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Biomedical subjects

P Rommens

Publications and source records attributed to P Rommens.

36 records · Page 2Linked to original sources
PubMedDate not supplied

Bilateral ureteral obstruction and renal failure caused by massive retroperitoneal hematoma: is there a pelvic compartment syndrome analogous to abdominal compartment syndrome?

OBJECTIVES: To describe an intrapelvic compartment syndrome analogous to abdominal compartment syndrome and to characterize its diagnosis and treatment. DESIGN: Retrospective analysis. SETTING: Level I trauma center. PATIENTS: Three patients with pelvic ring or acetabular fractures presented with bilateral ureteral obstruction, renal organ failure, and anuria due to direct compression of both ureters in the true pelvis by a massive retroperitoneal hematoma. INTERVENTION: Surgical therapy consisted of fracture stabilization, decompression of the retroperitoneal space, and evacuation of the hematoma. Persistent isolated bleeding points were either embolized preoperatively or ligated. RESULTS: After decompression, all three patients promptly recovered their renal organ function. CONCLUSION: An intrapelvic compartment syndrome can be defined as bilateral ureteral obstruction and renal failure caused by a massive intrapelvic hematoma with increased retroperitoneal pressure. Diagnostic differentiation of anuria in patients with pelvic ring or acetabular fractures must include intrapelvic compartment syndrome. Early diagnosis and treatment are mandatory.

Acetabulum↗
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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↗
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[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↗
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[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↗
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[Autogeneic and allogeneic bone transplantation: indication, technic and results].

Autograft and allograft bone transplantation is frequently performed to achieve sufficient stability in the primary or secondary treatment of fractures with cortical defects. The ingrowth of bone in his new environment develops in three consecutive periods: the revascularisation, the osteogenic regeneration and the functional adaptation. There is an important histomorphologic difference between the autografts and allografts in the first period of their development. Therefore there are different indications for the performance of autograft or allograft bone transplantation. An autograft bone transplantation implies an adjuvant surgical procedure with possible complications, otherwise after allograft bone transplantation a higher infection risk exists. At the University Clinic of Essen we performed 374 autograft bone transplantations with a complication rate of 2.7% at the donor site and only 0.6% at the receptor site. Infection rate after allograft bone transplantation was 5.7%.

Adaptation, Physiological↗
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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 treatment of deep hand infections].

Thirty patients with deep infections of the hand presented between 1982 and 1986 in our Department of Traumatology. Twenty infections were caused by neglected cut- or stab-wounds or animal bite injuries. Mostly Staphylococci or Streptococci were isolated from the wound culture. Only twelve patients could be operated upon ambulatory basis. Postoperative treatment was necessary for more than two months in half of the patients. The patients had a moderate or severe diminution of hand function. All cut- or stab-wounds and human or animal bite injuries of the fingers and hand must be considered as infected wounds. In patients with deep hand infections, surgical debridement and exploration should be performed urgently. Postoperative daily cleaning of the wound, washing out of the infected tendon sheath and passive mobilization of the fingers should be done. The active mobilization starts when infection is regressed and is continued for several weeks. Nevertheless we have to accept a significant loss of hand function in many patients.

Adolescent↗
PubMedDate not supplied

[Classification of hand fractures and their treatment].

Fractures and fracture-dislocations of the hand can inhibit directly and indirectly the precision of the hand mobility. The fracture of the scaphoid mostly occurs through his middle third and is stable. In unstable fractures or fractures through the proximal third pseudarthrosis or aseptic necrosis of the proximal fragment is seen. The fracture of the trapezium can prevent the normal mobility of the thumb, and therefore an anatomical reduction is desirable. The most important fractures of the metacarpals are Bennett's fracture and Rolando's fracture of metacarpal I and the boxer's fracture of metacarpal V. Fractures of the shaft of the metacarpals tend to heal in a dorsal angulation and rotational deformity. The distal intra-articular fracture of the metacarpals also needs an anatomical reduction and fixation. Frequently there is a volar angulation of the fracture of the proximal phalanx. The angulation of the fracture of the middle phalanx depends on the place of attachment of the superficial flexor tendon. The fractures of the distal phalanx mostly are stable and doesn't need a reduction. The fracture-dislocations of the little joints directly threaten the function of the lesioned joint. The fracture-dislocation of the carpometacarpal joints are always combined with an important soft-tissue damage. The treatment of the fracture-dislocations of the metacarpophalangeal or interphalangeal joints depends on the magnitude and displacement of the fracture fragments.

Carpal Bones↗
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[Carpal tunnel syndrome].

