Biomedical subjects

V Vécsei

Publications and source records attributed to V Vécsei.

At least 19 recordsLinked to original sources

PubMed2006

Minimally invasive ilioinguinal approach to the acetabulum.

The classic ilioinguinal approach is a gold standard in acetabular surgery. We developed a modification, a minimally invasive method that entails a median lower abdominal approach with extraperitoneal dissection and exposure of the pubic symphysis. The second incision is lateral, next to the iliac crest. This allows an easy, safe and quick exposure of the anterior iliac ring as well as easy access to the posterior column and wall towards the sacroiliac joint. The iliac vessels and nerves are thereby protected, and no preparation of neurovascular structures is required. The technique was applied in 23 clinical cases and compared with the classic ilioinguinal approach in 9 similar cases over the same period.

Acetabulum↗

PubMed2006

[The use of sonography in muscular injuries of the lower leg].

BACKGROUND: Over one third of all sports related injuries affect the muscle-tendon apparatus. Therefore an easy, quick and cost effective method for diagnosis and follow up is necessary. METHODS: We studied 50 patients with muscle strain injuries divided in two groups. The patients of group A received an elastic bandage, within the next 24 hours the first sonography of the affected limb was performed. The next check up was after 7 to 14 days and after 4 to 6 weeks. The average duration of use was registered. The visual analogue scale (VAS) was used to register pain, and the reduction of activity and motion was classified in three grades. In the patients of group B a tape bandage was applied to the injured leg. The same schedule was used for these patients. In all patients a cooling therapy was started as soon as possible. The two groups of patients were checked regularly using ultrasonography and compared to each other due to the different parameter. RESULTS: In 36 patients a muscular injury was detected sonographically during the first check up. In 13 patients on day 7 to 14, still a lesion was detectable. And in one patient 6 weeks after injury a lesion was still detectable. The 37 patients of group A reported an average of 6.9 points on VAS on day one, after 7 to 14 days 3.3 points and 0.8 points after the last check up. The 13 patients of group B reported an average of 6.7 points on VAS on day one, after 7 to 14 days 3.8 points and 2.0 points after the last check up. CONCLUSIONS: The clinical symptoms show good correlation to the sonographic results.

Adult↗

PubMed2005

Mid-term results of conservative, conventional and endovascular treatment for acute traumatic aortic lesions.

BACKGROUND: To analyze our results after conservative, conventional and endovascular treatment for acute traumatic aortic lesions during the last decade. METHODS: From June 1993 to September 2004, a total of 19 patients with traumatic aortic lesions were referred to our department. All patients sustained injuries from blunt deceleration trauma. In hemodynamically stable patients, initial evaluation was by multi-slice CT scan. The diagnosis of traumatic aortic injury was confirmed and an individual treatment strategy was determined. In hemodynamically unstable patients, emergency thoracotomy was performed. RESULTS: An emergency thoracotomy was performed in seven (37%) patients. Mortality in this group was 100%. In the remaining group of 12 (63%) patients without hemodynamic instability at time of admission, in-hospital mortality was 0%. Treatment was surgical in five patients (26%), endovascular in five (26%) and conservative in two patients (11%). Mean follow-up was 63 months (5-108 months). No patient died during follow-up. In patients treated by endovascular stent-graft placement no signs of endoleaks could be detected. CONCLUSIONS: Hemodynamic stability and an individual treatment strategy are prerequisites for survival of acute traumatic aortic lesions. Endovascular stent-graft placement has emerged as an innovative and minimally invasive therapeutic option in this polytraumatic high-risk patient cohort.

Adult↗

PubMed2005

[Polytrauma and air rescue. A retrospective analysis of trauma care in eastern Austria exemplified by an urban trauma center].

