Biomedical subjects

O Kwasny

Publications and source records attributed to O Kwasny.

At least 37 records · Page 2Linked to original sources

PubMed1992

[Importance of measuring stability and function in knee ligament surgery].

To compare results in knee ligament surgery between different surgeons and between different centers, too, is difficult. We investigated if an improvement can be achieved by using easy to handle methods of measurement. The long-term results of 180 patients who underwent ACL surgery between 1983 and 1986 (n = 191) were evaluated. For international comparing of our results we used the scoring of the OAK (Orthopädische Arbeitsgemeinschaft Knie). In addition stability was measured by use of the KT-1000 arthrometer and function by "one leg hop for distance". Together with different usual functional tests those two methods were investigated for being comparable, practicable, and relevant. We found that both measurements came up to these conditions. We succeeded in rating the patients' result by measuring KT-1000 and one leg hop for distance. Examination after knee ligament surgery has to contain these two parameters for international comparison.

Adolescent↗

PubMed1992

[Results after conservatively managed vertebral fractures of the thoracolumbar level with special reference to bony stenosis of the spinal canal].

Seventy-two patients with compression fractures of the lower thoracic and lumbar spine who were treated by the Böhler method from 1972 to 1987 were followed up to compare the clinical signs and the results of conventional radiography and spinal computed tomography. There were 33 men and 39 women with an average age of 44.3 years (23-69 years). Treatment by the Böhler method is indicated for fractures between T12 and L5, which constitute 60% of all vertebral fractures. The main distribution in our patients was T12 (n = 26) and L1 (n = 33). Four patients primarily had neurological symptoms. The mean duration of hospitalization was 16 days (4-54). In our results, back pain is the most frequent complaint. A comparison with the findings on the day of the accident showed that the vertebral deformity decreased in all cases (index: mean accident = 0.64; mean follow-up = 0.82). In the CT scan we found spinal stenosis in up to 30% in 9 patients (12.5%) with no neurological symptoms. Based on these results, the authors recommend the Böhler method in lower thoracic and lumbar compression fractures without neurological symptoms. The main aim of the treatment must be reduction of the vertebral deformity to a minimum in order to maximize the biomechanical integrity of the vertebral column and prevent degenerative changes. The use of computed tomography is recommended even in these fractures because of possible spinal stenosis. CT is accurate, especially in evaluating the nature of facet joint failure.

Adult↗

PubMed1991

[Therapeutic measures in subluxation and dislocation of the patella].

The pathology of patella dislocation is divided into different groups: primary, secondary, recurrent dislocation and patella subluxation. In the diagnosis, in addition to clinical and X-ray investigations a certain computerized tomography extended on the SEG examination. A new examination of the EG tomographs had increased the diagnostic facilities. Our therapeutical program is based on physical therapy. After failure of physiotherapy to achieve satisfactory results the operation technique according to Slocum and Larson is performed.

Adolescent↗

PubMed1991

[Biological reaction to alloplastic reinforcement of the anterior cruciate ligament].

Control arthroscopy in usually done 6-12 months after reconstruction of the ACL with ligamentum patellae transplant augmented with LAD using Marshall's technique. During these control arthroscopies the metal implants are removed and a biopsy of the synovial lining was performed in 38 cases. We normally anchor both ends of the LAD to obtain better stability and these anchors are removed after 6-12 months (release of the fixation points). Up to now control arthroscopy has been performed on 97 patients, who had their ACL reinserted and 114 patients, whose ACL were replaced by ligamentum patellae transplant, in both cases augmented with LAD. The control arthroscopy revealed 11 cases of tears of the LAD in case ACL were reinserted and 24 cases of LAD tears in case LAD were replaced by ligamentum patellae transplant. The findings of 38 biopsies of the synovial lining are as follows: In 18 cases LAD tears, in 15 cases foreign body reactions with wear particles and an instance of lymphocytic infiltration of the synovia was seen. In 20 cases arthroscopy was inconspicuous: In 2 cases wear particles were seen and lymphocytic infiltration in a single case. In all cases of LAD tears with foreign body reactions the LAD was removed.

Anterior Cruciate Ligament↗

PubMed1991

[Control arthroscopy following alloplastically augmented anterior cruciate ligament reconstruction].

