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Biomedical subjects

B Strömqvist

Publications and source records attributed to B Strömqvist.

At least 73 records · Page 4Linked to original sources
PubMed1990

Isthmic lumbar spondylolisthesis with sciatica. MR imaging vs myelography.

Seventeen patients with sciatica and isthmic lumbar spondylolisthesis were studied with magnetic resonance (MR) imaging. In 13, myelography was also performed: 5 had dural sac deformation and root sleeve shortening, 2 had deformation with unilateral root sleeve shortening, one had bilateral root sleeve shortening only, and one had sac deformation only. In 4, myelography was normal. On sagittal MR examinations the neural foramen had an altered shape bilaterally with the long axis horizontal in all cases. In addition to altered shape the following was found in the 33 foramina evaluated. I: normal nerve (n = 8); II: compressed nerve (n = 16); III: disappearance of fat, nerve not possible to identify (n = 9). In patients with unilateral sciatica, the degree of foraminal stenosis correlated well with the side of symptoms. Coronal views showed the course of the nerve and pedicular kinking. Eight patients underwent decompressive surgery which revealed nerve compression by hypertrophic fibrous tissue and pedicular kinking, which correlated well with the findings on MR. Since the site of nerve compression often was peripheral to the root sleeves, myelography did not give complete information.

Adult↗
PubMed1989

Anomalous lumbosacral articulations and low-back pain. Evaluation and treatment.

Eleven patients ranging from 13 to 76 years in age with low-back pain and asymmetric sacro-transverse joints were studied. Preoperatively, scintimetry was performed in eight of the patients, in all cases with normal results. Ten of the 11 patients had their sacrotransverse joint anesthesized in fluoroscopy. Nine of these experienced pain reduction or alleviation. Resection of the transverse process was performed in all cases. At follow-up, at 6 to 42 months postoperatively, seven patients reported total alleviation of pain, and two, significant improvement. Two patients had unchanged symptoms; one patient was 76 years of age, had associated degenerative changes of the spine, and had no effect of local anesthetics in his joint, and the other was a 13-year-old male competitive swimmer. The authors conclude that, in patients with anomalous unilateral lumbosacral articulations and low-back pain, in whom local anesthesia into the joint gives pain alleviation, resection of the transverse process may be a worthwhile procedure.

Adolescent↗
PubMed1989

Secondary arthroplasty for complications of femoral neck fracture.

We report a series of 640 consecutive cervical hip fractures which were followed prospectively for two years after primary internal fixation with two hook-pins. Secondary arthroplasties were performed as salvage procedures in 75 cases and the early outcome of these was studied retrospectively. The mean time in hospital was 25 days for prosthetic replacement, though 60% of the patients had other medical conditions considered as risk factors. Mortality was 5% after six months and 8% after one year. Dislocation was seen in 11% and additional surgery was required in 4%. There was one case of deep infection and one supracondylar femoral fracture. In some cases there was considerable delay between the primary and secondary operation due to lack of awareness of functional deterioration, but although many patients had poor mobility before the secondary operation this was greatly improved within six weeks of the arthroplasty. We conclude that elective secondary hip arthroplasty for failure of fracture fixation is a safe and successful procedure. Once the decision to perform an arthroplasty is taken, this should be done without delay to avoid deterioration of function.

Aged↗
PubMed1989

Internal fixation of femoral neck fractures in Parkinson's disease. 32 patients followed for 2 years.

32 patients, suffering from Parkinson's disease, had internal fixation of femoral neck fractures. In 24 displaced fractures, 6 nonunions and 3 segmental collapses were seen; and in 8 undisplaced fractures, 1 case of segmental collapse was diagnosed. Healing complications were thus seen in one third. Total hip replacement for healing complication was performed in 3 of 32 patients. 9 patients died within 2 years. No difference in the rate of healing or mortality was detected compared with hip fracture patients without Parkinson's disease. Our study does not support primary arthroplasty for femoral neck fracture in patients with Parkinson's disease.

Adult↗
PubMed1989

Function after hook-pin fixation of femoral neck fractures. Prospective 2-year follow-up of 191 cases.

Totally, 191 consecutive patients with femoral neck fractures during 1984 and 1985 had internal fixation with hook-pins and were prospectively investigated. Within 2 years, 62 patients had died and 47 had developed healing complications, 30 of whom had been treated with total hip replacement. Thus, 82 healed without complication. Forty-one of 47 patients without other handicaps affecting their walking ability considered their gait as good as it was preoperatively; 45 used no walking aids or a cane. Nine of 35 patients with a nonfracture-related disease affecting their walking ability managed to walk with or without a cane; 13 considered their walking ability unaltered compared with their prefracture state. Three of 82 patients complained of pain on walking and 2 of pain at rest. All but 1 could flex their hip 90 degrees or more. We believe that the function after internal fixation of cervical hip fracture with uncomplicated healing is superior to that achieved by primary hip replacement; primary replacement is recommended only in rheumatoid patients with displaced fractures.

