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Biomedical subjects

D L Fernandez

Publications and source records attributed to D L Fernandez.

At least 55 records · Page 3Linked to original sources
PubMed1990

Anterior bone grafting and conventional lag screw fixation to treat scaphoid nonunions.

The results of 20 established nonunions of the scaphoid treated with resection of the pseudoarthrosis, anterior cortic-cancellous iliac bone grafting, and conventional lag screw fixation with the ASIF 2.7 mm cortical screw are presented. Union rate was 95% and the average time off work was 8.9 weeks. Review of the relevant literature uniformly shows that the most common reasons for failure are improper internal fixation techniques and/or the absence of bone grafting. Successful treatment of scaphoid nonunions with screw fixation and cast-free after-treatment does not depend on the implant used but rather on careful case selection and precise surgical technique.

Adolescent↗
PubMed1989

[Corrective interventions in malunited fractures of the distal radius].

The current indications and technique of wrist osteotomies for ununited fractures of the distal radius are presented. A three-dimensional correction at the metaphyseal level is technically feasible. This not only restores the normal orientation of the articular surface thus reestablishing normal load distribution but also the radial length up to 10 mm which is a prerequisite to prevent ulno-carpal impingement. Painful limitation of forearm rotation due to degenerative changes in the distal radioulnar joint may be treated with Bowers hemiresection arthroplasty. If the radioulnar index should be greater than 10-12 mm an additional shortening osteotomy of the ulna may become necessary. Every additional operation on the ulna should be based on the radiological comparison of the distal radioulnar joint of the opposite hand.

Bone Nails↗
PubMed1988

Radial osteotomy and Bowers arthroplasty for malunited fractures of the distal end of the radius.

Radial osteotomy and hemiresection arthroplasty was performed in fifteen patients who had malunion of a fracture of the distal end of the radius with symptoms predominantly in the radio-ulnar joint and limited rotation of the forearm. Postoperatively, all of the patients had improved rotation and stability of the distal radio-ulnar joint, as well as satisfactory relief of pain. Over-all, grip strength increased an average of 30 per cent, and every patient had substantial improvement in function. The result was very good in four patients, good in eight, and fair in three.

Adult↗
PubMed1988

Anterior approach to the knee with osteotomy of the tibial tubercle for bicondylar tibial fractures.

Eight patients--six who had a bicondylar fracture of the tibia and two who had a complex fracture-dislocation--were treated by open reduction and internal fixation that was achieved through an anterior approach to the knee. The approach included elevation of the tibial tubercle, proximal retraction of the extensor mechanism (patellar tendon, retropatellar fat pad, and patella), and transection and detachment of the anterior horn of one or both menisci. The extent of the approach depended on the specific need for exposure. The quality of reduction was better and the rate of complications was lower, compared with conventional approaches. The main advantage of this approach is that the tibial plateau and the intercondylar notch are exposed clearly and completely; this is a prerequisite for the rapid reconstruction of the joint surface and, in some patients, for the reattachment or primary suture of the cruciate ligaments. I recommend the anterior approach with osteotomy of the tibial tubercle in the treatment of patients who have a severe displaced bicondylar fracture of the proximal end of the tibia.

Adolescent↗
PubMed1987

External fixation of complex carpal dislocations: a preliminary report.

In ten cases of complex carpal fracture dislocations an external fixator between the radius and the second or third metacarpals was used as an adjunct to open reduction and internal fixation. The external fixator facilitates reduction, ligamentous repair, and internal fixation of the carpal bones. Furthermore, continuous postoperative distraction of the wrist maintains a stable reduction of the carpus permitting cast free after treatment and early active motion of the neighboring joints. This method is particularly useful for carpal stabilization when combined injuries of the same extremity coexist.

Adult↗
PubMed1984

Transarticular fracture of the calcaneus. A technical note.

A detailed description of an extensile posterolateral approach for open reduction, grafting, and internal fixation of articular calcaneal fractures is presented. The graft is obtained through the same incision from the distal tibia. Internal lag screw fixation is combined with percutaneous axial pinning. Guidelines for prophylaxis of iatrogenic soft tissue complications are briefly discussed.

Calcaneus↗
PubMed1984

A technique for anterior wedge-shaped grafts for scaphoid nonunions with carpal instability.

This article presents a brief description of the following modifications of the original Fisk procedure for navicular nonunions with carpal instability: (1) preoperative calculation of exact scaphoid length and form based on comparative roentgenograms of the opposite wrist, (2) the use of a palmar approach, (3) the insertion of a wedge-shaped corticocancellous graft from the iliac crest after resection of the pseudarthrosis, and (4) the use of internal fixation. Preoperative planning is considered essential to restore the anatomic length, analyze the angular deformity, evaluate the pathologic scapholunate angle, and calculate the resection and size of the graft needed. The palmar approach reduces the danger of iatrogenic damage of the vascular supply of the scaphoid and accidental lesions of the superficial branches of the radial nerve. Furthermore it provides a better exposure of the scapholunate joint to correct lunate rotation. Iliac bone is preferred to the radial styloid graft, as proposed by Fisk, because of its better ability to resist compression forces. Internal fixation adds rotational stability so that continued postoperative plaster immobilization can be reduced to a minimum of 8 weeks.

Adolescent↗
PubMed1984

Chiari's osteotomy. A note on technique.

Direct joint distraction of the hip facilitates the performance of Chiari's osteotomy on a standard operating table as opposed to the classic procedure on the traction table. Some useful modifications of the original technique include a guide wire to control the direction of the osteotomy, insertion of an additional bone graft to provide better anterior coverage of the head, and internal fixation of the osteotomy.

Adolescent↗
PubMed1983

External fixation of the wrist. Current indications and technique.

Based on a clinical material of over 100 cases treated between 1977 and 1982, indications and technique of external fixation of the wrist are reviewed. The basic indication is the comminuted intra-articular fracture of the distal radius. Due to the versatility of the fixateur used, indications have been extended for stabilization of complex carpal dislocations and combined injuries of the forearm and hand. Complications and pitfalls of the method are briefly discussed.

Carpal Bones↗
PubMed1982

Correction of post-traumatic wrist deformity in adults by osteotomy, bone-grafting, and internal fixation.

A corrective osteotomy for post-traumatic malalignment of the distal end of the radius was performed in twenty patients who were followed for an average of 3.6 years. The indications for correction were based on age, degree of deformity, limitation of function, pain, and appearance of the wrist. The procedure included an opening-wedge metaphyseal osteotomy combined with insertion of a graft and rigid internal fixation with a plate and screws to permit early motion. Depending on the direction of the angulation, a dorsal or volar approach was employed to guarantee a buttressing effect of the plate. The procedure gave satisfactory results when there were no degenerative changes in the radiocarpal or intercarpal joints and when the preoperative range of motion of the wrist was adequate. The results were graded as excellent in five patients, good in ten, fair in four, and poor in one.

Adult↗