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R W Poolman

Publications and source records attributed to R W Poolman.

7 recordsLinked to original sources
PubMed2005

Conservative treatment for closed fifth (small finger) metacarpal neck fractures.

BACKGROUND: Subcapital fractures of the fifth metacarpal bone, meaning fractures just below the knuckle of the little finger, account for approximately 20% of all hand fractures. Currently, there is no consensus concerning the optimal management of these fractures. Traditionally, treatment consists of closed reduction and external splinting in a neutral position using plaster of Paris (POP), involving the metacarpal joint, the proximal interphalangeal joint and the carpo-metacarpal joint. An alternative treatment strategy is functional treatment using taping or bracing that does not restrict movement. OBJECTIVES: To compare functional treatment with immobilization, and to compare different periods and types of immobilization, for the treatment of closed fifth metacarpal neck fractures in adults. SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialized Register (July 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004), OVID OldMEDLINE (1951 to 1965), OVID MEDLINE (1966 to July 2004), OVID MEDLINE In-Process (July 2004), EMBASE (1988 to 2004, week 29), the Internet, and reference lists of articles. No language restrictions were applied. SELECTION CRITERIA: All randomized and quasi-randomized controlled trials which compare functional treatment with immobilization or different types of immobilization for closed fifth metacarpal neck fractures. DATA COLLECTION AND ANALYSIS: Two review authors assessed abstracts of all studies identified by the initial search, identified studies meeting the selection criteria, independently assessed the quality of the trial reports, and extracted and analysed the data. MAIN RESULTS: Five studies met the inclusion criteria including a total of 252 participants. Most studies were of poor quality. The primary outcome measure, function of the hand, was not used in any studies. There was no evidence that any of the treatment modalities was statistically significantly superior. AUTHORS' CONCLUSIONS: No included studies reported our primary outcome measure of interest, validated hand function. There was heterogeneity between the studies, which were of limited quality and size. No single non-operative treatment regimen for fracture of the neck of the fifth metacarpal can be recommended as superior to another in result. Further research is definitely warranted.

Bandages↗
PubMed2003

Clinical outcome and radiographic results after surgical treatment of post-traumatic thoracolumbar kyphosis following simple type A fractures.

The surgical management of post-traumatic thoracolumbar kyphosis remains controversial. The need for combined procedures is subject to debate, especially for post-traumatic kyphosis after simple type A fractures. The aim of this retrospective study was to evaluate radiographic findings, patient satisfaction and clinical outcome after mono-segmental surgical treatment using an anterior procedure alone (group 1, n = 10 patients) and using a one-stage combined anterior and posterior procedure (group 2, n = 15 patients) for post-traumatic thoracolumbar kyphosis after simple type A fractures. The main indication for surgery was pain. There were no statistically significant differences between the patients in the two groups concerning age, cause of injury, time interval between trauma and surgery, preoperative kyphosis and preoperative back pain score. For all these 25 patients, complete follow-up data were available for retrospective evaluation. The median follow-up was 17 years in group 1 and 8 years in group 2. Radiographic documentation and classification was made on the basis of standing antero-posterior and lateral views and computed tomographic scans. Fractures were categorized according to the Magerl classification. Kyphotic deformity was assessed on lateral radiographs using the Cobb method. Kyphosis angles were measured preoperatively, directly postoperatively, and at final follow-up. For clinical evaluation, the back pain scoring system of Greenough and Fraser was used. Patients were requested to score their status prior to trauma, preoperatively and at follow-up. The Wilcoxon test was used for statistical analysis ( P < 0.05 is significant). In all cases radiographic union was achieved. Median kyphosis in group 1 was corrected from 23 degrees preoperatively to 12 degrees postoperatively ( P < 0.01) and was 11 degrees at follow-up. Median kyphosis in group 2 was corrected from 21 degrees pre-operatively to 12 degrees postoperatively ( P < 0.01) and was 12 degrees at follow-up. The median back score in group 1 changed from 66 points before the trauma to 23 points ( P < 0.01) preoperatively and 35 points at follow-up ( P < 0.01). The median back score in group 2 changed from 67 points before the trauma to 20 points ( P < 0.01) preoperatively and 38 points at follow-up ( P < 0.01). In group 2, four patients had complaints due to annoying prominence of the dorsal instrumentation. In all these cases the dorsal instrumentation was removed. Statistical analysis in this series of ten patients with anterior spondylodesis compared with 15 patients with combined one-stage spondylodesis did not reveal objective advantages of the combined procedure as far as the outcome of radiographic correction of kyphosis or patient outcome is concerned. It is therefore concluded that in cases of post-traumatic thoracolumbar kyphosis after simple type A fractures, mono-segmental correction using an anterior procedure alone, with spondylodesis, is the surgical procedure of choice.

Adolescent↗
PubMed2003

Anal fistulotomy between Skylla and Charybdis.

OBJECTIVE: This study was undertaken to assess the results of anal fistulotomy on faecal continence, recurrence and satisfaction. METHODS: We reviewed the records of 60 patients who underwent anal fistulotomy between 1997 and 2000. Follow-up was by a questionnaire with 46 (77%) patients responding. Mean follow-up was 1-4 years. Fistulas were intersphincteric in 12 patients and transsphincteric in 34 patients. Operative procedure consisted of fistulotomy. RESULTS: Of 11 patients with high fistula, 9 (82%) had impaired continence; Of 17 patients with midanal fistula, 4 (24%) suffered impaired continence. Eighteen patients had a low fistula and 8 (44%) developed impaired continence. In the whole group 50% had suffered faecal incontinence. There were no recurrences and there was satisfaction with the situation in 87% of patients. CONCLUSIONS: Fistulotomy for primary fistula in ano in this retrospective study with a follow-up up to 4 years was associated with no recurrences. Eighty-two percent of patients with a high anal opening have impaired faecal continence, nevertheless patients' satisfaction is high.

