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PubMed1993

[Experiences with the Herbert screw].

Matti-Russe grafting has proven effective in the surgical treatment of scaphoid non-union. Old or recurrent cases as well as the small proximal fragment give rise to problems. Stabilization with the Herbert screw in addition to cancellous bone grafting has proven effective in such problematical cases. Proximally located fractures also constitute an indication for primary surgery. This does not only improve the chances of healing, but also substantially shortens the period of immobilization. We have treated 34 non-unions and 12 fractures with this method between 1989 and 1990; these were mainly problem cases. The follow-up examinations show convincing results: all fractures healed primarily with plaster-cast immobilization for two to three weeks. In non-union cases, consolidation did not occur in two patients, but the fragments were rendered sufficiently stable by the screw. The mobility of the wrist and the period of the rehabilitation were also favorably affected by the short period of immobilization (four to six weeks). A disadvantage in the operation is the extensive exposure and subluxation of the STT-joint, which is why we have modified the reposition jig.

Adolescent↗
PubMed1993

[Para-articular hip fracture in childhood].

Femoral neck fractures during childhood are very rare. Up to 60% complications have to be expected due to the special epiphyseal development and vascularization, i.e. necroses of the femoral head, pseudarthroses and growth disturbances. Only undislocated fractures are treated conservatively in a plaster cast. The end result may be improved with early reposition and operative treatment. The outlook of our own 16 cases using this procedure was considerably better than in the current literature. The preferred technique consists of stabilizing the fracture with a cannulated screw and two K-wires to prevent rotation. For pertrochanteric, mostly pathologic fractures, a T-plate in conjunction with cannulated screws and transplantation of homologous spongiosa has proved successful.

Adolescent↗
PubMed1977

Immobilization effect on the tensile properties of striated muscle: an experimental study in the rat.

To investigate the effect of immobilization on the tensile properties of atrophied gastrocnemius muscle, the left hind legs of 40 rats were fixed with padded plaster casts for three weeks. Seven to 42 days after starting the immobilization, load-deformation curves were registered from both gastrocnemius muscles of each rat and several parameters assessed from the curves. The rupture always occurred at the muscle belly. The decrease in breaking strength and energy absorption capacity following immobilization for one week averaged 20% and 34%, respectively, and the values fell further to about 32% and 46% at the end of the immobilization (21 days), when compared to the contralateral control muscles of the same animals. The elastic stiffness of the immobilized muscles was markedly decreased but rose nearly to the level of the controls after removal of the casts. The tensile properties of the previously immobilized muscles had not yet reached the control levels three weeks after removal of the casts.

Animals↗
PubMed1993

The Maisonneuve fracture of the fibula.

Nine patients sustained a Maisonneuve fracture of the fibula (MFF), which is a proximal fibula fracture associated with an ankle fracture or deltoid ligament tear. Eight were treated with closed reduction and plaster casts. One was treated by open reduction and internal fixation. Reexamination was performed at an average of 25.7 months. This included subjective, objective, and functional evaluations, along with stress roentgenograms. Six patients had an excellent result, two a good result, and one a fair result. The MFF is often more stable than generally assumed. For injuries with only a partial syndesmotic disruption, nonoperative treatment is recommended.

Ankle Injuries↗
PubMed1993

[Lateral ligament ruptures of the ankle joint in young athletes].

Treatment of lateral ligament rupture of the ankle has previously been primarily surgical. Immobilisation in a plaster cast has recently become more usual, and gradually this treatment is partially being replaced by immobilisation in adhesive elastic bandage. Operation of younger, athletic patients with large ruptures is, however, still recommended. It is inexpedient to operate these patients. They will be delayed for several weeks in their return to sport.

Adult↗
PubMed1993

[Prevention of thrombosis in ambulatory patients].

In surgical outpatients who required immobilization with a plaster cast because of injury to the lower limb a deep vein thrombosis occurred in 14%. General thromboprophylaxis seems advisable for surgical outpatients and depends on the severity of trauma and thrombosis risk factors. In a study of 97 patients who received a daily subcutaneous injection of heparin fragment calcium throughout their cast period, only one patient with a deep vein thrombosis was seen.

