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Biomedical subjects

B F Claudi

Publications and source records attributed to B F Claudi.

8 recordsLinked to original sources
PubMed1996

[The monorail system--bone segment transport over unreamed interlocking nails].

A treatment protocol is demonstrated, consisting of an osteotomy, either proximal or distal, of the bone defect with subsequent segmental transport via an anteromedially (tibia) or laterally (femur) mounted AO external fixation over an unreamed interlocking nail (monorail system). Twenty patients were treated by this method with indications as follows: 13 had a segmental bone defect of the tibia, 3 of the femur. Three patients showed post-traumatic and postinfectious leg-length discrepancies and one was treated for hypertrophic non-union of the femur. Defect distance varied between 5 and 18.5 cm and average time for transport was 19,42 days/ cm for the tibial shaft, 15,93 days/cm for the femur. Two patients developed deep infection, which required change of treatment, removing the monorail system and application of an Ilizarov apparatus. Despite complications using the monorail system, all patients healed and no amputations were required. The monorail system can be used as an alternative to the Ilizarov method under certain criteria of patient selection; these criteria are shown by an algorithm for segmental bone defects without infection, respecting the soft-tissue status with or without neurovascular compromise.

Adolescent↗
PubMed1994

Iatrogenic fractures of the femoral neck during closed nailing of the femoral shaft.

We have reviewed our experience of four iatrogenic femoral neck fractures in 315 consecutive closed intramedullary nailings with the AO/ASIF universal femoral nail. The average neck-shaft angle in the bones that fractured was 139.3 degrees +/- 1.2 degrees SD (136 to 141); in the whole series the average neck-shaft angle was 125.3 degrees +/- 8.6 degrees and only 11 had angles of more than 135 degrees. The upper ends of the nails in the four which fractured were 17 mm, 5 mm, 3 mm, and 1 mm below the tip of the greater trochanter. In the seven patients with neck-shaft angles greater than 135 degrees but with no fracture, none of the nails had been inserted beyond the tip of the greater trochanter. We nailed six cadaver femora to simulate the forces produced by intramedullary nailing. Despite deep insertion, only one of the six sustained a neck fracture. This specimen had a radiographic neck-shaft angle of 140 degrees against an average of 127.3 degrees +/- 4.0 degrees for the other five. We believe that the medial prong of the AO insertion jig, with its medial overhang of 2 to 3 mm, may impinge on the superior aspect of a valgus femoral neck during final impaction, causing a neck fracture. This may be avoided by leaving the end of the nail above the tip of the trochanter in such cases.

Adolescent↗
PubMed1992

Segmental transport after unreamed intramedullary nailing. Preliminary report of a "Monorail" system.

The Ilizarov method of segmental bone transport has been shown to be an alternative to more conventional treatments of posttraumatic bony defects. After extensive clinical experience with the unreamed tibial nail in open fractures up to Grade IIIb, a new monorail fixation system for callus distraction and segmental bone transport was devised. This Monorail system is composed of an unreamed intramedullary (IM) nail and a unilateral AO distraction device. The new fixation method and the preliminary clinical experience are reported here. Four patients who previously sustained Grades II-IIIb open tibial fractures had an average bony defect of 9 cm. Two patients had previous bony infections. All patients had had serial debridements and myocutaneous flaps were required in three patients. An unreamed IM nail was inserted, and the transport device was applied. After an osteotomy, segmental transport was carried out until docking was achieved. The external fixator was removed after interlocking of the transported segment. The mean duration of external fixation was 17.9 days/cm and the mean period until roentgenographic consolidation of the distraction and nonunion site was 41.2 days/cm. There were two pin-tract infections but no IM infections. One nail broke after osseous consolidation of the regenerate at the distal interlocking site and required exchange. The goal of transport was achieved in all cases without angular or rotational deformity or length discrepancy. There were no neurovascular injuries.

Bone Lengthening↗
PubMed1992

Closed retrograde Hackethal nail stabilization of humeral shaft fractures.

We retrospectively reviewed 48 consecutive humeral shaft fractures treated with Hackethal stacked, flexible, intramedullary (IM) nails. The indications for fixation were polytrauma or fracture patterns not amenable to bracing. The average age of patients was 40 years. Eight had associated primary nerve injuries. All fractures were reduced closed, and the nails were inserted retrograde through a distal posterior cortical window. Follow-up was possible in 33 patients. Ninety-seven percent (32 of 33) had healed at 1 year. There were no iatrogenic nerve palsies. There was one delayed union, one nonunion, one deep infection, and three occurrences of heterotopic ossification at the entry portal. Two patients with distal nail migration required second operations. Clinical examination showed normal range of motion at the shoulder and an average of 5 degrees loss of extension at the elbow. Hackethal's bundled IM nailing was shown to be a reliable, inexpensive, and relatively atraumatic method for stabilization of simple and comminuted humeral shaft fractures.

Adult↗
PubMed1990

[Aggressive debridement and early soft tissue coverage of 3d degree open tibial fractures].

93 patients with grade III open tibial fractures were treated without a treatment protocol from 1980 to 1982. This group is compared to 147 pts. managed between 1983 to 1986 according to a standardized prospectively designed protocol with aggressive debridement augmented by pulsatile Jet-lavage. Serial debridement were performed at 48-hour intervales until early soft-tissue coverage were obtained using local or free muscle-flaps. The mean follow-up was 80 months respectively 44 months. --The aggressive regimen led to a statistically significant decrease in infection (30% vs 12%), nonunion (16% vs 6%), amputation (18% vs 6%) and combined hospitalization-periods (137 vs 74 days) [all p less than 0.001]. The aggressively treated groups showed a trend toward early fracture-healing (30 vs 23 weeks) although this was not statistically significant.

Adolescent↗
PubMed1988

[Results of surgical treatment of pelvic fractures in polytraumatized patients].

High-speed accidents involving automobiles and two-wheeled vehicles with resultant entrapment and crush injuries have led to an ever-increasing incidence of pelvic fracture within the realm of multiple trauma. Between the years 1982 and 1986 ninety-eight cases of pelvic fracture were operatively stabilised by the Department of Surgery and the Outpatient Department of the Technical University, Klinikum Rechts der Isar, Munich, West Germany. This paper is a report on fifty-five of these patients who were discovered to have suffered additional multitrauma. Independent from those patients found to have sustained multitraumatisation, twenty-four cases of isolated acetabulum fracture as well as four instances of pelvic ring fracture and one fracture of the pelvic brim were also documented. Combinations of the above mentioned fractures were uncovered in twenty-six patients. With fifty-four of the fracture injuries, osteosynthesis was carried out while in one case primary alloarthroplasty was deemed necessary. Following a mean post-treatment period of twenty-six months forty-five of the patients were objectively evaluated for results of treatment according to the methodology of Merle d'Aubigne. 70% of those patients assessed were rated with a "good" result. At the time of follow-up thirty-five (78%) of the forty-five reexamined individuals reported to be once again employed. Early operative treatment along with internal stabilisation and prompt initiation of physiotherapy have proved decisive in obtaining a favourable postoperative result.

Adolescent↗