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Biomedical subjects

S T Hansen

Publications and source records attributed to S T Hansen.

At least 55 records · Page 3Linked to original sources
PubMed1989

[Thromboxane A2 and granulocyte elastase after severe trauma--relationship to complications and survival rates].

Of 64 polytraumatized patients with a mean injury severity score of 33.1, 42 showed marked systemic release of thromboxane B2 and granulocyte elastase during the initial 18 hours after trauma, reaching peak arterial levels of greater than 1,000 pg/ml and ng/ml, respectively. If those patients ("responders": plasma TXB2 greater than 250 pg/ml) were compared with the remaining 22 ("non-responders": TXB2 less than 250 pg/ml) the following became obvious: "Late" mortality (greater than 3 d) was 31% in responders, which is significantly higher than in non-responders (9%). No correlation was observed between "early" mortality (less than 3 d) and mediator release. There was no difference in the incidence of the adult respiratory distress syndrome (ARDS) (38% versus 32%) or the late sepsis syndrome (17% versus 18%) between responders and non-responders. Morbidity, however, differed markedly in that ARDS in responders was associated with significantly higher elastase levels, a higher mortality and 10 times higher incidence of sepsis as compared to responders without ARDS. ARDS in non-responders, by contrast, did not change elastase maxima or the mortality rate as compared to non-responders without ARDS. It is concluded that TXB2 is not a predictor of posttraumatic ARDS, but is related to a complicated course, in particular to sepsis and mortality. Elastase with high probability predicts ARDS and/or the late sepsis syndrome. Simultaneous determination of TXB2 further enhances the predictive value of elastase.

Adult↗
PubMed1989

Mathematically directed single-cut osteotomy for correction of tibial malunion.

In 1986 and 1987, four patients with tibial malunion involving both angular and torsional misalignment underwent surgical correction by a single-cut technique based on a mathematical model of long bone deformity. The technique involved a single surgical cut, followed by rotation of the two fragments along the osteotomy plane. The orientation of the osteotomy is based on a computer-assisted design. The deformity is measured on radiographs, computed tomography, and clinical exam and is then plotted on graphs to find the osteotomy orientation. The deformity involved varus and extension in four cases, internal rotation in 2, and external rotation in two. The deformities ranged from 9 to 26 degrees. The cutting angle of the osteotomy ranged from 50 to 66 degrees as measured from the transverse plane. Actual lengthening of 1 cm and functional lengthening over 1.5 cm was obtained without the use of bone graft. As no wedge of bone was removed, all corrected bones were easily suited to rigid internal fixation across the cut surface. In all cases, the desired correction was obtained within measurable error, and union was obtained with minimal immobilization. There were no soft tissue or joint contractures, and no neurovascular complications. In one patient, who had had four prior surgical procedures on the involved limb, an infection developed 6 weeks postoperatively that required debridement and delayed primary closure. As the technique involves only one cut, no wedge of bone is removed, no shortening occurs, and the osteotomy is highly suitable for rigid internal fixation. The described technique is the first to integrate in a precise way the correction of torsion with the correction of angular deformity.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanical Phenomena↗
PubMed1989

Modified Lapidus procedure for hallux valgus.

A modified Lapidus procedure was introduced at Harborview Medical Center in 1979 for the treatment of symptomatic hallux valgus with hypermobile first ray. The results of the procedures were reviewed retrospectively in 32 patients with 40 feet that were operated on between 1979 and 1984. Preoperative diagnosis was symptomatic hallux valgus complex with hypermobile first ray in 33 and failed bunion surgery in 7. Follow-up ranged from 30 months to 6 1/2 years. Union of the arthrodesis site occurred in 36 (90%). The average preoperative intrametatarsal angle was 14 degrees (range 7.5 to 20 degrees) and the hallux valgus angle was 26 degrees (range 0 to 50 degrees). At healing, the angles were as follows: intermetatarsal angle 6 degrees (range 0 to 18 degrees) and hallux valgus angle 11 degrees (range -3 to 30 degrees). The average change in the length of the first metatarsal was -5 mm for those without bone graft and +4 mm for those with bone graft. Of 33 feet operated on as a primary procedure, successful results were reported in 75% by our rating system. Of 7 feet operated on for failed previous surgery, all were improved. Best results were obtained in those with multiple screw fixation, use of bone graft, and attention to plantarflexion of the first metatarsal.

