did not produce uniformly successful results because of high rates of varus nonunion of the femoral neck fracture.

Academic Medical Centers↗
PubMed1992

Tinel's sign and Phalen's test in carpal tunnel syndrome.

Tinel's sign and Phalen's test are two provocative tests used in the diagnosis of carpal tunnel syndrome. A review of the literature reveals a wide range of sensitivity for these tests. Analyzing the historical data and comparing these to the Tinel's sign and Phalen's test results of 100 individuals without carpal tunnel syndrome (200 wrists), we conclude that the Tinel's sign is not useful in the evaluation of patients with carpal tunnel syndrome, whereas Phalen's test, which has a greater sensitivity and specificity, can be of use.

Adolescent↗
PubMed1992

Concomitant injuries of the hip joint and abdomen resulting from gunshot wounds.

Septic arthritis is a devastating complication of transabdominal gunshot wounds to the hip. Five patients sustained gunshot wounds to the hip which violated the alimentary tract. Diagnosis was established with plain radiographs in three patients, arthrogram in one patient, and a gastrointestinal series in one patient. Three patients had an exploratory laparotomy with diverting colostomy followed by immediate hip arthrotomy within 24 hours and no joint infections occurred. In the other two patients, hip involvement was identified late after septic arthritis occurred. Early diagnosis, diverting colostomy, and immediate arthrotomy are recommended for gunshot wounds to the hip which involve the alimentary tract.

Abdominal Injuries↗
PubMed1992

Synovial sarcoma. A clinicopathologic study.

Twenty-five cases of synovial sarcoma were reviewed clinically, roentgenographically, and pathologically. The histopathology of each tumor was classified as either monophasic (19 cases) or biphasic (six cases). A soft-tissue mass was seen on roentgenography in 70% of patients; calcification was present in 15% of cases. Treatment included surgery, with or without radiation and/or chemotherapy. Fifteen patients remained disease free at an average of 7.5 years, one patient had pulmonary metastasis, and nine patients have died. The critical prognostic factor was adequate surgical margins; there were no local recurrences with adequate tumor-free margins, but there was an 83% recurrence rate with inadequate treatment.

Adolescent↗
PubMed1992

Subtrochanteric fractures of the femur. Results of treatment by interlocking nailing.

Ninety-five subtrochanteric femoral fractures were treated with an interlocking nail. There were 69 closed and 26 open fractures. This injury was the result of high-energy trauma in 77% of the cases. The average time to healing was 25 weeks. There were three delayed unions, one nonunion, and six malunions. Essentially all nonpathologic, subtrochanteric femur fractures can be stabilized by interlocking nailing, regardless of the fracture pattern or degree of comminution. Favorable mechanical characteristics of interlocking nails have eliminated the requirement of surgically reconstituting the medial femoral cortex. Closed interlocking nailing is the preferred treatment for subtrochanteric fractures of the femur resulting from trauma.

Adolescent↗
PubMed1992

Metal levels in cemented total hip arthroplasty. A comparison of well-fixed and loose implants.

In a prospective study, synovial fluid metal levels from stainless steel, cobalt-chromium, and titanium-alloy cemented total hip implants were measured. There were 37 well-fixed and 44 loose hip arthroplasties. Tissue-metal levels were quantitated in the cases revised for loosening. Retrieval analysis for implant wear was performed. Synovial fluid analysis showed a fivefold increase in metal levels of loose compared with well-fixed stainless steel implants. There was a sevenfold increase in metal levels of loose compared with well-fixed cobalt-chromium implants. There was a 21-fold increase in metal levels of loose compared with well-fixed titanium-alloy (Ti-6Al-4V) implants. Tissue-metal levels from revised cobalt-chromium implants averaged 45 micrograms/g dry tissue weight compared to 4,470 micrograms/g dry tissue weight from revised titanium-alloy implants, a 100-fold increase. Implant retrieval analysis showed severe burnishing and scratching in all titanium-alloy femoral heads and extensive burnishing and scratching in the majority of the femoral stems. Well-fixed cemented implants have similar low synovial fluid metal levels. However, when loosening of implants occurs, titanium-alloy implants release disproportionate levels of metal into synovial fluid and local tissues compared to stainless steel or cobalt-chromium.

Alloys↗
PubMed1992

Intraoperative adjusted-dose heparin thromboembolic prophylaxis in primary total hip arthroplasty.