OBJECTIVE: The aim of this study was a retrospective analysis of polytraumatized patients who were treated by a helicopter emergency medical service (HEMS) crew. This study was performed to evaluate the level of prehospital care provided for severely injured patients. Special consideration was given to treatment strategies of specific injuries which led to multiple injuries, defined as "polytrauma." METHODS: From September 1992 to April 2001 data of 386 patients treated in the Department of Traumatology of the University of Vienna were collected. A total of 104 patients (26.9%) were transported by helicopter directly from the accident scene. This collective was analyzed demographically; relevant prehospital data such as therapeutic interventions and the early clinical course were examined. RESULTS: The mean Injury Severity Score (ISS) was 36.9: 70 (67.3%) patients were male and 34 (32.7%) female; the median age was 36.1 years. Traffic accidents were the most frequent trauma mechanism (78.9%) followed by falls from height (17.3%). The mean period between trauma and trauma emergency room was 0.73 h; 77 (74.0%) patients were intubated and mechanically ventilated at the scene and all patients received analgosedation. The mean preclinical fluid load was 1673 ml. The mean duration of treatment in the emergency room was 53 min. The mean length of intensive care was 8.6 days and the mortality rate was 19.2% within the first 24 h. CONCLUSION: Major trauma is an important cause for requesting a primary HEMS mission. As the results of this study show, immediate and invasive interventions at the scene lead to an improvement of vital functions at admission. For the patients' further course of treatment, the choice of a trauma center seems to be important, too.

Adolescent↗

PubMed2005

[Long-term results in the treatment of foot injuries in polytraumatized patients].

INTRODUCTION: The aim of this study was to evaluate the long-term outcome of multiple injured patients with foot injuries. While severity and frequency of multiple injuries could be decreased in the last years, it was not possible to decrease the severity of injuries of the foot and ankle region. These injuries are often not detected and their severity is underestimated in primarily diagnostics what might lead to complaints in the longterm course. METHODS: The multiple trauma database of the Department of Traumatology of the University of Vienna includes 386 patients from September 1992 to April 2001. 40 (10.4 %) of these patients suffered a fracture or dislocation of foot or ankle. 33 (82.5 %) multiple injured patients with injuries of foot or ankle could be reexamined between April and September 2002 and the longterm outcome of the foot and ankle region could be evaluated objectively and subjectively. RESULTS: 22 (66.7 %) patients were male, 11 (33.3 %) female. The mean age was 34.5 years. 27 (81.8 %) patients still suffered from complaints related to their injured foot and ankle region. After calculation of the AOFAS these complaints were predominantly located in the ankle-hindfoot region. 22 (66.7 %) patients had to limit their sports activity. DISCUSSION: In our study period an increasing number and severity of injuries of foot or ankle can be shown. Furthermore multiple injured patients with concomitant injuries of foot or ankle show a lower ISS what suggests that these patients might have a higher survival rate and consecutively enter rehabilitation process.

Abbreviated Injury Scale↗

PubMed2004

A new simplified technique for producing platelet-rich plasma: a short technical note.

A possible strategy to promote the wound-healing cascade in both soft and hard tissues is the preparation of an autologous platelet-rich plasma (PRP) to encourage the release of growth factors from activated platelets. In this process, PRP combines the advantage of an autologous fibrin clot that will aid in hemostasis as well as provide growth factors in high concentrations to the site of a tissue defect. The PRP preparation can be used as a biological enhancer in the healing of fractures and lumbar fusions. The local application of growth factors seems to promote initiation and early maturation of bone formation. Autologous bone or bone substitutes can be added to this mixture to increase the volume of grafting material. A simplified technique utilizing a commercially available separation system (GPS-Gravitational Platelet Separation System) is described. This system provides a less costly alternative to other previously described augmentation techniques and also presents a patient-friendly and operator-safe alternative. Further experimental studies of the actual concentrations of the growth factors in the PRP samples are necessary in order to validate the platelet concentration and growth-factor activation by laboratory evidence. In further prospective clinical trials, the safety and efficacy of PRP, in combination with autologous bone or bone graft substitutes, must be evaluated.

Blood Loss, Surgical↗

PubMed2004

[Therapeutic options in the treatment of cartilage defects. Techniques and indications].

