Biomedical subjects

R Ganz

Publications and source records attributed to R Ganz.

At least 19 recordsLinked to original sources

PubMed1992

Alignment of supracondylar/intercondylar fractures of the femur after internal fixation by AO/ASIF technique.

Fifty-nine supracondylar-intercondylar fractures of the femur in 57 patients were evaluated after a mean follow-up of 5 years 7 months (range 2 years to 11 years 3 months) after internal fixation using AO/ASIF technique. Axial alignment was compared with that of the uninjured side by orthoroentgenography in the upright position and by bilateral anteroposterior (AP) and lateral views of the femur. Identical values for varus/valgus were noted in 24%, for ante/recurvation in 72%, and for rotation in 61%; differences were within 5 degrees of varus/valgus in 74%, of ante/recurvation in 78%, and of rotation in 83%. Alignment differences were more frequent in complicated and intercondylar fractures according to the AO classification of fractures. We conclude that restoration of the distal femoral angle is far more difficult than restoration of the sagittal plane and rotation, but a satisfactory functional result appears to be compatible with angulation differences of less than or equal to 5 degrees in any plane and that this difference appears to be within the reasonably achievable limits. 93% of the patients were satisfied; 64% of patients were pain-free, and 27% had slight intermittent pain (not interfering with daily activity); 67% of the patients had unlimited walking distance, and 78% of the patients were able to walk without aid. Excellent and good results according to the rating systems of Neer et al., Pritchett, and Schatzker and Lambert were noted in 82, 39, and 26%, respectively. This discrepancy between alignment, pain, function, and results according to different rating systems underlines the need for future standardized, clearly defined reporting and classification of rating.

Adolescent↗

PubMed1992

[Results of repositioning osteotomies in delayed healing or pseudarthrosis of the proximal femur].

The results after valgus osteotomy for delayed or nonunion in 20 patients with femoral neck fractures (9 Pauwels type II and 11 type III) and 10 intertrochanteric fractures are reported. The mean age of the patients at presentation with delayed/nonunion of femoral neck fractures and intertrochanteric fractures was 37.5 and 60 years, respectively. The average interval between injury and valgus osteotomy in the first and second group was 8 and 13 months, respectively. The average size of the preoperatively determined and intraoperatively removed wedge was 30 degrees in both groups. The results of the two fracture groups were analyzed separately. All but one osteotomy in a patient with a nonunion of a femoral neck fracture consolidated without complications. This case developed a nonunion at the osteotomy and required additional surgery consisting of bone graft and refixation to heal. Of the femoral neck delayed/nonunion cases, 15 (75%) healed immediately following valgus osteotomy. In the intertrochanteric delayed/nonunion patients, valgus osteotomy led directly to bone consolidation in 6 (60%). In each fracture group 3 additional cases healed following reoperation for a total consolidation rate of 90%. In the femoral neck group one union was complicated by infection, resulting in ankylosis of the hip and 3.5 years later another patient with a revascularized femoral head required total hip arthroplasty because of a large, loose osteochondral fragment. In two cases union of the former femoral neck fracture could not be achieved. Partial avascular necrosis determined the course and total hip arthroplasty was required for both cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1992

[Pelvic clamps for controlling shock in posterior pelvic ring injuries. Application, biomechanical aspects and initial clinical results].

The antishock pelvic clamp provides direct reduction and compression of unstable posterior pelvic ring disruptions. This is effective in preventing excessive blood loss, which is common in these fractures. Comparable to a carpenter's C-clamp, this device is applied in less than 10 min and exerts transverse compression directly over the iliosacral region, reducing the displaced sacral fractures or SI joint diastasis. Early reduction closes the bleeding surfaces and restores the intrapelvic space, providing for earlier tamponade, further decreasing blood loss. The clamp does not interfere with a possible subsequent laparotomy or necessary diagnostic procedures. On 10 cadaveric pelvic specimens the bone yield under compression with the pelvic clamp ranged from 135 N to 685 N relative to the mechanical quality of the bone. This is sufficient to stabilize the posterior ring during further manipulation of the patient in the early phase. Details of the application technique and our clinical experience with the pelvic clamp in the first 17 patients are discussed.

Adolescent↗

PubMed1992

[Bilateral femoral fracture at the site of bilateral hip prostheses. A case report].