Arthrodesis↗
PubMed1989

Early and late posttraumatic foot reconstruction.

When complex trauma occurs in the foot, there is (1) loss of structural continuity that renders the bony architecture mechanically useless and (2) changes in the soft tissue that subject the foot to potential contractures and atrophy. The priorities of salvage of such injuries are early and accurate diagnosis, early reduction and stabilization, careful handling of soft tissues, tissue transfer to fill defects, and early motion. By these means it is possible to diminish the effects of edema, atrophy, stiffness, and osteoporosis. When initial treatment fails, salvage procedures must consider the length of disability, the expected functional outcome after salvage, and the lifestyle of the individual. Late salvage is by selective arthrodesis and realignment of mechanical relationships, followed by aggressive functional rehabilitation.

Foot↗
PubMed1989

Displaced intra-articular fractures of the tarsal navicular.

Between 1980 and 1987, twenty-one patients who had a displaced fracture of the body of the tarsal navicular were treated with open reduction and internal fixation. A classification system was devised on the basis of the direction of the fracture line, the pattern of disruption of the surrounding joints, and the direction of displacement of the foot. In a Type-1 injury, the fracture line is in the coronal plane and there is no angulation of the fore part of the foot. In a Type-2 fracture, the primary fracture line is dorsal-lateral to plantar-medial, and the major fragment and the fore part of the foot are displaced medially. In a Type-3 injury, there is a comminuted fracture in the sagittal plane of the body of the tarsal navicular, and the fore part of the foot is laterally displaced. Satisfactory reduction, which was defined as restoration of more than 60 per cent of the joint surface in the anteroposterior and lateral planes, was achieved in all Type-1 injuries, 67 per cent of the Type-2 fractures, and 50 per cent of the Type-3 fractures. Radiographic evidence of healing was seen at an average of 8.5 weeks after injury. At an average follow-up of forty-four months (range, twelve to 106 months), a good result was noted in fourteen patients (67 per cent); a fair result, in four (19 per cent); and a poor result, in three (14 per cent). Both the type of fracture and the accuracy of the operative reduction directly correlated with the final clinical outcome.

Adolescent↗
PubMed1989

Plates versus external fixation in severe open tibial shaft fractures. A randomized trial.

A prospective study of 59 patients with Grade II or III open tibial shaft fractures compared internal and external fixation. Bony stabilization was with plating by AO principles or with external fixation with the one-half pin technique, prospectively randomized. In 12 cases, minimal internal fixation of the tibia and external fixation were combined. Definitive wound closure was delayed in all cases. Three free-flap transfers and two gastrocnemius myoplasties were done; vascular injury necessitated three early limb amputations. Fifty-six patients were followed for at least one year. Five plate fixations (19%) were complicated by severe osteomyelitis, and three plate fixations failed. Severe osteomyelitis occurred in one case (3%) treated with external fixation. Three pin-tract infections occurred. In two patients, a 10 degrees anteroposterior angulation occurred after external fixation removal. One patient healed with a 25 degrees external rotation deformity. At final follow-up evaluation, all tibial shaft fractures had healed. Knee and ankle ranges of motion were affected by ipsilateral femoral shaft fracture, knee injury, or ankle and foot trauma but not by the type of fixation. Both methods yielded excellent results, but the rate and extent of complications were lower with external fixation. Therefore, external fixation using the one-half pin technique should be regarded as a primary method of stabilization for Grades II and III open tibial shaft fractures.

Adolescent↗
PubMed1988

Tibialis posterior tendon rupture: a cause of rheumatoid flat foot.