BACKGROUND: Cartilage is composed of chondrocytes embedded within an extracellular matrix of collagens, proteoglycans, and noncollagenous proteins. Together, these structures maintain the unique mechanical properties and manifest its striking inability to heal even the most minor injury. METHODS: This review presents the principles of cartilage structure and the biological background of cartilage repair and gives information about the surgical techniques for treating cartilage defects. RESULTS: The response of cartilage to injuries differs from that of other tissues because of its avascularity, the immobility of chondrocytes and the limited ability of mature chondrocytes to proliferate and alter their synthetic patterns. Surgical therapeutic efforts in treating cartilage defects have focused on bringing new cells and tissues capable of chondrogenesis into the lesions and facilitating the access to the vascular system. CONCLUSION: The right indication and the treatment of joint instability and axis deformation are essential for the successful use of cartilage repair procedures.

Cartilage, Articular↗

PubMed2004

[Autologous chondrocyte transplantation for the treatment of articular cartilage defects inf the knee joint. Techniques and results].

BACKGROUND: Currently the use of autologous chondrocytes as a cartilage-repair procedure for the repair of injured articular cartilage of the knee joint, is recommended. METHODS: This review presents the technique of autologous chondrocyte transplantation (ACT) and their modifications as matrix-associated autologous chondrocyte transplantation (MACT). Beside the surgical procedure the experimental and clinical results are discussed. Furthermore the major complications and the indication guidelines are presented. RESULTS: Articular cartilage in adults has a poor ability to self-repair after a substantial injury. Surgical therapeutic efforts in treating cartilage defects have focused on bringing new cells capable of chondrogenesis into the lesions. With ACT good to excellent clinical results are seen in isolated posttraumatic lesions of the knee joint in the younger patient with the formation of hyaline-like repair tissue. The major complications are periosteal hypertrophy, delamination of the transplant, arthrofibrosis and transplant failure. The current limitations include osteoarthritic defects and higher patient age. CONCLUSION: With the right indication and operative technique ACT is an effective and save option for the treatment of large full thickness cartilage defect of the knee joint.

Cartilage Diseases↗

PubMed2004

[Osteochondritis dissecans of the knee joint].

BACKGROUND: Osteochondritis dissecans (OD) is an affection of the subchondral bone involving progressive detachment of an osteochondral fragment. METHODS: This article describes the epidemiology, etiology, clinical appearance, possibilities for radiological diagnostics, and classification of OD and presents conservative and surgical therapeutic techniques. RESULTS: Treatment of OD depends on the size, location, stability of the fragment, and skeletal maturity. The majority of young patients can be treated conservatively. Surgical interventions include antegrade or retrograde drilling with optional refixation and osteochondral transplantation as well as autologous chondrocyte transplantation. CONCLUSION: The results of surgical intervention are quite promising; nevertheless, further prospective comparative studies are necessary to evaluate effectivity.

Cartilage, Articular↗

PubMed2004

Displaced fractures of the proximal humerus in children require open/closed reduction and internal fixation.

Fractures of the proximal humerus in children are rare and constitute only 3% of all epiphyseal injuries. From 1992 to 2002 sixteen patients aged 4 - 15 years with a displaced fracture of the proximal humerus were treated at our level I trauma unit. The mean follow-up of the patients was 23.8 months (8 - 72). Ten children had a metaphyseal fracture and six a Salter and Harris Type II injury. Only one metaphyseal fracture was treated conservatively; the other patients underwent surgery (ORIF [= open reduction internal fixation] in ten patients, CRIF [= closed reduction internal fixation] in five patients). Follow-up examination showed no shortening or major angulation of the humerus in any of the sixteen cases. Fifteen children showed excellent and good results. There was only one average result in a polytraumatized child with additional injuries in both upper extremities. Based on the results of this study we suggest performing ORIF/CRIF in displaced fractures of the proximal humerus in children.

Child↗

PubMed2003

Shortening of the patellar tendon length does not influence the patellofemoral alignment in a cadaveric model.

