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Biomedical subjects

R K Marti

Publications and source records attributed to R K Marti.

At least 37 records · Page 2Linked to original sources
PubMed2003

Trochanteric reduction osteotomy as a treatment for refractory trochanteric bursitis.

We describe a new operative procedure for patients with chronic trochanteric bursitis. Between March 1994 and May 2000, a trochanteric reduction osteotomy was performed on ten patients (12 hips). All had received conservative treatment for at least one year. Previous surgical treatment with a longitudinal release of the iliotibial band combined with excision of the trochanteric bursa had been performed on five hips. None had responded to these treatments. The mean follow-up was 23.5 months (6 to 77). The mean Merle d'Aubigné and Postel score improved from 15.8 (8 to 20) before to 27.5 (18 to 30) after operation, six patients showing very great improvement, five great improvement and one fair improvement. We conclude that trochanteric reduction osteotomy is a safe and effective procedure for patients with refractory trochanteric bursitis who do not respond to conservative treatment.

Adult↗
PubMed2003

Operative and functional treatment of rupture of the lateral ligament of the ankle. A randomised, prospective trial.

Consecutive patients with a confirmed rupture of at least one of the lateral ligaments of the ankle were randomly assigned to receive either operative or functional treatment. They were evaluated at a median of 8 years (6 to 11). In total, 370 patients were included. Follow-up was available for 317 (86%). Fewer patients allocated to operative treatment reported residual pain compared with those who had been allocated to functional treatment (16% versus 25%, RR 0.64, CI 041 to 1.0). Fewer surgically-treated patients reported symptoms of giving way (20% versus 32%, RR 0.62, CI 0.42 to 0.92) and recurrent sprains (22% versus 34%, RR 0.66, CI 0.45 to 0.94). The anterior drawer test was less frequently positive in surgically-treated patients (30% versus 54%, RR 0.54, CI 0.41 to 0.72). The median Povacz score was significantly higher in the operative group (26 versus 22, p < 0.001). Compared with functional treatment, operative treatment gives a better long-term outcome in terms of residual pain, recurrent sprains and stability.

Adolescent↗
PubMed2002

Functional treatment after surgical repair of acute Achilles tendon rupture: wrap vs walking cast.

The aim of this study was to compare the clinical outcome for patients treated with walking cast immobilization and wrap early mobilization after surgical repair of acute Achilles tendon ruptures. A total of 39 consecutive patients with complete ruptures of the Achilles tendon were identified, treated, and functionally rehabilitated with either a walking cast or a wrap. Because the randomization was quasi-random, chi-square and t-tests were performed to compare the baseline characteristics. A statistically significant difference was present only for the injured side ( p<0.05). Therefore, groups were considered comparable for analysis of outcome. All patients were evaluated at an average follow-up of 6.7 years (range 5-8 years). Functional postoperative treatment with a wrap allowed a significantly shorter hospital stay ( p<0.05) as well as a shorter period to return to pre-injury sports level ( p<0.01) compared with treatment with a walking cast. According to the modified Rupp score, 91.3% of patients in the walking cast group had a good or excellent result, as did 93.8% in the wrap group ( p=0.9). Slight atrophy of the calf muscles was reported in 3 patients in the walking cast group (13.0%) and in 4 in the wrap group (25.0%). One re-rupture was reported in the walking cast group (4.3%). Functional treatment after surgical Achilles tendon repair is safe, and there is no increased risk of re-rupture or wound healing problems. Functional treatment with a wrap is preferable to treatment with a walking cast with respect to hospitalization time and return to sports.

Achilles Tendon↗
PubMed2002

Different functional treatment strategies for acute lateral ankle ligament injuries in adults.

