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F Bonnaire

Publications and source records attributed to F Bonnaire.

At least 19 recordsLinked to original sources
PubMed2006

[Morel-Lavallée lesion. A grave soft tissue injury].

The Morel-Lavallée lesion is a rare condition that was first described by the French physician Maurice Morel-Lavallée in 1853. The lesion is caused by forces of pressure and shear stress at the borders of subcutaneous tissue to the muscle fascia or bone as they are seen in run-over accidents. It leads to a shear of skin and subcutaneous tissue from the neighboring fascia followed by the development of a blood-filled hollow space at predestined regions of the body. If therapy is insufficient, large areas of necrosis can form, which will negatively influence operative measures. We report about three patients with the diagnosis of a Morel-Lavallée lesion. The history and the impressive clinical findings are demonstrated as well as the differential operative therapy performed, partially with osteosynthesis of accompanying bone injuries. According to the recommendations of the literature known to us, an adjusted therapeutic regime suited to the particular findings was carried out and in all three cases uncomplicated healing can be reported. Our results are in line with the existing recommendations, which are to relieve the soft tissue hematoma in time and sufficiently, and secondly to carry out débridements initially as well as planned second-look operations.

Accidental Falls↗
PubMed2005

[Simultaneous bilateral ventral and dorsal shoulder dislocation following an epileptic convulsion--a rare combination of injuries].

We report about a 29 year old male patient who had a simultaneous bilateral ventral and dorsal shoulder dislocation. The dislocation happened during a first incident of an epileptic convulsion, previously not diagnosed. On the right shoulder following a closed reduction manoeuvre a dislocation fracture was seen. It needed operative open reduction and fixation with angular stable plate osteosynthesis. The locked dorsal shoulder dislocation on the left was operated dorsally secondary via a dorsal approach. In a first step the reduction was carried out and in the same intervention the humeral head defect was lifted and supported in a closed technique under radiographic control.6 months postoperatively the patient was free of pain in both shoulder joints. The range of motion was unimpeded on the left and only with slight deficits in abduction and anteversion on the right. The diagnostics and the treatment strategy for this rare injury combination are described critically in this paper.

Adult↗
PubMed2005

[Prosthetic care of proximal femur fractures].

The endoprosthetic replacement of the hip joint or its components in fractures of the proximal femur is a standard method. Indications for replacement are strongly dislocated intracapsular femoral neck fractures in elderly patients, fractures with an existing arthritis of the hip joint, and profound osteoporosis. Improved perioperative management and more gentle anesthetic techniques have helped to reduce perioperative mortality from nearly 50% to 11.5% over the last 40 years. As routine treatment options, the bipolar endoprosthesis without replacement of the acetabular joint surface and total hip replacement in case of degenerative arthritis of the acetabular joint surface are commonly used. The mere replacement of the femoral head with a simple femoral head prosthesis should be reserved for exceptional cases. For the implantation of a hip joint prosthesis and its uncomplicated post-treatment and long-term durability, careful preoperative planning is essential together with the selection of a suitable implant, its optimal bony fixation, avoidance of intra-operative complications and restoration of the anatomical landmarks such as the centre of rotation of the hip joint, the offset of the prosthetic shaft as well as leg length. Despite the high standard of endoprosthetics in Germany, the results are still improvable in comparison to other countries. Measures which preserve the joint as well as the bone will be increasingly important in prophylaxis of further complications. In addition, more attention should be paid to the prophylaxis of falls and a sufficiently guide-lined therapy of osteoporosis for the prophylaxis of fractures of the elderly.

Arthroplasty, Replacement, Hip↗
PubMed2003

Experimental model for a new distal locking aiming device for solid intramedullary tibia nails.

A distal locking device for the solid intramedullary tibial nails has been tried on bone models. This device allows simple and accurate insertion of distal locking screws with minimum radiation exposure to the patient and the surgeons. It also reduces the operation time. The aim of this experiment was to test the accuracy of the new aiming device and to measure the radiation exposure time during the procedure.

Bone Nails↗
PubMed2002

[Complex pelvic injury in childhood].

