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Biomedical subjects

G Walch

Publications and source records attributed to G Walch.

At least 91 records · Page 5Linked to original sources
PubMed1988

[The natural history of rupture of the posterior cruciate ligament].

A study has been made in a series of 45 patients, 36 of whom were re-examined and 11 of whom replied to a questionnaire, of the fate of knees that had suffered a rupture of the posterior cruciate ligament which had not had a primary or secondary repair. The follow-up was between 5 and 44 years, with a mean of 15 years. In the 36 who were reviewed, 21 showed an isolated posterior laxity, 8 a postero-lateral laxity and 7 a postero-medial laxity. Even though the posterior cruciate ligament is the strongest ligament in the knee, an isolated rupture of the ligament is often well tolerated after a mean period of adaptation of 12 months. This functional tolerance is remarkable since it allows a return to sporting activity, even at high level. However, the disturbance of the kinematics of the knee resulting from the loss of the posterior cruciate ligament leads, after an average of 25 years, to osteoarthritis, either medial tibio-femoral or generalised depending on the morphological features of the patient. These findings have stimulated us to repair fresh lesions in young persons, especially in the presence of combined lesions but care needs to be exercised about the indications for surgery in chronic laxities during the first year of adaptation.

Adaptation, Physiological↗
PubMed1987

[Recurrent anterior luxation of the shoulder occurring after the age of 40].

Twenty-four recurrent dislocations of the shoulder with an onset after the age of 40 years have been operated on using the Trillat technique. The results have been studied with a mean follow-up of 10 years. This type of lesion, which is not rare, forming five per cent of cases in the authors series between 1953 and 1982, deserves separate consideration because of the frequency of associated rupture of the rotator cuff which seems to arise as a consequence of the first dislocation. There were 75 per cent of indirect tuberosity signs and 20 per cent of elevations of the humeral head before operation. It is responsible for osteoarthritis in the shoulder found in the follow-up. There were 70 per cent of osteoarthritic shoulders and 50 per cent of cases with elevation of the humeral head. The clinical results obtained, without any associated procedures on the cuff, were investigated by the criteria established for the surgery of shoulder instability (Rowe). They were satisfactory, with 63 per cent of good objective results and 88 per cent of satisfied patients. There appears to be a beneficial effect from the downward displacement of the subscapularis which should be taken into account as well as consideration of treatment for the lesions of the rotator cuff.

Adult↗
PubMed1987

[Chronic posterior instabilities].

As an introduction, isolated posterior, posterolateral, posteromedial, as well as combined posterior stability are defined. Rupture of the posterior cruciate ligament leads to pathological patterns for both concentric and eccentric quadriceps movements. Special attention is drawn to the significance of the peripheral stabilizers and their influence on instability. Ruptures of the posterior cruciate ligament are commonly followed by a phase of functional adaptation, functional tolerance, and arthrotic decompensation. Diagnosis should not only be based on the posterior drawer test, but also consider stability tests in the frontal plane and eventual rotational instabilities. What constitutes adequate therapy is still a subject of controversy today. Among the operative procedures, the most common are the pes anserinus graft according to Hey-Groves and Lindemann, the gastrocnemius graft of Hughston and Insall, the free patellar ligament graft, and synthetic replacement. The decision about indications for surgery should not be made earlier than 18 months after the accident, when the phase of functional adaptation has been completed.

Biomechanical Phenomena↗
PubMed1987

[Arthrosis of the knee in chronic anterior laxity].

