Biomedical subjects

P Broos

Publications and source records attributed to P Broos.

At least 37 records · Page 2Linked to original sources

PubMed1998

Fasciotomies of the limbs: how to do it?

The compartment syndrome has been defined as an elevation of the interstitial pressure in a closed osteofascial compartment resulting in microvascular compromise. The only effective treatment is early decompression of the involved compartment. In acute conditions, this decompression can only be established if skin and fascia are incised over the muscular part of the compartment. A good knowledge of the anatomy and importance of the fascia generalis, communis and propria is necessary for successful and complete decompression. Classic and more recent anatomical and clinical data are selected from the surgical literature to provide comprehensive and anatomically based guidelines for fasciotomies of the upper and lower limbs.

Anterior Compartment Syndrome↗

PubMed1998

The unreamed locked intramedullary tibial nail: a follow-up study in 51 patients.

The authors reviewed 51 patients with a fracture of the tibia primarily treated with an unreamed intramedullary nail. There were 29 open and 22 closed fractures. All fractures healed within one year of the trauma. There were no deep infections. The most frequently observed complication was failure of interlocking screws (20%), but this complication had a negligible influence on bone healing. Re-nailing with a reamed nail was necessary in 18%. According to the criteria of Klemm and Börner an excellent result was obtained in 55% and a good result in 44%. The authors recommend unreamed nailing in fractures with soft tissue injuries; they recommend to dynamize the implant after six weeks in transverse and short oblique fractures and to replace the unreamed nail by a reamed one after three months in case of delayed union.

Adolescent↗

PubMed1998

The unreamed AO femoral intramedullary nail, advantages and disadvantages of a new modular interlocking system. A prospective study of 67 cases.

Compared with the Reamed Femoral Nail (RFN), the Unreamed Femoral Nail (UFN) has some theoretical advantages. It can also be used for subtrochanteric fractures and ipsilateral fractures of the femoral neck, there is less iatrogenic damage to the vascularisation of the bone, the risk of fat embolism syndrome and ARDS is reduced and the operation is a less time consuming procedure, associated with less blood loss. From April 1995 to July 1996, 66 patients with 67 fractures have been treated with the UFN: 16 patients with metastatic disease, 18 patients with a subtrochanteric fracture, 32 patients with 33 diaphyseal fractures. In 6 cases however, previous reaming was necessary. The spiral blade (SB) was used 35 times. Four patients died within six months after the operation. Fat embolism syndrome or ARDS were never observed. Five mechanical complications were observed in four patients. In one patient with a metastatic fracture, we noted a breakage of the SB twice. Migration of the SB was observed three times needing reintervention twice. Delayed union needing renailing with a reamed nail was observed twice. The reoperation rate for all patients treated with an UFN-SB was 9%. For diaphyseal fractures, the rate of delayed-union was 6%. This complication was only observed in open fractures. We concluded that the UFN is a safe and less severe procedure than the reamed nail in multiply injured patients. For subtrochanteric fractures, the UFN-SB is a useful implant, but not superior to other methods of treatment. As a definitive treatment for a femoral fracture primarily stabilized with an external fixator, we strongly suggest to carry on using a reamed nail.

Adolescent↗

PubMed1998

Pathologic fractures due to metastatic disease. A retrospective study of 160 surgically treated fractures.

Orthopaedic surgeons are increasingly confronted with metastatic fractures. As the majority of metastatic fractures never heal, surgical treatment is required. The goals of surgical therapy are to achieve early mobilization, relief pain and improve quality of life. One hundred twenty nine patients with 160 metastatic fractures of a long bone, completed or impending, were retrospectively analysed with regard to the type of treatment, effect on pain relief and mobility. Seven of the patients (4.4%) died postoperatively, a good functional result was obtained in 86.9% of the cases and for all patients a good analgesic effect was achieved. In 3.75% of the cases a mechanical complication was seen which needed reintervention. In general, the only indication for endoprosthesis is an intracapsular or very proximal lesion. In almost all other cases, intramedullary nailing is preferred.

Aged↗

PubMed1997

[Surgical management of complete Tossy III acromioclavicular joint dislocation with the Bosworth screw or the Wolter plate. A critical evaluation].

The long-term results with an average of 4.3 years of 87 patients with an AC-dislocation grade III according to Tossy, treated operatively with a Bosworth screw or a Wolter plate are described and submitted to critical evaluation. Of the patients 16% had implant failures. Redislocation was seen in 25% of the patients, calcifications in 39% and arthritis in 41%. The end-result was good or excellent in 60% of the patients and fair or bad in 40%. The only factor, influencing the end result was the redislocation rate (p < 0.05). These moderate results surprised and disappointed us. They made us conclude that the grade III acromioclavicular dislocation is no absolute indication for surgical treatment, as is often suggested in literature. No significant differences could be revealed between both surgical techniques.

