Biomedical subjects

P Regazzoni

Publications and source records attributed to P Regazzoni.

At least 73 records · Page 4Linked to original sources

PubMed1993

Surgical treatment of humeral shaft fractures--the Basel experience.

One hundred twenty seven patients with fractures of the humeral shaft were treated by open reduction and internal fixation using 4.5-mm dynamic compression plates (DCP). Seventy one osteosyntheses were performed primarily, 36 following attempted closed reduction, and 20 secondarily after a failed conservative treatment of about 8 weeks. A primary radial nerve palsy was present in 19 patients, and appeared subsequently in four additional patients. One hundred two of the 127 patients could be clinically and radiologically examined 1 year after internal fixation: 89 patients (87.3%) had excellent or good results with full functional recovery. Thirteen patients (12.7%) showed a limited range of motion of either the shoulder or elbow or both. This was mostly because of other fractures of the same limb or persistent neurologic impairment. We observed two transitory postoperative nerve palsies, five early failures of internal fixation because of technical errors, two pseudarthroses and four postoperative infections, which healed with one exception by suction drainage and early removal of the plate. We conclude that a correct plate fixation of humeral shaft fractures in a selected group of patients represents an alternative to conservative treatment with the advantage of greater patient comfort.

Adolescent↗

PubMed1993

[The AO universal femur intramedullary nail: problems and their amelioration. Retrospective quality control study of 57 femur shaft fractures].

Today intramedullary nailing is considered the treatment method of choice in fractures of the femoral diaphysis. In this retrospective quality control study 57 femoral fractures treated with the AO-Universal Femoral Nail have been reviewed. The average follow up time was 2.9 years. Intramedullary nailing was done as a primary procedure in 40 cases and in 17 cases as a secondary procedure following various initial operations. The results were evaluated according to the Stromsoe score. 27 of the 40 primary procedures went on to an uneventful healing and showed good to excellent final result. Technical errors (7), non-unions (4) and 1 deep infection required various secondary procedures. Thereafter the final number of good to excellent results amounted to 35 out of 40 patients. In the group with secondary i.m. nailing 9 out of 17 patients showed a good to excellent final result. 2 non unions persisted. In conclusion the AO-Universal Femoral Nail proved to be suited for the treatment of femoral shaft fractures for both primary and secondary procedures. In this series, however, technical imperfections led to a high rate of secondary procedures. Strict observation of the recommended operative technique is therefore mandatory.

Adolescent↗

PubMed1993

[Proximal femoral fractures: trochanteric area (classification 31 A1-A3)].

The increasing incidence of trochanteric fractures renders their treatment a challenging task concerning both medical and increasingly socio-economical questions as well. The majority of these fractures occurs in elderly patients compromised by various preexisting medical problems. The primary goal of treatment therefore has to be early mobilisation to avoid secondary complications. This can only be achieved by operative treatment. Regarding the perioperative management an antibiotic as well as an antithrombotic prophylaxis is advisable. Recent data also suggest to add an enteral nutritional supplement during the postoperative period. The social reintegration depends however primarily upon the rapid restoration of the walking capacity. In this concern the Dynamic Hip Screw (DHS) is an optimal implant for ORIF, since it allows early full weight-bearing and shows a lower complication rate than static implants (e.g. the condylar blade plate).

Aged↗

PubMed1993

[The dynamic hip screw support plate for management of unstable proximal femoral fractures].

The DHS-Implant system is a technically simple and widely used operative treatment modality for pertrochanteric fractures of the femur. In unstable 4 part-fractures rotation of the head and neck fragment around the lag screw and a significant impaction might lead to a lateralisation of the greater trochanter and therefore to an important shortening. To prevent these effects we treated 17 patients with 4 part-fractures with a prototype of a modular trochanteric DHS buttress plate. With this additional implant the lateralisation of the greater trochanter could be prevented in all cases. This also leads to a limitation of the telescoping, with less shortening even with immediate full weight bearing.

