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Biomedical subjects

C Gerber

Publications and source records attributed to C Gerber.

At least 73 records · Page 4Linked to original sources
PubMed1994

Iatrogenic displacement of fracture-dislocations of the shoulder. A report of seven cases.

We report seven cases in which open or closed reduction of a shoulder dislocation associated with a fracture of the humeral neck led to displacement of the neck fracture. Avascular necrosis of the humeral head developed in all six patients with anatomical neck fractures. All five anterior dislocations also had a fracture of the greater tuberosity and both posterior dislocations had a fracture of the lesser tuberosity. The neck fracture had not initially been recognised in three of the seven cases. In five cases attempted shoulder reduction led to complete displacement of the head segment, which was treated by open reduction and minimal internal fixation. In the other two cases, shoulder reduction caused only mild to moderate displacement which was accepted and the fracture was treated conservatively. We conclude that biplane radiography is essential before reduction of a shoulder dislocation. Neck fractures must always be ruled out, especially where there are tuberosity fractures. In our series, careful closed reduction under general anaesthesia with optimal relaxation and fluoroscopic control did not prevent iatrogenic displacement. Prophylactic stabilisation of the neck fracture should be considered before reduction of such a fracture-dislocation. It may be, however, that the prevention of displacement by prophylactic stabilisation does not always prevent late avascular necrosis; we observed this in one case.

Adult↗
PubMed1993

The reproducibility of classification of fractures of the proximal end of the humerus.

The radiographs of ninety-five fractures of the proximal end of the humerus were classified with the Neer and the AO/ASIF systems by five orthopaedic surgeons who had a special interest in problems of the shoulder. Without access to their initial interpretations, the same five orthopaedic surgeons reevaluated the same radiographs eight weeks later. Intraobserver and intraobserver reliability were found to be fair or poor for both classification systems. Kappa values for the interobserver reliability were 0.40 for the Neer system and 0.53 for the AO/ASIF system. When the fractures were subclassified, according to the recommendations of the AO/ASIF, into groups and subgroups, reproducibility became progressively worse. Intraobserver reliability showed kappa values of 0.60 and 0.58, respectively. A so-called extended radiographic trauma series, consisting of three perpendicular radiographs, was available for thirty-five fractures; the third perpendicular projection did not significantly improve the reproducibility values for either classification compared with those obtained with only two perpendicular projections. We concluded that neither the Neer nor the AO/ASIF classification of fractures of the proximal end of the humerus is sufficiently reproducible to allow meaningful comparison of similarly classified fractures in different studies.

Humans↗
PubMed1993

Distal radioulnar joint function after Galeazzi fracture-dislocations treated by open reduction and internal plate fixation.

Nineteen Galeazzi fracture-dislocations were reviewed clinically and roentgenographically at an average of 83 months after open reduction and internal fixation. Radiographic observation of fracture reduction was correlated with clinical results. Patients with anatomic fracture reduction had minimal sequelae and better or equal functional results than patients with imperfect reduction. Manual laborers had no weakness, but nonmanual laborers showed significant deficits in supination strength. Concomitant fractures of the wrist, the hand, or both were associated with significant pronation weakness. The volar approach was associated with a significant deficit of flexion/extension range of motion (ROM). Attention was focused on distal radioulnar joint (DRUJ) function and pain. Distal radioulnar joint function was fully restored by open reduction and internal fixation of the radius and indirect anatomic reduction and functional aftercare of the DRUJ in 16 cases. Open revision, repair of the triangular fibrocartilage complex (TFCC), and immobilization of the wrist are not necessary if anatomic reduction of the joint is obtained by indirect means such as open reduction and internal fixation of the radius.

Adult↗
PubMed1993

[Fractures near the femur head in children and adolescents].

13 patients (1981-1991) between 1.5-15.5 years (average 10.2 years) with Delbet I-III fractures were analysed of the incidence of avascular necrosis. Only one (type II fracture) of our 13 patients was associated with a severe complication (Ratliff type I) of an avascular necrosis of the femoral head. This satisfactory result may be explained by our concept of immediate open reduction and minimal internal fixation of the displaced fractures.

Adolescent↗
PubMed1993

The treatment of fractures of the femoral neck.

