Biomedical subjects

S Pechlaner

Publications and source records attributed to S Pechlaner.

At least 37 records · Page 2Linked to original sources

PubMed2001

Small free vascularized iliac crest bone grafts in reconstruction of the scaphoid bone: a retrospective study in 60 cases.

Carpal instability may result in progressive degenerative arthritis of the wrist. The surgical goal of the reconstruction of scaphoid nonunion is to achieve bone union and to restore the scaphoid. Many procedures are described to treat scaphoid nonunion for different indications. This retrospective study reports on the anatomical fundamentals, the operative procedure, and the results of 60 patients (21 with recalcitrant scaphoid nonunion that lasted longer than 4 years, 26 with an avascular pole fragment, and 13 with scaphoid nonunion after previous surgery) who were treated by a small free vascularized iliac crest bone graft. All 60 patients have routinely been followed up clinically and with magnetic resonance imaging. Union was achieved in 91.7 percent by improvement of stability and the compromised vascularity of the scaphoid. The bone flap loss rate and persisting nonunion was 8.3 percent, leading to progressive arthritis and carpal collapse. Complaints concerning discomforts caused by the scar were heard from 40.1 percent of the patients, and 31.7 percent complained of discomforts caused by the bony deformity. Bone deformations on the donor site were detected radiologically in 63.3 percent of the patients. In 31.7 percent, an impairment of the lateral femoral cutaneous nerve was noted. Reconstruction of the scaphoid by means of implantation of a vascularized iliac bone graft proved efficient to treat avascular recalcitrant scaphoid nonunion and pseudarthrosis with avascular proximal pole fragments.

Adolescent↗

PubMed2001

[Dorsal dislocation of the proximal interphalangeal joints of the finger. Results after static and functional treatment].

In a follow-up examination of 30 patients who had sustained dorsal dislocations of the PIP joint, the results of two conservative therapy regimens, either immobilisation or early motion were investigated. In Group A, 15 patients were treated by closed reduction and immobilisation with a forearm cast for four weeks. Nine patients showed normal range of motion, whereas a limitation of extension of ten degrees and more was seen in six cases. All PIP joints were stable. Nine patients were satisfied. Three patients complained of a limitation of extension, two of a limitation of extension and pain and one of swelling. In Group B, 15 patients were treated by dorsal block splinting of the PIP joint following reposition. The finger was released in extension with daily active exercise of the PIP joint. Only two of 15 patients showed limitation of extension, whereas 13 cases showed normal range of motion. Instability of one collateral ligament was seen in two cases. Palmar instability did not occur. Eleven patients were satisfied. One patient complained of instability, pain and lack of extension, one of pain in combination with instability, one of pain and one of swelling of the joint.

Adult↗

PubMed2000

The use of a graft from the second extensor compartment to reconstruct the A2 flexor pulley in the long finger.

A 10 mm wide ring graft from the second extensor compartment with periosteum from the floor of the sheath was used to correct bowstringing in six patients who sustained an isolated rupture of the A2 pulley. It was attached to the lateral rims of the sheath. Periosteum was used for additional graft fixation. Bowstringing was assessed by magnetic resonance imaging and ultrasound preoperatively and 19.5 months after surgery. It was corrected in five patients and improved in one. Pain was reduced from 35 to 7 points on a visual analogue scale. Digital circumference decreased from 76 to 71 mm. Flexion at the PIP joint increased from 88 degrees to 116 degrees. Pinch grip improved from 28 to 56 N.

Adult↗

PubMed2000

[Monteggia injuries in childhood].

The Monteggia-fracture dislocation is a characteristic combined injury of the forearm with fracture of the ulna and dislocation of the head of the radius. Monteggia- and equivalent injuries are rare. In the present study, we attempt to clarify the concept of therapy and observe the influence of this injury on the growth of the forearm bones. Between 1977 and 1996, 27 patients (three to thirteen years) with a Monteggia or a Monteggia-equivalent injury were treated. We present clinical and radiological long-term results of 20 patients, two to 21 years following the injury. Group I includes 12 patients with a classic Monteggia injury, five patients were treated conservatively, seven patients surgically. Ten patients were free of pain and had no loss of motion. In one patient there was a loss of pronation following an accompanying injury of the distal radius. Primary paresis of the radial nerve has a good prognosis. One patient presents a persisting dislocation of the radius head with a loss of flexion in the elbow joint, and a secondary persisting paraesthesia of the median nerve. Group II includes eight patients with a Monteggia-equivalent injury; all of them were treated surgically. The results in this group showed more loss of motion in elbow function, forearm rotation, and dislocation of the axis in the elbow joint. Monteggia and Monteggia-equivalent injuries in childhood have good functional results if correct reduction of the fracture of the ulna and the head of the radius is performed. If this is not possible conservatively, patients need open reduction and internal fixation.