Arthrosis following rupture of the anterior cruciate ligament has been analysed in two series. The first series was derived from a review of 150 cases of reconstruction of the anterior cruciate ligament with a follow-up of 3 years or more. Arthrosis was seen to have developed in 13.3%. The second series was concerned with 64 cases of unilateral arthrosis treated by upper tibial valgus osteotomy in whom there had been a previous rupture of the anterior cruciate ligament. The "tolerance time"--that is the time between the original ligamentous injury and the time of osteotomy--for the development of arthrosis was very variable, ranging in cases with a "natural history" from 10 to 50 years with a mean of 35 years. It is important to recognise the radiological signs of the onset of arthrosis. These are osteophytosis of the intercondylar notch, osteophyte formation at the posterior part of the medial tibial plateau, and, in particular, narrowing of the medial joint line with posterior subluxation of the medial femoral condyle, well seen in lateral radiographs whilst standing on one lower limb. Early arthroses, appearing after 10 years, may occur as a "natural arthrosis", but it develops much more frequently after surgical treatment that had failed to correct anterior laxity and particularly when it had been performed on knees that were already pre-arthrotic. The main factor in arthrosis is anterior laxity measured radiologically by an "active Lachman" radiograph. Removal of the medial meniscus, which, in itself, is liable to produce arthrosis is even more harmful in anterior cruciate laxity since it doubles the degree of anterior subluxation of the tibia seen on unilateral weight-bearing. The development of varus deformity, which characterises progressive arthrosis, has its origin in wear of the posterior part of the medial tibial plateau caused by anterior cruciate laxity. Other factors play an important part such as associated lateral laxity, constitutional genu varum and weakness of the hamstring muscles which oppose the subluxating action of the quadriceps.

Adult↗
PubMed1986

[Anterior recurrent luxation of the shoulder. Postoperative recurrences].

Seventy-nine recurrences have been seen after surgical procedures for recurrent dislocation of the shoulder. There were 58 "true" recurrences, 17 shoulders with anterior instability and 4 with instability in all directions. The "true" recurrences were more frequent in young people with a mean age of 20 years at the time of the first surgical procedure. Two-thirds of them occurred on the dominant side. Most of the cases had been treated by distal displacement or lengthening of the coracoid process (38 Trillat procedures, 8 Latarjet procedures and 8 Oudart procedures). Only two had been treated by a Bankart procedure. The main cause of recurrence was a failure of repair of the antero-inferior part of the joint. Twenty three cases were operated on again, the most usual procedures being the Trillat procedure and rarely the Latarjet or Eden Hybinette procedures. Six cases recurred once again. Cases with anterior instability were observed after the Trillat procedure. They were due to capsular laxity and did not have to be operated on again. Instability in multiple directions was observed in young women who continued to dislocate their shoulder inferiorly or posteriorly, despite two or three surgical procedures.

Adolescent↗
PubMed1984

Anatomical and functional study on the musculus semimembranosus.

The dissection of 18 knees taken from fresh cadavers has led to a detailed description of the semimembranosus muscle (musculus semimembranosus). It is exclusively tibial with its three tendons rendering the muscle functional, whatever the position of the knee may be. There are other attachments, sometimes described are merely expansions extending to the menisco-tibial and menisco-femoral formations, from which this distal termination must be distinguished. Electromyography performed on 17 specimens confirms that this muscle serves more as a brake on outer rotation than an inner rotator muscle, especially when the hip is flexed and the knee stretched.

Action Potentials↗
PubMed1982

[Lengthening technique of the ulna in Kienboeck's disease. Results after ten years].

The writers had re-examined several patients who had an operation for Kienböck disease before 1970. All had had an elongation of ulna through the same technique and no other operation for pseudarthrosis had been necessary. Eight patients were able to be examined 14.7 years after their operation (on an average). The analytical functional results were evaluated following Michon's criteria. The best results had been obtained as far as pain and strenght of the wrist were concerned, yet those obtained on mobility proved disappointing. X-Rays showed a lunatum keeping its shape 6 times out of 8 and an almost constant development of arthrosis. The use of the technique is questioned in the treatment of Kienböck disease.

Adolescent↗
PubMed1982

[Posttraumatic club-hand. Therapeutic problems (apropos of 5 cases)].

Progressive radial deviation after epiphyseal separation in children is a rare complication. It is related to an imbalance of residual growth potential of the lower ends of the radius and ulna together. The functional disability is generally moderate. 5 cases were observed by the authors, all of which were treated surgically. The mechanism of the deformity and the surgical techniques are described. These are lengthening of the radius, angulation osteotomy of the radius, shortening of the ulna or epiphysiodeses. In some cases, operative excision of a partial epiphyseal closure can be done provided that there has been a close follow up after the trauma and an early diagnosis.

