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Biomedical subjects

G Walch

Publications and source records attributed to G Walch.

At least 73 records · Page 4Linked to original sources
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↗
PubMed1990

[Unreduced posterior luxations and fractures-luxations of the shoulder. Apropos of 30 cases].

Twenty-seven patients (30 shoulders) presenting with an unreduced posterior dislocation or fracture-dislocation were operated on and followed up for at least 2 years. The lesions were classified in 4 types, after Randelli: posterior dislocation with cephalic fracture inferior to 50 per cent (type I = 10 cases) or superior to 50 per cent (type II = 8 cases) and posterior fracture-dislocations with two fragments (type III = 6 cases) or several fragments (type IV = 6 cases). The first patients of the series underwent a resection of the humeral head (5 cases) or an open reduction (7 cases). During a second period 10 shoulders were reduced by a posterior approach and stabilized by transfer of the subscapularis tendon with or without the lesser tuberosity in the humeral defect 6 shoulders were reduced by an anterior approach together with derotation osteotomy. Lastly, one patient refused to be operated on and we performed a shoulder prosthesis to the last one. Necrosis of the humeral head (9 cases) appeared to be related to the severity of the lesion (type III and IV) and the type of surgical procedure (5 derotation osteotomy out of 6 and 3 open reductions out of 7) rather than to the approach route or the interval from injury to diagnosis. These results show that an anatomical repair may be attempted when the dislocation is less than 6 months old and when the impression defect involved less than 50 per cent of the articular surface. Otherwise and a fortiori in old posterior fracture-dislocations, an arthroplasty seems to be the best solution. Even if it may be clinically difficult, it offers the best chance for a functional shoulder in an active patient.

Adult↗
PubMed1989

Cerclage for torsional fractures of the tibia.

We report the technique and results of percutaneous cerclage used in treating 186 torsional fractures of the tibia, most of which were due to skiing accidents in young patients. It is recommended only for this type of fracture and has the advantages of simplicity, a low rate of complications and a relatively brief period in hospital.

Adult↗
PubMed1989

[Percutaneous Goetze cerclage in torsion fractures of the tibia. A computer-assisted follow-up of 186 cases].

186 lower leg torsional fractures treated via percutaneous cerclage wiring (Götze's method) yielded good to very good final results. There were no intraoperative complications such as lesions of the vessels and nerves. The number of refractures (1.61%), the incidence of delayed healing (4.3%), infections (3.23%) and misalignments (6.9%) are all comparable with data that can be found in the literature. No pseudoarthroses were seen. Besides low rate of complications and the rapidity of the procedure, the simplicity and low cost of the required instrumentarium are also very attractive. The fact that the patients remain in the hospital for a short while only, is yet another contribution to keeping the cost of general health care low in these times of exploding expenditure for medical attendance.

Adult↗
PubMed1989

[Radiology in femoro-patellar pathology].

For the evaluation of the femoro-patellar joint, the authors use a pure lateral view with 30 degrees flexion without weightbearing- an axial view of the patella with 30 degrees flexion- with neutral rotation- and the same view with external rotation of the foot. With these 3 X-Rays, a precise diagnosis is made possible.

Femur↗
PubMed1989

[The incidence, therapy and results of combined ankle joint and tibial shaft fractures].

Forty combined tibial shaft and ankle fractures were admitted to our Trauma Department between 1980 and 1985; these cases were followed up, and the results are presented. Using the classification scheme of Johner/Wruhs for lower-leg fractures and that of Lauge-Hansen for ankle fractures, we found 25 pronation-eversion and 14 supination-eversion lesions combined with pure spiral fractures (A1, 9 cases), spiral bending-type fractures (B1, 25 cases), comminuted spiral lesions (C1, 5 cases), and 1 crush fracture (C3). Although no fibular or ligamentous reconstruction had been done and various methods had been used, overall, the late results were good. In contrast to previous reports about this rare condition, no incongruencies at the ankle joint were found. Only 2 cases of late arthritis due to infection and/or improper reduction were seen. Nevertheless, the importance of thorough analysis of the fracture pathomechanics before treatment cannot be overemphasized. If anatomical reduction of the tibial shaft fracture does not imply congruency at the joint line, reconstruction of the fibular or ligamentous lesion should be undertaken.

