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Biomedical subjects

B Jeanneret

Publications and source records attributed to B Jeanneret.

At least 19 recordsLinked to original sources
PubMed1992

Primary posterior fusion C1/2 in odontoid fractures: indications, technique, and results of transarticular screw fixation.

Odontoid fractures, especially unstable type II fractures have a poor prognosis in respect to healing. Therefore, operative stabilization (posterior fusion C1/2 or anterior screw fixation) has been suggested for the treatment of unstable type II and for some unstable type III fractures. Compared to posterior fusion C1/2, anterior screw fixation has proven to be effective; it has the advantage of leaving the motion segment C1/2 intact, therefore preserving at least some C1/2 rotation. However, in some instances, this method of stabilization is not indicated. In these cases, posterior fusion C1/2 is the treatment of choice. Primary posterior fusion C1/2 is indicated in (a) odontoid fracture associated with comminution of one or both atlanto-axial joints; (b) fracture of the odontoid associated with an unstable Jefferson fracture; (c) unstable type III odontoid fracture, when immobilization in a halo jacket or plaster cast is not suitable, as in elderly people or polytraumatized patients; (d) atypical type II fractures (comminuted or with oblique fracture in the frontal plane); (e) irreducible fracture dislocation C1/2, e.g., several-weeks-old fracture; (f) unstable type II or shallow and unstable type III odontoid fracture, when marked thoracic kyphosis is associated with limited extension of the cervical spine; (g) unstable type II or shallow type III odontoid fracture in elderly people with degenerative narrow spinal canal; (h) pathologic fracture of the odontoid. In all these instances, posterior fusion C1/2 is the treatment of choice. We prefer the transarticular screw fixation technique. Compared to other posterior fusion techniques, it has the advantage of increased stability and allows effective stabilization of C1/2 in a reduced position as well as immediate ambulation with minimal head support. This technique can also be performed when the posterior arch of the atlas is fractured or absent. Our experience of 12 acute odontoid fractures, managed by this technique, is presented. At follow-up, all C1/2 fusions were united in reduced position.

Adult↗
PubMed1992

[Vertebral fractures and abdominal trauma. A retrospective study based on 415 documented vertebral fractures].

415 spinal fractures were analysed retrospectively. A simultaneous occurrence of vertebral fracture and abdominal trauma was found in 14 patients (3.4%). The mechanism of injury was a fall from a considerable height in 9 cases, a car accident in 3 and a motorcycle accident in 2. Isolated fractures of the transverse processes and rotational injuries of the spine were found to be associated particularly frequently with an abdominal trauma (3 of 14 isolated fractures of the transverse processes = 22%, 5 of 61 rotational injuries = 8.2%), while compression injuries only showed such a simultaneous abdominal injury in 2% of the 300 fractures of this type. We never encountered the combination of distraction injury/abdominal trauma. This is probably because two-point lap-type seat belts are only rarely used in our country. In 2 patients with rotational injuries neurological deficits were observed. The abdominal injuries encountered in our patients were: massive concussion of the kidney (6 cases), rupture of the spleen (3 cases), rupture of the liver (2 cases), rupture of the mesocolon (2 cases), rupture of the caecum (1 case), rupture of a pre-existent aneurysm of the aorta (1 case), rupture of a renal artery (1 case), massive retroperitoneal haematoma (1 case). Other injuries were present in 12 of the 14 patients: 3 craniocerebral injuries, 7 fractures of the long bones, 6 injuries to the thorax and 3 to the pelvis. In conclusion, a simultaneous finding of vertebral fracture and abdominal trauma is rare in our patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed1991

Overdistraction: a hazard of skull traction in the management of acute injuries of the cervical spine.

In acute cervical spine trauma, skull traction is used to reduce a dislocation or fracture dislocation, to immobilize an unstable lesion until definitive treatment (operative or conservative) is possible or, more rarely, as a definitive treatment until healing occurs. This method may be dangerous when an unstable lesion is accidentally overdistracted. A few cases have been reported in the literature, some with neurological complications. We report five cases in which overdistraction was seen. Two hangman's fractures were overdistracted. One of the two patients developed a Cheyne-Stokes breathing pattern during traction which resolved after the weight was reduced. Furthermore, two hyperextension/distraction injuries (C4/5 and C6/7) and one bilateral C5/6 fracture dislocation were overdistracted without neurological deterioration. Occipitocervical dislocations, fractures of the odontoid process, hangman's fractures, hyperextension/distraction injuries and bilateral dislocations or fracture dislocations may present disruption of both the anterior and posterior elements. Therefore, these injuries are specially vulnerable to overdistraction when skull traction is used. To prevent accidental overdistraction during skull traction, we recommend the use of less weight than is generally proposed in the literature. To reduce a dislocation, we start traction weight at 2 kg and slowly increase it under continuous neurological and radiological monitoring until reduction is completed. Traction of 5-7 kg is usually sufficient; however, heavier traction may occasionally be necessary. After reduction is completed, traction is reduced to 2 kg. This weight is sufficient to immobilize a lesion until definitive treatment is possible. Inadvertent rotation may be prevented by placing sandbags on both sides of the head.