BACKGROUND: Acute lateral ankle ligament ruptures are common problems in present health care. Early mobilisation and functional treatment are advocated as a preferable treatment strategy. However, functional treatment comprises a broad spectrum of treatment strategies and as of yet no optimal strategy has been identified. OBJECTIVES: The objective of this review is to assess different functional treatment strategies for acute lateral ankle ligament ruptures in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register (December 2001), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001), MEDLINE (1966 to May 2000), EMBASE (1980 to May 2000), CURRENT CONTENTS (1993 to 1999), BIOSIS (to 1999), reference lists of articles, and contacted organisations and researchers in the field. SELECTION CRITERIA: Randomised clinical trials describing skeletally mature individuals with an acute lateral ankle ligament rupture and comparing different functional treatment strategies were evaluated for inclusion. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the quality of included trials and extracted relevant data on treatment outcome. Where appropriate, results of comparable studies were pooled. Individual and pooled statistics are reported as relative risks (RR) for dichotomous outcome and (weighted) mean differences (WMD) for continuous outcome measures with 95 per cent confidence intervals (95%CI). Heterogeneity between trials was tested using a standard chi-squared test. MAIN RESULTS: Nine trials involving 892 participants were included. Lace-up ankle support had significantly better results for persistent swelling at short-term follow up when compared with semi-rigid ankle support (RR 4.19, 95% CI 1.26 to 13.98); elastic bandage (RR 5.48; 95% CI 1.69 to 17.76); and to tape (RR 4.07, 95% CI 1.21 to 13.68). Use of a semi-rigid ankle support resulted in a significantly shorter time to return to work when compared with an elastic bandage (WMD (days) 4.24; 95% CI 2.42 to 6.06); one trial found the use of a semi-rigid ankle support saw a significantly quicker return to sport compared with elastic bandage (RR 9.60; 95% CI 6.34 to 12.86) and another trial found fewer patients reported instability at short-term follow-up when treated with a semi-rigid support than with an elastic bandage (RR 8.00; 95% CI 1.03 to 62.07). Tape treatment resulted in significantly more complications, the majority being skin irritations, when compared with treatment with an elastic bandage (RR 0.11; 95% CI 0.01 to 0.86). No other results showed statistically significant differences. REVIEWER'S CONCLUSIONS: The use of an elastic bandage has fewer complications than taping but appears to be associated with a slower return to work and sport, and more reported instability than a semi-rigid ankle support. Lace-up ankle support appears to be effective in reducing swelling in the short-term compared with semi-rigid ankle support, elastic bandage and tape. However, definitive conclusions are hampered by the variety of treatments used, and the inconsistency of reported follow-up times. The most effective treatment, both clinically and in costs, is unclear from currently available randomised trials.

Adult↗
PubMed2002

Results of a prospective randomised study comparing a non-invasive surgical zipper versus intracutaneous sutures for wound closure.

A prospective randomised study was undertaken to investigate the advantages and disadvantages of a non-invasive surgical zipper (Medizip) vs intracutaneous sutures skin closure in orthopaedic surgery. The study group consisted of 120 consecutive patients, 45 men and 75 women with a mean age of 47 years. The Medizip was used in 20 surgical knee wounds, 20 hip wounds and 20 orthopaedic spine wounds. The same number of patients received intracutaneous sutures. Handling, wound healing and scar formation on day 1, at 2 weeks and 6 weeks were evaluated. The average time for wound closure with the zipper was 2 min and 9.4 min when the wound was closed with intracutaneous sutures (p = 0 .01). Patients were positive in their assessment of the wound healing progress and results; they found the skin closure device agreeable to wear. The scar result was rated very good in 82% (n = 4 9) of the zipper group, and 85% (n = 5 1) in the intracutaneous group (p = 0 .67). Based on the results obtained, the non-invasive skin closure system Medizip represents a safe option in the spectrum of surgical wound treatment.

Adolescent↗
PubMed2002

Surgical treatment of basal joint disease of the thumb: comparison between resection-interposition arthroplasty and trapezio-metacarpal arthrodesis.

Thirty-six thumbs with symptomatic osteoarthritis of the first carpometacarpal joint were treated either by trapezio-metacarpal arthrodesis (n = 18) or resection-tendon-interposition arthroplasty (n = 18). The mean follow-up of the 29 patients was 42 months. With the data available, we could not find any difference in the outcome of either procedure. In the majority of cases, the main aim of the operation, relief of pain, was achieved, the patients were satisfied and pleased with the functional result of the operation. No difference in grip strength between the operated and the normal contralateral hand could be established. Nevertheless, the arthrodesis seems to be the procedure causing fewer problems (only one patient not completely satisfied) and is therefore preferred over the resection-tendon-interposition arthroplasty.

Aged↗
PubMed2002

Humeral shaft nonunion: evaluation of uniform surgical repair in fifty-one patients.