Adolescent↗

PubMed2000

[Late sequelae of fractures of the distal third of the forearm during the growth period].

Fractures to the distal third of the forearm are the most common fractures of the upper extremity, with the majority occurring between the age of ten and 14 years. With the exception of the rare epiphyseal fractures, they have a favourable prognosis. The present study investigates the frequency and extent of potential clinical and radiological late sequelae of fractures in the distal third of the forearm during growth. Of the patients treated at the Innsbruck University Department of Traumatology from 1980 to 1992, 220 patients of a growing age with 232 closed fractures in the distal third of the forearm were followed up. The radius alone was affected in 60% of these cases; the radius and the ulna in 40%. Fractures of the ulna alone were not present. The mean age of the patients at the time of injury was nine years (range one to 16 years) and the mean time of follow-up ten years (range five to 16 years). In addition to the patient's subjective assessment, the right and left sides were compared with regard to mobility of the wrist and rotational movement of the forearm. Based on standard X-rays, the frontal (radio-ulnar) and lateral (dorso-palmar) radial joint angle as well as the difference in the radio-ulnar plane were compared with the contralateral side. Clinical and radiological findings were summarised into an overall result. 19% of the patients reported pain in the injured wrist. Mobility of the wrist in the sagittal and/or frontal plane was limited in 5% of patients and rotation of the forearm was limited in 16% of patients. A statistically significant accumulation of limited rotation was seen after physeal fractures of the ulna ("one-way" ANOVA-test, p = 0.0033). A difference between the left and right side in regard to the frontal radial joint angle was seen in 6% of patients and a difference in the lateral radial joint angle was registered in 2% of patients. A difference in the radio-ulnar plane was observed in 37% of patients. In the presence of relative ulna-plus variance, 75% of patients complained of pain in the ulnocarpal compartment of the wrist. In these patients, dynamic magnetic resonance tomography revealed a compression of the ulnocarpal disk between the proximal carpal bones and the head of the ulna, as well as degeneration in the central portion of the disk. The overall outcome was very good in 72%, good in 19%, moderate in 6% and poor in 3% of patients. The younger the children had been at the time of injury, the more favourable were the results (chi-square test, p = 0.009). Children older than ten years of age with an angulatory deformity of more than 20 degrees and/or fragment dislocation over half of the breadth of the shaft at fracture consolidation showed the poorest results. Further factors having a negative influence on the outcome were repeated reduction manoeuvres and an additional fracture of the ulna.

Adolescent↗

PubMed1999

[Integration of porous hydroxyapatite ceramic prosthesis at the distal radius in elderly patients. Radiological examination].

Between April 1994 and December 1995 14 patients (average age 56 (41-71) years, 13 women, one man) suffering from a fracture of the distal radius (Extensionsfracture, type 1B by Pechlaner, AO-classification A2 and A3) were treated by minimal invasiv procedure. The bone defect was substituted with hydroxylapatit ceramic. In a prospective study the osteointegration of the alloplastic bone graft was evaluated radiographically and on MRI. Up to week 12 X-ray revealed a radiolucenty around the allograft in all patients. After 6 months trabecular structure reached the alloplastic bone graft in 57% of the patients. After one year the surface of the hydroxylapatit ceramic was remodelled in 36% of the patients. At this time MRI examination with contrast agent demonstrated marginal integration of the alloplastic bone craft in 71%. X-ray follow up showed stageable integration of the porous hydroxylapatit ceramic. MRI examination demonstrated partial osteointegration. Hydroxylapatit ceramic was incorporated in radial metaphyse of elder patients without any complications.

Adult↗

PubMed1999

[Post-traumatic palmar instability of the thumb metacarpophalangeal joint. The "other skier's thumb"].

