Biomedical subjects

M Wambacher

Publications and source records attributed to M Wambacher.

9 recordsLinked to original sources

PubMed2006

[Comparison of open versus percutaneous treatment for humeral head fracture].

BACKGROUND: The hypothesis of this study was that percutaneous techniques lower the risk of post-traumatic avascular necrosis. MATERIALS AND METHODS: In this retrospective study 83 patients were followed up clinically and radiologically for signs of avascular necrosis and nonunion after open or percutaneous treatment of proximal humerus fractures. Mean age was 50 years. Fractures were classified in 22 patients (26.5%) as two part, in 21 patients (25.3%) as three part, in 39 patients (47%) as four part, and in 1 patient (1.2%) as fracture dislocation (Neer classification). Fractures were treated in 12 patients (14.5%) by ORIF (open reduction and internal fixation) and in 71 patients (85.5%) by CRPF (closed reduction and percutaneous fixation). Both groups were statistically equally distributed according to fracture type (Mann-Whitney U, p=0.267) and age (One-way-Annova, p=0.740). The postoperative regime did not differ between the two groups. RESULTS: Patients suffered significantly more avascular necrosis after open treatment [five patients (50%) versus eight patients (12.7%) in the percutaneous group, Mann-Whitney, p=0.004]. The risk for avascular necrosis and nonunion increased with age. Mean age of patients with avascular necrosis was 57 years, and the age of patients with nonunion was 67 years. CONCLUSION: Percutaneous treatment of humeral head fractures seems to be a reliable method for lowering the risk of avascular necrosis in young patients.

Adult↗

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↗

PubMed2004

Outcome after primary hemiarthroplasty for fracture of the head of the humerus. A retrospective multicentre study of 167 patients.

We have examined 167 patients who had a hemiarthroplasty for three- and four-part fractures and fracture-dislocations of the head of the humerus in a multicentre study involving 12 Austrian hospitals. All patients were followed for more than a year. Anatomical healing of the tuberosity significantly influenced the outcome as measured by the Constant score and subjective patient satisfaction. With regard to pain, the outcome was generally satisfactory but only 41.9% of patients were able to flex the shoulder above 90 degrees. The age of the patient and the type of prosthesis significantly influenced the healing of the tuberosity, but bone grafting did not. Achievement of healing of the tuberosity was inferior in institutions at which less than 15 hemiarthroplasties had been performed (Mann-Witney U test, p = 0.0001).

Adolescent↗

PubMed1998

[Post-traumatic ischemia of the talus. Is talus necrosis unavoidable?].

50 patients following talar fractures type Marti 2, 3 and 4 during the years 1972-1993, could be analysed retrospectively. Evaluated factors effecting posttraumatic avascular necrosis of the body of the talus are: type of fracture, age of the patient, additional fracture of the medial malleolus and time of non weight bearing. The Hawkins sign is reliable to show vitality in the body of the talus. We could see vascular impairment in 51% of all Marti 3 fractures and in 100% of all Marti 4 fractures. Patients with a concomitant fracture of the inner malleolus showed positive influence on the blood supply of the talus. In this case the ligamentum deltoideum and the ramus deltoideus of the arteria tibialis posterior remained intact. In addition to this the prognosis was better in young patients. A long period of non weight bearing could not preserve vitality of the talus. Necrosis of the talus did only appear in 34% of the Marti 3 and in 51% of the Marti 4 fractures. This means that early anatomic reconstruction of the talus is necessary. Primary arthrodesis of the ankle joint and talectomie are not up to date.

Adolescent↗

PubMed1998

[Distal, metaphyseal compression fractures of the radius. Results of open reposition, stable defect replacement with cortico-cancellous iliac crest bone and plate osteosynthesis].

Conservative treated distal radius fractures with extended metaphyseal void and missing cortical support resulted in loss of reduction. From 1988 till 1994 117 fractures of the distal radius were treated by open reduction, filling the metaphyseal void with a corticocancellous iliac bone graft and plate fixation. In this retrospective study results after surgical reconstruction were evaluated radiologically and clinically and were discussed to conservative treatment. 30 patients suffering from extraarticular metaphyseal distal radius fracture were evaluated after a mean of 42 months (minimum 20, maximum 68 months) after surgery. Ulnar variance was restored in 70% to the uninvolved side. Ulnar minus variance up to 2 mm persisted in 30%. Radial joint angles were restored to normal in 53%. In 40% of the patients a loss of reduction up to 10 degrees and in 7% up to 25 degrees occured. Active range of motion in the sagittal and frontal plane was equivalent to the non involved side in 30%. 70% of the patients showed reduced range of motion up to 20%. Rotation was unlimited in 77%, reduced up to 10% in 23%. Subjective results were excellent in 90%, good in 10%. Compared to conservative therapie, surgery showed superior results.

Adolescent↗

PubMed1998

[Arthroscopic extra-articular Bankart procedure].

