Biomedical subjects

M Gabl

Publications and source records attributed to M Gabl.

At least 19 recordsLinked to original sources

PubMed2006

Reconstruction of the digital flexor pulley system: a retrospective comparison of two methods of treatment.

The rare injury of closed rupture of the A2 and A3 flexor pulleys was treated using two non-encircling techniques of pulley reconstruction. Thirteen patients were treated with an extensor retinaculum graft (Group A). At a mean follow-up time of 48 months, the average PIP flexion was 97%, the power grip strength 96%, the pinch grip strength 100% and the thickening 94% of the uninjured side. Ten patients were treated with a free palmaris longus tendon grafts (Group B). At a mean follow-up time of 57 months, the average PIP flexion was 94%, the power grip strength 98%, the pinch grip strength 100% and the thickening 95% of the uninjured side. In both groups, finger extension was unrestricted. The Buck Gramcko score included 10 excellent, two good and one fair result in Group A and seven excellent, two good and one fair result in Group B. Both techniques proved beneficial. All climbers returned to their previous standard and all non-climbers regained full finger dexterity in their previous job.

Adult↗

PubMed2006

Fixation of nondisplaced scaphoid fractures: making treatment cost effective. Prospective controlled trial.

INTRODUCTION: Nondisplaced scaphoid waist fractures treated with prolonged plaster immobilisation often lead in transient joint stiffness and to a delay in return to sport and work activity. The long time off work increases the work off compensation costs. Internal fixation of scaphoid fractures has resulted in a shorter time to union and to return to work and sports. This prospective study compares cast immobilisation with screw fixation and the direct cost with indirect cost of conservative and minimally invasive treatment of undisplaced scaphoid fractures. MATERIALS AND METHODS: Forty-seven patients with an acute nondisplaced waist fracture of the scaphoid were allocated into either cast immobilisation or internal screw fixation for this study. Cost data concerning the groups of nonoperated and operated patients were analysed. Range of wrist motion, grip strength, DASH-score, time to fracture union, return to work time and the needed physiotherapy at the final follow-up at 6 months were evaluated. RESULTS: Twenty-one patients were included in the group of screw fixation and 23 patients were included in the group of cast immobilisation. At final follow-up there was no significant difference in the range of motion of the wrist or in grip strength. The operatively treated group had a better mean DASH-score than the conservative group. Fracture union was seen in the screw fixation group at a mean of 43 days and in the cast immobilisation group at a mean of 74 days (P < 0.5). The average time of return to work was 8 days for patients who had an internal screw fixation, while those treated with a cast returned to work at a mean of 55 days (P < 0.5). In total the internal fixation of undisplaced scaphoid fractures is less expensive than conservative treatment. CONCLUSION: Internal screw fixation of nondisplaced scaphoid fractures had a shorter time to bony union and the patients returned earlier to work compared with cast immobilisation. Although it is assumed that operative treatment is more expensive, in this study the cost was not found to be higher.

Adult↗

PubMed2006

Status 5 years after bilateral hand transplantation.

Graft survival and function early after hand transplantation is good. It remains unknown, however, whether long-term survival is limited by chronic rejection. We here describe the clinical course and the status 5 years after bilateral hand transplantation with emphasis on immunosuppression (IS), function, morphology and graft vascular changes. Clinical observation, evaluation of hand function, skin biopsies, X-ray, ultrasound, angiography, CT angiography, electrophysiologic studies including compound motor and sensory action potentials (CMAP, CSAP) and somatosensory evoked potentials were performed and results recorded at regular intervals. Following reduction of IS one mild (grade II) rejection episode occurred at 4 years. Subsequently, skin histology remained normal and without signs of chronic rejection. Hand function continuously improved during the first 3 years and remained stable with minor improvement thereafter. CMAP and CSAP progressively increased during the observation period. Latencies of the cortical responses were prolonged but amplitudes were within normal range. Investigation of hand vessels revealed no signs of occlusion but showed revascularization of a primarily occluded right radialis artery. Motor and sensory function improved profoundly between years 1 and 5 after hand transplantation. No signs whatsoever of chronic rejection have been observed.

