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Biomedical subjects

V Vahvanen

Publications and source records attributed to V Vahvanen.

At least 37 records · Page 2Linked to original sources
PubMed1980

Classification of ankle fractures in children.

The roentgenograms of 310 children treated for ankle fractures were evaluated for grouping according to the classifications of Ashhurst-Bromer-Weber, Lauge-Hansen, and Salter-Harris. The mean age of the children at the time of injury was 11.1 years (range 2-14 years). Two hundred twenty-one (71.3%) children had malleolar fractures, 71 (22.9%) had tibial epiphyseal fractures, and 18 (5.8%) had syndesmotic lesions. The age distribution of fractures was typical: malleolar fractures predominated among the younger children, epiphyseal fractures among the older. Only the oldest children had avulsion fractures of the syndesmosis. Grouping of the fractures according to Lauge-Hansen and Ashhurst-Bromer-Weber, classifications suited to adults was largely unsuccessful. Epiphyseal fractures, moreover, were easily classified according to Salter-Harris. In spite of their complexity, ankle fractures in children can be roughly divided into avulsional and epiphyseal fractures. Adequately reduced avulsional fractures can be expected to heal well; epiphyseal fractures, however, may five rise to late complications. We propose, therefore, that ankle fractures in children be classified on the basis of roentgenological findings with respect primarily to epiphyseal lesions as well as on an additional simple grouping as to risk for clinical purposes: Group I, low risk, avulsional fractures and epiphyseal separations; Group II, high risk, fractures through the epiphyseal plate.

Adolescent↗
PubMed1980

Resection arthroplasty of the metatarsophalangeal joints in rheumatoid arthritis. A follow-up study of 100 patients.

The follow-up results 1 to 11 years (mean 5 years) after resection arthroplasty of the forefoot or arthrodesis of the first metatarsophalangeal (MTP) joint performed on 100 patients (179 feet) with classical or definite rheumatoid arthritis are presented and analysed. The main indication for surgery was pain in the damaged and more or less luxated MTP joint. Resection arthroplasty of MTP joints II-V was performed from the plantar approach in 167 feet. The Keller or Mayo operation was performed on the first MTP joint in 129 feet. Arthrodesis of the first MTP joint was done in 17 feet. The proximal joint of the hallux was not treated in 33 feet. According to the subjective assessment, results after surgery were considered good by 49 patients (91 feet, 51%), fair by 44 (76 feet, 42%), and poor by 7 (12 feet, 7%). These 7 patients complained of persistent pain or a disabling deformity of the toes, or both. Although these results were generally satisfactory, the objective results were not good. At follow-up more than 50% of the patients had recidivistic callosities, a hallux valgus deformity, a dorsal dislocation and lateral deviation of the lesser toes, or radiologically observable bony proliferations of the distal ends of the metatarsals--or a combination of these. All patients in whom a proximal or interphalangeal joint of the hallux was surgically or spontaneously fused were satisfied: the stiff joint was painless on walking. When destruction of the first MTP joint is severe and painful, arthrodesis is recommended.

Adult↗
PubMed1980

Fracture of the carpal scaphoid in children. A clinical and roentgenological study of 108 cases.

A series of 108 carpal scaphoid fractures in children was analysed with respect to the site, type and treatment of the fracture. The patients were followed until radiological fusion occurred. All fractures united and healed completely with conservative treatment. Ninety-four fractures, 41 of which were avulsions, were located in the distal third of the scaphoid. There were 13 waist fractures, and one avulsion fracture was located in the proximal pole of the scaphoid. The great number of avulsion fractures and the location of the fractures in the distal third of the scaphoid is very typical in children. In three neglected cases marked bone resorption was seen on the fracture surface 3 weeks after the injury. Because non-union is possible especially in neglected cases of waist fractures, control radiographs should be taken 1 or 2 weeks after the injury if the fracture is not visible on the primary radiographs but is suspected clinically. Immobilization with an adequate plaster cast is mandatory in all transverse fractures of the carpal scaphoid in children.

Adolescent↗
PubMed1979

Meniscectomy in children.

The results of 42 meniscectomies in 41 children were evaluated 1 to 13 years (mean 5.6 years) after the operation. At the follow-up 11 patients (12 operated knees) had complaints. In four of these patients, all having had removel of the lateral meniscus, roentgenological examination revealed degenerative changes. The results of the clinical and roentgenological follow-up examination showed that insufficiently rigorous appraisal of the indications for surgery had led, in some cases, to unnecessary meniscectomies. The results of operations had not always been satisfactory. The reliability of arthrographic findings alone as an indication for surgery are discussed and the indications for operative treatment are presented.

