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Biomedical subjects

P P Casteleyn

Publications and source records attributed to P P Casteleyn.

At least 19 recordsLinked to original sources
PubMed2001

"Tripolar" hip arthroplasty for failed hip resurfacing: nineteen years follow-up.

The authors describe the case of a 37-year-old patient who sustained a subcapital femoral neck fracture six months after ICLH double-cup hip resurfacing. As the polyethylene acetabular resurfacing component was undamaged and well fixed, a standard femoral stem with a bipolar head was inserted. The outer diameter of the bipolar head was chosen to fit the resurfacing socket. The "tripolar" hip arthroplasty has functioned well for 19 years and was revised for aseptic cup loosening. The cemented femoral stem was still well fixed and was not revised. Although the "tripolar" hip has functioned well in our case, we believe it is not indicated for metal on metal bearings. In this case the use of an appropriate modular head with a correct head-socket clearance is preferred.

Adult↗
PubMed2000

Vanishing distal clavicle after arthroscopic acromioplasty.

Arthroscopic subacromial decompression is gaining wide acceptance. There are several reports on its technique, its limitations, and its efficacy. However, papers describing complications are rare. We describe a case of osteolysis of the distal clavicle after overenthusiastic arthroscopic subacromial decompression.

Acromioclavicular Joint↗
PubMed1999

Management of anterior cruciate ligament lesions: surgical fashion, personal whim or scientific evidence? Study of medium- and long-term results.

The medium- and long-term results of conservative and surgical treatment of ACL lesions were evaluated by analysis of the current literature. Only reports with a minimum follow-up of 4 years were taken into account. Concerning conservative treatment, the literature search revealed only 7 papers with a total of 636 cases. Reports on the results of surgical treatment were separated into four categories: primary repair, with 13 papers (1205 cases), extraarticular tenodesis, with 4 papers (232 cases), ACL reconstruction, with 26 papers (2693 cases) and ACL prosthetic replacement (reconstruction using synthetics) with 5 papers (370 cases). The mean functional scores show about 70% good and excellent results for all treatment regimens. Clinical laxity persists in almost all conservatively treated cases, in almost half of the cases with primary repair, extra-articular tenodesis, and synthetic substitution, and in almost one-third of the cases with ACL reconstruction. The incidence of secondary ACL surgery was lowest in the conservative group (4.6%), whereas secondary meniscus surgery was lowest in the ACL reconstruction group (3.5%). Compared with the conservative group (12%), surgical treatment evolved to a higher osteoarthritic morbidity. Sports participation was higher in the ACL reconstruction group. This analysis may provide a more realistic view on the outcome of treatment of ACL lesions, and on the relationship between treatment, activity level and osteoarthritis.

Anterior Cruciate Ligament↗
PubMed1998

Medium-term results of percutaneous, arthroscopically-assisted osteosynthesis of fractures of the tibial plateau.

We carried out percutaneous, arthroscopically- and fluoroscopically-assisted osteosynthesis of fractures of the tibial plateau in 52 patients, of whom 38 were assessed using the HSS knee score and standing radiographs. We reviewed 31 AO type-B fractures and seven type-C fractures after a mean follow-up of five years (1 to 14). Fixation was achieved using percutaneous screws and/or an external frame; 33 associated intra-articular injuries, diagnosed in 21 out of the 38 patients, were treated arthroscopically. Subjectively, 94.7% of the patients reviewed were satisfied. According to the HSS knee score 78.9% of the results were excellent, 13.2% good, 7.9% fair and none was poor. Narrowing of the joint space was found in 28.9% of the injured and 5.3% of the unaffected knees and axial deviation of 5 degrees to 10 degrees in 15.8% of the injured and 10.5% of the unaffected knees. Of the 52 fractures, reduction was incomplete in one, and in two secondary displacement occurred, of which one required corrective osteotomy. Deep-venous thrombosis occurred in four cases. The technique has proved to be safe but demanding. It facilitates diagnosis and appropriate treatment of associated intra-articular lesions.

Adolescent↗
PubMed1998

Norian SRS cement augmentation in hip fracture treatment. Laboratory and initial clinical results.

