Karel Stappaerts - Academia.edu (original) (raw)
Papers by Karel Stappaerts
The Journal of Orthopaedic and Sports Physical Therapy, Jul 1, 2003
Randomized clinical trial. To analyze the immediate treatment effects of cervical mobilization an... more Randomized clinical trial. To analyze the immediate treatment effects of cervical mobilization and therapeutic ultrasound in patients with neurogenic cervicobrachial pain. Different treatment modalities have been described for patients with neurogenic cervicobrachial pain. Although it has been suggested that a more specific approach, like cervical mobilization, would be more effective, effect studies are scarce. Twenty patients with subacute peripheral neurogenic cervicobrachial pain were assessed. Besides other criteria, patients were included if a cervical segmental motion restriction was present which could be regarded as a possible cause of the neurogenic disorder. Patients were randomly assigned to a mobilization or ultrasound group. Mobilization consisted of a contralateral lateral glide technique. The range of elbow extension, symptom distribution, and pain intensity during the neural tissue provocation test for the median nerve were used as outcome measures. Results were analyzed using a 2-way mixed-design ANOVA. Significant differences in treatment effects between the 2 groups could be observed for all outcome measures (P < or = .0306). For the mobilization group, the increase in elbow extension from 137.3 degrees to 156.7 degrees, the 43.4% decrease in area of symptom distribution, and the decreased pain intensity from 7.3 to 5.8 were significant (P < or = .0003). For the ultrasound group, there were no significant improvements (P > or = .0521). When a cervical dysfunction can be regarded as a cause of the neurogenic disorder or as a contributing factor that impedes natural recovery, a cervical lateral glide mobilization has positive immediate effects in patients with subacute peripheral neurogenic cervicobrachial pain. This movement-based approach seems preferable to ultrasound.
Acta Paediat, 2007
The test-retest reproducibility of visual analogue scales for the perceived influence of exertion... more The test-retest reproducibility of visual analogue scales for the perceived influence of exertion and movements/positions on low back problems in adolescents was investigated. The study was performed on 61 adolescents with low back problems. Item completion, median score, interquartile range and weighted kappa were calculated. Results showed that visual analogue scales produce repeatable information for all items tested (weighted kappa: 0.59-0.83), except for the influence of pulling materials on back problems (0.45). The results of this study suggest that adolescents, aged 16-18 y, can reproduce their visual analogue scores.
Der Unfallchirurg
ABSTRACT
Acta chirurgica Belgica
A retrospective study of 118 femoral neck fractures treated with multiple Knowles pins or with AO... more A retrospective study of 118 femoral neck fractures treated with multiple Knowles pins or with AO (ASIF) cancellous bone screws, and followed for at least 22 months, revealed nonunion in 1/33 undisplaced fractures and in 27/85 displaced fractures. Avascular necrosis was radiographically evident in respectively 2/32 and 19/58 united undisplaced and displaced fractures. Four factors were adversely associated with union: inaccurate reduction, mental confusion, age above 80 years and fixation with less than 6 Knowles pins. Late segmental collapse was not significantly related with any of the 9 analyzed factors. It was concluded that displaced femoral neck fractures in confused patients older than 80 years, or fractures one cannot adequately reduce, should be primarily treated with arthroplasty. Following accurate reduction, internal fixation with less than 6 Knowles pins cannot be recommended.
Journal of Orthopaedic Trauma
During a 10-year period (1978-1988), 565 patients, aged greater than or equal to 70 years, who su... more During a 10-year period (1978-1988), 565 patients, aged greater than or equal to 70 years, who sustained a fresh pertrochanteric fracture, were treated in the Department of Traumatology at the University Hospitals of Leuven, Belgium. Three hundred eighty-eight fractures were complex and unstable, according to the Evans-Jensen system and the AO system. Special attention was given to the 324 cases of type IC and ID in Evans' system, type A2 in the AO system. The method of treatment changed greatly during the period of study. All patients were followed prospectively during 1 year. Our study showed that for these unstable fractures, fixation with an angled plate or Ender nails should be forsaken. The overall results of the compression hip screw treatment were good (reoperation rate 2%, good functional results in 64%), but as this treatment has a risk for serious collapse and pain in about 80% of all type ID fractures, one could suggest treating these complex multifragment fractures primarily with an endoprosthesis. This treatment need no longer be considered severe intervention, as the danger of mechanical complications is minimal (less than 1%).
