Biomedical subjects

A Leutenegger

Publications and source records attributed to A Leutenegger.

At least 55 records · Page 3Linked to original sources

PubMed1990

[Post-traumatic osteitis. The acute infection].

The acute infection is defined as bacterial growth within the surgical wound, that may occur within days to weeks after initial surgery but before bone union. The chances of complete recovery after an acute soft tissue inflammation are closely related to the interval between initial surgery and first signs of infection, the early recognition of the complication, the type of bacteria involved and the therapeutic measures. The first symptoms of an impending infection are the classical clinical ones of any inflammation: tenderness, swelling and reddening. All imaging procedures are of little or no value. The therapy consists of very aggressive and, if required, repeated wound revisions with debridement of all necrotic tissue, removal of loose bone fragments or loose implant material, wash-outs with antiseptic solutions (e.g. Taurolin) or even deposition of gentamycin beads. Systemic antibiotics may be added temporarily. The in- or external fixation devices must provide stable fracture fixation and the bone as well as the soft tissue envelope must be well vascularized.

Acute Disease↗

PubMed1990

[Surgical stabilization of juvenile lower leg fractures using the external fixator. Retrospective analysis of 10 cases].

Ten cases seen over the last eight years were reviewed by clinical and radiological re-examination one year after injury. The results encourage us to continue treating young patients with critical soft-tissue injury, compartmental syndrome, open fracture and multiple injury by this technique.

Adolescent↗

PubMed1989

[Principles and practice of nutrition following trauma].

Nutrition should form part of intensive care for all polytrauma patients to prevent catabolic breakdown of body proteins. Enteral (tube) feeding is preferable whenever normal gastrointestinal function is confirmed. Parenteral nutrition is best tolerated via an adapted "all-in-one" solution. Due to the catabolic trauma reaction, a high protein content of 1.5-2 g/kg body weight/day and a calorie-nitrogen ratio of 80-100:1 is recommended. Energy supply should be partly in the form of fat and carbohydrates, mainly glucose. Xylitol as sugar substitute can be added to prevent hyperglycemia in the event of trauma-related glucose intolerance.

Energy Intake↗

PubMed1989

[Intra-articular fracture of the distal radius: results following osteosynthesis with a support plate].

The treatment of comminuted intra-articular fractures of the distal radius often requires an operative fixation. Beside the recently recommended external fixator, the support plate fixation offers a helpful alternative to treatment. Between 1980 and 1986, 30 wrists in 29 patients with intra-articular fractures of the distal radius were stabilized with a buttress plate an the Kantonsspital Chur, Switzerland. The mean follow-up-time was 15 months. These follow-ups showed that the buttress plate in treatment of complicated intra-articular fractures allows a satisfactory reduction and stabilization with restoration of the articular congruity and the possibility for early active assisted motion. Buttress plate fixation still remains a demanding technique, which in complicated cases, should be reserved for the experienced surgeon.

Adult↗

PubMed1989

[Initial results with the new tibial interlocking nail of the Orthopedic Study Group].

The new AO universal tibia nail with interlocking possibility has several new features. The wall thickness has been increased from 1.0 to 1.2 mm. In order to give the stiffer nail smoother insertion properties and better cortical contact, the overall design has been altered with the help of computer calculation. Proximally there are 3 holes for locking purposes in the frontal plane, while distally we find two holes in the frontal and one in the sagittal plane to accommodate the locking bolts. The new nail has been applied in 17 clinical cases with overall good results. The indications were deliberately pushed to the extremes and even 5 open fractures were nailed after minimal remaining. There were 2 major perioperative complications: one proximal blow-out of the anterior cortex due to a wrong point of insertion and several other technical mistakes. The situation was salvaged with an external fixator. In an 85-year-old multiple injured lady with a 3-degree open tibia, the initial fixateur externe was replaced after 3 weeks by a 10 mm universal nail. Due to severe porosis and rather proximal extensive cortical comminution, the locking bolts and therefore the nail did not find a good hold in the tibia plateau. After uneventful healing of the soft tissues and additional splinting, the fracture, however, consolidated within 4 months. There were two superficial soft tissue infections early postoperatively, but no cases of osteitis. Healing of the fractures seems to progress without delay.(ABSTRACT TRUNCATED AT 250 WORDS)

Follow-Up Studies↗

PubMed1989

[After-care of fractures, especially following osteosynthesis].

Depending on the choice of fixation and implant, the aftercare of fractures has to occur in different manners. Postoperatively the CPM-machines have taken the place of conventional supports, and there is a distinct tendency to even earlier mobilisation of fracture patients. Except for comminuted, intraarticular fractures, partial weight bearing with 10 to 15 kg (toe-touch) is encouraged as of the first postoperative week. Since the introduction of the locked nail for shaft fractures, we have to get used to look at X-rays with hardly reduced fragments and abundant callus formation. This contrasts to what we are used to from the conventional plate fixations. In case of stable plating, the old rules remain valid: anatomic reconstruction and direct fracture healing without visible callus.

Bone Plates↗

PubMed1989

[The dynamized external fixator. Use and problems].

We report our experience with 11 patients treated with an external fixator that was dynamized at some stage of the treatment. In 7 patients bone union occurred without any other measures, 2 patients were protected in a cast after the external fixator removal, while 2 patients developed a non union that was plated and subsequently healed. According to these experiences, dynamization of an external fixator seems to be a reliable and elegant way to treat simple open shaft fractures, the method is however not advocated for more complex or comminuted fractures.

Adult↗

PubMed1989

[Plate osteosynthesis in humeral shaft fractures. Indications and results].

Non operative management of humeral shaft fractures is well recognized as the standard of care for uncomplicated injuries. Operative treatment of humeral fractures may be performed when limited indications are present as in patients with multiple trauma including ipsilateral forearm injuries, arterial injury or primary radial nerve palsy. 18 patients with humeral shaft fractures underwent open reduction and internal fixation (ORIF) using the AO plating technique at the Kantonsspital Chur from 1980 to 1986. Follow-up was available for 17 patients of whom 16 suffered from multiple injury trauma. The broad DC plate combined with lag screws was used in most cases. Two brachial artery transections were repaired at the time of primary osteosynthesis by the same surgeons with full functional recovery. Concomitant nerve injuries were repaired primarily in one case and postprimarily in 3 more cases. The overall result was excellent in 9 patients, good in 5 patients, fair in 2 patients and poor in one patient with complete brachial plexus injury. Bone healing was uneventful in all 17 patients. No infection and no delayed union or pseudarthrosis has been observed.

Adult↗

PubMed1988

[Morbid obesity. Our results with the appetite-depressing stomach balloon].

Morbid obesity still remains a controversial topic with varied therapeutic approaches. In cases of unsuccessful conservative management we implant a gastric balloon or bubble. 30 balloons have been introduced in 24 patients with a mean age of 43 years (26-68 y.) and a mean body weight of 115 kg (87-160 kg). Mean overweight was 47 kg. The balloons were introduced immediately after gastroscopy performed to identify possible contraindications. Except in the initial 3 patients this procedure was carried out in the outpatient clinic. 25 silicon mammary prostheses were implanted until a special balloon (Ballobes-Balloon) became available for the last 5 cases. Implantation and follow-up has been uneventful in all cases. Our data suggest that a combination of this approach with close dietary management provides more efficient and rapid weight reduction than any diet alone.

Adult↗

PubMed1988