"Passive" and "active" stabilizers give the thumb metacarpophalangeal (MP) joint the necessary palmar stability. It is possible to temporarily stabilize the joint by means of the flexor muscles in cases where there is an injury to the palmar ligaments due to hyperextension trauma. However, sudden severe or prolonged strain may lead to palmar instability and/or stress-related pain. In an experimental study, the MP joints of 40 specimen thumbs were hyperextended to varying degrees. The extent of tissue damage was evaluated during dissection. Between 1984 and 1992, in 72 cases with acute hyperextension injury of the thumb MP joint, we X-rayed the thumb under stress during primary examination. Habitual instability was excluded by comparing X-ray films under stress of the opposite uninjured thumb. The treatment of the lesion depends on the degree of instability documented by the X-ray films. Experimentally, we found only partial lesions or ruptures with only slight dislocation of the ligament ends in cases where the MP joint was hyperextended up to 30 degrees. In cases with hyperextension of 60 degrees or more, there was usually a complete rupture of the ligaments or a fracture of the sesamoid bones with dislocation of the ligament ends as well as partial rupture of the thenar muscles. This injury pattern was also observed in clinical cases during surgery. Partial lesions of the palmar ligaments of the thumb MP joint can be treated conservatively with good results. In cases of complete palmar instability due to trauma, we saw better results after surgical reconstruction of the ligaments particularly in manual workers.

Athletic Injuries↗

PubMed1999

[Proximal scaphoid pseudarthrosis with avascular pol fragment: long-term outcome after reconstruction with microvascular pedicled iliac crest bone graft].

56 patients suffering from scaphoid nonunion with avascular necrosis of the proximal pole were treated by a free vascularized iliac bone graft. Follow-up examination of 27 patients at 8.8 years included evaluation of scaphoid nonunion, progression of arthrosis and clinical parameters. Union was achieved in 85% of the patients (Group A). Arthrosis remained unchanged in 75%. No carpal collapse occurred. 81% of the patients were painfree. Grip strength was 95% and range of motion 75% compared to the noninvolved wrist. Nonunion persisted in 15% (Group B). In all these patients carpal collapse had established. 66% of the patients showed mild pain. Grip strength was 71% and range of motion 65% of normal. Transplantation of a free vascularized iliac bone graft resulted in union of a scaphoid pseudarthrosis with avascular proximal pole in 85%. When union occurred, progression of degenerative arthrosis could be arrested and good clinical late results could be achieved.

Adolescent↗

PubMed1999

Vascularized bone graft from the iliac crest for the treatment of nonunion of the proximal part of the scaphoid with an avascular fragment.

BACKGROUND: It was hypothesized that nonunion of the proximal third of the scaphoid associated with avascular necrosis could be treated successfully with a free vascularized bone graft obtained from the iliac crest. METHODS: Fifteen patients who had a nonunion of the proximal part of the scaphoid that had been present for an average of two years and three months (range, nine months to seven years) were managed with use of a free vascularized bone graft obtained from the iliac crest. Avascularity of the scaphoid, as assessed on preoperative radiographs, was characterized by loss of trabecular structure, collapse of subchondral bone, and formation of bone cysts. The results of the procedure were assessed in terms of osseous union, pain, active motion of the wrist, and osteoarthritis. Postoperatively, vascularity of the scaphoid was evaluated with use of magnetic resonance imaging and color Doppler ultrasonography. The average duration of follow-up was six years and one month (range, two years and one month to eight years and one month). RESULTS: Preoperatively, one patient had had pain with any movement of the wrist and fourteen had had pain after strenuous manual labor or sports activity. The average pain score, derived with use of a 10-point visual analog scale, was 2.4 points (range, 1.0 to 6.7 points). Postoperatively, union was achieved in twelve patients; six were pain-free, and six had occasional pain during strenuous manual labor or sports activity, or both. The average pain score for these twelve patients was 1.1 points (range, 0.0 to 4.2 points) on the visual analog scale. Preoperatively, osteoarthritis was limited to the region between the radial styloid process and the distal part of the scaphoid in fourteen patients and to the radioscaphoid region in one patient. Postoperatively, the degree of osteoarthritis remained unchanged in seven of the twelve patients who had union and progressed to the radioscaphoid region in five. Vascularity, as seen on the imaging studies, was restored in all twelve patients who had union. The nonunion persisted in three patients, all of whom had progressive osteoarthritis leading to carpal collapse. CONCLUSIONS: The index procedure was successful in twelve of the fifteen patients who had a symptomatic nonunion of the proximal part of the scaphoid associated with avascular necrosis and osteoarthritis that was limited to the radioscaphoid joint.

