Musculoskeletal surgery in eighteenth century America.

Surgeons in America in the eighteenth century treated wounds, fractures, dislocations, and gunshot injuries of the skeletal structures and also contended with osteomyelitis and tuberculosis of bones and joints. In meeting this challenge, they proved innovative, adaptive and courageous, and developed principles of surgery, some of which still are in use today.

Tibial nonunion treated with direct current, capacitive coupling, or bone graft.

Two hundred seventy-one tibial nonunions of average duration of 23.5 months (range, 9-69 months) were treated with direct current (167 patients), capacitive coupled electrical stimulation (56 patients), or bone graft surgery (48 patients). Logistic regression analysis was used to compare heal rates among the 3 treatment methods, to identify risk factors adversely affecting the heal rate, and to predict the probability of successful healing of a nonunion of any given risk profile treated with each of the 3 forms of therapy.

A prospective assessment of nutritional status and complications in patients with fractures of the hip.

A group of 40 consecutive patients with hip fractures were studied and confirmed to have a high incidence of protein-calorie malnutrition. The prospective nutritional assessment performed for this study included: serum albumin, serum transferrin, anthropometric measurements, skin testing for delayed hypersensitivity, total lymphocyte count, and a 24-h urine collection for metabolic and nitrogen balance determinations. At 3 months after their hip fracture, 37.

The effects of demineralized bone matrix and direct current on an "in vivo" culture of bone marrow cells.

Bone marrow cells (BMCs) from rabbit femora and tibiae were grown in diffusion chambers implanted in rabbit muscle. At 42 days 80% of the BMC chambers exhibited cartilage formation within them. Demineralized bone matrix added to the marrow cell suspension in the chamber accelerated the appearance and increased the number of chambers with cartilage.

Bipolar femoral endoprosthesis: a study correlating component movement with clinical outcome.

Fifty-five bipolar femoral hemiarthroplasties performed between January 1979 and February 1986 were reviewed to correlate component movement with clinical outcome. Fourteen of these patients were examined clinically using the Harris Hip Score and radiographically by the method of Drinker and Murray to determine the per cent of total motion in abduction present at the inner bearing surface. The average followup was 19.

Changes in bioelectric potentials on bone associated with direct current stimulation of osteogenesis.

This study was designed to determine whether changes occur in the bioelectric potentials on bone during and after bone stimulation with a 20-microA direct current (DC) and whether the variations in bioelectric potentials are related to the variations in bone formation. The bioelectric potentials were recorded at different times on the rabbit distal tibial surface, during (current-on state) and after (current-off state) DC stimulation with a cathode implanted within the medullary canal. The new bone formed at the end of the experiment was quantitated and related to the bioelectric potentials recorded at current-on and current-off states, respectively.

Temporal course of bone formation in response to constant direct current stimulation.

Reactive, post-traumatic bone formation in response to intramedullary insertion of a polytetrafluorethylene-coated, 28 gauge stainless steel wire was compared with the sequential bone formation seen in response to an identical intramedullary stainless steel cathode delivering 20 microA constant direct current. Animals were studied at days 1, 2, 3, 4, 5, 7, 9, 11, 14, 17, and 21 after wire insertion. Point count analysis revealed progressive bone formation beginning as early as day 3 on the constant direct current-stimulated side, progressing steadily through day 21.

Electrical osteogenesis by low direct current.

A constant direct current cathode was employed in the medullary canal of the rabbit tibia to investigate electrical osteogenesis at low current levels. Currents of 0.015 or 0.

Electrically induced osteogenesis: relationship between charge, current density, and the amount of bone formed: introduction of a new cathode concept.

A study was performed exploring the relationship between charge, current density, and the amount of new bone formed in the medullary canal of the intact rabbit tibia. The results indicate that the amount of bone formed in the vicinity of a cathode is directly related to both current density and charge. Utilizing stainless steel cathodes delivering a constant current of 20 muamps, the optimum current density was found to be 1.

A multicenter study of the treatment of non-union with constant direct current.

A clinical study was initiated at the University of Pennsylvania in 1970 to evaluate the use of constant direct current in treating acquired non-union. In 1977 the study was expanded to include twelve participating investigators throughout the United States. The results indicate that, given proper electrical parameters and proper cast immobilization, a rate of bone union comparable to that seen with bone-graft surgery was achieved.

Treatment of nonunion with constant direct current.

Laboratory experiments show the following relationships between electricity and bone: (1) stressed bone exhibits electronegativity in areas of compression, (2) living, nonstressed bone exhibits electronegativity in areas of bone growth and healing, and (3) the application of low magnitude direct current to bone induces osteogenesis at the negative electrode or cathode. Based on the above principles, a clinical study was performed in which 10-20 microamperes of constant direct current was used in treating nonunion in 57 patients. The results suggest that specific electrical parameters are required for successful osteogenic stimulation in patients.

A study of radiographic variations of the hip joint.

Anteroposterior radiographs of the pelvis were studied in 920 patients free of hip joint diseases. The average joint space was between 3 and 4 mm in width. Narrowing of the superior joint space was seen in 13 percent of the hips and may represent the earliest finding in osteoarthritis.

Direct-current stimulation of non-union and congenital pseudarthrosis. Exploration of its clinical application.

Based on the response of bone to electrical current in previous studies, an exploratory clinical study of the effect of electrical current on non-union and congenital pseudarthrosis was performed. Constant direct current of ten to twenty microamperes was applied to twenty-four non-unions and five congenital pseudarthroses. Complete union occurred in fifteen non-unions and in one congenital pseudarthrosis.

Cathodic oxygen consumption and electrically induced osteogenesis.

Small amounts of electric current stimulate bone formation in the region of a cathode. The purpose of this experiment is to compare changes in oxygen and hydroxyl ion concentration that occur at the cathode at current levels known to be capable of inducing osteogenesis (10-20 muamps) with those changes that occur at current levels known to be toxic to bone (100 muamps). An oxygen consumption chamber containing an oxygen electrode is fitted with two stainless steel electrodes which are connected to a constant current source.