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Biomedical subjects

P L Broos

Publications and source records attributed to P L Broos.

At least 19 recordsLinked to original sources
PubMed2005

[Trauma during pregnancy].

In the past 60 years trauma has become the most important cause of morbidity and mortality in pregnancy. Motor vehicle accidents are the most common cause of abdominal trauma and lead to the highest mortality. The typical anatomical and physiological changes occurring during pregnancy demand a specific resuscitation procedure in which stabilization of the mother hemodynamically has to be done first. During the secondary survey the mother and fetus have to be examined thoroughly. The correct use of safety belts is an essential part of prevention.

Female↗
PubMed2003

Notorious pitfalls in the care of multi-trauma patients.

In this review we elaborate on the more specific circumstances that are needed for adequate trauma care, such as the correct recognition and management of a tension pneumothorax, a tracheobronchial disruption, systemic air embolism and hypoventilation. Furthermore the trauma clinician must be aware of the different life threatening causes of haemorrhage and hypovolemia. Traumatic pericardial tamponade, myocardial contusion and a tension pneumothorax can all prove to be difficult diagnoses, but may all present with signs of hypotension with an increase in central venous pressure (CVP). In contrast, internal haemorrhage is most often accompanied by hypotension with a low CVP. Immediate evaluation and treatment of thoracic trauma, such as rupture of the aortal arch, is mandatory, as is the utilisation of the correct diagnostic strategy to evaluate the possibility of intra-abdominal and retroperitoneal injury. Both an unnecessary laparotomy and a delayed diagnosis must be avoided when dealing intra-abdominal injuries, such as kidney trauma. Furthermore, we stress the importance of the swift diagnosis and treatment of fractures of long bones and the pelvis, to prevent ongoing massive haemorrhage. Certain criteria should be met, in a hospital setting with sufficient day-to-day trauma experience, to be able to provide quality care for the multi-trauma patient. This will minimise the risk of errors and serious medical and judicial consequences.

Central Venous Pressure↗
PubMed2001

Routine monitoring of compartment pressure in patients with tibial fractures: Beware of overtreatment!

PURPOSE: This prospective clinical study sought to evaluate the possible effects of routine compartment pressure monitoring in tibial fractures and to assess the previously published criteria. Pressures in the anterior compartment were measured in consecutive cases of tibial fractures. In 95 patients, the protocol was completed with a follow-up after 1 yr. An optimal threshold pressure with both good sensitivity and specificity could not be identified. Such monitoring is a useful tool in the diagnosis of compartment syndrome, mainly in symptomatic patients or those who are difficult to assess, but routine monitoring and the use of most popular threshold pressures, which have low specificity, can result in overtreatment.

Adolescent↗
PubMed2001

A nurse-led interdisciplinary intervention program for delirium in elderly hip-fracture patients.

OBJECTIVES: To develop and test the effect of a nurse-led interdisciplinary intervention program for delirium on the incidence and course (severity and duration) of delirium, cognitive functioning, functional rehabilitation, mortality, and length of stay in older hip-fracture patients. DESIGN: Longitudinal prospective before/after design (sequential design). SETTING: The emergency room and two traumatological units of an academic medical center located in an urban area in Belgium. PARTICIPANTS: 60 patients in an intervention cohort (81.7% females, median age = 82, interquartile range (IQR) = 13) and another 60 patients in a usual care/nonintervention cohort (80% females, median age = 80, IQR = 12). INTERVENTION: (1) Education of nursing staff, (2) systematic cognitive screening, (3) consultative services by a delirium resource nurse, a geriatric nurse specialist, or a psychogeriatrician, and (4) use of a scheduled pain protocol. MEASUREMENTS: All patients were monitored for signs of delirium, as measured by the Confusion Assessment Method (CAM). Severity of delirium was assessed using a variant of the CAM. Cognitive and functional status were measured by the Mini-Mental State Examination (MMSE) (including subscales of memory, linguistic ability, concentration, and psychomotor executive skills) and the Katz Index of activities of daily living (ADLs), respectively. RESULTS: Although there was no significant effect on the incidence of delirium (23.3% in the control vs 20.0% in the intervention cohort; P =.82), duration of delirium was shorter (P =.03) and severity of delirium was less (P =.0049) in the intervention cohort. Further, clinically higher cognitive functioning was observed for the delirious patients in the intervention cohort compared with the nonintervention cohort. Additionally, a trend toward decreased length of stay postoperatively was noted for the delirious patients in the intervention cohort. Despite these positive intervention effects, no effect on ADL rehabilitation was found. Results for risk of mortality were inconclusive. CONCLUSIONS: This study demonstrated the beneficial effects of an intervention program focusing on early recognition and treatment of delirium in older hip-fracture patients and confirms the reversibility of the syndrome in view of the delirium's duration and severity.

