Biomedical subjects

G R Sennwald

Publications and source records attributed to G R Sennwald.

At least 19 recordsLinked to original sources

PubMed2001

[Unstable fracture of the distal radius and its treatment: comparison of three techniques: external fixation, intramedullary pinning and AO plates].

This retrospective study compares 94 distal radius fractures. Sixty one women (median age 66) and 33 men (median age 42) were reviewed clinically and radiologically by a surgeon not involved in treatment. Fractures were classified into three AO groups. Standard X-rays were used for radiological evaluation. Fractures of the distal ulna were evaluated separately. Chi-square tests, Wilcoxon, Mann-Whitney and Fisher's tests were used for statistical evaluation. Women presented mainly "A" type fractures. They were treated by intramedullary pinning. Forty two fractures were grafted, using autogenous bone for young patients and bone substitute for the elderly. Twelve scapholunate dissociations were recorded, all but one were detected in women, 50 years of age or more. Four were painfree, two presented climatic pain and six claimed pain during effort; none had snapping. Radio-ulnar laxity was similar with or without styloid fractures. External fixator and autogenous grafts appeared the most efficient technique for maintaining radial length. Ulnar head fractures were related to a significant higher incidence of sympathetic dystrophy with reduced prono-supination, a correlation not previously noted to your knowledge. This suggests that radius and ulnar head fracture should be classified independently. The amount of pain was not related to classification, internal fixation or gender.

Adolescent↗

PubMed2000

[Prosthetic replacement of the first carpometacarpal joint with a cemented ball and socket prosthesis (de la Caffinière)].

We analysed the fate of 43 de la Caffinière prostheses implanted for arthrosis of the first carpometacarpal joint after a follow-up of 63 months (range 45 to 81). Ten prostheses failed. Further eight patients were lost for follow up. In the remaining 25 patients the rate of tilting of the cups (92%) was extremely high and the survival rate disappointing: 66% at 68 months. The prostheses were implanted in cancellous bone and the ball and socket reduces the moving axes of the normal joint to one center of rotation. These factors might explain the higher rate of loosening of the cups (28%), compared to 15% for the stems. In contrast, the clinical results were comparable with other operative procedures. The advantage is the brief postoperative rehabilitation period. Accordingly, this prosthesis can not be universally recommended and should be reserved for elderly patients, who must not undertake strenuous work.

Adult↗

PubMed1999

Analysis of two bone-prosthesis interfaces and membranes from non-cemented trapeziometacarpal prostheses.

The non-cemented Ledoux trapeziometacarpal prosthesis has a high failure rate. In order to better understand the mechanism responsible for pain and loosening, we thoroughly analysed the membranes surrounding the prosthesis and the bone-prosthesis interface in two trapezia, each containing a Ledoux cup, which were resected after unsuccessful implantation. Serial sections, perpendicular to the longitudinal axis of the implanted cup, allowed histological examination of the interface and were used to quantify bone apposition. The tissues surrounding the prosthesis showed a foreign-body reaction to particles identified as titanium. The interface showed bony integration of the cup, mainly on the radial side and on the proximal part of the cup, with an appositional index of 28%. Our findings suggest that bony apposition might not be sufficient to ensure successful anchoring of the Ledoux cup in the trapezium in the presence of an intense foreign body reaction to titanium. Moreover, the presence of metal might be secondary to micromotion of the wings of the metallic part of the cup, induced by axial movement of the underlying polyethylene during pinch grip. The combination of polyethylene as an expander and titanium may need to be reviewed.

Humans↗

PubMed1998

Cemented and non-cemented replacements of the trapeziometacarpal joint.

We performed 88 primary ball-and-socket arthroplasties of the trapeziometacarpal joint in 84 patients (69 women and 15 men) with a mean age of 61 years (37 to 81). Cemented de la Caffinière prostheses were implanted in 43 joints from 1988 to 1991 and 45 cementless Ledoux implants were used between 1992 and 1994. Of the 61 surviving prostheses still in situ, 51 were reviewed clinically and radiologically with a mean follow-up of 25 months for the Ledoux and 63 months for the de la Caffinière implant. The survival rate for the Ledoux prosthesis was 58.9% at 16 months and for the de la Caffinière implant 66.4% at 68 months. Loosening occurred in 15% of the Ledoux stems, in 46% of the Ledoux cups, in 24% of the de la Caffinière stems and in 28% of the de la Caffinière cups. Both prostheses behaved similarly, and it is clear that a constrained ball-and-socket prosthesis is not suitable for the trapeziometacarpal joint.

Adult↗

PubMed1997

[Radiological course of cemented and uncemented trapeziometacarpal prostheses].