Fracture of the femoral shaft after hip arthroplasty is a serious problem. In most cases, minimal trauma is responsible for the fracture. Predisposing factors include severe osteoporosis, loosening of the prosthetic stem and perforations of the cortex. The incidence in our patient material in 2.3% after total hip arthroplasty and 2.9% after revision. Operative treatment may consist in osteosynthesis with compression plates, screws, or cerclage wires with or without revision of the arthroplasty. We give a case report covering treatment and 2-year follow-up for a bilateral proximal femoral fracture in a 72-year-old farmer with bilateral total hip replacements. Both fractures were treated similarly, with replacement of the femoral components by a cementless Wagner revision stem prosthesis and cerclage wiring of the fragments. No classic osteosynthesis was required to manage the fractures.

Aged↗

PubMed1991

[Osteonecrosis following short-term, high-dosage steroid therapy].

Osteonecrosis of the femoral head is one of many well documented side effects of long term steroid (glucocorticoid) use. Studies have reported on the skeletal effects of short term, high dose steroid therapy. This paper illustrates that short term (up to 6 weeks), high dose steroid therapy, utilized in neurotraumatology or central nervous system disease, can lead to necrosis of bone at multiple sites. This retrospective review of 6 patients supports the 18 previously reported cases: there were 5 male and one female patient, with a mean age of 32.2 years. The patients received an average dose of 5100 mg methylprednisolone for 23 days. The average interval between steroid administration and the onset of symptoms was 28 months. There was radiographic evidence of osteonecrosis of both femoral heads in all 6 patients. The female patient also had osteonecrosis of both humeral heads and both femoral condyles. Five of twelve hip joints were healed by intertrochanteric osteotomy and revascularization. One patient underwent total hip replacement. We were unable to find risk factors in these 6 patients which would make them susceptible to belated osteonecrosis of the femoral head. It is reasonable to conclude that there is a substantial risk of osteonecrosis in patients treated with high dose steroids even on a short term basis.

Adult↗

PubMed1991

Long-term results of tibial plafond fractures treated with open reduction and internal fixation.

In this study a series of 41 consecutive cases of operatively treated fractures of the tibial plafond was retrospectively analysed. The fractures were classified into types I (9.75%), II (41.5%) and III (48.75%) as defined by Rüedi. The 10-year average follow-up revealed 66% good and 24% fair objective results overall. The recent literature uniformly reports good results in operatively treated type-I and -II fractures. In this series, these essentially low-velocity injuries resulted in a satisfactory outcome in 86% of cases. Controversy exists in reports of operative treatment of type-III fractures. The incidence of satisfactory results in the present series in type-III fractures was 95% good and fair results, which appears to be better than in other authors' experience. This can be partially explained by the relatively few high-velocity injuries (50% of the type-III fractures) and also by certain technical procedures used in surgery to stabilise these fractures. The initial type of fracture and articular cartilage damage are directly related to late arthrosis. There is clear evidence that the quality of reduction correlates with later development of arthrosis. However, anatomical reduction may still be followed by significant joint arthrosis because of articular cartilage damage. Severe arthrosis present at late follow-up did not correlate with poor subjective or objective results. With adequate open reduction and internal fixation, satisfactory results can be obtained in severe tibial plafond fractures. Meticulous soft tissue care and handling at surgery are important. Various fixation devices may need to be incorporated to ensure optimal soft tissue status for fracture healing.

Adult↗

PubMed1991

Four-part valgus impacted fractures of the proximal humerus.

There is a specific type of displaced four-part fracture of the proximal humerus which consists of valgus impaction of the head fragment; this deserves special consideration because the rate of avascular necrosis is lower than that of other displaced four-part fractures. Using either closed reduction or limited open reduction and minimal internal fixation, 74% satisfactory results can be achieved in this injury.

Adult↗

PubMed1991

The acetabular rim syndrome. A clinical presentation of dysplasia of the hip.

The acetabular rim syndrome is a pathological entity which we illustrate by reference to 29 cases. The syndrome is a precursor of osteoarthritis of the hip secondary to acetabular dysplasia. The symptoms are pain and impaired function. All our cases were treated by operation which consisted in most instances of re-orientation of the acetabulum by peri-acetabular osteotomy and arthrotomy of the hip. In all cases, the limbus was found to be detached from the bony rim of the acetabulum. In several instances there was a separated bone fragment, or 'os acetabuli' as well. In acetabular dysplasia, the acetabular rim is subject to abnormal stress which may cause the limbus to rupture, and a fragment of bone to separate from the adjacent bone margin. Dysplastic acetabuli may be classified into two radiological types. In type I there is an incongruent shallow acetabulum. In type II the acetabulum is congruent but the coverage of the femoral head is deficient.

Acetabulum↗

PubMed1991

[Malunited juvenile fractures in pelvic and hip area].

