Biomedical subjects
Publications and source records attributed to A D Hanssen.
We describe a patient in whom, despite normal initial radiographs, tomograms, bone scan, and magnetic resonance imaging, Kienböck's disease developed without the patient suffering an intercurrent injury. This case suggests that Kienböck's disease may not always develop acutely after a single injury but may have a more gradual onset.
The series involves 42 consecutive acute fractures of the dens, of which 41 were treated nonoperatively. There were 26 Type II and 16 Type III fractures, as classified by Anderson and D'Alonzo. All Type III fractures and undisplaced or anteriorly displaced Type II fractures united. Posteriorly displaced Type II fractures had an overall nonunion rate of 50%, which increased to 75% if displacement was more than 5 mm. Eight patients died within 40 days after sustaining their fracture; seven had Type II fractures with an average of 10-mm posterior displacement. Seven patients with a Type II fracture had an associated atlas fracture; five of these patients died early. In Type II fractures, posterior displacement is an important prognostic factor for union and possibly for early mortality of elderly patients. In Type II fractures with an associated atlas fracture, the mortality rate is high. Nonoperative management, preferably halo-thoracic immobilization, is successful in all acute fractures of dens, except posteriorly displaced Type II fractures.
Forty-three prosthetic hip replacements (twenty-nine conventional total hip replacements and fourteen bipolar endoprosthetic replacements) were implanted between January 1971 and June 1982 in thirty-one patients who had systemic lupus erythematosus. All but four patients had stage-III or IV osteonecrosis of the femoral head. The median age at operation was forty-three years, and the median length of follow-up was fifty-seven months. Ratings were good or excellent for all but three total hip arthroplasties at a mean of sixty-six months of follow-up. Complications included delayed wound-healing (in approximately 15 per cent) and superficial wound infection (in approximately 10 per cent). The occurrence of these complications could not be correlated with the use of corticosteroids at the time of the operation. Twenty-five per cent of the patients, who were a mean of forty-three years old at operation, died less than five years postoperatively from complications related to systemic lupus erythematosus. Conclusions regarding the systemic effects of hip arthroplasty in patients with systemic lupus erythematosus could not be drawn on the basis of this study. Total hip arthroplasty uniformly provided a good or excellent result in patients of all ages who had systemic lupus erythematosus at a mean length of follow-up of sixty-six months. An increased incidence of local wound complications, which were unrelated to the use of corticosteroids, should be expected in patients with systemic lupus erythematosus who undergo prosthetic arthroplasty of the hip.
Sixteen patients (15 men and 1 woman) were treated for infection complicating rotator cuff repair during the period 1975 through 1994. Eight of the 16 patients had their initial procedure performed elsewhere. The remaining 8 procedures were performed at our institution with the known incidence of this complication being 0.27%. In addition to intravenous antibiotic therapy, an average of 3.5 (range 2 to 8) operative procedures were required to eradicate the infections. Micro-organisms cultured were Propionibacter in 6, coagulase negative Staphylococcus in 4, Staphylococcus aureus in 4, Peptostreptococcus magnus in 1, and both Propionibacter and coagulase-negative Staphylococcus in 1. The deltoid was restored in all patients; the rotator cuff was reparable in 11. In the 12 shoulders with greater than 1 year of follow-up (average 51 months, range 14 to 165 months), active elevation averaged 110 degrees and external rotation 50 degrees. Four patients had no pain, 4 had minimal pain, and the remaining 4 had moderate pain. Satisfactory final results, which were determined by the patients' opinion or with the use of either the University of California, Los Angeles score or the modified Neer system, were obtained in 5 (42%) of the shoulders.