Biomedical subjects

J Degreif

Publications and source records attributed to J Degreif.

At least 37 records · Page 2Linked to original sources

PubMed1996

[Long-term outcome of managing medial femoral neck fractures with ceramic head endoprostheses].

Total hip replacement is often recommended for the treatment of femoral neck fractures in elderly patients. A less invasive approach with shorter operating time is the replacement of the femoral head only, leaving the acetabular cartilage in situ. Hemiarthroplastic hip replacement using a metallic head prosthesis was not successful in the past, because the majority of patients developed protrusio acetabuli after surgery. In the present study hemiarthroplastic hip replacement using an Al2O3-ceramic head was shown to be a useful method for the treatment of femoral neck fractures in elderly patients. From 1985 to 1990 277 patients were treated with hemiarthroplasty. The average age at the time of accident and operation was 81.7 years. At the time of follow-up in 1993 only 77 survivors were available for examination. A standardized score was calculated assessing activity, gait, hip pain, etc., with the patients obtaining an average score of 58 out of possible 78 points. Only three patients had hip pain, and in four cases the roentgenographic examination revealed protrusio acetabuli. Two of these four patients underwent revision surgery for replacement of the cup, leaving the stem in situ. In view of the small number of approach-related complications, hemiarthroplastic hip replacement using an Al2O3-ceramic head is the recommended surgical treatment for femoral neck fractures in elderly patients. In the rare patient with protrusio acetabuli, revision surgery can be performed to replace the cup, leaving the stem in situ.

Activities of Daily Living↗

PubMed1996

[Results of primary unreamed tibial nailing of tibial fractures with severe open or closed soft tissue injuries].

Primary stabilization was performed in 72 tibial fractures with sever open (n = 37) or closed (n = 35) soft tissue injury using unreamed interlocking nails. In 60 (83%) cases the fractures healed without additional procedures. There were 2 cases of osteitis, but both these fractures healed after removal of the nail or after reamed nailing. In 9 patients with delayed union reamed nailing (n = 8) or bone grafting (n = 1) led to healing. In 1 patient with hypertrophic pseudarthrosis, union was achieved after substitution of a reamed nail for the anreamed nail. The infection rate was similar to that observed with external fixation. More secondary procedures, such as bone grafting or a change of the osteosynthesis technique, are necessary with external fixation than with unreamed nailing. Further advantages of unreamed nailing are the internal treatment of the fracture and the patient's greater comfort. Therefore, unreamed nailing can be recommended for the primary treatment of tibial fractures with severe open or closed soft tissue trauma.

Adolescent↗

PubMed1996

[Ultrasound anatomy of the spinal canal of the lumbar spine. Results ofan experimental study and report of initial clinical applications of intraoperative ultrasound in nucleotomies].

UNLABELLED: Results of an Experimental Study and Report of Intraoperative Application: AIM: Intraoperative sonography has been used in neurosurgery (especially in tumors) and in traumatology (assess reduction of dorsal vertebral body fragments). This study was performed to determine the value of sonography in detecting vertebral disc tissue. RESULTS: We examined 6 specimens of the Lumbar spine using the extended flavectomy approach. We found that sono-anatomy was reproducible and that the assessable area was large enough to make sonography useful for detection of sequesters. Dislocated vertebral disc tissue could be differentiated clearly from original disc tissue and from other intraspinal structures. In 6 of 8 cases of intraoperative sonography in nucleotomies we were able to evaluate intraspinal and intraforaminal structures. The complete removal of the detected prolapses could be documented. In 2 cases the examination failed because the probe had a too large diameter and could not be pushed down between the spinous processus and the wound distractor to the extended flavectomy. CONCLUSIONS: Sonography allows one to document complete resection of disc herniations. Limitations of the method are due to technical problems.

Adult↗

PubMed1996

[Intraoperative ultrasound in lumbar intervertebral disk displacement].

