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Biomedical subjects

P Broos

Publications and source records attributed to P Broos.

At least 73 records · Page 4Linked to original sources
PubMed1980

Lymphatic complications in renal transplantation.

Lymphocele and lymphatic fistulae are relatively benign complications in renal transplantation. The incidence in our series of 248 renal transplants was 8%. The origin and pathogenesis of lymph collection and augmented lymph flow are discussed. The main importance of this complication lies in its differential diagnosis with urinary fistula and acute rejection episode or deep phlebothrombosis with all its therapeutic implications. Important lymph accumulations should be drained. We prefer as initial treatment a percutaneous closed aspiration which most successfully solves the problem. In case this method should fail, one can choose between external or internal drainage. As in literature, we actually prefer an internal marsupialisation, but completed by an omentoplasty if the leakage originates from the kidney.

Adolescent↗
PubMedDate not supplied

The operative treatment of unstable pelvic ring fractures.

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 July 1989, 44 patients with an unstable lesion, type B or type C in Tile's classification have been treated in the University Hospital Gasthuisberg of the Katholieke Universiteit Leuven. In 28 cases, primary stabilisation was done by means of an external fixator, "Monofixateur" type. The overall mortality rate was less than 7%. Thirty-five patients could be seen for follow-up six months to three 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 lesion (p < 0.05). The external fixator, used in the immediate post injury period provides an effective splint that reduces bleedings 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 patho-anatomy by means of a CT-scan has to be performed in selected areas.

Adult↗
PubMedDate not supplied

[Functional results following the surgical treatment of unstable pelvic girdle fractures].

Unstable pelvic ring fractures, during the first days post-trauma, are potentially life-threatening lesions. In the long term, these lesions can lead to important functional deficits. 44 patients with an unstable pelvic ring fracture were included in this study. 35 of which were reevaluated after an average of 19 months. It is demonstrated that a rapid stabilisation of the pelvic ring fracture decreases the mortality and that after surgical intervention, the M. Tile Fracture Classification is of prognostically significant value with respect to the functional outcome. Type B fractures, which are only rotationally unstable, have a better final functional result compared with the Type C fractures with rotational and vertical instability. There exists a significant difference between the two groups.

Adolescent↗
PubMedDate not supplied

[Aseptic pseudarthrosis of the tibial shaft: cause and treatment].

A consecutive series of 23 aseptic pseudarthroses of the tibial shaft is proposed. The aetiology of a pseudarthrosis of the tibia depends on the original fracture form, the associated soft tissue injury, the treatment technique and the surgical procedure. Twelve times the pseudarthrosis developed after a primary treatment with an external fixation device, 6 times after plaster cast immobilization, and 5 times after plate osteosynthesis. Fifteen times, the pseudarthrosis was hypertrophic, and 8 times hypotrophic. Sixteen pseudarthroses were treated with a plate osteosynthesis, 8 times in combination with a decortication and a cancellous bone grafting. Seven times, a closed intramedullary nailing was performed. Healing was achieved after an average time of 5.1 month. After plaster cast immobilization and external fixation treatment, the non-union is caused by a lack of stability in the fracture region; after plate osteosynthesis by a too extensive decortication, resulting in fragment necrosis. Stability and vitality in the fracture site are the principles in the treatment of the pseudarthrosis.

Adult↗
PubMedDate not supplied

[Specific problems in the management of segmental fractures of the tibial shaft].

Specific problems in the treatment of the segmental fracture of the tibial shaft. The management, the postoperative problems and the functional results of 40 patients with 41 segmental fractures of the tibial shaft were reviewed. 63.4% of the fractures were open and 75% of the patients had one or more associated lesions. All fractures were treated operatively: 23 (56.1%) with a single or double plate osteosynthesis and 18 (43.9%) with an external fixator. 37 fractures could be followed-up until bony consolidation. The postoperative problems of each stabilization method are discussed. A pseudarthrosis is seen in 18.9% and a deep infection in 10.8% of the patients. A good functional result could be obtained in 78.4%. The segmental fracture of the tibial shaft is connected with specific biomechanical and fracture healing problems. The vascularization of the intermediate fragment is severely disturbed by the trauma itself and may surely not be endangered secondarily by the operative procedure.

Adult↗
PubMedDate not supplied

Treatment of unstable, intracapsular fractures of the femoral neck by the cementless self-locking cephalic endoprosthesis.

Between July 1981 and July 1986, 152 patients with an unstable, intracapsular fracture of the femoral neck were treated with a prosthetic replacement. In a selected group of 75 very old individuals, with an average age of 82 years, a self-locking cephalic endoprosthesis was chosen. These patients were closely followed prospectively, during 3 months. The operative technique, the pre- and postoperative management are discussed. There was no peroperative mortality. The postoperative mortality rate (30 days) was very low (5.3%). Accidental fracture of the proximal femoral shaft occurred twice, during insertion of the prosthesis. No postoperative luxation was seen. The walking capacity of the survivors, 3 months after surgery, was compared with the status before injury. The self-locking cephalic endoprosthesis is a safe and time-economizing operative procedure. In our opinion, it is the treatment of choice for unstable, medial neck fractures of the femur in elderly patients, with a poor general condition and a limited life expectancy.

Aged↗
PubMedDate not supplied

The operative treatment of humeral shaft fractures.

