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Biomedical subjects

U Büchler

Publications and source records attributed to U Büchler.

At least 37 records · Page 2Linked to original sources
PubMed1997

Prospective multicenter trial of a plate for dorsal fixation of distal radius fractures.

A new plate designed specifically to address complex wrist pathology was used for the internal fixation of 22 complex fractures of the distal radius in 22 patients in a prospective multicenter trial. The majority of fractures were group C2- and C3-type fractures according to the Comprehensive Classification of Fractures. No plate failures, loss of reduction, nonunions, or infections occurred. Within the average follow-up time of 14 months, the functional results (including an average motion of 76% and an average grip strength of 56% of the contralateral side) were comparable to those reported for similar fractures in previous investigations. Five patients had irritation of the tendons in the second dorsal compartment. This trial serves both as a verification of the safety and efficacy of this distal radius plate as well as a demonstration of its utility in the treatment of complex fractures of the distal radius.

Adult↗
PubMed1996

Corrective osteotomy for post-traumatic malunion of the phalanges in the hand.

Rotation, angulation, deviation, shortening or a combination of deformities can occur due to phalangeal malunion and can lead to impairment of hand function. A historical cohort study of 57 patients who had phalangeal corrective osteotomies for posttraumatic malunion between 1978 and 1990 was undertaken. 59 rotational, radial/ulnar deviation, flexion/extension, length adjustment procedures, and combinations thereof were performed, using rigid internal fixation. Concurrent tenocapsulolysis was done in 50% of the cases. Satisfactory correction was obtained in 76% of the patients. Bony union was obtained in all cases. A net gain in active range of motion was achieved in 89% of the patients. Excellent and good results were obtained in 96% of the patients who had corrective osteotomies for malunion involving only the bone and in 64% of the patients who had corrections for malunion with involvement of multiple structures (P < 0.01).

Adult↗
PubMed1995

[Tumors of the hand].

Most of the numerous tumors of the hand, arising from the skin, soft-tissues and bones show a benign course. The vast majority of those tumors is classified as a tumor-like lesion, of which the ganglia are the most frequent. Malignant tumors of the hand are extremely rare. The diagnosis of those usually visible and obvious tumors is regularly made on clinical findings. Only tumors of the deep structures and unclear masses of soft-tissues and bone need further diagnostic procedures. In case of potentially malignant tumors of the hand a systematic and thorough approach should be started to receive a full and complete staging of the tumor. Modern treatment regimens include for malignant tumors of the hand an interdisciplinary approach with a combination of chemotherapy, surgery and radiation-therapy.

Adolescent↗
PubMed1994

Implants of pure titanium for internal fixation of the peripheral skeleton.

In a multicentre study, a clinical evaluation of the new titanium implants of the sizes 2.7, 2.0 and 1.5 mm was done. In seven centres, 133 patients were operated on and the personal, subjective opinions of the surgeons were recorded. In the opinion of these surgeons experienced in using steel implants, the outcome of the internal fixations was the same for titanium as for steel implants. Three metal-related complications occurred in the smallest size screw type (1.5 mm), namely, one screw broke and two bent. In the cases in which the implant had been removed, good tissue contact with the implant could be seen. Only in one case was there discolouring of the soft tissue due to titanium. It is recommended that surgeons who are used to handling stainless steel screws should be aware of the slightly different behaviour of titanium screws.

Adolescent↗
PubMed1994

The small AO external fixator in hand surgery.

At our institution, the small AO external fixator has been utilized on the wrist and hand on over 200 patients since 1979. Disregarding fractures of the distal radius, the main indications were fracture dislocations of the wrist, Kienböck's disease, combined injuries with bone defects of the wrist and metacarpals, and basilar fractures of the thumb metacarpal. In this paper, five well-established applications will be described with respect to treatment concept, indication, technique, and personal results. Furthermore, recommendations and reservations are listed to help in the prevention of the most frequent complications.

Arthrodesis↗
PubMed1994

Kienböck's disease, early stage 3--height reconstruction and core revascularization of the lunate.