Fifty-four femoral neck fractures in young adults (20-50 years old; Group I) were compared with 397 fractures in the elderly population (older than 60 years of age; Group III). Patients in Group I were more frequently men and had often sustained vertical shear fractures in high-energy injuries. Treatment consisted mostly of open reduction and internal fixation (88%). There were no infections, pulmonary embolisms, or deaths. The rate of avascular necrosis was 10%; the rate of delayed union or nonunion, 17%; and the revision rate, 20%. Reoperation did not preclude an excellent final outcome. Patients in Group III were mostly women who fell at home and sustained an adduction fracture, which was most frequently (80%) treated with a cemented monopolar arthroplasty. Complications included pulmonary embolisms (3.5%), other cardiovascular complications (8%), and respiratory complications (7%). The death rate during hospitalization was 6.5%; for the first year after surgery it was 21%. These complications were not more frequent with either hemiarthroplasty or internal fixation. Local complications required revision of 17% of the cases treated with internal fixation and 1.4% of the patients treated with hemiarthroplasty. In the entire series, the deep infection rate without prophylactic antibiotics was 1.5%; with prophylactic systemic antibiotics it was 0.7%. The incidence of pulmonary embolism without thromboprophylaxis was 3.2%; with fixed-dose, subcutaneous heparin it was 1.1%. Of those treatments tested, open reduction and internal fixation with cancellous bone screws (for the younger patients) and hemiarthroplasty (for the elderly patients) yield the best short-to-midterm results. In addition, thromboprophylaxis with fixed-dose subcutaneous heparin and systemic antibiotic prophylaxis will continue to be used.

Adult↗
PubMed1992

[Classification of fractures and problems in proximal humeral fractures].

Complex fractures of the proximal humerus may be difficult to assess and treat. Open or closed reduction and fixation may lead to malunion, nonunion, and/or avascular necrosis. Conversely, hemiarthroplasty also does not always result in satisfactory functional results. Various classifications have been established to compare the results of treatment and assist in decision making. The most commonly used classifications are those of Neer and the AO/ASIF group both of which appear to overestimate the relevance of avascular necrosis and underestimate the relevance of malunion. Because of the inter- and intraobserver variability in classifying these fractures, there is the potential for a wide variety of treatment recommendations, and predicting the prognosis becomes less accurate. Further work should be done in standardizing the classifications of proximal humerus fractures and defining the necessary X-ray projections.

Fracture Fixation, Internal↗
PubMed1992

Periodontal conditions in Swiss Army recruits.

The purpose of the present study was to assess the oral hygiene and periodontal conditions of a young male population representative for Switzerland. 757 Swiss Army recruits were examined for their oral health status including the assessment of Plaque Index (PlI), Retention Index (RI) and Sulcus Bleeding Index (SBI) as well as Probing Depth (PD) and Loss of Probing Attachment (LA). All the teeth of the right maxillary and mandibular dental arch were evaluated on four aspects. One recruit yielded a status of juvenile periodontitis and was excluded from further analysis. 2.3% of the teeth had been lost, mainly as a result of orthodontic therapy. Mean PlI and SBI for all 756 recruits approximated 0.6, while the mean RI was around 0.1. The mean PD was 2.3 mm, and the mean LA of 0.9 mm was measured. PD and LA were slightly higher on proximal than on buccal or oral aspects. Site specific analysis for all parameters are presented. Since only 0.4% of the recruits showed probing depths of greater than or equal to 5 mm and only 1% of the subjects showed LA greater than or equal to 4 mm on any surfaces it may be concluded that severe signs of chronic adult periodontitis are absent in 99% of young male Swiss citizens.

Adult↗
PubMed1992

Anatomy and relationships of the suprascapular nerve: anatomical constraints to mobilization of the supraspinatus and infraspinatus muscles in the management of massive rotator-cuff tears.