Adult↗
PubMed1995

[Various therapy concepts in severe fractures of the tibial pilon (type C injuries). A comparative study].

Between 1982 and 1992, 79 pylon fractures were treated with internal fixation as the primary treatment at the trauma department of the Hannover Medical School. In a retrospective study 71 patients were evaluated, and 51 of them were re-examined clinically and radiographically an average of 68 months after injury. The purpose of this study was to compare these different forms of surgical management concerning their long-term results: 1. Minimal invasive internal fixation for reconstruction of the joint with external transfixation of the ankle joint and/or plaster cast until bony healing occurred. 2. Primary internal fixation with plating of tibia and fibula following the AO techniques. 3. Internal fixation with a plate applied in a second step after initial reconstruction of the joint with minimal internal fixation and short-term external transfixation. Evaluation was based on the infection rate, the development of posttraumatic arthritis and the range of motion in the ankle joint as objective criteria. Subjective criteria were pain, swelling, and restrictions of working or leisure activities. Although only closed fractures were treated primarily by internal fixation with plating no significant differences between the three groups were found in the classification of fractures and soft tissue damage. All but 4 fractures were type-C lesions according to the AO classification, and 19 patients sustained open injuries. The infection rate for minimal invasive internal fixation was significantly lower with a two-step procedure (group 3) than with the one-step procedure according to a suitable statistic test (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1996

Comparison of two conservative methods of treating an isolated fracture of the lateral malleolus.

We compared two conservative methods of treating Weber B1 (Lauge-Hansen supination-eversion 2) isolated fractures of the lateral malleolus in 65 patients. Treatment by immediate weight-bearing and mobilisation resulted in earlier rehabilitation than immobilisation for four weeks in a plaster cast. There was no significant difference in the amount of pain experienced or in the requirement for analgesics and early mobilisation was not associated with any complications. We therefore advocate early mobilisation for these stable ankle fractures.

Adult↗
PubMed1990

[Fractures of the radius in the typical site, conservative and surgical treatment--comparison of results].

In the years 1987-1988, 372 fractures of the radius in the typical zone were treated at the trauma station. 178 were included into our study, the remaining 194 did not return for check-ups. 123 cases were treated conservatively and 55 operatively. According to statistical data, more women than men were injured (p < 0.01). More patients aged over 60 were treated conservatively. In operative and conservative treatment, the types of fractures were similar (p < 0.01). In comparing the results of operative treatment with those from 1985, we establish that the present results are better (p < 0.0001), owing above all to the shorter period of time elapsing between injury and operation. In conservative treatment, the results are also better owing to a change in the method of plaster casting. All unstable fractures must be treated operatively. Among the applied operative methods, transcutaneous fixation with Kierschner's wires under X-ray monitoring proved to be the best. Etiologically, injuries listed under other hold the first place, followed by occupational and traffic injuries. Treatment and control must be managed by a surgeon who is acquainted with problems of bone tissue injuries. Continuous cooperation with the physiotherapist is of extreme importance.

Adult↗
PubMed1996

Is there a place for radionuclide bone scintigraphy in the management of radiograph-negative scaphoid trauma?

OBJECTIVE: To evaluate the role of radionuclide bone scanning in patients with suspected scaphoid trauma, particularly in those with negative radiographs. DESIGN: Prospective. Radionuclide scans and carpal bone radiography were performed on all participants in the early post-injury period. SETTING: Cape Town tertiary centre trauma unit. PARTICIPANTS: Fifty patients who presented with clinical features suggestive of scaphoid trauma. MAIN OUTCOME MEASURE: Definitive radiographic diagnosis of fracture or persistent clinical features of scaphoid trauma. RESULTS: All patients who had fractures demonstrated on standard radiography either at the initial visit (13 patients) or at 2 weeks (8 patients) had positive scintiscans (sensitivity 100%). Four of 6 patients who had a positive scan but negative first and second radiographs had persistent tenderness on clinical examination which required extended immobilisation in a plaster cast. The overall positive predictive value of scintigraphy was 93%. All patients with a negative scan were clinically and radiologically negative at 2 weeks (negative predictive value 100%). Evidence of multifocal injury was present in 12 scans, but only 1 radiograph. Thirty-one patients (62%) were scanned within 48 hours of injury. CONCLUSION: Bone scintigraphy can be used in radiograph-negative scaphoid area injury to exclude the need for further follow-up reliably, but those with positive scans still require clinical examination and radiography at 2 weeks.