Adult↗
PubMed1988

Intracapsular pressures in undisplaced fractures of the femoral neck.

We studied intracapsular pressure in 50 patients with Garden Grade I and II subcapital fractures. Before operation pressures varied from zero to 320 mmHg, 16 patients having an intracapsular pressure of over 80 mmHg. The pressure was increased considerably by medial rotation and decreased by lateral rotation and especially by semi-flexion. From zero to 36 ml of blood was aspirated; the amount did not correlate with the intracapsular pressure. Of 25 patients who were also examined by scintimetry, 13 had reduced uptake at the femoral head before aspiration, and nine of these showed a marked increase in uptake after aspiration. Intracapsular tamponade of the hip may be one reason for the occasional occurrence of segmental collapse of the femoral head after subcapital fracture with minor displacement.

Adult↗
PubMed1988

Hemarthrosis after femoral neck fracture fixation.

In 34 femoral neck fractures, CT was performed within 1-32 days after internal fixation. All the cases except one showed an increased distance between the femoral neck and the anterior aspect of the joint capsule as compared with the intact side, indicating varying degrees of hip joint effusion and/or synovitis. Hip joint aspiration in 11 patients revealed increased intracapsular pressure varying between 10 and 112 mmHg and volumes of aspirated joint effusion up to 23 ml. Pain relief and increased joint motion after drainage of the intracapsular effusion was observed in 3 patients whose postoperative mobilization was facilitated.

Aged↗
PubMed1988

Acetabular fracture causing hip joint tamponade. A case report.

An 81-year-old woman had severe hip pain after a fall. Radiography was normal, but computed tomography and sonography showed a minor, displaced acetabular fracture and hemarthrosis. Aspiration of 15 ml of blood reduced the intracapsular pressure in the neutral position from 30 kPa to atmospheric pressure with relief of pain and increased joint motion. This case confirms that acetabular fracture may escape radiographic diagnosis and cause hip joint tamponade. Aspiration should be considered as a palliative and possibly therapeutic measure.

Acetabulum↗
PubMed1988

Nailing of femoral neck fracture. Clinical and sociologic 5-year follow-up of 510 consecutive hips.

In a retrospective population-based study, 510 consecutive cervical hip fractures treated by internal fixation with a spring-loaded four-flanged nail, early weight bearing, and social rehabilitation were examined at 5 years after primary nailing. Six (1.6 percent) deep infections occurred. After a new trauma, seven fractures through the nail entrance were seen. Mortality at 2 years was 32 percent and at 5 years 53 percent. With a program for active rehabilitation, 80 percent of the survivors coming from independent living returned to this and remained there. The frequency of reoperations in patients below age 70 years was twice as high as in those over 70. Secondary arthroplasty was performed in 6 percent of the 129 undisplaced fractures and in 25 percent of the 381 displaced fractures. Totally, 67 percent of the fractures had no secondary procedure, not even nail extraction.

Aged↗
PubMed1988

Diagnostic lumbar nerve root block.

Lumbar nerve root anesthesia using a local anesthetic was performed in 100 cases of sciatica. The neurological state before and after nerve block was recorded and also the degree of pain alleviation caused by the block. Three indications for the block were used in the study: unilateral sciatic pain and normal findings on myelography and/or CT or MR (n = 51), minor myelographic findings that possibly but not necessarily explained the patient's symptom (n = 40), and multiple pathological findings on myelography (n = 9). In 87% of the patients, the nerve block inflicted temporary sensory and/or motor disturbance within the dermatome anesthesized. In total, 51% experienced total, 31 partial, and 18 no pain relief after injection. No side effects of the procedure were noted. Patients with pain alleviation after anesthesia were offered an operative nerve root decompression and short-term results of this decompression seem to be comparable to conventional disc surgery. Anesthetizing the lumbar nerve root outside the intervertebral foramen may be considered in the preoperative evaluation of patients with sciatic pain and minor or no radiographic findings.

Adult↗
PubMed1988

Treatment of hip fractures in rheumatoid arthritis.

Of 1100 femoral neck fractures observed through an eight-year period, 27 occurred in rheumatoid conditions. The complications and functional results were compared with unselected femoral neck fracture data of nonrheumatoid patients. At two-year follow-up examinations, five of 27 surviving rheumatoid patients had had undisplaced fractures; one of the five developed segmental femoral head collapse. Nineteen of 20 patients with displaced fractures lost position or developed non-union or segmental femoral head collapse; 14 required total hip arthroplasty. In the control non-rheumatoid group, six of 27 undisplaced fractures and 34 of 67 displaced fractures developed complications. In displaced fractures, complications occurred more often in rheumatoid patients (p less than 0.0004). Because in rheumatoid patients internal fixation in displaced fractures is associated with an unacceptably high failure rate, primary hip arthroplasty may prove to be the procedure of choice.