Adult↗

PubMed1993

[Initial experiences with the unreamed tibial nail].

During a one-year period starting January 1991, 17 tibial shaft fractures have been treated with the new AO unreamed tibial nail in a prospective study. Fractures were classified according to the AO classification: 10 type A, 6 type B, one type C. 7 fractures were closed. Out of those 3 showed marked soft tissue contusions and 2 required a fasciotomy because of a concomitant compartment syndrome. The open fractures were classified according to the Gustilo classification: 3 grade I, 5 grade II, 1 grade III B and 1 grade III C injury. There were 5 polytraumatised patients (ISS 27-34). The nailing procedure was preformed on the day of admission in 11 cases and in a delayed fashion (2-14 days after the accident) in 6 cases. There were no specific technical problems encountered intraoperatively. The only perioperative complication consisted of 1 case of fat embolism syndrome. 1 fracture required secondary plate osteosynthesis because of a unacceptable valgus deformity 6 weeks postoperatively. There was 1 too long nail implanted at the initial surgery, which then had to be changed during the rehabilitation period because of pain in the region of the knee. In 3 cases the interlocking bolts broke and 3 other cases required secondary dynamisation. There was a complete follow-up in all cases of at least 6 months. There were no infections. All fractures are healed. Full weight bearing was allowed at a mean of 10 weeks for closed fractures and 14 weeks for open fractures, respectively. All but one fracture (valgus 8 degrees) healed in a correct axial alignment without shortening.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1992

Stable temporary traction substitute with the Pinless external fixator.

The stable traction substitute with a JBPF seems a very promising indication for pinless clamps, offering good patient comfort and easy care. The implantation of a JBPF is possible under the same conditions as for conventional calcaneal traction. Although the stability provided is less than for conventional external fixators, it is sufficient for a temporary traction device. The JBPF does not affect secondary ORIF.

Adult↗

PubMed1992

[Radiation-sparing intramedullary nailing with a radiolucent drilling system].

The indications for intramedullary fixation of tibial and femoral shaft fractures markedly increased by the introduction of interlocking techniques. Distal interlocking however remains a major problem although a variety of different aiming devices have been proposed. To reduce the radiation exposure both of the surgeon and the patient the AO has produced a radiolucent drive which allows easy aiming and drilling with a minimum of X-ray exposure.

Femoral Fractures↗

PubMed1992

[Can humerus shaft fractures be treated with osteosynthesis?].

The treatment of fractures of the humerus shaft is still controversial. The results of functional treatment (brace) are good, consolidation occurs in most cases within 8-10 weeks, slight malalignment can be accepted, and there is no risk of postoperative complications like osteitis, neurological iatrogenic disorders and technical errors. On the other hand a correct osteosynthesis allows painless functional postoperative treatment, the patient comfort is excellent and a selected group of patients might return to work faster. We present the results of plate fixation of humerus shaft fractures in 127 patients, operated from 1980 to 1988. 102 patients were clinically and radiologically controlled after 1 year: 85 patients (83.4%) presented an excellent or good result with complete functional recovery. 17 patients (16.6%) showed a limited range of motion in shoulder and/or elbow mostly due to other fractures of the same arm or to persistent neurological disorders (plexus or radial lesions). Postoperative complications included 2 postoperative radial palsies recovering completely within months, 5 failures of internal fixation due to technical errors, 2 pseudarthrosis and 4 postoperative infections, healed by reoperation and early removal of the implant with one exception (osteitis). We therefore conclude, that a correct plate fixation of humerus shaft fractures is an alternative to conservative treatment. The main advantage is better patient comfort and shorter disability for a selected group of patients.

Adolescent↗

PubMed1992

[Proximal femoral fractures. Is there an indication for the condylar screw (DCS)?].

