Search PubMed⌕ Search

Biomedical subjects

S T Hansen

Publications and source records attributed to S T Hansen.

At least 73 records · Page 4Linked to original sources
PubMed1987

Adolescent bunions treated by the modified Lapidus procedure.

The modified Lapidus procedure with rigid internal fixation was used to correct adolescent bunion deformities in 20 patients (32 feet). All patients were female and skeletally mature at surgery. Their average age was 18 years. Preoperatively, 100% had bunion pain and trouble with shoe wear, and 93% had a hypermobile first ray. Sixteen patients (24 feet) were available for follow-up examination and radiographs. The average follow-up time for the entire group was 24.3 months (range 3-72 months). Excellent or good results were obtained in 91% of patients. One recurrence required reoperation with first metatarsal osteotomy and MTP joint debridement. In our experience, the modified Lapidus procedure is the procedure of choice for the adolescent bunion with a hypermobile first ray.

Adolescent↗
PubMed1987

Bilateral fractures of the tibia: a severe injury associated with multiple trauma.

Trauma which results in bilateral fractures of the tibia represents a serious physical insult to the victim. A review of our experience at the Harborview Medical Center in the treatment of 14 consecutive patients with this injury provides insights into the management of multiply injured patients with long bone fractures. All of the 28 tibial fractures were the result of high-energy forces, and 16 were open injuries. Thirteen of the patients had sustained severe multiple trauma and three died as a result of their injuries. All surviving patients were followed until complete healing and long-term followup examination was obtained. The severe injuries which result in bilateral tibial fractures are associated with a high morbidity and mortality. Aggressive and meticulous management of the bony and soft-tissue injuries can provide for good results, early mobilization, and full functional return in these multiply injured patients. Primary amputation should be undertaken only as a final alternative, as most open fractures are salvageable.

Adolescent↗
PubMed1987

Subtrochanteric fracture of the femur. Fixation using the Zickel nail.

We divided 131 patients who had a subtrochanteric fracture into four clinical groups: elderly patients who had a fracture secondary to minor trauma, patients who had a fracture due to high-energy trauma, those who had a pathological fracture, and patients who had a fracture that previously had been treated unsuccessfully with internal fixation. In each patient operative fixation was performed using the Zickel device, and overall satisfactory results were obtained in 90 per cent. Considering the challenging nature of subtrochanteric fractures, complications, which included a rate of non-union of approximately 5 per cent, were minimum. Technical details for each of the four groups are emphasized.

Adolescent↗
PubMed1987

Dislocations and fracture dislocations of the tarsometatarsal joints.

Dislocations and fracture-dislocations of the tarsometatarsal joints are potentially disabling injuries that present challenging therapeutic problems. Early recognition is imperative and is based on a familiarity with the important anatomic features of this joint, mechanism of injury, and subtle radiographic changes that often accompany these lesions. Following injury, a precise anatomic reduction of the tarsometatarsal joint is critical if long-term disability is to be avoided. There appears to be a direct correlation between achieving an accurate reduction and a satisfactory clinical result. In our experience, surgical reduction offers the most effective and reliable means of achieving this goal. We have presented an approach for the management of these lesions, which we believe offers advantages over previously described techniques. Our experience has shown that accurate anatomic operative reduction and rigid internal fixation provide an increased assurance of a pain-free, durable, and functional foot in the great majority of cases.

Bone Screws↗
PubMed1986

Percutaneous Neufeld pinning for femoral neck fractures.

Percutaneous Neufeld pinning was performed for 32 femoral neck fractures in elderly medically debilitated patients (mean age, 75 years). The technical complications were minimal in the 25 impacted or nondisplaced fractures and in the seven displaced fractures. Although 23 of the 25 patients with impacted or nondisplaced fractures were ambulatory at a mean follow-up period of two years, none of the patients with displaced fractures achieved functional ambulation. Percutaneous Neufeld pinning may be considered for elderly, medically unstable patients with impacted or nondisplaced fractures, using no more than three pins. Some other internal fixation device, endoprosthetic arthroplasty, or another implant should be considered for displaced fractures.

Aged↗
PubMed1986

The Deyerle device for fixation of femoral neck fractures. A review of one hundred twenty-five consecutive cases.