Angiography↗

PubMed2005

Palmar locking plate for treatment of unstable dorsal dislocated distal radius fractures.

INTRODUCTION: This study investigates the clinical and radiological results of open reduction and internal fixation of unstable distal radial fractures using a palmar placed interlocking plate system with no substitutes for treatment of the dorsal metaphyseal fracture void. MATERIALS AND METHODS: Nineteen patients with a mean age of 61 years (range 49-78 years) and a dorsally displaced distal radial fracture were treated using a palmar placed 2.4 mm interlocking plate system. All 17 women and 2 men were followed up according to the study protocol. Standardised radiographs in anteroposterior and lateral projection were performed before reduction and at 2, 6, 12 and 24 weeks after surgery. Radiological measurements included palmar tilt, radial inclination and radial shortening as defined by ulnar variance and intra-articular steps. Clinical assessment included active range of motion (ARM) of the wrist, pain according to a visual analogue scale (VAS), grip power, working ability, Disability of Arm, Shoulder and Hand-Score (DASH Score) and Mayo Wrist Score. RESULTS: At final follow-up after a minimum of 11 months, the palmar tilt was +1 degrees , radial inclination 19.8 degrees and ulnar variance 1.0 mm. Mean loss of palmar tilt measured 1.9 degrees , radial inclination 1.3 degrees and ulnar variance 0.4 mm. Mean wrist extension measured 58 degrees , wrist flexion 41 degrees , pronation 83 degrees and supination 84 degrees . The Mayo Wrist Score showed 21% excellent, 58% good, 16% fair and 5% poor results. CONCLUSION: The treatment of unstable, dorsally dislocated, distal radius fractures AO types A3, C1 and C2, with a palmar placed 2.4 mm interlocking plate system and without additional treatment of the metaphyseal defects showed good radiological and functional results with minimal loss of reduction.

Aged↗

PubMed2005

Sagittal wrist motion of carpal bones following intraarticular fractures of the distal radius.

Forty patients (mean age, 37 years) with intraarticular C2 and C3 Colles fractures were treated by open reduction, internal fixation and bone grafting. At a mean follow-up of 8 years radiocarpal and midcarpal motion was evaluated, the depth of the articular surface of the distal radius in the sagittal plane was measured and the presence of arthritis was noted. The fractures healed with a mean palmar tilt of 6 degrees , a mean ulnar tilt of 18 degrees and ulna variance within 1 mm of the contralateral side. The depth of the articular surface of the distal radius was 1.3 mm greater than the uninvolved side. Measurement of carpal bone angles relative to the radius in maximum flexion and extension revealed lunate extension of 23 degrees , lunate flexion of 15 degrees , capitate extension of 62 degrees , capitate flexion of 40 degrees . There was a significant correlation between articular surface depth and radiocarpal motion.

Adolescent↗

PubMed2005

Delayed single Kirschner wire compression technique for mallet fracture.

Twenty-four mallet fractures which involved at least one third% of the articular surface of the distal interphalangeal joint were treated by open reduction and internal fixation using a single double-ended Kirschner wire at a mean of 9 days after injury (range 4-15). At a mean follow-up of 43 (range 12-18) months the active range of motion, pain and the Warren and Norris criteria were evaluated. The mean active range of motion was from - 2 degrees extension (range 0-10 degrees ) to 72 degrees flexion (range 50-90 degrees ). Nineteen patients were pain free and five suffered from mild pain during strenuous work. The Warren and Norris results were successful in 22 and improved in two cases. Radiographs showed, that all the fractures united in a near-anatomic position but with joint narrowing in six digits.

Adolescent↗

PubMed2005

[Therapy for static scapholunate instability -- reconstruction of the dorsal part of the scapholunate ligament with a periosteal flap of the iliac crest].

