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Biomedical subjects

D L Fernandez

Publications and source records attributed to D L Fernandez.

At least 37 records · Page 2Linked to original sources
PubMed1997

Fixation methods in contaminated wounds and massive crush injuries of the forearm.

This article presents a critical review of the current literature on the stabilization methods of severe open fractures or crush injuries of the forearm. Due to the complexity of the problem, the advantages and disadvantages of the different fixation methods are presented in order to provide the reader with a combination of possibilities for timing and decision-making when confronted with such fractures in clinical practice.

Bone Transplantation↗
PubMed1996

Distal radioulnar joint injuries associated with fractures of the distal radius.

The most common cause of residual wrist disability after fractures of the distal radius is the distal radioulnar joint. The 3 basic conditions that produce radioulnar pain and limitation of forearm rotation are instability, joint incongruency, and ulnocarpal abutment. The last 2 entities initiate irreversible cartilage damage that eventually leads to degenerative joint disease. Early recognition and management in the acute stage aim at the anatomic reconstruction of the distal radioulnar joint including bone, joint surfaces, and ligaments in an effort to reduce the incidence of painful sequelae and functional deficit. This article provides a description and the treatment options of the distal radioulnar joint lesions that occur in association with fractures of the distal radius, and the results obtained with open and arthroscopic techniques. Both acute and chronic disorders are analyzed, and a prognostic and treatment oriented classification is presented Furthermore, the pathoanatomy and management of chronic distal radioulnar joint derangement after fracture of the distal radius are reviewed briefly.

Adult↗
PubMed1996

Operative treatment of volar intra-articular fractures of the distal end of the radius.

We retrospectively reviewed the results of operative treatment of forty-nine volar marginal intra-articular fractures of the distal end of the radius. According to the Comprehensive Classification of Fractures, there were two B3.1 fractures (characterized by a small volar fragment, with the sigmoid notch intact), three B3.2 fractures (characterized by a large volar fragment that included the sigmoid notch), and forty-four B3.3 fractures (characterized by comminution of the volar fragment). Although all fractures healed and only nine patients had evidence of osteoarthrosis on follow-up radiographs, there were six early and fourteen late complications, some of which adversely influenced the over-all outcome. After an average of fifty-one months (range, twenty-four to 117 months), there were thirty-one excellent, ten good, and eight fair results according to the system described by Gartland and Werley, and thirty-two excellent, nine good, five fair, and three poor results according to the modified system of Green and O'Brien. Two factors were found to have a significant association with a fair or poor outcome: evidence of osteoarthrosis on the most recent follow-up radiographs and reversal of the normal volar tilt of the distal end of the radius. The age of the patient, the interval from the injury to the operation, a concomitant injury of the ipsilateral upper extremity, an associated fracture of the ulnar styloid process, the radio-ulnar index, ulnar angulation, the classification of the fracture, comminution of the volar fragment, and articular incongruity were not significantly associated with the outcome.

Adolescent↗
PubMed1996

Acute and chronic changes in luteinizing hormone secretion and postpartum interval to estrus in first-calf suckled beef cows exposed continuously or intermittently to mature bulls.

The objective of this study was to determine whether patterns of LH secretion are acutely or chronically affected by the presence of mature bulls in postpartum first-calf suckled beef cows exposed to bulls either continuously or intermittently beginning on d 30 after birth. Crossbred cows were assigned randomly to be either continuously exposed to (BE; n = 20) or isolated from bulls (NE; n = 32) at calving, or exposed continuously (NEBE; n = 10) or intermittently (BEI; n = 21) to bulls beginning on d 30. The BEI cows were exposed to bulls for 2 h every 3rd d for 18 d. Ten cows from the NEBE, BEI, and NE treatments only were fitted with indwelling jugular catheters. Intensive blood sampling of NEBE and BEI cows began within 45 min after they were placed with bulls for 2 h on d 30, and for BEI cows on each d after 2 h exposure. Samples were collected at 15-min intervals for 6 h beginning on d 30 for NEBE, BEI, and NE cows; sampling continued at 3-d intervals until d 48. Samples were assayed for LH by RIA. Cows were observed twice daily (am:pm) for estrus. More (P = .07) BE and NEBE (75%) cows showed estrus by the end of the study than BEI and NE cows (48%). Interval to estrus was longer (P < .05) in BEI and NE cows (95.6 +/- 6.1 d) than in BE and NEBE cows (75.9 +/- 6.1 d). Baseline LH and amplitude and interpeak interval of LH peaks during the first 6 h after 2 h of bull exposure did not differ (P > .10) among treatments on d 30 after birth. However, mean LH and LH pulse frequency were higher (P = .06) for NEBE and BEI cows than in NE cows. Baseline LH and amplitude and duration of LH peaks did not differ (P > .10) over the seven sampling periods among NEBE, BEI, or NE cows. Mean LH and LH pulse frequency were higher (P < .05) in NEBE and BEI cows than in NE cows on each sampling period. Exposing first-calf suckled beef cows to bulls on d 30 after birth increased mean LH concentrations by increasing pulse frequency within a short period after a 2-h exposure. Thereafter, mean LH concentrations were higher in cows that were either continuously or intermittently exposed to bulls. Although mean LH and LH pulse frequency in NEBE and BEI cows were similar, intervals to estrus after bull exposure differed between treatments. The mechanism whereby bulls alter postpartum interval to estrus seems to involve other factors that may be related to but not directly linked with LH secretion.

