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Biomedical subjects

D L Fernandez

Publications and source records attributed to D L Fernandez.

18 recordsLinked to original sources
PubMed1992

[Analysis of the "user friendliness" of the AO classification of fractures].

The AO-classification of long bone fractures has been introduced as a universal system and depends mainly on morphological characteristics and fracture-location. It includes the fracture severity and outcome and should be a basis for treatment. To evaluate the AO-classification in the "daily use", we were interested if this system is really userfriendly, where the problems of coding occur and which is the agreement in different codings of several surgeons in relation to segment, type, group and subgroup. 58 fractures were classified, totally we got 456 classifications. The agreement in relation to segment was 95%, to type 79%, to group 63% and to the subgroup only 45%. Endsegment-fractures had a better agreement than shaft fractures. Common mistakes are discussed and some "user-guidelines" are given.

Documentation↗
PubMed1992

[Combined "percutaneous and minimal" osteosynthesis for dislocated intra-articular calcaneus fractures].

41 displaced intraarticular fractures of the calcaneus were treated with open reduction, limited internal screw fixation, bone grafting and percutaneous pinning, using an extensile postero-lateral approach. Despite early functional after treatment all fractures healed without secondary displacement in an average time of 8 weeks. At follow-up (average 4.2 years) there was a strict correlation between the clinical results and the severity of articular comminution. A satisfactory outcome seems to depend on the ability to restore the best possible articular congruency and extra-articular alignment of the os calcis. Results and advantages of our method are discussed.

Adolescent↗
PubMed1991

Treatment of displaced articular fractures of the radius.

Forty patients with articular fractures of the distal radius in which anatomic reduction of the joint surface could not be obtained by closed manipulation or by ligamentotaxis with external fixators had a combination of percutaneous and/or open reduction techniques to restore articular congruity. X-ray films taken after treatment with an average follow-up of 4 years showed satisfactory extraarticular alignment in 85% of the cases, and 37 (92.5%) patients demonstrated an articular step-off of 1 mm or less at late follow-up examination. Radiographic evidence of radiocarpal arthritis was present in 5% of the cases at follow-up examination.

Adolescent↗
PubMed1991

Percutaneous and limited open reduction of the articular surface of the distal radius.

Between 1979 and 1986, 40 patients with intraarticular fractures of the distal radius, in which anatomic reduction could not be obtained by closed manipulation or external fixation, underwent a combination of percutaneous and/or limited open reduction techniques to restore articular congruity. All 40 patients' radiographs that were retrospectively reviewed with an average follow-up of 4 years showed satisfactory extraarticular alignment in 85% of cases, and 37 patients (92.5%) demonstrated an articular step-off of less than or equal to 1 mm. Thirty-one patients retrieved for follow-up had a good functional result. The treatment goals of intraarticular fractures of the distal radius are anatomic restoration of the joint surface and optimal fixation to maintain reduction in an effort to prevent posttraumatic arthrosis of the wrist.

Adolescent↗
PubMed1990

Anterior interosseous nerve palsy complicating a forearm fracture in a child.

An anterior interosseous nerve palsy occurring as a complication of a closed both bone forearm fracture in a child is presented. Surgical exploration showed that a bone spike from the proximal fragment was perforating the median nerve. The fractured radius was reduced and inspection of the nerve under the microscope showed no fasicular disruption. Complete motor recovery occurred in 4 months and sensibility had fully returned at 10 months after the operation.

Child↗
PubMed1990

Anterior bone grafting and conventional lag screw fixation to treat scaphoid nonunions.

The results of 20 established nonunions of the scaphoid treated with resection of the pseudoarthrosis, anterior cortic-cancellous iliac bone grafting, and conventional lag screw fixation with the ASIF 2.7 mm cortical screw are presented. Union rate was 95% and the average time off work was 8.9 weeks. Review of the relevant literature uniformly shows that the most common reasons for failure are improper internal fixation techniques and/or the absence of bone grafting. Successful treatment of scaphoid nonunions with screw fixation and cast-free after-treatment does not depend on the implant used but rather on careful case selection and precise surgical technique.

