PubMed Health⌕ Search

Biomedical subjects

S Pechlaner

Publications and source records attributed to S Pechlaner.

At least 19 recordsLinked to original sources
PubMed2005

Sagittal wrist motion of carpal bones following intraarticular fractures of the distal radius.

Forty patients (mean age, 37 years) with intraarticular C2 and C3 Colles fractures were treated by open reduction, internal fixation and bone grafting. At a mean follow-up of 8 years radiocarpal and midcarpal motion was evaluated, the depth of the articular surface of the distal radius in the sagittal plane was measured and the presence of arthritis was noted. The fractures healed with a mean palmar tilt of 6 degrees , a mean ulnar tilt of 18 degrees and ulna variance within 1 mm of the contralateral side. The depth of the articular surface of the distal radius was 1.3 mm greater than the uninvolved side. Measurement of carpal bone angles relative to the radius in maximum flexion and extension revealed lunate extension of 23 degrees , lunate flexion of 15 degrees , capitate extension of 62 degrees , capitate flexion of 40 degrees . There was a significant correlation between articular surface depth and radiocarpal motion.

Adolescent↗
PubMed2005

Delayed single Kirschner wire compression technique for mallet fracture.

Twenty-four mallet fractures which involved at least one third% of the articular surface of the distal interphalangeal joint were treated by open reduction and internal fixation using a single double-ended Kirschner wire at a mean of 9 days after injury (range 4-15). At a mean follow-up of 43 (range 12-18) months the active range of motion, pain and the Warren and Norris criteria were evaluated. The mean active range of motion was from - 2 degrees extension (range 0-10 degrees ) to 72 degrees flexion (range 50-90 degrees ). Nineteen patients were pain free and five suffered from mild pain during strenuous work. The Warren and Norris results were successful in 22 and improved in two cases. Radiographs showed, that all the fractures united in a near-anatomic position but with joint narrowing in six digits.

Adolescent↗
PubMed2005

Cortical motor activation patterns following hand transplantation and replantation.

We studied cortical activation patterns by functional MRI in a patient who received bilateral hand transplantation after amputation 6 years ago and in a patient who had received unilateral hand replantation within 2 hours after amputation. In the early postoperative period, the patient who had had the hand transplantation revealed strong activation of a higher motor area, only weak activation of the primary sensorimotor motor cortex and no activation of the primary somatosensory cortex. At 1-year follow-up, a small increase in primary sensorimotor motor cortex activation was observed. Activation of the primary somatosensory cortex was only seen at the 2 year follow-up. By contrast, after hand replantation, the activation pattern was similar to that of the uninjured hand within 6 weeks. This included activation of the primary sensorimotor motor cortex, higher motor areas and primary somatosensory cortex. Transplantation after long-standing amputation results in cortical reorganization occurring over a 2-year period. In contrast, hand replantation within a few hours preserves a normal activation pattern.

Adult↗
PubMed2005

[Therapy for static scapholunate instability -- reconstruction of the dorsal part of the scapholunate ligament with a periosteal flap of the iliac crest].

Recurrent instability is frequent following capsulodesis, tenodesis, or ligament reconstruction in static scapholunate instability. Therefore a periosteal flap of the iliac crest was designed to reconstruct the dorsal part of the SL ligament, which is known to be the biomechanically strongest portion and also the axis of rotation between the scaphoid and lunate. Biomechanical testing of ten fresh frozen dorsal SL ligaments and ten periosteal flaps of the iliac crest showed similar properties concerning failure force, failure displacement, failure stress, energy to failure and stiffness. Results of eight specimens in each group were available following successful testing. Failure force of the dorsal SL ligament was 171.8 N (SD 44.2), energy to failure amounted 269.1 N-mm (SD 98.9), failure stress was 10.3 N/mm (2) (SD 1.3), failure displacement 2.9 mm (SD 0.4), and stiffness 77.2 N/mm (SD 21.4). Testing of the periosteal flap gave the following values: failure force 144.3 N (SD 38.7), energy to failure 217.9 N-mm (SD 85.0), failure stress 9.9 N/mm (2) (SD 1.7), failure displacement 3.0 mm (SD 0.4) and stiffness 60.5 N/mm (SD 14.7). In addition to these test values, clinical and radiological data of eleven patients were available following reconstruction of the dorsal SL ligament with a periosteal flap of the iliac crest. The interval between trauma and surgery was 15 months, mean follow-up was 29 months. One patient was free of pain, whereas ten mentioned pain during or following strenuous work. Two patients were completely satisfied, nine complained about some restriction during special activities. Active range of motion amounted to 56 degrees extension, 46 degrees flexion, 17 degrees radial abduction, 30 degrees ulnar abduction. Grip strength was 38.5 kg, which was 79 % of the contralateral side. Radiological evaluation demonstrated a correction of the static instability in nine cases. In two patients recurrence of static instability was obvious. The prerequisite for success of the procedure is the easy reduction of the carpals. In cases of a fixed rotatory subluxation of the scaphoid, the technique cannot maintain the reduction.

