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Biomedical subjects

P Broos

Publications and source records attributed to P Broos.

At least 55 records · Page 3Linked to original sources
PubMed1995

A review on 161 subtrochanteric fractures--risk factors influencing outcome: age, fracture pattern and fracture level.

The results obtained in 161 subtrochanteric fractures of the femur following treatment with a 95 degrees condylar blade plate or a dynamic condylar screw or a gamma nail were retrospectively analyzed. A 95 degrees angular blade plate was used in 107 cases, a dynamic condylar screw in 25, and a gamma nail in 29. There were 114 patients who were admitted after a simple fall and 47 who had sustained a high-energy trauma. In the type of trauma, associated lesions, ISS, pre-existing diseases and finally age we found statistically significant difference (P < 0.001) between patients admitted after a simple fall and patients admitted after a high-energy trauma. The mean operating times for the 95 degrees angled blade plate, the dynamic condylar screw and the gamma nail were 86, 85 and 74 min, respectively. Of the 161 patients, 18 required a revision operation. Of these 18 patients, 8 were initially treated using a 95 degrees condylar blade plate, 2 with a dynamic condylar screw and finally 8 with insertion of a gamma nail; 5 of these patients were less than 70 years old, while the other 13 were older than 70 years (P = 0.025; Fisher's exact test P = 0.042). The post-injury roentgenogram showed a fracture at the level of the lesser trochanter in 11 of the patients older than 50 years (P = 0.017; Fisher exact P = 0.053). Among the 18 patients who underwent revision operations, the post-injury roentgenograms showed 6 type IIIA fractures and 5 type V fractures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

[Three-dimensional imaging of acetabular fractures using spiral CT].

Seven adult patients with acetabular fractures were investigated with conventional X-rays, axial spiral computed tomographic (CT) images and three-dimensional (3D) surface rendered reconstructions. Spiral CT has the advantage that it acquires the data much faster than incremental CT, resulting in less motion artefacts. A semi-automatic three-dimensional environment for segmentation has been developed in our institution. It created significant reduction of user interaction and improved visualization of acetabular and femoral joint surfaces. The main advantages of three-dimensional visualization of acetabular fractures included: creation of unlimited and unique views by which fracture location, fracture extension, fragment shape and fragment position became more clear, better visualization of acetabular dome and quadrilateral plate and more simple and easier interpretation of these complex fracture patterns. On the other hand, 3D surface reconstructions do not accurately demonstrate undisplaced fractures, intra-articular fragments may be obscured, congruence assessment is uneasy, and soft tissue injuries are not shown. Therefore, we consider 3D images of acetabular fractures as being complementary to and not a substitute to plain radiographs and axial CT scans.

Acetabulum↗
PubMed1994

Prospective study of 713 below-knee amputations for ischaemia and the effect of a prostacyclin analogue on healing. Hawaii Study Group.

In 51 hospitals in six European countries 713 patients requiring below-knee amputation for ischaemic disease were studied prospectively. The patients were allocated randomly to receive standard postoperative treatment or standard treatment plus intravenous infusion of the prostacyclin analogue iloprost for 6 h per day over 14-21 days. Healing of the amputation stump and the need for reamputation at a higher level were similar in the two groups. Overall at 3 months 59 per cent of stumps had healed, 19 per cent of patients had required reamputation at a higher level, 11 per cent had died and the remaining 11 per cent remained with unhealed stumps. Preoperative characteristics were analysed as possible risk factors or markers for primary healing, reamputation and death. Previous arterial reopening procedures (surgical or radiological) almost doubled the chances of primary stump healing (P < 0.05). The surgeon's assessment of the likelihood of healing was wrong in 21 per cent of cases in which the operating surgeon thought that healing would probably occur and in 52 per cent of those in which it was thought healing was improbable.

Adult↗
PubMed1994

Neurological outcome after surgery for thoracolumbar fractures. A retrospective study of 93 consecutive cases, treated with dorsal instrumentation.

