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D Schiedts

Publications and source records attributed to D Schiedts.

6 recordsLinked to original sources
PubMed1997

Lunatomalacia associated with congenital shortening of the ulna in Langer-Giedion syndrome: a case report.

A 22-year-old patient with type I trichorinophalangeal Langer-Giedion syndrome presented a stage 2 osteonecrosis of the lunate associated with congenital shortening of the ulna and carpal tunnel syndrome. The patient was treated by shortening osteotomy of the radius and median nerve neurolysis, with an excellent result. This case provides an additional piece of evidence associating ulnar-minus variance with lunatomalacia, and another argument in favor of the theory that Kienböck's disease results from microfractures sustained by the lunate under an abnormal stress distribution situation.

Abnormalities, Multiple↗
PubMed1997

[Osteosynthesis of internal malleolar fracture by staplers].

PURPOSE OF THE STUDY: Rigid medial and lateral fixation should stabilize the syndesmosis without further additional supplementation. We used Titanium staples for medial malleolar fixation. MATERIAL: This study included 21 medial malleolar fractures (6 isolated medial malleolar fractures). Ankle fractures were classified according to Weber's system for lateral malleolar fracture. TECHNICAL: Tension band was used for Weber A lateral malleolar fracture and a plate for Weber B and C. One Weber A fracture was stabilized by staples. After reduction with clamps, three staples are placed perpendicular to the fracture line. All medial malleolar fractures were treated by staples including comminutive fractures or fractures who extended proximally into the tibia pilon. Only three transversal fractures of the anterior rim were treated by staples. Closure was made without any drainage. A below the knee cast was placed for 6 weeks. RESULTS: All fractures healed without further displacement. According to Weber Score, eleven ankle had an excellent result, seven a good result and three a bad result. We never removed the staples except in one case of technical error. DISCUSSION: Titanium staple present an attractive alternative for medial malleolar fixation. Plaster cast don't impair ankle function. Titanium staples are easy to use, are of little bulk and removal is not necessary. Skie et al. described three types of anterior rim fracture: one transversal and two oblique. The small size of the fragment makes reduction difficult to maintain, and impacted staple tends to displace laterally this small fragment. In this series we stapled only transverse fracture of the anterior rim (three times). But even in this case, it is difficult to maintain reduction during stapling. In case of lass of reduction, removal of the staple is responsible for fragmentation of the small fragment. Excluding the anterior rim fracture, other fractures, including T fractures and fractures who extend to the tibial pilon can be treated by this technique. CONCLUSION: Titanium staple is easy to use in medial malleolar fractures excluding anterior rim fractures.

Adult↗
PubMed1996

[Ipsilateral fractures of the femoral and tibial diaphyses].