Recurrent instability is frequent following capsulodesis, tenodesis, or ligament reconstruction in static scapholunate instability. Therefore a periosteal flap of the iliac crest was designed to reconstruct the dorsal part of the SL ligament, which is known to be the biomechanically strongest portion and also the axis of rotation between the scaphoid and lunate. Biomechanical testing of ten fresh frozen dorsal SL ligaments and ten periosteal flaps of the iliac crest showed similar properties concerning failure force, failure displacement, failure stress, energy to failure and stiffness. Results of eight specimens in each group were available following successful testing. Failure force of the dorsal SL ligament was 171.8 N (SD 44.2), energy to failure amounted 269.1 N-mm (SD 98.9), failure stress was 10.3 N/mm (2) (SD 1.3), failure displacement 2.9 mm (SD 0.4), and stiffness 77.2 N/mm (SD 21.4). Testing of the periosteal flap gave the following values: failure force 144.3 N (SD 38.7), energy to failure 217.9 N-mm (SD 85.0), failure stress 9.9 N/mm (2) (SD 1.7), failure displacement 3.0 mm (SD 0.4) and stiffness 60.5 N/mm (SD 14.7). In addition to these test values, clinical and radiological data of eleven patients were available following reconstruction of the dorsal SL ligament with a periosteal flap of the iliac crest. The interval between trauma and surgery was 15 months, mean follow-up was 29 months. One patient was free of pain, whereas ten mentioned pain during or following strenuous work. Two patients were completely satisfied, nine complained about some restriction during special activities. Active range of motion amounted to 56 degrees extension, 46 degrees flexion, 17 degrees radial abduction, 30 degrees ulnar abduction. Grip strength was 38.5 kg, which was 79 % of the contralateral side. Radiological evaluation demonstrated a correction of the static instability in nine cases. In two patients recurrence of static instability was obvious. The prerequisite for success of the procedure is the easy reduction of the carpals. In cases of a fixed rotatory subluxation of the scaphoid, the technique cannot maintain the reduction.

Adult↗

PubMed2005

Intraocular pressure during lumbar disc surgery in the knee-elbow position.

Increased intraocular pressure is often implicated in the aetiology of postoperative visual impairment. Such an increase in intraocular pressure has been demonstrated in the prone position. We investigated intraocular pressure in seven patients undergoing lumbar disc surgery in the knee-elbow position with the head resting on a cushion and turned to the side. Measurements were performed in the supine position before induction of anaesthesia and in the knee-elbow position after surgery with the patient still anaesthetised. After a mean (SD) duration of prone positioning of 121 (18) min, mean (SD) intraocular pressure in the nondependent eye was unchanged when compared to the awake state (17.7 (2.4) mmHg vs 18.9 (5.5) mmHg), whereas the intraocular pressure in the dependent eye had significantly decreased (17.0 (3.6) mmHg vs 8.1 (1.8) mmHg; p < 0.01). These results may be important for choosing the optimal position for spinal surgery when an increase in intraocular pressure should be avoided.

Adult↗

PubMed2004

Dorsolateral dislocation of the proximal interphalangeal joint: closed reduction and early active motion or static splinting; a retrospective study.

INTRODUCTION: In a follow-up examination 50 patients who had sustained dorsal dislocations of the proximal interphalangeal (PIP) joint, the results of two conservative therapy regimens, either immobilisation or early motion, were investigated. The patients were assigned randomly. The inclusion criteria were: adult patients over the age of 18 with isolated, acute, closed dorsolateral dislocation of the PIP joint. MATERIALS AND METHODS: In group A, 25 patients were treated by closed reduction and immobilisation with a short-arm cast including both interphalangeal joints for 4 weeks. In group B, 25 patients were treated by dorsal block splinting of the PIP joint following reduction. The finger was released in extension with daily active exercise of the PIP joint. RESULTS: In group A, 9 patients showed a normal range of motion, whereas a limitation of extension of 10 deg and more was seen in 16 patients. All PIP joints were clinically stable, and 19 patients were satisfied. Two patients complained of a limitation of extension, 3 of limitation of extension and pain, and 1 of pain and swelling. In group B, only 2 of 25 patients showed a limitation of extension of 10 deg and more, whereas 23 patients showed a normal range of motion. Instability of one collateral ligament was seen in 2 cases. Palmar instability did not occur, and 18 patients were satisfied. One patient complained of instability, pain and lack of extension during hard work, 1 of pain in combination with instability, 2 of pain and 3 of swelling of the joint. CONCLUSION: Early active motion after dorsolateral dislocation of the PIP joint produces significantly superior results regarding the active range of motion and pinch power than static splinting.

