[Thoracic disk hernia--a difficult diagnosis].
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Humans↗
Biomedical subjects
S Olerud
Publications and source records attributed to S Olerud.
Internal fixation of fractures and dislocations in the cervical spine.
The treatment of fractures of the cervical spine, like that of fractures of the extremities, has been considerably improved in the last decade. The aim of these changes has been to prevent and correct deformities and to achieve such a high degree of primary stability with the use of different internal fixation techniques that traditional external fixation can be avoided. Non-stable internal fixation and laminectomies, which invariably result in further loss of stability, have thus been completely eliminated from the therapeutic arsenal. The new system implies a considerably milder course of treatment for the patient. Confinement to bed is limited to a few days, even for tetraplegic patients. The duration of stay in the hospital is short and any necessary rehabilitation can be started at an extremely early stage. This article describes some of the new techniques and provides examples of indications for and methods of performing stable internal fixation.
Adolescent↗
Genu recurvatum caused by partial growth arrest of the proximal tibial physis: simultaneous correction and lengthening with physeal distraction. A report of two cases.
Two cases of genu recurvatum deformity and leg length discrepancy after partial growth arrest of the proximal tibial physis are described. The patients are both boys thirteen and fifteen years old respectively. The etiology of the deformity is considered to be local pressure on the tibial tuberosity, in the first case after treatment with plaster cast after correction of an angular deformity in a tibial fracture and in the second case after prolonged treatment with patellar tendon bearing brace. The boys were treated with physeal distraction which corrected both the leg length discrepancy and the angular deformity. The technique is recommended because the correction is done at the site of the deformity and knee motion is possible during the entire treatment period.
Adolescent↗
External fixation as a test for instability after spinal fusion L 4-S 1. A case report.
A case presented with severe backache after fusion of the L 4-S 1 levels; the patient became immediately painfree after external transpedicular fixation between L 4 and the sacrum. The device was kept in place for 10 weeks. After an additional 4 weeks the patient was able to return to his work after several years of sick-leave. The case indicates instability as a cause of backache. Painful nonunion of a fusion can be present in spite of signs of healing on radiographs and CT-scan. External transpedicular fixation may be a good tool in assessing instability of the lower lumbar spine.
Adult↗
Intramedullary reaming and nailing: its early effects on cortical bone vascularization.
The early effect of reaming the medullary cavity prior to intramedullary nailing using Küntscher's method, on human cortical bone vascularization in the femur is discussed. In sections of the femur where the medullary tissue had been totally reamed, the inner two-thirds of the cortical bone tube was completely avascularized one week after the reaming. In the outer third of the cortex the vascularization was only moderately decreased. In the parts of the femur where the medullary tissue was not totally destroyed there was a marginal effect on the amount of intact cortical vessels. The observation is thus in accordance with corresponding results from experimental studies on animals. Microcracks, and cracks in the cortical wall, caused by the reaming and procedure are also described in the article.
Adult↗
Spontaneous effect of increased stability of the lower lumbar spine in cases of severe chronic back pain. The answer of an external transpeduncular fixation test.
Eighteen patients with severe low-back pain of long duration were externally stabilized over selected segments of the lumbar spine to evaluate the pain relieving effect of increased stability. Five millimeter Schantz screws were driven into the vertebral body transpeduncularly by a closed technique using an image intensifier. A modified Hoffmann fixation device with possibilities to compress and distract was used for external stabilization. The results were recorded by means of pain area sketches and pain lines. All but one patient experienced remarkable relief of low-back pain and often of pain radiating into the lower extremities. No serious complications were seen. Of eight patients with residual severe pain after fusions, five were considered healed using radiologic techniques and three were improved by external stabilization. This test could be used to identify candidates, select levels for lumbar fusion, and evaluate the stability of previous fusions.
Adult↗
The spectrum of intramedullary nailing of the tibia.
Intramedullary nailing of the tibia has been used mainly in selected cases of fresh diaphyseal fractures and nonunions. However, with modern variations of the technique, the indications can be expanded considerably. Interlocking nailing has increased the number of fractures suitable for intramedullary fixation. With this technique or with other additional measures, intramedullary fixation can be used after correction osteotomies and for stabilization of metastases and pathologic fractures. When used on correct indications and in the absence of complications, intramedullary nailing is the method of choice for stabilization of the tibia. The advantages are short stay in hospital, short morbidity, early range of motion exercises, and weight-bearing without immobilization in plaster. A prerequisite, however, is that the surgeon be very familiar with the technique, and its indications and complications.
Bone Nails↗
[Anterior plating of the cervical spine with the hollow screw-plate system of titanium].
A hollow screw-plate system made of titanium for osteosynthesis of the cervical spine is presented. This system is designed to achieve a stable fixation for fusion of the vertebra. The posterior corticalis of the vertebral body need not and indeed cannot be perforated by the screws. Loosening of the screws is not longer possible because of growth of bone into the lumen of the screw and direct attachment of bone to the surface of the screw.