Surgical reconstruction and fusion form the treatment of choice for unstable thoracolumbar fractures. It remains difficult, however, to prove that surgical treatment provides an increased potential for neurological recovery. Also, the role of a decompressive laminectomy is still unclear. To address these issues, 93 consecutive cases of thoracolumbar fractures treated with dorsal instrumentation were reviewed. The neurological status at the time of admission and at a mean of 26 months postinjury was graded according to a modified Frankel scale. By using preoperative radiographs and computed tomography scans, we differentiated between fracture-dislocation lesions, dislocation lesions, flexion-distraction lesions, complete and incomplete burst fractures. Spinal stenosis was classified from grade 0 (no stenosis) to grade 3 (> 66% stenosis). All thoracolumbar fractures were treated with posterior instrumentation, using Dick's fixateur interne and Steffee's VSP plates and screws. During this procedure, laminectomy was performed in 33 patients (35%). In 17 cases (52% of the laminectomies), a surgically treatable lesion (dural tear, trapped nerve root, etc.) was found, especially in patients with a combination of a neurological deficit and a dislocation lesion, a fracture-dislocation lesion or a complete burst fracture with spinal stenosis grade 2 or 3. The neurological and functional outcome was excellent: none of the patients deteriorated, 68% made a complete neurological recovery, and 61% regained their previous level of activity.

Adult↗
PubMed1994

Primary arthrodesis of the injured knee: still a solution in 1994?--case report.

We describe a case of a major trauma to a knee joint with extensive destruction of soft tissues, ligamentary structures, and bone loss. Although in extensive trauma of the knee, conservation and reconstruction of the joint structures is usually attempted, the massive destruction and gross contamination in this case prompted us to perform a primary arthrodesis in order to avoid life-threatening complications and to obtain early functional recuperation of the involved limb.

Accidents, Occupational↗
PubMed1994

Hip arthroplasty for failed internal fixation of intertrochanteric and subtrochanteric fractures in the elderly patient.

Failure of internal fixation in hip fractures can lead to difficult problems, especially in elderly patients. At the intertrochanteric or subtrochanteric level a prosthesis with diaphyseal support is one of the solutions to this problem. In 12 patients an endoprosthesis was performed for failed internal fixation. The mean age at the time of initial fracture fixation was 79 years (range: 61 to 94 years). The mean time from initial fracture fixation to failure and salvage by an endoprosthesis was 6 months (range: 5 days to 19 months). Eleven patients could be reviewed clinically and radiographically after a mean follow-up time of 32 months (range: 4 months to 7 years). The functional results were satisfactory considering the age of the patients. The current series shows that endoprosthesis might be considered as a valuable method in the salvage treatment of failed internal fixation of a subtrochanteric or intertrochanteric hip fracture.

Aged↗
PubMed1993

Transepiphysial fixation of anterior cruciate avulsion in a child. Report of a complication and review of the literature.

An avulsion of the anterior cruciate of an 11 year old girl was internally fixed with a transepiphysial screw. Two years later, anterior epiphysiodesis was evident, causing hyperextension of the knee. To avoid this complication, we recommend early removal of transepiphysial metalwork in children. Arthroscopical intrafocal fixation is proposed as a safe alternative.

Anterior Cruciate Ligament↗
PubMed1993

Surgical treatment of metastatic fracture of the femur improvement of quality of life.

Radiotherapy and chemotherapy will result in an increase in the number of pathological fractures that occur, principally as a consequence of metastatic disease. Especially at the level of the femur, these lesions are painful and are apt to make the patient invalid. Aggressive surgery is often the only possible treatment for such patients, who in many cases may live on for several weeks, months or years. Contra-indications, however are: a survival expectancy of less than 4 weeks, a poor general condition that is an obstacle to a safe operation, or complete mental deterioration. If possible, internal fixation should be performed prophylactically before the real fracture occurs. From January 1980 to December 1990, 65 patients (53 women and 12 men) with 77 pathological fractures of the femur were operated on in the department of traumatology and emergency surgery of the Leuven University Hospital. The average age was 65 years. Metastatic spread from breast cancer was by far the most frequent pathology (75%). Sixty fractures out of the 77 (78%) occurred at the level of the proximal end of the femur in 29 cases (38%) the fracture was in the subtrochanteric region. In 6 cases a "prophylactic" osteosynthesis was performed because of an impending fracture. Endoprosthetic surgery was performed in 36 cases (47%). In 41 cases we performed osteosynthesis: 34 times a compound double-plate fixation, 5 times a gamma nail, 2 times an interlocking nail. Fourty-six patients (71%) obtained very reasonable functional results: they were able to walk again independently or with the help of sticks and crutches.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1993