Activities of Daily Living↗
PubMed2001

Dermatotraction: an effective technique for the closure of fasciotomy wounds: a preliminary report of fifteen patients.

Dermatotraction was evaluated as an alternative technique for the closure of dermatofasciotomy wounds, with a review of literature and of our clinical experience. The dermatotraction technique provides closure of fasciotomy wounds and avoids the use of skin grafting. Patients treated with dermatofasciotomy for an acute compartment syndrome of the limbs, without obvious tissue necrosis and without shock or urgent life saving surgery, had their fasciotomy wound closed with dermatotraction with vessel loops, the skin approximation system, or the prepositioned intracutaneous suture. In our experience, the mean time to wound closure was nine days. Dermatotraction techniques that cause local skin compression should be avoided because skin necrosis might occur (skin approximation system). Dermatotraction with vessel loops or the prepositioned intracutaneous suture provides good skin apposition without the necessity for skin grafting.

Arm↗
PubMed2001

Metastatic fractures of the tibia.

Pathologic fractures of the tibia due to a metastasis are rare. The treatment of an established fracture is sometimes conservative, but more often surgical. The purpose of the surgical procedure is to improve the quality of life and the ambulatory status, to relieve pain and to facilitate activities of daily living and nursing care. Four cases of operatively managed metastatic fractures of the tibia are presented with emphasis on the surgical technique. The scarce literature on metastatic tibial fractures in reviewed. The operative technique to be used does not only depend on the location of the tumor but also on the primary tumor, the response to adjuvant therapy and the life expectancy. For metastatic shaft fractures an intramedullary nail, sometimes augmented with bone cement, is preferred. For distal or proximal fractures a compound osteosynthesis with plates and screws offers a good solution. In the epiphyseal and metaphyseal region of the tibia an amputation or a tumor prosthesis is the procedure of choice.

Activities of Daily Living↗
PubMed2001

Fractures of the distal radius. Current concepts for treatment.

The authors review the treatment of fractures of the distal radius, based on their experience and from data in the literature. The choice of a treatment for any given fracture must take into account first of all the stability of the fracture. The best results are achieved in stable fractures. Only minimally displaced distal radius fractures can be treated functionally. However, a plaster cast for one week is indicated for the comfort of the patient. In displaced but stable fractures both closed reduction and percutaneous fixation are indicated. In case of closed reduction, the plaster cast should be applied for 5 to 6 weeks with an above-elbow cast for 3 weeks. Percutaneous fixation gives the best results in extraarticular fractures in younger patients. Because of its simplicity however, it should not be ignored in the elderly osteoporotic patients. In the authors' experience, both techniques were only used for extraarticular fractures. Good and excellent results were found in the closed reduction and plaster cast group in 74% of the patients; the Kapandji technique gave 75% good and excellent results. These results are in line with other findings which show that, for simple fracture types, the Kapandji technique and closed reduction seem to give similar results. External fixation is widely used for intra-articular comminuted fractures. Dynamic external fixation does not show any advantage over static devices. Additional K-wires or bone grafting may be necessary. External fixation gives superior results to plate and screw fixation. Internal fixation should be reserved for fractures with ventral comminution or severe displacement with unacceptable reduction by closed or minimally invasive techniques.

Adolescent↗
PubMed2000

Healing of closed femoral shaft fractures treated with the AO unreamed femoral nail. A comparative study with the AO reamed femoral nail.

Out of a hundred and seven closed femoral fractures, fifty-three were treated with the unreamed femoral nail and fifty-four with the reamed femoral nail. There were four delayed unions in the Unreamed Femoral Nail group (UFN) and three in the Reamed Femoral Nail group (RFN). There were no cases of infection or malunion. Implant failure was the cause of implant conversion in one patient of the UFN group. Healing time of the femoral fractures was 19.2 weeks in the UFN group and 19.6 weeks in the RFN group. Due to the significant decrease in operating time with the UFN (70 min) in comparison with the RFN (125 min) and the possible risk of posttraumatic pulmonary oedema (ARDS) with reaming techniques, the authors recommend the UFN for the treatment of acute closed femoral shaft fractures.

Adult↗
PubMed2000

Life saving surgery in polytrauma patients.