UNLABELLED: Intraoperative ultrasound of the spine has been used in neurosurgery (tumours) and traumatology (reposition of fractured vertebral bodies fragments). AIM: To describe initial experiences with this method and to document the opportunities and problems. METHOD: 24 nucleotomies were documented and evaluated. Sonography was performed using a 7.5 MHz sector probe and a typical surgical approach. RESULTS: In 21 of 24 cases, imaging of intraspinal structures was possible. The complete extraction of the herniated disk could be documented. In 3 cases the examination failed because the probe was too large to be pushed down between the spinous processes and the wound retractor to the operative site. CONCLUSIONS: Intraoperative sonography can be used easily as a routine method for exploration of the spinal canal. Technical innovations in the probes would make the method even more feasible.

Adult↗

PubMed1995

[The effect of bone marrow embolization on the choice of procedure in the stabilization of femoral fractures].

Because of an extended venous drainage system, especially in the supracondylar area, a pressure increase in the femoral cavity results in embolization of the contents of the bone marrow cavity. Bone marrow embolization alone is mostly not apparent clinically but together with cofactors it may result in severe pulmonary damage and occasionally even in death. Cofactors are volume deficit, shock, thoracic and polytrauma and preexisting pulmonary disease. In the field of traumatology a pressure increase in the femoral cavity regularly occurs during unavoidable movement of femoral fragments in traction, during reduction, intraoperatively during intramedullary nailing, and in hip replacement. A hematoma acts as a hydraulic transmitter. Early osteosynthesis within 24 h avoids permanent intravasation of moderate amounts of the contents of the bone marrow cavity. Concerning intramedullary nailing, there are considerable differences between reamed and unreamed nailing. Reaming always leads to high-pressure increases in the femoral cavity, resulting in embolization. Therefore, reaming should not be performed if cofactors of manifestation of pulmonary impairment are present. Unreamed nailing results in less intravasation, but is not entirely harmless, as considerable pressure increases occur in unreamed nailing as well. The gap between the nail and the entrance of the distal fragment is the decisive parameter. Not just the smaller intravasation of bone marrow during unreamed nailing is important. After each reaming process, the bone marrow cavity rapidly refills with blood, which is activated concerning coagulation and pressed into the circulation during the following reaming process. Because of superior bone healing, interlocking nailing is the treatment of choice in diaphysial femoral fractures. As far as the differential indications of reaming are concerned, the discussion is not yet closed. However, reaming should undoubtedly be restricted to a few reaming processes. Before unreamed femoral nailing, the width of the bone marrow cavity must be examined exactly. If the width of the bone marrow cavity, the patient's condition and experience of the surgeon allow unreamed nailing, this procedure can be recommended. As the venous drainage system of the tibia is not important compared to the femur, the question of reaming or not in tibial fractures is not influenced by the danger of embolization, but by soft tissue damage and the stability of interlocking bolts. In patients with femoral fractures and co-factors for the manifestation of pulmonary impairment, the choice of osteosynthesis type should take plating in its improved form into consideration, as this preserves the vascularity of the fragments.(ABSTRACT TRUNCATED AT 400 WORDS)

Bone Marrow↗

PubMed1994

[Results of implantation of uncemented porous metal hip prostheses].

72 patients having cementless spongy-metal hip prosthesis were reexamined by clinical and radiological check up two to seven years after implantation (average 43 months). In case of five patients hip prosthesis had to be changed due to loosening (no bony ingrowth n = 2, loosening of acetabular component due to technical faults n = 3). In correlation to clinical results 88% could be considered as excellent or good, 9% acceptable and 3% as inadequate. 10% of the patients complained about thigh pain. The typical radiological bony reactions of the surrounding bone are described. An evaluation of the radiological results can only be done under consideration of the clinical problems involved. In view of the positive results obtained in the recent time the use of spongy-metal hip prosthesis can be recommended for cementless hip joint replacement in case of younger patients. Especially in case of cemented hip joints which have become loose it will be an advantage to use spongy-metal hip prosthesis.

Adult↗

PubMed1994

[Rotational stability of the thoracolumbar spine after interlaminar ultrasound window, hemilaminectomy and laminectomy. A comparative experimental study].