Adult↗
PubMed2004

Dorsolateral dislocation of the proximal interphalangeal joint: closed reduction and early active motion or static splinting; a retrospective study.

INTRODUCTION: In a follow-up examination 50 patients who had sustained dorsal dislocations of the proximal interphalangeal (PIP) joint, the results of two conservative therapy regimens, either immobilisation or early motion, were investigated. The patients were assigned randomly. The inclusion criteria were: adult patients over the age of 18 with isolated, acute, closed dorsolateral dislocation of the PIP joint. MATERIALS AND METHODS: In group A, 25 patients were treated by closed reduction and immobilisation with a short-arm cast including both interphalangeal joints for 4 weeks. In group B, 25 patients were treated by dorsal block splinting of the PIP joint following reduction. The finger was released in extension with daily active exercise of the PIP joint. RESULTS: In group A, 9 patients showed a normal range of motion, whereas a limitation of extension of 10 deg and more was seen in 16 patients. All PIP joints were clinically stable, and 19 patients were satisfied. Two patients complained of a limitation of extension, 3 of limitation of extension and pain, and 1 of pain and swelling. In group B, only 2 of 25 patients showed a limitation of extension of 10 deg and more, whereas 23 patients showed a normal range of motion. Instability of one collateral ligament was seen in 2 cases. Palmar instability did not occur, and 18 patients were satisfied. One patient complained of instability, pain and lack of extension during hard work, 1 of pain in combination with instability, 2 of pain and 3 of swelling of the joint. CONCLUSION: Early active motion after dorsolateral dislocation of the PIP joint produces significantly superior results regarding the active range of motion and pinch power than static splinting.

Casts, Surgical↗
PubMed2004

Dorsal scapholunate ligament reconstruction using a periosteal flap of the iliac crest.

INTRODUCTION: To report a new technique for scapholunate ligament reconstruction, using a periosteal flap of the iliac crest. MATERIALS AND METHODS: In 12 patients with static SL instability, a periosteal flap was harvested from the anterior portion of the iliac crest. Following repositioning of the carpals, the flap was fixed to the scaphoid and lunate between an incompletely osteotomised scale at the dorsal horn of the scaphoid and lunate. Pin fixation of the scapholunate (SL) and CL interval secured postoperative reduction for 8 weeks. A forearm plaster cast was worn for 12 weeks. RESULTS: Eleven patients, all male, were available for follow-up at an average of 29 months. The interval between trauma and surgery averaged 15 months. The preoperative SL angle measured 77 deg, CL angle was -10 deg, and SL gap amounted to 5.2 mm. At follow-up, SL angle was 59 deg, CL angle measured -2 deg, and SL gap was 2.1 mm. SL gap, SL angle, and CL angle improved significantly from preoperative to follow-up values. According to the clinical grading system of Green and O'Brian, 6 patients scored in the excellent and good category and 5 in the fair category. Using the radiologic grading system of Gickel and Millender, 9 patients scored as excellent and good, whereas the 2 poor results were due to failure of the technique. CONCLUSION: The technique enables reduction of the SL angle and SL gap in patients with static reducible scapholunate instability. The initial results are quite encouraging.

Bone Transplantation↗
PubMed2004

Anatomical basis for functional treatment of dorsolateral dislocation of the proximal interphalangeal joint.