The carpal tunnel syndrome is the most frequent entrapment syndrome of peripheral nerves. Either a diminution of the volume of the whole carpal tunnel or increasement of the intracarpal structures can enhance the pressure on the median nerve and so develop a carpal tunnel syndrome. Fibrosis or thickening of the synovia of the wrist joint is the most common cause of the syndrome, that appears usually in women more than 50 years old. Irradiating pain and sensory disturbances are the most frequent subjective complaints. Motoric changes appear in a minority of patients with the syndrome. The operative procedure is done ambulatory with brachial plexus anesthesia. The subcutaneous 'ramus palmaris nervi mediani' should be treated carefully when releasing the transverse ligament. After a mean time of 24.1 months, 28 of carpal tunnel syndromes treated operatively had a significant amelioration. Seven patients had recurrent sensible or motoric complaints, one of them was operated on a second time. Postoperative recurrent carpal tunnel syndrome mostly is due to inadequate technique or fibrous proliferations.

Adult↗
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[10 years of emergency medical care at the traumatology center of the university clinic in Essen].

10 years of experience with emergency treatment at a University Center sufficiently proved the necessity of an emergency physician at the site of the accident. Because of its inefficiency, the separate and individual displacement of the doctor and the emergency vehicle to the site of the accident has been abandoned in 1976. The professional qualifications of the emergency team are as important as the technical equipment. Specific attention has to be paid to the education of nursing -, ambulance personnel and doctors belonging to the team. Very early and efficient shock therapy is essential in polytrauma victims. Intubation, artificial ventilation, fluid administration (electrolyte-solution) are of utmost importance for their survival and to reduce the frequency of major complications.

Emergency Medical Service Communication Systems↗
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Diagnosis and treatment of unstable fractures of the pelvic ring.

The operative treatment of unstable fractures of the pelvic ring has gained upon the conservative treatment during the last years. The anatomical reconstruction and the stability of the bony structures allow a rapid postoperative mobilization and avoid the complications due to a difficult nursing and a long-time bedrest. The operative management could significantly diminish the mortality and morbidity in multitraumatized patients. The most recent classification of fractures of the pelvic ring pays great attention to the trauma mechanism and the degree of instability. Also in diagnostic procedures the surgeon pays attention to the stability of the dorsal pelvic ring. The value of CT-images is greater than the conventional roentgenograms in evaluating fracture form, dislocation and instability. A primary operative treatment is only necessary in certain emergency situations. All other operations can be carried out secondarily on the stable and well prepared patient. The external fixation is a simple procedure in emergency situations. In secondary operations we have the choice between the plate osteosynthesis on the ventral pelvic ring and a plate osteosynthesis or a transarticular arthrodesis on the dorsal pelvic ring. 53 of 62 patients with unstable fractures of the pelvic ring were operated upon in the Department of Traumatology of the University Clinic of Essen. The postoperative complications are reviewed and discussed. The invalidity in patients with fractures of the pelvic ring is more dependent on the lesions of the intra- or extrapelvic structures accompanying the fractures, than on the fractures themselves.

Adult↗
PubMedDate not supplied

[Locating and treating nonpalpable breast tumors].

Between 1980-1984 a total of 40 female patients underwent excision of a radiologically diagnosed non-palpable breast tumor. The lesion was malignant in 42,9% (18 patients); 12 specimens showed invasive carcinoma and 6 carcinoma "in situ". "Clustered" microcalcifications were highly suggestive of a malignant lesion. The technique of surgical excision is simple, reliable, surgically not demanding and readily acceptable to the patient.

Adult↗
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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

[The surgical treatment of the post-phlebitis syndrome].

Between 1978 and 1983 a total of 62 Linton procedures were performed in 53 patients. The results are presented. 62% suffered from an insufficient superficial venous system for longer than 10 years. 34% had an active ulcer at the time of operation. Pre-operative preparation and operative technique are extensively dealt with. Post-operative wound necrosis occurred in 22.5%. This was mainly due to extensive subcutaneous dissection and tissue removal. Recurrent ulcer occurred in 4.8%.

Adult↗
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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↗
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Does the intrapelvic compartment syndrome exist?

Pelvic compartment syndrome is a rare condition. As in other musculoskeletal localizations, the intra-compartmental pressure raises above a critical level. In the pelvic compartment syndromes, the gluteal compartments are mainly concerned. We report on three patients with bilateral ureteral obstruction, due to compression by a massive retroperitoneal haematoma as a complication of an unstable pelvic ring or acetabular fracture. Anuria with renal organ failure, due to compression of the ureters in the small true pelvis represents an intrapelvic compartment syndrome. Anuria, due to ureteral compression, mostly developing 24 to 48 hours after injury, has to be differentiated from anuria due to hypovolaemic shock or lesions of the lower urine tract. Bilateral tube nephrostomy represents a temporary and suboptimal therapy. Treatment of the intrapelvic compartment syndrome consists in fracture stabilization and surgical revision of the retroperitoneal space, including evacuation of the haematoma and decompression of the ureters, as it was performed in our patients. Persistent isolated bleeding points can be ligated. If the patient is haemodynamically stable, internal fracture fixation can be performed during the same operative session. A second look procedure may be required for prevention of septic complications.

Adult↗