Search PubMed⌕ Search

Biomedical subjects

D Fritschy

Publications and source records attributed to D Fritschy.

46 records · Page 3Linked to original sources
PubMedDate not supplied

The axial view to measure posterior laxity of the knee. A mathematical analysis.

Posterior laxity of the knee can be assessed clinically, but interpretation of the amount of displacement is highly subjective. Mechanical methods are more efficacious for measuring anterior laxity. Radiologic techniques are available for measurement in a lateral projection, but some variables may interfere with their accuracy. We undertook a trigonometric analysis of the axial view to confirm that it can be used to reliably measure posterior displacement. The ideal radiologic conditions consist of 80 degrees of knee flexion in both knees maintained with a knee support and a 26 degrees x-ray beam incidence with respect to the tibia. Although such accuracy is rarely obtained in routine clinical practice, even with a variability of +/- 10 degrees in the x-ray beam incidence the error factor will be less than 10%. Such a degree of error is in the same range (+/- 2 mm) as noted by investigators using the lateral radiograph to measure anteroposterior displacement. We believe that our study validates the use of a single axial radiograph of both knees to assess the state of the posterior cruciate ligament of an injured knee as compared with a normal knee.

Arthrography↗
PubMedDate not supplied

Skiers' lower leg shaft fracture. Outcome in 91 cases treated conservatively with Sarmiento's brace.

We report our experience using Sarmiento's method for the conservative treatment of 91 consecutive fractures of the lower leg. The mean age of the patients in our series was 34 years. One patient had an open fracture. All of the patients were followed and were evaluated clinically and radiographically 6 to 12 months after injury. After a period of immobilization by traditional methods (traction/long leg cast), the Sarmiento brace was applied at a mean of 42 days, allowing early weightbearing and mobilization. The brace was removed at a mean of 90 days. Clinical results were excellent; there was minimal persistence of knee or ankle limitation; 84% of the patients had less than 5 mm of final shortening; 96% had less than 4 degrees of final angulation. Work was resumed at a mean of 103 days. We had one nonunion, which we treated operatively 6 months after injury by osteosynthesis and autologous bone grafting. All of the patients were asked to complete a questionnaire; 51% responded, with an average followup of 5 years (range, 1 to 10 years). These patients had been able to resume sports activity 8 months after injury; 52% were skiing 1 year after injury, and 96% were satisfied with the treatment method used. One patient complained of persistent pain.

Adolescent↗
PubMedDate not supplied

Jumper's knee and ultrasonography.

Twenty-five patients, aged between 15 and 45 years old, who were athletically active, presented with jumper's knee (patellar tendinitis). By use of ultrasonographic examination, new and precise information was obtained that benefited the diagnosis, choice of treatment, and monitoring of the evolution of jumper's knee in our patients. In 18 of the 25 patients, only 1 knee was affected; in 7 of the patients, both knees were affected, thus making a total of 32 painful tendons. These 25 patients were compared with a control group of 15 healthy, athletically active subjects between the ages of 25 and 35 years old. In all of the 32 painful tendons, ultrasonographic anomalies were observed: thickening or swelling of the tendon (15 knees) appeared in acute cases; a heterogeneous structure of the tendon (24 knees); and thickening and irregularities of the tendinous envelope (8 knees). The 15 acute patients all responded to classic conservative treatment including physical therapy and electrotherapy. Four of the remaining 10 patients were treated successfully with various conservative treatments, including deep transverse friction massage with ice. The other six patients were treated surgically, with tenolysis and "carding" of the patellar tendon. In one patient, this procedure failed, and 12 months later a second operation was performed, in which the distal pole of the patella was resected and the patellar tendon reinserted into bone. Recovery was uneventful. Now, at least 2 years after treatment, all of the patients consider themselves healed.

Adolescent↗
PubMedDate not supplied

An unusual ankle injury in top skiers.

Although skiers' feet are immobilized in extremely rigid boots, ligamentous lesions of the ankle may occur, especially in world class slalom skiers. The lesion arises when a sudden external rotation of the ankle causes the talus to press against the fibula and thus open the distal tibiofibular articulation. This study reports on a group of 10 skiers recruited between 1975 and 1986. These are professional skiers participating in World Cup races. Three patients underwent an operation for lesion of the tibiofibular syndesmosis, while the other seven were treated conservatively. All were able to resume their previous level of competition and only one skier later complained of painful instability in distal tibiofibular joint.

Adolescent↗
PubMedDate not supplied

Hamstrings--an anterior cruciate ligament protagonist. An in vitro study.

A cadaveric model that incorporated quadriceps and hamstrings muscle loads was developed to simulate the squat exercise. The addition of hamstrings load affected knee kinematics in two ways. First, anterior tibial translation during flexion ("femoral roll-back") was significantly reduced (P = 0.003) and second, internal tibial rotation during flexion was reduced (P = 0.008). However, quadriceps force was unaffected by the addition of hamstrings load. Thus, it seems likely that hamstrings muscle activity that has been observed in vivo during a squat probably functions synergistically with the anterior cruciate ligament to provide anterior knee stability. After the ACL was sectioned, anterior tibial translation was significantly increased during the squat (P = 0.04). The anterior cruciate ligament was then reconstructed using a graft instrumented with a load cell. During passive motion, maximal graft tension was at full extension. During simulated squat exercise, the addition of hamstrings caused a significant decrease in graft load (P = 0.006). During the squat, maximal graft tension was at full extension, and was equal to the graft tension at full passive extension. Thus, the squat exercise may be useful in the early stages of anterior cruciate ligament rehabilitation.

Aged↗
PubMedDate not supplied

Subtalar subluxation in ballet dancers.

Ankle injuries frequently occur in dancers. Among these injuries, only a few cases of talar subluxation have been reported in the literature. In our series, we diagnosed and treated 25 subtalar subluxations over a 1-year period in the Ballet Béjart Lausanne company. The subluxations occurred after a grand plie on pointes or at the landing of a jump on demi-pointes, without any mechanism of ankle sprain. The dancer usually noted a sudden and sharp pain in the talonavicular joint and hindfoot with a feeling of "forward displacement" of the foot. At palpation, the talonavicular ligament, the anterior talofibular ligament, and the posteromedial part of the subtalar joint were painful. A limitation of the ankle extension and a clear hypomobility of the subtalar joint were noted. Under the effect of shearing forces on the midtarsal joint, a posteromedial subtalar subluxation occurred. Treatment consisted of a manipulation that reduced the subluxation. Continuous taping, which locks the talonavicular joint in the anterior direction, was recommended for 6 weeks. Dancing could be resumed in a swimming pool after 2 weeks, and on the ground after 3 to 4 weeks. We found that subluxation could recur, and that it could eventually become chronic.

Adult↗
PubMedDate not supplied

[Sarmiento functional bracing of tibial fractures (author's transl)].

The functional bracing advocated by Sarmiento was used in the conservative treatment of 74 recent tibial fractures (6) adults, 13 children) and in 12 fractures with delayed union. The leg was immobilized in an Orthoplast below-the-knee functional brace with patellar tendon bearing. A flexible plastic insert fitted on the heel allowed the use of sock and shoe. Knee and ankle motion were possible and early weight-bearing was allowed. The results of this method of treatment in recent fractures was excellent since healing occured without delay and function restoration was rapid. In delayed union of tibial fractures this method gave promising results. It is the authors' opinion that Sarmiento's functional bracing is a highly satisfactory method of conservative treatment of tibial fractures.

Adolescent↗