Dorsolateral dislocation of the proximal interphalangeal (PIP) joint is a common injury to the hand. Closed reduction of the dislocation anatomically realigns the avulsed ligaments; thus patients may be managed non-operatively. Standard treatment involves placement of a dorsal splint to prevent hyperextension and lateral stresses. This allows early active motion of the PIP joint while preventing a flexion contracture. In this fresh cadaver study, the PIP joint in 24 fingers was dorsolaterally dislocated. Four digits had to be excluded from the investigation due to a fracture dislocation with a bony fragment of >40% of the articular surface of the middle phalanx. After closed reduction, seven digits were further studied using the cryosection technique described by Kathrein et al. (1996, Clin. Anat. 9:227-231) to demonstrate the position of the avulsed palmar plate. In another 13 joints, the torn ligaments were examined by gross dissection. In 10 degrees of finger flexion, the avulsed palmar plate lay at its previous attachment to the base of the middle phalanx. The collateral ligament, ruptured at its attachment to the side of the head of the proximal phalanx, returned to its original position and was not interposed in the joint. The split between the collateral ligament and the accessory collateral ligament was also closed. Our data suggest that the ligamentous structures of the PIP joint, namely the palmar plate and collateral ligaments, typically return to their anatomic positions upon simple closed reduction of dorsolateral dislocations in fresh cadavers.

Aged↗
PubMed2004

Bilateral hand transplantation: bone healing under immunosuppression with tacrolimus, mycophenolate mofetil, and prednisolone.

PURPOSE: Little is known about bone healing after composite tissue transplantation that requires pharmacologic immunosuppression. Bone integration and callus development were assessed in bilateral hand transplantation. METHODS: In this study the course of callus development and callus maturation were assessed by color Doppler sonography and radiography in a double hand transplant and compared with forearm replantation. RESULTS: After hand transplantation, ingrowth of small vessels at the bone junction was observed at week 3, calcified callus became visible at month 4, and bone union was completed at month 11. A similar time course of bone integration was observed after replantation. Plating offered sufficient stability. A recipient periostal flap is thought to have improved blood supply and favored development and induction of callus. CONCLUSIONS: Bone healing after hand transplantation under immunosuppression with tacrolimus, mycophenolate mofetil, and prednisolone is identical to that after forearm replantation.

Amputation, Traumatic↗
PubMed2003

Scapholunate ligament reconstruction using a periosteal flap of the iliac crest: a biomechanical study.

INTRODUCTION: Advances continue to improve direct reconstruction of the dorsal scapholunate (SL) ligament, which is the strongest part of the entire SL ligament and is known as the turning point between the scaphoid and lunate. This study was designed to compare the biomechanical properties of the dorsal SL ligament with those of a periosteal flap of the iliac crest, which is a new graft candidate for dorsal SL reconstruction. MATERIALS AND METHODS: A bone-ligament-bone complex was harvested for biomechanical testing from the iliac crest and the dorsal SL complex. Ten specimens could be prepared in each group. After potting the bone blocks in methylmethacrylate for stable fixation, the specimens were tested, using a servohydraulic testing system, at a rate of 10 mm/min. RESULTS: Failure displacement, failure force, failure stress, energy to failure, and stiffness were assessed for both groups. Eight specimens in each group were tested successfully. In the ligament group, six specimens failed at the ligament level, whereas two failed at the insertion of the scaphoid. In the periosteum group, all eight specimens failed at the ligament level. The failure force of the dorsal SL ligament averaged 171.8 N, failure stress was 10.3 N/mm2, and failure displacement amounted to 2.9 mm. Energy to failure was 269.1 N-mm, and stiffness averaged 77.2 N/mm. Failure force of the periosteal flap amounted to 144.3 N, failure stress was 9.9 N/mm2, failure displacement was 3.0 mm, and energy to failure was 217.9 N-mm. Stiffness of the periosteal flap measured 60.5 N/mm. Comparison of the dorsal SL ligament and the periosteal flap of the iliac crest revealed no significant biomechanical differences. CONCLUSION: Therefore, the biomechanical properties of the periosteal flap recommend its use for reconstruction of the dorsal SL ligament.

Biomechanical Phenomena↗
PubMed2003

Functional outcome with special attention to the DASH questionnaire following callus distraction and phalangization of the thumb after traumatic amputation in the middle one-third.

