Biomedical subjects

A Leutenegger

Publications and source records attributed to A Leutenegger.

At least 37 records · Page 2Linked to original sources

PubMed1994

[The primary cruciate ligament suture--is the method outdated? Results in follow-up of 58 patients].

In the present study 58 out of 105 patients, who had been operated on for anterior cruciate ligament rupture from 1980-1992 by the same experienced surgeon, were followed up clinically and by X-ray examination. Most of them were sports accidents, above all skiing and soccer. In 11 patients an isolated rupture of the anterior cruciate ligament was found, the remaining 47 had sustained additional injuries (mainly the medial collateral ligament and the medial meniscus). In 52 cases the operation was performed with primary repair of the anterior cruciate ligament. For chronic instability 4 patients (7%) had to be treated with secondary anterior cruciate ligament reconstruction. In the follow-up study 60% of all patients achieved a Lysholm-score of 95-100 points, 19% of 84-94 points. The remaining 21% achieved less than 84 points. In the side to side comparison the Lachman Test was equal or showed a slightly diminished stability of the operated knee in 91% of 54 patients without secondary reconstruction. The anterior stability with 90 degrees flexed knee in neutral position was within a similar scope, the anterior medial stability was a little worse. In 48% of all patients we found radiological signs of osteoarthritis (stage II and III according to the classification of Jäger and Wirth).

Adolescent↗

PubMed1994

[High grade liver rupture--is nonsurgical therapy feasible?].

Although well accepted in pediatric patients, the nonoperative management of severe blunt hepatic trauma in adults remains controversial. On the basis of 3 cases with major liver injury, the rationale and prerequisites for a successful nonoperative treatment are discussed.

Adult↗

PubMed1994

[Blessings of technology? The severely injured skier--a result of technical equipment on the ski slope].

In a retrospective manner we studied the injury pattern of 2053 patients following a skiing accident that required hospital admission in the year 1984-1992. Of these 361 or 18% were categorised as severely injured according to the AIS/ISS scoring system. 31% of these 361 skiers were injured by colliding at considerable speed with either a moving object (other skier, snow cat, ski-lift, etc) or fixed obstacles (trees, rocks, pilons, etc) along the ski slopes. As the most extensive injuries seem to result from collisions with the latter, fixed obstacles, it should be requested that more protective measures are being taken to prevent such severe accidents.

Adolescent↗

PubMed1993

[Initial results with the unreamed AO tibial nail].

It is generally accepted that intramedullary nailing in combination with reaming should be avoided in treating open fractures. However, the use of an unreamed, solid nail combined with interlocking also allows stabilization of open and complex fractures. 20 tibia fractures (65% open, 45% complex fractures) have been treated by the AO unreamed tibial nail (UTN), 12 (5 of them open fractures) by direct nailing and 8 after initial stabilization by an external fixator. In our series no intraoperative complications, no soft-tissue healing problems and no infections occurred. Thus, treatment of both open and comminuted fractures by UTN appears to be safe and generally needs no secondary stabilization.

Adult↗

PubMed1993

Tibial fractures treated with the AO unreamed tibial nail.

During the last 2 years 20 fractures of the tibial shaft have been treated with the new, 'unreamed' solid AO tibial nail (UTN). There were 13 open fractures, while four of the seven closed fractures had severe soft tissue injuries. There were nine fractures classified as 'complex' or type C according to the AO classification. All UTNs were introduced without reaming but with proximal and distal interlocking. In all, 12 fractures (five of them open) were stabilized primarily by 'unreamed' nailing, whereas the first eight (open) fractures of the series were fixed initially by an external fixator and then nailed after about 14 days. In our series no intraoperative complications occurred, and no major soft tissue problems or infections were observed. The functional results were generally good; however, fracture healing appeared to be delayed in six cases. One patient had a further operation because of non-union. Intramedullary nailing, without reaming, seems to be a reliable and safe treatment for closed and open fractures with severe soft tissue injuries as an alternative to external fixation. The use of a thin, solid nail combined with interlocking allows the stabilization even of complex fractures. Contrary to initial assumptions, the UTN can be used as a definitive implant with no need for further stabilization in the majority of cases.