Between 1983 and 1989 66 consecutive fractures of the proximal femur were treated with a condylar screw DCS. 42 patients were available for a follow-up study, 12 subtrochanteric fractures (mean age 58.5 years) and 30 intertrochanteric fractures (mean age 73 years). The primary union rate was clearly higher in the subtrochanteric group (10/12) compared to the intertrochanteric group (22/30). All the 8 implant complications (pull-out, metal fatigue) in the intertrochanteric group were associated with important posteromedial comminution in elderly patients who cannot be mobilized with only partial weight bearing postoperatively. Unstable intertrochanteric fractures in elderly patients should not be treated with the DCS. These are indications for the DHS which allows controlled telescoping. The indication for the DCS is limited to proximal shaft fractures in younger patients capable of partial weight bearing.

Adult↗

PubMed1992

[Is implantation of a unipolar femoral endoprosthesis obsolete?].

The authors are presenting a retrospective study of the long-term results of 702 femoral cephalic endoprostheses (451 unipolar and 251 bipolar prostheses). The mean age of the patients at operation was 80.1, in the majority of the cases the indication was a fracture of the femoral neck. The average follow-up was 33 months for the unipolar, and 24 months for the bipolar prostheses. The rate of reoperations is similar in both series, but the rate of dislocations is slightly lower for the unipolar prostheses. 82 patients (out of 120 surviving) have been controlled with an average follow-up of 6.51 and 4.76 years. The unipolar prostheses have a lower average New Mayo Hip Score (58.5 vs. 68.2). Radiologically, there are 7 acetabular protrusions in the group of unipolar prostheses and none in the other group. If both types of prostheses have their place in surgery of the hip, the authors recommend to implant bipolar prostheses in younger and more active patients, where a survival of many years is expected.

Aged↗

PubMed1992

[Results of treatment of patellar fractures].

In a retrospective study the long-term results after treatment of 140 fractures of the patella were rated with a knee score. Compared with other studies our results were slightly better, although we did not have a smaller rate of comminuted fractures. Most cases were treated with tension band wiring. K-wires, partial and total patellectomy--compared with other studies--were rarely used, even in severe fracture types. The AO-classification in our study did not satisfy at all. For that reason, we suggest a new classification which should be useful to predict the outcome of patella fractures and give guidelines for treatment.

Bone Wires↗

PubMed1991

[The treatment of fresh Lisfranc dislocations and fracture-dislocations].

Dislocations and fracture dislocations of the tarsometatarsal joint are usually the result of a high energy trauma to the forefoot. A missed diagnosis or an insufficient treatment or a massive destruction of the tarsometatarsal joint result in a high rate of late morbidity. An appropriate radiological assessment, open anatomical reduction and temporary K-wire arthrodesis followed by a functional after-treatment can improve the long-term results of this severe forefoot injuries. The long term results (7 months to 20 years) of 24 tarsometatarsal injuries are analysed and a concept of their treatment presented.

Adolescent↗

PubMed1991

[Cephalic prosthesis for fractures of the femoral neck (702 cases). Comparative results of simple and intermediate cephalic prostheses].

The authors are presenting a retrospective study of the long time results of 702 femoral cephalic endoprostheses, 451 unipolar and 251 bipolar. The mean age of the patients at the moment of intervention was 80 years, the operation was done in the majority of the cases for a fracture of the femoral neck. The average follow-up was 33 months for the unipolar, and 24 months for the bipolar prostheses. The rate of reoperations was similar in both series, but the rate of luxations was slightly lower for the unipolar prostheses. 82 patients (out of 120 surviving) have been controlled with an average follow-up of 6.5 and 4.5 years. The unipolar prostheses had a lower average New Mayo Hip Score (58.5 vs. 68.2). Radiologically, there were 7 acetabular protrusions in the group of unipolar prostheses and none in the other group. If both types of prostheses have their place in surgery of the hip, the authors recommend to implant bipolar prostheses in younger and more active patients, where a survival of many years is expected.

Actuarial Analysis↗

PubMed1991

[6 years experiences with the "dynamic condylar screw" in supra- and intercondylar fractures].

