Eugene J Dabezies

FACTORS AFFECTING POSTOPERATIVE FLEXION IN TOTAL KNEE ARTHROPLASTY

In the review of 67 cases with total condylar (TC) prostheses, 59 with TC posterior stabilizers, 70 with TC prostheses modified with flat posterior tibial plateau, and 35 with porous-coated arthroplasty (PCA) prostheses, multiple cross-examinations of various factors for postoperative flexion were performed. Follow up was 2 to 9 years. In nearly all cases, no further improvement of flexion was noted after 1 year following surgery. The most influential factor for good postoperative flexion was intense physical therapy, leading to good suprapatellar pouch reconstitution. Residual flexion contracture was more frequent when the posterior cruciate ligament (PCL) was retained in the cases with significant preoperative flexion contracture. However, retention of PCL or preoperative ACL condition did not bear any significance to the ultimate flexion.

Measurement of Effective Pedicle Diameter in the Human Spine

Effective pedicle diameter (EPD), the maximal cancellous diameter of the spinal pedicle, demonstrates the maximal diameter available for transpedicular screw placement. The pedicles of 16 spines from T6 to L5 were measured directly with a graduated mean increase in the EPD ranging from 4.8 mm at T6 to 5.9 mm at L5. This direct pedicle measurement was significantly smaller than that of previously reported studies, which directly and radiographically measured pedicle outside width rather than inner diameter. Three specimens had little, if any, pedicular medullary cavity on direct measurement, although radiographic appearance of a medullary cavity existed. If EPD is significantly smaller than radiographic pedicle width measurements, safe transpedicular screw fixation may not be achieved. Preoperative planning must account for this so that transpedicular screws of correct diameter may be used and the complications of pedicular blowout fracture and neurologic impairment may be avoided.

High Vacuum As a Method of Reducing Porosity of Polymethylmethacrylate

In total hip arthroplasty, fracture and subsequent premature loosening are directly related to the strength of the cement mantle serving as an interface between bone and prosthesis. The cement has been shown to be weakened by its porosity, which enhances the formation of microfractures that contribute to crack propagation. By means of a vacuum mixing method for preparing the cement, nearly all the porosity can be removed and cement strength enhanced by about 17%.

Two-stage superficialis tendon reconstruction in severely damaged fingers

In 16 fingers in 12 patients, where profundus tendon reconstruction was contraindicated due to soft tissue and distal joint changes, the superficialis tendon was reconstructed in two stages using a round silicone rod from the distal interphalangeal joint to the lumbrical level in the palm and profundus-superficialis tenorrhaphy as the first stage. The proximal end of the pedicled superficialis was used as the graft in the second stage. Fifteen fingers obtained a satisfactory result; one was a failure when the rod protruded through the skin. Two patients required a third surgical procedure: one a tenolysis at the superficialis-profundus junction, the other reattachment of the graft distally.

Hand Infections in Patients With Diabetes Mellitus

Fifty diabetic patients with hand infections were studied retrospectively. The cause of infection varied, and the infections were divided into two groups: superficial infections and abscesses. The amputation rate was 14%. Only patients who presented with an abscess required amputation, and of those patients with abscesses, 17.5% required amputation. Eighteen of 38 cultured infections were polymicrobial, 4 contained Enterococcus, 11 contained gram-negative bacteria, and 3 contained anaerobic organisms. Bacteriologic culture analysis initiated a two-drug protocol: ampicillin with sulbactam (Unasyn; Pfizer, New York, NY) or piperacillin with tazobactam (Zosyn; Lederle, Pearl River, NY) and gentamicin (renal adjusted).

CHEMONUCLEOLYSIS VS LAMINECTOMY

Three hundred and nine patients having herniated nucleus pulposus syndrome were treated by chemonucleolysis with chymopapain. We analyzed the results of that treatment in the first 100 patients who had been followed up for two years. No significant allergic reactions, deaths, spinal cord injury or paralysis occurred. One patient had pulmonary embolus and another had a disk space infection. Diskitis did not occur. Of the 100 patients receiving chymopapain, 71% of the results were rated good to excellent; of those in a comparably followed-up group of 100 patients who underwent surgery, 63% of the results were rated good to excellent. The end result was achieved more quickly after chemonucleolysis and with less physiologic stress on the patient. The beneficial result was considered to be long lasting, and in our opinion, the quality of the end result was superior after chemonucleolysis.

Posteromedial Elbow Approach for Treatment of Olecranon and Coronoid Fractures

This article illustrates the posteromedial elbow approach to address both coronoid and olecranon ulnar fractures. Olecranon and coronoid fractures were simulated in 6 cadaveric elbows. The osteotomies were made with a percutaneously placed osteotome through the olecranon fossa and the elbow joint. To expose these osteotomies, each elbow underwent a posterior midline skin incision, medial skin flap elevation, anterior transposition of the ulnar nerve, and subperiosteal elevation of the ulnar arm of the flexor carpi ulnaris. Fracture fixation was performed with posteriorly placed plates and screws. Each procedure was documented using radiographs and digital photography. The 6 procedures illustrated a surgical approach that is expedient in exposing the olecranon, medial elbow joint, and medial coronoid wall. All osteotomies were anatomically reduced and internally fixed in this setting. This technique allowed supine positioning of the cadaver and the use of an arm table for radiographic imaging in the lateral and anteroposterior planes. The direct visualization of both the coronoid and olecranon fracture facilitated anatomic reduction using standard surgical techniques. This technique also preserved the pronator attachment to the humerus, transposed the ulna nerve, and reapproximated the flexor carpi ulnaris fascia.

Chymopapain in perspective.

Three hundred fifty-nine patients with herniated nucleus pulposus syndrome were treated by chemonucleolysis with chymopapain. Good to excellent results were achieved in 71% with a minimum of six months follow-up observation. In a group followed for an average of ten years, the result was favorable in 86.6%; 58% of all patients injected had a good to excellent long-term result. Disc space narrowing averaged 2 mm, with no adverse effect on the result. Firm conclusions about the cause of failure of chemonucleolysis could not be drawn. Injection at two levels was recommended when a single offending level could not be identified. There were no cases of anaphylaxis with a premedication regimen of dexamethasone, diphenhydramine, and cimetidine. The procedure was safe and the results were reproducible.

Dural Puncture Using the Lateral Approach for Chemonucleolysis

The lateral approach for chemonucleolysis was developed to avoid dural puncture, which occurs with midline and posterolateral approaches. It is important to check for dural punctures during the procedure. If the dura is penetrated, a potential pathway is created for chymopapain to enter the subarachnoid space. Large doses of intrathecal chymopapaln are highly toxic and small doses show a variable response. Because of the potential disastrous complications associated with intrathecal chymopapain, the chymopapain injection is contraindicated in the presence of a dural leak.

The effect of local hematoma blocks on early fracture healing.

To test the effects of lidocaine and bupivacaine on early fracture healing, the tensile strength of five groups of femora from normal rats 14 and 35 days after production of a closed diaphyseal fracture were compared. Data indicate that, in experimental animals injected with local anesthetics at the fracture site, no measurable difference is noted in callus composition, tensile strength, or histological appearance during the early phases of fracture repair prior to callus remodeling.