INTRODUCTION: Aim of this retrospective study was to obtain a functional outcome following callus distraction and phalangization of the thumb after traumatic amputation in the middle one-third. MATERIALS AND METHODS: From January 1998 to June 2001, 12 patients were treated in a staged procedure starting with corticotomy and continuous distraction (1 mm/day) of the first metacarpal bone using a unilateral external fixator device. After distraction until day 31 (range 25-35 days), the first metacarpal bone was stabilized with a plate, and phalangization was performed. RESULTS. At follow-up 1 year after surgery, the thumb was lengthened to 25-35 mm (average 28 mm) in all but 1 patient. In 1 patient a bone graft from the iliac crest had to be interposed. Pinch grip improved by 45%; grip strength improved by 55%. The function/symptom score from the DASH questionnaire was 25 points (range 16-38 points). In a 'pick-up test' all patients were able to pick up a pencil, they were able to write and could hold a full cup of water. Nine patients were able to pick up a paper clip, and 8 patients could hold a 1-liter bottle of water. CONCLUSION: Callus distraction can be considered a suitable procedure to reconstruct an amputated thumb levelled at the middle one-third. Additional phalangization proved essential as it deepened the first web space, enabling good motion and grasp. Callus formation was delayed in elderly patients, but adequate lengthening and bone healing also occurred in this age group. The procedure will not be as beneficial in cases of osteoarthritis of the trapezometacarpal joint or when coverage of the stump is insufficient. The DASH questionnaire is very helpful in evaluating the effect of thumb reconstruction on the entire upper limb.

Adolescent↗
PubMed2003

[Long-term results after a modified Sauvé-Kapandji procedure. Report on 105 post-traumatic cases].

A modified Sauvé-Kapandji procedure was performed on 105 patients for a painfully limited range of motion and arthritis of the distal radioulnar joint following distal fracture of the radius ( n=81), the radius and ulna in the distal one-third ( n=18) and of the forearm shaft ( n=6). After an average of 8 years all patients were followed up clinically (motion, strength, pain) and radiographically (union of the arthrodesis, carpal translation, radioulnar distance). Rotation of the forearm had been improved by 53%. The amount of strength lay by 70% in comparison to the contralateral side. In 97% of the patients pain could be reduced. In all cases the arthrodesis had fused completely. An ulnar drift of the carpus was observed in 5% of the patients, and 74% of the patients showed radiological signs of approximation of the proximal ulnar stump to the radius. This reduction of the radioulnar distance amounted to less than 3 mm in 65% of the patients and lay between 3 and 5 mm in 29% of the patients. In none of the cases was direct contact between the ulna and the radius encountered.

Adult↗
PubMed2003

Closed reduction transarticular Kirschner wire fixation versus open reduction internal fixation in the treatment of Bennett's fracture dislocation.

Thirty two patients with fracture dislocations of the base of the thumb metacarpal with a single large fracture fragment (Bennett's fracture) were either treated by open reduction and internal fixation or closed reduction and percutaneous transarticular Kirschner wiring. All were assessed at a mean follow up of 7 (range 3-18) years. Patients with an articular step off more than 1mm were excluded. The type of treatment did not influence the clinical outcome or the prevalence of radiological post-traumatic arthritis. The percutaneous group had a significantly higher incidence of adduction deformity of the first metacarpal. This was attributed to Kirschner wire placement near the fracture line or in the compression zone of the fracture, resulting in loss of reduction. This however did not result in an inferior outcome.

Adult↗
PubMed2003

[Clinical long-term outcome after Kapandji-Sauvé procedure].

PURPOSE: The present study was designed to evaluate long-term outcome of upper extremities and subjective self-assessment of patient disability after a Kapandji-Sauvé procedure by means of the DASH score. PATIENTS AND METHOD: Between 1986 and 1996, a modified Kapandji-Sauvé procedure was performed in 117 patients with painfully limited forearm rotation and arthrosis of the distal radioulnar joint (DRUJ). Of the 117 patients, 73 women and 32 men, whose ages at operation ranged from 22 to 74 years (average, 58 years) were retrospectively reviewed clinically and radiologically eight years (range, five to twelve years) after the operation. The DASH questionnaire was used in 43 patients. RESULTS: The mean DASH score was 28 points (range, 0 to 53 points). The mean score in part A was 1.9 points, in part B 1.8 points. Worst outcomes were noted for activities requiring the exertion of force. Pain was reduced in 97 % of the patients. Forearm rotation and grip strength improved in all patients. CONCLUSION: Our clinical findings suggest that the Kapandji-Sauvé procedure is indicated in symptomatic, non-reconstructable disorders of the DRU-joint with or without ulnocarpal impaction syndrome. The DASH questionnaire provides a general view of functional outcome after the Kapandji-Sauvé procedure, though rotation is absolutely necessary to evaluate the success of the operation.