Fractures of the hip and pelvis are rare in the growing skeleton. Conversely, they are complicated by morphological and functional abnormalities in a particularly high percentage of cases. We present a review of posttraumatic structural abnormalities and their consequences. In addition to the common presentations, less well-known abnormalities and their possible treatments are discussed.

Acetabulum↗

PubMed1991

[Arthritis following osteosynthesis of supra-/intercondylar femoral fractures].

Of 104 supra-/intercondylar femur fractures in adults (AO/ASIF Classification types A 1-3 and C 1-3), who were treated by open reduction and internal fixation from 1975 to 1985 59 fractures in 57 patients could be traced and reviewed clinically and radiographically after a mean follow-up period of 5 years and 7 months (range: 2-11 years). Among these, 47 knees/patients without preexisting knee-joint pathology were analyzed for the development of degenerative arthritis. The incidence for grade 2 and 3 changes in the femoropatellar compartment were 23% for supracondylar fractures (A type) and 62% for intercondylar lesions (C type). In the femorotibial compartment the incidence for supracondylar fractures was 38% and 23% for intercondylar fractures. In 93% of the patients the arthritic changes were radiographical findings, which did not cause relevant symptoms. The development of radiographical degenerative changes depends mainly on the type of the fracture; it is favoured by axial malalignment of more than 5 degrees of varus or valgus and local complications.

Adolescent↗

PubMed1991

The antishock pelvic clamp.

Unstable posterior pelvic ring disruptions are frequently accompanied by severe venous bleeding and hypotension. Mechanical stabilization has been shown to help reduce such blood loss. A new external fixator called an antishock clamp provides direct reduction and compression of such fracture-diastases about the sacroiliac joint. It is used acutely to rapidly stabilize the posterior pelvic ring in hypotensive patients. The simplicity of design allows the device to be applied in less than ten minutes in the emergency room. Most importantly, it does not interfere with the ability to carry out subsequent laparotomy or other required procedures. Although more clinical experience is needed, the clamp has provided hemodynamic stabilization accompanying fracture reduction. The device is not expected to be of benefit in the cases with significant bleeding of arterial origin.

Adult↗

PubMed1991

[Cervico-acetabular impingement after femoral neck fracture].

Six cases of femoral neck-acetabular impingement following fracture of the femoral neck are reported. To our knowledge, this complication has not previously been described in the literature. A bony prominence at the level of the former fracture site following primary or secondary valgus position of the femoral head showed a conflict with the acetabular rim causing pain and limited motion. In four patients this impingement was posterior, between the femoral neck and the acetabulum in extension with external rotation, and in two patients it was anterior in flexion with internal rotation. A detailed description of the symptoms, diagnostic procedures and treatment options is presented.

Acetabulum↗

PubMed1990

Biological internal fixation of fractures.

Trauma centers treat more and more patients who have sustained multiple injuries during high energy accidents. The techniques of internal fixation of such fractures may be dictated by the concomitant soft tissue trauma, rather than by the bony injury. Three stages of soft tissue injuries are recognised: Stage I delineates compromised soft tissues which may be treated with standard techniques of internal fixation, provided that further devialization by surgery is avoided. Stage II implies partial, non-circumferential destruction of soft tissues, requiring alternative techniques of internal fixation to prevent (mainly septic) complications. In stage III, the soft tissues about the fracture site are destroyed and need early, specific soft tissue reconstruction. Indirect reduction without further devascularization of bone, aiming at perfect alignment rather than anatomical reduction of extraarticular fractures, optimal rather than maximal internal fixation as well as the inclusion of soft tissue reconstructive procedures into the armamentarium of the orthopaedic surgeon, require an intellectual and technical reorientation but can be shown to improve the results of the treatment of fractures with concomitant soft tissue injury.

Bone Plates↗

PubMed1990

[Peri-acetabular reorientation osteotomy].

A new technique to plan and perform a reorientation pelvic osteotomy around the hip joint in adolescents and adults is described. Planning is based on 3-dimensional reconstruction of the hip joint. The operation is simulated by computer before surgery to find the correction angles which optimize alignment both quantitatively (amount of femoral head covered) as well as qualitatively (joint congruency). These angles are then utilized at the time of surgery. A Smith-Petersen approach is always used to perform the osteotomy. The pelvic ring is not displaced, but nevertheless the acetabular fragment can be tilted without limitation around all 3 axes. Furthermore, linear displacement permits medialization of a lateralized hip joint. Stability is obtained by simple screw fixation. The posterior column remains mechanically intact, and thus no cast is required. Since 1984, about 200 peri-acetabular osteotomies have been performed. The success of correction was evaluated on plain radiographs using A P and "false profile" views as well as by CT. Conventional radiographs showed fully normalized VCE (Wiberg) and VCA (de Sèze and Lequesne) angles and well-centered joints on the CT-based reconstructions. Four types of complications occurred: there were 2 cases with intra articular extension of the osteotomy; 1 transient femoral neuropraxia; 2 non-unions and 4 cases with ectopic ossifications which limited motion of the joint. The latter problem appear to have been eliminated by the administration of prophylactic indomethacin. Symptomatic fixation screws had to be removed after union in 13 cases.

