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At least 1,405 records · Page 78Linked to original sources
PubMed1994

[Is there a surgical indication for fracture of the os naviculare pedis?].

In the period from 1986 through 1991 121 patients with injuries of the os naviculare pedis were treated at the Graz Hospital for Accident Surgery. The paper describes our experiences with the diagnosis and surgical management of such lesions. Only 7% of all fractures received surgical treatment. In the overwhelming majority of these cases drill wire osteosynthesis with subsequent plaster cast immobilization proved to be the method of choice, splintered fractures with a tendency to shortening of the limb had to be treated by spongiosa osteoplasty. Follow-up examinations (on average 42.6 weeks after primary management) using the score according to Gainor et al. showed very good and good results in 7 cases and only one negative result. Rotational X-ray examination is indispensable for establishing the diagnosis. Whenever possible, the exact extent of the injury should also be determined by CT.

Adult↗
PubMed1994

Grade III open ankle fractures--a review of the outcome of treatment.

A retrospective review of fifteen patients with Grade III open ankle fractures, admitted to the Singapore General Hospital from January 1980 to December 1990 was done. Nine of the patients were males with a mean age of 47 years. Road traffic and industrial accidents accounted for 12 of the cases. Eleven of the fractures were associated with ankle dislocation or subluxation. Eleven of the fractures were fixed with plate and screws. Two of the ankles were stabilised with Steinmann pins inserted from the calcaneum to the lower end of the tibia. In ten cases the wounds were closed primarily or by delayed primary closure. One case required a flap to cover the defect and the rest were skin grafted. Eleven were immobilised in a plaster cast ranging from six to twelve weeks. Superficial infection was found in three cases and deep infection involving the bone and joint was present in three. Range of motion at one year was satisfactory in eleven but poor in two. Seven patients developed osteoarthritis of the ankle and three had ankle arthrodesis for pain and instability.

Adolescent↗
PubMed1993

Persistent ulcer of the knee.

A 15-year-old female suffered from a persistent ulcer which developed in her knee. At the ninth operation, intraarticular knee arthrodesis was performed but the ulcer recurred. The most effective treatment was neither thorough debridement nor a free musculocutaneous flap covering, but the application of a plaster cast. The condition is thought to have been Munchausen syndrome.

Adolescent↗
PubMed1994

[Tuberculosis of the spine in children. Personal experience].

We are currently witnessing a worldwide return of tuberculosis. An extremely rare form is tuberculosis of the spine which is reported above all in extra-European studies. The authors report a case of Pott's disease in a child aged 3 years and 3 months who was referred to their attention due to the appearance of left inguinal swelling, fever and anemia. Diagnostic tests (ETG, CT, MR) showed an abscess involving the L5-S1 intersomatic space, the intervertebral disc and osteolytic lesions of S1, with impairment of the left psoas muscle and diffusion as far as the inguinal region. Chemotherapy was commenced using isoniazid, ethambutol, rifampicin, and streptomycin and lasted 24 months associated with drainage of the ileopsoas abscess. Conservative orthopedic treatment lasting for one year initially took the form of decubitus in bed with hyperdistension of the vertebral column, followed by the creation of a plaster-cast cot on the back and lastly a glass-reinforced resin orthopedic jacket. The follow-up of 2 years and 10 months showed recovery with reconstruction of the vertebral elements and the preservation of intervertebral space.

Abscess↗
PubMed1993

[Design of the scorpion-like dynamic nitinol osteo-connector and its use in the treatment of fractures and the nonunion of the upper extremity tubular bones].

Preparation of the scorpion-like dynamic nitinol osteo-connector (NT-SDOC) and its clinical application in 57 cases were reported. The apparatus was designed with two longitudinal pressure hooks and two to eight semicircular fixation hooks, which could exert an axial continuing stress of 24-56kg on the fracture ends until bone union. Of the 57 cases 31 were fracture and 26 were nonunion, as no plaster cast was applied postoperatively, all patients could exercise their injured arms early. Follow-up was 4 to 32 months with an average of 13.7 months. The osteo-plate substitution was shown at the fracture site at an average of 2.2 months in 31 cases, and at the nonunion site with an average of 3.64 months in 26 cases. No postoperative infection, nonunion and other complications were observed NT-S DOC was removed in 46 cases at about 6 months postoperatively. No refracture occurred at the osteo-plate substitution site.

