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Biomedical subjects

B Tjernström

Publications and source records attributed to B Tjernström.

12 recordsLinked to original sources
PubMed1996

Reliability of radiological measurements of the distraction gap during leg lengthening.

PURPOSE: The aim of this study was to determine the accuracy of length measurements on plain radiographs during leg lengthening and to evaluate a reliable method of measuring the amount of lengthening suitable for clinical praxis. MATERIAL AND METHODS: In an experimental study, a plastic femur was lengthened 40 mm and assessed radiographically in different positions, and the orthoradiographically calculated total length of the femur was compared with the true value. In a clinical study, 96 radiographs encompassing 14 femoral and 2 tibial lengthenings were assessed on a digitized table with a computer program (PROFILE) with regard to the amount of lengthening and the degree of magnification. RESULTS: The radiographic magnification in the experimental study, depending on position of the femur, was 17% (5-25%), and in the clinical material it averaged 16% (0-36%). CONCLUSION: Radiographs obtained with a radiopaque ruler placed at the same level as the lengthened bone allowed reliable measurements of the distraction gap.

Adolescent↗
PubMed1996

Correction of persistent clubfoot deformities with the Ilizarov external fixator. Experience in 10 previously operated feet followed for 2-5 years.

We reviewed the outcome in 10 idiopathic clubfeet in 7 patients treated with the Ilizarov external fixator (IEF) for persistent foot deformities after previous surgery. After follow-up of a median of 40 (25-56) months, 6 patients/parents were satisfied with the results and most of them reported better walking capacity and fewer problems finding shoes that fit. Severe equinus deformity was seen in 9/10 feet prior to treatment in the IEF and in no foot at follow-up. However, persistent reduction of ankle joint motion, limited walking capacity and intermittent pain were commonly found.

Adolescent↗
PubMed1994

Back pain and arthralgia before and after lengthening. 75 patients questioned after 6 (1-11) years.

We performed 100 lengthenings of the lower extremities in 85 patients from 1980 to 1991, using three different surgical techniques. 6 (1-11) years after lengthening 75 of these patients with a preoperative leg length inequality of 6 (3-14) cm were clinically and radiographically assessed, and replied to a questionnaire on pre- and postoperative complaints of low back pain and pain from the joints of the lower extremities. Patients 15 years of age or younger at surgery had few complaints. Before lengthening, 18 patients suffered from severe low back pain compared with 6 at follow-up. Complaints from the joints of the lower extremities were less common and the effect of lengthening on these symptoms was minor. The ability to work, walk and to perform recreational activities was improved. 60 patients were satisfied with the result of the lengthening.

Adolescent↗
PubMed1994

Limb lengthening by callus distraction. Complications in 53 cases operated 1980-1991.

We reviewed our first 53 lengthenings performed in 45 patients with an average age of 19 years at the time of lengthening. The shortening was congenital in 16 patients, post-traumatic in 15 and had various causes in the 14 remaining. 31 femurs and 22 tibias with an average shortening of 6 and 5 cm, respectively, were lengthened 6 (2-14) cm. The aim was achieved in all but 4 patients, where lengthening had to be discontinued due to complications. Potential complications of lengthening can be numerous but, if recognized, can in most cases be dealt with during the extended lengthening procedure. 38 cases of pin-tract infections healed with antibiotics. Restricted motion in one or more joints was registered in 49 cases during lengthening; minor restriction of joint motion persisted in 14 patients. 28 cases had angular deviations during lengthening. After additional surgery all but 10 could be corrected. 4 fractures occurred after removal of the external fixator. The total number of complications was 146, and of these 76 were minor, 42 moderate and 28 severe. 36 of the 42 patients available to follow-up were satisfied with the results of the lengthening procedure.

Adult↗
PubMed1993

Direct leg lengthening.

Twenty patients with an average posttraumatic leg length shortening of 4.6 cm (range 2.5-9) underwent direct leg lengthening. The operation time averaged 210 min and the peroperative blood loss was 1,800 ml. Angular and rotational malalignment, when present, were corrected. Lengthening averaged 3 cm. At follow-up, two patients had serious sequelae after vascular injuries. Seven patients had postoperative neurological complications, which in four cases resolved completely. The time required for solid union of the lengthened segment averaged 10 months. Bone grafting two or more times was performed in six patients. Seventeen patients were assessed an average of 7 years (range 3-10) after surgery. Thirteen of these were satisfied with the results of the lengthening. Complications of the procedure and/or a remaining major leg length inequality could explain the dissatisfaction of the others. A majority of the patients complained of low-back pain both preoperatively and at follow-up. Few complaints about the joints in the long leg were expressed. Preoperative pain about the hip and knee in the short leg existed in more than half of the patients, and these complaints were reduced on a weak statistical level at follow-up. Walking ability improved in 12 patients, working ability in 10, and recreational activity level in eight. Direct leg lengthening is generally regarded as major, demanding surgery, entailing potential risks of serious complications, and should be used with great care and only in selected cases.

Adolescent↗
PubMed1990

[Leg lengthening--historical review and current techniques].

The techniques earlier used for leg lengthening were notorious for their complications, and as late as the 1960s some authorities would not consider lengthening unless amputation was the alternative. The method introduced by Wagner in the 60s had the advantage of a stable external fixation, permitting the patients to be mobilized. The drawback was that at least three operations were needed: external fixation and osteotomy, bone grafting and internal fixation, and, finally, removal of the plate. With the Ilizarov technique, no bone grafting is needed and bone lengthening up to at least 15 cm is possible. The main problems in leg lengthening are related to joints and soft tissue. Every surgeon performing leg lengthenings should be familiar with the possible problems and complications. He must establish very good relations with the patient and be ready to spend a considerable amount of time with the patient during the process.

Bone Lengthening↗
PubMed1990

[Reconstructive surgery following malunion of intra-articular fractures of the knee joint].

The anatomical reduction of intra-articular knee fractures is a major challenge if a satisfying functional result and limited post-traumatic arthrosis is to be obtained. In some cases even after malunion a good result can be achieved. In this paper, our experience with reconstructive surgery is described after a description of possible extended approaches to the knee and osteotomy techniques and advanced osteosynthesis. Four illustrated cases of distal femoral and three of proximal tibial reconstruction are discussed. In all patients the primary treatment led to malunion of the comminuted fractures. The only complication seen was the breaking of an angulated plate at the distal femur and even here, after re-osteosynthesis, normal healing occurred. In all cases a satisfactory knee motion was achieved: 90 degrees of flexion in the femoral group and 120 degrees in the tibial group was reached without any extension deficit. Alignment and axial correction were optimal in all patients. From these results we believe that reconstructive surgery can ba advocated for malunited knee fractures and that it represents a primary alternative to joint replacement surgery and arthrodesis.

Adolescent↗
PubMedDate not supplied

Bone remodeling after leg lengthening: evaluation with plain radiographs, and computed tomography and magnetic resonance imaging scans.

Ten patients who had undergone leg lengthening were monitored with plain radiographs and computed tomography (CT) scans at 3-month intervals. Four of them were examined with magnetic resonance imaging (MRI) scans. When the external fixator was removed, MRI scans could not demonstrate any continuous fat signals in the lengthened region, suggesting the lack of medullary cavity. CT scans disclosed double cortex in three patients and irregular new bone formation in seven. At 6 months, a medullary cavity could be detected. Other aberrations were less evident. Remodeling of new bone material required at least 1 year.

Adolescent↗