97 patients who had their ACL replaced with ligamentum patellae transplant augmented with LAD were reviewed arthroscopically after an average period of 9.1 months (4-22 months). 52 patients whose metal implants have been removed are virtually symptom-free clinically (no swelling, stable knee joint, extension limitation of less than 5 degrees, less than 10 degrees limitation of flexion). Arthroscopy on these 52 patients revealed the following; no abnormalities in 37, 11 cases of cartilage lesions, 1 case of medial meniscal tear and 7 cases of LAD tears. 45 patients who have also had their metal implants removed have complaints, arthroscopy revealed the following; hypertrophy of Hoffa's fat pad in 5 cases, 3 cases of medial meniscal tears, 2 cases of lateral meniscal tears. Tears of the LAD were seen in 9 cases. In 2 cases the transplant was missing, in 5 cases the transplant was elongated and in 2 cases the transplant showed normal structure. There were cartilage lesions in 9 cases, 4 cases of synovitis and scar tissue adhesion in 3. In all there were 16 cases of LAD tears, in 9 out of these 16 cases the transplant ACL of good structure. All of this knees were stable. Control arthroscopy is routinely carried out when we remove the metal implants. This enables us to detect any early problems, such as limitation of extension or swelling, assess the success of the operation and commence the corresponding additional therapy.

Adolescent↗

PubMed1991

[Results and analysis of poor results after conservative therapy of distal radius fracture].

The authors report on the results of a follow-up study of 120 conservatively treated distal radius fractures. Follow-up averaged 35 months (25 to 48 months). The quality of initial reduction has a crucial impact on the final outcome. 87 fractures showed nearly perfect anatomical reduction, of these, 48 resulted in excellent, 16 in good, 15 in satisfactory, and 8 in poor final anatomical outcomes. In comparison, in 33 fractures with unsuccessful initial reduction, only two cases gave excellent and 12 cases good results (42%); 11 fractures were considered satisfactory and 8 poor. The necessity of a second reduction was significantly lower in the first group of initially well-reduced fractures when compared to the second group: 8 (9.2%) to 14 (42.4%) respectively. Evaluation of the functional outcome according to the Sarmiento scheme showed a strong correlation between the AO fracture classification and the final outcome. In group A fractures, 78% gave excellent or good, 22% satisfactory or bad results. Type B fractures gave 82% excellent or good and 18% satisfactory or poor results. In group C, only 50% reached excellent or good results, the C 3 fractures having the worst prognosis, achieving excellent or good results in only 20% of the cases. Regression analysis demonstrated a significant correlation between anatomical and functional outcome.

Adult↗

PubMed1991

[The dynamic hip screw for the management of per- and subtrochanteric femoral fractures].

A total of 125 patients with pertrochanteric or subtrochanteric fractures were treated by means of internal fixation with dynamic hip screws (DHS), and 77 were reviewed both clinically and radiologically after an average period of 29 months (6-69 months). This study included group A 2 fractures (with a large lesser trochanter fragment) and group A 3 fractures (pertrochanteric region) according to the ASIF classification, and also fractures of the proximal femoral shaft. With proper surgical technique only 5 cases of early infection (4%) were recorded. Early mobilization of these patients was possible owing to stable implants. There were 7 patients (5.6%) who died while still in hospital. Of the 77 patients in whom follow-up was possible, 76 had results falling in the very good or good categories according to the Merle d'Aubigné scheme. During this follow-up period 3 cases of implant fracture were encountered. In all other cases progression to bone union was uneventful. These results show that the use of DHS is a reliable method of stabilizing unstable pertrochanteric and subtrochanteric fractures.

Adolescent↗

PubMed1991

[The significance of nerve damage in upper arm fractures].

Lesions of the nerves are a relatively frequent complication after humeral shaft fractures, the nerve most commonly affected being the radial nerve. In the case of proximal fractures of the humerus, particularly dislocation fractures and luxated fractures, lesion of the axillary nerve and irritation of the plexus, are most frequent. In distal humeral fractures the ulnar nerve is most frequently first place and shows a serious complication. The therapy of the fracture must differ in most of these cases from conventional procedure. We believe that primary paresis of the radial nerve is a relative indication for surgery and secondary paresis of the radial nerve, an absolute indication for operation. When we find a subcapital humeral shaft fracture with rare paresis of the nervus axillaris we wait with an operation, but if remission does not occur within approximately 8 weeks a revision should be done. Fracture luxations with irritation of the plexus are an acute indication for operation, because repositioning or displacement of the head fragment can afford relief.

Adult↗

PubMed1991

[Corrective osteotomy for the treatment of carpal tunnel syndrome in malaligned healed fractures of the distal radius].

This report deals with 12 patients with fractures of the distal radius that healed with malpositioning with dorsal sinking of the articular surface. This malalignment was followed in all patients by a compression syndrome of the median nerve. All patients underwent an osteotomy by the dorsal approach to correct this malalignment of the distal radius. The carpal ligament was not released simultaneously. In 11 patients a significant reduction in the typical night pain was noticed. Normal or almost normal sensitivity was achieved within the first 2 months (2 weeks to 4 months). Only in one patient was release of the carpal ligament necessary after 6 months, because the osteotomy had no effect on the pain. In the follow-up examination after 6 years, significantly better wrist function was noticed in all patients, and 11 had normal function of the median nerve. In only one patient with moderate loss of sensitivity still present, although these was an obvious significant reduction in pain. In this patient the osteotomy was performed very late (after 10 months). Thus, an osteotomy by the dorsal approach has the advantage of restoring normal function of both the wrist and median nerve.

