Biomedical subjects

K C Bertin

Publications and source records attributed to K C Bertin.

6 recordsLinked to original sources

PubMed1988

Simultaneous fractures of the distal radius and scaphoid.

Simultaneous fractures of the distal radius and scaphoid are uncommon injuries for which the treatment is controversial. Nine patients with these fractures are presented. Five patients were available for long-term followup. In the series, there were five Colles and four Smith's fractures of the distal radius. All scaphoid fractures occurred at the anatomic waist. All injuries resulted from falls of considerable force producing hyperextension at the wrist. The ages of the patients ranged from 21 to 90 years (median, 34). All fractures were placed in a thumb spica cast with the wrist in neutral position. Five fractures required a second reduction of the radius and were placed in external skeletal fixation. No scaphoid fracture was displaced by this treatment, and all scaphoid fractures progressed to union. The principal deformity at followup was an average 16 degrees loss of volar tilt. Residual pain or functional disability was not noted. We conclude that these fractures can be successfully treated by reduction of the radius and immobilization by whatever means necessary to maintain an acceptable position. Scaphoid reduction and healing seemed unaffected by the method of treatment used to treat the distal radius fracture in this series.

Adult↗

PubMed1985

Cementless acetabular replacement using a pegged polyethylene prosthesis.

Acetabular replacement without cement using three types of pegged polyethylene prostheses was begun as a prospective trial by Morscher (August 1977). Ring (June 1979), and Freeman (January 1980); 1878 hips have been replaced using this technique and are reviewed. Follow-up averaged 2 years (range: 6 months-6 years). Successful pain relief and satisfactory walking ability were present in 97% and adequate flexion in 90%. Radiographic review showed the consistent development of a stable, uniform sclerotic line adjacent to the prosthesis. No component migration could be documented. Ten hips have been revised for obvious femoral loosening, and two acetabula showed slight motion during revision for femoral failure and were revised. Deep infection (0.37%) occurred only in patients not receiving perioperative antibiotics and not operated upon in unidirectional filtered air-flow enclosures. Postmortem histological evaluation of eight hips showed a thin fibrous membrane separating the prosthesis from viable bone. These results are preliminary, but nevertheless at least as good as those in any large series of cemented acetabula with the same follow-up. The advantages of this technique are its reproducible results, low complication rate, limited invasion of the skeleton, and easy revision should failure occur.

Acetabulum↗

PubMed1985

Stemmed revision arthroplasty for aseptic loosening of total knee replacement.

Fifty-three failed knee replacements were revised using minimally constrained implants with smooth uncemented intramedullary stems and metal-backed tibial components. Polymethylmethacrylate was used only to replace lost bone near the surface of the implant. Excluding four knees which had serious postoperative complications, 91% had successful relief of pain, 84% had over 90 degrees of movement and 80% could walk for more than 30 minutes. Review of the radiographs showed that there were no progressive lucencies at the interface between bone and cement, and no subsidence of components or changes in alignment. At the uncemented stem-to-bone interface, thin white lines developed near the metal, and their significance is discussed. This revision technique is an effective treatment for aseptic failure of primary total knee arthroplasty.

Adult↗

PubMed1984

Isolated fracture of the lesser trochanter in adults: an initial manifestation of metastatic malignant disease.

An avulsion fracture of the lesser trochanter in the absence of known or appropriate antecedent trauma was the initial manifestation of unrecognized metastatic malignant disease in the subtrochanteric area of four patients. In three patients the fracture healed but a pathological subtrochanteric fracture then occurred, and in one patient prophylactic nailing of the hip was performed to prevent this fracture. A thorough search for occult metastatic malignant disease should be made whenever this fracture occurs in an adult. Prophylactic internal fixation to prevent or delay a subsequent pathological subtrochanteric fracture seems worth while.

Adenocarcinoma↗

PubMedDate not supplied

Freeman-Samuelson total arthroplasty of the knee.

Experience with cementless fixation over the last six years indicates that the technique offers greater opportunities for bone conservation. Thus, when cement is used, and especially if it is forced into the skeleton under pressure, the amount of bone incorporated into the implant is considerable. Conversely, if no cement is used, grafting techniques to fill defects are becoming increasingly routine, so that today no bone may be removed from the replaced knee or hip--all fragments that are excised are repositioned as grafts in defects. Thus, cementless fixation meets the fundamental orthopedic maxim of the conservation of bone stock. Given that an implant can be fixed with satisfactory clinical results without cement and without bone ingrowth, it becomes difficult to demonstrate a clinical advantage for the latter. Nevertheless, bone ingrowth is possible both experimentally and (with less confidence) in man. Thus, it is clearly a technique that should be evaluated. However, it is not, in the senior author's view, a technique that should as yet be generally used. Hopefully, investigations of this problem will take place in a restrained scientific way rather than by the current method, which is in response to the dictates of fashion and commerce.

Adult↗

PubMedDate not supplied

Ligament injuries associated with physeal fractures about the knee.

A retrospective study of 29 cases of epiphyseal plate fractures about the knee revealed 14 patients with ligament instability at follow-up evaluation an average of 66 months after injury. Distal femoral physeal fractures had occurred in 16 of the 29 patients. Six of these patients had ligament insufficiency, which was recognized by positive anterior drawer and Lachman tests in all six and laxity to valgus stress in one. Proximal tibial physeal fractures were noted in 13 of the 29 patients. Eight of these patients had ligament laxity; anterior drawer and Lachman tests were positive in five, and laxity with valgus stress was present in four patients. It is concluded that because 14 of 29 patients (48%) had ligament insufficiency at follow-up evaluation, physeal fracture about the knee does not exclude ligament damage and, in fact, is associated with a high incidence of ligament injury. Furthermore, a complex proximal tibial physeal fracture associated with medial collateral ligament rupture is described for the first time. This resulted in medial collateral ligament insufficiency, genu valgus, and early degenerative changes. A treatment plan of primary ligament repair, fracture reduction, and follow-up evaluation to skeletal maturity is suggested for this unique fracture.

Adolescent↗