Bone quality, initial fracture displacement, severity of fracture comminution, accuracy of fracture reduction, and the placement of the internal fixation device are important factors that affect fixation stability. New high strength cements that are susceptible to remodeling and replacement for fracture fixation may lead to improved clinical outcome in the treatment of hip fractures. Norian SRS is an injectable, fast setting cement that cures in vivo to form an osteoconductive carbonated apatite of high compressive strength (55 MPa) with chemical and physical characteristics similar to the mineral phase of bone. It can be used as a space filling internal fixation device to facilitate the geometric reconstruction, load transfer, and healing of bone with defects and/or fractures in regions of cancellous bone. Furthermore, this cement can improve the mechanical holding strength of conventional fixation devices. Use of this material potentially could improve fracture stability, retain anatomy during fracture healing and improve hip function, thus achieving better clinical outcomes. In vivo animal studies have shown the material's biocompatibility, and cadaveric studies have shown the biomechanical advantage of its use in hip fractures. Initial clinical experience (in 52 femoral neck fractures and 39 intertrochanteric fractures) showed the potential clinical use of this innovative cement in the treatment of hip fractures.

Aged↗
PubMed1998

Objective roentgenologic measurements of the influence of ankle braces on pathologic joint mobility. A comparison of 9 braces.

The stabilizing effect of external support (taping and nine different ankle braces) was tested in a total of 220 functionally unstable ankles. A standard surface EMG controlled stress Roentgen test protocol was used, measuring talar tilt (TT) without support and with tape bandage or brace. Different levels of TT restraining by external support could be identified. Tape bandage and two braces had a highly significant influence on the talar tilt. The mean TT without support was decreased by using from 13.4 degrees to 4.9 degrees, by using one brace to 4.8 degrees and by using another brace to 5.9 degrees. These two braces are effective for protection during functional treatment. A classification into three grades of effectiveness is proposed. It is concluded that the stabilizing influence offered by bandages and braces should be measured before using the external support as a treatment device for acute ankle sprain and as a reliable protection against sprain injuries in daily living and sports.

Activities of Daily Living↗
PubMed1997

Imaging in sports-medicine--knee.

Since the last decade, the introduction of Magnetic Resonance Imaging has provided a powerful new tool for the clinician to diagnose sports-related knee injuries. The main objective of this paper is to familiarise the relevant specialists with the proven clinical indications and semiology of MRI of the knee. At the present time, the knee joint is the area in which the advantages of MRI are most spectacularly apparent. The MR appearances of meniscal tears in particular, are first discussed in detail, referring to recent literature and personal experience based on more than ten thousands MR examinations of traumatic knees. Also the mechanisms of injuries and the most commonly involved sports are described. The precise types of meniscal lesions, as visualised at arthroscopy, are abundantly illustrated on MR images: e.g., bucket-handle, radial and horizontal cleavage tears, meniscocapsular separations, discoid menisci and meniscal cysts. We discuss the numerous pitfalls due to neighbouring anatomical structures as well as non clinically or surgically significant intrameniscal hypersignals in athletes. Towards other imaging techniques, MRI is particularly suited for the diagnosis of ligamentous injuries, especially the cruciate ligaments. We develop the currently used direct and indirect signs of rupture, the diagnostic difficulties related to the age of trauma and the detection of associated lesions. Sport-induced tendinous and bursal pathology is another interesting indication of MRI, not only lesions of the more superficial extensor tendons but also the pes anserinus or hamstring tendons. We finally treat the recent developments of MRI in assessment of cartilage, subchondral and medullary bone disorders of traumatic or microtraumatic origin.

Athletic Injuries↗
PubMed1996

Treatment of isolated distal ulnar shaft fractures with below-elbow plaster cast. A prospective study.

In a prospective study 52 patients with an isolated fracture of the distal ulna were treated with a below-elbow plaster cast. The histories of 46 patients were reviewed after a mean follow-up of 3.5 years (ranging from 10 months to 7 years). Forty-three fractures united. There were two non-unions. One fracture displaced while in the plaster, so that there was no longer any bone contact between the fragments. The fracture was consequently treated by open reduction and internal fixation. The type of fracture, the initial displacement (all fractures had bone contact) or the initial angulation (maximum 10 deg) was not found to influence the final clinical results. Below-elbow plaster cast appeared to produce satisfactory results in 89% of the patients.

Adult↗
PubMed1996

Non-operative management of anterior cruciate ligament injuries in the general population.

The operative treatment of lesions of the anterior cruciate ligament (ACL) in athletes has been widely advocated and performed. We have investigated the outcome of non-operative management in a lower-demand, general population. We reviewed a consecutive group of 228 patients, which excluded professional and high-level athletes, for two to 12 years after an ACL lesion had been diagnosed by arthroscopy. There was a low incidence of secondary ACL and meniscal surgery, 5.4% and 3.5% respectively, and all these procedures were performed during the first three years after the ACL injury. We studied a subgroup of 109 patients with follow-up of at least five years (mean 8.5 years) and evaluated them using the IKDC score. The general outcome was reasonably satisfactory, with 23% in grade A, 50% in grade B, 21% in grade C and only 6.4% in grade D. We found no statistically significant prognostic effect within this group as regards age, activity levels, or the incidence of associated lesions.

