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Biomedical subjects

C N van Dijk

Publications and source records attributed to C N van Dijk.

49 records · Page 3Linked to original sources
PubMed1996

Distal tibiofibular synostosis after ankle fracture. A 14-year follow-up study.

Over an eight-year period up to 1983, a total of 322 consecutive patients had operations for ankle fractures; 176 were Weber type B and 128 type C. We were able to review 230 of these patients after a mean follow-up of six years (1 to 11) including 128 with Weber B and 102 with Weber C fractures. We used an ankle score which combined symptoms and clinical and radiological findings, with a maximum score of 100 points. The mean score for all 230 was 92 (68 to 100). Fifteen of these patients had developed a distal synostosis between the tibia and fibula, three after a Weber B and 12 after a Weber C fracture. In 13 of these 15 ankles the synostosis had been visible radiologically within three months of the operation. In the other two there had been radiologically visible calcification at the three-month follow-up. In 1993, we were able to review nine of the 15 patients with synostosis using the same scoring system. At a mean follow-up of 14 years (12 to 18) the mean score for those with synostosis was 91 (71 to 100), much the same as this group's previous score and the mean score of the whole group of operated patients. We conclude that distal tibiofibular synostosis after ankle fracture usually causes few symptoms and does not generally require any treatment.

Aged↗
PubMed1996

Medial ankle pain after lateral ligament rupture.

After a severe ankle sprain the incidence of residual complaints, particularly on the medial side of the joint, is high. We studied a consecutive series of 30 patients who had operative repair of acute ruptures of lateral ligaments. During operation, arthroscopy revealed a fresh injury to the articular cartilage in 20 ankles, in 19 at the tip and/or anterior distal part of the medial malleolus as well as on the opposite medial facet of the talus. In six patients, a loose piece of articular cartilage was found. We conclude that in patients with a rupture of one or more of the lateral ankle ligaments after an inversion injury, an impingement occurs between the medial malleolus and the medial facet of the talus. Patients with a lesion of the lateral ankle ligament caused by a high-velocity injury (a faulty landing during jumping or running) had a higher incidence of macroscopic cartilage damage (p < 0.01), medially-located pressure pain (p = 0.06) and medially-located complaints at one-year follow-up (p = 0.02) than those with low-velocity injury (a stumble).

Adolescent↗
PubMed1995

Long-term follow-up of inversion trauma of the ankle.

In our institution lateral ankle ligament injuries are classified into three grades according to the extent of instability found on physical examination and/or stress X-rays. Grade I and II lesions are taped, while treatment of grade III lesions consists of operative reconstruction of the ruptured ligaments. In 1989 we published the results of 1012 patients after 9 months' follow-up. About 30% had residual complaints. The nature and frequency of the complaints were equally divided among the three groups. To examine the long-term follow-up results, we conducted a retrospective study with the same group of patients after 6.5 years. Although ankle ligament injuries are still considered rather innocent lesions, we conclude that even after 6.5 years patients can still have residual complaints (pain, fear of giving-way, actual instability, swelling), which interfere with daily living and/or sport activities. The result deteriorated with time. This was especially prominent in the grade II group, where the percentage of poor and fair results doubled. The overall percentage of residual complaints was 39%. We conclude that there is no such thing as "a simple sprain".

Adult↗
PubMed1989

[Treatment of tibial shaft fractures using plate osteosynthesis].

A retrospective study of 203 fractures of the tibial shaft, treated with ASIF-plate osteosynthesis between 1975 and 1986, revealed that the rate of osteitis and pseudarthrosis in closed and first-degree open fractures compares favourably with nationwide figures. The same applies to the duration of disability. Early treatment of osteitis, delayed union and pseudarthrosis in all cases led to complete recovery. Moving to modern hospital premises appears to have lowered the prevalence of infectious complications. Despite several negative prognostic factors, the results showed that ASIF-plate osteosynthesis if correctly performed on the right indication, is still the treatment of choice for a large group of patients with fractures of the tibial shaft.

Adolescent↗
PubMed1987

Poor results of double osteotomy for the rheumatoid knee.

A series of 27 patients (30 knees) with rheumatoid arthritis was studied 3 to 8 years after double osteotomy of the knee. Long-term results were poor. Double osteotomy should be abandoned in the management of the rheumatoid knee.

Adult↗
PubMedDate not supplied

Arthroscopic surgery of the metatarsophalangeal first joint.

Arthroscopic surgery of the metatarsophalangeal first joint was used to treat a dorsal impingement syndrome of the hallux by removing the dorsally located osteophytes. Also, osteochondritis dissecans, painful sesamoid bones resistant to conservative therapy, and hallux rigidus were arthroscopically treated in a prospective study enrolling 24 consecutive patients. Seventeen patients were high-level athletes. Pain, swelling, sports, and work involvement were recorded. The operative technique is described. There was one persistent loss of sensitivity of the hallux. In the dorsal impingement group, 8 of 12 patients had a good or excellent result after a minimum follow-up of 2 years. In patients with osteochondritis dissecans, 3 of 4 showed good or excellent results. In hallux rigidus and sesamoid bone removal the results were less favorable. As in all arthroscopic procedures there was a fast rehabilitation and work resumption. Especially in athletes arthroscopically, treatment of a dorsal impingement syndrome or osteochondritis dissecans can be recommended because of the diminished chance of scar fibrosis.