Adult↗
PubMed1988

[Indications for surgical management of lower leg fractures].

A follow-up series of 324 lower leg fractures treated between 1980 and 1985 in a regional hospital showed overall good results. Besides a non-union-rate of 0% there were also low values for infection (3.7%), re-fracture (2.16%), delayed healing (4.63%) and thrombosis (3.42%). Many reasons are dealing with that. First of all, most of our patients were young, active people, who sustained their injuries during ski-accidents with a high amount of torsional-type lesions (A1, B1, C1; Johner/Wruhs-scheme). The second important point was, to use a simple, quick and safe method with the possibility of a short hospital stay and good final outcome, managing the high frequency of victims, admitting the trauma unit in the late afternoon after closure of ski-lifts. Finally, one has to realize, that most of our patients had been treated by one surgeon, who has a lot of experience with the aforementioned methods. We can state finally, that percutaneous cerclage-wires (Götzes method) will be used for spiral fractures, occurring in the second to fourthfifth, in future, too. Bending-type fractures with one or more butterfly-fragments (B2, B3) and segmental fractures (C2), should be treated by interlocking nailing. Only fractures with severe closed soft tissue injuries or open fractures (grade II-III-Tscherne), will be managed by an external frame. Compression plates should only be used for fractures in the first or fifth fifth with articular lesions.

Adult↗
PubMed1988

[Results of surgically treated chronic anterior laxities. Apropos of 251 cases reviewed with a minimum follow-up of 3 years].

Two hundred and fifty one chronic anterior laxities operated by intra-articular plasty using a free knee-cap tendon and by the Lemaire extra-articular procedure were reviewed with a minimum 3 year follow-up. Eighty-three per cent of the patients obtained a global functional result excellent or good, eight per cent fair and nine per cent poor. Clinical examination disclosed 24% equivocal pivot shifts and 4% true jerks in internal rotation. Most of the patients, at the check-up clinic, underwent a radiographic and dynamic examination, thereby allowing evaluation of postoperative arthrosis and residual anterior laxity in extension. Frontal radiographs of the knee on unilateral weight-bearing showed 29% joint remodelling, 16% "prearthrosis" and 8% arthrosis. These radiological modifications were most often medial femoro-tibial, they were highly correlated with the patient's age at the time of operation, with the state of the medial meniscus and with the residual laxity in extension. The residual anterior laxity in extension measured on the dynamic radiographs was, on average, 9 mm, i.e. an average difference of 5 mm in relation to the healthy knee; it was highly influenced by the pre- or peroperative treatment of the medial meniscus. Indications of precautions to be taken are defined and suggestions are drawn up whereby residual laxity in extension may be limited.

Adolescent↗
PubMed1988

[Intramural internal meniscectomy using the Trillat technic. Long-term results of 258 operations].

A study of 258 meniscectomy (245 patients), with a minimum follow-up of twenty years, confirms the excellent functional result obtained by intramural medial meniscectomy performed for isolated meniscus lesions. The joint remodelling, with absence of joint-space narrowing, represents the radiological cicatrix resulting from this surgery. It is a non-evolutive condition. The incidence of meniscectomy in the occurrence of an arthrosis is low (20%). On the other hand, when the meniscus lesion in associated with rupture of the anterior cruciate ligament, medial meniscectomy often proves to be inadequate. Clinical and radiological evolution is governed by tearing of the ligament. The radiological signs are, in this case, characteristic on unilateral weightbearing in profile at 20 degrees flexion. At the end of this study, the signs described by Fairbank (9) are discussed and the factors liable to determine the onset of a late arthrosis after medial meniscectomy are analysed.

Follow-Up Studies↗