Displaced fracture of the lunate in a child.

This is a report of an additional case of transverse fracture of the lunate with marked displacement, requiring open reduction and osteosynthesis. The lunate became necrotic with all features of Kienböck's disease.

Bone Nails↗
PubMed1993

Splenic function after splenic rupture treated with an absorbable mesh.

Overwhelming postsplenectomy sepsis remains a problem despite the introduction of a vaccine and antimicrobial prophylaxis. Removal of the spleen increases the risk of death from overwhelming sepsis to approximately 50 times that in healthy persons. The morbidity and mortality due to infection increase with the extent of associated injuries. Between 1987 and 1991, 24 patients were admitted at the Katholieke Universiteit Leuven for a splenic injury and treated with an absorbable vicryl mesh (woven polyglycolic acid mesh; Polyglactine 910). The injuries to the spleen were classified according to Barrett. Three patients died of severe craniocerebral trauma. A splenectomy was performed in one polytraumatized patient because of rebleeding. The spleen was evaluated in 20 patients after a mean of 20 weeks using 99mTc-denaturated erythrocyte scintigraphy together with tomographies. A type IV injury is a contraindication. All abnormalities on scintigraphy are mainly seen in type III lesions and less in type II and type I lesions. In type IV injury splenectomy and autotransplantation are indicated. Except for type IV lesions, we conclude that a ruptured spleen can be safely treated with a vicryl mesh without great loss of function.

Adolescent↗
PubMed1993

[Internal hemorrhages associated with fractures of the pelvic girdle. Importance of early stabilization using an external fixator].

Pelvic ring injuries due to high-energy forces are among the most serious involving the musculoskeletal system. Life-threatening hemorrhage, local and distant associated injuries, deformity, pain and diminished functional capacity are all potential problems for a patient with a disrupted pelvis. There is a clear correlation between total blood loss, incidence of associated injuries, final functional result and the type of pelvic ring injury. Between January 1987 and December 1990, 66 patients with an unstable lesion, type B or type C in Tie's classification, were treated in the University Hospital Gasthusiberg of the Katholieke Universiteit Leuven. In 42 cases, primary stabilization was achieved by means of an external fixator, of the type "Monofixateur". The overall mortality rate was less than 7%, and 53 patients could be seen for follow-up 6 months to 4 years after injury. Our findings confirm that compared to type B lesions there is a higher incidence of pain, permanent deformity and diminished functional capacity in type C lesions (P < 0.05). The external fixator used in the immediate post-injury period provides an effective splint that reduces bleeding from bone and veins but cannot maintain reduction in lesions with rotational and vertical instability. In these cases, a semi-elective internal fixation, after defining the exact pathoanatomy by means of a CT-scan, should be performed in selected centers.

Activities of Daily Living↗
PubMed1992

Posttraumatic ulnar translation of the carpus. A case report.

A 24-year-old miner sustained wrist trauma in a car accident. The initial radiographs showed a dorsal rim fracture of the radius without any dislocation of the wrist. Fourteen days later, radiography revealed a total ulnar translation of the carpus. Open reduction was performed with a good clinical and radiographic result.

Adult↗
PubMed1992

Acute colonic pseudo-obstruction.