One hundred twenty-five consecutive femoral neck fractures were treated with Deyerle fixation in the ten-year period from 1970 to 1980. The 123 patients in the series of 125 fractures had a mean age of 62.2 years. Sixty-nine percent of the fractures were displaced. Fewer than nine pins were used in only eight cases. In 102 cases, impaction was recorded and quantitated. Pin penetration was noted in 44 cases (35%), and infection in 14 cases (11%). Sixty-four percent of the patients were followed for at least two years; 31 (39%) developed aseptic necrosis and five (6.3%) had nonunited fractures. Owing to the risks of increased operating time, blood loss, and technical difficulties encountered in the authors' teaching hospital, the method was discontinued.

Adult↗
PubMed1986

Immediate internal fixation of open fractures of the diaphysis of the forearm.

Between 1975 and 1983, fifty-seven patients were treated at Sunnybrook and Harborview Medical Centers with immediate internal plate fixation of an open diaphyseal fracture of the forearm. Fifty patients were available for follow-up, which ranged from one to nine years and averaged three years. The injuries were classified on the basis of the extent of soft-tissue injury as defined by Gustilo and Anderson, and consisted of twenty Type-I injuries, nineteen Type-II injuries, and eleven Type-III injuries. The complications included deep infection in two patients and non-union in six. The functional results were excellent or good in 85 per cent of the series. This study demonstrates that immediate stable plate fixation is a beneficial method of treatment of open fractures of the forearm. The results are related to the severity of the initial soft-tissue injury and the surgical technique. Autogenous cancellous bone-grafting at the time of closure of the wound in comminuted fractures in which interfragmental compression cannot be obtained is recommended.

Adolescent↗
PubMed1986

Intramedullary nailing and reaming for delayed union or nonunion of the femoral shaft. A report of 105 consecutive cases.

One hundred five consecutive patients with a diagnosis of delayed union (61 patients) or nonunion (44 patients) of the femoral shaft from February 1968 to November 1983 were managed by intramedullary reaming and nailing. The procedure was accomplished by closed techniques in 82 of the cases. Adequate follow-up study was obtained in 101 patients; all but four showed clinical and radiologic union at an average of 20 weeks following the procedure, with an overall union rate of 96%. The four patients whose fractures failed to consolidate with this treatment had repeat procedures with placement of thicker nails, and all subsequently healed.

Adult↗
PubMed1986

Treatment of failures after plating of tibial fractures.

Eighteen patients with tibial fractures treated by plating that had failed were treated by intramedullary nailing. Nine patients had a broken plate or screw that had pulled out. In seven, the plate and screws were intact but no healing was evident, and in two patients the plate was intact but one or more screws were broken. The plate and screws were removed from all patients and immediate limited open intramedullary nailing was done with a Küntscher nail after the bone was reamed. In one patient the method failed, while in fifteen patients the fracture united and in the two remaining patients who could not be contacted union was thought to be in process when they were last seen, five and ten months postoperatively. Two bone grafts were used in one patient. Six fibular osteotomies were performed in conjunction with the intramedullary nailing.

Adult↗
PubMed1985

Management of acute distal radioulnar dislocations associated with radial shaft substance loss.

In patients with distal radioulnar dislocations that are associated with a loss of radial shaft substance, the use of an external distractor that is applied to the distal radial fragment and the proximal ulnar shaft allows proper reduction of distal radioulnar articulation. The pins should be placed close to a joint so that the holes left after the pins are removed do not act as diaphyseal stress risers. The position is maintained by appropriate internal fixation and bone grafting of the radius. In cases where the bone is severely crushed and internal fixation cannot be applied, the external distractor may be converted to an external fixator.

Accidents, Traffic↗
PubMed1985

Open tibial fractures with associated vascular injuries: prognosis for limb salvage.

Open tibial fractures complicated by limb-threatening vascular injuries present an infrequent but difficult management problem. Twenty-three cases were reviewed with an ultimate amputation rate of 61% (22% primary, 39% delayed). Crush injuries, segmental tibial fractures, and revascularization delays of greater than 6 hours were associated with a bad outcome. Guidelines for primary amputation (crushing injuries, delay in revascularization, segmental tibial fractures) are proposed and implications of limb salvage are reviewed.

Accidents, Traffic↗
PubMed1985

Pelvic ring disruptions with symphysis pubis diastasis. Indications, technique, and limitations of anterior internal fixation.