Acta chirurgica Belgica
In a first study of 416 polytrauma patients, 49 were aged 65 years or older. These "old ... more In a first study of 416 polytrauma patients, 49 were aged 65 years or older. These "old patients" (mean age 72.1) were compared with the remaining 367 "young patients" (mean age 31.3). In a second study concerning 126 polytrauma patients of 65 and over, the survivors and non survivors were profiled and compared. The typical injured old patient was a pedestrian hit by a car or a motorbike or someone who had simply fallen at home. Despite the fact that the mean Injury Severity Score (ISS) was significantly lower in the old patients' groups (33.2 versus 42.1 degrees) (p < 0.0001) the mortality rate was higher (18% versus 7.6%) (p < 0.05). In old trauma victims multiple system organ failure (MSOF) was responsible for the fatal outcome in 48% of the cases and in 71% of the deaths more than 7 days after trauma. Seventy eight percent of the surviving old patients still living at home pre-injury were able to go back to their normal surroundings. In the old patients groups there was no significant difference in age nor in ISS nor in pre-existing diseases between survivors and non-survivors. On the other hand the Glasgow Coma Scale (GCS) was of important prognostic value, as well as to survival as to functional recovery (p < 0.001). Also the need for early intubation and continued ventilation were predictive of survival (p < 0.001). Nevertheless this need for respiratory assistance was not an indication for withdrawing support as also 9% of the survivors required endotracheal intubation for 5 days or longer.(ABSTRACT TRUNCATED AT 250 WORDS)
Acta chirurgica Belgica
... Is the Belgian VDP prosthesis the best treatment for unstable fractures with severe comminuti... more ... Is the Belgian VDP prosthesis the best treatment for unstable fractures with severe comminution? Broos PL, Rommens PM, Geens VR, Stappaerts KH. ... Our study showed that for these unstable fractures, fixation with an angled plate or Ender nails should be forsaken. ...
Journal of Applied Biomechanics, Aug 1, 2003
The purpose of this study was to present a method for repeated measurement of flexion force of th... more The purpose of this study was to present a method for repeated measurement of flexion force of the hallux in the metatarsophalangeal joint. The reliability of this measurement device was also examined. This device is suitable for situations where weight-bearing is contraindicated or when it is not possible for patients to bear load on their toes, such as hallux valgus patients. Since most such patients are female, the participants in this study were 24 healthy female volunteers. Age, weight, height, and leg dominance were determined for each. Muscle strength was measured using a device with a built-in MicroFET dynamometer. The result for the left hallux was ICC(3,1) .89 (95% CI .77-.95). The result for the right hallux was ICC(3,1) .94 (95% CI .87-.97). In the Bland and Altman plots, the reliability again appeared to be sufficient. The Pearson product-moment correlations gave poor results for the association between body weight, height, age, and mean force of the four trails. The test results indicate good reliability of the measurement device as used in this study. The advantage of this testing device is that it makes it easier to standardize measurements as opposed to the MicroFET used as a hand-held dynamometer. Also, patients can be tested in a nonload situation, which makes it possible to test hallux valgus at any time, and therefore it is possible to monitor variations in progression (or regression).
Electromyography and clinical neurophysiology
Nederlands tijdschrift voor geneeskunde
767 patients over the age of 70 with a fracture of one hip were studied prospectively. The result... more 767 patients over the age of 70 with a fracture of one hip were studied prospectively. The results were compared with the literature. The overall mortality rate within 3 months was 24%. This mortality was significantly influenced by the general health condition of the patient at the time of the injury, his living quarters and the ability to walk again after operation (p less than 0.001). For 38% of the survivors, able-bodied before the injury, the fracture meant an important loss of functional independence. The degree of impairment was closely related to the patient's age and fracture type (p less than 0.05). Of patients living in their own homes before injury only 60% were able to go back home. In predicting the probability of going back home, the functional status before injury and the ability to walk again at the time of discharge from the surgical department were highly important (p less than 0.001).
Nederlands tijdschrift voor geneeskunde
767 patients over the age of 70 with a fracture of one hip were studied prospectively. The result... more 767 patients over the age of 70 with a fracture of one hip were studied prospectively. The results were compared with the literature. The overall mortality rate within 3 months was 24%. This mortality was significantly influenced by the general health condition of the patient at the time of the injury, his living quarters and the ability to walk again after operation (p less than 0.001). For 38% of the survivors, able-bodied before the injury, the fracture meant an important loss of functional independence. The degree of impairment was closely related to the patient's age and fracture type (p less than 0.05). Of patients living in their own homes before injury only 60% were able to go back home. In predicting the probability of going back home, the functional status before injury and the ability to walk again at the time of discharge from the surgical department were highly important (p less than 0.001).