Animals↗
PubMed1995

Uncemented total wrist arthroplasty.

We report our experience with a non-cemented wrist implant we developed in 1986. Between 1986 and 1991, 50 prostheses were implanted in 45 patients, 33 with rheumatoid arthritis and 12 with traumatic arthritis. After an average of 4.5 years (range, 2-6 years), we evaluated pain, daily activities, motion, grip strength, and x-ray films. The results were excellent in 24 wrists, good in 12, fair in 5, and poor in 8.

Adult↗
PubMed1995

Non-union of the scaphoid. Revascularization of the proximal pole with implantation of a vascular bundle and bone-grafting.

Eleven patients who had an ununited fracture of the scaphoid associated with loss of the blood supply to the proximal fragment were managed operatively with a combination of an inlay corticocancellous bone graft from the iliac crest and implantation of the second dorsal intermetacarpal artery, its accompanying venae comitantes, and a thin cuff of perivascular tissue. The absence of the blood supply to the proximal pole was evidenced both by radiographic changes--which included increased bone density, absence of normal trabeculae, and cystic changes--and by failure to observe bleeding bone during the operation. There were ten men and one woman. The average duration of non-union was fourteen months (range, six to thirty-three months). Six patients had had previous unsuccessful operative attempts to obtain union. Eight non-unions were in the proximal one-third and three, at the waist of the scaphoid. Union was achieved in ten patients at an average of ten weeks postoperatively. According to the wrist-scoring system of the Mayo Clinic, at an average of five years (range, 2.5 to eleven years), three patients had a grade of excellent; three, good; three, fair; and two, poor. Four patients had subsequent reconstructive procedures; radial styloidectomy, styloidectomy and resection of osteophytes, radioscapholunate arthrodesis, and total wrist arthrodesis were performed in one patient each.

Adult↗
PubMed1994

[Complex distal radius fracture: value of spongiosa-plasty in combination with external fixator treatment].

22 Patients with complex fracture of the distal radius (Fernandez III/Frykman VII-VIII/AO 23.C) underwent treatment with external fixation and auxiliary autologous bone grafting in purpose to reconstruct and stabilize the radiocarpal articular surface, reset the radius length, obtain a quicker bone healing and avoid secondary radius shortening after removing of the external fixation. In spite of reassessment of radius length in 80% and reconstruction of the radiocarpal articular surface in 75%, late control showed the development of radiological signs of radiocarpal arthritis. 50% of the patients have a moderate loss of strength and motility in the wrist; this seems to be a good result for a very negative selection of complex fractures of distal radius. We recommend autologous bone grafting in treatment of complex fractures of the distal radius with external fixation.

Adult↗
PubMed1993

[Monteggia injury in childhood: a frequent cause of chronic dislocation of the head of the radius].

Two cases of chronic dislocation of the radial head after Monteggia lesions in children are described. The late reconstruction with open reduction of the radial head combined with osteotomy of the ulna is mentioned as the therapy of choice before skeletal maturity, because the pathophysiology of the lesion is best considered. The operative procedure in detail is given. Finally, alternative procedures are presented and discussed.

Child↗
PubMed1993

[Giant cell tumor--an unusual cause of pathologic fracture of the femoral neck].

The uncommon giant cell tumors of bone are generally benign but locally aggressive with tendency for local recurrence. They are located in the epimetaphysis of the long bones, predominantly in the distal femur, proximal tibia and distal radius; the location in the proximal femur is very rare. Because of their location and the high local recurrence, therapy, mainly of the rare pathological fractures, is difficult and controversial. We are presenting a well documented case with joint salvage and good outcome.

