Biomedical subjects

P Reynders

Publications and source records attributed to P Reynders.

At least 19 recordsLinked to original sources

PubMed2002

The use of the unreamed AO femoral intramedullary nail with spiral blade in nonpathologic fractures of the femur: experiences with eighty consecutive cases.

OBJECTIVE: To evaluate the unreamed femoral nail with spiral blade (UFN-SB) in the treatment of nonpathologic subtrochanteric and segmental femoral fractures. DESIGN: Prospective follow-up of eighty consecutive fractures in eighty patients still alive at least ten months after the operation. SETTING: Academic teaching hospital. PATIENTS: Eighty patients with a subtrochanteric or segmental femoral fracture. Excluded were patients with pathologic fractures and those who died within ten months of the operation. INTERVENTION: Unreamed femoral nail with spiral blade. MAIN OUTCOME MEASURES: Clinical and radiographic examination. RESULTS: In seventeen fractures, the UFN-SB failed before bony union (21 percent): bending of the spiral blade, five times; migration, nine times; and breakage, three times. Revision surgery was necessary in seven cases (9 percent). All complications except one were observed in elderly women with a Seinsheimer fracture type IIC or V. Nevertheless, all fractures healed within one year, including those that needed revision surgery. CONCLUSIONS: There is predictive value of the Seinsheimer classification as to outcome using UFN-SB. The UFN-SB is an option for the treatment of subtrochanteric or segmental fractures of the femur, especially in patients with a good quality of bone. The complications using this device are not caused by the learning curve, but by the characteristics of the implant and the type of fracture for which it is used. The implant should not be used in elderly women with a reversed oblique fracture or a subtrochanteric fracture with an intertrochanteric component.

Adult↗

PubMed2001

Metastatic fractures of the tibia.

Pathologic fractures of the tibia due to a metastasis are rare. The treatment of an established fracture is sometimes conservative, but more often surgical. The purpose of the surgical procedure is to improve the quality of life and the ambulatory status, to relieve pain and to facilitate activities of daily living and nursing care. Four cases of operatively managed metastatic fractures of the tibia are presented with emphasis on the surgical technique. The scarce literature on metastatic tibial fractures in reviewed. The operative technique to be used does not only depend on the location of the tumor but also on the primary tumor, the response to adjuvant therapy and the life expectancy. For metastatic shaft fractures an intramedullary nail, sometimes augmented with bone cement, is preferred. For distal or proximal fractures a compound osteosynthesis with plates and screws offers a good solution. In the epiphyseal and metaphyseal region of the tibia an amputation or a tumor prosthesis is the procedure of choice.

Activities of Daily Living↗

PubMed2001

Brachial artery injury in closed posterior elbow dislocation case report.

The authors describe a case with a closed posterior elbow dislocation associated with a distal radial fracture and complete transsection of the brachial artery. The patient had a pulseless distal upper extremity and immediate gross swelling of the elbow and forearm. As closed reduction was not possible, open reduction had to be performed through an anteromedial approach to the elbow. End-to-end suture of the brachial artery was successful. After fasciotomy and internal fixation of the distal radial fracture, the elbow was stabilized with an external fixator spanning the elbow joint. After two years, despite good function of the elbow, restoration of the hand function is not optimal owing to persistent motor deficit of the ulnar nerve.

Accidental Falls↗

PubMed1999

Osteogenic ability of free periosteal autografts in tibial fractures with severe soft tissue damage: an experimental study.