The arthroscopic extraarticular Bankart procedure tries to imitate the open Bankart procedure. An anterior-inferior transmuscular approach through the subscapular muscle permits to implant self-locking tacks into the anterior inferior third of the glenoid rim. The extraarticular location of the implants makes a superomedial capsular shift possible, if required. A total of 257 arthroscopic repairs following traumatic recurrent anterior shoulder dislocation have been carried out between 1992 and 1996. 177 patients were treated only with bioabsorbable Suretac device. Clinical and radiological follow up was possible in 165 patients. According to the Rowe score 69.7% were classified as excellent, 10.9% as good, 9.7% fair and 9.7% poor. Postoperative complications: the recurrence rate was 9.7%, allergic reactions representing a foreign body reaction to the synthetic material were seen in 5 cases (3%) and a frozen shoulder in 6 cases 3.6%). 61% of the patients involved in overhead or contact sports returned to their preoperative sport activities.

Accidents↗

PubMed1997

Arthroscopic extra-articular Bankart repair for the treatment of recurrent anterior shoulder dislocation.

This study describes a new arthroscopic procedure for the stabilization of recurrent anterior shoulder dislocations. The technique involves two important features. The first is the anterior inferior transmuscular approach through the subscapularis muscle, which permits self-locking implants to be inserted into the anterior inferior third of the glenoid rim so that they oppose the direction of pull of the capsule. This approach was studied on 79 cadaveric shoulders before clinical application. The second feature is the extracapsular (extra-articular) location of the self-locking implants, which permits a superomedial capsular shift as required. The technique offers a high degree of capsular stability. Of a total of 318 patients undergoing this procedure, the first 100 shoulders (98 patients) were evaluated postoperatively at an average of 35 months (range, 18 to 62 months). The diagnosis in all cases was traumatic recurrent anterior shoulder dislocation. Repair of the capsule was performed initially with screws and later with absorbable tacks. The overall recurrence rate was 9% (9 shoulders). Excluding the first 30 shoulders to take account of the learning curve, the recurrence rate for the subsequent 70 shoulders was only 5.7%. Limitation of external rotation at 0 degrees abduction averaged 6.7 degrees and 6.1 degrees at 90 degrees abduction for all shoulders; 61% of participants in overhead sports and 70% of participants in contact sports resumed their preinjury activities. The recurrence rate for patients involved in overhead sports was 10% and for collision sports it was 14%. There were no recurrences in the case of patients whose sports involve minimum risk to the shoulder (cycling, jogging). Most recurrences were observed in patients with lax shoulders and small Bankart lesions.

Adolescent↗

PubMed1997

Percutaneous fixation of three- and four-part fractures of the proximal humerus.

Untreated 3- and 4-part fractures of the proximal humerus have a poor functional outcome. Open operation increases the risk of avascular necrosis and percutaneous reduction and fixation may be preferable. We report 27 patients, 9 with 3-part and 18 with 4-part fractures, treated by percutaneous reduction and screw fixation. Thirteen of the 4-part fractures were of the valgus type with no significant lateral displacement of the articular segment, and five showed significant shift. Instruments were introduced into the fracture through small incisions so that the fragments could be manoeuvred under the control of an image intensifier, taking advantage of ligamentotaxis as far as possible. A good reduction was achieved in most cases. The average follow-up was 24 months (18 to 47). All the 3-part fractures showed good to very good functional results, with an average Constant score of 91% (84% to 100%), and no signs of avascular necrosis. Good radiological results were achieved in 4-part fractures when impacted in valgus except for one patient with partial avascular necrosis of the head. In those with lateral displacement of the head, revision to a prosthesis was required in one patient because of avascular necrosis and in another because of secondary redisplacement of the fracture. Avascular necrosis was seen in 11% of 4-part fractures. The average Constant score in patients with 4-part fractures who did not need further operation was 87% (75% to 100%).

Accidental Falls↗

PubMed1996

The antero-inferior (transmuscular) approach for arthroscopic repair of the Bankart lesion: an anatomic and clinical study.

In order to find a direct approach to the antero-inferior third of the glenoid rim, an anatomic study was performed on a total of 89 shoulders (48 cadavers). To obtain defined reference points for the anterior inferior third of the glenoid cavity, it was compared with the hour markings on a clock face. The 4:30 position on the right shoulder and the 7:30 position on the left shoulder were defined as the relevant reference points. The average distance between the palpable end of the coracoid process and the 4:30 and 7:30 positions was 19 mm. The average distance to the point of intersection of the musculocutaneous nerve with the medial margin of the conjoined tendon was more than 5 cm, and was never less than 2 cm. The average distance of the axillary nerve from the 4:30 position was 2.5 cm in the horizontal plane, with a minimum of 1.5 cm. Radially, the average distance of the axillary nerve was 1.7 cm, with a minimum of 1.3 cm. The anatomic study was followed by a clinical study of 264 patients. An antero-inferior portal located maximum 2 cm distal from the palpable coracoid tip was selected for the introduction of a trocar sheath and blunt trocar, passing through the subscapularis muscle to access the antero-inferior area of the glenoid rim. As additional protection for the musculocutaneous nerve, the direction of the trocar was adjusted during introduction. Reattachment of the labrum-capsule complex was performed extra-articularly. In all cases, at least one implant was located inferior to the 4:30 or 7:30 position. No neurovascular complications arose out of the choice of portal. Out of the 264 patients, the first 100 shoulders (98 patients) were followed-up after an average time of 35 months (18 to 62 months). The recurrence rate was 9%. Excluding the first 30 shoulders (30 patients) from the development phase of the technique, the recurrence rate is only 5.7%. The rate of return to overhead sports activities was 62% and to collision sports activities 70%.

Adult↗