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Biomedical subjects

A Alho

Publications and source records attributed to A Alho.

At least 37 records · Page 2Linked to original sources
PubMed1996

A locked hip screw-intramedullary nail (cephalomedullary nail) for the treatment of fractures of the proximal part of the femur combined with fractures of the femoral shaft.

Twenty-seven patients with complex femoral fractures (combined shaft and proximal femoral fractures) were treated with a modified Grosse-Kempf slotted locking nail (cephalomedullary nail), wherein two screws were inserted in the hip. Four types of complex, multifocal femoral fractures were represented in the series. Eleven of the femoral shaft fractures were secondary to a previous, internally fixed, not yet united hip fracture (type I). Ten comminuted peritrochanteric fractures occurred in normal bone (type II). Three similar fractures were pathologic because of metastasis. Two patients had an ipsilateral fracture of the femoral shaft and the trochanteric area (type III), and one of the shaft and the femoral neck (type IV). Locking was made static in 24 cases. Additional cerclage wiring was used in three type II fractures. Five complications were as follows: one cutting out of a screw in the femoral head, two fractures of the nail, one deep venous thrombosis, and one wound hematoma. Reoperations were two salvage operations using a new nail and one evacuation of hematoma. One patient with multiple injuries and four elderly patients died within 2 months. Eighteen patients with fractures in normal bone were followed for a median of 20 (6 to 37) months. All fractures united. Two nails were removed. The end result was excellent in ten patients, good in seven, and fair in one (2-cm shortening and 20-degree external rotation). We conclude that a locked intramedullary construct with locking screws in femoral neck and distal femur controls a complex fracture situation well.

Adult↗
PubMed1996

Experimental telemedicine in orthopaedics.

There have so far been few telemedical applications in orthopaedics. This experiment involved clinicians in three different locations, two in Helsinki and the third in Tampere, consulting one another simultaneously. We used an ATM network to transfer X-ray pictures, digitized by a 12-bit CCD scanner and archived in a central image server. The consultations between the clinicians and the examination of the patient were transmitted by a videoconferencing system using the ISDN. We found that telemedicine offers new possibilities in orthopaedics, for clinical work, for training and for research.

Finland↗
PubMed1996

Concurrent ipsilateral fractures of the hip and femoral shaft: a meta-analysis of 659 cases.

659 cases of concurrent, ipsilateral fractures in the hip and femoral shaft reported in 59 studies were analyzed. The causes were a road traffic accident in 78% and other types of high-energy traumas in 13% of the patients. This injury combination was rare in children. The median age was 34 years. 78% of the patients were men. One-third had multiple injuries, one-half had injuries of the ipsilateral knee and one-half had other lower limb injuries. The femoral neck fractures were most often basilar and the reported rate of avascular necrosis was 3%. The trochanteric fractures were intertrochanteric transverse, and seldom comminuted. The important factors in reducing morbidity were an early diagnosis of all injuries and efficient treatment of the shaft fractures. Locked intramedullary nails yielded results which were superior to combinations of plates or unlocked nails and separate hip screws. Reconstruction nails (cephalomedullary nails) gave results equal to those of customary locked nails and separate hip screws. The rate of healing of the hip fracture was over 99%, the treatment of the shaft fracture being of main importance for the outcome.

Adolescent↗
PubMed1996

Primary and secondary Charnley-Hastings hemiarthroplasty in displaced femoral neck fractures and their sequelae.

298 women and 36 men, median age 80 (range 40-95) years with 340 femoral neck fractures were treated with Charnley-Hastings hemiarthroplasty and followed for 41 (range 12-86) months. 107 replacements were primary because of poor reduction and 233 were secondary, performed during 60 months after the injury because of disturbed fracture healing. The results of primary and secondary replacements regarding morbidity, mortality, prosthesis failure and survival were similar. The major postoperative complications were: early wound infection (10 cases, 2.9%), dislocation of the prosthesis (16 cases, 4.7%), fracture of femoral shaft (nine cases, 2.7%), and loosening of components with reoperation (six cases, 1.8%). In total 33 reoperations (9.7%) were performed. When failure of the prosthesis was defined as dislocation, fracture or removal of part or whole prosthesis, the three-year and six-year survival rates were 89 and 80%, respectively. Defining the failure as removal of prosthesis component(s) only, the success rates were 96 and 94%, respectively. We conclude that cemented bipolar prosthesis offers a good alternative for salvage of displaced or failed femoral neck fracture.

Adult↗
PubMed1995

Pairwise strength relationships of cortical and cancellous bone in human femur: an autopsy study.