Thirty-one shoulders in eighteen cadavera were dissected to allow study of the neurovascular anatomy of the rotator cuff and to help determine the limits of mobilization of the cuff for the repair of chronic massive retracted tears. The dissection demonstrated the diameter, length, and relationships of the suprascapular nerve and its branches and made clear the dangers of extensive mobilization and advancement of the supraspinatus and infraspinatus muscles. The suprascapular nerve ran an oblique course across the supraspinatus fossa, was relatively fixed on the floor of the fossa, and was tethered underneath the transverse scapular ligament. In twenty-six (84 per cent) of the thirty-one shoulders, there were no more than two motor branches to the supraspinatus muscle, and the first was always the larger of the two. In twenty-six (84 per cent) of the thirty-one shoulders, the first motor branch originated underneath the transverse scapular ligament or just distal to it. In one shoulder (3 per cent), the first motor branch passed over the ligament. The average distance from the origin of the long tendon of the biceps to the motor branches of the supraspinatus was three centimeters. In fifteen (48 per cent) of the thirty-one shoulders, the infraspinatus muscle had three or four motor branches of the same size. The average distance from the posterior rim of the glenoid to the motor branches of the infraspinatus muscle was two centimeters. The motor branches to the supraspinatus muscle were fewer, usually smaller, and significantly shorter than those to the infraspinatus muscle. The standard anterosuperior approach allowed only one centimeter of lateral advancement of either tendon and limited the ability of the surgeon to dissect safely beyond the neurovascular pedicle. The advancement technique of Debeyre et al., or a modification of that technique, permitted lateral advancement of each muscle of as much as three centimeters and was limited by tension in the motor branches of the suprascapular nerve. In some situations, the safe limit of advancement may be even less. We concluded that lateral advancement of the rotator cuff is limited anatomically and may place the neurovascular structures at risk.

Female↗
PubMed1992

Latissimus dorsi transfer for the treatment of irreparable tears of the rotator cuff.

Sixteen irreparable, massive rotator cuff tears were treated with latissimus dorsi transfer and reviewed after an average of 33 months. There were no neurovascular complications or infections. Pain relief was satisfactory in 94% of the shoulders at rest and in 81% on exertion. Flexion was 83 degrees preoperatively and 135 degrees postoperatively. The functional value of the shoulder averaged 73% of an age- and gender-adjusted normal score. For the 12 shoulders with a functional subscapularis, it averaged 82%; for those four without a functioning subscapularis, 48%. If the subscapularis was torn and could not be adequately repaired, latissimus dorsi transfer was of no value. In cases with good subscapularis function but irreparable defects in the external rotator tendons, restoration of approximately 80% of normal shoulder function was obtained, indicating that latissimus dorsi transfer is a safe and valuable alternative for the treatment of this specific type of irreparable rotator cuff tear.

Adult↗
PubMed1991

Coracoclavicular screw fixation for unstable fractures of the distal clavicle. A report of five cases.

Five consecutive unstable fractures of the distal third of the clavicle were treated by indirect open reduction and internal fixation using a temporary Bosworth-type screw. Coracoclavicular fixation provided and maintained reduction of the fracture. Healing occurred uneventfully within nine weeks in all cases. The screw was removed under local anaesthesia after healing of the fracture and there were no surgical complications. Shoulder function was restored to the pre-injury level. Temporary coracoclavicular screw fixation appears to be a valuable alternative for the treatment of type II fractures of the distal third of the clavicle.

Adult↗
PubMed1991

Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases.

Traumatic rupture of the tendon of the subscapularis muscle was documented as an isolated lesion in the shoulders of 16 men. The injury was caused either by forceful hyperextension or external rotation of the adducted arm. The patients complained of anterior shoulder pain and weakness of the arm when it was used above and below the shoulder level. They did not experience shoulder instability. The injured shoulders exhibited increased external rotation and decreased strength of internal rotation. A simple clinical manoeuvre called the 'lift-off test', reliably diagnosed or excluded clinically relevant rupture of the subscapularis tendon. Confirmation of the clinical diagnosis was best achieved by ultrasonography or MRI, but arthrography or CT arthrography were also useful. Surgical exploration confirmed the diagnosis in every case. Repair of the ruptured tendon was technically demanding and required good exposure to identify and protect the axillary nerve.

Adult↗
PubMed1991

[Malunited juvenile fractures in pelvic and hip area].

Fractures of the hip and pelvis are rare in the growing skeleton. Conversely, they are complicated by morphological and functional abnormalities in a particularly high percentage of cases. We present a review of posttraumatic structural abnormalities and their consequences. In addition to the common presentations, less well-known abnormalities and their possible treatments are discussed.

