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Biomedical subjects

G Walch

Publications and source records attributed to G Walch.

At least 55 records · Page 3Linked to original sources
PubMed1993

[Results of endoscopic treatment of non-broken tendinopathies of the rotator cuff. 2. Calcifications of the rotator cuff].

The authors studied the results of the arthroscopic treatment of the chronic calcifying tendinitis within a multi-center study of the French Society of Arthroscopy. 112 patients were available for the study. All shoulders had a preoperative radiographic clinical and radiographic evaluation. At follow up, functional results were assessed, using the Constant score, and X rays allowed to appreciate the acromial shape and the calcific deposit aspect. Several arthroscopic procedures were used on the calcification (respect or removal), and the coracoacromial arch (respect, ACL release or acromioplasty). This study found an objective success rate of 89 per cent and a patient subjective satisfaction rate of 82 per cent. Based on follow up radiographs, 88 per cent of the patients had a complete disappearance of the calcific deposit. There were no recurrence, no secondary rotator cuff tear. The results were not correlated with the age of the patients, or with the radiographic aspect (type, size, localization) of the calcification. The results were correlated with the arthroscopic procedure: they were better when the calcification had been removed (superior to deposit respect). Associated acromioplasty gave no better results: it was only considered as necessary when the calcification was not found (12 per cent). The greatest care must be taken in the surgical indication for this pathology because of a high rate of spontaneous resorption. The authors conclude that the arthroscopic surgery is a very effective method for chronic calcific tendinitis, compared to open procedure.

Adult↗
PubMed1993

[Comminuted open tibial fracture. An alternative treatment method].

The treatment of comminuted fracture of the tibia is one of the problem cases in operative fracture care. In our department we favour stabilization with the aid of interlocking nails, providing absolute fixation of the interlocking screw is possible. The patient is positioned on the Maquet table, and the fracture of the tibia is temporarily reduced by the Goetze percutaneous cerclage wiring technique. The special feature of our method is that we remove the wires after nailing. In this way the advantages of both techniques, anatomical reduction with cerclage wires and the stability and possibility of early mobilization afforded by interlocking nailing are combined. Poor blood flow in the periosteum is avoided by the immediate removal of the wires.

Fibula↗
PubMed1993

[Postero-superior glenoid impingement. Another impingement of the shoulder].

An impingement occurring between the deep side of the supraspinatus tendon and the postero-superior edge of the glenoid cavity was evidenced in a young sports thrower presenting with a partial tear of the deep side of the tendon. This impingement occurred when the arm was in abduction-retropulsion and in forced lateral rotation. It was visualized on arthroscopy. The semiology was mixed, including signs of anterior instability and cuff impairment. The possible causes of partial tears of the deep side of the supraspinatus are discussed: sub-acromial impingement of NEER, anterior instability with secondary impingement, postero-superior glenoid impingement.

Adult↗
PubMed1992

[Radio-cinematographic study of active elevation of the prosthetic shoulder].

In order to verify whether it is possible to reproduce the physiologic anterior elevation of the shoulder with a non constrained Neer type prosthesis, the authors have examined the dynamic comportement of 21 total shoulder arthroplasties. Recording of anterior active elevation with video-fluoroscopy and evaluation glenohumeral motion and scapulothoracic motion allowed to distinguish 3 types of biomechanics after total shoulder replacement. A first group of prosthesis (4 cases) had normal biomechanics with conservation of a normal scapulohumeral rythm. This concerned arthroplasties performed for necrosis or osteoarthritis with no cuff tear or loose bone stock and no technical error. A second group of prosthesis (10 cases) had an abnormal biomechanics. There was a superior excursion of the humeral head prosthesis without real glenohumeral motion. A more severe pathology (cuff tear arthropathy, rheumatoid arthritis, old traumas) with bone and/or muscular destruction was sufficient to explain this elevation possible only because of the scapulothoracic motion. Finally, there was a third group of prosthesis (7 cases) which had a reversed scapulohumeral rythm: there was less motion between the prosthetic components but the scapulothoracic motion was unchanged. Three factors can be responsible for this reversed scapulohumeral rythm: 1) The initial pathology, because of the difference in the cuff trophicity. 2) The surgical technic because of the difficulties to respect the position of the joint line and the lever arms. 3) The prosthesis itself, because of the higher degree of conformity and stability between the prosthetic components.

Adult↗
PubMed1992

[Surgical treatment of rotator cuff rupture. Prognostic factors].