Intraoperative spinal sonography to check whether fragments have been successfully repositioned requires enlargement of the natural interlaminar window to 8 x 10 mm. The present study was performed to measure any rotational instability caused by such a laminotomy and compare it with that resulting when the conventional methods of checking the spinal canal, e.g. hemilaminectomy and laminectomy, are applied. The investigations were carried out in 10 human vertebral columns, in the area of T-12, L-2 and L-4. Torsional loads of up to 20 Nm were applied to the spines and axial rotations were recorded. Laminotomy, hemilaminectomy and laminectomy were done step by step. The loading-unloading cycles were achieved with initial axial rotation and decreasing torsional moment after measurement the dorsal manipulations. It was shown that interlaminar fenestration causes a hardly measurable instability. A laminotomy to 10 x 20 mm, allowing direct repositioning of the posterior vertebral surface, causes a 6% loss of stability. A significant decrease is caused by hemilaminectomy, with a 20% loss and by laminectomy, with 27% loss of rotational stability compared with the intact spine. Rotational instability of the spine causes severe pain and often has to be treated by spondylodesis. The present investigations show that the spinal canal should not be checked by hemilaminectomy or laminectomy. For this we now use intraoperative ultrasound.

Biomechanical Phenomena↗

PubMed1994

[Technique of plate osteosynthesis of the femur].

When plating is performed for fixation of complex femoral fractures the need for medial buttress to give durable weight-bearing ability of the bone is mandatory. However the means of achieving this is controversial. Many authors are in favour of mechanical reconstruction of the medial buttress, if necessary with a bone graft. Alternatively, medial buttress can be achieved by means of a technique allowing biological fracture healing, which is only possible, when the vascularity of all fragments is preserved. In 39 cases of osteosynthesis with plates for complex femoral fractures the bridging technique was used at surgery, to avoid denudation of the fragments. All osteosyntheses were performed without the application of bone clamps. After minimal exposure of the femur at the lateral side only, the plates were fixed in the main proximal fragment with one screw, in the case of blade plates the blade was fixed without bone clamps too. Afterwards the main distal fragment was drawn up to the plate and fixed directly and with a screw. In 9 cases the plates were inserted behind the vastus lateralis muscle, preserving its continuity, and fixed distally with another screw. After fine checking of the fracture alignment for rotation and length the plates were fixed with four or five screws in each main fragment, all at sites distant from the fracture. Meanwhile, all 39 fractures have consolidated. There were no cases of infection. Bone grafting was necessary in 8 cases. Only in 2 cases were the defects located in the medial area. In 37 of the 39 osteosyntheses an excellent medial buttress was achieved by bone healing.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Plates↗

PubMed1993

Pathogenesis and prophylaxis of circulatory reactions during total hip replacement.

Circulatory reactions such as a drop in blood pressure, bradycardia, cardiac arrest, and even intraoperative death after insertion of the stem are well known events during total hip replacement. The present paper reports bone marrow intravasation after rise of intramedullary pressure in the femoral cavity during insertion of hip prostheses, demonstrated by intraoperative transesophageal echocardiography. In an animal study, the ultrasound echoes were identified as "mixed emboli" consisting of a core of bone marrow surrounded by thrombus. These results suggested the use of an intramedullary plug to restrict the intravasation of bone marrow. A trial was undertaken in 60 total hip replacement operations. The first 30 were performed using the conventional technique without an intramedullary plug. In a second series of 30 operations, an intramedullary plug made of cancellous bone taken from the resected femoral head was placed 2 cm below the expected location of the tip of the stem. The cement was applied from distal to proximal by syringe. After implantation of the prosthesis using the conventional technique, a significant drop in blood pressure was observed. In the second series, the drop in blood pressure did not occur. In conclusion, it was demonstrated that effective venting of the bone marrow cavity by a bore hole, and avoidance of compression of the bone-marrow-filled distal femoral cavity by using a plug, results in effective prevention of circulatory reactions: no drop in blood pressure occurred. The use of an intramedullary plug is discussed and recommended.

Aged↗

PubMed1993

[Experimental studies in weakening the stability of the trochanter major by lateral fenestration].