OBJECTIVE: To determine whether a standardized treatment of aseptic humeral shaft nonunions results in union after one operation without substantial complications. DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: Between 1975 and 1998, fifty-eight patients sustained a humeral shaft fracture that resulted in an aseptic nonunion. Fifty-one patients between the ages of twenty-three and eighty-six years (mean 50.8 years) were included and evaluated. INTERVENTION: Surgical treatment consisted of an anterolateral approach with radial nerve identification and subsequent neurolysis, decortication, compression plating, and frequent application of autogenous bone grafts. No immobilization with brace or cast after treatment was functional. MAIN OUTCOME MEASURES: Success rate of nonunion repair, reinterventions, complications, range of motion, patient satisfaction. RESULTS: After one year, consolidation was apparent in all cases. All but two patients had an essentially normal range of motion of the shoulder and elbow, and 96 percent rated their result as excellent or good. After nonunion repair, two patients had a transient sensory neuropathy of the radial nerve. In one patient, a second intervention was needed after a fall from bed one week after the index operation. CONCLUSIONS: The results of this study indicate that our standard surgical procedure for treatment of nonunion of the humeral shaft is reliable and achieves consolidation in one procedure without significant complications.

Adult↗
PubMed2002

Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus.

BACKGROUND: Controversy persists concerning the preferred treatment of displaced fractures of the proximal part of the humerus. The present study was undertaken to evaluate the results of open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus and the functional limitations of patients in whom avascular necrosis of the humeral head develops as a complication of this fracture. METHODS: We assessed the intermediate and long-term results for sixty patients with a three or four-part fracture of the proximal part of the humerus who had undergone open reduction and internal fixation with cerclage wires or a T-plate. The Constant score and a visual analog score for pain were calculated, and radiographs of the proximal part of the humerus were evaluated. RESULTS: After an average of ten years of follow-up, fifty-two patients (87%) had a good or excellent result on the basis of the Constant score whereas eight patients (13%) had a poor result. Fifty-one patients (85%) were satisfied with the result at the time of the most recent examination. Twenty-two patients (37%) had development of avascular necrosis of the humeral head, and seventeen (77%) of these twenty-two patients had a good or excellent Constant score. CONCLUSIONS: Open reduction and internal fixation with cerclage wires or a T-plate yields good functional results in most patients. This option should be considered even for patients with fracture-dislocation patterns that are associated with a high risk for avascular necrosis of the humeral head, as this complication did not preclude a good result.

Adult↗
PubMed2001

[Treatment of united or malunited fractures of the elbow].

Nonunions and malunions around the elbow are often due to incorrect initial treatment of a fracture. We have to differentiate between nonunions and malunion of adults and children. There are general principles for the treatment of nonunions and malunions of the distal humerus. They should not always be treated by decortication, internal fixation and bone graft. Removal of non-united fragments or a correction osteotomy may be good alternatives. A correct surgical approach and a biologically accurate osteosynthesis are necessary for good joint mobility, whereby the most difficult problem is to regain extension. An arthrolysis is not normally necessary during the first operation of a non- or malunion. It can be carried out, if necessary, on removal of implants. If these principles are followed, then the operation is usually successful and the patient satisfied. If treatment fails, the possibility of a joint replacement or an arthrodesis should not be forgotten.

Adult↗
PubMed2001

Lengthening osteotomy at the intertrochanteric level with simultaneous correction of angular deformities.

Fixed multiplane deformities around the hip representing a combination of rotational, angular, and leg-length discrepancies are disabling for the patient and pose a challenge for the orthopaedic surgeon. We describe a joint-preserving, one-stage procedure to address these complex problems using an intertrochanteric osteotomy with a step-cut to allow for corrective lengthening, angulation, and rotation. We present our results in nine patients. The aim of this paper is to provide the orthopaedic surgeon with a detailed approach to treating these deformities with reproducible results.

Adolescent↗
PubMed2001

Open versus arthroscopic treatment of chronic rotator cuff impingement.

We report the results of 238 consecutive patients who underwent in total 261 acromioplasties because of chronic rotator cuff impingement. The procedure was performed either in conventional open technique (80) or arthroscopically (181). Two years (1-10) after the operation 68% of the patients treated with the open technique had an excellent or good result compared 82% of the patients treated arthroscopically by an experienced arthroscopic surgeon. Compared to the open technique, the arthroscopic procedure had a statistically significant superior result concerning outcome, operating time and hospital stay. Arthroscopic procedures performed by less experienced surgeons had inferior results.