Adult↗
PubMed1993

Combined percutaneous and "minimal" internal fixation for displaced articular fractures of the calcaneus.

Forty-one displaced intraarticular fractures of the calcaneus in 38 patients were treated with open reduction and screw fixation of the posterior facet, bone grafting, and percutaneous pinning of the body. A single extensile posterolateral approach was used in all but two cases in which an additional medial incision was needed. Using early functional aftercare, all fractures healed without secondary displacement in an average of eight weeks. Follow-up periods averaged 4.2 years. Results were graded as excellent in 14 patients, good in 16, fair in three, and poor in five. There was a strict correlation between the clinical results and the severity of the articular comminution. A satisfactory outcome depended on the restoration of articular congruency and extraarticular alignment of the os calcis.

Adolescent↗
PubMed1993

Reconstructive procedures for malunion and traumatic arthritis.

Despite the fact that surgical management of fractures of the distal radius has become more aggressive, leading to substantial improvement of anatomic results, malunion and post-traumatic arthritis remain the two most common complications following conservative treatment. Techniques, operations, and salvage procedures are discussed in this article.

Arthrodesis↗
PubMed1992

[Analysis of the "user friendliness" of the AO classification of fractures].

The AO-classification of long bone fractures has been introduced as a universal system and depends mainly on morphological characteristics and fracture-location. It includes the fracture severity and outcome and should be a basis for treatment. To evaluate the AO-classification in the "daily use", we were interested if this system is really userfriendly, where the problems of coding occur and which is the agreement in different codings of several surgeons in relation to segment, type, group and subgroup. 58 fractures were classified, totally we got 456 classifications. The agreement in relation to segment was 95%, to type 79%, to group 63% and to the subgroup only 45%. Endsegment-fractures had a better agreement than shaft fractures. Common mistakes are discussed and some "user-guidelines" are given.

Documentation↗
PubMed1992

[Combined "percutaneous and minimal" osteosynthesis for dislocated intra-articular calcaneus fractures].

41 displaced intraarticular fractures of the calcaneus were treated with open reduction, limited internal screw fixation, bone grafting and percutaneous pinning, using an extensile postero-lateral approach. Despite early functional after treatment all fractures healed without secondary displacement in an average time of 8 weeks. At follow-up (average 4.2 years) there was a strict correlation between the clinical results and the severity of articular comminution. A satisfactory outcome seems to depend on the ability to restore the best possible articular congruency and extra-articular alignment of the os calcis. Results and advantages of our method are discussed.

Adolescent↗
PubMed1991

Treatment of displaced articular fractures of the radius.

Forty patients with articular fractures of the distal radius in which anatomic reduction of the joint surface could not be obtained by closed manipulation or by ligamentotaxis with external fixators had a combination of percutaneous and/or open reduction techniques to restore articular congruity. X-ray films taken after treatment with an average follow-up of 4 years showed satisfactory extraarticular alignment in 85% of the cases, and 37 (92.5%) patients demonstrated an articular step-off of 1 mm or less at late follow-up examination. Radiographic evidence of radiocarpal arthritis was present in 5% of the cases at follow-up examination.

Adolescent↗
PubMed1991

Percutaneous and limited open reduction of the articular surface of the distal radius.

Between 1979 and 1986, 40 patients with intraarticular fractures of the distal radius, in which anatomic reduction could not be obtained by closed manipulation or external fixation, underwent a combination of percutaneous and/or limited open reduction techniques to restore articular congruity. All 40 patients' radiographs that were retrospectively reviewed with an average follow-up of 4 years showed satisfactory extraarticular alignment in 85% of cases, and 37 patients (92.5%) demonstrated an articular step-off of less than or equal to 1 mm. Thirty-one patients retrieved for follow-up had a good functional result. The treatment goals of intraarticular fractures of the distal radius are anatomic restoration of the joint surface and optimal fixation to maintain reduction in an effort to prevent posttraumatic arthrosis of the wrist.

Adolescent↗
PubMed1990

Anterior interosseous nerve palsy complicating a forearm fracture in a child.

An anterior interosseous nerve palsy occurring as a complication of a closed both bone forearm fracture in a child is presented. Surgical exploration showed that a bone spike from the proximal fragment was perforating the median nerve. The fractured radius was reduced and inspection of the nerve under the microscope showed no fasicular disruption. Complete motor recovery occurred in 4 months and sensibility had fully returned at 10 months after the operation.

Child↗