Pelvic disruptions are rare in children caused by the flexible anchoring of bony parts associated with a high elasticity of the skeleton. Portion of pelvic fractures in infants is lower than 5% even when reviewing cases of specialized centers. The part of complex pelvic injuries and multiple injured patients in infants is higher when compared to adults, a fact caused by the more intense forces that are necessary to lead to pelvic disruption in children. Combination of a rare injury and the capability of children to compensate blood loss for a long time may implicate a wrong security and prolong diagnostic and therapeutic procedures--a problem that definitely should be avoided. Three cases were analyzed and established algorithms for treatment of patients matching these special injury-features demonstrated. A good outcome may only be achieved when all components of injury pattern get recognized and treatment is organized following the hierarchy of necessity. Therefore in the time table first life-saving steps have to be taken and then accompanying injuries can be treated that often decisively influence life quality. As seen in our cases unstable and dislocated fractures require open reduction and internal fixation ensuring nerval decompression, stop of hemorrhage and realizing the prerequisite for effective treatment of soft tissue damage. The acute hemorrhagic shock is one of the leading causes of death following severe pelvic injuries. After stabilization of fracture, surgical treatment of soft tissue injuries and intraabdominal bleeding sources the immediate diagnostic angiography possibly in combination with a therapeutic selective embolization is a well established part of the treatment. The aim of complete restitution can only be accomplished by cooperation of several different specialists and consultants in a trauma center.

Child↗
PubMed1998

Hemarthrosis and hip joint pressure in femoral neck fractures.

In a prospective clinical study the intraarticular pressure of 55 patients with intracapsular femoral neck fractures was measured intraoperatively with the hip in different positions. Intraarticular hemarthrosis was quantified by a preoperative sonography examination. In 75% of the patients, increased intraarticular pressure caused by the hemarthrosis was found. The spontaneous median pressure increased significantly from 22 mm Hg with extension (28 mm Hg) and internal rotation of the hip joint (56 mm Hg). The lowest pressure was found in 70 degrees flexion (15 mm Hg). The median pressures increased within the first 24 hours after injury from 26 mm Hg in the first 6 hours to 46 mm Hg from 7 to 24 hours. Even in the first and second weeks after trauma, increased median pressures were detected (8.5 mm Hg and 13 mm Hg, respectively). No significant difference was found between undisplaced and displaced fracture types. Because increased joint pressure in other studies correlates with reduced perfusion of the femoral head, it can be deduced that reduction maneuvers without capsulotomy can compromise the circulation of the femoral head. Capsulotomy and osteosynthesis of the femoral neck at the earliest time possible is the best prophylaxis of tamponade. If the osteosynthesis is delayed, a preoperative sonography after admission and a control sonogram after 6 hours is recommended. In the event of relevant hemarthrosis, immediate therapeutic drainage is suggested for patients who will receive joint conserving osteosynthesis.

Adult↗
PubMed1997

[Indications for nuclear medicine diagnosis in trauma surgery].

Skeletal scintigraphy is the most frequently utilized nuclear medicine imaging procedure in traumatology. Concerning any skeletal abnormality associated with changes in local perfusion, exudation and metabolism, it is a sensitive functional imaging procedure to detect bony disease. However, because of the varying causes of bony disease, it is characterized by a low specificity. Further, specificity may be enhanced, when patient history, clinical and lab results as well as results obtained from other diagnostic imaging procedures are combined with the result of skeletal scintigraphy. On the other hand, it is known that metabolic abnormalities of the skeleton depicted by radionuclide imaging occur much earlier than structural changes visible on X-ray imaging. Beside skeletal scintigraphy, antigranulocyte antibody or labelled leucocyte imaging may greatly assist in the detection of inflammation or infection following joint replacement surgery, respectively. Ultimatively, a combination of clinical, lab and imaging results including radionuclide imaging may represent the best approach to answer some questions asked by surgical traumatologists.

Bone and Bones↗
PubMed1997

[Quantitative CT assessment of the proximal femur. Experimental studies on its correlation with breaking load in femoral neck fractures].