A major disadvantage of the usual 130 degree angle plates when handling the fracture of the neck of the femur is the fact that the lateral corticalis of the femur is almost completely interrupted by the broad window at a biomechanical important and highly strained location. This often leads to the complications such as the breaking off of the greater trochanter or lack of stability etc. The experiment examines ten pairs of human femora for a decrease of stability, which results from the lateral fenestration for the osteosynthesis. One of the two bones out of a pair received a slit at a right angle concerning the axis of the femur, the other one a round hole. The slit was made into the proximal lateral femur as if preparing for the installation of a 130 degree angle plate. On the corresponding spot of the second bone a round hole was drilled. The remaining stability of the compact bone was measured by experimental pulling on the greater trochanter. Under the assumption that left and right femur have about the same stability, which was proven in one of the experiments, a significant disadvantage was found for the relatively wide slit.

Biomechanical Phenomena↗

PubMed1993

Pathogenesis and clinical relevance of bone marrow embolism in medullary nailing--demonstrated by intraoperative echocardiography.

For the clarification of pulmonary impairment after medullary nailing of femoral fractures, the intramedullary pressure in the femoral cavity during the operative procedure was investigated. In addition, an intraoperative transoesophageal echocardiography was performed which revealed two phenomena occurring once the intramedullary pressure had increased: snow-flurry and configured emboli. An experimental study in sheep was performed in order to define the substrata of the sonographic echoes. The level of intrafemoral pressure which would result in bone marrow intravasation and the substrata of the echocardiographic echoes were studied in sheep by applying pressure to the femoral cavity. Sonography of the distal vena cava by laparotomy and macroscopic and histological investigation of the venous blood received throughout a proximal subdiaphragmal venotomy were undertaken. The intrafemoral pressure peaks correlated with the appearance of sonographic echoes in both patients and sheep. Snow-flurry is an indication of small amounts of bone marrow and already appears at an intramedullary pressure of 50 mmHg, which can easily occur during movement of non-stabilised fractures (values up to 90 mmHg were observed)--configured emboli consist of a core of bone marrow surrounded by thrombotic aggregate and only appeared at pressure increases of over 200 mmHg in the animal experiments. During medullary nailing in patients the intrafemoral pressure increases up to 200-600 mmHg in all reaming procedures. Configured emboli were seen in 8 of 20 patients being treated with reamed nailing. In five nailing procedures performed using the unreamed technique, no pressure increases greater than 70 mmHg and no configured emboli were observed. I.v. injected bone marrow results in pulmonary impairment.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1993

[The safety belt: effects on injury patterns of automobile passengers].

Since 1984 the law concerning safety belts has been implemented; this paper deals with the findings in 386 victims of motor accidents who were x-rayed between 1981 and 1989. Minor injuries have been ignored. The number of passengers wearing belts increased by 30% after 1984. The number of passenger injuries did not decrease. Injuries directly caused by the belts included a small number of fractures of clavicles, the sternum and ribs and one pelvic fracture, one serious abdominal injury with tearing of the mesenteric artery and one ruptured spleen. An indirect result of wearing seat belts was a marked increase in cervical whiplash injuries and some increase in thoracic vertebral fractures. None of the belt induced injuries proved fatal. Amongst those using seat belts there was a significantly lower fatality rate and injuries causing prolonged disability. In particular, using seat belts, serious injuries to the skull and brain were reduced by 80%. Similarly injuries to the abdomen, the odontoid, pelvis and hip joint were greatly reduced. The advantages of wearing a seat belt greatly outweigh the disadvantages.

Accidents, Traffic↗

PubMed1993

[Clinical and neurologic results after surgical management of the cubital tunnel syndrome].

Fourty-two patients suffering from cubital tunnel syndrome were reexamined after anterior subcutaneous transposition of the ulnar nerve. In 25 patients, electrophysiological results could be compared pre- and postoperatively. Only few patients recovered completely, however, electrophysiological results showed an improvement in most of the patients. Sensory velocity proved to be more sensitive than motor velocity. We advice patients for early operation to avoid aggravation of symptoms, even if remission will be incomplete.