Adolescent↗
PubMed1979

Arthroplasty of the knee joint. With special reference to complications.

Ninety-one arthroplasties of the knee joint--all performed by the same orthopaedic surgeon, were followed for from 6 months to 6 years (mean 3.5 years). At the time of the primary operation the mean age of the patients, most of whom had rheumatoid arthritis, was 60 years. The prostheses most often used were the Geomedic, the modular and the polycentric. The most consistently good results were achieved with the Geomedic prosthesis. The primary arthroplasty failed in 16 knees (17.6%); deep infections developed in four knees (4.4%). In three knees the prosthesis fractured and in two knees the supporting bone fractured. All these fractures occurred in the medial compartment of the knee joint. Loosening of the prosthesis--with or without concomitant infection or fracture of the prosthesis--was the most common local complication (nine knees). Reoperations were performed, during the follow-up period reported on here, on all knees in which complications developed, except one. Eight knees, about 9%, required arthrodesis. In six knees the prosthesis was replaced, and one knee was treated by arthrotomy and closed irrigation. The four deep infections resolved during the follow-up period--one after arthrodesis of the joint and one after arthrotomy and closed irrigation. In the other two knees with deep infection the prosthesis was replaced.

Adult↗
PubMed1979

Arthrodesis in failed knee replacement in eight rheumatoid patients.

The series of eight rheumatoid patients is presented in whom arthrodesis of the knee had been performed after a failed knee replacement. Compression arthrodesis was used as a salvage procedure. The fusion rate was 75% (6/8 knees). In two patients arthrodesis was attempted three times before fusion occurred. The causes of failure are discussed. The compression technique of Charnley or Hoffman is recommended but with two frames. When the arthrodeses were properly fixed fusion seemed to occur in 2-3 months.

Aged↗
PubMed1978

Fracture of the radial neck in children. A long-term follow-up study of 43 cases.

A series of 43 radial neck or head fractures in children was analysed with respect to the type of fracture and whether conservative or surgical treatment had been employed. Thirty-seven patients were examined after a follow-up period of 1-18 years (average 8 years). Tilting of the radial head, the length of the radius and the size of the radial head were measured roentgenologically to evaluate any growth disturbances. The results were good in 24, fair in 10 and poor in 3 cases. In the 14 patients treated surgically results were good in five, fair in six and poor in three cases. All but two of these patients had an angulation of the radial head of 30 degrees or more. The result was good in 20 of the 23 patients who were treated conservatively because the angulation was less than 30 degrees after reduction. In fair and poor cases the function was impaired by the limitation of motion. Disturbances in growth were generally slight, but an enlargement of the radial head was observed in 16 cases at the follow-up.

Adolescent↗
PubMed1978

Supracondylar fracture of the humerus in children. A long-term follow-up study of 107 cases.

A total of 107 cases of supracondylar fracture of the humerus in children were examined after a follow-up period of 8 to 18 years. No serious complications were found. Conservative treatment gave good results, and open reduction was seldom indicated. Rotational displacement and displacement in the frontal or sagittal plane remodelled by the end of the growth period, whereas tilting of the distal fragment into varus or valgus remained. The position of reduction should be checked roentgenologically until bony consolidation occurs, by measuring Baumann's angle or the carrying angle, and rereductions should be performed within 2 weeks.

Adolescent↗
PubMed1977

Arthrodesis of the wrist in rheumatoid arthritis. A follow-up study of 62 cases.

Two cases of pseudarthrosis of the total of 62 wrists are reported. The motion of the first, fourth and fifth C-MC joints has practical value after "subtotal" wrist arthrodesis in rheumatoid patients. The frequent non-union of the joints between the trapezium/scaphoid and around the os triquetrum was painless and without clinical significance. If the wrist was fused in a neutral position (41 wrists) the position of the index finger was increased more than five degrees in the ulnar direction at follow-up in nine hands (22%). In no single case was the change in the deviation more than five degrees in the radial direction. If the wrist was fused in the radial position more than five degrees (five cases), the change in the deviation of the index finger was correspondingly ulnar in every case. If the wrist was fused over five degrees in the ulnar position (12 cases), in four cases the index finger deviated more than five but ten degrees or less in the radial direction at follow-up compared with the position before the arthrodesis. The wrist was 15 degrees or more in the ulnar direction in each of these four cases at follow-up. The position of the wrist should be in only slight ulnar deviation, less than 10 degrees, when the angle between the radius and the second metacarpal bone is measured. Either slight dorsal flexion or the zero position are recommended.

Adult↗