Life saving surgery is the surgery which has to be performed during the acute or reanimation period (1 to 3 h) and during the primary or stabilisation period (first day surgery). During the reanimation period lifethreatening conditions are identified and management is begun simultaneously. Many trauma surgeons talk about the first "golden hours" as the time interval starting immediately after the injury when rapid intervention will save lives and a lack of intervention will result in life loss. Most common, these critical conditions are exsanguinating hemorrhage, acute pump failure, obstruction of airways, mechanical failure of ventilation or severe brain damage with tentorial herniation. During this period, the following acts are necessary: surgical access to live support systems (airway, veins), life saving decompression of body cavities, resuscitative thoracotomy, control of exsanguinating external hemorrhage and control of exsanguinating hemorrhage into the body cavities. The primary or stabilisation period starts when vital functions stabilise. This period consists of further diagnostic procedures and treatment of injuries that are not directly life-threatening, but which may become life endangering or severely disabling if not treated promptly. The priorities of the surgical treatment are: brain injuries, eye- and facial injuries, progressive compression of the spinal cord, visceral injuries, musculoskeletal injuries. By improving prehospital care, rapid transport and last but not least immediate life saving surgical treatment preventable deaths can be reduced from 20-30% to 2-9% (5).

Brain Injuries↗
PubMed1999

Closed reduction versus Kapandji-pinning for extra-articular distal radial fractures.

In a randomized prospective trial, treatment of extra-articular distal radial fractures by closed reduction and plaster application was compared with Kapandji-pinning. Closed reduction and plaster cast was used in 50 patients, Kapandji-pinning in 48 patients. According to the Cooney score, good and excellent results were found in the closed reduction and plaster cast group in 74%, compared with 75% in the Kapandji-pinning group. After measuring the maintenance of reduction as well as the functional outcome at 1 year follow-up, no statistically significant differences could be found between the two groups. We conclude that both techniques can be used in treating extra-articular fractures of the distal radius.

Bone Nails↗
PubMed1999

Prosthetic replacement in the management of unstable femoral neck fractures in the elderly. Analysis of the mechanical complications noted in 778 fractures.

From 1987 to 1996, 778 unstable fractures of the femoral neck Garden type III or IV in 736 patients over 70 years of age have been treated surgically. Based on age and functional preinjury status, 477 patients were treated with a hemiarthroplasty; a total hip prosthesis was implanted in another 301 patients. The overall mortality rate at one year was 20%. Of the 472 surviving patients pre-operatively classified as "independent", 68% regained an independent active level; in the remaining 32%, the femoral neck fracture caused an important additional impairment. One also has to admit that the complications after prosthetic replacement are not harmless: dislocation (2%) requiring an early revision arthroplasty in about half of the cases; deep infection (< 1%) leading to a Girdlestone situation and sometimes even to death. It is generally accepted that, if prosthetic surgery is chosen, the best implant for this category of patients is a bipolar system. Despite good functional results observed after total hip arthroplasty for fractures, we recommend this technique only in selected cases. The risk for prosthetic loosening is also much higher after replacement for fracture than after replacement for osteoarthritis (at least 14% within 5 years). Nevertheless, we prefer a total prosthesis implant in patients with a good life expectancy and good functional condition, aged between 70 and 80 years, presenting a severely displaced unstable fracture.

Activities of Daily Living↗
PubMed1998

Treatment of distal femoral fractures in the elderly. Results with the retrograde intramedullary supracondylar nail.

The drawbacks of plating techniques for the treatment of distal femoral fractures are the need for a large exposure with the possible risk of soft tissue damage, devascularisation of bone fragments and loss of the possible positive effect of the fracture hematoma. Moreover, early weight bearing is not advisable with these implants. To find out whether the retrograde nailing of distal femoral fractures is beneficial we performed this study. Between March 1, 1993 and September 1, 1995, 25 patients with 26 distal femoral fractures were treated in our department with retrograde femoral nailing. According to the ASIF-classification we classified 20 fractures as supracondylar A fractures and 6 fractures as intercondylar C fractures. All fractures were closed and without important soft tissue damage. One patient dies of a not fracture-related cause before fracture healing was achieved. Twenty-five fractures healed. According to our relative Neer-score we counted 18/25 (72%) excellent results (> or = 85 points), 5/25 (20%) good results (> or = 70 points), 1 (4%) fair result (> or = 55 points and 1 (4%) bad result (< 55 points). The retrograde intramedullary nailing makes a biological osteosynthesis of distal femoral fractures possible. Also in our aged patients good functional results could be obtained. Poor hold of the distal interlocking screws and difficult interlocking are the 2 major technical problems encountered with this implant. Early weight bearing is not advisable.

Adolescent↗
PubMed1998

The retrograde intramedullary supracondylar nail: an alternative in the treatment of distal femoral fractures in the elderly?

