The use of gentamicin collagen floss in the treatment of infections in trauma surgery.
Explore the source record for details and available documents.
Collagen↗
Biomedical subjects
V Vécsei
Publications and source records attributed to V Vécsei.
[Complications and errors in use of the gamma nail. Causes and prevention].
The analysis of 310 cases of fractures of the femur, treated with a Gamma-nail osteosynthesis, done in two clinics for trauma surgery in Vienna, revealed to a high number of complications. For this reason we decided to start an evaluation aming at complications in connection to this type of treatment, with 440 patients treated over a five year period. We observed 148 complications, which will be described. The intraoperative failures were as follows: False drilling during the interlocking procedure 64, wrong length of lag screw 13, breakage of the drill bit during interlocking procedure 7, additional shattering of shaft 5, external malrotation of diaphysis (> or = 20 degrees) 6, internal malrotation of the diaphysis (> or = 20 degrees) 1, elongation of diaphysis (2 cm) 1, mistakes in using the proximal nail-plaque 4, breakage of bone elevator, used for reduction procedure 1 and 1 failure at the target-device during nailing. The complications during the postoperative treatment were: Infection 11, perforation of lag screw towards cranial 10, towards central 2, migration of the lack screw within the femoral head 7, diaphysial fracture at the distal end of nail 6, movement of interlocking bolts 4, osteolytic process at fracture site 2 and 3 haematomas, needing a revision. Most of these reported complications were due to technical failures, lack of experience or inadequate treatment modality. The specifications and descriptions should give information about the reasons of these complications, but it is the purpose of this publication too, to figure out the technical errors which were responsible for most of the complications described.
Aged↗
[Value of gamma nailing in management of hip para-articular fractures. Clinical use in 310 cases].
Treatment of fractures of the coxal femur has become routine at the Clinic for Trauma Surgery at the University of Vienna. This paper reports on the follow up on 310 patients treated with the gamma nailing (average follow up: 21.4 months). In all, 240 women and 70 men were operated on between 1987 and 1992. Most of the fractures wer unstable and many were located in the subtrochanteric region (38.3% A3). It was possible to operate on 45.8% of these patients during the first 2 days. The modalities of treatment and mobilization are described, and the clinical and radiological results are presented. Mobilization was possible after an average of 10.2 days in 81.6% of these cases. Complications we had to face and ways they might be prevented in future are discussed.
Adult↗
[Results of surgical treatment of fractures of the distal thigh with joint involvement].
The results of treatment of 35 intraarticular distal fractures of the femur are presented. Treatment was performed in 8 cases with a condylar plate, in 8 cases with dynamic compression screw (DCS), in 2 cases with two plates, in 9 cases with screws only, and eight times the fracture was treated with a combination of lag screws and locking nail. Examination took place at an average of 45.5 months after the accident. 19 patients had an isolated fracture, 8 patients one accidental injury and 8 patients had more than one fracture or were polytraumatised. In 75% of the patients treatment lasted for between day 1 and 5. We found 17.1% open fractures and had to face infections in 5.7% (two cases). Bone healing occurred in all fractures, the reported infections could be overcome by early revision and the use of gentamycin-PMMA beds. It is remarkable that locking nails were successfully used in 8 cases of fractures with intraarticular component of the distal femur.
Adult↗
[Canaliculitis: conservative versus surgical therapy].
Explore the source record for details and available documents.
Actinomycosis↗
[The gamma nail. A new implant for the management of hip para-articular fractures].
An alternative treatment of fractures of the coxal femur side is a new implant called "GAMMA-NAIL". The article describes the new implant and the operative technique. Furthermore, we present the results of a first series of 58 patients, mainly women (w:m = 8:1) with an average on age of 78.09 years. Although these patients were characterised by a number of complicating factors, it was possible to mobilise 86.2% at an average of 9.4 days after surgery with full load. We present a report on the quality of walking, a pain report, data on the mobility of joints and the x-ray findings. The 5.1% of infections and 8.6% of operative and postoperative complications we have to face, are described in detail.
