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Biomedical subjects

F T Ballmer

Publications and source records attributed to F T Ballmer.

32 records · Page 2Linked to original sources
PubMed1990

[Alternative treatment methods in complex fractures and fracture-dislocations of the anterior tarsus].

Obtaining and maintaining an anatomic reduction are the keystones in the treatment of severe midtarsal injuries to avoid long-term disability. The use of the small external fixator or the minidistractor allows an indirect reduction with careful management of the soft tissues. By leaving the external fixation for at least 8 weeks the important length of the medial and lateral longitudinal arch can be maintained. Further advantages are the postoperative observation of the soft tissues and circulation without cast immobilisation.

Adult↗
PubMed1990

Pauwels osteotomy for nonunions of the femoral neck.

The concept of the Pauwels osteotomy seems to be a valuable method of treating nonunions of the femoral neck. If there is concomitant avascular necrosis, the involved area should be small and the patient younger than 60 years old.

Adolescent↗
PubMed1990

[Multiple recurrence of tibial fracture].

After a historical review of the term refracture and the related nomenclature, three cases of multiple refracture of the tibia are presented. Radiological findings confirm that the major etiology in refracture is bone necrosis as a result of vascular damage caused by the initial trauma and/or the surgical maneuvers performed to treat it. Normal loads then lead to microfractures of the avascular bone, which is unable to provide adequate substitution or remodelling. In our three cases not only was the periosteal blood supply diminished, but also the medullary canal was narrowed or closed at the fracture site by bone fragments and/or poorly vascularized new bone formation. These pathogenetic findings are supported by experimental studies. Part of the logical therapeutic concept is the opening of the medullary canal and closed medullary nailing. Although reaming and intramedullary rod placement causes transient circulatory disturbances in the inner diaphyseal cortex, this allows restoration of the medullary vascular network. Bone perfusion of the refracture zone is thereby improved and definitive consolidation can take place, as shown in our three cases.

Adult↗
PubMed1989

[Hanggliding accidents. Distribution of injuries and accident analysis].

Paragliding--a relatively new sport to Switzerland--brought 23 patients with 48 injuries (38% lower limb and 29% spinal) within a period of 8 months to the Inselspital University hospital in Berne. The aim of the study in characterizing these injuries is to formulate some guidelines towards prevention. With over 90% of accidents occurring at either take off or landing, emphasis on better training for the beginner is proposed with strict guidelines for the more experienced pilot flying in unfavourable conditions.

Accidents, Aviation↗
PubMed1989

Proximal tibial osteotomy. A new fixation device.

A new internal fixation device was applied to 41 proximal tibial osteotomies to ensure against loss of postoperative correction. An oblique osteotomy was stabilized by two screws and a five-hole one-half tubular plate. Thirty-six patients with 41 proximal tibial osteotomies were reviewed for an average roentgenographic follow-up time of 22.6 months (range, six to 48 months) with no loss of correction. In addition, 16 patients with 19 osteotomies and a minimum clinical follow-up time of two years were reviewed using the Hospital for Special Surgery knee scoring system; these early results demonstrated a similar outcome to previously published series. The new fixation device is simple to use, permits early postoperative motion, and maintains the exact correction obtained at the time of surgery.

Arthritis↗
PubMed1987

[Hepatic portal tumor--today].

Hilar cholangiocarcinoma is relatively rare. Typically it spreads locally, the main manifestation being painless jaundice. Exact preoperative staging includes sonography or CT scan, cholangiography, angiography and aspiration cytology. This assessment should delineate the tumor extent and provide an excellent index of tumors which are clearly unresectable. Therapy has two objectives: firstly, if possible, to eliminate the tumor, and secondly, to restore bile flow. Resection of hilar cholangiocarcinoma can be accomplished in some 20% of cases with a 30 day hospital mortality close to zero for local excision and of approximately 10% for hepatic resections. The median time resected patients remain alive is 24 months, and the 5 year survival rate of resected patients is 12%. The mortality rate for palliative relief of biliary obstruction by any method in hilar cholangiocarcinoma is reported at 16-30%. Survival after intubation averages only 3 to 6 months and for surgical bypass about 8 months.

Adenoma, Bile Duct↗
PubMed1987

Extracorporeal isolated pig liver perfusion: influence of various blood primes on liver function.