INTRODUCTION: Anterior cruciate ligament (ACL) reconstruction with the use of autograft tissue represents the standard treatment. The use of a bone-patellar tendon-bone transplant for symptomatic ACL deficiency achieves good long-term results. The purpose of the study was to investigate in a cadaveric model whether reproducible patellar tendon shortening changes the patellofemoral alignment. MATERIALS AND METHODS: Using five cadaveric knees, an MRI investigation was performed with the patellar tendon left unchanged, shortened 5 mm and shortened 10 mm, respectively, in both 20 and 45 degrees of knee flexion. The lateral patellofemoral and the congruence angles were measured and compared using a one-way analysis of variance for repeated measurements. RESULTS: Shortening the patella tendon by approximately 20% did not significantly influence the patellofemoral alignment. CONCLUSION: Although anterior cruciate ligament-reconstruction using the patellar tendon has become a standard procedure, postoperative problems such as anterior knee pain, and patellofemoral osteoarthritis occur quite often. In this cadaver study we did not find a significant difference for the patellofemoral alignment, irrespective of the patellar tendon length.

Adult↗

PubMed2002

[Technical defects of tourniquet manometers].

The use of a tourniquet causes in 0.013% to 1.15% complications (e.g. delayed wound healing, increased rate of infections, thrombosis, pulmonary embolisms,rhabdomyolysis, and compartment syndromes). The rate of these complications depends on the applied pressure, the duration and the cuff design. Also a technical defect of the pressure gauge can lead to complications. A patient with a peroneal palsy after the use of a tourniquet was referred to the Department for Trauma Surgery of the Medical School of the University of Vienna for medical evidence. As there were no reports in the literature about the occurrence rate of technical defects of tourniquet manometers, we checked all tourniquet pressure gauges used at our clinic. Six from eleven gauges were defect and had to be replaced. To minimize the risk for our patients we recommend to check the calibration of the pressure gauges periodically. With regard to the used pressure rate and duration only different recommendations can be found in literature.

Adult↗

PubMed2002

Dedifferentiation-associated changes in morphology and gene expression in primary human articular chondrocytes in cell culture.

OBJECTIVE: The aim of the present study was the investigation of differential gene expression in primary human articular chondrocytes (HACs) and in cultivated cells derived from HACs. DESIGN: Primary human articular chondrocytes (HACs) isolated from non-arthritic human articular cartilage and monolayer cultures of HACs were investigated by immunohistochemistry, Northern analysis, RT-PCR and cDNA arrays. RESULTS: By immunohistochemistry we detected expression of collagen II, protein S-100, chondroitin-4-sulphate and vimentin in freshly isolated HACs. Cultivated HACs, however, showed only collagen I and vimentin expression. These data were corroborated by the results of Northern analysis using specifc cDNA probes for collagens I, II and III and chondromodulin, respectively, demonstrating collagen II and chondromodulin expression in primary HACs but not in cultivated cells. Hybridization of mRNA from primary HACs and cultivated cells to cDNA arrays revealed additional transcriptional changes associated with dedifferentiation during propagation of chondrocytes in vitro. We found a more complex hybridization pattern for primary HACs than for cultivated cells. Of the genes expressed in primary HACs the early growth response (EGR1) transcription factor showed the strongest expression whereas D-type cyclin was expressed in proliferating cells. Other factors associated with differentiated HACs were the adhesion molecules ICAM-1 and VCAM-1, VEGF, TGFbeta2, and the monocyte chemotactic protein receptor. CONCLUSIONS: Our data support the hypothesis that HACs dedifferentiate when grown in monolayer cultures. Moreover, the expression patterns also show that proliferation and differentiation are exclusive features of human chondrocytes.

Aged↗

PubMed2001

[Intramedullary fixation of humerus shaft fractures. An analysis of complications of 2 implants with special reference to outcome after management with the unreamed humerus interlocking nail].