Adult↗

PubMed1993

[Follow-up care of surgically-treated fractures and evaluation of healing process in the roentgen picture].

The aim of surgical therapy of a fracture is the restoration of the original integrity of the limb. X-rays are the only means by which the surgeon can observe fracture healing over time. This includes direct bone healing without major radiological changes and indirect bone healing which shows callus formation. The two requirements needed for rapid bone remodelling and early mobilization after operation are an exact repositioning of the fracture fragments, if possible, and the maintenance of soft tissue and joints. Postoperative findings, complications and aftertreatment are discussed. X-ray series are presented, and the differences in fracture healing are shown.

Bone Plates↗

PubMed1993

[Fractures of the scapula and injuries of the acromioclavicular joint. The traumatized shoulder and its sequelae].

Fractures of the scapula are rare and mainly result from a severe direct trauma. Most fractures may be treated non-operatively, only severely displaced and unstable fractures of the neck and/or the clavicula, unstable intraarticular fractures of the glenoid or open fractures (especially in combination with neurovascular lesions) should be fixed operatively. A dislocated fracture of the clavicula or glenoid should be approached first ventrally. Displaced fractures of the neck and body may also require an open reduction and fixation through a dorsal approach. Careful preoperative planning and anatomical studies are required to prevent intraoperative damage of innervation and vascularization. Cannulated single screws, 1/3 tubular plates or 3.5 LC-DC plates are recommended for the stable fixation of the scapula, whereas a Bosworth screw or a hook plate are helpful to stabilize the lateral clavicula and the acromioclavicular joint. Postoperative treatment: Temporary immobilization in a Gilchrist or Desault bandage for about 3 to 4 days thereafter careful passive and active mobilization.

Acromioclavicular Joint↗

PubMed1993

[The dynamic hip screw (DHS) in femoral neck fractures].

Out of 224 patients with femoral neck fractures, 40 patients have been treated by ORIF with the dynamic hip screw, whereas 27 have been fixed by large cancellous bone screws and 148 femoral heads were replaced by a prosthesis. The ORIF with dynamic hip screw has been performed as an emergency intervention within 6.2 hours after accident. Good general condition without contraindication against an emergency operation as well as a biological age below 65 years and no pre-existing coxarthrosis are mandatory for the indication for open rigid internal fixation. Personal follow-up of 37 patients with x-ray documentation after at least 18 months (mean 35.4 months) showed complete rehabilitation in 31 patients and 4 femoral head necrosis (10.8%). We conclude that these good results are due to the short interval between accident and operation as well as to the evacuation of the intraarticular hematoma together with stable internal fixation and functional rehabilitation. Due to our good results we prefer long cancellous bone screws for the operative fixation of femoral neck fractures in younger patients, whereas in the older group the dynamic hip screw is preferred.

Adolescent↗

PubMed1993

[Initial experiences with the unreamed AO tibial nail].

It is generally accepted that intramedullary nailing in combination with reaming should be avoided in treating open fractures. However the use of an unreamed, solid nail combined with interlocking allows stabilization also of open and complex fractures. 20 tibia fractures (65% open, 45% complex fractures) have been treated by the AO unreamed tibial nail (UTN), 12 (5 of them open fractures) by direct nailing and 8 after initial stabilization by an external fixator. In our series no intraoperative complications, no soft-tissue healing problems and no infections occurred. Thus, treatment of both, open and comminuted fractures by UTN appears to be rather safe and generally needs no secondary stabilization.

Adult↗

PubMed1992

[Vascular injuries--management in a non-university central hospital].