Between 1988 and 1994, eighty-eight trapeziometacarpal arthroplasties were performed on eighty-four patients (69 females and 15 males), with a mean age of 61 years (37 to 81). Forty-five Ledoux and forty-three De la Caffinière prosthesis were implanted. Of the 61 non-reoperated prosthesis, 51 were reviewed with a mean follow-up of 25 months for the Ledoux prosthesis and 63 months for the De la Caffinière prosthesis. Survival rate was 58.8% at 16 months for the Ledoux prosthesis and 66.4% at 68 months for the De la Caffinière prosthesis, with a statistically significant difference (p < 0.001). In the Ledoux group, 15% of the shafts and 46% of the cups were loose. In the De la Caffinière group 24% of the shafts and 28% of the cups were loose. The final outcome of both prosthesis was similar, and we therefore concluded that spherical prostheses fixed in the trapezium are inadequate for the trapeziometacarpal joint.

Adult↗

PubMed1997

A new radiographic method of measuring carpal collapse.

We assessed carpal collapse by measuring the capitate-radius (CR) distance on standard plain radiographs. This new method required validation of diagnostic accuracy, so we compared it with the method of Nattrass et al known as revised carpal height (RCH). We studied wrist radiographs from 16 normal subjects and 11 patients with unilateral Kienböck's disease. We found that there was a significant difference in the left/right CR index between the normal wrists and those with Kienbock's disease (p < 0.001). The use of left/right RCH index showed no significant difference (p = 0.30). Diagnostic accuracy was shown to be higher for the CR index using ROC curves. We then assessed 40 normal wrists and found the mean CR index to be 0.999 +/- 0.034, and suggest that values less than 0.92 are abnormal. The CR index can be used for diagnosis in unilateral carpal collapse, and for monitoring progress where the condition is bilateral.

Adult↗

PubMed1997

Wrist arthroscopy: a prospective analysis of 53 post-traumatic carpal injuries.

We carried out a prospective study of 53 consecutive patients who had sustained a serious wrist injury. Patients who presented with a previous condition or who had undergone surgery to the wrist were excluded. History, clinical findings, standard radiographs and arthrography were correlated with the uninjured side and with arthroscopic findings. The radiolunate (RL) angle of the injured wrist differed significantly from that of the "normal" wrist (p = 0.088). POssible correlations within the whole group were studied by multivariate analysis, particularly k-means clustering, a procedure which enables the detection of natural groups. We found that ligamentous tears at the triquetrum in the midcarpal joint significantly (p = 0.004) affected the equilibrium of the proximal row defined by clustering with the RL and scapholunate (SL) angles. The use of multivariate analysis techniques in combination with cross tabulation for the surgery of intracarpal ligamentous abnormalities seen at arthroscopy might help us to define better the function of the ligaments of the wrist. These findings, of little help in daily practice, might be important for clinical research.

Adult↗

PubMed1996

Non-cemented replacement of the trapeziometacarpal joint.

We treated 43 patients (38 women and 5 men) with osteoarthritis of the basal joint of the thumb by non-cemented arthroplasty of the first carpometacarpal joint as described by Ledoux. The probability of a patient avoiding revision for 12 months was 62% and for 16 months 59%. The indications for revision were aseptic loosening in 83% and luxation in 17%. The surviving prostheses were reviewed clinically and radiologically at a mean follow-up of 25.3 months. Pain on loading, movement or at rest was seen in 75% of the patients. There was significant reduction in the range of movement of the trapeziometacarpal joint and of wrist strength. Radiological assessment showed significant subsidence of the stem in the first metacarpal and migration of the cup, with the stem loose in 15% and the cup in 46%. We no longer recommend this method of joint replacement.

Adult↗

PubMed1996

The value of arthroscopy in the evaluation of carpal instability.

In a prospective study, arthroscopic examinations were performed on 42 wrists following injury. Clinical findings, radiology, and arthrography were compared to the arthroscopic findings. Only obvious or total ligamentous ruptures found on arthroscopy were considered in the analysis. No direct correlation could be demonstrated with clinical findings or arthrography. The distribution pattern of ligament injury involving the radial and ulnar compartment of the wrist joint in 40% of the cases suggests that carpal dysfunction following injury and ligamentous tears is a more complex problem than usually accepted. The ulnar midcarpal joint seems more prone to injury than the radiocarpal portion of the wrist. This suggests an important biomechanical function of the palmar ligaments inserting on the triquetrum.

Adolescent↗

PubMed1995

[Arthroscopy of the wrist: diagnostic and therapeutic contribution].

An arthroscopy was carried out on 23 wrist joints following trauma. There were 11 women and 12 men with a mean age of 36 years, and they were followed up for an average of 33 months. Statistically significant differences were observed in the radiolunate and scapho-lunate angles between the injured and normal sides. Arthroscopy detected 72 ligament tears, an average of 3 per wrist, compared with 1 per wrist demonstrated by arthrography. However the findings of the two investigations did not correlate, indicating that both are worth undertaking. Chondromalacia was seen in 10 wrists, mostly in the radiocarpal and mid carpal joints. On the basis of the findings at arthroscopy, conservative treatment was followed in 60% of the patients and the investigation was of great help in planning operation in the remainder.