PURPOSE: In an experimental study, the correlation between the trabecular bone density of the different regions of the proximal femur and the fracture load in the setting of femoral neck fractures was examined. METHODS: The bone mineral density of 41 random proximal human femora was estimated by single-energy quantitative CT (SE-QCT). The trabecular bone density was measured at the greatest possible extracortical volume at midcapital, midneck and intertrochanteric level and in the 1 cm3 volumes of the centres of these regions in a standardised 10 mm thick slice in the middle of the femoral neck axis (in mg/ml Ca-hydroxyl apatite). The proximal femora were then isolated and mounted on a compression/bending device under two-legged stand conditions and loaded up to the point when a femoral neck fracture occurred. RESULTS: Statistical analysis revealed a linear correlation between the trabecular bone density and the fracture load for the greater regions, with the highest value in the maximal area of the head (coefficient factor r = 0.76). CONCLUSION: According to our data, the measurement of the trabecular bone by SE-QCT at the femoral head is a more confident adjunct than the neck or trochanteric area to predict a femoral neck fracture.

Adult↗
PubMed1996

[Recurrent hemarthrosis after cruciate ligament refixation by wire suture. A case report].

Recurrent haemarthros is described as consequence of cruciate ligament repair. The main cause of haemarthros is described after unisometric fixation of the ligaments which leads to the rupture of the synovia membrane. This is a case report of a young man, who suffered from recurrent haemarthros for several years although he has intensively examined by radiological and arthroscopical means. It was falsely presumed to be a muscular arthrophy. The cause, however, was found in a wire suture, which was used to fix the anterior cruciate ligament in the femoral bone. This suture was laying under the synovia within the ligament and there fore could be seen and taken away arthroscopically only after total synovialectomy.

Adult↗
PubMed1996

[3-phase bone scintigraphy: perfusion and vitality of the femur head after media femoral neck fracture and osteosynthesis].

UNLABELLED: Perfusion and Vitality of the Femoral Head after Medial Neck Fracture and Osteosynthesis. AIMS: to analyse with regard to necrosis the perfusion and vitality of the femoral head after medial neck fracture and repair by placement of a dynamic hip screw. PATIENTS AND METHODS: Twenty-one patients were examined by scintigraphy immediately following operation as well as at 3 and 6 months postoperative for evaluation of dysfunctions of perfusion and mineralization. RESULTS: Complete perfusion and mineralization defects with a tendency for revascularization at 3 months will be normal at 6 months. Persisting dysfunctions at 3 and 6 months will progress to femoral head necrosis irrespective of the fracture staging. CONCLUSIONS: Three-phase skeletal scintigraphy is a highly sensitive, non-invasive method for evaluating perfusion and revascularization of the femoral head after femoral neck fracture and repair by means of a dynamic hip screw. When perfusion of the femoral head is observed one week after the trauma, femoral head necrosis will not arise. Immobilization is necessary after partial or complete perfusion and mineralization dysfunctions until the scintigraphic findings return to normal. The present results may serve as a recommendation for loading after fracture repair with a dynamic hip screw.

Adult↗
PubMed1995

[Can the results of cruciate ligament operations be arthrometrically evaluated? A comparison of subjective assessment, Lysholm score, clinical stability classification and measuring stability with the KT 1000 after complex knee injuries].

In a long-term follow-up of 88 patients with complex ligament knee injuries we examined 70 of these who were operated upon between 1.4. 1988 and 31.3. 1990. We specifically looked at local complications, clinical results and knee stability, using subjective and arthrometrical (KT-1000) results 1 or 2 years after operation. The only parameters with a good correlation with stability were the clinical examination (Lachman-test) and the results with the arthrometer in the anterior-posterior translation. Stability after ACL-reconstruction with augmentation with a polydiaxonaon (PDS) augmentation band was physiological (2 mm under 89 N anterior-posterior traction) in 77% of all knees but only in 57% under maximal anterior-posterior manual stress. Neither the subjective outcome of Lysholm-Score correlated with arthrometry and clinical examination.

Adolescent↗
PubMed1995

[Femoral neck fractures in adults: joint sparing operations. I. Results of an AO collective study with 328 patients].