Acetabulum↗

PubMed1990

Pauwels osteotomy for nonunions of the femoral neck.

The concept of the Pauwels osteotomy seems to be a valuable method of treating nonunions of the femoral neck. If there is concomitant avascular necrosis, the involved area should be small and the patient younger than 60 years old.

Adolescent↗

PubMed1990

[Partial femur head necrosis in adults--results with intertrochanteric osteotomy and revascularization].

Osteotomy and revascularization have both been used for many years in the therapy of partial aseptic necrosis of the femoral head in the adult. We first attempted a combination of the two techniques in 1978. Stress on the necrotic sector was relieved by intertrochanteric osteotomy, and the necrotic part of the bone was revascularized with a pedicled iliac crest bone graft based on the deep circumflex iliac vessels. Long-term results are now available in 45 hips in 38 patients, with a mean follow-up time of 32 months. Clinically, 71% of the hips were rated very good or good, and among those classed as stage II before surgery the results were rated as very good or good in as many as 90%. Subjective evaluation of the hips by the patients confirmed these results: 85% of the hips were judged to be optimal or markedly improved compared with before operation. Radiological evaluation showed further flattening of the femoral head in one case. A segmental collapse of the femoral head, i.e. stage III lesion according to Ficat, occurred in 2 hips with stage II preoperatively. In 6 hips with stage III necrosis preoperatively secondary arthritis developed. Computerized tomograms taken of all 25 hips from which metal implants had been removed showed signs of integration of the graft in 68%. Scintigraphy with 99-Tc-diphosphonate showed a homogeneous uptake in 42.8% and a non-homogeneous uptake in the remaining 57.2% of the cases. So-called photopenia was not observed in any of the hip joints treated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1990

[Femoral fractures following total hip prosthesis].

Fractures of the ipsilateral femur after hip arthroplasty are a serious problem. In most cases, minimal trauma is responsible for the fracture. Predisposing factors, such as severe osteoporosis, loosening of the stem of the prosthesis, or cortex perforations, are often found. Such fractures occurred between 1979 and 1989 in 30 patients, i.e. 2.3% of our patients who had received primary prosthesis and 2.9% of those who had undergone revision. The patients' ages at the time of fracture ranged from 41 to 88 years (mean 63 years), 33% of the patients in these group being female. The time lapse from implantation of the prosthesis to the fracture varied between 1 month and 11 years (mean 4.4 years). The fracture was at the level of the proximal trochanteric region in 3% of these patients, between the trochanteric line and the tip of the prosthesis in 20%, and below the tip of the prosthesis in 70%. Operative treatment was performed in 29 patients. Fractures were fixed with a compression plate in 19 (63%), and in 3 the plate fixation was reinforced with intramedullary cement. In 2 osteoporotic patients with supracondylar fractures the osteosynthesis ruptured and a successful revision operation with cement was performed. In 3 others internal fixation was combined with replacement of the prosthesis; 3 patients received a Wagner revision prosthesis and 1 a long-stem Protek tumor prosthesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1990

[Multiple recurrence of tibial fracture].

After a historical review of the term refracture and the related nomenclature, three cases of multiple refracture of the tibia are presented. Radiological findings confirm that the major etiology in refracture is bone necrosis as a result of vascular damage caused by the initial trauma and/or the surgical maneuvers performed to treat it. Normal loads then lead to microfractures of the avascular bone, which is unable to provide adequate substitution or remodelling. In our three cases not only was the periosteal blood supply diminished, but also the medullary canal was narrowed or closed at the fracture site by bone fragments and/or poorly vascularized new bone formation. These pathogenetic findings are supported by experimental studies. Part of the logical therapeutic concept is the opening of the medullary canal and closed medullary nailing. Although reaming and intramedullary rod placement causes transient circulatory disturbances in the inner diaphyseal cortex, this allows restoration of the medullary vascular network. Bone perfusion of the refracture zone is thereby improved and definitive consolidation can take place, as shown in our three cases.

Adult↗