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N Gschwend

Publications and source records attributed to N Gschwend.

142 records · Page 8Linked to original sources
PubMedDate not supplied

Late complications in elbow arthroplasty.

The world literature (1986 to 92) reports an amazingly high complication rate of elbow arthroplasty, amounting to 43%. Accordingly, we also find a high revision rate (18% on average) and a considerable rate (15%) of permanent complications. These figures do not correspond to our own experience with the GSB III (Gschwend/Scheier/Bähler) elbow prosthesis, a sloppy hinge with flanges on the lower and anterior part of the distal humerus. Our respective figures of complications are two to four times lower for rheumatoid elbows. When complications are discussed, a clear distinction of the type of prosthesis is mandatory, because linked or nonlinked and nonconstrained or semiconstrained prostheses have specific complications. The following complications are discussed separately: loosening (radiologic and clinical), ulnar neuropathy, infection, dislocation and subluxation, uncoupling, intraoperative bone fractures, and failure of the implant. The possible causes are analyzed, and means to avoid or treat these complications are discussed. We conclude that even in the long term ( > 10 years), results obtained with elbow arthroplasty are approaching those of hip and knee arthroplasty.

Adult↗
PubMedDate not supplied

[Shoulder arthrodesis. Possible causes of functionally poor results].

Due to severe articular destruction of the glenohumeral joint with corresponding soft tissue changes arthrodesis has been performed in 24 patients since 1973. After an average period of 5.4 years (2-15) years, 22 patients were reviewed. Primary bone consolidation was achieved in all cases. During the observation period in 7 cases one of the following additional operations had to be performed on the involved shoulder: subcapital osteotomy due to excessive abduction (2 cases), resection of the acromio-clavicular joint due to painful osteoarthritis (2 cases), partial resection of an ugly acromion projecting laterally (1 case), removal of the fixation plate protruding proximally (4 cases). 18 patients experienced a marked improvement after arthrodesis. No improvement in 2 cases and a deterioration in 2 cases were the result of a not optimal positioning of the arthrodesis. A position of 20 of abduction, 20 to 30 of flexion and 45 of internal rotation proved to be functionally the most beneficial. Patients will be only painless if the optimal position of the arthrodesis was achieved. Excessive abduction and flexion was generally experienced as unpleasant. Deviation in the rotational position leads to functional restriction. The remaining function after arthrodesis is often overrated.

Activities of Daily Living↗
PubMedDate not supplied

[Indications for rheumatoid orthopedic interventions and priorities in the long-term treatment plan].

The treatment of the polyarthritic patient has to consider the whole personality in order to be effective. This difficult task calls for a well functioning team. In this team the Rheuma-surgeon plays a decisive role. He will only be able to satisfy all the expectations if he masters, by virtue of his training and experience, the art of setting up a treatment plan with priorities. In order to outline a list of priorities, he has to answer the questions: What are the patient's needs, desires and expectations? What are the predictable end results of the measures envisaged and what are the remaining possibilities in case of surgical failure or when abstaining from surgery? Three categories of operation are outlined according to the expected success rate. Of particular importance is the patient's motivation.

Arthritis, Rheumatoid↗
PubMedDate not supplied

[Value of synovectomy].

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Arthritis, Rheumatoid↗
PubMedDate not supplied

Internal derangement of the knee joint due to pathologic synovial folds: the mediopatellar plica syndrome.

A prospective study of the mediopatellar plica was performed by arthroscopy in 134 patients. The mediopatellar plica is a fold of synovial tissue attaching medially at the undersurface of the quadriceps tendon which extends distally around the patella and over the medial femoral condyle to insert into the fat pad. Extensor mechanism derangement may be produced by a mediopatellar plica when it loses its pliability owing to fibrosis or hyalinization. Persistent disabling symptoms require surgical treatment consisting of excision by arthrotomy or by operative arthroscopy.

Adolescent↗