A retrospective study of 67 total ruptures of the rotator cuff operated on was carried on, with an average follow-up of 25 months. The lesions were characterised by their size (19 tears of less than 2 cm, 30 between 2 and 4 cm, 18 over 4 cm) and location (27 tears of the supraspinatus, 15 tears of the supraspinatus extending to the front (coraco-humeral, long biceps, subscapular), 20 supra and infra-spinatus, 5 "massive" tears). The tendon of the long biceps was pathological in half of the cases. Fourteen patients presented with a subacromial osteoarthritis. All patients benefited from a decompression and repair of the rupture. Whereas the subjective results indicate 92 per cent satisfied patients, from the objective point of view the average score with Constant's rating was 62.5 pts with 53 per cent favorable results. Evaluation of force was a particular subject of attention: the results obtained with three charts were compared; the conclusion was in favour of an objective measurement using a dynamometer but with a weighting according to age and sex. The characteristics of the tear (location especially), the state of the long biceps, the presence of a subacromial osteoarthritis and the pre-operative mobility affected statistically and significantly the final result. The authors reserve reconstructive surgery for tears without osteoarthritis, isolated lesions of the supraspinatus having the best prognosis. The existence of a subacromial osteoarthritis, always a sign of a massive tear, in elderly patients should lead one to choose a procedure a minima under arthroscopy.

Adult↗
PubMed1991

Focal myositis: a pseudotumoral form of polymyositis.

The authors report a case of pseudotumoral focal myositis found in a 55 year-old man, in the anteroexternal area of the right leg. The diagnosis was based on the pathological findings, the absence of any further clinical signs or laboratory findings, and no further development over time. They compare their patient's characteristics with cases found in the literature (24 cases during the past 20 years). Diagnostic certainty confirms the benign character of this pathology, which contrasts with the gravity of the classical form of polymyositis.

Electromyography↗
PubMed1991

[Interlocking nailing of compound lower leg fractures].

Seventy-eight patients with lower leg fractures treated by interlocking nailing at the hospital in Schwaz were reviewed. The overall results were satisfying. There were nine misalignements, two of which underwent subsequent correction. Two infections took place, one after precipitant bone grafting at another place and another one following new trauma. Seven first and five second degree open fractures had an uneventful healing. Interlocking nailing was found to be the treatment of choice for compound fractures with open or closed soft tissue injury of first or second degree after Tscherne. Compared with a previous study about ski injuries, complex fracture patterns combined with severe closed soft tissue lesions showed an increasing incidence during the last ten years. This contrast with the decreasing number of ski injuries in general.

Adult↗
PubMed1991

[2 roentgen projections for the subacromial space before and following acromioplasty. Results of a study series of 40 patients].

It is suggested that two radiological projections of the scapula, an AP view and a lateral (tunnel) view, be obtained in order to estimate the form and size of the acromion before and after acromioplasty. In order to evaluate the standardized films precisely, a film must have been taken for comparison before the surgery. As the method described is easily reproducible, it can be used to evaluate the effect of an acromioplasty irrespective of whether the procedure was an open or an arthroscopic one. The radiological results can be correlated with the functional results at the beginning of rehabilitation and at the end of this period. More sophisticated studies might require a more elaborate X-ray technique than the one proposed in this article.

Acromion↗
PubMed1991

[Postero-superior glenoid impingement. Another shoulder impingement].

An impingement occurring between the deep side of the supraspinatus tendon and the posterosuperior edge of the glenoid cavity was evidenced in a young sports thrower presenting with a partial tear of the deep side of the tendon. This impingement occurred when the arm was in abduction-retropulsion and in forced lateral rotation. It was visualized on arthroscopy. The semiology was mixed, including signs of anterior instability and cuff impairment. The possible causes of partial tears of the deep side of the supraspinatus are discussed: sub-acromial impingement of NEER, anterior instability with secondary impingement, postero-superior glenoid impingement.

Adult↗
PubMed1991

[Surgical treatment of painful shoulders caused by lesions of the rotator cuff and biceps, treatment as a function of lesions. Reflections on the Neer's concept].

On the basis of their clinical and surgical experience of 480 shoulders operated upon for rotator cuff pathology, together with a review of the literature, the authors undertake a critical analysis of the Neer impingement syndrome. Since this syndrome cannot explain all lesions and above all cover all rotator cuff pathology, they suggest an anatomical classification based upon a description of lesions. They describe their indications for surgery on the basis of their results and of those from the literature.