Carpal Bones↗
PubMedDate not supplied

Spinal tuberculosis with neurological deficits.

Two hundred patients suffering from tuberculosis (TB) of the spine with neurological complications were the subjects of this review. They were graded according to the Frankel system into--A: complete neurological deficit; B: sparing of some sensation; C: sparing of sensation but no useful motor function; D: sparing of sensation and useful motor function; and E: no deficits. Investigations carried out included detailed neurological assessment, radiography, contrast myelography and, in the later stages of the study, spinal computerized tomography (CT) scan. The authors believe that contrast myelography provides the best indication of spinal compression in TB spine. Treatment was by surgical decompression followed by chemotherapy. The surgical approach for thoracic spine disease was by the anterior transthoracic route. Cervical lesions were also approached by the anterior route, lateral to the carotid vessels. Unexpected findings during operation included lymphoma, plasmacytoma, non-tuberculous granulation tissue, salmonella osteomyelitis and tumour metastasis. Ten patients died during the postoperative period, all of whom had extensive systemic TB. When indicated, antituberculous drugs were administered postoperatively for two years and immobilization was done in a plaster cast for 3 months. Only 30 patients showed partial recovery. Improvement was found to be related to the grade of deficit; thoracic lesions with severe neurological deficits showed the least improvement while lumbar disease had the best outcome. The study recommended a combination of surgery and chemotherapy for all cases of TB spine with neurological deficits after a short delay during which respiratory function should be improved. The surgery should aim at decompression of the cord by removal of pus, granulation tissue and sequestra, with internal splintage with bone grafts to reduce the hospital stay. Conservative treatment is unwise because it is not always possible to distinguish between TB and neoplastic lesions.

Female↗
PubMed1995

[Fractures of the tibial tuberosity associated with avulsion of the patellar ligament in adolescents].

PURPOSE OF THE STUDY: Avulsion fracture of the tibial tuberosity is considered as a relatively uncommon adolescent injury. The avulsion of the patellar ligament may occur as part of the injury. Two cases of sixteen year old boys with this kind of injury have been reported. Fractures are described using Ogden et al. classification : type I is an avulsion fracture of the most distal portion of the ossification center of the tubercle ; type II, an upward angulation of the lip fragment ; type III, a fracture of the lip fragment with propagation of the fracture-line into the knee joint. Each type is subdivised into A (no comminution) and B (comminution). Frankl et al. in 1990 address the possibility that patellar ligament avulsion may occur as part of the injury (type C). CASE REPORTS: Two sixteen-year old boys suffered from sharp pain in the knee during a jump while playing basketball. Radiographic evaluation demonstrated an avulsion fracture of the tibial tubercle type III C. The osseous fragment was sutured with trans-osseous suture. The fixation was protected with a tension band passed above the patella and distally in the tibia. It was removed at six weeks. One patient was not reviewed and the other had no complaint one year after. DISCUSSION: Avulsion fracture of the tibial tuberosity Ogden type I and II is generally treated by plaster cast. When the patient is unable to extend his knee actively, an avulsion of the patellar ligament should be suspected. In this case, Frankl et al. proposed radiographic evaluation: the distance between the distal end of the patella and the avulsed fragment was noted to increase during flexion. Avulsion of the distal tuberosity usually occurs just prior to complete closure of the proximal tibial physis. Interfragmental transphyseal screws can thus be used safely. In the younger patient or in extensive comminution, tension band wire should be used. The use of a tension band between patella and tibia to protect the ligament reinsertion provise early knee mobilisation (between 0 and 60 degrees). It should be removed within six weeks. CONCLUSION: Avulsion fracture of the tibial tuberosity is rare. When conservative treatment is indicated, it is important to search an avulsion of the patellar ligament. When such an injury is suspected, lateral radiographs of the knee should be made in flexion as well as in extension. We believe that treatment should include open reduction and internal fixation associated with a protect tension band allowing early rehabilitation.