To find out whether retrograde nailing of distal femoral fractures is beneficial for the aged patient, we performed a prospective study of consecutive patients 65 years or older with distal femoral fracture treated with a retrograde femoral nail between 1 March 1993 and 30 April 1996 in our department. In total, 26 patients with unilateral distal femoral fractures had been treated in our department, and 24 patients had been followed up for more than 12 months. All fractures had healed. Six patients did not walk before the injury. According to the Neerscore we counted 10/18 excellent results (> or = 85 points), 6/18 good results (> or = 70 points), 2/18 fair results (> or = 55 points) and no failures (< 55 points). Retrograde intramedullary nailing makes a biological osteosynthesis of distal femoral fractures possible. Even in our aged patients good functional results could be obtained. Poor hold of the distal interlocking screws and difficult proximal locking are the two major technical problems encountered with this implant. Early weight-bearing is not advisable.

Aged↗
PubMed1998

Unreamed intramedullary nailing of femoral shaft fractures using a traction device.

The authors present a simple distraction apparatus that is used in the sterile field and makes it possible to perform unreamed intramedullary nailing of the femur on a normal operation table. Intramedullary (IM) nails were placed, without reaming, in 24 femoral shaft fractures with the use of this device. Although it appears as though the use of the distractor did not lengthen the operative procedure, the set-up time was 60 per cent less compared with a stratified group of 28 femoral nailing using the fracture table. We feel that this device provides a safe and effective means for achieving fracture reduction without the need for a fracture table. It is especially useful in the multiply injured patient where the additional lesions can be treated without the need for patient transfer to the fracture table.

Adult↗
PubMed1998

Postoperative variation in neurocognitive and functional status in elderly hip fracture patients.

Regaining independence in the performance of activities of daily living (ADL) is a nursing priority in the postoperative care of hip fracture patients, though often impeded by a temporary yet reversible decrease in cognitive status postoperatively. This study investigated the incidence and evolution of decreased cognitive status in geriatric hip fracture patients from admission through to the fifth postoperative day, and the relationship between cognitive abilities and functional (ADL) status. Twenty-six elderly hip fracture patients (f: 21, m: 5) with a mean age of 79.5 years (SD = 8.2) admitted to the emergency room of an academic medical centre were monitored longitudinally from admission until the fifth postoperative day regarding neurocognitive status and ADL status, as measured by the mini-mental state exam (MMSE; including subscales of memory, linguistic ability, concentration and psychomotor executive skills) and an adapted version of the Katz ADL-scale, respectively. Patients were categorized on the basis of cognitive status as follows: no cognitive impairment (MMSE > or = 24), moderate (MMSE < or = 23 but > or = 18) and severe impairment (MMSE < or = 17). Nineteen of the 26 patients (73.1%) showed cognitive impairment (MMSE < or = 23) at some point in time before and/or after surgery. Some improvement in cognitive status was observed yet only selectively across patient cohorts and neurocognitive dimensions. Cognitive status, especially memorial ability and psychomotor executive skills, seemed to be most vulnerable to becoming impaired after hip fracture surgery. A relationship was found between cognitive and functional status, specifically, strong associations between memory and psychomotor skills relative to ADL and modest associations between linguistic ability and concentration relative to ADL. Further, patients with decreased cognitive status postoperatively remained more ADL-dependent than non-impaired patients. This study underscores the importance of a systematic assessment of the cognitive status of elderly hip fracture patients and linking these observations to functional ability in order to enhance the postoperative rehabilitation of this patient group.

Activities of Daily Living↗
PubMed1998

Unstable femoral neck fractures in young adults: treatment with the AO 130-degree blade plate.

OBJECTIVE: To evaluate the clinical outcome of the treatment of unstable femoral neck fractures using the AO 130-degree blade plate. DESIGN: Between 1980 and 1994, thirty-four consecutive patients younger than age fifty years with an unstable intracapsular femoral neck fracture (Garden Types III-IV) were treated with internal fixation. SETTING: University Hospital Gasthuisberg, Leuven, Belgium. INTERVENTION: The AO 130-degree blade plate with an antirotation, 6.5-millimeter, partially threaded cancellous lag screw was used. RESULTS: Nineteen (63.3 percent) patients had an excellent result, seven (23.3 percent) had a good result, three (10 percent) had a fair result, and one (3.3 percent) had a poor result. Delayed union was observed in one case, and avascular necrosis was observed in two cases. Two implants perforated the subchondral bone. CONCLUSION: Stable fixation with the AO 130-degree blade plate avoids damage to the adjacent blood supply to the femoral head and appears to guarantee a good final outcome of unstable intracapsular femoral neck fractures in young adults.

Adult↗