The management of disruption of the pelvic ring is both complex and controversial. Twenty-four injuries associated with symphysis pubis diastasis were reviewed to evaluate a two-hole plate technique of anterior internal fixation as compared to four-hole plate anterior fixation. The two-hole plate technique appears to be quite acceptable for maintaining reduction of the diastasis and therefore can be used to manage most anteroposterior compression injuries (those without complete posterior disruption). Vertical shear injuries, all of which are grossly unstable, can also be managed with anterior two-hole plates. However, this fixation method must be supplemented with some form of posterior stabilization to maintain pelvic ring reduction.

Adolescent↗
PubMed1984

Fractures of the femoral neck in patients between the ages of twelve and forty-nine years.

Femoral neck fractures in young adults have a poor prognosis because the incidence of non-union and aseptic necrosis is high. We reviewed the results in twenty-seven consecutive patients with a femoral neck fracture who were younger than fifty years and who were treated with a standard protocol at Harborview Medical Center from 1975 to 1981. There were twenty-two male and five female patients, and they ranged in age from twelve to forty-nine years (mean, 32.4 years). Twenty patients were involved in high-velocity trauma and twelve of them had significant injuries to other organ systems. One of the remaining seven patients had sustained the fracture while running, and in the other six the fracture was associated with a metabolic disorder. Eight patients had a Garden Stage-II fracture; twelve, Stage-III; and seven, Stage-IV. The fractures were fixed with multiple 6.5-millimeter cancellous screws after adequate closed reduction, which was usually performed within eight hours after injury. All of the fractures united and there were no wound infections. Aseptic necrosis of the femoral head developed in five patients (20 per cent), three of whom had symptoms at the time of writing and will require surgical revision of the hip.

Adolescent↗
PubMed1984

Immediate internal fixation of open ankle fractures. Report of thirty-eight cases treated with a standard protocol.

We reviewed thirty-eight cases of open ankle fractures that had been treated with a standard protocol: alignment and splinting of the fracture at the scene of injury if possible, antibiotics administered in the emergency room and continued for forty-eight hours, admission of the patient to the operating room as quickly as possible, copious irrigation and thorough débridement of the wound, immediate rigid anatomical internal fixation, and delayed primary closure at five days. All of the fractures united, but three patients required subsequent ankle fusion because of cartilage damage noted at the initial operation. Of the thirty-five ankles with complete follow-up, the functional result was excellent in twenty-six and fair or poor in nine.

Adolescent↗
PubMed1984

Ipsilateral fractures of the femur and tibia. A report of fifty-seven consecutive cases.

We treated fifty-seven consecutive ipsilateral fractures of the femur and tibia in fifty-four adults from 1968 through 1978. Twenty-one patients had concomitant life-threatening injuries, and in thirty-three extremities the fractures were open. All but one of the femoral fractures and about half of the tibial fractures were internally fixed. The length of hospitalization averaged five weeks. Local complications included one below-the-knee amputation, three deep infections, and four ununited fractures. A fat embolism syndrome was diagnosed in 13 per cent of the patients. At the last follow-up examination, at an average of 40.5 months after injury, the mean range of motion of the knee was 129 degrees. Over-all, a good or excellent functional result was achieved in about 80 per cent of the patients. The best results were achieved when both fractures were stabilized surgically.

Adolescent↗
PubMed1984

Ipsilateral fractures of the femoral neck and shaft. A treatment protocol.

Ipsilateral fractures of the femoral neck and shaft present diagnostic difficulties and complex choices as to treatment. A review of the eighty-three cases reported in the literature revealed that one-third of the fractures of the femoral neck were missed initially. No consistent method of treatment can be recommended on the basis of this review. Our present protocol for this double fracture is treatment with immediate internal fixation: the femoral neck fracture is given first priority and is reduced and immobilized with multiple cancellous screws, and the femoral shaft fracture is then treated with retrograde closed intramedullary Küntscher nailing. Appropriate exceptions to the protocol exist. We reviewed the cases of fifteen patients who were treated at Harborview Medical Center and University Hospital from 1971 through 1981. Our experience with the first two patients led to the development of our protocol, which was applied in the thirteen subsequent double fractures. Two of the fifteen femoral-neck fractures were missed initially. All of the fractures had united four months postoperatively. Of the nine patients who were followed for three years or more, two had aseptic necrosis of the femoral head. Compared with other reports, our protocol seems to have produced somewhat better functional results.

Adult↗