Osteolysis after open shoulder stabilization using a new bio-resorbable bone anchor: a prospective, non-randomized clinical trial.
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Absorbable Implants↗
Biomedical subjects
P Holzach
Publications and source records attributed to P Holzach.
Fulkerson's modified Elmslie-Trillat procedure for objective patellar instability and patellofemoral pain syndrome.
Twenty two knees were either operated for objective patellar instability (Group A: 14 patients) or patellofemoral pain syndrome (Group B: 8 patients) using Fulkerson's modified Elmslie-Trillat procedure. The objective of this retrospective study was to evaluate the results of this method and to detect whether or not there were differences in the outcome comparing the two groups. Twenty knee joints (Group A: 13; group B: 7) were available for clinical and radiographic examination after an overall mean follow-up of 63 months. Duration of pre- and postoperative physical therapy was significantly longer for group B, the activity level increased significantly for these patients and the Q-angle could be corrected significantly in this group comparing pre- and postoperative values. The overall outcome (Turba score) detected no statistically significant difference between the groups, only good and excellent results were obtained. No signs of osteoarthritis were found radiologically. A pathological patellar congruence angle could be corrected significantly by this method. We conclude that Fulkerson's modified Elmslie-Trillat operation is an excellent treatment method with a very low morbidity for patients with patellofemoral malalignment after failed conservative treatment.
Adolescent↗
[Arthroscopic repair of the medial retinaculum after first time dislocation of the patella].
Between March 1994 and December 1997, an arthroscopic repair of the medial retinaculum after first time dislocation of the patella was performed 38 times in 34 patients. The operative technique is being described as well as the results after an average follow-up of 25 months in 31 cases. In the group with radiologically determined predisposing factors (n = 20) as many osteochondral flakes were found as in the group without these factors, but there were significantly less chondral lesions on the lateral femoral condyle and the medial patellar facet. There were no complications during hospitalization, although in 3 (10%) cases a redislocation occurred during follow-up. According to the subjective Turba Score, 84% of the patients showed a good or very good, and 16% a fair result, including cases with redislocation. The arthroscopic repair of the medial retinaculum after first time patellar dislocation is a minimal invasive method with very low peri- and postoperative morbidity. The redislocation rate can be reduced to at least 50% compared to the published data on conservative treatment.
Adolescent↗
[Isolated coracoid fracture--open reposition and osteosynthesis--report of 3 cases].
UNLABELLED: Usually coracoid-fractures are "chain-injuries" in association with complex shoulder injuries. Isolated fractures of the coracoid process are uncommon. In the literature there is no consensus about the treatment. The conservative method is generally advocated. For better recognizing the particularities of coracoid-anatomy and fracture-analysis we performed dissections on cadaver shoulders and also evaluated a useful radiologic technique for diagnosis. Between 1995 and 1997 three patients with isolated displaced coracoid-fractures had open surgical repair. The postoperative course was very good in all three cases with complete recovery of shoulder function. DISCUSSION: We believe that isolated coracoid-fractures with infero-lateral dislocation and loss of function should sustain open reduction and internal fixation with functional after treatment.
Adolescent↗
Arthroscopically assisted treatment of lateral tibial plateau fractures in skiers: use of a cannulated reduction system.
A prospective study was performed on 16 patients with lateral tibial plateau fractures. All injuries were associated with alpine or cross-country skiing. Included in the study were those patients with an articular surface depression of > or = 2 mm with radiographic findings consistent with the AO/ASIF classification of tibial plateau fractures (41 B2.2/B3.1). A combined procedure was performed with arthroscopic visualization of the knee joint and utilization of a cannulated plateau elevator. All fractures were reduced with this device with subsequent autogenous bone graft and, when indicated, transverse cancellous lag screw fixation. Follow-up was 1-6.5 years for the 16 patients, with all but two reporting resumption of activity to preinjury levels.
Adult↗
[Epidemiology of internal knee injuries in Alpine skiing].
The incidence of sport injuries in Switzerland is twice as high compared to traffic injuries. Soccer and alpine skiing play the most important role in sport injuries. For the last twenty winter seasons all winter sport injuries were analysed at the hospital of Davos. About 85% are injuries caused by alpine skiing resulting in a total of 24,684 for the last twenty years. There is a great decline in the incidence of lower leg fractures with a contrary development of knee injuries. The treatment-quotient (amount of knee injuries in alpine skiers per 10(4) kilometers of vertical drop skied) has increased over the last seasons. Nowadays one part of four skiing injuries is an injury of the knee ligaments. In skiing areas favored by beginners, we have observed an incidence of knee ligament injuries three times as high compared to other areas. Since 1986 we have evaluated 206 patients operated for knee ligament injuries, 44% with unidirectional and 56% with multidirectional instabilities. We report about the preoperative data.
Adolescent↗
[Skier's thumb injury in the child].