Early stage 3 Kienböck's disease has been treated by inner débridement, recontouring, height reconstruction, bone grafting and core revascularization of the lunate; additional procedures included temporary external fixation of the wrist and/or shortening osteotomy of the radius in selected cases. 26 patients, representing an uninterrupted series of 28 procedures, were followed-up for an average of 6.7 years (range 2.5-9.3 years) with periodic clinical and radiographic evaluations until they reached the final comprehensive assessment that included trispiral tomography and MRI. Every patient was subjectively improved, pleased with the result and able to resume his previous job. Pain intensity, rated on a zero to five scale, improved from 2.5 points pre-operatively to a final score of 0.8 points. Wrist motion gained slightly. Grip strength improved significantly. Lunate reconstruction proved successful in 37% of the cases; in an additional 23%, the disease process was stabilized. Carpal height decreased 4.7%; ulnar translation was not substantially altered. Arthrosis increased postoperatively in 55%, remained unchanged in 36% and progressed in 9%. Overall, 43% good and excellent, 43% fair and 14% poor results were observed.

Adolescent↗
PubMed1994

[The treatment of combined digital-palmar injuries].

Different treatment modalities for palmar combined injuries of the fingers are described. Several possibilities are mentioned for each traumatized structure which can be involved in such injuries. Early functional after-treatment is emphasized, which usually needs stable reconstruction for all injured components (skin, nerves, arteries, fractures, joints, flexor tendons and pulleys), so as to allow immediate active mobilization. The results of palmar combined injuries of 178 fingers in 150 patients, treated from September 1986 to May 1991 at the Division of Hand Surgery, University of Bern, Switzerland, offer the more recent experience for the favoured handling of such injuries. The results were collected and statistically analyzed to seek for mutual interactions in the healing of the different structural components.

Adolescent↗
PubMed1993

Osteochondral metatarsophalangeal autografts for traumatic articular metacarpophalangeal defects: a preliminary report.

Five consecutive patients with saw injuries to the dorsal portion of the index metacarpophalangeal joint and resultant partial osteochondral defects underwent articular reconstruction using contoured metatarsophalangeal osteochondral autografts. At an average follow-up period of 33 months, all patients achieved full metacarpophalangeal extension, with 74 degrees of flexion and grip strength equal to 86% of the contralateral hand. Discomfort was minimal, with crepitus present in one patient. X-ray films revealed joint space narrowing or articular step-off of 1 mm or less.

Accidents, Occupational↗
PubMed1993

[Arthrogryposis multiplex congenita of the upper extremity].

This article is a comprehensive review on arthrogryposis multiplex congenita of the upper extremity. The introduction contains information on definition, etiology, pathogenesis, differential diagnosis and manifestations outside the upper extremity. The main section focuses on the upper limb and expands on epidemiology, patterns of deformity, their natural evolution, on related functional problems, and general principles of treatment. Finally, the various regional deformities are presented and guidelines are given for conservative or operative treatment.

Arm↗
PubMed1992

The surgical anatomy of the dorsal carpal branch of the ulnar artery: basis for a neurovascular dorso-ulnar pedicled flap.

In order to design a neurovascular flap from the dorso-ulnar aspect of the midhand for pedicled transfer to adjacent or distant locations, the surgical anatomy of the dorsal carpal branch of the ulnar artery (DCBUA) was studied in 12 cadavers. The DCBUA was identified in all specimens. It originates from the ulnar artery 1.6 to 4.4 centimeters proximal to the ulnar styloid, passing deep to the flexor carpi ulnaris tendon, and spirals superficially to the extensor retinaculum around the ulnar border of the wrist. Its terminal branches supply an undetermined area of skin overlying the ulnar metacarpals and the ulnar hypothenar region, either by direct cutaneous supply (3/12 specimens) or by septo-cutaneous perforators (8/12 specimens). The DCBUA is closely related to the dorsal sensory branch of the ulnar nerve, with which it supplies a common neurovascular territory.

Arteries↗
PubMed1992

[Microsurgical and histological observations in schwannoma of peripheral nerves].