Intraoperative, fixed, intermittent, low-dose intravenous heparin prophylaxis has been reported to significantly reduce the incidence of thromboembolic disease from 24.3% to 8.3% after primary total hip arthroplasty (THA). This study examined the potential efficacy of adjusted-dose intraoperative heparin administration, keeping the activated clotting time at 30%-50% greater than normal. It was hypothesized that prolongation of clotting parameters in a uniform manner would further decrease the incidence of thromboembolic disease postoperatively. Sixty-one patients completed the protocol. The overall incidence of thromboembolic disease was 9.8%. Five patients had a positive postoperative venogram: four in the calf and one in the proximal deep thigh vein. One patient had a symptomatic nonfatal pulmonary embolus diagnosed by ventilation-perfusion scan. There were no complications related to heparin administration. This approach was therefore equally as effective as the fixed-dose regimen, and it further confirmed the efficacy and safety of an intraoperative heparin prophylaxis regimen. The extra efforts required to maintain a constant intraoperative level of anticoagulation did not prove advantageous over the simpler, fixed-dose regimen in reducing the incidence of thromboembolic disease after primary THA.

Adult↗
PubMed1992

Fractures of the forearm resulting from low-velocity gunshot wounds.

Thirty-seven extraarticular fractures of the forearm resulting from low-velocity gunshot injuries were treated by cast immobilization or open reduction and internal fixation with dynamic compression plates. All patients received 72 h of intravenous antibiotics. There were 14 isolated ulna fractures, 17 isolated radius fractures, and six both-bone (radius and ulna) fractures. Cast immobilization was used in 22 of 23 nondisplaced or minimally displaced fractures and eight of 14 displaced fractures. The remaining seven fractures were treated by open reduction and internal fixation. All fractures united within 16 weeks of injury regardless of the method of treatment. Poor clinical results related to the fracture occurred in six patients, five of whom were treated by cast immobilization. Fourteen patients had nerve palsies; eight resolved spontaneously and six had permanent neurologic deficits. There were two compartment syndromes and one ulnar artery transection. There were no infections. We conclude that displaced fractures of the radius, and both bone fractures, are best treated by open reduction and internal fixation. All patients should be closely monitored for 24 h for compartment syndrome, regardless of the fracture type or pattern. Early dynamic splinting is important when associated nerve injuries are present.

Academic Medical Centers↗
PubMed1992

Review of treatment results for Kienbock's disease.

A review of the literature reveals that Kienbock's disease has been treated in many different ways. Excision of the lunate, with or without replacement arthroplasty, and joint-leveling procedures (radial shortening or ulnar lengthening) are the most popular procedures, but other methods of treatment (nonoperative, wrist denervation, lunate revascularization, intercarpal arthrodesis and proximal-row carpectomy) have also been performed. Based on our current understanding of the etiology, a joint-leveling procedure seems to make the most sense when surgery is indicated. However, other procedures have yielded a high success rate as well.

Carpal Bones↗
PubMed1992

Intraoperative heparin thromboembolic prophylaxis in primary total hip arthroplasty. A prospective, randomized, controlled, clinical trial.

Venous thromboembolic disease remains the most common and potentially fatal complication after total hip arthroplasty (THA). Proximal femoral deep vein thrombosis (DVT) is especially prone to propagate and embolize. The authors' hypothesis was that intraoperative intravenous heparin administration could reduce proximal DVT in THA. There were 286 patients who entered into a prospective, double-blind, randomized clinical trial at the authors' institution between June 1988 and May 1990. All patients had unilateral primary THA under hypotensive epidural anesthesia. The epidural catheter was placed at least 60 minutes before heparin administration. Intravenous heparin was given during surgery only. All patients received aspirin twice daily (650 mg/day) after surgery. Detection of DVT was by contrast venography on Postoperative Day 6 or 7. The study was divided into three phases. There was four groups: control (intraoperative saline), 30 minutes (1000 U heparin at beginning of surgery followed by 500 U every 30 minutes), continuous adjusted (1000 U or 1500 U initial bolus followed by continuous heparin infusion maintaining anticoagulation at 30%-50% elevation from baseline), and fixed dose (1000 U bolus before hip dislocation, and 500 U bolus before femoral canal preparation). Proximal femoral DVT was effectively reduced from 9.1% in the control group to 1.7% in the heparin groups (1.7% in 30 minute, 1.6% in continuous adjusted, 1.7% in fixed dose) (p less than 0.02). The overall DVT rate was also significantly reduced from 24.3% to 10% (p less than 0.01). No adverse effects from heparin administration were noted. Postoperative drainage, hematocrit levels on Postoperative Day 2 and at discharge, and transfusion requirements were not significantly different among the groups. The current recommended protocol is 1000 U bolus five minutes before hip dislocation, followed by 500 U bolus five minutes before femoral preparation. This, in conjunction with hypotensive epidural anesthesia and postoperative aspirin, is effective in reducing proximal DVT to less than 2% in primary THA.

Aged↗