Acute rupture of the ulnar collateral ligament (UCL) of the metacarpophalangeal joint of the thumb (skier's thumb) is a common skiing injury in adults. Do we find this injury in children? Of the 302 skier's thumbs during the last 4 years we found 24 (8%) injuries in children (mean age 13.4 years) with open growth plates. They had the following diagnosis and consecutive treatment: 5 partial ruptures of the UCL, 3 Salter I and 6 Salter II fractures with radial fragment of the proximal phalanx I; all these had conservative treatment. In addition one had a Salter III fracture with open reduction and fixation, 6 avulsion fractures, which were treated twice operatively and 4x conservatively and 3 ruptures of the ligament which needed reconstruction. Supposing the trauma mechanism in adults, we see a different, age-dependent injury pattern in children. The younger had Salter-I- and Salter-II-lesions of the proximal phalanx, where as the adolescents showed avulsion fractures and ruptures of the UCL as seen in adults. The follow-up of 17 cases minimally 1 year after the accident showed in 12 a full recovery, in 4 cases small subjective symptoms but full function and in 1 case an ankylosis of the MCP-joint following a postoperative infection.
Adolescent↗
[Preoperative arthroscopy in fresh complicated internal knee lesions].
In a prospective study, 197 preoperative arthroscopies were carried out on 194 patients with fresh severe internal lesions of the knee. The injuries are analyzed, with reference in particular to diagnosis and treatment of additional meniscus lesions. Advantages and disadvantages of the procedure are discussed.
Adolescent↗
[Special positioning aids in fractures and dislocations of the spine].
Early recognition of spine injuries is of outmost importance. In the case of suspected fractures and in all severe skull injuries, a careful approach and careful positioning of the injured patient is mandatory. Immobilization of the spine is the prime concern during transportation of trauma patients to prevent neurologic compromise. We prefer the supine position on a stable support. In the case of cervical spine injury, immobilisation with a cervical collar in extension is necessary. Definitive transportation should be performed on a vacuum mattress supported by a scoop-stretcher. In fractures of the thoraco-lumbar spine, a lordotic support with a soft pillow is recommended.
Athletic Injuries↗
[Preoperative arthroscopy immediately before reconstruction of internal knee injuries].
With reference to a prospective study 197 preoperative arthroscopies were carried out on 194 patients with fresh severe knee injuries. The injuries are analysed, in particular for diagnosis and treatment of additional meniscus lesions. Advantages and disadvantages of the procedure are discussed.
Adolescent↗
[Meniscus ultrasound--a reliable way for diagnosis of meniscus lesions?].
Controversies exists about the value of sosgraphy in diagnosis of meniscal injuries. We therefore examined 179 knee joints. In a prospective study of 177 patients with knee problems, ultrasound was utilized to assess its values as a screening tool for meniscal tears. Prior to the arthroscopy the menisci were scanned from an independent team by using 7.5 and 10.0 MHz ultra-sound waves. 113 meniscal tears were seen at arthroscopy; 22% of these tears could not be detected by scanning (false negative results) while 10% of intact menisci showed positive echogenic structures analysed as meniscal tears. The results showed a sensitivity of 30.0% and a specificity of 85.3%. We cannot share the opinion of some autors that ultrasound is a reliable means of accurately diagnosing meniscal tears. It seems that ultrasound scanning of the menisci is still a experimental method without any clinical importance.
Adolescent↗
[Epidemiology, treatment and follow-up of acute ligamentous knee injuries in Alpine skiing].
In Switzerland the incidence of sport injuries is twice as high as traffic injuries. Soccer and alpine skiing are the major reasons for such injuries. Nowadays one out of four skiing injuries is an injury of the knee ligaments. Especially in skiing areas favored by beginners, we observed an incidence of knee ligament injuries three times as high compared to other areas. Since 1986 we evaluated 206 patients which were operated for knee ligament injuries. In 44% the direction of instability was unidirectional, most of them in the anterior direction. 115 patients had combined instabilities, 86% of those were anteromedial. 179 patients (87%) were followed up for at least 20 months. The knee was evaluated with the scoring system of the OAK (Orthopädische Arbeitsgruppe Knie der Schweizerischen Gesellschaft für Orthopädie) and judged by four criterias (pain/swelling; movement/force; stability and function). As expected, unidirectional instabilities show better results than multidirectional. The mean value of the total score for isolated medial collateral injuries was 95.3 of 100, for isolated anterior instabilities 90.4 and for combined antero-medial instabilities 86.7 Altogether 2/3 of the patients showed very good results in stability but, 4/5 showed good results in function, so 4/5 of the patients and their physicians considered the final result as good to very good and 2/3 of those patients are back to sports, only two percent do no more sports at all.
Adult↗
[Arthroscopically guided osteosynthesis of lateral tibial plateau fractures].