Bone Plates↗
[Medial plate for reinforcement in trochanteric femoral pseudarthrosis].
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Adult↗
Recurrent dislocation after total hip replacement. Treatment by fixing an additional sector to the acetabular component.
Six patients with recurrent dislocation after total hip replacement have been treated by fixing an additional sector to the acetabular component. Muscle imbalance or unsatisfactory positioning of the prosthetic components (or both) had caused the dislocations in five patients. In the sixth, a schizophrenic, the dislocations were due to the positions in which the patient placed his limb. At operation a sector was cut from another acetabular prosthesis and screwed on to the previously inserted acetabular component in such a position as to prevent further dislocation. This method has been successful and seems a simple alternative to exchange arthroplasty.
Aged↗
Ender nailing of pertrochanteric fractures. Complications related to technical failures and bone quality.
In a series of 127 consecutive patients with trochanteric femoral fractures treated with Ender nailing, bone quality and technical failures were analysed. Of the fractures, 35 per cent were stable and 65 per cent unstable according to the definitions of Evans. There were no implant failures. Technical failures occurred in 16 cases. These could be referred to unsuitable location of the nails in the femoral head and/or to an insufficient fixation of the nails in the medullary cavity, especially in patients with poor bone quality and unstable fractures. Technical failures should therefore be preventable. When a correct surgical technique is used with a sufficient number of nails in femurs with low bone quality and a wide medullary canal, the method seems to be a simple and safe treatment for most pertrochanteric fractures, with elimination of many of the problems often associated with this injury.
Aged↗
[Angulation osteotomy as an alternative in the treatment of non-union of the femoral neck].
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Adult↗
Subtrochanteric fractures. Classification and results of Ender nailing.
With use of a simple classification based on anatomical criteria and anatomical function, 27 subtrochanteric fractures of the femur were studied. The series was derived from 156 elderly patients with extracapsular hip fractures, all of whom were operated on by the Ender method. There were no infections. Regarding intra- and postoperative bleeding, early mobilization, length of hospital stay, and final clinical outcome, the results were superior to those obtained with other methods so far presented. Three patients died within 3 months postoperatively. Technical failure occurred at an early stage in 4% and at a later stage in 12.5%. Short oblique fractures did not require any supplementary fixation. Neither comminution nor obliquity prevented early mobilization with full weight-bearing. Tibial traction for a short period in one patient did not prevent expected mechanical failure. The mean time in hospital was 19 days. The functional result was excellent or good in 79% of the patients.
Aged↗
The influence of age on the morphology of trochanteric fracture.
A series of 127 trochanteric femoral fractures was analyzed with respect to fracture type, age, and bone quality (osteoporosis). There was a continuous decrease in bone quantity (measured as femoral score) with age and a direct relation between bone quality and the severity of the pattern of the trochanteric fracture. The skeletal ageing process starts earlier in women. However, after the age of 85 years the process is more rapid in men. Consequently, the risk of sustaining a trochanteric fracture is greater in men than in women above this age. The increasing age of the population and the longer survival of the oldest people results in more unstable and more comminuted fractures, which have increased by a factor of nearly 3 during the past three decades.
Age Factors↗
Mobility of the pubic symphysis. Measurements by an electromechanical method.
Two pins were inserted, one on each side of the symphysis in 15 volunteers and four cadavers. Movements between the pins were registered by two transducers. Symphyseal movements were small. Translations in the transverse and sagittal directions were around or below 1 mm. Rotations in the frontal and sagittal planes were below 1.5 degrees. Movements in the vertical direction were around 2 mm in both sexes. Higher values were observed in multiparous than in nulliparous volunteers.
Adult↗
Rising incidence of hip fracture in Uppsala, 1965-1980.
The frequency and incidence of hip fracture in persons aged 55 years and older in the county of Uppsala during the years 1965, 1970, 1975 and 1980 are reported. For every 5-year interval, the number of hip fractures increased by 21-25 per cent. The ratio of women to men changed from 3.8 in 1965 to 3.1 in 1980. Trochanteric fractures were more common during the later years. The ratio of femoral neck fractures to trochanteric fractures decreased from 1.8 to 1.1 between 1965 and 1980. The incidence of hip fracture in the investigated part of the population increased from 43 per 10 000 in 1965 to 65 in 1980. The age-specific incidence increased especially in the group aged 85 years and older, in which fractures of the femoral neck were three times and trochanteric fractures four times more common in 1980 than in 1965. This investigation shows that the incidence of hip fracture has increased, particularly in the higher age groups. If the age-specific incidences continue to rise in the higher age groups, the frequency of hip fractures will be doubled within a 20-year period.
Age Factors↗
Symphysiodesis with a new compression plate.
A specially designed compression plate has been used in symphysiodesis for chronic symphysiolysis with pelvic pain and discomfort suspected to be due to pelvic instability. Eight patients have been operated with this technique, and stable symphysiodesis was achieved in all. No signs of plate loosening were observed in any case.
Adult↗