To analyze the mechanical properties of cortical and cancellous bone in the femur and relate them to bone mineral, we retrieved 14 pairs of femurs from elderly subjects at autopsy. Bone mineral was measured by quantitative single-energy computed tomography. Significant associations were found between two types of cortical bone mechanical tests, three-point bending and pull-out of screw, one performed on the right and the other on the left femur. Similarly, pairwise associations were found between the mechanical tests of cancellous bone, punch and cube compression, one performed on the right and the other on the left femur. Also, all mechanical tests correlated with bone mineral as determined by quantitative single-energy computed tomography. In general, bone mass measures correlated better with bone strength than did bone density measures. However, the cortical and cancellous bone mechanical properties were not interrelated, which suggests a separate regulation of the strength of these two types of bone. Bone mineral may not only have importance for the occurrence of fractures; it should be considered as an important factor in the fixation of fragile bone.

Aged↗
PubMed1995

Bending strength of the femur in relation to non-invasive bone mineral assessment.

To analyze the importance of bone mineral for the strength of the distal diaphyseal femur, we studied 14 distal cadaver femora by quantitative computed tomography, (QCT) dual energy X-ray (DXA) absorptiometry and three-point bending. The femora were retrieved at autopsy from 10 male and 4 female donors aged median 74 yr (range 59-92 yr). Significant correlations were found between three bone mineral mass related parameters--QCT bone mass (density x slice area), DXA mineral density (BMD) and content (BMC)--and mechanical parameters. Second area moment equivalents correlated significantly with the mechanical properties of the distal femur. QCT density did not show the same high correlations. The results indicate that the structural strength of diaphyseal bone is determined more by its geometry than mineral density. Assessment of bone mass by QCT or DXA may become important not only for assessment of fracture risk but also for planning of internal fixation in the treatment of osteporotic fractures. Further studies are required to investigate the clinical importance of these observations.

Absorptiometry, Photon↗
PubMed1995

The repair of a ruptured deltoid ligament is not necessary in ankle fractures.

We randomised 50 patients with ankle fractures of Weber types B and C and a ruptured deltoid ligament treated by open reduction and internal fixation to two treatment groups to examine the influence of the repair of a ruptured deltoid ligament. No differences were found except for a longer duration of surgery in the repair group. Our findings suggest that a ruptured deltoid ligament can be left unexplored without any effect either on early mobilisation or on the long-term result.

Adolescent↗
PubMed1994

Aneuploidy in benign tumors and nonneoplastic lesions of musculoskeletal tissues.

BACKGROUND: Aneuploidy in DNA flow cytometry (FCM) of musculoskeletal tumors is generally considered to be a sign of malignancy. Previously, giant cell tumor of the bone has been reported to contain aneuploid (near-diploid) DNA stemlines. Otherwise, only spordic cases have been reported. The authors wanted to study the relationships among DNA FCM, histology, and clinical course of nonmalignant musculoskeletal lesions. METHODS: Twenty-eight histologically benign tumors and seven nonneoplastic lesions were subjected to DNA FCM: After tissue preparation mechanically and with ribonuclease and trypsin, the isolated nuclei were stained with propidium iodine using chicken and rainbow trout erythrocytes as controls. In the DNA FCM histograms, ploidy and cell cycle fractions were determined using a computerized mathematical model. The histologic diagnoses were made without knowledge of the DNA FCM results. RESULTS: Aneuploidy was found in eight lesions. A shoulder in the diploid peak, suggesting a diploid and a near-diploid population, was found in DNA histograms of a condensing osteitis of the clavicle (a benign inflammatory process) and of a giant cell tumor of bone. The latter lesion also had a tetraploid population. Six benign tumors--two enchondromas, one osteochondroma, one subcutaneous and one intramuscular lipoma, and a calcifying aponeurotic fibroma--showed clear aneuploidy with separate peaks. The S-phase fraction was less than 10% in all cases. The highest aneuploid population, DNA index = 1.70, in a subcutaneous lipoma, was small, with an undetectable S phase. Despite nonradical operations in seven lesions, no recurrences were observed during a median follow-up of 49 months (range, 28-73 months). CONCLUSIONS: Small aneuploid populations with low DNA synthetic activity may be compatible with a benign histologic picture and uneventful clinical course of the musculoskeletal lesion.

Adolescent↗
PubMed1994

Retention of distal femoral osteotomy fixed with a AO condylar plate and Grosse-Kempf locked nail in relation to bone mineral in cadavers.

