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Based on the
assumption that capsular strain is uniform, the data implies that dorsal
capsular elongation is over 4 times that of the volar for a
given amount of distraction. This means the volar capsule will
pull out to length more readily than the dorsal, and explains why
distraction alone will not restore the normal distal radial tilt
when using ligamentotaxis to reduce distal radius fractures.
Radiographs of a specimen loaded to failure showed failure in a
radiolunate pattern, with the lunate maintaining a normal
relationship with the distal radius. This implies that
distraction, even to failure, will not completely reduce "die
punch" fractures of the distal radial articular surface. (Abstract)
Orthopaedic Transactions, Volume 17, Number 2, p. 355 and p. 1064;
1993. Original manuscript only.
"Severe
Fractures of the Distal Radius: Effect of Amount and Duration of
External Fixator Distraction on Outcome." FA
Kaempffe, MD, DR Wheeler, MD, CA Peimer, MD, KS Hvisdak, MS, J Ceravolo,
MD, J Senall, BA.
Although severe intra-articular fractures of the distal radius are
often treated with external fixation/distraction, little attention has
been devoted to the amount and duration of fixator distraction required
to maximize outcome. To determine these effects, we conducted a
retrospective study of 26 patients whose primary treatment was external
fixation/distraction. Patients were evaluated by chart review,
questionnaire, x-ray films, and physical examination an average of 104
weeks after injury. The carpal height index was used to quantify
distraction. Scores for pain, function, wrist motion and grip strength
and the total score were adversely affected in proportion to the
increase in carpal height index by distraction. Outcome was adversely
affected as the duration of distraction increased. Motion scores were
affected most. Overall, patients recovered at least 75% of motion and
grip strength, and 85% attained New York Orthopaedic Hospital Grades of
good or excellent. These are the first data to show that there are
potential adverse effects from increasing amounts of distraction and
prolonged use of the external fixator. Journal of Hand Surgery,
Volume 18A, Number 1, pp. 33-41; January, 1993.
"Clinical
and Hemodynamic Sequelae of Lower-Extremity, Deep Vein Thombosis After
Total Joint Arthroplasty." FA
Kaempffe, MD, RM Lifeso, MD, K Phillips, BSN, K Hvisdak, MS, C Carrier,
BA.
To determine the long-term sequelae of lower extremity deep vein
thrombosis (DVT) after total hip or knee arthroplasty, 25 patients with
venographically proven lower-extremity DVT were studied. A study group
of 16 patients was available 14 months postoperatively. The results of
clinical and hemodynamic evaluation were compared to those of a randomly
selected group of patients who had negative venographic findings after
total joint arthroplasty. There were no statistically significant
differences in calf pain or swelling between the two groups. The
presence of venous varicosities and pigmentation were unreliable
indicators of the postthrombotic syndrome. There were no statistically
significant differences in vein patency, valve competency, and venous
recovery times. There was a high incidence of hemodynamic abnormalities
in the historically uninvolved extremity of patients with postoperative
DVT. Orthopaedic Review, Volume 21, Number 2, pp. 212-219; February,
1992.
"Open
Reduction and Internal Fixation of Acetabular Fractures: Heterotopic
Ossification and Other Complications of Treatment." FA
Kaempffe, MD, LB Bone, MD, JR Border, MD.
Open reduction and internal fixation was performed on 50 displaced
acetabular fractures in 49 patients by nine different attending surgeons
over a 10-year period. At an average follow-up of 38 months, poor
results were noted clinically in 38% and radiographically in 40%. The
incidence of short- and long-term complications was greater than in
other studies. Particularly distressing was the 58% incidence of
heterotopic ossification (HO). Twenty-four percent had grade III or IV;
five hips were autofused and the remainder had 40-60% loss of motion.
There was no correlation of HO with age, sex, fracture type, degree of
comminution, associated femoral head fracture of dislocation, delay to
surgery, or operative time. However, 26 of 28 patients who had a
trochanteric osteotomy as part of the operative exposure developed HO.
Other complications included wound infection (12%), avascular necrosis
of the femoral head (10%), nerve palsy (8%), and deep vein
thrombosis/pulmonary embolism (8%). The data suggest formulation of
specific treatment protocols, an awareness of surgical risks, and staff
specialization may reduce complications and improve outcome. Avoiding a
trochanteric osteotomy at surgery and using prophylactic postoperative
irradiation or indomethacin are suggested to reduce HO. Journal of
Orthopaedic Trauma, Volume 5, Number 4, pp. 439-445; 1991.
"Intermittant
Pneumatic Compression Versus Coumadin. Prevention of Deep Vein
Thrombosis in Lower Extremity Total Joint Arthroplasty." FA
Kaempffe, MD, RM Lifeso, MD, Craig Meinking, RPA.