Adult↗
PubMed1994

Jones fracture. Surgical versus nonsurgical treatment.

Sixty-three patients with 66 transverse and short oblique fractures of the proximal shaft of the fifth metatarsal bone (Jones fracture) were evaluated an average of five years (range, one to ten years) after the injury. There were 27 acute fractures and 39 chronic, or stress, fractures. The primary treatment was surgical for one third of the injuries and nonsurgical for the others. Surgical treatment consisted of the insertion of medullary screws. Nonsurgical treatment consisted of the application of either a plaster cast or an elastic bandage. Almost one fourth of the fractures treated nonsurgically later had to be treated surgically because of delayed unions or refractures. Late surgery was required in 12% of acute fractures and in 50% of chronic fractures with sclerosis narrowing the medullary canal. Irrespective of the primary treatment, all the patients had full function at the time of the follow-up evaluation, and no nonunions were diagnosed.

Adolescent↗
PubMed1993

[A new external fixator for treatment of unstable distal radius fracture].

Unstable distal radius fractures cannot be immobilized in a plaster cast: mal-unions (and later arthrosis of the wrist) are the result. Most symptoms are attributable to the shortening of the radius. Retention by means of an external fixator is the therapy of choice in such cases. Various fixator systems have become known. In this paper, a new fixator is presented which has the following advantages: It is very mobile and adaptable, and corrections are possible after attachment of the fixator. The screws can be inserted depending on the anatomical situation. The fixator is handy and light. The fixator has proved its effectiveness for a long time and is also suitable for complicated wrist injuries.

Bone Wires↗
PubMed1993

Autologous marrow injection in the treatment of delayed and non-union in long bones.

A retrospective study of the use of autologous bone marrow injection for the treatment of delayed and non-union of long bones in an Orthopaedic Department, Singapore General Hospital from 1990-1991 is presented. There were 10 patients with 11 fractures (8 tibia and one each of humerus, femur and radius-ulna) available for study. Percutaneous injection of autologous marrow alone was used to stimulate healing of delayed and non-unions treated initially by plating, external fixation and in one case, by plaster cast. Marrow injection stimulated a callus formation sufficient to unite 9 of the fractures. The median time to clinical union was 10 weeks (range 4-23 weeks) and radiological union 17 weeks (range 9-29 weeks). Most patients had discomfort at the donor and injected sites for one to two days. There was one case of infection but none of the significant donor site morbidity was associated with standard open autologous grafting. Bone marrow injection was effective in stimulating bony union, with numerous advantages and considerably lower morbidity compared with standard open autologous grafting. Shorter inpatient stay was a significant feature.

Adult↗
PubMed1993

[Distal radius fractures: conservative or surgical treatment?].

The "classical" Colles fracture of the distal radius is the most common fracture in the adult. In order to reduce the still rather high rate of permanent disability, this fracture involving a functionally important joint requires accurate reduction. The AO-fracture classification introduced by Müller not only defines the severity of an injury, but also allows for decision-making as to the most adequate treatment. Besides the purely conservative management by closed reduction and plaster cast for the type-A fractures, we have a number of other treatment modalities for the more complex-B and C-type fractures, such as closed reduction and percutaneous K-wire application or the use of the small external fixator as well as open reduction and internal fixation by plates and screws for a few selected indications.

Adolescent↗
PubMed1993

[Treatment of radial club hand with double articulated external fixators].

Congenital absence of the radius is a rare malformation, characterized by radial deviation of the hand to more than 90 degrees. Early treatment with plaster cast use to be enough to correct radial deviation, making easier surgical correction on several years later. We report a case of a newborn with radial club hand absence of the thumb of the right hand, bilateral hydronephrosis and bilateral cryptorchidism. Was treated with a new procedure, permitting wrist centralization, coupled with osteotomy and callostasis of the ulnar diaphysis using external fixation. We obtained an important success with this serial lengthening of the ulna.