Although conservative treatment is still the treatment of choice in simple humeral shaft fractures, there are some distinct indications for operative stabilisation, namely association with other injuries or conditions aggravating the traumatic impact of the in itself banal fracture. These indications are discussed and our 41 operatively treated humeral shaft fractures are reviewed.

Adolescent↗
PubMedDate not supplied

[The treatment of chronic osteitis using genta-PMMA chains].

Disulphine blue vital staining, cancellous bone grafts to Papineau and local implantation of genta-PMMA-chains are new procedures in treatment of chronic osteitis. Between May 1978 and December 1984 a total of 24 patients underwent surgery for osteitis. The mean follow up was 25 months (range 17 m. and 35 m.). Good results were obtained in 70.8% (17/24).

Adolescent↗
PubMedDate not supplied

A plate osteosynthesis for femoral shaft fractures in adults.

Between 1978 and 1982 154 femoral shaft fractures were treated in 145 adults in our department of general surgery and traumatology. 52 fractures were nailed intramedullary. We reserved the intramedullary nailing for ideal cases like the transverse and the short oblique fractures in the middle 3/5 of the shaft. 102 fractures were treated by a dynamic compression plate applying the AO principles correctly. Condylar plates were not included in this study. 88 patients with 95 FSF were followed up. In our prospective study a significant relationship was found between the types of fractures, the consolidation, the rehabilitation (including walking), the hospitalisation time and the full weight-bearing results. The prognosis for simple fractures was better than for comminuted fractures. Polytrauma patients showed a significantly slower limb rehabilitation, a longer hospitalisation and a worse clinical result than patients with isolated fractures. A significant relationship was shown between the mobility of the knee and the localisation of the fracture. In the beginning of our study we thought a delayed osteosynthesis (1-2 weeks) should lead to a faster consolidation but afterwards we didn't notice any significant difference with the early operation. General complications were restricted to one fat embolism. Important bone shortening (greater than or equal to 2 cm) was only measured 4 times (4.2%). Distinct rotation or angulation deformities were not observed. Bone infection occurred twice (2.1%). All but two of the 9 comminuted fractures healed within a year in spite of an initial delayed union.

Adult↗
PubMedDate not supplied

The operative treatment of tibial shaft fractures: a review of 277 cases.

From 1978 to 1982 two hundred and seventy seven consecutive fractures of the tibial shaft were treated in our centre of traumatic surgery. One hundred and fifty-three were closed fractures and one hundred and twenty-four open. Seven required amputations, eleven patients died to associated lesions. Twenty-one patients did not show up for the follow-up. The remainder two hundred and thirty-eight patients were followed-up for an average time of nineteen months. In the closed fractures the rate of deep infection was 0.74 percent and the rate of non-union was 1.48 percent. In the open fractures the rate of deep infection was 5.7 percent. The end results were good in more than 90 percent of the closed and in more than 80 percent of the open fractures.

Adolescent↗
PubMedDate not supplied

[Aseptic pseudoarthroses of the long bones].

When treating fractures, whether by closed or open technique, the event of a pseudarthrosis is always a threatening complication. Absolute immobilization of the fracture site and tissue viability are the two essential conditions to obtain ossification of a pseudarthrosis. Consequently, after a reasonable period of conservative therapy, consolidation can best be obtained by osteosynthesis associated with decortication and/or cancellous bone grafting. The application of the two biomechanical laws is demonstrated in our series of 32 cases with pseudarthrosis.

Adolescent↗
PubMedDate not supplied

[Traumatic rupture of the diaphragm: a diagnostic problem].

About 5% of the heavy abdominal traumas present a traumatic diaphragm rupture (14). A correct diagnosis of such a rupture is usually not obvious. A collective review by Alivisatos concluded that only 1/3 of the diaphragm ruptures was recognized within the first 24 hours (2). In the department of general surgery of the academic hospitals St-Raphaël and St-Pieter, 38 cases were seen during the last ten years (1970-1980). The diagnosis was made within the first 24 hours (pre- or peroperatively) in 28 cases. In 34 cases, diagnosis was achieved within a week of time and in 36 cases within a year. In only 2 of the cases it was achieved after 1 years time. In this paper two points are especially emphasized, first why a correct diagnosis sometimes is so difficult to reach and second which dangers can result from an unseen diaphragm tear. These points of interest are illustrated by a few remarkables case.

Abdominal Injuries↗
PubMedDate not supplied

Primary arthrodesis of the injured knee: still a solution in 1995? A case report.

After major trauma of the knee joint, conservation and reconstruction of the different bony, ligamentary and soft tissue structures is usually attempted. The end results of these reconstructive procedures are not always gratifying, and in many cases significant instability remains, combined with severe restriction in motion, pain or infectious problems, leading to severe functional impairment. Many patients need secondary corrective procedures, such as arthrodesis. We present a case of an unusual injury to the knee with massive destruction, loss, and contamination of bony, ligamentary, and soft tissue structures. Because attempts at reconstruction would have led to the above-mentioned problems, including possible life-threatening septic complications necessitating amputation, a primary arthrodesis was performed, followed by simple reconstruction of the soft tissue envelope. Two years after the accident, the patient is doing very well. To our knowledge, no such cases have previously been described. We therefore want to communicate our experience with this procedure, which led to an early, pain free, and good functional recovery.

Adult↗