Activities of Daily Living↗
PubMed1995

Distraction for ankle arthroscopy.

Distraction has proven to be usefull for arthroscopic visualisation and instrumental access to some ankle pathology. A distraction technique using a single calcaneal pin combined with the installation of the patient on a fracture table is described. The method has already been used by the authors in more than 100 ankle arthroscopy procedures without distraction-related complications.

Ankle Joint↗
PubMed1994

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

Nine elderly patients were treated by salvage hip arthroplasty following failed internal fixation of an intertrochanteric or subtrochanteric hip fracture. The mean age at time of fracture was 79 years (range 67-94 years). The mean interval from initial fracture fixation to conversion arthroplasty was 7 months (range 5 days to 19 months). One 84-year-old patient died 6 weeks postoperatively from a pulmonary infection. The remaining eight patients were assessed clinically and roentgenographically after a mean follow-up period of 41 months (range 4-85 months). The functional results, rated according to the Merle d'Aubigné hip rating scale, were excellent in one patient, very good in four patients, good in two patients, and fair in one patient. Serial roentgenographic analysis showed new bone formation around the extramedullary part of the femoral component in all these patients and bone remodelling of the diaphyseal part of the femur in all patients. The preservation of the functional continuity of the abduction apparatus during surgery and the early walking with full unrestricted weight-bearing made possible by the arthroplasty are considered to be the major contributing factors to these results.

Aged↗
PubMed1994

Primary bipolar arthroplasty or total hip arthroplasty for the treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients.

One hundred independently mobile patients over the age of 75 who had an unstable intertrochanteric or subtrochanteric fracture were treated with primary prosthetic replacement. In all patients a cemented femoral component with diaphyseal support was used. A bipolar arthroplasty was performed in 91 patients and a total hip arthroplasty in 9 patients because of associated coxarthrosis. The functional results according to the Merle d'Aubigné hip rating scale were excellent, very good or good in 78% of the hips. The dislocation rate of 44.5% in the patient group who underwent total hip arthroplasty was significantly higher than the 3.3% in those who had bipolar arthroplasty. Associated with the dislocations was a much higher incidence of pressure sores and pulmonary complications. Adverse effects on the femoral side included 4 cases with progressive loosening of the screws used to fix the greater trochanter to the femoral component, 1 fracture of the distal femur and 1 pseudarthrosis of the bone envelope surrounding the femoral component.

Aged↗
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

The rate of recurrence of traumatic anterior dislocation of the shoulder. A study of 154 cases and a review of the literature.

We have reviewed the history of 154 primary, traumatic dislocations of the shoulder in order to determine the risk of recurrence. We found a recurrence rate of 68% in patients under the age of 20, after a follow-up period of 1-9 years (average 4.5 years). There was a highly significant difference (p < 0.0001) in the recurrence rate of patients under, and above, 30 years of age. Twenty per cent of the patients had a concurrent minor fracture at the shoulder with 2 out of 39 of the recurrent cases (5%) and 29 of the 115 non-recurrent cases (25%); this is also a significant difference (p < 0.01). Neither the need for general anaesthesia at primary injury nor the occupation of the patient was a relevant factor in the final outcome of the dislocation. Four nerve injuries were encountered (3%), with no severe sequelae at follow-up. The young patient with no concurrent fracture at the time of the primary shoulder dislocation has a high risk of recurrence.

Adolescent↗
PubMed1993

Surgical treatment of acute type-V acromioclavicular injuries in athletes.

In a prospective study, 18 consecutive athletes with an acute type-V acromioclavicular sprain were treated with a coracoclavicular repair using a double velour Dacron graft. All patients were reviewed after a mean follow-up period of 6 years (range: 2-9 years). At follow-up, 12 patients (66.7%) showed a good or excellent result according to the Imatani evaluation system, and six patients (33.3%) demonstrated a fair or poor result according to the same system. Loss of reduction was encountered in eight shoulders (44.4%) despite an initial anatomical reduction. No correlation was seen between the overall scores at follow-up and the degree of residual dislocation, between the overall scores and the presence of coracoclavicular calcifications or ossifications, between the overall scores and the development of post-traumatic arthritic changes, or between the overall scores and the presence of osteolysis of the distal clavicle.

Acromioclavicular Joint↗