Child, Preschool↗
PubMed1993

[A clinical research of three dimensional computerized imaging in the aid of operative design for reconstructive surgery of the face].

This article reports the utilization of three dimensional imaging technique of computer in reconstructive surgery of the face. In 312 cases, the technique has been proved that it can make the preoperative analysis computerized, quantitated and picturized. The measurement and analysis through computer are quick and exact, rendering operative designs feasible. The use of the evaluation system can also help enhance the communication and understanding between the surgeon and his patient. The surgical simulation system can replace the traditional preoperative manual work such as paper molds, plaster casts, and wax mold, and it is therefore much valuable for practical use.

Computer-Aided Design↗
PubMedDate not supplied

Atrophy of the soleus muscle in the albino rat induced by immobilization.

The morphological changes in the soleus muscle, immobilized by means of a plaster cast applied to the posterior limb of albino rats was studied. The animals were sacrificed 20 and 30 days after immobilization. The Authors agree with the hypothesis put forth by Lazarides regarding the cytoskeleton model of striated muscle fiber: morphological changes of the sarcomeres and myofilaments are brought on by translateral and longitudinal bridge damage.

Animals↗
PubMed1993

[Arterial vascular diagnosis by Doppler pulse curve analysis of the first dorsal metatarsal artery].

In patients with peripheral arterial occlusive disease diagnostics by Doppler-sonography at the toe arteries and by Doppler-pressure measurement at the ankle arteries is often difficult and sometimes impossible. Using the first dorsal metatarsal artery for Doppler-waveform analysis yields exact information on haemodynamically relevant circulatory disturbances. Painful ulcers, gangrene, oedemata, mediasclerosis, burns, plaster casts, posttraumatic or postoperative conditions prevent the application of cuffs at the lower leg or foot. This Doppler-waveform analysis evidently represents the degree and the specialties of a disturbed blood circulation and allows an additional assessment of the vessels distal from the ankle arteries and enables a functional test on the anastomosis of the artery tibialis posterior and the artery dorsalis pedis. Functional and pharmacological influences on the tone of the vessels can be shown. The typical diagnostic features of Doppler-wave-form analysis used at the proximal measuring points are also valid at the dorsal metatarsal artery. The results of own comparative investigations in 69 patients and 44 healthy test persons are demonstrated.

Adult↗
PubMedDate not supplied

[Galeazzi fracture. 9 cases in the orthopedic-traumatology service (Brazzaville-Congo)].

The authors give an account of nine cases of Galeazzi fractures, observed on a four-year period (1987-1991). These uncommon and unstable injuries were treated, in all cases, by rigid osteosynthesis of the radius. The treatment of the distal radio-ulnar dislocation, depending on its importance, was K-wire stabilization (4 cases), plaster-cast immobilization in supination (2 cases). There was no peculiar treatment in 3 cases. The results were influenced by operative delays. However we obtained 4 excellent results, 3 good results and 2 fair results.

Adult↗
PubMed1994

[Markedly varying physiotherapeutic treatment following carpal injuries].

OBJECTIVE: To inventory long-term symptomatic and physiotherapeutic results in patients treated conservatively for a carpal injury. DESIGN: Follow-up investigation and case control study. SETTING: University Medical Centre, Amsterdam. METHOD: A follow-up investigation was conducted in a group of 100 patients with carpal injury. In this group clinical parameters of patients treated conservatively and with physiotherapy (PT) (n = 16) were compared with 16 case controls without PT, selected for age, sex, diagnosis and duration of immobilisation. RESULTS: After removal of the plaster cast, 16 patients had been referred to a physiotherapist because pain was a major complaint. PT was given 2-3 times a week for an average of 11 days after a period of immobilisation of about 9.5 weeks. Treatment varied strongly among the physiotherapists. Follow-up took place 13-50 months after injury. Patients treated with PT had significantly more complaints concerning the traumatised hand than patients without PT. In the long run only 2 patients benefited from PT. CONCLUSION: Physiotherapy after carpal injury lacks method. Applications were arbitrary added or omitted. Patients with carpal injury who were treated with physiotherapy after immobilisation had more complaints in the long run. This difference may be due to selectivity in the policy of referring for physiotherapy.