Der Unfallchirurg
Between 1980 and 1990, 81 fractures of the pilon tibial of type B or C in the AO classification, ... more Between 1980 and 1990, 81 fractures of the pilon tibial of type B or C in the AO classification, presenting in 78 patients, were treated operatively in the Department of Traumatology and Emergency Surgery of the University Hospitals of Leuven. One-fourth of the fractures were open, 36 had second- or third-degree soft tissue damage according to the Tscherne classification system. The relationship between the fracture type and soft tissue damage was significant: the more severe the soft tissue damage, the more complex the fracture type. Screw osteosynthesis was performed mostly in fractures without soft tissue damage; plate osteosynthesis was used more frequently than external fixation in fractures with severe soft tissue damage. The number of late complications was much higher when the fracture was combined with severe soft tissue lesions. The number of secondary operative procedures on the soft tissue and bones was especially elevated in fractures primarily stabilized with a plate osteosynthesis. Sixty-four patients were reviewed clinically and radiologically after a mean time of 52.7 months. The subjective and objective end results were classified in accordance to the scales of Ovadia. Of the patients without soft tissue lesions, 86.4% showed excellent or good subjective and 74.6% excellent or good objective end results; 55.6% of the patients with severe soft tissue damage had excellent or good subjective and 48.1% excellent or good objective end results. In pilon fractures with severe soft tissue damage, bony consolidation can only be reached after several operative steps. In the primary procedure, only minimal osteosynthesis, combined with medial external fixation should be performed.(ABSTRACT TRUNCATED AT 250 WORDS)
Acta orthopaedica Belgica
Forearm rotation affects grip strength. In a study with 40 volunteers, an overall decrease in gri... more Forearm rotation affects grip strength. In a study with 40 volunteers, an overall decrease in grip strength was observed when the forearm rotated from pronation to supination. In males grip strength in pronation was significantly lower compared to the neutral and supinated position, with the wrist free as well as in an immobilized wrist position. In females this was only observed with a free wrist position, but with the wrist immobilized, the grip strength was higher in supination compared to neutral and pronation.
International surgery
In a consecutive series of 416 patients with multiple injuries, 49 were aged 65 years or older (m... more In a consecutive series of 416 patients with multiple injuries, 49 were aged 65 years or older (mean age 72.1). This group of "old" patients was compared with the remaining 367 "young" patients (mean age 31.3). In the old patients group, survivors and non-survivors were profiled. In general the injured old patient was a pedestrian hit by a car or a motorbike or someone who had simply fallen at home. Despite the fact that the mean Injury Severity Score (ISS) was significantly lower in the old patients' group (33.2 versus 42.1) (p less than 0.001), the mortality rate was significantly higher (18% versus 7.6%) (p less than 0.05). We found that in the elderly injured the ISS and preexisting diseases were not predictive of survival. However, brain injury with unconsciousness and the need for early intubation followed by long-term assisted ventilation were predictive of survival (p less than 0.001). Seventy-six per cent of the survivors were able to return home aga...
Acta chirurgica Belgica
Between 1978 and 1982 154 femoral shaft fractures were treated in 145 adults in our department of... more Between 1978 and 1982 154 femoral shaft fractures were treated in 145 adults in our department of general surgery and traumatology. 52 fractures were nailed intramedullary. We reserved the intramedullary nailing for ideal cases like the transverse and the short oblique fractures in the middle 3/5 of the shaft. 102 fractures were treated by a dynamic compression plate applying the AO principles correctly. Condylar plates were not included in this study. 88 patients with 95 FSF were followed up. In our prospective study a significant relationship was found between the types of fractures, the consolidation, the rehabilitation (including walking), the hospitalisation time and the full weight-bearing results. The prognosis for simple fractures was better than for comminuted fractures. Polytrauma patients showed a significantly slower limb rehabilitation, a longer hospitalisation and a worse clinical result than patients with isolated fractures. A significant relationship was shown betwee...
International surgery
Two hundred and forty-one hip fracture patients over 70 years of age still living at home at the ... more Two hundred and forty-one hip fracture patients over 70 years of age still living at home at the moment of the accident were followed prospectively until three months postoperatively. The patients were admitted to the department over a five year period (1978-1983). One hundred and forty-four patients returned home. In order to predict whether an elderly hip fracture patient will be able to return home within three months, the following prognostic factors will have to be taken into account: pre-operative functional status (p = 0.0001), ambulatory capacity at discharge (p = 0.0001), age (p = 0.001), presence of relatives at home to return to (p = 0.02) and general medical postoperative complications (p = 0.0006). In this respect it was noted that sex, fracture type or mechanical complication with possible operation do not significantly influence the home-going rate within three months after surgery (p greater than 0.05).