In a retrospective study the surgically treated vascular injuries (n = 35) of the last 10 years were evaluated. One third of the patients had multiple trauma and in 57% of the cases vascular injury was accompanied by a fracture. All patients (n = 28) except those who underwent delayed amputation (amputation rate 14%) have been followed personally for an average of 5.1 years. 90% of these patients showed an excellent or acceptable longtime result in regard to vascularity, nobody complained of claudication. Diagnosis of a vascular injury was mostly confirmed by direct surgical exploration, only one third of the lesions were diagnosed by arteriogram. A positive signal in Doppler examination does not exclude vascular injury and therefore cannot replace arteriography or exact clinical evaluation.

Adult↗

PubMed1991

[Pleural empyema--rational diagnosis and therapy].

A pyothorax is a relatively rare occurrence in a general hospital and is posing a number of problems. Among these the long mean duration of hospitalisation is of note lasting 47 days for 24 patients at our clinic. The course and the mortality rate are influenced by early detection and judicious use of interdisciplinary treatment. Small effusions accompanying pneumonia are frequent and likely to disappear after treatment of the underlying disease. In these instances a precipitate punction may lead to secondary infection. In case of a sterile punctate the pH value and consideration of glucose and LDH values determine further measures. Computed tomography is of great value since it yields decisive information not available from conventional radiography. If the empyema is not segregated in compartments a closed drainage with a large caliber chest-tube ist the method of choice. Limited thoracotomy is advised when several empyema chambers develop after short duration of the illness. Persistent disease or widespread scarring necessitate decortication in most cases.

Adolescent↗

PubMed1991

Five years' follow-up of severely injured ICU patients.

We conducted a 5-year follow-up study of a group of 461 consecutive trauma patients treated in our Intensive Care Unit from 1980 to 1983. The entry criteria (initial survival and severe injury: ISS greater than or equal to 18) were fulfilled by 233 patients with a mean ISS of 29.3 and mean age of 35.6 years. Data on prehospital care, type and timing of surgery, and hospital and ICU stay were recorded during hospital discharge. The protocol strictly asked for a personal interview and a physical examination. Mailed questionnaires or phone interviews were not allowed. The areas of medical sequelae, aftercare, missed injuries, occupation, insurance, social integration, economics, legal aspects, and traffic involvement were covered. We were able to gather final information from 223 (95.6%) of the 233 cases. Forty-three patients (18.4%) died in the hospital, 13 patients (5.6%) died later, and 167 (76.5%) were eventually seen. Only 10 patients (4.4%) were lost to follow-up. Outcome was judged using the Glasgow Outcome Scale (GOS), which was compared with a GOS value given prospectively at the time of hospital discharge. Eighty-nine percent of the survivors were healthy or slightly disabled (GOS 5 and 4), 9% were severely disabled, and only 2% were in a persistent vegetative state. Outcome after 5 years was better than tentatively prognosed at the time of hospital discharge. Ninety-one patients with severe head injuries (AIS 4-5) were additionally tested using the Mini Mental State instrument. This test revealed normal mental functions in 77% and dementia, mostly of a minor degree, in 23% of the head-injured patients. Almost all the early deaths and two thirds of the late deaths were related to severe head injury. Seventy-nine percent of the survivors were working after 5 years. During the post-trauma period, patients experienced reduced social well-being and also changed professional and recreational activities. There appears to be extensive room for improvement in the posthospital recovery phase. We conclude that survivors of critical trauma have a very good chance, after 5 years, of regaining a high quality of life. All efforts at improving trauma survival and quality of trauma care are therefore worthwhile and deserve high priority.

Adolescent↗

PubMed1991

[Emergency screw osteosynthesis of femoral neck fractures].