Adult↗
PubMed1993

[The signification of total elbow replacement in the treatment of rheumatoid arthritis].

The purpose of this paper is to emphasis the signification of total elbow replacement in the treatment of rheumatoid arthritis. Total elbow replacement were performed in twenty elbows in fourteen patients who had rheumatoid arthritis from 1982 to 1990. The follow-up period ranged from 2 to 9 years. Pain relief was complete in twelve patients. Preoperation flexion averaged 119 degrees, increasing to 127 degrees. Preoperation extension averaged -34 degrees, increasing to -24 degrees postoperation. There were no infection and fracture postoperatively. Radiolucent lines were seen in four humeral components, in one ulnar component. Proximal subsidence of the humeral component were found in two elbows. Posterior dislocation occurred in three elbows. In two cases, reduction was successful by three weeks immobilization in a plaster cast with the elbow in the flexion position. Transient ulnar nerve palsy was evident in two elbows. Revision surgeries were performed in two cases, which occurred dislocation and progressive subsidence. Multiple replacements of major joints were performed in ten patients. Two joints were replaced in two patients, three joints were replaced in six patients, four joints were replaced in two patients. Four total elbow replacements were performed accompanied with other joints replacement in the same anesthesia. We recommended two joint replacements in the same anesthesia in patient with good general condition. All patients had functional improvements after total elbow replacement, especially reaching of the arm. Four patients improved the walking by being able to use stich after total elbow replacement.

Activities of Daily Living↗
PubMed1993

[Injuries of the cervical spine in children and adolescents].

Ligamentous and osseous injuries of the cervical spine during growth are extremely rare and therapeutic principles for such lesions are ill-defined. In order to help solve some diagnostic and therapeutic problems a retrospective study of 30 children was carried out. There were 5 discoligamentous injuries, 5 fractures of the atlas, 1 fracture of the arcus C2, 8 fractures of the odontoid, and 11 vertebral body compression fractures. The injuries were caused by motor vehicle accident in 9, by diving into shallow water in 7, by falling from a height in 7, by a sports accident in 6, and by a direct trauma in 1 patient. Four children died, three of them due to concomitant brain injury. Two patients suffered permanent neurologic disability due to spinal cord trauma. Five patients underwent an operation. Conservative therapy of flexion-compression fractures of the vertebral bodies caused kyphotic deformity. Ventral interbody fusion in two patients had excellent long-term results. All odontoid fractures were treated by applying a plaster cast and healed promptly. Diagnostic problems were mainly caused by the hypermobility of the upper cervical spine.

Adolescent↗
PubMed1993

The closed treatment of severe malleolar fractures.

The authors studied, with clinical and radiological criteria the results of closed treatment (reduction by manipulation and immobilization in a plaster cast for 7 or 8 weeks) of severe displaced malleolar fractures. Of 145 patients who had suffered an ankle fracture and were treated with closed methods between 1979 and 1989, 78 were reviewed, with an average follow-up of 6.2 years. The main difficulties of closed treatment concerned reduction of the fractures; anatomical reduction was achieved only in 32.4% of the cases, and deterioration of the position achieved often occurred (26.2%). Although some joints healed in a fair position, subjective and objective late results were excellent or good in 77% of the cases, fair in 20.5% and poor in 2.6%. The most common clinical outcome was a slight decrease of the range of motion in the injured ankle, which was found in 68% of the cases. Arthritis developed in 28.2% of the reviewed ankles, both after an initial good reduction as well as after an initial poor reduction. A complete failure of closed treatment occurred in 8.3% of the cases, caused by an interpositioning of soft tissues among bone fragments leading to unsuccessful manipulation or by late deterioration of the initial position of reduction causing healing of the fracture in a poor position (severe talar shift).

Adolescent↗