H Janzing

The Gotfried PerCutaneous Compression Plate versus the Dynamic Hip Screw in the treatment of pertrochanteric hip fractures: minimal invasive treatment reduces operative time and postoperative pain

BACKGROUND The PerCutaneous Compression Plate (PCCP) was developed by Gotfried (Israel, Haifa) for minimal-approach osteosynthesis of pertrochanteric fractures. METHODS One hundred fifteen patients, aged 60 or more, with intertrochanteric fractures (AO type 31A1 or 31A2) were selected randomly for fixation with either the PCCP (53 patients) or the Dynamic Hip Screw (62 patients). All surviving patients were scheduled for a 1-year follow-up. RESULTS Less invasive surgical stabilization of pertrochanteric fractures with the PCCP resulted in shorter theater and surgical time and reduced postoperative pain. The PCCP treatment showed a tendency toward a lower transfusion need and a reduction of fracture impaction; however, results were not statistically significant. There was a trend toward a higher mechanical complication rate with the PCCP: anatomic closed reduction without posterior sagging of the fracture and fluoroscopic control of the placement of the first neck screw in two directions are essential to avoid technical complications. CONCLUSION Minimal invasive treatment of pertrochanteric fractures with the PCCP reduces operation time and postoperative pain.

The retrograde intramedullary nail : Prospective experience in patients older than sixty-five years

HYPOTHESIS To determine whether retrograde nailing of distal femoral fractures is beneficial for the elderly patient. METHODS Prospective study of consecutive patients, aged sixty-five years or older, whose distal femoral fractures were treated with a retrograde femoral nail between January 3, 1993, and April 30, 1996. RESULTS Twenty-four of twenty-six patients were followed for more than twelve months. There were twenty AO/ASIF 33A and four AO/ASIF 33C fractures. Twenty-three were closed. There was one Gustilo type 1 fracture. All fractures healed. Six patients did not walk before injury. Using the Neer scoring system, there were ten (56 percent) excellent (85 or more points), six (33 percent) good (70 or more points), and two (11 percent) fair (55 or more points) results; none of the cases were considered as failures (less than 55 points). CONCLUSIONS Retrograde intramedullary nailing makes possible a biological osteosynthesis of distal femoral fractures. It also produces good functional results in elderly patients. The two major technical problems encountered with this implant are the poor hold of the distal interlocking screws and difficulties with proximal interlocking. Early weight-bearing is not advisable.

Dermatotraction: an effective technique for the closure of fasciotomy wounds: a preliminary report of fifteen patients.

Dermatotraction was evaluated as an alternative technique for the closure of dermatofasciotomy wounds, with a review of literature and of our clinical experience. The dermatotraction technique provides closure of fasciotomy wounds and avoids the use of skin grafting. Patients treated with dermatofasciotomy for an acute compartment syndrome of the limbs, without obvious tissue necrosis and without shock or urgent life saving surgery, had their fasciotomy wound closed with dermatotraction with vessel loops, the skin approximation system, or the prepositioned intracutaneous suture. In our experience, the mean time to wound closure was nine days. Dermatotraction techniques that cause local skin compression should be avoided because skin necrosis might occur (skin approximation system). Dermatotraction with vessel loops or the prepositioned intracutaneous suture provides good skin apposition without the necessity for skin grafting.

Treatment of distal femoral fractures in the elderly. Results with the retrograde intramedullary supracondylar nail.