Adult↗
PubMed2002

Double hand transplantation: functional outcome after 18 months.

In March 2000, we performed a double hand transplantation on a patient who had suffered traumatic hand amputations 6 years previously. The transplantations were both successful and, 18 months later, the patient has regained some complex hand functions and remarkably good tactile gnosis.

Amputation, Traumatic↗
PubMed2002

Stage 3 Kienböck's disease: reconstruction of the fractured lunate using a free vascularized iliac bone graft and external fixation.

Eighteen patients with stage 3 Kienböck's disease were treated by débridement of the necrotic core of the lunate and implantation of a free vascularized corticocancellous iliac bone. The wrist was stabilized with an external fixator during healing. The efficiency of the procedure for restoring the structure of the fractured lunate, preventing carpal collapse and improving the clinical outcome was assessed at a mean follow-up of 5 years. The graft became incorporated in the lunate in 16 of the 18 patients and no fracture of the reconstructed lunate or carpal collapse occurred in these cases. The graft did not integrate and was resorbed in the other two patients.

Adolescent↗
PubMed2002

[Bilateral hand transplantation].

In March 2000 we performed a bilateral hand transplantation on a 47-year-old policeman who had lost both hands in a bomb accident. Although he was fitted with myoelectric prostheses, he kept investigating the possibility of hand transplantation. The ethical, surgical, medical, legal and human aspects of this special kind of reconstruction was discussed in a symposium in Vienna, and it was decided to go ahead with it if a suitable candidate presented. The operation was successful, the immunosuppressive regimen well-planned and carried out, the post-operative course without any remarkable events. Under intensive physical therapy, the patient gradually but steadily regained sensory and motor functions in his hands. Now, two years after the operation, the patient is practically independent in the activities of daily living and is able to work at his job.

Activities of Daily Living↗
PubMed2002

[Distal radius fractures and concomitant lesions. Experimental studies concerning the pathomechanism].

Since Colles (1814) first described a distal radius fracture and the publication by Dupuytren (1834), the frequency of and problems surrounding these fractures were increasingly recognised. Not only the treatment but also the formation and type of fracture were repeatedly analysed. The various theories concerning the pathomechanism led to names such as: "tear fracture", "bend fracture", "thrust fracture", "compression fracture", "snap fracture" and others. In our experimental studies we attempted to simulate the pathomechanism of distal radius fractures and present them pictorially. With the help of a materials testing machine, 63 prepared cadaver arms were hyperextended in the wrist joint until a radius fracture occurred. The concomitant lesions were registered radiologically and by dissection. Moreover, additional cadaver arms were deep-frozen and examined by means of computer tomography and cryosection according to Kathrein. Through experimental hyperextension it was possible to generate dorsal, central, and palmar types of fractures. We produced 42 dorsal, 14 central and 7 palmar fractures. Fundamentally, it seems that the fracture depends on the extent in which the carpal bones of the proximal row are pressed against the dorsal, central or palmar part of the articular surface of the distal radius. The subsequent dissection showed in 40 cases (63 %) mostly multiple concomitant lesions and in 23 cases (37 %) none of these. The reason for concomitant lesions may be the proportion of bone stability to the strength of ligaments. Most frequently (27 cases, i.e. 43 %), we found a destabilisation of the articular disk with or without a bony avulsion fragment (fracture of the ulnar styloid). We also commonly found ruptures of the interosseous ligaments between scaphoid and lunate (20 cases, i.e. 32 %) and lunate and triquetrum (11 cases, i.e. 18 %). It is difficult to apply knowledge gained from experimental studies on preserved cadaver arms clinically. There are of course no physiological reflexes and the slow fracture process must be taken into consideration. This holds true not only for concomitant lesions but also for the type of fracture. On the other hand, in these experimental studies it was possible to generate many realistic types of fractures with their concomitant lesions.

Biomechanical Phenomena↗