Adult↗
PubMed2002

Clinical outcome and radiographic results after operative treatment of Scheuermann's disease.

The aim of this prospective study was to evaluate radiographic findings, patient satisfaction and clinical outcome, and to report complications and instrumentation failure after operative treatment of Scheuermann's disease using a combined anterior and posterior spondylodesis. The loss of sagittal plane correction after removal of the posterior instrumentation was analysed. The indication for surgery was a thoracic kyphosis greater than 60 degrees in adolescents and adults with persistent back pain, which failed to respond to conservative treatment. Thoracic kyphosis and lumbar lordosis angles were measured by the Cobb method at preselected time points and at final follow-up. Sagittal plane alignment was measured as translation. The validated Scoliosis Research Society Instrument (SRSI) questionnaire was sent to all patients at follow-up. P-values were calculated using the Wilcoxon signed rank test (P<0.05 is significant). Between October 1987 and August 1999, 23 consecutive patients underwent operative treatment. The median follow-up was 75 months (range 25-126 months). Median preoperative thoracic kyphosis was 70 degrees (range 62 degrees-78 degrees) and median preoperative lumbar lordosis was 68 degrees (range 54 degrees-84 degrees). Immediate postoperative median thoracic kyphosis was 39 degrees (range 28 degrees-54 degrees) (P<0.05) and immediate postoperative median lumbar lordosis was 49 degrees (range 35 degrees-63 degrees) (P<0.05). These significant corrections were maintained at early follow-ups conducted 1 year and 2 years postoperatively. At final follow-up, the median thoracic kyphosis had significantly increased, to 55 degrees (range 36 degrees-65 degrees) (P<0.05 relative to immediate postoperative value), and the median lumbar lordosis had increased to 57 degrees (range 44 degrees-70 degrees) (P<0.05). The late deterioration of correction in the sagittal plane was mainly caused by removal of the posterior instrumentation, and occurred despite radiographs, bone scans and thorough intra-operative explorations demonstrating solid fusions. The median SRSI score was 83 points (range 55-106). There was no significant correlation between the radiographic outcome and the SRSI score (P>0.05). Our series showed relatively fair outcome after operative treatment in Scheuermann's disease. Therefore, the indication for surgery in patients with Scheuermann's disease can be questioned.

Adolescent↗
PubMed2002

[Insufficient health care capacity for patients requiring immediate admission; a prospective study in a general hospital in Amsterdam, March-November 2001].

OBJECTIVE: To gain insight into the shortage in health care capacity for patients who require immediate admission to hospital. DESIGN: Prospective, descriptive. METHOD: During the period 1 March-30 November 2001, data were collected on all patients presenting at the casualty department at the Sint Lucas Andreas Hospital in Amsterdam, the Netherlands, who had a surgical, internal medicine or neurological condition which required immediate admission and who could not be admitted due to a shortage in health care capacity. The following data were registered: date of transfer, age, gender, diagnosis, referring specialty, time of telephone call, accepting hospital and time of acceptance. During the same period, the surgery department also noted details of patients requiring immediate admission or transfer whom they turned away after presentation via the telephone by either the general practitioner or a different hospital. RESULTS: 131 patients could not be admitted, 68 men and 63 women with a mean age of 69 years. The distribution across the specialties was as follows: surgery: 63 patients (48%; mean age: 68 years); internal medicine: 48 patients (37%; 65 years); neurology: 20 patients (15%; 74 years). The most common reasons for admission were proximal femur fractures (24; 18%) and gastrointestinal disorders (27; 21%). Mean duration from making the telephone call until acceptance elsewhere was 70 min (range: 1-330) for surgery, 42 min (5-180) for internal medicine and 116 min (10-870) for neurology. The transfer of patients with proximal femur fractures (97 min) and cerebrovascular accident (129 min) took the longest. During the same period, 170 patients were refused by the department of surgery for first-time admission or transfer.

Aged↗
PubMed1999

Subtalar arthrodesis with correction of deformity after fractures of the os calcis.

We have reviewed the long-term results of 22 patients (23 fusions) with fractures of the os calcis, who had subtalar arthrodesis with correction of the deformity between 1975 and 1991. The mean follow-up was nine years (5 to 20). All patients were evaluated according to a modified foot score. A radiological assessment was used in which linear and angular variables were measured including the fibulocalcaneal abutment, the height of the heel and fat pad, the angle of the arch and the lateral talocalcaneal and the lateral talar declination angles. The technique used restores the normal relationship between the hindfoot and midfoot and corrects the height of the heel. This leads to better biomechanical balance of the neighbouring joints and gives a favourable clinical outcome. The modified foot score showed a good or excellent result in 51% of the feet. Residual complaints were mostly due to problems with the soft tissues. Subjectively, an excellent or good score was achieved in 78% of the cases. After statistical analysis, except for the height of the heel and the degenerative changes in the calcaneocuboid joint, no significant difference was found in the measured variables between the operated and the contralateral side.

Adult↗