From 1986 to 1991, eight patients with benign schwannomas (neurilemomas) of peripheral nerves underwent tumor resection. In six of eight cases, microsurgical dissection revealed one or several nerve fascicles "disappearing" in the center of the schwannoma. Therefore, these fascicles had to be removed along with the tumor. This observation contradicts the current opinion that enucleation of benign schwannomas is usually straightforward and possible without fascicular damage. Interestingly, the resection of fascicles did not create additional neurological deficits. For functional reasons, partial nerve grafts bridging the resulting fascicular defects were considered appropriate in two cases. Tumors of peripheral nerves should be treated by surgeons familiar with microsurgical operative techniques.

Adult↗
PubMed1991

Retrograde posterior interosseous flap.

A retrospective, continuous clinical series of 36 distally based posterior interosseous island flap procedures is reported. Major anatomic variations precluded the final dissection of the flap on two occasions (6%). Thirty-four patients had septocutaneous or septofascial flap coverage for treatment of acute complex injuries (12), subacute soft tissue defects (10), chronic ulcers (5), or contractures (7). The sizes of the flap islands varied from 1.5 by 4 centimeters to 9 by 11 centimeters. The arc of rotation, centered over the distal radioulnar joint, measured up to 19 centimeters, allowing the flaps to reach the dorsum of the proximal interphalangeal joints. Partial necrosis occurred in seven flaps; four (12%) required additional local or distant flaps. Partial failures were related to bleeding from the pedicle or compression thereof, while other assumed causes of hypoperfusion were not statistically relevant. The flaps remained slightly bulky in about 30% of the patients, but otherwise adapted well to the recipient site and had excellent texture and color match. The donor morbidity was minimal.

Adult↗
PubMed1991

Radio-scapho-lunate partial wrist arthrodesis following comminuted fractures of the distal radius.

Painful radiocarpal arthritis following comminuted fractures of the distal radius may be treated either by total wrist fusion or by procedures which preserve movement. The authors have reviewed 15 patients with such fractures who have undergone radio-scapho-lunate partial arthrodesis. They report the results with an average follow-up of 23.8 months. Pain was abolished in 7 patients and resolved virtually completely in 4 cases. Restored grip strength averaged 49% of the contralateral side. There was considerable limitation of postoperative range of motion which was restricted to an oblique plane extending dorso-radial to palmar-ulnar. Most patients did not report this as a problem. Two cases of non-union were reported as well as a 35.7% incidence of secondary degenerative change in the midcarpal joint. This feature casts doubt on the predictability of outcome of this procedure.

Adult↗
PubMed1990

Traumatic soft-tissue defects of the extremities. Implications and treatment guidelines.

The presence of traumatic soft-tissue defects in the extremity indicates serious damage that may compromise the systems of motion, circulation or sensibility and therefore jeopardize functional rehabilitation. This overview highlights the significance and the various causes of soft-tissue defects, of which several types may be distinguished. Principles for the selection of various flap procedures are outlined, in accordance with the need for elevation and early motion therapy. The requirements placed on flap tissue are described, such as surface characteristics, ability to restore sensibility, cosmesis, capacity to fill voids in the depth of defects and revascularization of adjacent areas.

Arm Injuries↗
PubMed1990

[Hand surgery. Soft tissue defects].

The presence of soft tissue defects in the hand indicates serious traumatic damage that may compromise the systems involved in movement, circulation or touch and therefore jeopardize functional rehabilitation. This overview highlights the significance and the various causes of soft tissue defects. Several types are distinguished. Selection criteria for various flap procedures are outlined with reference to the need for elevation of the hand, the necessity for early movement, adequate wound drainage, and range of motion therapy. The characteristics required of flap tissue are described, such as surface characteristics, ability to restore sense of touch, cosmetic appearance, ability to close deep volume defects, and potential for revascularization of adjacent tissue. Finally, commonly used, selected flaps are presented with notes on their advantages, disadvantages, and modifications, the techniques required and the indications for each.

Amputation, Traumatic↗