Clyde B Kernek

The plight of the traumatic amputee.

This retrospective review of the long-term problems of patients with lower extremity amputation from trauma fails to support the opinion that most traumatic amputees do well. Overall, anatomic problems involved 51% of the amputees, and social problems involved 56%. Attempting limb salvage with subsequent secondary amputation did not seem to compromise the long-term outcome for these problems. The surgeon performing the amputation should try to obtain the best possible stump and insure that the patient gets the careful follow up and multidisciplinary team support needed to manage the anticipated problems.

Mortality associated with hip fractures in a single geriatric hospital and residential health facility: a ten-year review

Mortality in 159 patients who sustained 163 hip fractures in a single geriatric hospital and residential health facility in a ten‐year period was studied. This study confirms the major problem of mortality associated with hip fractures in the very elderly. Factors that seemed associated with mortality were preoperative and postoperative ambulatory status and the overall medical condition of the patients, as evidenced by the higher percentage of patients in the hospital who died after sustaining hip fractures. The age of these elderly patients did not seem to affect the type of fracture or the final outcome significantly.

Simultaneous Bilateral Tibial Tubercle Avulsion Fracture

Bilateral simultaneous tibial tubercle avulsion fractures are extremely rare. The present case was a 16-year-old boy who sustained bilateral simultaneous tibial tubercle avulsion fractures (Watson-Jones Type III) from jumping while playing basketball. Both fractures were treated successfully by open reduction and internal fixation with screws. Three years later, the patient had the screws removed because of knee pain and tenderness over the screws.

Osteoid Osteoma of the Foot: Presentation Following Trauma

A 15 year old black boy presented with a seven-month history of apparent post traumatic foot pain. Radiologic workup including bone scan, tomograms, and CT scan showed osteoid osteoma, which was treated by surgical excision. This treatment resulted in complete pain relief and return to full activities.

Retained wooden foreign body in the foot detected by computed tomography

A 20-year-old female presented with a 12-week history of a penetrating wound by a pointed wooden slat to the dorsum of her right foot. She had persistent pain, swelling, and an open wound. Initial radiographs were normal, and three surgical explorations failed to find a foreign body. Later radiographs showed erosion of the second metatarsal. Computed tomography detected and localized the wooden foreign body. Removal of the foreign body was followed by healing of the foot.

Fracture Healing in the Rat Tibia: Open Medullary Pin versus Closed Medullary Pin Insertion

Fracture healing was compared in open medullary pin fixation and closed medullary pin fixation of the rat tibia to determine if the closed method promotes healing faster than the open method. Severe and mild closed tibial fractures were fixed immediately by open and closed medullary pin fixation methods, and fracture healing was tested mechanically. Diaphyseal fractures treated immediately by closed medullary pin fixation healed faster than those treated by the open pinning; the difference was statistically significant in mild fractures, but not in severe fractures.

Intrapelvic Migration of Knowles Pin Through External Iliac Vein

Intrapelvic migration of a Knowles pin is rare. A case is reported of Knowles pin migration into the pelvis and through the external iliac vein. This was caused by a combination of excessive motion of the femoral neck nonunion and osteoporosis of the femoral head which allowed forward migration of the pin.

Simplified two-stage below-knee amputation for unsalvageable diabetic foot infections

A simplified two-stage below-knee amputation for unsalvageable diabetic foot infections was done on 19 limbs with 84% good results for healing. The first stage was the standard below-knee amputation with a long posterior flap in which the fascia and skin were closed in the central portion with the medial and lateral portions of the wound left open for drainage. The second stage was delayed until closure of the open wounds three to seven days after the first stage. Wagners classification of diabetic foot lesions was used to stratify these cases. Grades 3 and 4 foot infections had a uniformly good prognosis for healing with this surgical technique. Grade 5 foot infections had a poor prognosis for healing, especially if associated with renal failure and dialysis, even with an initial guillotine amputation.

Intertrochanteric fractures after hip surface arthroplasty. A report of two cases

Intertrochanteric fractures of the femur recently occurred following trauma in two young adult patients who had undergone Indiana Conservative Hip (ICH) surface arthroplasty. Although femoral neck fractures have occurred following ICH surface arthroplasty, these are the only two patients treated by the authors for intertrochanteric fractures following ICH surface arthroplasty.