Adolescent↗
PubMedDate not supplied

Replacement arthroplasty in the weight-bearing shoulder of paraplegic patients.

We review the early results of shoulder arthroplasty in the weight-bearing shoulder of long-term paraplegic patients. We have been unable to find previously published results of this subgroup of shoulder arthroplasty patients in the literature. Five paraplegic, female patients who had undergone shoulder arthroplasty were analyzed. All patients had been prospectively assessed with the American Shoulder and Elbow Surgeons (ASES) function score and the Constant score. The mean age at the time of surgery was 70 years. Three shoulders had full-thickness rotator cuff tears, and two were repaired at the time of shoulder arthroplasty. The mean preoperative Constant score was 30 out of 100, improving to 52 out of 100 at a mean follow-up of 30 months (range, 24-36 months). The mean preoperative ASES function score was 28 out of 55, improving to 37 out of 55. One patient was pain-free after surgery, and the mean postoperative pain score was 10 out of 15. There were no features of progressive radiolucency around the glenoid or the humeral components at last review apart from one case in which glenoid implant migration occurred. In view of the satisfactory improvement in terms of pain, mobility, and independence, we believe that it is reasonable to continue to offer this procedure to this subgroup of patients. We will, however, remain vigilant with regard to any further complications arising in these prostheses in the medium to long term as a result of increased loading.

Aged↗
PubMedDate not supplied

Arthroscopic assessment of full-thickness rotator cuff tears.

SUMMARY: To evaluate the reliability of the arthroscopic assessment of full-thickness rotator cuff tears, 117 cases were prospectively investigated by imaging, arthroscopy, and open surgery. The confidence of the surgeon, his accuracy, and the surgeon-dependent character of arthroscopic assessment were evaluated in terms of the description of the main anatomic parameters. The surgeons were confident and accurate in diagnosing a full-thickness tear of the supraspinatus, but they underestimated its coronal and sagittal extent and its reducibility to the greater tuberosity. Conversely, the technique appeared very accurate in describing the rotator interval. Endoscopic assessment was particularly operator-dependent in the anteroposterior analysis of the tear. This study shows the limits of endoscopic assessment of full-thickness rotator cuff tears. It illustrates the need for an adequate arthroscopic technique with a thorough knowledge of normal and pathological anatomy of the rotator cuff.

Arthroscopy↗
PubMedDate not supplied

Nonunions of the surgical neck of the humerus: surgical treatment with an intramedullary bone peg, internal fixation, and cancellous bone grafting.

Twenty patients with pseudarthrosis of the upper humerus underwent surgery with the intramedullary bone peg technique. A 6 to 10 cm corticocancellous autogenous bone graft (11 iliac crest, 6 anterior tibial crest, 3 middle-third of the fibula) was pegged] into the humerus and bridged the pseudarthrosis. Stability of the fracture site was obtained by plate osteosynthesis; an additional peripheral cancellous graft was performed. Our patient series included 15 women and five men with an average age at operation of 58 years; the dominant side was involved in 12 cases. Eleven had undergone 22 previous operations. The average delay between fracture and surgery was 12 months, (range 6 to 72 months). The patients were monitored an average of 42 months (range 12 to 120 months). Union was confirmed in 19 cases; the last case demonstrated no peripheral callus. No necrosis of the humeral head was seen. Active anterior elevation of the shoulder improved from an average of 60 degrees to an average of 131 degrees. According to Constant's scale adjusted according to age and sex, the results obtained averaged 81.2%. Subjectively, 65% of patients were very satisfied, 30% were satisfied, and 5% were disappointed. The rate of union (96%) is in contrast with the results reported in the literature, underlining the importance of an intramedullary bone graft in association with peripheral osteosynthesis in the treatment of pseudarthrosis of the surgical neck of the humerus.

Adult↗