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Biomedical subjects

E L Raaymakers

Publications and source records attributed to E L Raaymakers.

At least 19 recordsLinked to original sources
PubMed1998

[Femoral shaft fracture in children younger than 4 years: shorter hospital stays with the help of at home traction apparatus].

OBJECTIVE: Evaluation of home traction as a treatment as a treatment of femoral shaft fractures in children with the objective to shorten the hospital stay. DESIGN: Retrospective. SETTING: Paediatric Surgical Centre Amsterdam (EKZ/AMC and AZVU), the Netherlands. METHOD: In the period 1991-1995, 18 femoral shaft fractures in children younger then 4 years were treated. In ten of them traction was applied at home (in the other cases the parents refused to co-operate, the home situation was not appropriate, there were additional medical problems or there was a suspicion of child abuse). During follow-up of the group treated at home with traction, angulation, deformity and leg length discrepancy were determined with special attention to complications. The parents' experience of this method was evaluated by telephone (n = 8). RESULTS: The median age of the children was 2.4 years. The mean hospital stay was 7 days (range: 3-12), the mean follow-up 2.4 years (range: 1.0-4.3). Angulation, rotational deformities and leg length discrepancy > 1 cm did not occur. Oedema and pain were seen in 1 patient as a result of incorrect treatment at home. In one patient a compartment syndrome occurred after a switch from traction to a plaster treatment in another hospital. With exception of some small practical and informational problems, parents were very pleased with this method. CONCLUSION: Treatment at home of femoral shaft fractures in children with traction is a simple and effective method which reduces the hospital stay to one week with minimal complications. Good patient selection and instructions of the parents are mandatory.

Child, Preschool↗
PubMed1996

Hip fracture.

Explore the source record for details and available documents.

Femoral Neck Fractures↗
PubMed1996

[Pseudarthrosis of the proximal femur].

Mechanical and biological factors are responsible for non-unions of the proximal femur. We analyse the causal treatment-possibilities of the different localisations. Fifty-five patients with non-unions of the femoral neck (average age 53 years) with or without preexistent femoral head necrosis (44%) were treated by abduction osteotomy and followed up at regular intervals. In 15% of cases a second operation was necessary after an average of 9.3 years, including the early complications. At the latest control 90% of the patients were satisfied, with an average Harris hip score (HHS) of 91. The survivorship analysis with end point total hip replacement is favourable. In the same period 22 patients were treated with a total hip replacement. The 11 survivors had a clearly worse HHS of 65. The low-risk, technically demanding valgization osteotomy should be the first step in the treatment of femoral neck non-unions, even in the presence of femoral head necrosis; secondary operations are not compromised. Pertrochanteric non-unions are rare. The pertrochanteric fragment very often heals, leaving a lateral femoral neck non-union which can be treated with valgization osteotomy. Depending on the type of non-union and the age of the patient, anatomical reduction, medial displacement and valgization osteotomy can be employed. With the angulated plates of the ASIF (95 degrees, 120 degrees, 130 degrees) 23 of the 24 non-unions could be healed in one operation. Fourteen patients underwent total hip replacement. In the subtrochanteric area mechanical and vascular instability leads to implant failure or fatigue fracture. Rigid compression-re-osteosynthesis is the therapy of choice, the 95 degrees condylar plate the implant. Twenty-three of our documented 24 subtrochanteric non-unions healed, 4 in the presence of an infection. Multiple operations have been necessary in 2 of the 4 non-unions following a pathological fracture.

Adult↗
PubMed1995

The modified Pirogoff amputation for traumatic partial foot amputations.

OBJECTIVE: To describe our experience with a modification of the Pirogoff amputation, in the treatment of serious injuries to the hind foot. DESIGN: Retrospective study. SETTING: University hospital, The Netherlands. SUBJECTS: Six patients who required amputation of the hind foot after serious injury. INTERVENTIONS: The modified Pirogoff amputation (amputation of the foot at the ankle with part of the calcaneus left in the lower end of the stump) was done four times as an emergency and twice electively between 1979 and 1991. RESULTS: All the patients were satisfied with their stumps at follow up (7 months-13 years). None had stump pain or phantom pain and they were able to walk about indoors without using the prosthesis. CONCLUSION: We recommend the Pirogoff amputation as the treatment of choice in the management of partial traumatic amputation and other injuries of the foot, should a transmetatarsal amputation be impossible and about 5 cm of the sole of the foot can be preserved.

Adult↗
PubMed1991

Knee ligament injuries combined with ipsilateral tibial and femoral diaphyseal fractures: the "floating knee".

The incidence of rupture of the knee ligaments was retrospectively studied in 47 patients with ipsilateral fractures of the femoral and tibial diaphyseal shaft. Fifteen patients proved to have an instability of the knee at the time of follow up. Disruption of the knee ligaments had not been recognised initially. At the time of initial treatment, injury of the knee ligaments had been diagnosed in only three cases. After stabilisation of both fractures in these cases, the knee ligaments had been repaired; at re-examination these patients had no complaints and their knees were perfectly stable. In view of the high incidence of missed cases, the possibility of disruption of the knee ligaments should be considered in all patients with fractures of both the femoral and tibial shaft. Meticulous examination of the knee at the time of injury is strongly advocated.