PURPOSE OF THE STUDY: Simultaneous ipsilateral femoral and tibial fractures cause a floating knee. Treatment of such patients is complicated by fat-embolism syndrome (12 per cent), local soft tissue damage, ipsilateral knee ligament tear (5 to 39 per cent) and delayed shortening or torsional deformity. Our study aimed to determine the frequency of complaints about the knee and to study the causes of malunion. MATERIAL AND METHODS: Twenty-four patients with floating knee were treated between 1987 and 1992. Comminution was assessed according to Winquist et al. Associated soft tissue damage was assessed according to Gustilo et al. The grade III open fractures were always treated by external fixation. Intra-medullary nailing was always performed after reaming. RESULTS: One patient died and eighteen were reviewed. Fat-embolism syndrome occurred in three cases, one superficial infection occurred in femoral plating, nine deep infection occurred in tibial fracture: 7 for grade II and III open fracture treated by external fixation and one after nailing of a grade I open fracture. Malunion occurred in five patients: 2 shortening, 2 external rotational femoral deformity of 15 and 35 degrees, one shortening associated with external rotational femoral deformity of 30 degrees. Error in comminution evaluation was the leading cause of these malunions. Non-union occurred in 2 femoral and one tibial fracture. These complications were treated by decortication and osseous grafting. Four patients had a late diagnosis of ipsilateral ligamentous injury: antero and posterior in three and lateral isolated in one. Eighteen patients were reviewed. Results were excellent in 4, good in 7 and poor in 7. The seven poor results were: 1 amputation, four patients with ligamentous injury and 2 of the 5 malunions. DISCUSSION: Clinical evidence of fat embolism has been reported after reaming of fractured long bones. Reaming led to an increase in pulmonary artery pressure and in pulmonary free fatty acids. Reaming in the same time femoral and tibial diaphysis increased this kind of complication. We performed femoral and tibial fixation during the same operating time: first the femur and after the tibia. Tibial open grade III fractures were fixed first by external fixation. Ipsilateral femoral and tibial nailing increase malunion: shortening and rotational malunion. This problem can be reduced but not eliminated by using locking nails: the error was established during the operation. Distal femoral fraction gives better torsional control. Fractures in the distal segment of the femur are particularly prone to the development of axial malignement. In this series, malunion occurred in three cases. Knee effusion in patient with ipsilateral femoral and tibial fracture should not be ignored. It may indicate meniscal or articular pathology, or ligament disruption. If there is suspicion of ligament injury, a supracondylar femoral fraction is recommended for nailing. After femoral and tibial fixation, the knee must be examined clinically. Early surgical repair of peripheral tears is advocated. Repair of an anterior or posterior ligament without proximal or distal avulsion may not be warranted. CONCLUSION: Simultaneous ipsilaterla femoral and tibial fracture, or so called floating knee, occurs in patients who are involved in a high-velocity injury. Knee instability is however the major cause of poor results.

Adult↗
PubMed1995

[Fractures of the tibial tuberosity associated with avulsion of the patellar ligament in adolescents].

PURPOSE OF THE STUDY: Avulsion fracture of the tibial tuberosity is considered as a relatively uncommon adolescent injury. The avulsion of the patellar ligament may occur as part of the injury. Two cases of sixteen year old boys with this kind of injury have been reported. Fractures are described using Ogden et al. classification : type I is an avulsion fracture of the most distal portion of the ossification center of the tubercle ; type II, an upward angulation of the lip fragment ; type III, a fracture of the lip fragment with propagation of the fracture-line into the knee joint. Each type is subdivised into A (no comminution) and B (comminution). Frankl et al. in 1990 address the possibility that patellar ligament avulsion may occur as part of the injury (type C). CASE REPORTS: Two sixteen-year old boys suffered from sharp pain in the knee during a jump while playing basketball. Radiographic evaluation demonstrated an avulsion fracture of the tibial tubercle type III C. The osseous fragment was sutured with trans-osseous suture. The fixation was protected with a tension band passed above the patella and distally in the tibia. It was removed at six weeks. One patient was not reviewed and the other had no complaint one year after. DISCUSSION: Avulsion fracture of the tibial tuberosity Ogden type I and II is generally treated by plaster cast. When the patient is unable to extend his knee actively, an avulsion of the patellar ligament should be suspected. In this case, Frankl et al. proposed radiographic evaluation: the distance between the distal end of the patella and the avulsed fragment was noted to increase during flexion. Avulsion of the distal tuberosity usually occurs just prior to complete closure of the proximal tibial physis. Interfragmental transphyseal screws can thus be used safely. In the younger patient or in extensive comminution, tension band wire should be used. The use of a tension band between patella and tibia to protect the ligament reinsertion provise early knee mobilisation (between 0 and 60 degrees). It should be removed within six weeks. CONCLUSION: Avulsion fracture of the tibial tuberosity is rare. When conservative treatment is indicated, it is important to search an avulsion of the patellar ligament. When such an injury is suspected, lateral radiographs of the knee should be made in flexion as well as in extension. We believe that treatment should include open reduction and internal fixation associated with a protect tension band allowing early rehabilitation.

Adolescent↗