Adolescent↗
PubMed2001

Anterior lateral ankle ligament damage and anterior talocrural-joint laxity: an overview of the in vitro reports in literature.

OBJECTIVE: To provide a clear overview of the literature on the relationship between increased lateral ankle ligament damage and anterior talocrural-joint laxity. DESIGN: A systematic review of the literature. BACKGROUND: Diagnostic methods for inversion injuries of the ankle have remained controversial throughout the years. An instrumented test for anterior talocrural-joint laxity could be a diagnostic tool for evaluation of anterior lateral ankle ligament function. METHODS: An advanced electronic database search using MEDLINE and EMBASE was performed to find studies describing the correlation between lateral ankle ligament damage and talocrural-joint laxity. Two reviewers assessed the methodological quality for each study and agreement was noted. Two reviewers extracted all relevant data with respect to methodology, motion constraints and laxity measurement. RESULTS: The quality assessment resulted in 5 studies being scored as high quality and 5 as low quality. Different test devices were used to apply the load and measure the displacement. All in vitro tests applied a load to the calcaneus and subsequently measured the translation of the talus and/or calcaneus relative to the tibial dome. Rotation in the transversal and frontal plane was restricted in 8 tests. After analysis of the results presented by nine different studies, the mean value of anterior talocrural-joint laxity with intact ligaments is 4.2 mm. After sectioning of the anterior talofibular ligament, the mean anterior laxity value is 6.5 mm. The mean anterior laxity value after sectioning of the calcaneofibular ligament increases to 8.4 mm. The mean anterior laxity value with the foot in dorsal flexion (3.1 mm) is less than the mean value with the foot in neutral position (4.5 mm) or in plantar flexion (4.7 mm). The applied load and the anterior laxity values between the different studies vary greatly. CONCLUSIONS: Each ligament section results in significantly increased talocrural-joint laxity. Talocrural-joint laxity can be used as a measure for damage to the anterior talofibular ligament and/or the calcaneofibular ligament. From this review, it is neither possible to give universal recommendations about the optimal flexion angle for testing talocrural-joint laxity as a measure for lateral ankle ligament function, nor to recommend the ideal load for performing the test. RELEVANCE: The development of an instrumented test as a diagnostic tool for anterior talocrural-joint laxity in the clinical setting is near at hand and practicable.

Ankle Injuries↗
PubMed2001

Low-intensity ultrasound stimulates endochondral ossification in vitro.

Animal and clinical studies have shown an acceleration of bone healing by the application of low-intensity ultrasound. The objective of this study was to examine in vitro the influence of low-intensity ultrasound on endochondral ossification of 17-day-old fetal mouse metatarsal rudiments. Forty-six triplets of paired metatarsal rudiments were resected 'en block' and cultured for 7 days with and without low-intensity ultrasound stimulation (30 mw/cm2). At days 1, 3, 5, and 7, the total length of the metatarsal rudiments, as well as the length of the calcified diaphysis were measured. Histology of the tissue was performed to examine its vitality. The increase in length of the calcified diaphysis during 7 days of culture was significantly higher in the ultrasound-treated rudiments compared to the untreated controls (P = 0.006). The growth of the control diaphysis was 180 +/- 30 microm (mean +/- SEM), while the growth of the ultrasound-treated diaphysis was 530 +/- 120 microm. The total length of the metatarsal rudiments was not affected by ultrasound treatment. Histology revealed a healthy condition of both ultrasound-treated and control rudiments. In conclusion, low-intensity ultrasound treatment stimulated endochondral ossification of fetal mouse metatarsal rudiments. This might be due to stimulation of activity and/or differentiation of osteoblasts and hypertrophic chondrocytes. Our results support the hypothesis that low-intensity ultrasound activates ossification via a direct effect on osteoblasts and ossifying cartilage.

Animals↗
PubMed2001

Simultaneous bilateral femoral neck fractures: case report.

Bilateral fractures of the femoral neck are rare injuries. We report about the case of a 33-year old male with multiple injuries including fractures of both femoral neck after a fall from great height. The fractures were successfully treated with 130 degrees blade plates, allowing early mobilisation.

Adult↗
PubMed2001

Intertrochanteric osteotomy for posttraumatic arthritis after acetabular fractures.