We present two cases of acute colonic pseudo-obstruction, one complicated with perforation. Orthopedic surgery was the pathogenetic factor in both cases. Recovery was successful in both patients after appropriate treatment. The importance of conventional X-ray techniques, and more specially the plain X-ray of the abdomen, is stressed regarding early diagnosis and follow-up.

Aged↗
PubMed1990

[Positive Romberg test and the probability of falls in the aged].

Very little objective data are available on the subject of falling in the elderly. Yet there is an urgent need for simple tests to help identify those patients at risk. The predictive value of the Romberg-test was investigated with a group of 199 inhabitants of four homes for the elderly (76 had fallen three times in a period of six months and 123 never fell in a period of one year). Beside the age factor a positive Romberg-test meant an increased chance of falling. Elderly patients who fell but showed up as negative on the Romberg-test showed a marked tendency to stumble compared with the control group. The Romberg-test is useful in identifying certain specific causes in falling but it is unsuitable for use within a preventative strategy.

Accidental Falls↗
PubMed1989

Intrinsic problems with the external fixation device of Hoffmann-Vidal-Adrey: a critical evaluation of 117 patients with complex tibial shaft fractures.

In the 1978-1986 period, 117 patients with 119 fresh and complex fractures of the lower leg were secured primarily with a Hoffmann-Vidal-Adrey external fixation device. Ninety-five fractures could be followed until bony consolidation. In 12 fractures (12.7%) a pseudarthrosis developed, and a deep infection in four (4.2%). The external fixation device was attached for an average time of 25.0 weeks. Pin loosening was seen in seven patients (7.3%), minor pin-tract infection in nine (9.4%), and major pin-tract infection in three patients (3.1%). Fourteen fractures needed a secondary internal fixation; in 17 other fractures a secondary transplantation of cancellous bone autografts without internal fixation was carried out. After healing of the soft tissues, the tibial fracture can be regarded as a closed one and other therapeutic procedures to accelerate bony consolidation should be taken into account. The advantages and disadvantages of a second internal stabilization should be evaluated for every fracture with bone healing problems. The alteration from external to internal fixation makes an early removal of the external fixator possible and prevents in this way the intrinsic problems combined with this fixation type such as delayed union, nonunion, pin loosening, or pin-tract infection.

Adolescent↗
PubMed1986

External fixation of tibial shaft fractures with severe soft tissue injuries by Hoffmann-Vidal-Adrey osteotaxis.

The operative results in 65 patients with 66 tibial shaft fractures and severe soft tissue injuries, stabilized by an external fixation frame according to Hoffmann or Vidal-Adrey, are reviewed and the treatment principles are discussed. Four patients required secondary amputations. Fifty-three patients could be followed up for an average of 23.2 months. The infection rate was 9.2% and nonunion was found in 11.1% of cases. Two patients had a refracture after removal of the fixation device. Twenty-three patients (42.6%) required one or more secondary operations. Of the 65 patients, 70.4% had very good or good end results, 16.7% acceptable, and 12.9% poor. External fixation according to Hoffmann or Vidal-Adrey affords excellent definitive stabilization in simple fractures of the lower leg with soft tissue injuries. In comminuted fractures of the lower leg with loss of bone fragments and severe tissue damage, external fixation is better used as a means of temporary stabilization until soft tissues permit definitive rigid stabilization.

Accidents, Traffic↗
PubMed1986

[Follow-up results of 102 tibial shaft fractures stabilized by dynamic compression plate osteosynthesis].

From 1978 to 1982, 102 tibial shaft fractures in 100 patients were treated with a dynamic compression plate in our trauma center. Only 61 fractures were operated upon primarily. 84 fractures were followed for an average of 19,8 months. The mean hospital stay was 21.5 days. Postoperative minor would problems were present in ten fractures. The infection rate was 1.2% and non-union developed in 1.2%. In six fractures a second stabilisation was necessary. 88.1% of the patients had a good end result. The plate osteosynthesis of closed and first degree open tibial shaft fractures proved to be a reliable treatment procedure, when it is made by expert surgeons and in accordance with the AO-principles of fracture treatment.

Adolescent↗