Activities of Daily Living↗
[Surgical stabilization of thoracic wall fractures].
We report our experience with 12 patients whose chest wall injuries were treated with stable internal fixation by means of rib plates. Of all patients with chest wall injuries requiring inpatient treatment, only 5.19% were operated for this diagnosis; that is to say this operation is seldom indicated. In 5 patients stabilization was done "on the retreat" when thoracotomy had to be performed for intrathoracic injury anyway; in another 5 patients inadequate recovery from respiratory insufficiency following conservative treatment led to the operation, and in 2 patients extreme dislocation of chest wall fractures with restricted chest volume was the reason for surgical intervention. The mean age of these patients was 58 years, the mean PTS score 28.5 (ranging from 18 to 56), mean duration of postoperative mechanical ventilation 6 days (median 5 days), mean duration of stay in the intensive care unit 18 days, and duration of stay in hospital was 42 days, reflecting the severity of associated trauma. The stability achieved in the chest wall permitted sufficiently painfree spontaneous ventilation 1-5 days after the operation in 50% of patients. Two aged patients died of non-trauma-related myocardial infarction and myocardial insufficiency, respectively, while in hospital. Complications attributable to the specific surgical intervention were superficial infection of the incision (2 cases) and postoperative haemorrhage from an intercostal artery (1 case). No late complications related to the specific operative procedure occurred.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Surgical management of shoulderblade fractures].
Fractures of the scapula are a domain of conservative therapy. In the majority of cases early restoration of function produces good results. Nevertheless there are types of fractures which should be reduced in open procedures and treated by an osteosynthetic method stable enough to ensure early mobilisation. A report of 5 patients is presented, 2 of whom showing severe, 1 light and the remaining 2 no concomitant injuries. Indications, access, choice of procedure and results are described.
Adult↗
[The interlocking nail for long comminuted and compound fractures of the femur and tibia. Technique and results].
Interlocking nailing is presented as an optimal method for the treatment of fractures of femur and tibia, which are complicated because of the length of these bones. Cases from the literature and cases treated by the authors gave a total of 208 fractures of the femur and 158 fractures of the tibia (comminuted fractures and fractures "à deux étages"). There is a low complication rate as a closed procedure was applied whenever possible. In the femur the nail fractured in eight cases (3.9%), while in seven cases infection was observed (3.5%) and in three cases pseudarthrosis. Following interlocking nailing of the tibia we found deviation of the axis by greater than 5 degrees in eight cases (5%) of 158, including 44 open fractures. Fracture of the nail occurred in one case (0.6%), and we observed six cases of infection (3.8%) and one of pseudarthrosis (0.6%).
Adolescent↗
[Interlocking nailing of distal femoral fractures. Technique and results].
Treatment with interlocking nails is sufficient for fractures at the distal diaphysis and the distal methaphyseal region of the femur. Fractures associated with intracondylar fissures can be treated with an interlocking nail only in isolated cases. This paper gives a report on 47 cases and compares two series. The complications observed were: infection (4.25%); fracture of nail (4.25%); and deviation of axis (12.08%). We didn't observe pseudarthrosis in any of these patients. Bone healing occurred in all cases.
Adult↗
[Bousquet treatment of chronic anteromedial, anterolateral knee instability].
In 21 patients the treatment described in an original communication by Bousquet for chronic anteromedial anterolateral instability of the knee was applied. The basic components of treatment were static-dynamic substitution of the anterior crucial ligaments by the proximally pedunculated gracilis tendon, tightening of the dorsomedial capsule, bypass of the popliteal tendon, revision of the joint, treatment of medial instabilities with conservation of the menisci if possible, postoperative treatment without plaster and mobilization without weight-bearing until active bending at 90 degrees was attained. Of the 21 patients treated between April 1983 and December 1984, 18 were examined again an average of 52.5 months after treatment. According to a postoperative examination checklist, results were found to be excellent in 8 cases, good in 9, moderate in 1 and poor in another case. In spite of the good results a definite opinion of the method cannot be given.
Adult↗
[Management of hip fractures using a dynamic hip screw].
