Biomedical subjects

René Grass

Publications and source records attributed to René Grass.

7 recordsLinked to original sources

PubMed2006

Reconstruction after talar fractures.

Malunited and nonunited talar fractures cause significant disability. Distinction between partial and total avascular necrosis (AVN) determines the choice of treatment. Patients who have minimal or no AVN and well-preserved joint cartilage may be amenable to corrective osteotomy through the malunited fracture or removal of the pseudoarthrosis. Secondary reconstruction with joint preservation leads to considerable functional improvement in painful talar malunions and nonunions in reliable patients. If symptomatic arthritis is present, arthrodeses and correction of deformity through the fusion or with additional osteotomies provide predictable results, although they do not restore normal foot function. Fusions should be limited to the affected joint. If the subtalar joint shows severe arthritic changes, every attempt should be made to salvage the ankle and talonavicular joints.

Fracture Healing↗

PubMed2005

[Tibiotalocalcaneal arthrodesis using a distally introduced femur nail (DFN)].

OBJECTIVE: Simultaneous arthrodesis of ankle and subtalar joints and, at the same sitting, correction of axial malalignment of hindfoot, treatment of bony defects and of sequelae of circulatory disturbances after multiple previous interventions. Internal stabilization with a short distal femur nail. Restitution of a pain-free weight bearing. INDICATIONS: Failure of arthrodesis of ankle and subtalar joint causing pain in patients with severely altered bone structures particularly at the level of the talar dome. Malalignment of hind- and/or forefoot after previous arthrodesis of ankle and subtalar joint. Failure of conservative therapy in both above-enumerated conditions. CONTRAINDICATIONS: Poor skin or soft-tissue conditions. Reflex sympathetic dystrophy. Acute osteitis/osteomyelitis. SURGICAL TECHNIQUE: Posterolateral approach. Resection of the articular cartilage and the areas of sclerosis of the ankle and of the posterior facet of the subtalar joint. Interposition of bone grafts harvested from the iliac crest. Correction of malalignment of hind- and forefoot. Locked nailing with a short distal femur nail. POSTOPERATIVE MANAGEMENT: Fitting of a flexible custom-made arthrodesis boot; weight bearing in boot not exceeding half of body weight until the 8th week. Gait training. After 12 weeks wearing of normal shoes. Radiographs after 6 and 12 weeks. RESULTS: Between February 1, 2002 and September 1, 2003 this technique was performed on 18 feet in 17 patients (three women, 14 men, average age 53 years [38.9-73.7 years]). Average duration of follow-up: 1.2 years (0.6-2.1 years). The goal of surgery was reached in all patients. Subjective assessment: 14 times good, three times satisfactory. Four complications: one loss of nail purchase, one dislocation of locking screw, one breakage of locking bolt, one prolonged bone healing.

Adult↗

PubMed2005

[Ankle arthrodesis after failed joint replacement].

UNLABELLED: Report of four patients. OBJECTIVE: Restoration of a painless gait through ankle arthrodesis after failed total ankle replacement. INDICATIONS: Loosened or infected total ankle replacement. CONTRAINDICATIONS: Poor general health. Absent patient compliance. SURGICAL TECHNIQUE: Removal of total joint components. Filling of the defect with tricortical bone grafts harvested from the ipsilateral iliac crest and internal fixation. In instances of suspected infection a two-stage procedure is recommended, the first stage consisting of a removal of the components, a meticulous debridement, and filling of the defect with gentamycin-laden PMMA beads. Second stage: arthrodesis. RESULTS: The goal of surgery was reached without complications in two out of four patients. An absence of bony bridging was noted in the fourth patient after 9 months. A revision adding cancellous bone grafts and resorting to an intramedullary fixation led to a success.

Adult↗

PubMed2005

[Ankle arthrodesis with four cancellous lag screws].

OBJECTIVE: Arthrodesis of the ankle at 90 degrees and perfect axial alignment for restoration of a painless function. Early functional postoperative care. INDICATIONS: Painful posttraumatic or idiopathic osteoarthritis of the ankle either unresponsive to conservative measures or where these measures are not expected to be successful. Posttraumatic malalignment of the ankle, paralysis or instability, that cannot be improved or eliminated by joint-preserving measures. Joint destruction after infection. Failure of total joint replacement. CONTRAINDICATIONS: Acute osteitis. Poor skin or soft-tissue conditions. Severe peripheral arterial occlusive disease. SURGICAL TECHNIQUE: Anterior approach, judicious resection of the remaining articular cartilage. Freshening of the zones of sclerosis. Preservation of the anatomic shape of the mortise. Correction of malalignments in the sagittal and frontal planes and placement of the talus in line with the tibial axis. Tibiotalar stabilization with four 7.3-mm self-cutting cannulated cancellous lag screws or with four 6.5-mm cancellous lag screws. RESULTS: Between January 1, 1994 and December 31, 1998 this technique was performed in 50 ankles of 48 patients. 40 patients could be followed up for an average of 5.6 years (4.8-7.6 years). No serious complications. The average compensatory movement of the Chopart joint amounted to 26 degrees . Osteoarthritis of the subtalar joint was seen in 13%, and of the talonavicular joint in 12.5% of patients. Preexisting osteoarthritis of these joints remained in general unchanged. The AOFAS Score was assessed pre- and postoperatively. Preoperatively, 17.5% of patients showed a satisfactory and 82.5% a poor score. Postoperatively, 52.5% had an excellent, 30% a good, 10% a satisfactory, and 7.5% a poor outcome.