Acromioclavicular Joint↗

PubMed1997

The prevention or treatment of age-related osteoporosis in the elderly by systemic recombinant growth factor therapy (rhIGF-I or rhTGF beta): a perspective.

Both insulin-like growth factor-I (IGF-I) and transforming growth factor beta (TGF beta) have powerful modulatory effects in a variety of tissues. A major target of action is the skeletal system, where they enhance bone formation and decrease matrix degradation, thus playing a part in the maintenance of bone mass. Because of the potent mitogenic effect of these agents on osteoblasts, recombinant IGF-I (rhIGF-I) and recombinant TGF beta (rhTGF beta) have potential as drugs to stimulate bone formation in the prevention and treatment of osteoporosis. Using biochemical markers, subcutaneous rhIGF-I therapy has been shown to increase bone turnover and bone formation in nonosteoporotic older people. However, a corresponding increase in bone mass has not yet been documented nor have there been reports yet on the effects of systemically administered rhTGF beta in humans. Further investigation is required to define the clinical potential of rhIGF-I and rhTGF beta as therapeutic agents in age-related osteoporosis.

Age Factors↗

PubMed1997

The accuracy of peripheral skeletal assessment at the radius in estimating femoral bone density as measured by dual-energy X-ray absorptiometry: a comparative study of single-photon absorptiometry and computed tomography.

OBJECTIVES: One of the latest developments in bone densitometry is peripheral quantitative computed tomography (pQCT), a method which allows the separate determination of cortical and trabecular bone mineral density (BMD) in the peripheral skeleton. This study was designed to compare the relative abilities of single-photon absorptiometry (SPA) and pQCT to reflect BMD of the proximal femur as measured by dual-energy X-ray absorptiometry (DXA), an established predictor of osteoporotic hip fracture risk. DESIGN: Cross-sectional study. SUBJECTS: A well-defined community-based sample of 129 skeletally healthy women aged 70-87 years. MEASUREMENTS: Radial BMD by SPA and pQCT and femoral BMD by DXA. Univariate and multivariate regression analyses were performed relating the DXA measurements at the femoral neck and the trochanteric region with the values of SPA and pQCT. RESULTS: Approximately 38% of the variance in femoral neck BMD could be explained by BMD of the midradius assessed by SPA, in contrast to only 18-27% by pQCT. At the trochanter, 32% of BMD could be predicted by SPA as compared to 19-26% by pQCT. Moreover, according to multiple regression, prediction of femoral BMD by SPA was not enhanced by performing pQCT. CONCLUSIONS: Radial pQCT has little value as a screening tool to identify elderly women with low femoral BMD. Additional research is needed to determine whether or not pQCT will enhance fracture prediction beyond that obtainable from a density measurement by SPA.

Absorptiometry, Photon↗

PubMed1997

Calciotropic hormones and markers of bone remodeling in age-related (type II) femoral neck osteoporosis: alterations consistent with secondary hyperparathyroidism-induced bone resorption.

BACKGROUND: Both a decrease in bone formation and the skeletal consequences of secondary hyperparathyroidism have been implied in the pathogenesis of age-related femoral neck osteoporosis. However, studies using biochemical indices of bone remodeling in hip fracture patients have yielded conflicting results. Similarly, secondary hyperparathyroidism has not been a consistent finding in this population. Some of these inconsistencies might reflect differences in the assays used as well as in the timing of the sampling. Moreover, measurements were mostly performed in a limited number of patients. In this regard, the aim of the present study was to analyze potential alterations in bone metabolism in a large population of elderly hip fracture patients. METHODS: Circulating concentrations of 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH)2D3], intact parathyroid hormone (PTH), and calcitonin were measured in 117 elderly women (within a few hours after sustaining a fracture of the proximal femur) and in 117 healthy age-matched controls. In addition, serum osteocalcin and urinary excretion of (deoxy)pyridinoline were determined as markers of bone formation and resorption, respectively. RESULTS: Serum levels of 25(OH)D and 1,25(OH)2D3 were decreased in hip fracture patients. When correcting for differences in serum vitamin D binding protein, serum 25(OH)D was still significantly lower in patients than in controls, whereas serum 1,25(OH)2D3 was not. Moreover, 25(OH)D deficiency in hip fracture patients was associated with an increase in circulating PTH and urinary excretion of (deoxy)pyridinoline. Serum osteocalcin, on the other hand, was significantly decreased in fracture patients. There was no statistically significant difference in calcitonin. CONCLUSION: These data suggest that there is reduced bone formation and increased bone resorption in patients with hip fracture. Although limited by its cross-sectional design, the present study emphasizes the role of secondary hyperparathyroidism-induced bone resorption in the pathogenesis of age-related osteoporosis, mainly due to a lack of 25(OH)D.