Adult↗

PubMed1995

The value of one-portal endoscopic carpal tunnel release: a prospective randomized study.

A randomized prospective study was carried out to compare one-portal endoscopic carpal tunnel release with an open procedure. There were 47 patients (mean age 52.6 years); 25 underwent an endoscopic and 22 an open release. The aim of the study was to evaluate the risks against the benefits for pain, grip, key-pinch strength and ability to return to work. The distribution of age, occupation, sex, neurographic findings and operated hand was similar in both groups. We detected no serious nerve complications. One "open" patient developed a hypertrophic scar, a second "open" patient a disabling reflex sympathetic dystrophy, one "endo" patient a transient neurapraxia. The remaining patients experienced complete relief of symptoms. Improvement of grip strength is significantly better after endoscopic release (P = 0.0001 at 3 months). In contrast, the key-pinch showed a similar pattern of improvement in both groups. The ability to use the operated hand as effectively as the contralateral one developed after 24 days for the endoscopic group versus 42 for the open approach (P = 0.0000). The carpal arch alteration was less important for the endoscopic group (P = 0.013), but without any correlation with the grip strength. Agee's one-portal technique only allows correct placement of a knife, not an inspection of the structures being operated upon. This is a major limitation, reducing the surgeon to a technician. Further development of this procedure demands a device that will enable a fruitful inspection of the carpal tunnel.

Carpal Tunnel Syndrome↗

PubMed1995

Physical equilibrium of the normal wrist and its relation to clinically defined "instability".

The rotational stability of the proximal carpal row was tested on six unembalmed human cadaver hand specimens. The physiological load conditions were stimulated by loading the wrist flexor and extensor tendons. Pure torque was introduced to the lunate, scaphoid and triquetrum, one at a time, by means of a dynamometer wrench, forcing the bones loaded to perform a flexion-extension motion. A truly stable state of equilibrium could be found in the normal wrist only under axial load. A uni-directional coupling was observed through the scapho-lunate ligament as a counteraction to a tendency for the lunate to extend and the scaphoid to flex. The triquetrum and lunate moved together, showing close coupling in both directions. As conclusion: a stable wrist can be defined as one which, while being loaded within a physiological range of stress, does not deviate from a stable state of equilibrium (the ability to return to a single position when disturbed) at any point within the whole physiological range of motion.

Carpal Bones↗

PubMed1995

A new technique of reattachment after traumatic avulsion of the TFCC at its ulnar insertion.

One female and seven male patients (median age 25.5) presented with traumatic avulsion of the triangular fibrocartilage complex (TFCC), type 1B according to Palmer's classification. Reattachment of the TFCC near its anchoring point was combined with an intraarticular shortening osteotomy of the ulnar head. This provides an excellent approach to the TFCC and a well vascularized anchoring surface. The mooring point is biomechanically appropriate and the tissues with the best biomechanical properties are used. The functional results with a mean follow-up of 3 years were encouraging, as demonstrated by the significant improvement of pain (P = 0.017). All patients were able to return to their previous occupation; no further surgery was necessary to the distal radio-ulnar joint and no impairment of pronation and supination was detected. The final wrist score reflects the subjective results defined by the patient. However the correlation is not linear and the wrist scores are superior to the degree of satisfaction defined by the patient.

Adolescent↗

PubMed1995

X-ray analysis after repair of scaphoid non-union through a dorsal approach.

The consequences of non-union of the scaphoid with or without deformity were evaluated before and after surgery with non-parametric tests, MANOVA and discriminant analysis, and Spearman correlation and contingency tables. 18 consecutive cases of scaphoid non-union, operated upon through a dorsal approach preserving the carpal ligaments since 1987, were used for measurements. Carpal height, radio-lunate and radio-scaphoid angles, lunate covering ratio, and apparent translation of the capitate and lunate were analyzed on standard views of the wrist before and after scaphoid repair. We found that the lunate covering ratio combined with the radio-lunate angle was the main indicator of deformity before the repair as suggested by the strong correlation between the ratio-lunate angle and lunate covering ratio (P = 0.0001). After repair, the only indicator of mal-union was the apparent translation of the lunate on frontal views (P = 0.0033) as suggested by the strong correlation between mal-union and lunate translation (P = 0.0001). Translation of both the lunate and capitate correlated well before and after repair. Radio-scaphoid angle and carpal height showed no significant changes and are not informative in the presence of subtle carpal alteration. Repair of the scaphoid produced an improvement in the radio-lunate angle in all cases, even in the presence of mal-union. However, full restoration was never achieved even in the absence of mal-union. More precise techniques of measurement might contribute to a better understanding of the carpal mechanics in relation to well-defined diagnoses such as scaphoid non-union.