Extracorporeal isolated pig liver perfusion was performed in three groups of five piglets each to assess the influence of different blood primes on liver function. All prime volumes were hemodiluted to a hematocrit of 0.3-0.35 and adjusted to a pH of 7.35-7.45 with sodium bicarbonate at a temperature of 38 degrees C. Fresh slaughterhouse blood was collected, mechanically filtered and used in Group A, whereas analogously collected blood was biologically filtered by passage through the organism of the piglet in Group B. In Group C, the priming blood consisted of autologous blood gained during hepatectomy by a special technique. A high potassium concentration (10.4 +/- 0.94 mmol/l) in Group A and impurities of the slaughterhouse blood in both Groups A and B led to rapid edema formation and an increase in vascular resistance of the perfused liver, and a prolonged perfusion was not achieved. In the third group, however, liver perfusion over a period of 5 h without any deterioration of liver function was possible. Beside liver function tests, oxygen consumption, the macroscopic aspect and bile flow of the liver seemed to be the most reliable parameters in assessing the function of the isolated perfused pig liver. Our technique to gain autologous blood can be recommended not only for extracorporeal liver perfusion but also for any other extracorporeal isolated organ perfusion.

Animals↗
PubMedDate not supplied

Lag signs in the diagnosis of rotator cuff rupture.

We assessed the relative value of lag signs for the evaluation of rotator cuff rupture in a prospective study of 100 consecutive painful shoulders with impingement syndrome, stages 1 to 3. Lag signs were compared with the Jobe and lift-off signs. Three tests were designed to assess the main components of the rotator cuff: the external rotation lag sign (ERLS) for the supraspinatus and the infraspinatus tendons, the drop sign for the infraspinatus, and the internal rotation lag sign (IRLS) for the subscapularis tendon. For assessment of the supraspinatus and infraspinatus the ERLS was less sensitive but more specific than the jobe sign. The drop sign was the least sensitive but was as specific as the ERLS. Partial ruptures of the supraspinatus remained concealed to the ERLS. For assessment of the subscapularis the IRLS was as specific but more sensitive than the lift-off sign. Partial ruptures of the subscapularis tendon could be missed by the lift-off sign but were detected by the IRLS. The magnitude of the lag correlated with the size of the rupture for both the ERLS and the IRLS. Clinical testing for lag signs was efficient, reproducible, and reliable. In patients with little or no restriction of motion it enhanced the accuracy of clinical diagnosis in rotator cuff lesions.

Adolescent↗
PubMedDate not supplied

Decortication and plate osteosynthesis for nonunion of the clavicle.

Between 1968 and 1995, 37 patients with ununited fractures of the clavicle were treated by decortication and plate osteosynthesis. Thirty-two (86%) were failures of union of fractures of the middle third. Thirty-four (92%) patients had post-traumatic nonunion or delayed union. Sixteen (43%) patients had undergone primary operative treatment. Autogenous cancellous bone graft was used in 24 (65%) patients with atrophic nonunion. Nine tricortical, iliac crest, intercalary grafts were used for segmental bone loss equal to or greater than 15 mm. At the end of treatment, union had been achieved in 35 (95%) cases. At a mean follow-up of 8.6 years (range 13 months to 17 years), 32 (86%) patients had no symptoms and had a full range of motion of the shoulder. Decortication with plate osteosynthesis is a reliable, durable technique for the management of symptomatic, ununited fractures of the clavicle.

Adolescent↗
PubMedDate not supplied

Transacromial approach to obtain fusion of unstable os acromiale.