Flat foot, a major cause of foot pain and disability, may result from rupture of the tibialis posterior tendon. We describe 2 patients with rheumatoid arthritis who developed flat feet secondary to surgically confirmed tendon rupture, and we discuss the anatomy and diagnosis of this condition. In the second patient, we also present the results of tendon imaging with both magnetic resonance and ultrasound.

Aged↗
PubMed1988

Immediate spica casting for pelvic fractures.

Records of 52 polytraumatized patients with closed pelvic fractures were reviewed retrospectively to determine if spica cast application decreased mortality due to exsanguination. Twelve patients had supplemental stabilization with external fixators or internal fixation of the pelvis. Their results indicated that the spica cast is effective in decreasing or controlling bleeding since no patient died of exsanguination. Several patients did die, however, but the cause of death in these patients was usually adult respiratory distress syndrome with or without other sepsis. Injury severity score, age, hypotension, and platelet count were found to be prognostic indicators for both transfusion requirements and mortality. A spica cast may be a useful adjunctive method for decreasing blood loss in the immediate postinjury period, but prolonged or improper use may lead to additional complications and death.

Adolescent↗
PubMed1988

Two-hole plate fixation for traumatic symphysis pubis diastasis.

Techniques for managing traumatic diastasis of the pubic symphysis include bed rest, hip spica casting, pelvic slings, external fixation, and internal fixation. We report herein our experience with 14 consecutively managed patients in whom we successfully stabilized traumatic pubic diastasis with a single two-hole plate fixation. The average age of the 13 men and one woman was 30 years; followup averaged 17 months. Most of the patients had associated injuries (Injury Severity Score average, 19). Nine patients had concomitant disruption of the sacroiliac joint requiring either delayed open reduction and internal fixation or prolonged skeletal traction; among the five remaining patients, time to mobilization (bed to chair) averaged 1 day. There were no complications attributable to the procedure; i.e., no infections, and no failures of fixation. In this small series of patients early two-hole plate fixation of the traumatic diastasis of the pubis satisfactorily restored the disrupted anterior pelvic ring, contributed to early mobilization of the patients, and made reduction of a concomitantly disrupted sacroiliac joint easier, whether accomplished by skeletal traction or open reduction and internal fixation during a second procedure.

Adolescent↗
PubMed1988

Subtalar distraction bone block fusion for late complications of os calcis fractures.

The authors are presenting a new subtalar fusion technique for late complications of calcaneus fractures. These complications include pain, shoe wear difficulties, and foot deformity. The complex pathology includes incongruous subtalar joint, loss of calcaneal body height, and decreased lateral talocalcaneal angle. The latter two factors can result in tibiotalar neck impingement, a deformity that has received little attention in the literature. The subtalar fusion technique involves distraction of the subtalar joint, insertion of a bone block, and rigid screw fixation. The distraction allows correction of the talocalcaneal relationship and regains lost hindfoot height. The clinical series involved 16 feet with an average follow-up of 19 months. Results were satisfactory in 13 feet. Pre- and postoperative radiographic analysis for tibiotalar impingement, lateral talocalcaneal angle, and talonavicular subluxation was performed, with improvement to a normal range seen in the cases analyzed. The results are encouraging but should be considered preliminary based on the length of follow-up.

Arthrodesis↗
PubMed1988

Broken intramedullary nails.

Between 1962 and 1987, we treated fifty-six patients for sixty broken intramedullary nails, using a custom-made hook to extract the distal fragment of the nail. The charts and radiographs of all of the patients were reviewed. Thirty-nine of the nails had been inserted in a fresh fracture, which usually was comminuted; eight had been used for fixation of an osteotomy; nine, for fixation of a non-union; and four, for treatment of a pathological fracture. Several small-diameter intramedullary nails broke at the site of the fracture or non-union. In contrast, the sites of breakage in the interlocking nails were the interlocking holes and the welded junction of the top insertional portion and the proximal slot. Many of the breakages were in patients who had an unstable fracture pattern. The interval between insertion and breakage ranged from one to 120 months.

Adolescent↗
PubMed1988

Fractures and fracture-dislocations of the tarsometatarsal joint.