INTRODUCTION: Operative treatment of humeral shaft fractures has gained a new impetus with the development of intramedullary interlocking systems for the humerus. Because of the anatomical structure of the humeral marrow cavity, a regular jamming of nail into bone is not to be expected, so that the stability of these systems needs to be achieved through an interlocking mechanism. Among the commercially available interlocking nailing systems the unreamed humeral nail (UHN) and the Seidel-nail (SHN) can be regarded as the standard implants. DESIGN: In a retrospective study comparing two groups of patients, each treated with one of the two systems, problems and advantages, as well as disadvantages were analyzed, and the complications inherent in the systems examined. PATIENTS: Between 1988-1992, 47 patients with humeral shaft fractures were treated with a Seidel interlocking nail: 25 acute and 18 pathological fractures as well as 4 non-unions (Group 1). Between 1997-1999, 34 patients with humeral shaft fractures were treated with the unreamed humeral nail (UHN). A total of thirty-five (n = 35) nailings (30 acute and 4 pathological fractures, as well as one re-osteosynthesis after emergence of a non-union) were carried out. Three primary palsies of the radial nerve ensued: two with loss of sensitivity, and one complete paralysis (Group 2). METHODS: Based on pre- and postoperative X-rays and follow-up examinations, the healing process and complications inherent in each of the systems were evaluated. RESULTS: Intra-operative complications of Seidel-nailing (Group 1) were seen in 5 cases: failure of the proximal target device in 2 (4.2%) cases; the breaking of the long screwdriver during the distal locking in 1 (2.1%) case; blockade of nail-insertion due to the spreading distal lamellas in 1 (2.1%) case; in 1 (2.1%) case it was impossible to find the imbus of the distal locking screw with the screwdriver. Incorrect surgical technique resulting in further fragmentation of the shaft required revisions in 2 (4.2%) cases. In 3 cases (6.4%), the insertion of the nail was insufficient, so that an impingement resulted. In 12 cases, postoperative complications after Seidel-nailing resulted: 3 (6.4%) radial nerve palsies, of which 2 (4.2%) were transitory; 3 (6.4%) infections; in 3 (6.4%) cases, loosening of the locking bolt inserted in the frontal plane; in 1 (2.1%) case, loosening of the distal spreading screw. The system failed in treating 2 (of 4) non-unions, whereas successful ossification and repair occurred in all acute fractures. In Group 2 (UHN) the acute fractures of 33 cases healed without complications. Intra-operative complications of the unreamed nail: in 2 cases (5.6%), failure of the target devices resulted in malpositoning of interlocking screws. The following intra-operative complications of the retrograde technique were observed: burst of a fragment at the insertion site in 1 case (2.8%); intra-articular positioning of the most proximal interlocking screw in another case (2.8%). Postoperative complications of the unreamed nail: breaking of a proximal and a distal interlocking screw in 1 case (2.8%), which had no influence on the healing progress. In 1 case (2.8%) both proximal interlocking screws came loose and a non-union ensued. After re-osteosynthesis with the same technique, bony repair was achieved. CONCLUSION: The possibilities of operative methods in treatment of humeral shaft fractures are enhanced by intramedullary interlocking systems. Comparing with the Seidel nail, the unreamed humeral nail (UHN) has two advantages: it can be inserted anterogradely as well as retrogradely, and it provides the possibility of compressing the fracture, resulting in a high rotational stability. Due to these results, the application of the UHN is recommended.

Adult↗

PubMed2001

[Change in procedure and re-osteosynthesis of the femur. Definition and retrospective analysis].

The change of treatment modality in osteosynthesis is based on two principles. On one hand, one can exchange the implant as part of a two step procedure to reduce side effects of stabilizing fractures. On the other hand, a reosteosynthesis may be required for treatment of complications. A retrospective analysis was undertaken to differentiate the situation of indication, technique and results of patients with fractures of the femur. Indications for two step procedure of therapy at the femur are limited to fractures of polytraumatized patients and fractures with severe soft tissue damage. External fixator devices have been used for stabilization of long bone fractures with severe soft tissue damage using the two step procedure in the past decades; nowadays unreamed nailing is commonly preferred. Reosteosynthesis may be appropriate for the treatment of failing of osteosynthesis; they can also be used due to delayed union or nonunion of fractures, osseous deficiency or infection. In the case of failing osteosynthesis, the reasons for failing have to be studied thoroughly and a variety of subsequent procedures has to be taken into consideration for successful treatment.

Adolescent↗

PubMed2001

Diagnosis of occult scaphoid fractures and other wrist injuries. Are repeated clinical examinations and plain radiographs still state of the art?