The drawbacks of plating techniques for the treatment of distal femoral fractures are the need for a large exposure with the possible risk of soft tissue damage, devascularisation of bone fragments and loss of the possible positive effect of the fracture hematoma. Moreover, early weight bearing is not advisable with these implants. To find out whether the retrograde nailing of distal femoral fractures is beneficial we performed this study. Between March 1, 1993 and September 1, 1995, 25 patients with 26 distal femoral fractures were treated in our department with retrograde femoral nailing. According to the ASIF-classification we classified 20 fractures as supracondylar A fractures and 6 fractures as intercondylar C fractures. All fractures were closed and without important soft tissue damage. One patient died of a not fracture-related cause before fracture healing was achieved. Twenty-five fractures healed. According to our relative Neer-score we counted 18/25 (72%) excellent results (≥ 85 points), 5/25 (20%) good results (≥ 70 points), 1 (4%) fair result (≥ 55 points) and 1 (4%) bad result (< 55 points). The retrograde intramedullary nailing makes a biological osteosynthesis of distal femoral fractures possible. Also in our aged patients good functional results could be obtained. Poor hold of the distal interlocking screws and difficult interlocking are the 2 major technical problems encountered with this implant. Early weight bearing is not advisable.ZusammenfassungDie Nachteile konventioneller Stabilisierungsmethoden distaler Femurfrakturen sind die damit verbundene Schädigung der Weichteile und damit auch die Devaskularisierung der Frakturfragmente. Die gedeckte Osteosynthese mittels retrograder Femurnagelung wurde von uns als biologische Alternative untersucht. An der Unfallchirurgischen Abteilung der Universitätsklinik Gasthuisberg Leuven wurden vom 1. 3. 1993 his 1. 9. 1995 25 Patienten mit 26 distalen Femurfrakturen mit einem retrograden Femurnagel behandelt. Nach der AO-Klassifikation wurden 20 Frakturen als Typ-A- und sechs als Typ-C-Frakturen klassifiziert. Alle Frakturen wares geschlossen und ohne schwere Weichteilverletzung. Eine Patientin starb frühzeitig infolge einer nicht mit der Femurfraktur zusammenhängenden Erkrankung. Die anderen 25 Frakturen heilten komplikationslos. Nach unserer „relatives Neer-Klassifikation” fanden wir 18/25 (72%) ausgezeichnete (≥ 85 Punkte), 5/25 (20%) gute Ergebnisse (≥ 70 Punkte), ein (4%) mäßiges Ergebnis (≥ 55 Punkte) und ein (4%) schlechtes Ergebnis (< 55 Punkte). Die retrograde Femurnagelung ermöglicht eine biologische Osteosynthese distaler Femurfrakturen mit minimaler Schädigung der Weichteile und Devaskularisierung der Frakturfragmente.

Compartment syndrome as a complication of skin traction in children with femoral fractures

We report the history of two 3-year-old children with femoral shaft fractures, who developed severe compartment syndromes following skin traction. Both children were admitted in our department for treatment of their compartment syndromes. In both, important and permanent disability persisted. The causative role of the skin traction is proven by the fact that in one infant, the compartment syndrome developed in the non-fractured limb. Cautious application of skin traction, conscientious observation, immediate diagnosis, and aggressive treatment of threatening compartment syndromes will prevent these tragic complications.

Epidemiology, Etiology, Pathophysiology and Diagnosis of the Acute Compartment Syndrome of the Extremity.

Due to an insult that causes a pressure elevation in the compartment, which is the limited space surrounded by the unyielding bone and fascia, the circulation is compromised resulting in muscular and neural ischemia and eventually tissue necrosis. The diagnosis of the compartment syndrome has always been based on the clinical symptoms, however, multiple studies suggested that clinical examination alone is insufficient and may result in delayed diagnosis, delayed treatment and serious sequelae. To avoid delayed diagnosis and treatment the use of compartment pressure monitoring has been advised. There is, however, no consensus about the indications for the compartment pressure monitoring, or about the threshold pressure that should be used for dermatofasciotomy. A diagnostic guideline is proposed.Due to an insult that causes a pressure elevation in the compartment, which is the limited space surrounded by the unyielding bone and fascia, the circulation is compromised resulting in muscular and neural ischemia and eventually tissue necrosis. The diagnosis of the compartment syndrome has always been based on the clinical symptoms, however, multiple studies suggested that clinical examination alone is insufficient and may result in delayed diagnosis, delayed treatment and serious sequelae. To avoid delayed diagnosis and treatment the use of compartment pressure monitoring has been advised. There is, however, no consensus about the indications for the compartment pressure monitoring, or about the threshold pressure that should be used for dermatofasciotomy. A diagnostic guideline is proposed.

Severe liver rupture and tricuspid valve rupture in a patient with multiple trauma

A patient with a severe liver injury and an acute cardiac failure due to a traumatic tricuspid valve failure is presented. During liver surgery, massive venous bleeding was caused by regurgitation of blood through the insufficient tricuspid valve. Right ventricular failure, leading to persistent hemodynamic instability, and caused by massive posttraumatic tricuspid regurgitation, has been treated with biological valve replacement. Diagnosis and management of posttraumatic tricuspid insufficiency are discussed.

Traumatic herniation of the lung.

Abstract We present a relatively rare clinical presentation of herniation of lung parenchyma. In our case, the patient suffered multiple rib fractures, with an intercostal herniation of lung tissue after a trauma. We opted for a conservative treatment, given the clinical presentation, and the absence of incarceration or strangulation of the pulmonary tissue. In the absence of clear guidelines for this rare presentation, current treatment can be conservative or surgical, depending on the clinical presentation.