We are reporting the results in a consecutive series of forty adults in whom, between 1978 and 1984, forty-one tarsometatarsal fracture-dislocations were treated with open reduction followed by temporary internal fixation with AO screws. Ninety per cent of the patients had an intra-articular or a periarticular fracture. An anatomical or nearly anatomical reduction was achieved in all but a few patients, and there was no loss of fixation or displacement. For thirty-four patients (thirty-five injuries), the length of follow-up averaged 3.4 years, and a good or excellent functional result was obtained in all but two of the thirty in whom an anatomical reduction had been achieved. Of the six patients who had a fair or a poor result, five had an associated grade-II or grade-III open injury. The development of post-traumatic arthritis was directly related to damage to the articular surfaces or to inadequate reduction, or to both.

Adolescent↗
PubMed1988

Immediate nailing of open fractures of the femoral shaft.

Débridement of the wound and immediate reamed nailing were performed on sixty-seven patients who had an open fracture of the femoral diaphysis. Forty-two of these patients were followed for a minimum of twelve months (average, twenty-three months). Using the classification system of Gustilo and Anderson, there were fifteen (36 per cent) Grade-I, nineteen (45 per cent) Grade-II, and eight (19 per cent) Grade-III soft-tissue injuries. All of the fractures healed within four months after injury. The average flexion of the knee was 127 degrees and that of the hip, 129 degrees. At least 90 degrees of flexion was achieved in both joints of all patients. Perioperative complications included loss of fixation in four patients (10 per cent), infection of the wound in two patients (5 per cent), a wound seroma in two patients (5 per cent), and thrombophlebitis in one patient (2 per cent). Late complications were angular malunion in three patients (7 per cent), limb-length discrepancy in three patients (7 per cent), external rotation malunion in one patient (2 per cent), and sciatic-nerve palsy in one patient (2 per cent). We concluded that immediate intramedullary nailing of an open femoral fracture can be accomplished safely, with an acceptable rate of complications, given thorough débridement of the wound, proper equipment, and an experienced surgical team.

Adolescent↗
PubMed1987

Treatment of unstable femoral shaft fractures with closed interlocking intramedullary nailing.

From 1979 to 1982, 64 femoral shaft fractures in 62 patients were treated by closed interlocking nailing at Harborview Medical Center, Seattle, WA, U.S.A., and Parkland Memorial Hospital, Dallas, TX, U.S.A. Twenty-nine patients sustained multiple system injuries and 29 of the involved extremities (45%) had at least one additional injury. There were 17 (26%) open fractures. Static mode nailing was used to treat 52 fractures; dynamic mode nailing was performed for 12 fractures. Patient follow-up averaged 17 months (range 7-41 months). The average time to union was 13.5 weeks. Normal femoral length within 1 cm was achieved in 97% of cases. Knee range of motion averaged 127 degrees. Complications (9%) included two delayed unions, one nonunion, two cases of shortening or lengthening of more than 1 cm, and one case of malunion with angulation or more than 10 degrees. The delayed unions and nonunions healed after one additional procedure. This study shows that closed interlocking nailing is a safe, effective technique that provides stable fixation in most unstable femoral shaft fractures. This technique represents a major advance in the treatment of difficult femoral shaft fractures that would be poorly suited for standard closed nailing.

Adolescent↗
PubMed1987

Forefoot surgery in rheumatoid arthritis: subjective assessment of outcome.

Forefoot surgical outcomes were evaluated in 26 patients with rheumatoid arthritis. A total of 45 procedures were reviewed with emphasis on first ray intervention. Disease duration and aggressiveness of preceding medical therapy were combined to establish a disease severity index. Patients operated were predominantly in the midrange of disease severity. Subjective data on the relief of pain, callus, and deformity were favorable but this benefit was not long lasting inasmuch as patients were most satisfied in the period immediately following surgery and less so as time elapsed from intervention. Fusion of the first metatarsophalangeal joint seemed better than resection alone, indicating that stability should be the primary goal for surgical intervention of the rheumatoid forefoot.

Arthritis, Rheumatoid↗