Adult↗

PubMed1998

[Complex trauma of the hand].

The hand is very exposed to injuries in the daily man's work. The multiple functions of the hand are based on vitality, sensibility, motor function and stability. In severe hand injuries the functional results of the repair are often very poor. In a complex injury of the hand we are faced with the damage of the soft tissue and bone and the loss of vitality and function of the hand. The cause of hand injuries are mainly a crush trauma or the rotating saw. Basically, we recommend an extended primary repair. After the radical debridement we have to reconstruct the damaged structures. We start doing the osteosynthesis and stabilization of the joints. Thereafter, suturing of extensor and flexor tendons. Then, we do the microsurgical reconstructions of vessels and nerves. In case tendons and bones are exposed we have to cover the defect with a pedicled or a free flap. In a long ischemic time we have to change our concept and do the reconstruction of the vessels first. Our results in vitality and sensibility are listed. In the result of a complex hand injury each single functional restoration is very important. Therefore, it is necessary that severe hand injuries are treated at well established centres for hand surgery.

Accidents, Occupational↗

PubMed1998

[Distal, metaphyseal compression fractures of the radius. Results of open reposition, stable defect replacement with cortico-cancellous iliac crest bone and plate osteosynthesis].

Conservative treated distal radius fractures with extended metaphyseal void and missing cortical support resulted in loss of reduction. From 1988 till 1994 117 fractures of the distal radius were treated by open reduction, filling the metaphyseal void with a corticocancellous iliac bone graft and plate fixation. In this retrospective study results after surgical reconstruction were evaluated radiologically and clinically and were discussed to conservative treatment. 30 patients suffering from extraarticular metaphyseal distal radius fracture were evaluated after a mean of 42 months (minimum 20, maximum 68 months) after surgery. Ulnar variance was restored in 70% to the uninvolved side. Ulnar minus variance up to 2 mm persisted in 30%. Radial joint angles were restored to normal in 53%. In 40% of the patients a loss of reduction up to 10 degrees and in 7% up to 25 degrees occured. Active range of motion in the sagittal and frontal plane was equivalent to the non involved side in 30%. 70% of the patients showed reduced range of motion up to 20%. Rotation was unlimited in 77%, reduced up to 10% in 23%. Subjective results were excellent in 90%, good in 10%. Compared to conservative therapie, surgery showed superior results.

Adolescent↗

PubMed1998

The interosseous membrane and its influence on the distal radioulnar joint. An anatomical investigation of the distal tract.

From the interosseous membrane of the forearm a tract extends to the dorsal capsule of the distal radioulnar joint. The structure and function of this tract have been investigated. The tract originates from the radius 22 mm proximal to the distal dorsal corner of the sigmoid notch. Central fibres are attached there with fibrous cartilage and superficial bundles mix with the periosteum. The tract is 8 mm wide, 31 mm long and 1 mm thick. Distally it inserts at the capsule of the distal radioulnar joint between the tendon sheaths of extensor digiti minimi and extensor carpi ulnaris. Deep fibres insert directly at the triangular fibrocartilage. The tract of the interosseous membrane is taut in pronation and loose in supination. It strengthens the dorsal capsule of the distal radioulnar joint. During pronation the tract protects the ulnar head in a sling. Its attachment at the triangular fibrocartilage influences the distal radioulnar joint. Its insertion at the triangular fibrocartilage and the support of the weakest part of the dorsal capsule are of interest.

Aged↗

PubMed1998

[Decompression of the ulnar wrist joint compartment by decompression osteotomy of the head of the ulna].

Both post-traumatic shortening of the radius and positive ulnar variance can lead to a compression syndrome in the ulnar compartment of the wrist. The indication for a decompression osteotomy of the ulnar head after a distal radius fracture is limited to only those cases in which there is a slight shortening without a deviation of the axis of the distal radius. In order to enlarge the space between the ulnar head and proximal row of the carpal bones, a 2 to 3 mm slice is taken from the ulnar head by means of two oblique, parallel osteotomies and fragment retention with two screws. 47 patients were re-examined after an average period of 3 1/2 (1 to 8) years. In 23 cases the results were very good and in 17 cases good. In five cases the results were poor. In two cases, the bone did not heal and the Kapandji-Sauvé procedure was performed.

Adult↗

PubMed1998

[Alternative surgical method in malalignment of healed distal radius fracture: Kapandji-Sauvé procedure].