Adolescent↗

PubMed1993

[Development of thromboses in hip joint endoprostheses. A study with color-coded duplex ultrasound].

After 102 hip replacements in a surgical technique that avoids bone-marrow intravasation as much as possible, color-coded duplex sonography revealed thigh thrombi in only 4 cases without any signs of thrombosis. This rate is lower than that found in all other comparable studies. The investigations stress the role of bone-marrow intravasation in the induction of deep vein thrombosis in hip replacement. With an optimal surgical technique, thigh thrombi can be greatly reduced in hip replacements, which have a higher rate than all other operations.

Aged↗

PubMed1993

[Reposition of fragments of the posterior surface of the vertebral edge with intraoperative ultrasound guidance].

The question of whether fragments of the posterior vertebral surface have to be removed in every case remains to be answered. Nevertheless, in many cases it is important to establish the situation inside the spinal canal intraoperatively. To this end we have used intraoperative ultrasound in 21 cases. The results have always corresponded closely with the findings of preoperative and postoperative computed tomography. Under the influence of this method we have modified our operative procedure. The technique of intraoperative ultrasound and our current operative practice are described in the present paper. We use typical cases to show that intraoperative ultrasound of the spinal canal is a very useful technique for several reasons: Accurate depiction of the spinal canal is always possible without destabilizing the dorsal vertebral structures. The risks and disadvantages of intraoperative myelography are avoided. The method is easy and can be repeated as often as desired, an important advantage in checking the success of the removal of fragments and in reviewing the situation after transpedicular cancellous bone grafting.

Adult↗

PubMed1993

[Nuclear magnetic tomography in shoulder dislocation].

Sixty-two patients with anterior shoulder dislocations were examined by magnetic resonance imaging (MRI). After a primary dislocation, 30 patients showed 23 (77%) tears of the glenoid labrum, 13 (45%) anterior-inferior separation of the capsula, 24 (83%) Hill-Sachs lesions, 6 fractures of the greater tuberosity and 4 glenoid rim fractures. Thirty-two patients with recurrent shoulder dislocation had 14 (44%) tears and 15 (47%) defects of the glenoid labrum, 16 (50%) anterior-inferior separation of the capsula, 28 (88%) Hill-Sachs lesions and 3 glenoid rim fractures. MRI permits complete non-invasive documentation of glenohumeral instability if joint effusion is present. In the absence of joint effusion, diagnostic accuracy can be improved by application of a contrast medium.

Adolescent↗

PubMed1992

[Experimental trial of intraoperative spinal ultrasound].

Dorsal operative stabilization of spinal fractures by internal fixation is an established means of treatment directed at releasing the extrinsic compression of the intraspinal contents caused by the fractured posterior surface of the vertebral body. There are few ways of assessing how successful the repositioning is intraoperatively. Intraoperative ultrasound with a special small transducer is possible, but it is difficult to reach the intraspinal area by this means, because it is surrounded by bones. A laminectomy would destabilize the injured vertebral column even further. By experiments performed on six human vertebral columns we show that it is possible to view the entire length of the fractured posterior surface by ultrasound. The beam has to be projected between the laminae vertebrae following a small laminotomy. Preliminary intraoperative experiences with eight patients confirm our experimental results. The intraoperative ultrasound results have been confirmed by preoperative and postoperative CT. We expect the necessity for laminectomy for examination of the posterior surface of the vertebral body to decline in frequency in the near future.

Child↗

PubMed1992

[The disease factor of scapholunate dissociation].

Scapholunate dissociation is the most common form of instability of the wrist. Its occurrence has been consistently attributed to previous trauma and is supposed to be treated by operation. In the present paper we show that chronic bilateral scapholunate dissociation without any symptoms is not rare. In two years we accidently found four cases with bilateral scapholunate dissociation. In such cases an operation cannot be successful. Therefore, we recommend that a specific trauma should be checked very carefully and roentgenograms of both wrists done.

Carpal Bones↗