44 supra- and intercondylar fractures were treated with the "Dynamic Condylar Screw" (DCS). Our experience with this device in a teaching hospital with surgeons of different training levels was encouraging, since there was no complication due to the insertion technique in this complex fracture setting. When we compare our results obtained with the DCS with those in the literature achieved with the angled blade plate, we got the same or better results in respect to implant failure, infection, fracture healing and function.

Adolescent↗

PubMed1991

[External fixator as primary and definitive treatment of tibial fracture with severe soft tissue damage].

The initial treatment of choice of fractures with severe soft tissue damage of the leg is the stabilization with an external fixator. After successful healing the question arises whether to continue the initial treatment with the external fixator to bone union or to change the initial concept by an internal fixation. Our experience with 62 fractures of the tibia (follow-up of 59 fractures) from 1985 to 1989 shows that 72% of the fractures were healed by the external fixator alone. Delayed union or pseudoarthrosis occurred in 17% and were mostly treated by late internal fixation. An analysis of the fracture types (new AO classification) did not show certain fracture types, that did not respond to the external fixator treatment alone. We conclude that the reason for a delayed union or pseudoarthrosis is less a morphological than a biological one. We recommend the first and final external fixator as treatment for fractures with severe soft tissue damage of the leg.

External Fixators↗

PubMed1991

[Surgical treatment of Achilles tendon rupture].

Ruptures of the Achilles tendon are rare, but their incidence seems to become higher due to changes of life style and to increasing sports activities. Concerning the optimal therapy--conservative or surgical--there still exist diverging opinions. In our clinic, we have always preferred surgical therapy. We present a survey of the results of surgical treatment in 139 patients. Based on our own experience and on a literature review we recommend surgical therapy for rupture of the Achilles tendon, mainly in view of the high incidence of reruptures after conservative treatment and the existing functional results.

Achilles Tendon↗

PubMed1991

Bridging bone gaps with the Ilizarov technique. Biologic principles.

For the treatment of bone gaps of less than 4 cm, cancellous autografting remains the treatment of choice. But for gaps exceeding 4 cm, the distraction osteogenesis is a viable option. The following conditions should be satisfied: (1) patient selection; (2) stable fixation; (3) osteotomy by corticotomy; (4) 7- to 14-day latency period before initiating distraction; and (5) a controlled rate and rhythm of distraction of 1 mm per day (0.25 mm, four times a day). This type of treatment leaves the pathologic focus alone, and bone healing occurs on the healthy bone. The quality of bone regenerate may be improved by a motorized unit and by better soft-tissue coverage using early grafts and flaps. Interface healing is probably improved by cancellous grafting and internal fixation after the transport period, thus decreasing the fixator time.

Bone Lengthening↗

PubMed1990

The use of the Ilizarov concept with the AO/ASIF tubular fixateur in the treatment of segmental defects.

For the treatment of segmental defects of less than 4 cm, cancellous autografting remains the treatment of choice. Pedicled or free cortical grafts (fibula, ribs, iliac crest) often are not strong enough, particularly when used in the femur. Allografts, especially appealing because of the theoretic unlimited supply, should not be considered for segmental diaphyseal defects because they remain dead spacers, remodelled only very slowly and incompletely, and are often complicated by late infection. The technique of distraction histogenesis used by Putti and Anderson, improved and further differentiated towards corticotomy and fragment transport by Ilizarov, is a further possibility of treating long, segmental bone defects. Already clinical and experimental data clearly show that the effect of distraction histogenesis can be obtained using many different types of external fixators. Therefore, we should use as simple a fixator construction as possible. The standard unilateral sagittal frame we suggest is derived from a two-tube AO fixator using only a few additional elements. The majority of cases with segmental defects and minor additional axial or rotational deformities (which can be corrected primarily) can be treated with such a fixator. The quality of the regenerate may be improved with a motorized, continuous transport system and by better soft-tissue coverage using early flaps. Interface healing is very probably improved by cancellous grafting and internal fixation after the transport period, thus decreasing the fixator time.

Bone Lengthening↗