Adolescent↗
PubMed1991

Atlantoaxial mobility after screw fixation of the odontoid: a computed tomographic study.

Between 1979 and 1989, anterior screw fixation of the odontoid process was performed in 16 patients with fractures of the odontoid. One patient died suddenly 2 days after the operation. Postmortem examination could not disclose the cause of death. No other complication was noted. We followed 13 patients. At examinations 7 to 82 months after injury, all fractures were consolidated in reduced position. In all patients, a functional computed tomographic (CT) examination of the atlantoaxial rotation was performed. Atlantoaxial rotation measurement ranged from 7 to 38 degrees to the right (average: 25.2 degrees) and 7 to 41 degrees (average: 24.1 degrees) to the left side. Five patients presented a normal range of atlantoaxial rotation, 29 to 41 degrees; 3 had a rotation of 20 to 28 degrees; 3 a rotation of 10 to 20 degrees; and in 2, rotation was less than 10 degrees to one side. Our results suggest that anterior screw fixation is the therapy of choice for Type II and cephalad Type III dens fractures. However, significant complications have been reported by other authors. Therefore, a careful surgical technique is mandatory, and contraindications should be respected.

Adolescent↗
PubMed1991

Posterior stabilization of the cervical spine with hook plates.

Hook-plate fixation is designed for posterior cervical stabilization from C2 to C7. Indications remain the same as for standard posterior fixations. The prime indications are discoligamentous injuries. The plates are hooked under the lower laminas and attached to the articular masses of the upper vertebra by oblique screws. An H-graft is placed between the spinous processes. The vertebrae are compressed together by the plates at three points, the facet joints, and graft. The resulting pre-stressed system is stable in all directions. A protocol for safe reduction of cervical dislocations is observed. Of 70 patients treated from 1979 to 1986, 51 were examined 12-54 months after surgery. All fusions consolidated. Two neurologic complications not attributable to the fixation occurred. Other major complications were not seen.

Bone Plates↗
PubMed1991

Atlanto-axial fusion with transarticular screw fixation.

We reviewed 161 patients, from four centres in Switzerland, who had undergone posterior fusion of the upper cervical spine with transarticular screw fixation of the atlanto-axial joints. They were followed up for a mean 24.6 months. The vertebral artery and the medulla escaped injury and only 5.9% of the complications were directly related to the screws. The rate of pseudarthrosis was 0.6%.

Adolescent↗
PubMed1990

Congenital fusion C0-C2 associated with spondylolysis of C2.

This is the report of a very rare malformation at the cranio-cervical junction, including congenital occipito-cervical fusion C0-C2, spondylolysis of C2, and hypoplasia of the right vertebral artery. The malformation itself is part of a Klippel-Feil syndrome with sensory-neural hearing loss on the left side, congenital high thoracic scoliosis, rib agenesis on the right side, and kidney malformations on both sides.

Axis, Cervical Vertebra↗
PubMed1988

[Snapping palmar drawer phenomenon of the wrist: a physiologic or pathologic study finding?].

In the examination of a wrist, when this is held in neutral position and moderate ulnar deviation, a substantial palmar drawer translation combined with a snap can be elicited. The sign is most evident in about 15 degrees of ulnar deviation, while it is negative in the neutral position, in radial deviation or in maximal ulnar deviation. The translation and the snap have been consistently demonstrated in normal wrists and are therefore considered physiologic. The knowledge of this impressive phenomenon seems important for differential diagnosis when assessing the stability of a wrist; its clinical and cineradiographic picture are described.

Carpal Bones↗
PubMed1987

[Infectious spondylitis].

Nowadays, early diagnosis of spondylitis is possible. Technetium and gallium scintigrams are positive soon after the onset of the disease, while radiographs remain negative for weeks or even months. Blood and urine cultures and serologic tests may provide indications about the underlying infectious agent; however, needle biopsy establishes a precise bacteriologic diagnosis in up to 65% of the cases. Therefore, needle-biopsy is considered to be the most valuable diagnostic measure in spondylitis. Conservative treatment is indicated in cases of minimal destruction of the vertebral body. Surgery may be considered in cases of massive bone loss and kyphosis, and is strictly indicated in cases with spinal instability, abscess formation, and neurologic or septic complications, and when conservative treatment is ineffective.

Bacteria↗