OBJECTIVE: To evaluate the long-term results of intertrochanteric osteotomies for posttraumatic arthritis after acetabular fractures. DESIGN: Retrospective study of eight patients who underwent a total of ten intertrochanteric osteotomies. Two patients underwent two osteotomies of the same hip. SETTING: Academic Level I trauma center. PARTICIPANTS: Patients who developed posttraumatic hip arthritis after nonoperatively or operatively treated acetabulum fractures. The average age of patients was twenty-nine years (range 16 to 47 years). INTERVENTION: Patients underwent an intertrochanteric osteotomy to decrease contact pressures on damaged cartilage and to lessen contractures. All intertrochanteric osteotomies at our institution were performed by the senior author (R.K.M.). MAIN OUTCOME MEASUREMENTS: The Merle d'Aubigné score and the Thompson and Epstein score were determined based on each patient's last follow-up. RESULTS: At an average long-term follow-up of 10.2 years (range 2.5 to 22 years), all eight patients had a significant improvement based on the Merle d'Aubigné score (average increase 5.3 points). Less improvement was observed according to the Thompson and Epstein score, which is consistent with the fact that radiographic appearance is weighted disproportionally in that score. CONCLUSIONS: Because most acetabular fracture patients are relatively young, the option of joint replacement for posttraumatic hip arthritis is less than ideal. However, we have observed significant improvement in hip function with a decrease in pain and disability when such patients are treated with an intertochanteric osteotomy.

Accidental Falls↗
PubMed2001

The floating shoulder. A multicentre study.

The aim of this retrospective study was to review a series of patients with ipsilateral fractures of the neck of the scapula and of the clavicle. Between 1991 and 1996 a total of 79 general and orthopaedic surgeons treated 46 patients with a floating shoulder in The Netherlands. The records and radiographs of these patients were studied. Of the 35 patients available for follow-up, 31 had initially been treated conservatively and four by operation; three underwent secondary reconstructive surgery. The mean Constant score for the 28 patients treated conservatively was 76 and for the seven treated operatively it was 71 at a mean follow-up of 35 months. In six of the 28 patients treated conservatively the glenoid was dislocated caudally at the end of treatment; they had a score of 42. In the 22 patients without this dislocation the score was 85. We conclude that this rare injury is not inherently unstable and, in the absence of caudal dislocation of the glenoid, conservative treatment gives a good functional outcome.

Adolescent↗
PubMed2001

Proximal tibial varus osteotomy. Indications, technique, and five to twenty-one-year results.

BACKGROUND: Although high tibial osteotomy has been proved effective for the treatment of painful osteoarthritis of the medial compartment of the knee, the role of proximal tibial varus osteotomy for the treatment of painful osteoarthritis of the lateral compartment still remains controversial. METHODS: From 1974 to 1993, we performed proximal tibial varus osteotomy for the treatment of osteoarthritis of the lateral compartment of the knee in thirty-six consecutive patients. The procedure consisted of a proximal lateral opening-wedge varus osteotomy of the tibia with use of corticocancellous bone grafts from the iliac crest. The valgus deformity was posttraumatic in twenty-three patients, followed a lateral meniscectomy in five, was due to overcorrection of a varus deformity in four, and was idiopathic in four. The preoperative valgus deformity averaged 11.6 degrees (range, 4 degrees to 22 degrees ). RESULTS: At a mean of eleven years (range, five to twenty-one years) after the operation, the clinical results for thirty-four of the thirty-six patients were analyzed. None of the patients had severe progression of the osteoarthritis after the osteotomy, and none had a meaningful loss in the range of motion of the knee joint. A superficial wound infection developed in one patient, and another patient had thrombophlebitis. Three patients (9%) had a transient palsy of the peroneal nerve. According to the system of Insall et al., the mean knee score was 84 points (range, 54 to 99 points). According to the knee score described by Lysholm and Gillquist, the subjective result was excellent in nine patients (26%), good in twenty-one (62%), fair in three (9%), and poor in one (3%). CONCLUSIONS: We concluded that when the indications outlined in this study are followed and our opening-wedge technique is used, a proximal lateral opening-wedge varus osteotomy of the tibia is a good alternative for the treatment of isolated osteoarthritis of the lateral compartment of the knee. High accuracy in preoperative planning, based on a slight overcorrection, is important to prevent failure.

Adolescent↗