Authors describe the history of the dynamic hip screw and analyse the hip fracture. The operative technique of the DHS is described in details. In an analysis of the material of the Wilhelminenspital it is stressed that in the last years the DHS became dominant in the treatment of hip fractures. The treatment of four different types of fractures with DHS is demonstrated. The method is compared with other methods suitable for the treatment of hip fractures and it is stated that the less complications can be expected from the use of the DHS. On the basis of this comparison it is shown that the DHS is worthy to occupy a decisive place in the treatment of hip fractures.
Aged↗
[The value of dynamic adjustment in locking intramedullary nailing].
The so-called "dynamization", i.e. the removal of defined bolts after the first signs of osseous consolidation detected by X-ray film 6 to 10 weeks after surgery employing the static locking nail technique, cannot be translated into reality. In a total of 121 patients in whom static locking nail technique had been employed, dynamization was effected in 23 cases only, i.e. 19%. Complications are likely to occur if the indication for dynamization was wrong or if dynamization is not performed although it was indicated. Dynamization must be prescribed individually on the basis of X-ray film controls and is actually indicated in rare cases only. We refuse to perform it as a routine step after static nail locking of the femur and tibia.
Femoral Fractures↗
[Treatment and results of pathologic fractures. A collaborative study from 1965 to 1985 of 16 Austrian hospitals].
A total of 595 patients treated over a 20-year period in 16 Austrian hospitals for pathologic fractures, most caused by metastases of malignant disease, were analysed retrospectively. It appeared that women were affected by pathologic fractures 2.5 times as often as men. Most of the fractures had occurred when the patients were between 60 and 80 years of age. It was found that there were three types of carcinoma for which an association with pathologic fracture was particularly frequent (breast, bronchi, kidney). In a high percentage of these cases widespread metastatic disease was already present when the pathologic fracture occurred. Well over 80% of the fractures were surgically treated, and the complication rate associated with surgery was 19.8%. A questionnaire was also prepared, with questions relating to statistical parameters and to different forms of therapy and the results obtained with them.
Aged↗
[Results of biomechanical studies of various external fixation devices of the pelvis].
Various mounting systems used in fixation of the pelvis were tested for their stability. The systems were mounted on macerated pelvices and their firmness examined. The criterion for the examination was on the one hand the force needed under distraction to cause a distension in the region of the symphysis or of the sacroiliac joint of 1 cm., on the other hand the force needed to tilt the disjunction points for 1 cm. when shearing takes place. It was concluded from the study that in clinical use, given unstable pelvic fractures, mountings applied only anteriorly are not capable of withstanding the strain expected under biological conditions. Consequently, mobilisation with full weight bearing in instable pelvic fractures is not possible in a shorter period of time than with conservative (extension) treatment.
Biomechanical Phenomena↗
[From the nail/plate to the dynamic hip screw--example of a generation change in implants for para-articular femoral fractures].
In trochanteric fractures of the femur, where operative techniques are preferable to conservative treatment, a change in the choice of implants has taken place over the past years. As several comparative studies show, the traditional system of nail/plate fixation has not been completely replaced by Ender nailing in many surgical departments. The system of nail/plate is, however, losing significance in face of the increasing usage of screwing-systems (such as, for instance, DHS of AO-Dynamic Hip Screw). The possibility of compression during the operation in screwing methods is the decisive factor.
Aged↗
[Contribution to the treatment of epiphysiolysis of the proximal end of the tibia].
Explore the source record for details and available documents.
Adolescent↗
[Medium term results of treatment of post-traumatic osteitis and osteomyelitis with gentamycin-PMMA minichains].
In 10 cases of posttraumatic osteitis or osteomyelitis gentamicin-PMMA minichains have been used for treatment after radical local debridement. In 8 cases infection could be controlled completely by this regimen, one case needed adjuvant systemic antibiotic treatment and only one case with proved primarily gentamicin-resistant beta-haemolytic-streptococcus could be controlled after removal of PMMA-minichain by systemic antibiotic treatment. 3 to 9 months after therapy all infections were still under control.
Adolescent↗