Adolescent↗

PubMed1995

Lunotriquetral arthrodesis. A controversial procedure.

12 male (mean age 28) and 11 female (mean age 32) patients treated with lunotriquetral (LT) arthrodesis were reviewed with a median follow-up of 28 months (range 18-40 months) for this retrospective study. At first presentation 12 patients were unable to work, and at follow-up only three men remained out of work. The relief of pain was significant (P < 0.001) and the median Culp (1993) wrist score obtained 74 (min. 45, max. 96); however, only one patient was totally free of pain and seven men had to change their occupations. Men lost 455 working days, women 191, a highly significant difference (P = 0.006). This loss correlated (P = 0.007) with the LT angle measured in the frontal plane: all patients but one with a LT angle of less than 31 degrees returned to work within 1 year, but only four with a greater angle (P = 0.007). This emphasizes the importance of correct positioning of the triquetrum, which seems hard to achieve with two AO lag screws. Furthermore, even two screws seem unable to ensure solid fusion as shown by the high rate of pseudarthrosis (57%). LT fusion cannot be considered as a routine procedure and results are not yet predictable. According to these results, we feel that a bone graft placed in a slot from lunate to triquetrum is the procedure of choice. In the presence of a chondromalacia in the ulnar midcarpal joint, a four bone fusion is primarily recommended.

Adult↗

PubMed1995

Scaphocapitate arthrodesis for the treatment of Kienböck's disease.

Eleven consecutive patients, ten men and one woman (median age, 26 years) presenting with Kienböck's disease, were treated with scaphocapitate arthrodesis. Ten patients had grade III, and one had grade II disease by Lichtman classification. The average follow-up period was 36 months (minimum, 1 year). The lunate was left in situ and scaphocapitate arthrodesis was performed with two lag screws and corticocancellous bone graft. The ulnar variance of the affected wrist was negative (-2.23 mm) and significantly different from the unaffected side. Ten patients had complete pain relief and one had persistent pain. Nine returned to their previous vocations.

Adult↗

PubMed1995

[Distorsion of the wrist joint].

Wrist hyperextension is a common injury. However, obvious ligamentous ruptures are apparently seldom. The intracarpal locking phenomenon, allowing for correct load transmission, or overlooked pathology might explain this remarkable discrepancy. If the muscle tension fails, i.e., no locking phenomenon happens, and the ligaments are put under abnormal constraints with a high risk of secondary rupture. Such constraints might also appear secondary to bony alteration or previous ligamentous weakening. Patient history allows to define the pathophysiology of the accident, examination will locate the points of maximal tenderness whereas radiology allows to detect malalignment, step-off or bony anomaly. To be valid, radiology must be standardized. Accordingly we describe the radiological techniques. Scintigraphy will show if the lesion is focal (mainly osseous) or not (dystrophy). Arthrography helps to find out which group of ligaments are torn, whereas arthroscopy will quantify the tears and find out additional chondromalacia or synovitis. Magnetic resonance imaging remains limited to vascular trouble shooting. We propose a diagnostic and therapeutical scheme that will help the physician in advising the patient.

Diagnostic Imaging↗

PubMed1994

The palmar wrist ligaments revisited, clinical relevance.

In fifteen cadaver wrists and ten foetus wrists palmar ligaments were studied. As a result, the palmar scapho-triquetral ligament was presented by means of gross anatomical study, MR imaging, and histological study. A kinematic study was conducted on three cadaver wrists to analyze patterns of motion on the proximal carpal row bones based on the helical axis concept. Motion analysis showed that the scaphoid has a set of helical axes bundled at the radial side of the wrist. On the contrary, the triquetrum had axes bundled on the ulnar side, approximately in the same position as the lunate. That shows that the lunate and triquetrum are coordinated in motion and opposed to that of the scaphoid. The structure possibly ruling this pattern of motion could be the palmar scapho-triquetral ligament, whose insertions on the scaphoid and triquetrum are close to the crossing-point of the helical axes of the scaphoid and triquetrum/lunate, respectively. In order to study the clinical relevance of our findings, a prospective clinical study on 53 patients after wrist injury was conducted. All patients were clinically examined, simple and semi-stress X-rays were taken, and arthrography and arthroscopy performed. Ligament tears were often found, but any correlation to clinical findings or arthrography could not be found. However, high correlation could be found between the lesion of the palmar scapho-triquetral ligament and a DISI position of the lunate combined with increased scapho-lunate angle. It can be concluded that the tear of the palmar scapho-triquetral ligament causes instability pattern that is radiologically evident at an early stage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