Femoral Fractures↗
PubMed1991

Non-operative treatment of impacted femoral neck fractures. A prospective study of 170 cases.

In a prospective study, 170 impacted femoral neck fractures were treated by early mobilisation and weight-bearing. The overall mortality at one year was 16%. In the 167 patients who were followed up until fracture healing or secondary instability, 143 fractures (86%) united. Instability occurred only in patients over 70 years of age, and in younger patients with a short life expectancy. Stepwise logistic regression analysis indicated that poor general health and old age (over 70 years) were risk factors. None of the other variables, such as the Garden index, Pauwels' type, and time to full weight-bearing had any influence on the development of secondary instability. Delayed operation after secondary instability caused no increase in mortality, nonunion or avascular necrosis. Functional treatment of all patients with impacted femoral neck fractures seems therefore to be justified.

Adolescent↗
PubMed1991

Cicatricial hernia after bone grafting from the iliac crest.

Herniation of the abdominal wall is seldom encountered after harvesting cancellous bone from the iliac crest. The case history is presented of a patient with the symptoms, diagnostic work-up and repair of the hernia using a Goretex sheet.

Adult↗
PubMed1990

[Fracture of the first rib due to a trivial accident].

A patient is presented with an isolated fracture of the first rib due to a fall from a bicycle. Although fractures of the first rib are often the result of high impact injury, these fractures may occur after trivial accidents and in several kinds of sports. The mechanism of fractures of the anterior rib in this typical localization is elucidated. The reason why serious neurovascular lesions are frequently seen in displaced posterior rib fractures caused by high impact injury is discussed.

Accidents↗
PubMed1990

Malunited ankle fractures. The late results of reconstruction.

We have analysed 31 malunited ankle fractures treated by reconstructive osteotomies. In all cases the malunited fibula has been corrected; this has been combined with other osteotomies and with fixation of ununited fragments as indicated. Our results show that, unless function was severely impaired, reconstruction was always worth while, no matter how long ago the injury had occurred and even if there were already arthritic changes.

Adult↗
PubMed1990

[Secondary interventions in malunited fractures of the ankle joint].

When pain persists and activity is limited as a result of lack of union in a fracture of the upper ankle joint, for us this is a clear indication for a secondary procedure. The goal, of course, is to reconstruct the normal anatomy and correct any deformities present. The time interval between the trauma and secondary reconstruction is no contraindication. The arthrosis present and the patient's age are also not drawbacks. The only contraindication is how severely is function impaired. The final result is not dependent on the degree of malposition nor the arthrosis present before the procedure. In general, this is not predictable. Therefore, secondary reconstruction is the first step in the treatment of post-traumatic malpositioning. Other therapeutic measures such as nettoyage (cleaning up), extra-articular osteotomy, and arthrodesis must be implemented where indicated on an individual basis.

Ankle Injuries↗
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↗
PubMed1989

Intertrochanteric osteotomy for non-union of the femoral neck.

We report a series of 50 patients under 70 years of age who had an ununited femoral neck fracture treated by a Pauwels abduction osteotomy. At an average follow-up of 7.1 years, seven patients had required prosthetic replacement and 37 others were reviewed in detail. In these patients the Harris hip score averaged 91. Twenty-two hips showed radiographic evidence of avascular femoral head necrosis, but only three of these had been replaced. For active patients with non-union of a femoral neck fracture, Pauwels osteotomy provides a high proportion of good results even in the presence of avascular necrosis of the head, providing there has been no collapse. If osteotomy fails, prosthetic replacement is still possible.

Adult↗
PubMed1987

Complications and late therapeutic results of conservatively managed, unstable pelvic ring disruptions.

Fifteen patients admitted with unstable (type III) pelvic ring disruptions were analysed. Most injuries involved traffic accidents (73%); all 15 patients sustained additional injuries (ISS ranged from 16-57, mean 30.6). Six patients were polytraumatized (ISS 29-57, mean 41.2). The conservative treatment consisted of suspension in a pelvic sling with or without skeletal traction during 4-9 weeks. There was no mortality (patients who had died within 24 hours after admittance, had been excluded). Complications were seen in one patient who developed decubitus ulcers and one patient with persistent separation at the symphysis, ultimately requiring operative treatment. All patients were discharged with full or partial weight bearing. Twelve patients were available for follow-up 2-26 years after injury. Eight patients were asymptomatic, three complained of a residual low back pain. A leg length discrepancy was found in four patients (1-2.5 cm). Roentgen films showed restoration of the pelvic ring in all cases. The results suggest a more favourable perspective of the conservative management of pelvic ring disruptions than generally assumed.

Adolescent↗