Adolescent↗
PubMed1989

[Corrective interventions in malunited fractures of the distal radius].

The current indications and technique of wrist osteotomies for ununited fractures of the distal radius are presented. A three-dimensional correction at the metaphyseal level is technically feasible. This not only restores the normal orientation of the articular surface thus reestablishing normal load distribution but also the radial length up to 10 mm which is a prerequisite to prevent ulno-carpal impingement. Painful limitation of forearm rotation due to degenerative changes in the distal radioulnar joint may be treated with Bowers hemiresection arthroplasty. If the radioulnar index should be greater than 10-12 mm an additional shortening osteotomy of the ulna may become necessary. Every additional operation on the ulna should be based on the radiological comparison of the distal radioulnar joint of the opposite hand.

Bone Nails↗
PubMed1988

Radial osteotomy and Bowers arthroplasty for malunited fractures of the distal end of the radius.

Radial osteotomy and hemiresection arthroplasty was performed in fifteen patients who had malunion of a fracture of the distal end of the radius with symptoms predominantly in the radio-ulnar joint and limited rotation of the forearm. Postoperatively, all of the patients had improved rotation and stability of the distal radio-ulnar joint, as well as satisfactory relief of pain. Over-all, grip strength increased an average of 30 per cent, and every patient had substantial improvement in function. The result was very good in four patients, good in eight, and fair in three.

Adult↗
PubMed1988

Anterior approach to the knee with osteotomy of the tibial tubercle for bicondylar tibial fractures.

Eight patients--six who had a bicondylar fracture of the tibia and two who had a complex fracture-dislocation--were treated by open reduction and internal fixation that was achieved through an anterior approach to the knee. The approach included elevation of the tibial tubercle, proximal retraction of the extensor mechanism (patellar tendon, retropatellar fat pad, and patella), and transection and detachment of the anterior horn of one or both menisci. The extent of the approach depended on the specific need for exposure. The quality of reduction was better and the rate of complications was lower, compared with conventional approaches. The main advantage of this approach is that the tibial plateau and the intercondylar notch are exposed clearly and completely; this is a prerequisite for the rapid reconstruction of the joint surface and, in some patients, for the reattachment or primary suture of the cruciate ligaments. I recommend the anterior approach with osteotomy of the tibial tubercle in the treatment of patients who have a severe displaced bicondylar fracture of the proximal end of the tibia.

Adolescent↗
PubMed1987

External fixation of complex carpal dislocations: a preliminary report.

In ten cases of complex carpal fracture dislocations an external fixator between the radius and the second or third metacarpals was used as an adjunct to open reduction and internal fixation. The external fixator facilitates reduction, ligamentous repair, and internal fixation of the carpal bones. Furthermore, continuous postoperative distraction of the wrist maintains a stable reduction of the carpus permitting cast free after treatment and early active motion of the neighboring joints. This method is particularly useful for carpal stabilization when combined injuries of the same extremity coexist.

Adult↗
PubMed1977

[Corrective osteotomy for malalignment of fractures of the distal radius (author's transl)].

Corrective osteotomy is indicated in young manual workers with significant malalignment after fracture of the distal radius without associated degenerative changes in the wrist joint. Chronic pain, limited motion and impaired power can be avoided and the cosmetic appearance of the hand improved, by restoration of the functional anatomy of the wrist. The operation consists of an opening-wedge osteotomy at the fracture site, sometimes combined with resection of the distal ulna. The approach may be dorsal or volar. A small iliac cortico-cancellous bone graft is inserted at the osteotomy site. Fixation is by an AO-small fragment-T-plate allowing early functional after-treatment.

Adult↗
PubMed1977

[Treatment of Smith fractures (author's transl)].

A full description of the different types of Smith fractures following Thomas classification is given, together with the guidelines of treatment of each type. Conservative treatment is usually sufficient for types I and III, provided that reduction is anatomic and stable. The indication for internal fixation is given for all type II and unstable type III fractures. An exact description of the volar buttressing technique with the AO-T-plate is presented.

Bone Plates↗