Adolescent↗
PubMed1995

[Scaphoid fracture associated with displaced fracture of the distal end of the radius in children. Apropos of a case].

A child of 13 years, victim of a fall on his wrist at dorsal flexion position; he presented a scaphoid fracture associated with a displaced fracture of the distal end of the radius. The radius fracture was reduced under general anesthesia, by external manoeuvre; the consolidation was obtained after 10 weeks of plaster cast immobilization. The follow-up was of two years, with a good clinical and radiological result in spite of a non union of the Ulnar-styloid. It is important to remember this exceptionnel association in children not to forget the scaphoid fracture.

Adolescent↗
PubMed1996

[Treatment of clubfoot].

48 patients (70 club-feet) were reviewed clinically between the age of 4 and 14 years. The primary treatment had been serial plaster casts in the case of 43 feet and additional neonatal tenotomies in 27 feet. Operative treatment after the neonatal period was performed on 53 feet (75%) at a median age of ten months (2-60 months). Surgical procedures were posterior release in 29 and postero-medial release in 24 feet. Further surgery was required in the case of 18 feet. Satisfactory results (excellent and good) were obtained for 42 feet (60%), but fair results for 17 feet (24%) and poor results for 11 feet (16%). The results were significantly better when the release operation was performed before the patient was 2 years of age.

Adolescent↗
PubMed1977

[Injuries of the capsular ligament of the ankle joint, so-called "ankle joint distorsion"].

The capsular and ligamentous lesion of the ankle is the most frequent injury and very common in sports. Still these injuries are frequently minimized and not treated properly. Late results are instability, subluxation and finally posttraumatic osteoarthritis. Anterio-lateral instability indicates lateral capsular-ligamentous lesions. Antero-lateral instability can be proved chinically by the anterior drawer-test and radiologically by a standardized stress x-ray in lateral position. The fresh lesion has to be treated by primary ligamentous suture or by plaster cast for 6 weeks. The treatment of chronic instability is secondary reconstruction. Severe osteoarthritis can be treated by an ankle replacement (endoprosthesis) or by arthrodesis.

Ankle Injuries↗
PubMed1996

[Acute gastric dilatation and superior mesenteric artery syndrome in the mentally retarded].

Three mentally retarded male patients, 24, 30 and 14 years old, died from acute gastric dilatation leading to rupture and perforation. Superior mesenteric artery syndrome (SMA) was the cause of gastric dilatation in two of them. In the third patient the cause was not clear. The three patients had scoliosis and were underweight or thin. Two had spastic quadriplegia of perinatal origin and one had Down's syndrome. One patient with SMA was treated by Nissen fundoplication because of hiatus hernia with vomiting and gastro-oesophageal reflux one week before he died. Another patient had a severe gastric bleeding after decompression of the dilatation. In mentally retarded patients there are often several predisposing factors for SMA (anorexia, severe weight loss in a short time, pronounced lumbar lordosis, scoliosis, correction of scoliosis by operation or plaster cast, prolonged lying position, boulimia). Gastric dilatation may be prevented by ensuring adequate nutritional status.

Adolescent↗
PubMedDate not supplied

[Preliminary experiences on triscaphoid arthrodesis].

