J. Paul Harvey

Traumatic Dislocation of the Knee Joint: A Study Of Eighteen Cases

Eighteen traumatic dislocations of the knee treated at the Los Angeles County-University of Southern California Medical Center in recent years have been analyzed.The findings in this series differ from those in some of the studies reported in the literature. No one individual has had enough experien

Precise Evaluation of the Reduction of Severe Ankle Fractures

A method for the assessment of the accuracy of reduction in postreduction roentgenograms was developed. The final clinical results, one to 7.5 years after injury, were studied in 117 patients with 118 displaced bimalleolar or trimalleolar fractures at the ankle treated at the Los Angeles County-University of Southern California Medical Center between January 1966 and December 1970. Three variables were found to significantly affect the final clinical results: (1) the amount of talar displacement prior to reduction; (2) the type of fracture; and (3) the presence of rupture of the deltoid ligament.

Cast-brace Treatment for Fractures of the Distal Part of the Femur: A Prospective Controlled Study Of One Hundred And Fifty Patients

1. A total-contact, lower-extremity plaster device incorporating brace-joints at the knee has been described for the early ambulatory care of healing fractures in the distal part of the femur. 2. Prospective study of consecutive cases has demonstrated no non-unions or refractures in 150 patients treated with traction followed by early mobilization in a cast-brace and a mean healing time of 14.5 weeks. In a similar but smaller group of fractures treated in the traditional manner by preliminary traction and then immobilized in a spica cast, there were three non-unions, and three refractures occurred after longer periods of immobilization. 3. The factor considered most important for rapid and efficient fracture healing is an environment of function for the healing fracture. Ambulatory function is possible with an unfixed healing fracture of the distal part of the femur when appropriate total-contact support to the limb is provided.

Comparison of postoperative stump management: plaster vs. soft dressings.

A study of 182 diabetic, largely geriatric, amputees has been presented to compare three different methods of postoperative care. In random selected groups, a standard soft dressing was compared with a rigid plaster dressing and both were then compared with plaster rigid dressing with an ambulatory pylon attached. The patient population was relatively homogeneous in that they all bore the diagnosis of diabetes. When rigid dressings were applied, they were provided by prosthetists trained specifically for this method of care. The results of this study support the view that the rigid dressing and ambulation do not deter wound healing and probably are a positive factor in achieving a healed wound and a physical and mental attitude able to accept the prosthetic use. However, additional evidence supports the idea that immediate ambulation may be an early deterrent factor to healing and should be delayed for several weeks. The rate of prosthetic use in this study has been greatly improved when compared with previous experience with essentially the same type of patient population ten years ago. Two major reasons for this improvement are the more frequent use of the below-the-knee amputation and the early use of temporary, total-contact prosthetic devices.

False Aneurysm of the Femoral Artery following Total Hip Surgery

Many common surgical complications have been reported with total hip replacement surgery 2,4,9*10. Much attention has also been devoted to the pulmonary and cardiovascular responses elicited by the monomeric methylmethacrylate in the 1iquid.component of the cement The present case report is that of a mechanical complication perforation of a vessel by the methylmethacrylate polymer. The only other similar mechanical complication we were able to find in the literature is a single case report by Casagrande and Danahy, where methylmethacrylate was found to have extruded through drill holes in the acetabulum, pressing on the sciatic nerve 3. That case and our own illustrate two possible mechanical difficulties that can result from use of the cement.