Acetabulum↗
PubMed1991

[Prevention of serious injuries due to bicycle riding].

In 1984 there were 32,860 persons who suffered from bicycle-related injuries in Switzerland. They accounted for 27% of the persons injured on the road. Cranio-cerebral trauma had to be treated in 26% of the injured bicyclists. Two thirds of hospital admissions after bicycle accidents were due to head injuries. Craniocerebral trauma accounted for about 65% of the residual lesions and for 69% of the lethal injuries related to bicycle accidents. A relatively simple and effective protection for these injuries would consist of the use of a helmet. To estimate the expected reduction of head injuries if everybody had a helmet, the regression analysis of a previous study from Seattle was applied. By wearing hard-shell helmets, there would be a reduction in number and severity of 7500 head injuries and a decrease of 2000 hospital admissions each year in Switzerland. In addition to the decrease in suffering and quality of life of the use of helmets would lower health costs by at least 22 million swiss francs per year.

Accidents, Traffic↗
PubMed1991

[Possibilities of shoulder prostheses in arthritis].

The most dramatic progress in shoulder surgery in the last 50 years has been the introduction of replacement arthroplasty for the treatment of posttraumatic, inflammatory and degenerative arthropathies. In rheumatoid arthritis shoulder replacement arthroplasty provides good and excellent subjective and objective middle- and long-term results in more than 80% of the patients. Above, all pain relief is reliable. The state of the rotator cuff and deltoid muscle at the time of operation determine the gain in function. Despite the high incidence of radiolucent lines about the prosthetic components, clinical loosening is rare. Actually the survival rate of shoulder prostheses is comparable to that of total hip and total knee prostheses.

Adult↗
PubMed1990

Biological internal fixation of fractures.

Trauma centers treat more and more patients who have sustained multiple injuries during high energy accidents. The techniques of internal fixation of such fractures may be dictated by the concomitant soft tissue trauma, rather than by the bony injury. Three stages of soft tissue injuries are recognised: Stage I delineates compromised soft tissues which may be treated with standard techniques of internal fixation, provided that further devialization by surgery is avoided. Stage II implies partial, non-circumferential destruction of soft tissues, requiring alternative techniques of internal fixation to prevent (mainly septic) complications. In stage III, the soft tissues about the fracture site are destroyed and need early, specific soft tissue reconstruction. Indirect reduction without further devascularization of bone, aiming at perfect alignment rather than anatomical reduction of extraarticular fractures, optimal rather than maximal internal fixation as well as the inclusion of soft tissue reconstructive procedures into the armamentarium of the orthopaedic surgeon, require an intellectual and technical reorientation but can be shown to improve the results of the treatment of fractures with concomitant soft tissue injury.

Bone Plates↗
PubMed1990

Effect of bovine interferon on acute changes in body temperature and serum progesterone concentrations in heifers.

Bovine interferon-alpha I1 has extensive sequence and functional homology with the antiluteolytic protein, bovine trophoblast protein-1. Because of the possible use of interferon-alpha I1 as a drug that supplements embryonic secretion of bovine trophoblast protein-1, interferon-alpha I1 was tested for other biological actions that might affect its usefulness as a fertility-enhancing treatment. Experiments were performed to evaluate whether interferon-alpha I1 causes hyperthermia and an acute depression in circulating concentrations of progesterone. In four experiments, intramuscular administration of interferon-alpha I1 (range 1.25 to 20 mg) caused hyperthermia; average peak body temperatures of 40 to 40.4 degrees C occurred 2.5 to 6 h after injection. Temperatures returned to baseline 12 to 16 h later. The rise in rectal temperature could be reduced, but not totally alleviated, with concomitant administration of an inhibitor of prostaglandin synthesis. The maximal hyperthermic response was similar when interferon-alpha I1 was delivered via osmotic minipumps or through a series of intramuscular injections. The hyperthermic response decreased with repeated daily exposure to interferon-alpha I1. The increase in rectal temperatures was associated temporally with a decrease in serum progesterone. Effects of interferon-alpha I1 on body temperature and circulating progesterone could possibly limit its effectiveness in enhancing fertility.

Animals↗