Casts, Surgical↗

PubMed2004

Dorsal scapholunate ligament reconstruction using a periosteal flap of the iliac crest.

INTRODUCTION: To report a new technique for scapholunate ligament reconstruction, using a periosteal flap of the iliac crest. MATERIALS AND METHODS: In 12 patients with static SL instability, a periosteal flap was harvested from the anterior portion of the iliac crest. Following repositioning of the carpals, the flap was fixed to the scaphoid and lunate between an incompletely osteotomised scale at the dorsal horn of the scaphoid and lunate. Pin fixation of the scapholunate (SL) and CL interval secured postoperative reduction for 8 weeks. A forearm plaster cast was worn for 12 weeks. RESULTS: Eleven patients, all male, were available for follow-up at an average of 29 months. The interval between trauma and surgery averaged 15 months. The preoperative SL angle measured 77 deg, CL angle was -10 deg, and SL gap amounted to 5.2 mm. At follow-up, SL angle was 59 deg, CL angle measured -2 deg, and SL gap was 2.1 mm. SL gap, SL angle, and CL angle improved significantly from preoperative to follow-up values. According to the clinical grading system of Green and O'Brian, 6 patients scored in the excellent and good category and 5 in the fair category. Using the radiologic grading system of Gickel and Millender, 9 patients scored as excellent and good, whereas the 2 poor results were due to failure of the technique. CONCLUSION: The technique enables reduction of the SL angle and SL gap in patients with static reducible scapholunate instability. The initial results are quite encouraging.

Bone Transplantation↗

PubMed2004

Anatomical basis for functional treatment of dorsolateral dislocation of the proximal interphalangeal joint.

Dorsolateral dislocation of the proximal interphalangeal (PIP) joint is a common injury to the hand. Closed reduction of the dislocation anatomically realigns the avulsed ligaments; thus patients may be managed non-operatively. Standard treatment involves placement of a dorsal splint to prevent hyperextension and lateral stresses. This allows early active motion of the PIP joint while preventing a flexion contracture. In this fresh cadaver study, the PIP joint in 24 fingers was dorsolaterally dislocated. Four digits had to be excluded from the investigation due to a fracture dislocation with a bony fragment of >40% of the articular surface of the middle phalanx. After closed reduction, seven digits were further studied using the cryosection technique described by Kathrein et al. (1996, Clin. Anat. 9:227-231) to demonstrate the position of the avulsed palmar plate. In another 13 joints, the torn ligaments were examined by gross dissection. In 10 degrees of finger flexion, the avulsed palmar plate lay at its previous attachment to the base of the middle phalanx. The collateral ligament, ruptured at its attachment to the side of the head of the proximal phalanx, returned to its original position and was not interposed in the joint. The split between the collateral ligament and the accessory collateral ligament was also closed. Our data suggest that the ligamentous structures of the PIP joint, namely the palmar plate and collateral ligaments, typically return to their anatomic positions upon simple closed reduction of dorsolateral dislocations in fresh cadavers.

Aged↗

PubMed2003

Scapholunate ligament reconstruction using a periosteal flap of the iliac crest: a biomechanical study.