On the basis of previous studies showing good correlations between the structural strength of the femur and bone mass as assessed by single energy quantitative computed tomography, this study was scheduled to analyze the mode of failure of an oblique osteotomy in the distal femur in geriatric cadavers stabilized by an AO condylar plate and Grosse-Kempf locked intramedullary nail in axial eccentric loads and to relate the mode of failure to bone mineral content. A pilot study of two pairs of osteotomized, internally fixed femora were loaded axially and the loads correlated with bone mineral content. These correlations were used to calculate estimated failure load in 12 pairs of osteotomized femora (12 plated and 12 nailed specimens) which then were sustained to a cyclic eccentric axial load of 50% of the estimated failure load. The failure patterns in the two groups were different. Fixation failure occurred in all specimens in the plated group at the site of the osteotomy, while in the nailed group the fixation failures in 50% of the specimens were unrelated to the site of the osteotomy. The study suggests that locked intramedullary nailing of a distal femoral fracture in osteoporotic bone gives more secure fracture retention than fixation with a 95 degrees AO/ASIF condylar plate. Furthermore, it shows that bone mineral assessment by densitometric methods can be used to predict the mechanical strength of a bone/implant construct.

Aged↗
PubMed1994

Implant/bone constructs in femoral neck osteotomy. An autopsy study.

Previous studies have suggested that three rather than two screws may give better results in the treatment of femoral neck fractures. In the present study, the strength of various screw/bone constructs in femoral neck osteotomy was analyzed. Transverse osteotomies on 65 cadaver femora were fixed with two or three screws of two types: one with a shank diameter of 6 mm and thread diameter of 8 mm, and a prototype screw with equal shank and thread diameter of 7 mm. The femoral heads were subjected to static and cyclic loads in the one-legged stance position. Single-energy quantitative computed tomography measurements were correlated to load. The two experimental models resulted in different patterns of failure of the bone/implant constructs, otherwise the results were similar. Three of the prototype screws gave the strongest construct, while two of the other screw type were stronger than three. The explanations for the diverging properties of the different bone/implant constructs may be that large threads destroy too much of the bone trabeculae, and that screw threads larger than the shank may destroy the drill canal and produce an unstable situation compared with screws with equal shank and thread diameter.

Adult↗
PubMed1994

Operative treatment as a part of the comprehensive care for patients with injuries of the thoracolumbar spine. A review.

In a total appraisal, the advantages and drawbacks of operative decompression and stabilisation of the injured thoracolumbar spine should be evaluated in the treatment of a paraplegic patient and of a patient without neural damage. Operative treatment may be advantageous independent of its effect on the neural damage. Only a few studies allow direct comparison between operative and conservative treatment. Some studies are only of historical value. Today, a general operative policy is to use Harrington rods in the thoracic spine. For injuries caudal to the 9th thoracic vertebra and for those with injuries in the lumbar spine, internal fixators with transpedicular screws are used. Anterior decompression and stabilisation are also warranted in some cases. New implants are continuously being developed, e.g. implants which combine the advantages of hooks and pedicular screws. No study shows conclusively that operative treatment improves the neurological status compared with conservative care. Conservative and operative treatment may both have particular complications. It appears that neurological deterioration is more likely to occur after conservative treatment, while complications related to wound healing and from the implants burden the operative alternative. Mobilisation is quicker and easier after operative treatment, improving psychological and social rehabilitation. Also, these patients experience less in the way of chronic back pain. A high level of expertise is required for operative treatment and this illustrates the general need for the centralisation of the treatment of these relatively rare and severe injuries.

Humans↗
PubMed1994

Ruptured pectoralis major tendon. A case report on delayed repair with muscle advancement.

A total rupture at the humeral insertion of the pectoralis major tendon was repaired 3 months after the injury by sutures through 3 pairs of drill holes in the crest of the greater tubercle. To unload the sutures and to facilitate early mobilization, the muscle was advanced by fascial detachment in the medial-inferior origin of the muscle. Full mobility was achieved in 1 month and full activity was allowed 1 month later.

Adult↗
PubMed1994

Gamma nail vs compression screw for trochanteric femoral fractures. 15 reoperations in a prospective, randomized study of 378 patients.

A total of 378 trochanteric and subtrochanteric femoral fractures were randomized to treatment with Gamma nail (177) or Hip Compression Screw (HCS) (201). After a median follow-up time of 17 (10-27) months, 15 patients needed reoperations; 13 had been treated with Gamma nail and 2 with HCS. 10 patients, all treated with Gamma nail, were reoperated because of a femoral shaft fracture. 5 of these fractures occurred 8 (4-10) days postoperatively and were related to intraoperative complications. The other 5 shaft fractures occurred a median of 2 (1-3) months postoperatively after falls, and may be related to stress concentration at the tip of the solid nail. The lag screw cut out or penetrated the femoral head in 5 patients, 3 of them treated with Gamma nail and 2 with HCS.

Aged↗