The purpose of this study was to identify possible causes for the low union rate for surgically stabilized os acromiale. Between February 1990 and November 1995, fusion of an os acromiale was attempted in 15 shoulders in 12 patients at our institution. All patients were men. The mean age was 54 years (range 37 to 63 years). All shoulders had an os mesoacromiale considered too large for simple resection. An associated lesion of the rotator cuff ranging from partial-to full-thickness tear was present in all patients. Eleven had an unfused acromial epiphysis in both shoulders. Two different surgical approaches were used. Seven shoulders were approached through an anterior deltoid-off approach, thus potentially devascularizing the os acromiale. Eight shoulders were approached transacromially, preserving the deltoid origin and hence the terminal branches of the thoracoacromial artery. The technique of internal fixation (tension band wiring) was the same for both groups. The mean follow-up was 44 months (range 13 to 72 months). Union, as demonstrated by axial radiographic views, occurred in 3 out of 7 cases with a devascularized os acromiale and in 7 out of 8 shoulders with a perfused os acromiale (P = .017), respectively. Patients with a united os acromiale had a significantly better functional outcome as measured by the Constant score (P = .0169). In conclusion, aiming at a stable fusion of a sizable and hypermobile os acromiale is probably desirable because it enhances the overall functional result. Obtaining consolidation was possible when the vascularity of the acromial epiphysis was respected.

Acromion↗
PubMedDate not supplied

The deltoid extension lag sign for diagnosis and grading of axillary nerve palsy.

The deltoid extension lag sign has been developed to avoid the pitfalls confounding the diagnosis of an axillary nerve lesion. The physician elevates the arm into a position of near full extension. The patient is asked to attempt active maintenance of this position. If the deltoid is weak, the arm will drop. In five patients with traumatic axillary nerve palsy after anterior dislocation of the shoulder, the deltoid extension lag sign was used to evaluate the functional status of the deltoid muscle. The magnitude of the angular drop, or lag, of the arm was a precise indicator of the functional status and recovery of the deltoid. The sign proved to be objective and reproducible, allowing confident assessment of deltoid function and when repeated over time allowed precise follow-up of deltoid recovery.

Adolescent↗
PubMedDate not supplied

Surgical landmarks to determine humeral head retrotorsion for hemiarthroplasty in fractures.

Malrotation has been suggested as a cause of failure of hemiarthroplasty of the proximal humerus. Placing a shoulder prosthesis in relationship to the bicipital groove might reproduce individual anatomy more reliably than using a standardized retrotorsion. The purpose of this study was to determine criteria for accurate adjustment of retrotorsion even when the proximal bicipital groove is destroyed, as is the case in fractures. The distance of the humeral head equatorial plane to the center of the bicipital groove was measured by high-resolution computed tomography at 4 levels (proximal and distal with 2 intermediate levels). The distal distance was considered to correspond to available references in fracture cases. The mean proximal distance was 8.0 mm (10th percentile, 6.2 mm; 90th percentile, 9.8 mm), and the mean distal distance was 8.5 mm (10th percentile, 7.1 mm; 90th percentile, 9.9 mm). As to the clinical relevance, there was no statistically significant difference between distances. For practical purposes in fracture indications, it is adequate to adjust the retrotorsion of the prosthetic component to the distal bicipital groove.

Arthroplasty↗
PubMedDate not supplied

Treatment of tibial plateau fractures with small fragment internal fixation: a preliminary report.

OBJECTIVE: To evaluate the use of small fragment implants for fractures of the proximal tibia. DESIGN: Retrospective. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Seventeen patients with AO Classification Type B and C fractures of the proximal tibia. Two patients were lost to follow-up. INTERVENTION: After atraumatic dissection and open reduction, fracture stabilization was accomplished with the use of the AO/ASIF small T-plate (3.5-millimeter system). In two patients a medial uniplanar external fixator was applied as additional fixation. In six patients a cancellous autograft was performed. MAIN OUTCOME MEASUREMENTS: At an average follow-up of forty-two months (range, 24 to 75 months), all patients were evaluated radiographically and functionally. The incidence of local complications was specifically recorded. RESULTS: Postoperatively, the radiographs showed 86.7 percent anatomic or near anatomic reduction with respect to the articular joint surface. In three separate patients condylar widening, condylar narrowing or varus deformity was evident. In one patient, a minimal secondary displacement of less than two millimeters was observed before bony healing. All fractures healed within twelve weeks. At the latest follow-up, there were 53.3 percent excellent, 33.3 percent good, and 13.3 percent fair results. There were no infection or soft tissue complications. CONCLUSIONS: The use of small fragment implants combined with atraumatic soft tissue dissection potentially offers good results for the treatment of fractures of the proximal tibia. These initial results suggest that this technique may have the advantage of anatomic reduction while comparing favorably with less invasive methods regarding radiologic and functional outcome as well as incidence of complications.

Adolescent↗