OBJECTIVE: The present study was undertaken to assess whether free nonvascularized autologous periosteum transplants enhance bone healing in a rabbit fracture model designed to resemble a tibial fracture with severe soft tissue damage. DESIGN: Transplantation of free autologous periosteal grafts on the anteromedial site of the tibia (experimental group) was compared with nontransplantation on the contralateral tibia (control group). We produced a standardized transverse osteotomy of both tibial diaphyses in white male adult New Zealand rabbits. The endomedullary cavity was reamed and nailed, and then a one-centimeter segment of periosteum was excised from either side of the osteotomy. To prevent periosteal and extraosseous ingrowth at the osteotomy site, a silastic sheet was wrapped around two-thirds of the circumference of the tibia. In the first group, on the silastic-free bone window, we then spanned the osteotomy with a free, nonvascularized, longitudinally oriented autologous periosteum and sewed it to the adjacent periosteum both proximally and distally. In the second group, the periosteum was placed transversely, leaving a gap between it and the adjacent periosteum proximally and distally. Revascularization of the graft was determined with the colored microsphere technique. MAIN OUTCOME MEASUREMENTS: Histomorphometric analysis of the periosteal callus was done on a transparent grid superimposed on enlarged photographs of the histologic sections. RESULTS: Free, nonvascularized, longitudinally placed autologous periosteum in contact with intact periosteum produced significantly more periosteal callus than was seen in the control group, in which no periosteal graft was used. However, when transversely placed periosteal grafts were set in the silastic-free bone window and there was no contact with surrounding remnants of intact periosteum, no significant difference in callus production was noted when compared with the control. Revascularization of these grafts was seen within one week after transplantation. Bone healing occurred mainly through endochondral ossification. CONCLUSION: Our data suggest that orthotopically placed autologous nonvascularized periosteum retains its osteogenic potential in a poorly vascularized environment such as a tibial fracture with severe soft tissue damage. The effect is enhanced if the graft is in contact with intact periosteum. Histologically, callus formation after periosteal grafting resembles endochondral and intramembranous ossification.

Animals↗

PubMed1998

Unreamed intramedullary nailing of femoral shaft fractures using a traction device.

The authors present a simple distraction apparatus that is used in the sterile field and makes it possible to perform unreamed intramedullary nailing of the femur on a normal operation table. Intramedullary (IM) nails were placed, without reaming, in 24 femoral shaft fractures with the use of this device. Although it appears as though the use of the distractor did not lengthen the operative procedure, the set-up time was 60 per cent less compared with a stratified group of 28 femoral nailing using the fracture table. We feel that this device provides a safe and effective means for achieving fracture reduction without the need for a fracture table. It is especially useful in the multiply injured patient where the additional lesions can be treated without the need for patient transfer to the fracture table.

Adult↗

PubMed1998

Unreamed intramedullary nailing of acute femoral shaft fractures using a traction device without fracture table.

The authors present a simple distraction apparatus that makes it possible to perform nonreamed intramedullary nailing of the femur on a normal operating table. Nonreamed intramedullary (IM) nails were inserted in 24 femoral shaft fractures using this device. The setup time of this device was 60% shorter compared with a stratified group of 28 femoral nailings performed using the fracture table. The authors feel that this device is a safe and effective alternative to using a fracture table. It is especially useful in the polytrauma patient where the additional lesions can be treated without the need for patient transfer to another table.

Adult↗

PubMed1998

The osteogenic potential of free periosteal autografts in tibial fractures with severe soft tissue damage: an experimental study.

The present study was undertaken on 80 adult male New Zealand rabbits to assess the effect of free nonvascularized, autologous, periosteum transplants on bone healing in a rabbit fracture model comparable to a tibial fracture with severe soft tissue damage. Comparison was made between transplantation of free autologous periosteal grafts on the anteromedial side of the tibia and nontransplantation on the contralateral tibia (control). We produced a standardized transverse osteotomy of both tibial diaphyses. The medullary cavity was reamed and nailed ; a 1-cm segment of periosteum was excised from either side of the osteotomy. Periosteal and extraosseous ingrowth was prevented at the osteotomy site by a silastic sheet wrapped around two-thirds of the circumference of the tibia. On the silastic-free bone window, in one group we spanned the osteotomy with a free nonvascularized longitudinally-oriented autologous periosteum sewn to the adjacent periosteum proximally and distally. In the second group, the periosteum was placed transversely with a gap between it and the adjacent periosteum proximally and distally. Revascularization of the graft was determined with the colored microsphere technique. Our data suggest that orthotopically-placed autologous nonvascularized periosteum retains its osteogenic potential in a poorly vascularized environment comparable to a tibial fracture with severe soft tissue damage ; the effect is enhanced if the graft is in contact with intact periosteum. Histologically, callus formation after periosteal grafting resembles endochondral and intramembranous ossification.

Animals↗

PubMed1998

The unreamed locked intramedullary tibial nail: a follow-up study in 51 patients.

The authors reviewed 51 patients with a fracture of the tibia primarily treated with an unreamed intramedullary nail. There were 29 open and 22 closed fractures. All fractures healed within one year of the trauma. There were no deep infections. The most frequently observed complication was failure of interlocking screws (20%), but this complication had a negligible influence on bone healing. Re-nailing with a reamed nail was necessary in 18%. According to the criteria of Klemm and Börner an excellent result was obtained in 55% and a good result in 44%. The authors recommend unreamed nailing in fractures with soft tissue injuries; they recommend to dynamize the implant after six weeks in transverse and short oblique fractures and to replace the unreamed nail by a reamed one after three months in case of delayed union.