Adolescent↗
PubMedDate not supplied

Tendoscopy of the peroneal tendons.

An anatomic cadaver study was performed. Subsequently, in a prospective study, diagnostic and therapeutic tendoscopy (tendon sheath endoscopy) was performed in nine consecutive patients with a history of persistent posterolateral ankle pain for at least 6 months. All patients had pain on palpation over the peroneal tendons, a positive peroneal tendon resistance test, and most often local swelling. In two patients, a peroneal click was found without symptoms of dislocation of the tendons over the fibula. The indications for arthroscopy were diagnostic procedure postsurgery (3), diagnostic procedure postfracture (2), snapping sensation (2), removal of exostosis (1), and partial tendon rupture (1). Inspection and surgery of both tendons and tendon sheath could be performed well by a standard two-portal technique. A new finding is the vincula that was consistently present in all our autopsy specimens, as well as in all our patients. The vincula attaches both tendons to each other and to the tendon sheath. At a mean follow-up of 19 months, three of the four patients in which adhesions were found and resected were symptom free. In one patient, a symptomatic prominent peroneal tubercle was successfully removed. One patient had a longitudinal rupture of the peroneus brevis tendon that was successfully sutured. There were no complications.

Adolescent↗
PubMedDate not supplied

Endoscopic calcaneoplasty.

Endoscopic calcaneoplasty offers access to the retrocalcaneal space, thereby making it possible to remove inflamed retrocalcaneal bursa as well as the posterosuperior part of the calcaneus in applicable cases of painful hindfoot. In this study, endoscopic calcaneoplasty was performed in 21 procedures in 20 patients. All of the patients had typical complaints of inflammation of the retrocalcaneal bursa that were unresponsive to nonoperative treatment for more than 6 months. In all patients a superior calcaneal angle of more than 75 degrees and positive parallel pitch lines were present on the lateral calcaneal radiograph. The mean follow-up was 3.9 years (range, 2 to 6.5). There were no surgical complications and no postoperative infections. One patient had a fair result, 4 patients had good results, and the remaining 15 patients had excellent results. Whether this operation is performed by endoscopic or open technique, enough bone must be removed to prevent impingement of the bursa between the calcaneus and Achilles tendon. Endoscopic calcaneoplasty is a minimally invasive technique performed in an outpatient setting and combined with a functional rehabilitation program. The procedure has low morbidity. Patients have a short recovery time and quickly resume work and sports.

Adolescent↗
PubMedDate not supplied

Degenerative joint disease in female ballet dancers.

The relationship between long-term ballet dancing and eventual arthrosis of the hip, ankle, subtalar, and first metatarsophalangeal joint was examined in 19 former professional female dancers, aged 50 to 70 years. The dancers were compared with pair-matched controls. All 38 women underwent medical history taking, clinical examination, and roentgenography of the joints studied. The roentgenographs were independently judged by two investigators and grouped according to a modified classification of Hermodsson. We found a statistically significant increase in roentgenologic arthrosis of the ankle, subtalar, and first metatarsophalangeal joints in the ballet group compared with the control group. There was no significant difference regarding degenerative changes of the hip joint. However, subjects in the dance group who had evidence of degenerative changes on roentgenographs had no clinical complaints. There was a statistically significant increase in hallux valgus deformity in the ballet group (P < 0.05). The dancers also showed a statistically significant increase in flexion, external rotation, and abduction of the hip joint, dorsal flexion of the first metatarsophalangeal joint, and inversion and eversion of subtalar joint. But the control group had statistically significant increased plantar flexion of the first metatarsophalangeal joint. The most important cause of the statistically significant increase of arthrosis of the ankle and first metatarsophalangeal joints must be explained by repetitive microtrauma.

Aged↗
PubMedDate not supplied

A prospective study of prognostic factors concerning the outcome of arthroscopic surgery for anterior ankle impingement.

Sixty-two consecutive patients with painful limited dorsiflexion of the ankle not responding to nonoperative treatment participated in a prospective study. All 42 men and 20 women (average age, 31 years) underwent arthroscopic surgery. Preoperative radiographs were graded according to an osteoarthritic and an impingement classification. Standardized followup took place at 4 months and 1 and 2 years after surgery. Results showed that the degree of osteoarthritic changes is a better prognostic factor for the outcome of arthroscopic surgery for anterior ankle impingement than size and location of the spurs. The hypothesis is that osteophytes without joint space narrowing are not a manifestation of osteoarthritic changes but rather the result of local (micro)trauma. After 2 years, 73% of the patients experienced overall excellent or good results; 90% of those without joint space narrowing had good or excellent results, and 50% of those with joint space narrowing had good or excellent results. At the 2-year followup, the group without joint space narrowing showed significantly better scores in pain, swelling, ability to work, and engagement in sports. This study also revealed that patients with less than 2 years of ankle pain before surgery and spurs located anteromedially were more satisfied with the outcome than when longer periods of preoperative pain were involved and when spurs were located anterolaterally.

Adolescent↗