The authors report their experience of 5 patients (4 males, 1 female) with a mean age of 36.4 years (min 25 years, max 45 years), undergoing triscaphoid arthrodesis between May 1989 and August 1993. The patients suffered from rotatory dislocation of the scaphoid (1 case) and stage 3A of Kienboeck's disease according to Lichtman's classification (4 cases). The paper describes the surgical technique used for partial arthrodesis of the wrist performed using plexual anesthesia. A dorsal access route is used through a curved longitudinal skin incision corresponding to the anatomical site of the scaphoid. The skin flaps are then peeled back revealing the surface veins and sensitive branches of the radial nerve which are isolated and conserved. Having cut through the retinaculum of the extensors, the extensor tendons are spread so as to reach the joint capsule which is sectioned crosswise. After the bone to be fused have been exposed, the cartilage is removed from the joint faces between the scaphoid, trapezium and trapezoid and, using a osteotribe, the subchondral bone is removed to reveal the spongy bone, leaving a space of approximately 6 mm between the spongy surface of the bones to be fused. Arthodesis is stabilised using Kirschner wires or metal minicambres enclosing scaphoid, trapezium and trapezoid. Spongy tissue is taken from the distal radial head and used as a graft to fill the spaces created between them which will consolidate over time. The wrist is immobilised in a plaster cast for 8 weeks before starting functional rehabilitation. Patients were checked both clinically and radiographically with a mean follow-up of 36.4 months (min 25, max 50 months). Using the assessment criteria proposed by Minami et al. excellent results were obtained in 4 patients (80%) with the disappearance of painful symptoms, joint excursion 50% greater than the normal wrist, and hand grip 70% greater than in the controlateral hand. There was good radiographical consolidation of the arthrodesis. Poor results were only recorded in one case (20%) with persisting pain and functional impotent. Radio-scaphoid arthrosis was observed radiographically consequent to hypercorrection of the scaphoid with a radio-scaphoid angle of less than 45 degrees. The authors underline the technical difficulty of this arthrodesis characterised by reduction of the scaphoid in a correct position in which the radio-scaphoid angle must be 45 degrees when measured from a lateral position. Lastly, the authors conclude that this from of arthrodesis may be used with good results to treat wrist pathologies such as rotatory scaphoid dislocation, triscaphoid arthrosis and Kien-boeck's disease at stage 3A according to Lichtman. They also affirm that arthrodesis limited to the wrist is preferable to total arthrodesis because it enables some joint movement to be conserved which is important for hand function.

Adult↗
PubMed1996

[Fractures of the anterior rim of the distal part of the tibia. Apropos of a series of 38 cases].

PURPOSE OF THE STUDY: Fracture of the anterior rim of the distal tibia is a rare injury. This fracture seems less serious than other pilon fractures but its treatment is often difficult and didn't give better results. The aim of this study was to describe problem we dealed with and to suggest solutions in order to improve long term results. MATERIAL: The study included 38 cases, treated in 5 Paris district trauma centers, with a minimal follow-up of 6 months. All patients were asked for clinical and radiological review between september 92 and march 93 ; otherwise, latest review datas were used. METHODS: Authors suggest a radiological classification based upon type, width and talus anterior displacement. Different surgical procedures were performed for 33 cases (screw, plate, external fixation) ; conservative treatment was used 5 times (non weight bearing plaster cast). Anatomical reconstruction was analysed. Functional results scoring system included pain, global abilities and ankle range of motion. Ankle arthritis was rated according to 1992 SOFCOT scoring system at 1 and 3 year follow-up. RESULTS: Follow-up ranges from 6 months to 11 years (average 28 months). 55 per cent of cases were lost for review with 1 year mean follow-up. 45 per cent of patients were recently tested with 4 year mean follow-up. Three ankles had joint fusion 6 to 18 months after trauma. Functional result was poor. For 35 ankles analysed 1 out of 4 remained totally painless (9 cases), 1 out of 2 had a good function (20 cases) and 1 out of 3 normal X-rays (12 cases). Arthritis was found for 2 ankles out of 3 after one year follow-up (16 cases out of 23). Loss of reduction or incomplete reconstruction seemed the most important point (13 cases out 38, 13 cases after 35 surgical procedures). DISCUSSION: Many patients didn't get a long term evaluation, and this study has no statistical value. Anyway, function loss was always early on a weight bearing joint. A perfect and stable reconstruction gives a higher rate of good result (11 out of 14). Analysis of cases with anatomic imperfection leads to recommendations: fixation of separation fracture, even undisplaced, bone grafting to correct impaction, appropriate use of external fixation for neutralization. CONCLUSION: Better results should come from a better analysis of the bone lesions : separation, impaction or mix fracture. This analysis leads to appropriate surgical procedure which give back a stable and anatomic distal tibia. External fixation can be usefull for immobilization ; this can't avoid open reduction and internal fixation of the fracture. Bone grafting can be useful for impaction fracture.

Adolescent↗