Malunion after distal radius fracture with subluxation of the distal radioulnar joint can considerably limit the function of the hand. If the malunion cannot be eliminated by the corrective osteotomy of the radius, care must be taken not to additionally impair the stability of the wrist joint and the carpus, in the event of any necessary salvage procedure. In the Kapandji-Sauvé procedure, an arthrodesis is carried out after repositioning of the distal radioulnar joint. By segment resection of the ulnar shaft, a new joint is made to permit forearm rotation. Between 1984 and 1995, a total of 96 patients were treated with this procedure in our hospital. It was possible to re-examine 87 of those patients after an average period of 4 1/2 (1 to 11) years. The average age of the patients was 59 (14 to 72) years. In 25 cases the results were very good and in 52 cases good. In nine cases the results were poor. In one case the result was unsatisfactory.

Adolescent↗

PubMed1997

Flexor tenosynovitis in the hand caused by Mycobacterium malmoense: a case report.

This report analyzes a rare case of flexor tenosynovitis caused by Mycobacterium malmoense. A synovectomy was carried out on the index finger (no other finger was afflicted) of a 66-year-old farmer, followed by antibiotic therapy with ethambutol, rifampin, and clarithromycin. Because of strong side effects, the treatment with ethambutol and rifampicin had to be discontinued after 4 months. There was no recurrence after 14 months, and the patient's finger had a full range of motion.

Aged↗

PubMed1996

[Perilunate dislocation and dislocation fractures--results of surgical management].

We report 22 patients who sustained a perilunate dislocation (PD) with or without a fracture of the scaphoid. The carpal ligaments were explored and reattached in all cases. The fractured scaphoid in perilunate fracture dislocations (PFD) was stabilised by a Herbert screw in 13 cases and in one case with a Matti-Russe bone graft. After an average of 5 years the clinical score of Green and O'Brien showed good results for both PD and PFD. Patients with PFD had less pain and better grip than the patients with PD. The sagittal range of motion (average between 70 degrees and 99 degrees) and the subjective limitation in sports and work were equal for PD and PFD. The only open injury (PD) had the worst clinical result. All patients with PD showed a carpal instability dissociative of the proximal row (CID) and an arthrosis of the radiocarpal joint. In the patients with PFD a CID could be seen in 78% and an arthrosis in 93%. A carpal collapse occurred in 75% of cases after PD and in 29% after PFD. In 57% of cases the PFD was accompanied by a disruption of the SL ligament. The anatomical reconstruction of the scaphoid is essential for good carpal alignment. The stable fixation of bony avulsions showed good results. A CID could not be avoided in any of our patients with PD.

Adolescent↗

PubMed1996

The role of dynamic magnetic resonance imaging in the detection of lesions of the ulnocarpal complex.

A prospective study of 32 patients was carried out to investigate the significance of dynamic magnetic resonance imaging (MRI) in diagnosis of triangular fibrocartilage (TFC) lesions. Tears of the TFC can be diagnosed well by means of static MRI and arthroscopy. Dynamic MRI examination has an advantage in evaluating the stability of the TFC and ulnocarpal impingement. By means of dynamic MRI it was possible to make a preoperative diagnosis of an ulnocarpal impingement in five patients, a diagnosis which was confirmed through arthroscopy in all cases. In three further patients, dynamic MRI showed ulnocarpal impingement caused by instability of the ulnar attachment of the TFC. This kind of impingement could not be ascertained arthroscopically. Dynamic MRI extends the possibilities of evaluating obscure ulnar wrist pain. Its significance lies in the non-invasive examination of ulnocarpal impingement as well as the evaluation of TFC stability.

Adolescent↗

PubMed1996

[Functional treatment of the interphalangeal joints in palmar ligament rupture].

Palmar plate injuries of the interphalangeal joints are very common, yet they require careful treatment until full functional recovery is attained. This paper presents the results of follow-up examinations of 76 patients who underwent early functional treatment with a special dynamic splint. All had sustained an injury of the palmar plate of the PIP-joint (Type 1 or 2 according to Hintringer and Leixnering). After a velcro strip is released, the splint enables daily active exercise of the PIP joint with the joint being protected laterally and protected against hyperextension. This splint was worn for four weeks. After removal of the splint, 71% of all patients indicated that they did not have any problems, while 26% achieved the same mobility as the unaffected joint of the other hand after two more weeks of dynamic splinting. In only one case motion was inhibited for several further weeks.

Exercise Therapy↗