INTRODUCTION: Advances continue to improve direct reconstruction of the dorsal scapholunate (SL) ligament, which is the strongest part of the entire SL ligament and is known as the turning point between the scaphoid and lunate. This study was designed to compare the biomechanical properties of the dorsal SL ligament with those of a periosteal flap of the iliac crest, which is a new graft candidate for dorsal SL reconstruction. MATERIALS AND METHODS: A bone-ligament-bone complex was harvested for biomechanical testing from the iliac crest and the dorsal SL complex. Ten specimens could be prepared in each group. After potting the bone blocks in methylmethacrylate for stable fixation, the specimens were tested, using a servohydraulic testing system, at a rate of 10 mm/min. RESULTS: Failure displacement, failure force, failure stress, energy to failure, and stiffness were assessed for both groups. Eight specimens in each group were tested successfully. In the ligament group, six specimens failed at the ligament level, whereas two failed at the insertion of the scaphoid. In the periosteum group, all eight specimens failed at the ligament level. The failure force of the dorsal SL ligament averaged 171.8 N, failure stress was 10.3 N/mm2, and failure displacement amounted to 2.9 mm. Energy to failure was 269.1 N-mm, and stiffness averaged 77.2 N/mm. Failure force of the periosteal flap amounted to 144.3 N, failure stress was 9.9 N/mm2, failure displacement was 3.0 mm, and energy to failure was 217.9 N-mm. Stiffness of the periosteal flap measured 60.5 N/mm. Comparison of the dorsal SL ligament and the periosteal flap of the iliac crest revealed no significant biomechanical differences. CONCLUSION: Therefore, the biomechanical properties of the periosteal flap recommend its use for reconstruction of the dorsal SL ligament.

Biomechanical Phenomena↗

PubMed2003

Functional outcome with special attention to the DASH questionnaire following callus distraction and phalangization of the thumb after traumatic amputation in the middle one-third.

INTRODUCTION: Aim of this retrospective study was to obtain a functional outcome following callus distraction and phalangization of the thumb after traumatic amputation in the middle one-third. MATERIALS AND METHODS: From January 1998 to June 2001, 12 patients were treated in a staged procedure starting with corticotomy and continuous distraction (1 mm/day) of the first metacarpal bone using a unilateral external fixator device. After distraction until day 31 (range 25-35 days), the first metacarpal bone was stabilized with a plate, and phalangization was performed. RESULTS. At follow-up 1 year after surgery, the thumb was lengthened to 25-35 mm (average 28 mm) in all but 1 patient. In 1 patient a bone graft from the iliac crest had to be interposed. Pinch grip improved by 45%; grip strength improved by 55%. The function/symptom score from the DASH questionnaire was 25 points (range 16-38 points). In a 'pick-up test' all patients were able to pick up a pencil, they were able to write and could hold a full cup of water. Nine patients were able to pick up a paper clip, and 8 patients could hold a 1-liter bottle of water. CONCLUSION: Callus distraction can be considered a suitable procedure to reconstruct an amputated thumb levelled at the middle one-third. Additional phalangization proved essential as it deepened the first web space, enabling good motion and grasp. Callus formation was delayed in elderly patients, but adequate lengthening and bone healing also occurred in this age group. The procedure will not be as beneficial in cases of osteoarthritis of the trapezometacarpal joint or when coverage of the stump is insufficient. The DASH questionnaire is very helpful in evaluating the effect of thumb reconstruction on the entire upper limb.

Adolescent↗

PubMed2003

[Long-term results after a modified Sauvé-Kapandji procedure. Report on 105 post-traumatic cases].

A modified Sauvé-Kapandji procedure was performed on 105 patients for a painfully limited range of motion and arthritis of the distal radioulnar joint following distal fracture of the radius ( n=81), the radius and ulna in the distal one-third ( n=18) and of the forearm shaft ( n=6). After an average of 8 years all patients were followed up clinically (motion, strength, pain) and radiographically (union of the arthrodesis, carpal translation, radioulnar distance). Rotation of the forearm had been improved by 53%. The amount of strength lay by 70% in comparison to the contralateral side. In 97% of the patients pain could be reduced. In all cases the arthrodesis had fused completely. An ulnar drift of the carpus was observed in 5% of the patients, and 74% of the patients showed radiological signs of approximation of the proximal ulnar stump to the radius. This reduction of the radioulnar distance amounted to less than 3 mm in 65% of the patients and lay between 3 and 5 mm in 29% of the patients. In none of the cases was direct contact between the ulna and the radius encountered.