Aged↗

PubMed1991

[Computerized tomography in instability of the femoropatellar joint].

Compared with normal X-ray examination, a CT scan can give more information about patellar alignment, especially close to full extension of the knee-joint. We compared the normal knee-joints of 10 volunteers with the knee-joints of 15 patients (19 recurrent luxations, 5 habitual subluxations). We were able to distinguish between instabilities with and without changes seen on the X-ray pictures, making it possible to develop a systematic concept of treatment. In the case of recurrent dislocation with radiologically visible instability, surgical repair is the treatment of choice, while for habitual subluxation without radiologically visible instability the primary treatment of choice is conservative therapy with physiotherapy and muscle training. This is successful in most cases. If physiotherapy fails surgical repair is the next step in treatment. This dynamic type of investigation (the patella is stabilized by tension of the quadriceps femoris muscle) makes an objective judgement of the result of therapy possible.

Adult↗

PubMed1991

[Limbus-plasty in recurrent anterior shoulder dislocation].

We are reporting the results of labrum reconstruction following recurrent dislocations of the shoulder. From 1985 to 1988 35 patients (27 male/eight female) aged 28.4 years on the average (20 to 45 years old) had surgical treatment. 33 of these 35 came in for a follow-up about 40 months later (28 to 60 months). So far, only one patient suffered a re-dislocation from major trauma. In that case, therapy was continued on a conservative basis and the patient has been free of complaints and re-dislocation for three years. No one of the remaining 32 patients had another dislocation. Shoulder mobility is normal in 29 patients. One patient's abduction is impaired by 10 degrees and one has a 10 degrees to 15 degrees impairment of outward rotation. 30 patients have no complaints whatever. 32 patients consider the outcome satisfactory and only one does not. 30 of 33 patients say their dexterity in sports is the same as prior to the accident and only three feel slightly impaired during competitive sports.

Adult↗

PubMed1991

[Therapeutic procedure in initial traumatic shoulder dislocation (arthroscopy--limbus refixation)].

This is a report of the therapeutic measures following primary traumatic dislocation of the shoulder in young patients (under 40 years of age). In order to rule out a disruption of the glenoid labrum, all patients were subjected to arthroscopy and disruption thus diagnosed in 38 of 48 cases. Surgical refixation of the glenoid labrum was performed on these patients. The ten patients with a stable labrum were given a Gilchrist dressing, immobilizing the shoulder for two to three weeks. Eight of the ten patients who had only had arthroscopy were followed up for an average of three years (two to six years). One developed recurrent dislocation of the shoulder. 31 of 38 patients who had had surgical refixation of the glenoid labrum were followed up for an average of 2.4 years (two to 5.8 years). None of these patients developed recurrent dislocation. Clinically, 25 patients have no pain whatsoever, while five report minor complaints, 30 patients are satisfied with the surgical outcome and only one is not.

Adolescent↗

PubMed1990

[Rehabilitation following reconstruction of the anterior cruciate ligament. The effect of a 6-week training program].

Operations on the anterior cruciate ligament (ACL) represents a great challenge to the therapeutic team. Apart from early mobilisation, increasing attention must be paid to long-term after-care. Nineteen patients receiving reconstruction of the ACL underwent 6 weeks of training an average of 7.6 months after the procedure. At the start and end of the program, a dynamometric test (Dynamatik), and a function test, modified by Noyes, comprising a one-leg standing jump and hopping on one leg for six meters, were performed. Dynamometry revealed a clearly greater improvement in knee extension in the operated leg as compared with the non-operated leg, while the function tests revealed an improvement only in the operated leg. Correlation studies revealed no relationship between knee extension and function tests. For this reason, in addition to muscular strength, both training programs and after-care should take account also of the functional components of human locomotion, and should be carried out for a number of years.

Adolescent↗

PubMed1990

[Prevention of thromboembolism in para-articular femoral fractures of the hip--results of a prospective randomized study of heparin-DHE and ASS-DHE].