To examine the efficacy of repeated clinical examinations and follow-up radiographs, 121 patients were prospectively and consecutively randomised and clinically followed until a final diagnosis was achieved. All of these patients additionally underwent magnetic resonance imaging (MRI) scans within an average of 3 days after trauma to control the results of this study. MRI detected 112 injuries in 82 patients (67%). Twenty-eight (25%) of these injuries were scaphoid fractures. There were 15 fractures of other carpal bones, 14 avulsion fractures of extrinsic ligaments (AFL), 26 other bone injuries (fractures of distal radius, fractures of radial styloid, ulnar head fracture metacarpal fracture, bone bruises), and 29 soft tissue injuries (triangular fibro-cartilaginous complex injuries, complete or partial ruptures of the scapholunate ligament, ruptures of the radial collateral ligament, hemarthrosis). By means of repeated clinical examinations and plain scaphoid views, experienced observers were able to detect all the occult scaphoid fractures within 38 days, as well as most of the other fractures about the wrist except one fracture of the triquetrum. Soft tissue injuries, however, were diagnosed only in two cases of complete scapholunate ligament tears. It was further obvious that 70% of all scaphoid fractures and 60% of the AFLs were detected in a review of the initial X-rays by experienced surgeons. Only 30% of all scaphoid fractures detected were really occult and all of these were diagnosed correctly. This prospective study demonstrates that clinical and radiological standard procedures are reliable in the diagnosis of occult fractures of the carpus and wrist when performed by experienced observers. MRI scans are indicated for early diagnosis of occult fractures and soft tissue injuries about the wrist.

Adult↗

PubMed2001

The fatigue strength of small diameter tibial nails.

This study was performed to evaluate the fatigue strength of commonly used small diameter tibial nails. Five types of small diameter tibial nails (7 mm aap Biorigid Nail, 8 mm aap Biorigid Nail, 8 mm Ace UTN, 8 mm RT Tibial Nail, 8 mm Synthes UTN) with a sample size of 30 implants (six samples of each nail type) were tested with a new modular testing system. One module of the testing system was removed, simulating a 55-mm distal tibial defect, to induce maximum loading on the distal portion of the implant and locking bolts. The average yield strengths were obtained from static, single cycle tests and revealed an average static ultimate load of 1072 N (aap7), 1820 N (aap8), 1812 N (Ace), 1942 N (R&T), and 1543 N (Syn). The fatigue limits were evaluated by cyclic, sinusoidal loading and revealed a fatigue strength of 750 N (aap7), 1092 N (aap8), 906 N (Ace), 971 N (R&T), and 771 N (Syn) to endure 500000 cycles. Our results showed that the solid tibial nails fractured in the testing device in the same manner and location as they do in the clinical series. This study showed that all the small diameter tibial nails tested are obviously able to transmit loads of more than average body weight. The fatigue strength of the implants is relatively high, which means that patients without bone defects could be mobilised with full weight bearing as tolerated by pain. However, according to the results of this study, early mobilisation with full weight bearing in a normal gait cycle can not be suggested in patients with segmental tibial fractures or fractures with defect zones.

Biomechanical Phenomena↗

PubMed2001

A new modular testing system for biomechanical evaluation of tibial intramedullary fixation devices.

This biomechanical study was performed to evaluate a new modular, tibial testing system developed for analysis of tibial nails and their locking screws.A new testing system, consisting of five modules, was designed to simulate a tibia. For this study one module was removed to simulate a 55-mm distal tibial defect inducing maximum loading on the distal portion of the implant and locking bolts. The tibial load offsets were 23 mm proximally and 10 mm distally medial to the centreline of the tibial shaft to simulate the location of the expected resultant load during the peak loading and inversion torque on the ankle during the gait cycle. Four solid tibial nails (STN, Stryker-Howmedica-Osteonics, Kiel, Germany) were tested to static failure and 15 nails were tested dynamically. Our results showed that the solid tibial nails fractured in the testing device in the same manner and location as they do in clinical series. Evaluation of the results showed the mean fatigue limit of the STN to be 1.4 kN for 500,000 cycles with a standard deviation (S.D.) of 0.33 kN. This biomechanical study establishes a standard technique for the biomechanical testing of tibial nails, in a clinically relevant manner, avoiding the inconsistency of cadaver bone tests. As it is a standardised test set-up this new modular testing system could serve as a standard by which small diameter tibial nails and other devices could be evaluated and compared with other systems currently in use.

Biomechanical Phenomena↗