Adult↗

PubMed2003

Closed reduction transarticular Kirschner wire fixation versus open reduction internal fixation in the treatment of Bennett's fracture dislocation.

Thirty two patients with fracture dislocations of the base of the thumb metacarpal with a single large fracture fragment (Bennett's fracture) were either treated by open reduction and internal fixation or closed reduction and percutaneous transarticular Kirschner wiring. All were assessed at a mean follow up of 7 (range 3-18) years. Patients with an articular step off more than 1mm were excluded. The type of treatment did not influence the clinical outcome or the prevalence of radiological post-traumatic arthritis. The percutaneous group had a significantly higher incidence of adduction deformity of the first metacarpal. This was attributed to Kirschner wire placement near the fracture line or in the compression zone of the fracture, resulting in loss of reduction. This however did not result in an inferior outcome.

Adult↗

PubMed2003

[Clinical long-term outcome after Kapandji-Sauvé procedure].

PURPOSE: The present study was designed to evaluate long-term outcome of upper extremities and subjective self-assessment of patient disability after a Kapandji-Sauvé procedure by means of the DASH score. PATIENTS AND METHOD: Between 1986 and 1996, a modified Kapandji-Sauvé procedure was performed in 117 patients with painfully limited forearm rotation and arthrosis of the distal radioulnar joint (DRUJ). Of the 117 patients, 73 women and 32 men, whose ages at operation ranged from 22 to 74 years (average, 58 years) were retrospectively reviewed clinically and radiologically eight years (range, five to twelve years) after the operation. The DASH questionnaire was used in 43 patients. RESULTS: The mean DASH score was 28 points (range, 0 to 53 points). The mean score in part A was 1.9 points, in part B 1.8 points. Worst outcomes were noted for activities requiring the exertion of force. Pain was reduced in 97 % of the patients. Forearm rotation and grip strength improved in all patients. CONCLUSION: Our clinical findings suggest that the Kapandji-Sauvé procedure is indicated in symptomatic, non-reconstructable disorders of the DRU-joint with or without ulnocarpal impaction syndrome. The DASH questionnaire provides a general view of functional outcome after the Kapandji-Sauvé procedure, though rotation is absolutely necessary to evaluate the success of the operation.

Adult↗

PubMed2003

[Computer-assisted planning and corrective osteotomy in distal radius malunion].

Corrective osteotomy of the malunited distal radius following fracture was performed in six patients using virtual planning and computer-assisted surgery. Radius joint angles and ulnar variance were assessed by CT scan and compared with the uninvolved wrist. Dorsal tilt was improved by 6 degrees, radial inclination by 3 degrees, radius rotation by 7 degrees and ulnar variance by 4.6 mm. Results were almost equivalent to the noninvolved radius. Corrective osteotomy in extraarticular malunited distal radius fracture was optimized by computer-assisted planning and surgery.

Adult↗

PubMed2002

[Delayed radial paralysis after Monteggia fracture--a case report].

Concomittant lesions of neural structures represent a rare type of complications in Monteggia's fractures. In acute fractures spontaneous neurological remission usually occurs after reduction of the dislocated radial head. In the presented case a 33-year old man experienced a trady palsy of the posterior interosseus nerve 27 years after a Monteggia's fracture with the radial head left dislocated. Following a minimal trauma in badminton a neurological deficiency probably caused by distraction occurred and resulted in impairment of wrist extension and extension of the fingers. Initiated conservative treatment including intensive physiotherapy and electrotherapy for 4 months was unsuccessful. Consecutively the radial nerve was surgically exposed and released from an entrapping and thickened arcade of Frohse. The radial head was left dislocated. Full neurological recovery was obtained 9 months after surgery.

Adolescent↗