In a multi-center study in 14 trauma hospitals 328 patients with fractures and osteosyntheses of the femoral neck were investigated with reference to time between accident and operation implants used, early and late complications, and results in the years from 1974 to 1987. A follow-up examination was possible in 266 patients a mean of 46.7 months after their accidents. General postoperative complications were recorded in 12.2% and local complications in 11.6%. In 9.8% pseudarthrosis was observed, in 26% an aseptic femoral head necrosis and in 2.4% deep infections. Functional results were excellent to fair in 75%. The best results (significantly better than in other groups) were obtained in patients who were operated on early (< 24 h after trauma) (P < 0.05) and those in whom dynamic hip screws (DHS) were used (P < 0.01). Of all cases of aseptic necrosis 70% were seen within 3 years and 86% within 6 years after trauma. The rate was dependent on the degree of dislocation of the fracture (Garden III and IV), the time from trauma to operation, and the implant used (130 degrees blade plate 30.5%, DHS 9.2%).

Adolescent↗
PubMed1995

[Femoral neck fractures in adults: joint sparing operations. II. The significance of surgical timing and implant for development of aseptic femur head necrosis].

Statistical analysis of the results of the AO multi-center study (Part I) shows significant advantages of early (within 24 h) operative stabilization of the medial neck fracture (P < 0.05) and of use of the dynamic hip screw (DHS) as implant (P < 0.01). Secondary surgery necessitated by implant complications led to higher rates of aseptic femoral head necrosis (FHN) and non-unions (NU) (P < 0.05). According to the so-called logistic regression, the rate of NU is influenced most by the number of implant complications and the choice of implant, the rate of FHN by the interval time-lapse between fracture and follow up, the implant selected (the best being the DHS), primary dislocation (poorest results obtained in Garden types III and IV) and the time-lapse between fracture and operative stabilization. This puts the assumed paramount importance of dislocation in perspective and calls in question the dogma that a dislocated intracapsular neck fracture will necessarily be followed by FHN.

Adolescent↗
PubMed1995

[Classification and osteosynthesis technique of calcaneus fractures. External fixator as temporary distractor].

In the treatment of fractures of the calcaneus, the particularly intricate local anatomy, complicated fracture forms and associated soft tissue damage often prejudice operative, anatomical reconstruction. We propose a simplified classification that is based on the Regazzoni classification of 1993 and has six grades of severity. It can be helpful in the selection of operative treatment and, above all, make it possible to recognize whether operative reconstruction is possible and appropriate. When operative reconstruction is indicated we find the secondary operation important; it is also important to diagnose and treat compartment syndrome if present and otherwise to take steps to prevent it. In the first phase, in special cases we use an external fixator without reconstruction of the full length. The operative technique is largely standardized as as the fixator is placed only temporarily. Correct positioning allows easy correction of shortening or varus deformation, and joint surface reconstruction is also feasible. Autologous bone grafting is possible. The definitive fixation is achieved with internal plate stabilization by a lateral approach and removal of the fixator. Contraindications for this procedure are burst fractures with total destruction of the joint surfaces and cartilage. Out of 54 fractures we used the fixator to aid reduction in 45. In 71% of these we had very good and good results according to the Merle d'Aubigné scoring system.

Adult↗
PubMed1995

[Changes in the perioperative venous hemodynamics and after immobilization of the lower extremity].

In a prospective study we examined 60 patients with lower limb injuries preoperatively, every 2nd day after operation, and at 6 and 12 weeks after trauma with the Doppler and Duplex methods. We distinguished between patients with an above-knee plaster and those with a below-knee plaster after operation. We were able to measure blood flow velocity, transverse width of the deep femoral vein and the volume of flow in this vein. Both legs were measured and compared. The results show a significant reduction of blood flow velocity during immobilization, with a small increase of blood volume passing through the vein. We also saw significant dilatation of the vein by up to 20%. These changes were measured not only on the traumatized leg but also on the normal side. The changes were greater with an above-knee plaster than with the below-knee plaster. The venous haemodynamics had still not returned to normal 6 weeks after trauma in the traumatized limb.

Adolescent↗