Adult↗

PubMed2004

Arthrodesis of the ankle joint.

Arthrodesis of the ankle that uses lag screws for internal fixation is a safe and biomechanically stable method to obtain a solid ankle fusion; it generates good to excellent results in most patients. Prompt bone healing can be expected and allows a functional rehabilitation with full weight bearing. The surgical technique can be simplified further when using cannulated screws. Malalignment hazards while doing the ankle fusion are minimized by respecting the shape of the ankle mortise because no osteotomy of the lateral malleolus is performed. Generally, removal of the implanted material is not necessary. Major complications such as infection, stress fractures, or nonunion were not seen in our series. A meticulous resection of all cartilage and sclerotic bone and an atraumatic surgical technique are essential for preventing those major complications. The need for revision surgery is minimized by correction of talar malalignment, fusion with the ankle in a 90 degrees position, and preoperative evaluation of the subtalar joint. External fixation methods are used in cases of osteitis, osteonecrosis, osteoporosis, and poor soft tissue conditions. With severe loss of bone stock at the distal tibia, stability can be achieved by using an intramedullary nail for ankle fusion.

Ankle Joint↗

PubMed2004

Impact of helicopter transport and hospital level on mortality of polytrauma patients.

BACKGROUND: Despite numerous studies analyzing this topic, specific advantages of helicopter transport of blunt polytrauma patients as compared with ground ambulances have not yet been identified unequivocally. METHODS: Four possible pathways in 403 polytrauma patients (Injury Severity Score [ISS] > 16) who were in reach of the helicopter emergency medical service (HEMS) Dresden were analyzed as follows: HEMS-UNI group (n = 140), transfer by HEMS into a university hospital; AMB-REG group (n = 102), transfer by ground ambulance into a regional (Level II or III) hospital; AMB-UNI group (n = 70), transfer by ground ambulance into the university hospital; and INTER group (n = 91), transfer by ground ambulance into a regional hospital, followed by transfer to the university hospital. Scores used were the ISS and the TRISS. Tests used for statistical analysis included chi2 and Fisher's tests. Statistical significance was set at p > 0.05. RESULTS: Age, gender, and mean ISS (range, 33.3-35.6) revealed extensive homogeneity of the groups. Mortality of the AMB-REG group was almost doubled (41.2%) compared with HEMS-UNI (22.1%) patients (p = 0.002). The AMB-UNI group displayed the lowest mortality (15.7%, p = not significant). TRISS analysis (PRE-Chart) revealed identical outcome for AMB-UNI and HEMS-UNI patients. Rescue time averaged 90 +/- 29 minutes for HEMS-UNI patients, 68 +/- 25 minutes for AMB-UNI patients, and 69 +/- 26 minutes for the AMB-REG group. CONCLUSION: Primary transfer by HEMS into a Level I trauma center reduces mortality markedly. In principle, this benefit can be attributed to superior preclinical therapy, primary admission to a Level I trauma center, or both. However, the identical probability of survival of the AMB-UNI and HEMS-UNI groups in this and comparable studies does not confirm generally better survival rates on account of a more aggressive on-site approach.

Adult↗

PubMed2002

Ligamentous injuries about the ankle and subtalar joints.

Ligamentous injuries at the ankle and subtalar joint range from simple sprains to severe talar dislocations. While lateral ankle sprains are among the most frequently encountered injuries and do not pose a greater diagnostic problem, the surgeon must be suspicious not to overlook associated ligamentous injuries at the subtalar and midtarsal level that may result in chronic painful conditions. Syndesmotic instabilities with or without ankle fractures must be assessed carefully and treated properly, since these are prearthrotic conditions. In the treatment of chronic ankle or subtalar instability tenodeses provide mechanical stability while reducing subtalar mobility. Anatomic reconstruction methods therefore should be considered for both conditions.

Ankle Joint↗