Adult↗
PubMed1987

Recurrent shoulder dislocation and screw failure after the Bristow-Latarjet procedure. A case report.

A 22-year-old male was operated on with coracoid transfer according to the Bristow-Latarjet procedure because of recurrent anterior dislocation of his right shoulder. Nine months later the patient sustained a repeat shoulder dislocation after moderate trauma. The screw was radiographically found to be bent. Subscapularis shortening according to Putti-Platt was performed. No repeated episodes of dislocation and no instability has been experienced by the patient since then. However, one year later, he awoke with pain dorsal to the humeroscapular joint. Radiographs showed the screw to be broken. The proximal part of the screw was located underneath the humeroscapular joint and was removed. After this, the patient was free of pain and returned to work as a carpenter.

Adult↗
PubMed1987

Neurovascular injury complicating displaced proximal fractures of the humerus.

Three cases with injury of the axillary artery and brachial plexus complicating a displaced proximal fracture of the humerus are presented. In two patients the arterial injury was not recognized on admission. Vascular repair had to be carried out in all three cases. Two patients showed a persistent neurological deficit. In two of the cases, the arterial injury may have been caused by an attempt at closed reduction of the fracture. The possibility of axillary arterial injury should be considered in proximal fractures of the humerus with severe medial displacement of the shaft of the humerus.

Aged↗
PubMed1987

Prognostic precision in postoperative 99mTc-MDP scintimetry after femoral neck fracture.

A 2-year follow-up regarding healing complications, such as redisplacement, nonunion, and segmental collapse of the femoral head, was performed in 306 patients operated on for femoral neck fracture and examined with 99mTechnetium-MDP scintimetry within 2 weeks postoperatively. Scintimetric evaluation was performed by selecting regions of interest over the femoral head on the fracture side and the intact side and by comparing the uptake. A femoral head ratio fractured/intact side thus was obtained. Of 199 patients with an intact femoral head uptake (ratio greater than or equal to 1.0), 181 showed no signs of healing complications at 2 years, whereas 18 had developed healing complications. Of 107 cases with a deficient femoral-head uptake (ratio less than 1.0), 96 had developed healing complications within 2 years from the operation, while 11 cases had no signs of radiographic complications. We conclude that 99mTc-MDP scintimetry performed within 2 weeks from femoral neck fracture can predict the outcome of the healing course with a prognostic accuracy of 91 per cent.

Adolescent↗
PubMed1987

Effects of strategy changes in the treatment of femoral neck fractures during a 17-year period.

From 1966 to 1982 new concepts in the treatment of fresh femoral neck fractures were introduced at a university hospital in Sweden. These included immediate postoperative weight-bearing, a program with rehabilitation at home in collaboration with primary care, and an alteration of the treatment policy from primary hemiarthroplasty to a flanged nail and finally to hook pins. The total annual number of hospital days was reduced by about one-third during this period in spite of the fact that the annual number of femoral neck fractures doubled. Thus, the mean hospitalization time decreased from 44 to 16 days. The proportion of patients admitted from their own homes decreased from 80% to 52% during the 17-year period, and for these, the return rate home at discharge from the hospital increased from 44% to 75%. According to several reports from Scandinavia, the number of hip fractures will double in the next two decades. Ways of further reducing the hospitalization time, new techniques, and, if possible, methods of preventing hip fractures must be sought.

Femoral Neck Fractures↗
PubMed1987

Hook-pin fixation in femoral neck fractures. A two-year follow-up study of 300 cases.

In 300 femoral neck fractures treated with hook-pin internal fixation, no perioperative mortality and no deep infection was seen. Eighty-four patients (28%) died within two years of the date of fracture. At two-year follow-up examination, 56 of 300 cases (19%) had developed radiographic healing complications, i.e., redisplacement, nonunion, or segmental femoral head collapse (26% of the survivors). Three of 85 undisplaced fractures (4%) developed segmental collapse (5% of the survivors) while among displaced fractures, radiographic evidence of malhealing was found in 53 of 215 cases (25%; 35% of survivors) at two-year follow-up examination. In the total series, secondary hip arthroplasty was performed in 34 cases (11%). Atraumatic reduction and internal fixation are recommended as primary treatment in femoral neck fractures.

Adolescent↗
PubMed1986

Hemarthrosis in undisplaced cervical fractures. Tamponade may cause reversible femoral head ischemia.

In eight undisplaced intracapsular fractures of the femoral neck, an intracapsular hematoma was diagnosed by computed tomography. 99mTc-MDP scintimetry revealed markedly reduced or absent blood supply to the head of femur. The intracapsular pressure was 23 (2.7-43) kPa with the hip in neutral position. Following aspiration of 12 (0.5-36) ml of blood, pressure was reduced to zero, and postaspiration scintimetry revealed restitution of blood supply to the femoral head. Hip joint tamponade in these patients has caused femoral head ischemia, reversible by aspiration.

Aged↗