Calcinosis↗
PubMed1990

[Clinical examination of the traumatized shoulder].

In emergencies clinical examination and straight radiography are enough to make a diagnosis and indicate the kind of treatment required. When radiography gives normal results, slight and brief immobilization prevents the occurrence of retractile capsulitis. A second clinical examination, performed a fortnight later, provides a better evaluation of the severity of soft tissue lesions.

Fracture Fixation, Internal↗
PubMed1990

[Traumatic acromio-clavicular pathology].

Based on clinical and radiological findings, four types of acromioclavicular disjunction are described. Stage I and II require nothing more than orthopaedic appliances, whereas surgery is mandatory in stage IV. Treatment of stage III disjunctions varies from on school of orthopaedists to the other. Fractures of the lateral third of the clavicle may lead to diagnostic errors, and tomography is justified at the slightest doubt concerning the integrity of the acromial end of that bone.

Acromioclavicular Joint↗
PubMed1990

An anatomical and radiological study of the femoropatellar articulation.

An analytical study was made of 30 knees by dissection, 200 by conventional radiology, 120 by CT scans, and of 2,400 pathological knees by conventional radiology, and 900 by CT. The radiological and scanning methods most used for a study of the femoropatellar articulation are described and the normal values of each feature determined by a computer study. The femoral trochlea and its shape are very important for the stability of the patella. The normal and pathological types of trochlea are described. This study established a number of anatomical factors which influence patellar stability, and form a basis for proposing the correction of anatomical anomalies in the treatment of instability of the joint.

Fascia↗
PubMed1990

[Dysplasia of the femoral trochlea].

Dysplasia of the trochlea was studied on a strict profile image of the knee. 1305 radiographs were analysed corresponding to several patello-femoral conditions (major and subjective patello-femoral osteoarthritis) and to control subjects. Two criteria are defined: the depth and the eminence of the trochlea. The depth was often minimal in instabilities that give a radiological characteristic image of intersection between the trochlear end line and the lateral condyle. This picture had a great diagnostic value for patellar instability. The eminence represented the owerhang of the trochlear end line in relation to the anterior cortex of the femur. By measuring it, it was possible to establish a statistically significant variability of the degree of instability on one hand, between instabilities, patellar syndromes and controles on the other hand. The intersection sign and the trochlear eminence in isolated patello-femoral osteoarthritis allows the direct filiation between dysplasia of the trochlea and osteoarthritis to be confirmed. Taking into account the size of the eminence, the hollowing out type trochleoplasties appears more fiable than raising of the lateral edge.

Bone Diseases, Developmental↗
PubMed1990

[Idiopathic high patella in adolescents. Apropos of 61 surgical cases].

The patellar height was measured according to the index of Caton and Deschamps. The normal index equals 1, the patella considered as being high with an index of 1.2 or greater. The authors reviewed 50 patients presenting with such an anomaly in patellar height to verify whether this patella alta said to be idiopathic was simply a radiographic sign or represented a true anatomic and clinical entity. 61 knees were hence operated on between 1963 and 1988, 50% of which had a lowering of the tibial tuberosity. In 8 cases, the lowering was performed secondarily, after a failure of the first operation to correct the anomaly. The mean pre-operative index of patellar height was 1.34 and the trochlea appeared indisputably dysplastic in 50 of the 61 cases. The mean age at the time of surgery was 17 years. Medial translation of the tibial tuberosity averaged 9.5 mm and the lowering 7 mm allowing a normalization of the patellar index. 76.8% of patients had a perfect post-operative stability, evaluated as a score of 8 or 9 on the ARPEGE scale. At the completion of this study it appeared that patella alta is rarely an isolated finding and is most often part of a regional patello-femoral dysplasia. Its existence, when responsible for a functional problem, must absolutely be taken into account and treated to obtain a satisfactory result.

Adolescent↗
PubMed1990

[Bilateral congenital absence of the anterior cruciate ligament and the internal menisci of the knee. A case report].

Bilateral congenital absence of the anterior cruciate ligament associated with the absence of the medial meniscus is reported in a 34-year-old-woman. The simultaneous absence may be explained by a common embryological mesenchymal origin of the anterior cruciate ligament and the menisci. This absence was at the origin of an abnormal development of the condyles and especially of the tibial epiphysis which was tipped over in flexum. Treatment consisted of a central ligamentous plasty associated with a lateral plasty, a medial plasty and a closing anterior tibial osteotomy. The result was good.

Adult↗