Aged↗

PubMed1997

Age-related (type II) femoral neck osteoporosis in men: biochemical evidence for both hypovitaminosis D- and androgen deficiency-induced bone resorption.

The problem of osteoporosis in men has recently been recognized as an important public health issue. To test the hypothesis that endocrine deficiency-mediated alterations in bone metabolism might contribute to osteoporotic fracture risk in elderly men, serum levels of 25-hydroxycholecalciferol (25(OH)D), 1,25-dihydroxycholecalciferol (1,25(OH)2D), intact parathyroid hormone (PTH), testosterone, and estradiol were measured in 40 males (mean age 73 years) who were consecutively recruited within 18 h following a fracture of the proximal femur, and in an equal number of community-living older men (mean age 72 years) who served as controls. In addition, circulating osteocalcin and urinary excretion of (deoxy)pyridinoline were determined as markers of bone formation and resorption, respectively. No differences were observed between the mean serum concentrations of osteocalcin and estradiol. Serum levels of 25(OH)D, 1,25(OH)2D, and testosterone, however, were decreased in hip fracture patients. When correcting for differences in vitamin D binding protein, differences in 1,25(OH)2D did not persist, whereas serum 25(OH)D was still significantly lower in patients than in controls (6.1 +/- 4.3 vs. 7.6 +/- 2.8, p = 0.01). Similarly, a highly significant deficit was observed in the free testosterone index, calculated from total testosterone and the level of sex hormone binding globulin (2.6 +/- 1.3 vs. 8.2 +/- 2.9, p < 0.001). Serum PTH and urinary pyridinium cross-links, however, were markedly increased in the fracture group. Moreover, in fracture patients, free 25(OH)D and free testosterone were both significant and mutually independent negative predictors of (deoxy)pyridinoline excretion. Although limited by its cross-sectional design, the present study suggests that both hypovitaminosis D and androgen deficiency may predispose to bone resorption in elderly men and in turn to remodeling imbalance and fracture risk.

Aged↗

PubMed1997

The treatment of Lisfranc injuries.

Thirty-one patients with fracture-dislocations of the tarsometatarsal joint were examined to assess the functional end results after a mean follow-up of 2.9 years (range 20 to 56 months). Sixty-one percent were polytrauma patients; 39% suffered isolated fractures. Forty-five percent had associated lesions of the tarsal joint complex (Chopart and subtalar joint). According to the Baltimore Painful Foot Scoring System (PFS), 52% achieved an excellent or good result and 48% a fair or poor result. Of the four different treatment modalities, open reduction and temporary screw or K-wire fixation yielded the best results. The major determinants of acceptable results were the type of treatment, type of lesions, the quality of initial reduction and associated involvement of the tarsal joint complex. The extent of the initial injury was the determining factor in the development of late degenerative arthritis. Degenerative changes of the tarsal joint were seen in almost all cases (94%). Such changes were more frequent after temporary screw fixation but did not seem to influence the final results. An initial anatomical reduction did not guarantee excellent results but minimized the chance of late degenerative arthritis. Primary arthrodesis demonstrated no advantage in our series. Although partial arthrodesis may be necessary in severely comminuted joints, it cannot be routinely advocated and should be used as a salvage procedure.

Adolescent↗

PubMed1997

[Risk of hip fractures in the elderly: biomechanical aspects of the falling process].

Age-related fractures are considered to be primarily the consequence of bone loss and increased bone fragility. In line with this dominant view on fracture etiology, prevention studies have primarily focused on pharmacologic interventions to increase bone density of the femoral neck. However, osteoporotic fracture occurrence is not entirely accounted for by bone strength but also related to the incidence and impact of falls. Recent data have provided evidence that an intensive multifactorial intervention strategy can be used to decrease the incidence of falls, but it remains to be determined whether fall prevention can be used successfully to prevent fall-related injuries or hip fracture. In fact, while more than 90% of hip fractures involve falls, hip fracture occurs in only about 1% of falls, suggesting that falls that cause hip fracture may differ qualitatively from other falls. These differences relate to the biomechanical aspects of falls, i.e., the energy that is ultimately transmitted to the proximal femur. Fall severity, rather than fall initiation, may therefore have to be the primary subject of future research.

Accidental Falls↗

PubMed1996

Somatostatin in the treatment of a pancreatic pseudocyst in a child.