27 patients with femoral neck fractures have been treated by ORIF with 3 or 4 large cancellous bone screws. The operation has been performed as an emergency intervention within 5 1/2 hours after accident. Anterior arthrotomy in direction of the long axis of the neck for evacuation of the intraarticular hematoma has been performed as a routine. Personal follow-up with X-ray documentation after 18 to 106 months (mean 29.5 months) showed complete rehabilitation in 22 patients and 2 femoral head necroses (7.4%). We conclude that these good results are due to the short interval between accident and operation as well as to the evacuation of the intraarticular hematoma, together with a stable internal fixation and functional rehabilitation.

Adolescent↗

PubMed1991

[Interlocking intramedullary nailing of the femur: is the advantage of early mobilization gained by risking a malposition?].

We report a follow-up of 57 consecutive femoral fractures treated by internal fixation with the AO Universal Interlocking Nall. All fractures (91% follow-up) had healed within a mean of 22 months (range 9-50) after operation. Full weight-bearing was possible after an average of 9 weeks (range 2-20). The only infection occurred after a secondary open lengthening osteotomy. In 5 cases a rotational malposition or length discrepancy had to be corrected shortly after initial surgery. Rotational malposition in excess of 10 degrees occurred in 26% of cases (mostly external rotation) and length discrepancy exceeding 1 cm in 13% (mostly shortening). The frequency of malposition is explained by the absence of rotational or length control during operation. We recommend that malposition be correlated without delay by reoperation.

Adolescent↗

PubMed1991

[Talus fracture. Injury pattern, treatment tactics and results of operation (1980-1989)].

The results of 25 operated talus fractures are presented. 7 of these were peripheral fractures with excellent results, 18 central fractures with only satisfying or even bad outcome. Although we didn't see any avascular necrosis of the talus, almost all patients had pain and slight or even severe signs of arthrosis in the ankle or subtalar joint.

Follow-Up Studies↗

PubMed1991

Results of operative treatment for intra-articular fractures of the calcaneus.

Since 1980 our treatment of displaced intra-articular calcaneal fractures consists of open reduction with distractor, bone grafting, and internal fixation. Thereby no splints are applied and early postoperative movement is possible. For precise preoperative planning a CT scan is required. Proper timing and careful preoperative planning are essential to prevent soft-tissue complications. In a total of 16 fractures good clinical and radiologic results were achieved in 50% of the cases; results were satisfactory in 25% and poor in 25%. The patients returned to work after an average of 5 months. Only three patients (19%) received disability compensations, which compares favorably with nonoperative treatment. We believe that a majority of comminuted intra-articular fractures of the calcaneus profit from open reduction and internal fixation and that more reliable functional results are achieved than with conservative therapy.

Adult↗

PubMed1990

[Simple, safe postoperative parenteral nutrition with a ready-to-use all-in-one solution].

A newly developed, stable and ready-to-use industrially manufactured all-in-one solution for parenteral nutrition, containing amino acids, fat, glucose, xylitol and electrolytes, was tested in a prospective trial involving 21 patients from the 2nd to the 8th postoperative day. No side effects requiring interruption of the nutritional regimen, a positive nitrogen balance and a documented metabolic steady state proved that this solution is a safe therapeutic concept with respect to the typical postoperative metabolism. The all-in-one Vacu-Mix system is easy to handle, reduces the possibility of technical error and ensures safe and constant TPN administration.

Adolescent↗

PubMed1990

[Serial rib fractures: a differentiated treatment concept, illustrated by 59 severely injured intensive care patients].

In a group of 59 consecutive ICU trauma patients with blunt chest injury and considerable injury severity (ISS = 29) a three-staged therapeutic approach was followed, depending seriousness of chest injury, overall injury severity and age. Stage 1: i.v. analgesia and conventional respiratory therapy. Stage 2: continuous epidural analgesia (local anesthetics and opiates) and intermittent CPAP (continuous positive airway pressure) by face mask. Stage 3: Endotracheal intubation and internal pneumatic stabilization of the chest, preferably spontaneous breathing. Only 44% of the patients needed intubation, and none died. The authors recommend this three-step approach towards blunt chest injury and serial rib fractures.

Combined Modality Therapy↗