A prospective study was performed on 16 patients with lateral tibial plateau fractures. All injuries were associated with alpine or cross country skiing. Included in the study were those patients with a 2 mm or greater articular surface depression with radiographic findings consistent with the AO/ASIF classification of tibial plateau fractures, 41 B2.2./B3.1. A combined procedure was performed with arthroscopic visualization of the knee joint and utilization of a cannulated plateau elevator. All fractures were reduced with this device with subsequent autogenous bonegraft and when indicated, transverse cancellous lag screw fixation. Followup was from 1 to 6.5 years for the 15 patients with all but two reporting resumption of activity to pre-injury levels.
Adult↗
[Traumatic hip dislocations. Epidemiologic data at Davos Hospital and a multicenter study in Graubünden Canton].
We report about 86 patients with traumatic dislocation of the hip. Group 1 consisted of 26 patients of the hospital of Davos, group 2 of 60 patients of a multi-center evaluation of 7 hospitals in the Kanton Graubünden. 53 were males and 33 females. 13 patients were 16 years old or younger, of these 5 below 10 years. 69% are injuries in sports, 66% in alpine skiing. 78 had a posterior, 5 an anterior and 3 central dislocation with a fracture of the floor of the acetabulum. Concomitant local injuries were seen in 76.9% of traffic accidents and only in 22% of skiing injuries. Closed reduction was performed in 81 patients on the average less than two hours after injury, in 5 cases an open reduction was necessary. The subsequent treatment was in 15 cases operative, consisting in reconstruction of the concomitant injuries.
Adolescent↗
[Analgesic-free self-reduction of acute shoulder dislocation].
Incidence and severity of shoulder lesions are increasing especially in alpine skiing accidents. In case of a shoulder dislocation there is always the question of a safe and atraumatic reduction technique if possible without analgetics or even general anesthesia. We present a new reduction technique with the help of the patient's own body weight under muscular relaxation. Even in the presence of displaced fractures of the greater tuberosity or a depression fracture of the humeral head successful reductions were obtained. After the reduction, the arm is immobilized in a Gilet. The patient is able to leave immediately after a radiographic control. We have been using this method for some years with a primary success rate of about 60 per cent.
Adult↗
[Skier's thumb injury in the child].
Acute rupture of the ulnar collateral ligament (UCL) of the metacarpophalangeal joint of the thumb (skier's thumb) is a common skiing injury in adults. Do we find this injury in children? Of the 302 skier's thumbs during the last 4 years we found 24 (8%) injuries in children (mean age 13.4 years) with open growth plates: 5 partial ruptures of the UCL, 3 Salter I and 6 Salter II fractures with a radial fragment of the proximal phalanx I; all these had conservative treatment. In addition one had a Salter II fracture with open reduction and fixation, 6 avulsion fractures which were treated twice operatively and 4 times conservatively and 3 ruptures of the ligament which needed reconstruction. In contrast to adults, we see a different, age dependent injury pattern in children. The younger had Salter-I- and II-lesions of the proximal phalanx, whereas the adolescents showed avulsion fractures and ruptures of the UCL as seen in adults. The follow-up of 17 patients one year after the accident showed in 12 a full recovery, in 4 cases full function with minor complaints and in one case an ancylosis of the MCP-joint following a postoperative infection.
Adolescent↗
[Complex internal knee lesions--diagnosis, indications and timing].
Ligamentous knee injuries are nowadays more often seen in the office of the family physician, mainly because of an increase in recreational sports injuries. With the help of a questionnaire one can obtain a reliable impression of the injury pattern. The clinical examination is performed in a standardized way, so even in acute ligamentous injuries a correct diagnosis can be obtained at the first examination. The diagnosis of an instability is made with an accurate clinical examination; in case of marginal cooperation of the patient the examination is performed under anesthesia. Depending on the findings, the definitive operation will follow at the same time. In case of a big hemarthrosis we recommend an a.-p. and a lateral X-ray of the knee joint for exclusion of a bony injury before proceeding with the clinical examination. An arthroscopy is indicated in effusions of unclear origin, in the suspicion of meniscal or cartilaginous damage, in a stable knee with hemarthrosis and before definitive stabilization of complex injuries to exclude further damage to other intraarticular structures. Acute ACL ruptures are only operated on in case of bony avulsion fractures, in persons very active in sport and in case of relevant concomitant injuries. Medical collateral injuries without an ACL rupture are usually treated conservatively, except if there is an additional peripheral tear of the meniscus. PCL injuries are seldom operated, except if there is a complex concomitant instability. We aim for an early reconstruction within two weeks after the accident.
Diagnostic Imaging↗
[A new self-repositioning technique for fresh, anterior-lower shoulder dislocation].
In case of a shoulder dislocation there is always a question of a safe and atraumatic reduction technique if possible without analgetics or even general anesthesia. The dislocated humeral head is reduced anatomically with the help of the patient's own body weight under muscular relaxation without injuring manipulations. Even with displaced fractures of the greater tuberosity or an impression fracture of the humeral head successful reductions were obtained. We have been using this method for over three years with a primary success rate of over 60%.
Humans↗