Adolescent↗

PubMed1998

The unreamed AO femoral intramedullary nail, advantages and disadvantages of a new modular interlocking system. A prospective study of 67 cases.

Compared with the Reamed Femoral Nail (RFN), the Unreamed Femoral Nail (UFN) has some theoretical advantages. It can also be used for subtrochanteric fractures and ipsilateral fractures of the femoral neck, there is less iatrogenic damage to the vascularisation of the bone, the risk of fat embolism syndrome and ARDS is reduced and the operation is a less time consuming procedure, associated with less blood loss. From April 1995 to July 1996, 66 patients with 67 fractures have been treated with the UFN: 16 patients with metastatic disease, 18 patients with a subtrochanteric fracture, 32 patients with 33 diaphyseal fractures. In 6 cases however, previous reaming was necessary. The spiral blade (SB) was used 35 times. Four patients died within six months after the operation. Fat embolism syndrome or ARDS were never observed. Five mechanical complications were observed in four patients. In one patient with a metastatic fracture, we noted a breakage of the SB twice. Migration of the SB was observed three times needing reintervention twice. Delayed union needing renailing with a reamed nail was observed twice. The reoperation rate for all patients treated with an UFN-SB was 9%. For diaphyseal fractures, the rate of delayed-union was 6%. This complication was only observed in open fractures. We concluded that the UFN is a safe and less severe procedure than the reamed nail in multiply injured patients. For subtrochanteric fractures, the UFN-SB is a useful implant, but not superior to other methods of treatment. As a definitive treatment for a femoral fracture primarily stabilized with an external fixator, we strongly suggest to carry on using a reamed nail.

Adolescent↗

PubMed1997

The treatment of Lisfranc injuries.

Thirty-one patients with fracture-dislocations of the tarsometatarsal joint were examined to assess the functional end results after a mean follow-up of 2.9 years (range 20 to 56 months). Sixty-one percent were polytrauma patients; 39% suffered isolated fractures. Forty-five percent had associated lesions of the tarsal joint complex (Chopart and subtalar joint). According to the Baltimore Painful Foot Scoring System (PFS), 52% achieved an excellent or good result and 48% a fair or poor result. Of the four different treatment modalities, open reduction and temporary screw or K-wire fixation yielded the best results. The major determinants of acceptable results were the type of treatment, type of lesions, the quality of initial reduction and associated involvement of the tarsal joint complex. The extent of the initial injury was the determining factor in the development of late degenerative arthritis. Degenerative changes of the tarsal joint were seen in almost all cases (94%). Such changes were more frequent after temporary screw fixation but did not seem to influence the final results. An initial anatomical reduction did not guarantee excellent results but minimized the chance of late degenerative arthritis. Primary arthrodesis demonstrated no advantage in our series. Although partial arthrodesis may be necessary in severely comminuted joints, it cannot be routinely advocated and should be used as a salvage procedure.

Adolescent↗

PubMed1996

Monteggia lesions in adults. A multicenter Bota study.

Sixty-seven Monteggia lesions occurring in adults were reviewed. A follow-up of 1 to 14 years revealed that 53.7% had good to excellent results and 46.3% had results which were fair or poor. All fractures were treated with open reduction and internal fixation. Complications were encountered in 29 cases or 43%. Delayed bone healing in 10 cases and the persistent dislocation of the radial head in 7 cases were noted. Excellent or good results were seen in type III and I, according to Bado's classification; fair or poor results in type IV and II. The results are less good when the olecranon process is fractured, especially in type Ia fractures. The overall result of this injury is abysmal. To improve the outcomes, the authors recommend dorsal plating of the ulnar fracture, avoidance of early resection of the radial head and immediate mobilization of the elbow.

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

[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↗

PubMed1990

Syme's amputation.

Syme's amputation was performed in one stage in 8 and in two stages in 13 patients. Failures were defined as those requiring a more proximal amputation and were present in patients with vascular disease only. The failure rate was 38% in the group with vascular disease and 24% in the total group. Syme's amputation provides the patient with a durable end-bearing stump, even in insensitive feet.

Adolescent↗