The effectiveness of prophylaxis of thromboembolism either by acetyl-salicylic-acid (ASA) 0.5 g + dihydroergotamin (DHE) 2.5 mg three times a day or by Heparin 5000 IU + 0.5 mg DHE (HDHE) three times a day was compared in 404 patients, elder than 55 years, with fractures close by the hip joint. Effectiveness was proved daily clinical controls, perfusion scintigraphy on the day after admission, the fourth postoperative day and the day before discharge and by autopsy of the died patients. Clinical manifest thrombosis were seen on the operated legs in the HDHE-group in 7.6% of the patients, in ASA-DHE-group in 15.6%, on the not operated leg under prophylaxis by HDHE in 3.8%, by ASA-DHE in 4.1% of the patients. Increased postoperative bleeding could be found under HDHE in 16.1% of the patients, under ASA-DHE in 9.3% of the patients, wound haematoma in 9.5% under HDHE and in 5.7% of the patients of the ASA-DHE-group. Superficial wound infections occurred under HDHE in 8.1%, under ASA-DHE in 5.7% of the patients, deep infections under HDHE in 0.5% and under ASA-DHE in 1.6% of the patients. Gastrointestinal bleeding under HDHE in 0.5% of the cases and under ASA-DHE in 3.1% of the cases. Prophylaxis had to be discharged in 7.6% of the patients of the HDHE-group and of 19.7% of the ASA-DHE-group. Pathologic perfusion scars should be found in 54.0% of the patients of the HDHE-group and in 54.9% of the ASA-DHE-group. Pulmonal perfusion became worse despite of prophylaxis by HDHE in 15.6% of the cases and despite prophylaxis with ASA-DHE in 17.6%. Pulmonal perfusion became better under HDHE in 11.9% and under ASA-DHE in 12.4% of the cases. The mortality was 9.7%. Fatal thromboembolism occurred under HDHE in three patients (1.4%) and under ASA-DHE in three patients too (1.6%), after subcapital fractures in 0.5%, after pertrochanteric fractures in 2.1% and after subtrochanteric fractures in 6.25% of the patients without any significant difference between the two groups of prophylaxis. Fatal gastrointestinal bleeding had to be remarked in 1.0% of the patients of the HDHE-group and in 2.1% of the ASA-DHE-group, fatal infections in 0.5% of the patients of the HDHE-group and in 1.6% of the ASA-DHE-group. Fatal cardinal infarction could be seen under HDHE in 1.9% of the patients, under ASA-DHE no fatal cardial infarction occurred.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗

PubMed1990

Skeletal transfixation in treatment of comminuted fractures of the distal end of the radius in the elderly.

Ninety-five patients (71 females and 24 males), average age, 69 years (35-92 years), with comminuted distal radial fractures were treated with transfixation wires (Kirschner wires) through the bases of metacarpals II-V and an above-elbow plaster cast. Two cases of early infections and four of Sudeck's dystrophy (4.2%) were encountered. Followup studies which lasted an average of 24 months (9-50 months) could be conducted on 77 patients. Using Sarmiento's ratings 27 patients fell into the very good category, 44, good, eight, fair, and two, poor. Although most of the cases were of the comminuted intra-articular fracture types, good results were achieved with this simple and quite straightforward method.

Adult↗

PubMed1990

[Results of conservatively treated radius fractures at typical sites].

The results of 78 displaced Colles' fractures treated with reduction and below-elbow plaster were investigated. The follow-up varied from 11 to 24 months (phi 14 months). According to the schema of Sarmiento 66.7% of the patients had a very good or good result; 33.3% had a moderate or poor result. Most of the poor results were intraarticular fractures type C (AO). Primarily anatomical reduction leads to the best results. Every further reduction leads to a poor result, as well as to a higher number of Sudeck's disease.

Adult↗

PubMed1990

[The surgical treatment of humeral shaft fractures].

This is a study of 84 patients with upper arm fractures who were treated by plate osteosynthesis. The indication was mandatory in 9 patients with open fractures, 23 patients with primary radial nerve palsy on admission, 5 patients with radial nerve palsy after the initial treatment, 22 patients with pseudarthrosis and 7 patients who were polytraumatised. The operation was also indicated in 15 patients, because of the form of the fracture, in 3 patients with brachial plexus lesion, in 3 patients because it involved both upper arms and in 3 patients with segmental fractures. The 4.5 DCP was used in all these cases. All the cases of pseudarthrosis progressed to achieve bony union after the operation. There was no incidence of postoperative pseudarthrosis. We did encounter two cases (2.4%) of radial nerve palsy that required exploration. All the preoperative primary and secondary cases of radial nerve palsy recovered postoperatively. After an average follow-up period of 2.4 years (1-10 years) 90% of the patients could be classified as having very good or good results.

Adolescent↗

PubMed1990

[Percutaneous drill wire fixation in treating distal radius fractures at risk of dislocation].

We are presenting an investigation of 47 cases treated with Kirschner wire fixation using drill wires for distal radius fractures. The average study period was 18 months after the fixation (13-25 months). Using Sarmiento's ratings we obtained the following results: 21 patients were rated as excellent, 19 as good, 6 as fair and 1 as poor. In contrast to a good reduction with a stepless joint surface, the initial fracture form and displacement does not influence the functional end results.

Adult↗