Faculty Bibliography

The objective of this study was to determine the efficacy of postoperative single dose radiation therapy of 700 centigray on fracture/dislocations of the elbow in the prevention of heterotopic ossification. Eleven patients were reviewed for this study. Each patient sustained high-energy trauma to the extremity causing a fracture/dislocation of the elbow. After open reduction and internal fixation, a postoperative single dose of 700-centigray radiation therapy was administered to the patients within 72 hours of surgery. Primary outcome measurements were clinical physical examination of range of motion and radiographic analysis of heterotopic bone formation at 12 months follow-up. Three of eleven patients (27%) had radiographic evidence of heterotopic ossification formation. Ten of eleven patients (91%) however, were without functional limitations. All fractures healed without complications. There were no complications from the radiation therapy. A single dose of 700-centigray radiation therapy postoperatively within 72 hours may lessen the functional loss from heterotopic ossification formation without effecting healing at the fracture site

BACKGROUND: This study compared the fixation stability of two treatments for humeral shaft fractures with segmental bone loss during cyclic, physiologic loading. METHODS: Six matched pairs of human humeri received either a 10-hole broad dynamic compression plate or a locked antegrade inserted humeral nail applied to a humeral diaphyseal osteotomy with a 1.5-cm gap defect. The bone-implant humeral constructs were axially loaded for 10,000 cycles at 250 N and 500 N, with measurements of gap displacement and calculation of construct stiffness. The specimens were then loaded to failure. RESULTS: Cyclic loading showed no difference between the two groups for average gap displacement or construct stiffness. The intramedullary nail constructs failed by humeral shaft splitting (n = 4) or head cut-out (n = 2) at an average of 958.3 N, whereas the plate constructs failed by humeral shaft splitting and screw pull-out (n = 3) or plate bending (n = 3) at an average of 641.7 N (p < 0.001). CONCLUSION: Although both methods offer similar fixation stability under physiologic loads, the higher load to failure demonstrated by intramedullary nail fixation may have implications for the patient with multiple injuries for whom partial weightbearing on the injured upper extremity may be necessary

BACKGROUND: Contracture of the gastrocnemius-soleus complex has well-documented deleterious effects on lower-limb function in spastic or neurologically impaired individuals. There is scarce literature, however, on the existence of isolated gastrocnemius contracture or its impact in otherwise normal patients. We hypothesized that an inability to dorsiflex the ankle due to equinus contracture leads to increased pain in the forefoot and/or midfoot and therefore a population with such pain will have less maximum ankle dorsiflexion than controls. We further postulated that the difference would be present whether the knee was extended or flexed. METHODS: This investigation was a prospective comparison of maximal ankle dorsiflexion, as a proxy for gastrocnemius tension, in response to a load applied to the undersurface of the foot in two healthy age, weight, and sex-matched groups. The patient group comprised thirty-four consecutive patients with a diagnosis of metatarsalgia or related midfoot and/or forefoot symptoms. The control group consisted of thirty-four individuals without foot or ankle symptoms. The participants were clinically examined for gastrocnemius and soleus contracture and were subsequently assessed for tightness with use of a specially designed electrogoniometer. Measurements were made both with the knee extended (the gastrocnemius under tension) and with the knee flexed (the gastrocnemius relaxed). RESULTS: With the knee fully extended, the average maximal ankle dorsiflexion was 4.5 degrees in the patient group and 13.1 degrees in the control group (p < 0.001). With the knee flexed 90 degrees, the average was 17.9 degrees in the patient group and 22.3 degrees in the control population (p = 0.09). When gastrocnemius contracture was defined as dorsiflexion of < or = 5 degrees during knee extension, it was identified in 65% of the patients compared with 24% of the control population. However, when gastrocnemius contracture was defined as dorsiflexion of < or = 10 degrees, it was present in 88% and 44%, respectively. When gastrocnemius-soleus contracture was defined as dorsiflexion of < or = 10 degrees with the knee in 90 degrees of flexion, it was identified in 29% of the patient group and 15% of the control group. CONCLUSIONS: On the average, patients with forefoot and/or midfoot symptoms had less maximum ankle dorsiflexion with the knee extended than did a control population without foot or ankle symptoms. When the knee was flexed 90 degrees to relax the gastrocnemius, this difference was no longer present. Clinical Relevance: These findings support the existence of isolated gastrocnemius contracture in the development of forefoot and/or midfoot pathology in otherwise healthy people. These data may have implications for preventative and therapeutic care of patients with chronic foot problems

In this article, we briefly mention the personal, social, and economic costs of gunshot injuries; describe the science of ballistics and how differences in ballistics affect gunshot wounds and their treatment; and review the general principles involved in managing gunshot injuries. We will summarize the strategies for treating adults with gunshot injuries to specific regions of the lower extremities--the hip, the femur, the knee, the tibia, and the foot

The relative stiffness of five different external wrist fixators currently in use for distal radius fractures was determined using a uniform fracture model consisting of wood dowels to isolate the effects of the fixators themselves. Each construct was loaded in axial compression, eccentric and cantilever modes of bending, and torsion. The stiffest of the fixators varied by a factor of three in compression, five in bending, and three in torsion. Although the ideal stiffness of a wrist fixator is unknown, there is a large variation in the stiffness of existing devices

The purpose of this investigation was to compare the biomechanical analysis of a new plating technique for olecranon fractures to tension band wiring, and review early clinical results. Six matched pairs of cadaveric ulnae were used for the biomechanical analysis. A transverse osteotomy of the mid part of the olecranon was made. One ulna of each pair was stabilized using a tension band and the other with a posterior hook plate. The ulnae were mounted and loaded, and displacement at the osteotomy site recorded. Twenty patients treated with this new technique (14 fractures and 6 osteotomies) were reviewed at one year (range: 8 to 18 months) for infection, union rate, hardware related complaints. and removal. Statistical analysis showed significantly less displacement occurred at the osteotomy site in the plating group. Clinically, all patients had fracture union, and there were no hardware related problems. Posterior plating with this technique achieves greater stability compared to tension band wiring. Early clinical results indicate a low level of hardware related complications

To compare the intrinsic stability of two distal interlocking screw orientations for tibial nailing of distal third tibial diaphyseal fractures without isthmal support, six Depuy (Warsaw, Indiana) tibial intramedullary nails were implanted in simulated distal tibiae. The constructs received both two parallel (medial to lateral) and two perpendicular (one medial to lateral, one anterior to posterior) distal interlocking screws in a random order Angular, translational, and torsional displacements of the nails were measured in response to 70 N proximal applications of anterior, posterior, medial, and lateral loads, and a 7.7 Newton-meter torsional load. There were no differences in medial or lateral angulations between the screw orientations (average: 2.5 degrees, p > 0.8). Angulation in the sagittal plane (anterior and posterior) was slightly less for parallel screw fixation (1.6 degrees versus 2.4 degrees), but this was not statistically significant (p > 0.1). Rotational angulation was higher in the parallel (average: 9.9 degrees) versus the perpendicular (average: 8.1 degrees) screw orientation, but these results were not statistically significant (p > 0.1). Pure translation did not occur in either the parallel or perpendicular screw orientations. These results indicate that fixation stability of these tibial intramedullary nails is not significantly influenced by distal interlocking screw orientation in response to sagittal, coronal, or rotational forces