One hundred forty-none consecutive patients requiring lower
extremity total joint arthroplasty were randomized to either coumadin
(52 patients) or intermittant pneumatic compression (48 patients) as
prophylaxis against deep vein thrombosis (DVT). Forty-nine patients were
excluded. When full ambulatory, the presence of absence of DVT was
diagnosed by ascending venography (90% of patients), nuclear venography,
venous dopplers, or impedance plethysmography. The two groups were
similar in age (64 years), indications for arthroplasty (pain because of
arthritis in 90%), gender (98% male), and average number of risk factors
(2.4). Twenty-five percent of patients on coumadin and 25% of patients
on intermittant pneumatic compression (IPC) developed DVT. IPC was more
effective than coumadin following primary total hip arthroplasties (THAs)
(16% versus 24% incidence of DVT); coumadin was more effective than IPC
following primary total knee arthroplasties (TKA’s) (19% versus 32%
incidence of DVT). DVT developed in 36% of patients undergoing revision
arthroplasty. Seventy-five percent of all thombi were proximal. Both IPC
and coumadin were found to be safe; there was no increased perioperative
bleeding in the coumadin group. Of three postoperative deaths, one was
possibly due to pulmonary embolism. Clinical Orthopaedics and Related
Research, Volume 269, pp. 89-97; August, 1991.
"Quick
Fixation of Skin Grafts." FA
Kaempffe, MD, Clayton Peimer, MD.
Rigid fixation of a skin graft to its recipient bed is an essential
step in achieving survival during the first week until vascularization
and union are relatively adequate. Numbers of techniques and
modification of the original British "stent" have been
described. We have found that all are not uniformly predictable nor
simple; this led us to search for a method that would be rapidly precise
and effective for most circumstances. Journal of Hand Surgery, Volume
16, Number 4, pp. 761-762; July, 1991.
"Traction
Assembly for Shoulder Arthroscopy." FA
Kaempffe, MD.
Arthroscopy of the shoulder is facilitated by applying traction to
the affected extremity. A sturdy, easily constructed, and versatile
traction assembly is described. Orthopaedic Review, Volume 19, Number
8, pp. 725-728; August, 1990.
"Distraction
for Wrist Arthroscopy." FA
Kaempffe, MD, Clayton Peimer, MD.
Arthroscopy of the wrist is valuable and becoming more frequent and
accepted for diagnosis and treatment of pathologic conditions of joints.
Current literature advocates wrist distraction using fingertip traction
distally and sling countertraction around the arm, which helps stabilize
the extremity and facilitates visualization of the joint. The process of
traction set-up can be cumbersome, awkward, and inefficient; we have
modified the technique for speed and dependability. Journal of Hand
Surgery, Volume 15A, Number 3, pp. 520-521; May, 1990.
"Skin
Surface Temperature Reduction after Cryotherapy to a Casted
Extremity." FA
Kaempffe, MD.
Cryotherapy is widely used as standard therapy in the initial management
of acute musculoskeletal injuries. Early and more complete recovery in
certain acute soft tissue injuries is accomplished through a reduction
in inflammation, edema, hematoma formation and pain. The effectiveness
of cryotherapy in acutely casted extremities is unknown. This single
subject study demonstrates that a reduction in skin surface temperature
occurs after the application of cryotherapy to a casted upper extremity.
Conventional short arm plaster and fiberglass casts were fabricated. A
series of trials was performed for each in which cold gel packs were
applied to the dorsal surface of the cast for 60 minutes. The cast and
skin surface temperatures were then recorded at intervals. In both
models, a reduction of 3.5 deg. C was recorded at the skin surface after
application of cryotherapy. In the former, however, the reduction was
noted sooner and lasted longer. Cryotherapy may be of benefit in
reducing the temperature and therefore the inflammation, edema, hematoma
formation, and pain in certain casted acute upper extremity injuries. Journal
of Orthopaedic and Sports Physical Therapy, Volume 10, Number 11, pp.
448-450; May, 1989.
"An
Unusual Intra-Articular Ganglion of the Knee with Interosseous
Extension." FA
Kaempffe, MD, Charles D’Amato, MD.
A ganglion cyst is a soft mass that is surrounded by a dense
connective tissue capsule. Although ganglion cysts are rarely found
around the knee, they have been reported in association with the joint
capsule of the knee of the menisci and close to the peroneal tendons. We
are reporting the case of a patient in whom an intra-articular ganglion
cyst of the knee apparently arose from the posterior cruciate ligament
and involved the lateral aspect of the medial femoral condyle. Journal
of Bone and Joint Surgery, Volume 71A, Number 5, pp. 773-775; June,
1989.
"Pseudarthrosis
of the Radius after Fracture Through Normal Bone in a Child Who Had
Neurofibromatosis." FA
Kaempffe, MD, Robert Gillespie, MD.
Scoliosis, disorders of bone growth, and pseudarthrosis are the most
common skeletal manifestations of neurofibromatosis. Pseudarthrosis of
the radius or ulna, or both, are rare. In most reports, the
pseudarthroses are present at birth or they were the result of
pathologic fracture. We report the rare case of a child who had
neurofibromatosis and a pseudarthrosis of the radius after fracture
through radiographically normal bone. Journal of Bone and Joint
Surgery, Volume 71A, Number 9, pp. 1419-1421; October, 1989.
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