Pancreatic pseudocyst is a know complication of acute pancreatitis and pancreatic trauma. The treatment of pancreatitis remains a challenge and the pancreatic pseudocyst is often approached surgically. Lately, the use of somatostatin and its long-acting analogue octreotide have proved useful in the treatment of pancreatitis and its complications in adults. This is the first report on the use of somatostatin in the treatment of a pancreatic pseudocyst in a child. We present the case of a posttraumatic pancreatic pseudocyst in a 10-year-old boy, regressing rapidly under somatostatin treatment, by which means surgical re-intervention could be avoided.

Amylases↗

PubMed1996

Compartment syndrome as a complication of skin traction in children with femoral fractures.

We report the history of two 3-year-old children with femoral shaft fractures, who developed severe compartment syndromes after skin traction. Both children were admitted in our department for treatment of their compartment syndromes. In both, important and permanent disability persisted. The causative role of the skin traction is proved since, in one infant, the compartment syndrome developed in the nonfractured limb. Cautious application of skin traction, conscientious observation, immediate diagnosis, and aggressive treatment of threatening compartment syndromes will prevent these tragic complications.

Child, Preschool↗

PubMed1996

Dislocation of the distal radioulnar joint associated with a transstyloid radiocarpal fracture dislocation. A case report and review of the literature.

Dislocations of the distal radio-ulnar joint (DRUJ) can be isolated or combined with fractures. Cases of DRUJ dislocations have been described with Galleazi fractures, open radius and ulna fractures and intraarticular fractures of the distal radius. We report a case of a volar DRUJ dislocation combined with a transstyloid radio-carpal dislocation. Because of severe instability of the wrist, open reduction of the radial styloid combined with an open reduction of the dislocated DRUJ is advised.

Adult↗

PubMed1996

Compartment syndrome as complication of skin traction, in children with femoral fractures.

We report the history of two 3-year-old children with femoral shaft fractures, who developed severe compartment syndromes following skin traction. Both children were admitted in our department for treatment of their compartment syndromes. In both, important and permanent disability persisted. The causative role of the skin traction is proven by the fact that in one infant, the compartment syndrome developed in the non-fractured limb. Cautious application of skin traction, conscientious observation, immediate diagnosis, and aggressive treatment of threatening compartment syndromes will prevent these tragic complications.

Anterior Compartment Syndrome↗

PubMed1996

Age-related factors in the pathogenesis of senile (Type II) femoral neck fractures.

A variety of age-related factors may affect the two ultimate determinants of hip fracture: propensity to trauma and femoral bone quality. The decline in muscle function that occurs with aging increases the incidence and impact of falls. Vitamin D deficiency, common in the elderly, causes impaired mineralization and a hyper-parathyroidism-related increase in bone turnover, reducing bone quality. Skeletal growth factors, essential regulators of bone-cell replication and differentiation, may mediate the maintenance of normal bone mass; the age-related deficiency of these factors may contribute to senile osteoporosis as well. In elderly women, these age-related factors add to estrogen-deficiency-related bone loss, leading to a lifetime risk of hip fracture of approximately 16%. The relative clinical importance of these potential pathogenetic factors remains to be elucidated.

Accidental Falls↗

PubMed1995

Age-related bone loss and senile osteoporosis: evidence for both secondary hyperparathyroidism and skeletal growth factor deficiency in the elderly.

Aging is characterized by a decrease in bone volume, implying that net bone resorption exceeds net bone formation. This age-related bone loss can be regarded as the main determinant of hip fracture risk in the elderly. In the concept of senile osteoporosis, a key role has been attributed to vitamin D deficiency. Lack of vitamin D activity may affect femoral strength through impaired mineralization as well as through a hyperparathyroidism-mediated increase in bone resorption. In addition to vitamin D-related mechanisms, recent evidence has indicated a decline in the skeletal content of anabolic growth factors--such as insulin-like growth factor-I (IGF-I)--in femoral (cortical) bone, suggesting that skeletal growth factor deficiency may contribute to the age-related bone loss in the proximal femur as well. It is tempting to speculate that skeletal IGF-I loss might, at least partially, be accounted for by growth hormone deficiency. However, critical evidence does not yet support the concept that the decreased activity of the growth hormone-IGF-I-axis alters bone remodeling, and the extent to which serum concentrations of growth factors are reflective of skeletal activity remains to be clarified.

Aged↗

PubMed1995

Severe liver rupture and tricuspid valve rupture in a patient with multiple trauma.

A patient with a severe liver injury and an acute cardiac failure due to a traumatic tricuspid valve failure is presented. During liver surgery, massive venous bleeding was caused by regurgitation of blood through the insufficient tricuspid valve. Right ventricular failure, leading to persistent hemodynamic instability, and caused by massive posttraumatic tricuspid regurgitation, has been treated with biological valve replacement. Diagnosis and management of posttraumatic tricuspid insufficiency are discussed.

Accidents, Traffic↗