Der Unfallchirurg
The long-stem, long-neck endoprosthesis is used in the treatment of pertrochanteric hip fractures... more The long-stem, long-neck endoprosthesis is used in the treatment of pertrochanteric hip fractures in the elderly. Between 1978 and 1984, 157 patients 70 years of age and over were treated at our clinic for fresh unstable pertrochanteric hip fractures. Fifty-five patients had internal fixation. Because of the high incidence of mechanical complications, the long spherostem endoprosthesis became the treatment of choice between 1980 and 1984. Thus, 102 patients were treated with this type of arthroplasty. They were compared with the 55 patients treated with osteosynthesis, and we concluded that: (1) in comparison with osteosynthesis, the procedure of endoprosthetic replacement is no more extensive and the mortality is no higher; (2) the incidence of mechanical complications is significantly lower in the endoprosthesis group; (3) even if the dynamic hip screw is now the treatment of choice for pertrochanteric fractures, the long spherostem endoprosthesis is still indicated in arthrotic h...
Der Unfallchirurg
The long-stem, long-neck endoprosthesis is used in the treatment of pertrochanteric hip fractures... more The long-stem, long-neck endoprosthesis is used in the treatment of pertrochanteric hip fractures in the elderly. Between 1978 and 1984, 157 patients 70 years of age and over were treated at our clinic for fresh unstable pertrochanteric hip fractures. Fifty-five patients had internal fixation. Because of the high incidence of mechanical complications, the long spherostem endoprosthesis became the treatment of choice between 1980 and 1984. Thus, 102 patients were treated with this type of arthroplasty. They were compared with the 55 patients treated with osteosynthesis, and we concluded that: (1) in comparison with osteosynthesis, the procedure of endoprosthetic replacement is no more extensive and the mortality is no higher; (2) the incidence of mechanical complications is significantly lower in the endoprosthesis group; (3) even if the dynamic hip screw is now the treatment of choice for pertrochanteric fractures, the long spherostem endoprosthesis is still indicated in arthrotic h...
The Journal of Orthopaedic and Sports Physical Therapy, Jul 1, 2003
Randomized clinical trial. To analyze the immediate treatment effects of cervical mobilization an... more Randomized clinical trial. To analyze the immediate treatment effects of cervical mobilization and therapeutic ultrasound in patients with neurogenic cervicobrachial pain. Different treatment modalities have been described for patients with neurogenic cervicobrachial pain. Although it has been suggested that a more specific approach, like cervical mobilization, would be more effective, effect studies are scarce. Twenty patients with subacute peripheral neurogenic cervicobrachial pain were assessed. Besides other criteria, patients were included if a cervical segmental motion restriction was present which could be regarded as a possible cause of the neurogenic disorder. Patients were randomly assigned to a mobilization or ultrasound group. Mobilization consisted of a contralateral lateral glide technique. The range of elbow extension, symptom distribution, and pain intensity during the neural tissue provocation test for the median nerve were used as outcome measures. Results were analyzed using a 2-way mixed-design ANOVA. Significant differences in treatment effects between the 2 groups could be observed for all outcome measures (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = .0306). For the mobilization group, the increase in elbow extension from 137.3 degrees to 156.7 degrees, the 43.4% decrease in area of symptom distribution, and the decreased pain intensity from 7.3 to 5.8 were significant (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = .0003). For the ultrasound group, there were no significant improvements (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = .0521). When a cervical dysfunction can be regarded as a cause of the neurogenic disorder or as a contributing factor that impedes natural recovery, a cervical lateral glide mobilization has positive immediate effects in patients with subacute peripheral neurogenic cervicobrachial pain. This movement-based approach seems preferable to ultrasound.
Acta Paediat, 2007
The test-retest reproducibility of visual analogue scales for the perceived influence of exertion... more The test-retest reproducibility of visual analogue scales for the perceived influence of exertion and movements/positions on low back problems in adolescents was investigated. The study was performed on 61 adolescents with low back problems. Item completion, median score, interquartile range and weighted kappa were calculated. Results showed that visual analogue scales produce repeatable information for all items tested (weighted kappa: 0.59-0.83), except for the influence of pulling materials on back problems (0.45). The results of this study suggest that adolescents, aged 16-18 y, can reproduce their visual analogue scores.
Der Unfallchirurg
ABSTRACT
Acta chirurgica Belgica
A retrospective study of 118 femoral neck fractures treated with multiple Knowles pins or with AO... more A retrospective study of 118 femoral neck fractures treated with multiple Knowles pins or with AO (ASIF) cancellous bone screws, and followed for at least 22 months, revealed nonunion in 1/33 undisplaced fractures and in 27/85 displaced fractures. Avascular necrosis was radiographically evident in respectively 2/32 and 19/58 united undisplaced and displaced fractures. Four factors were adversely associated with union: inaccurate reduction, mental confusion, age above 80 years and fixation with less than 6 Knowles pins. Late segmental collapse was not significantly related with any of the 9 analyzed factors. It was concluded that displaced femoral neck fractures in confused patients older than 80 years, or fractures one cannot adequately reduce, should be primarily treated with arthroplasty. Following accurate reduction, internal fixation with less than 6 Knowles pins cannot be recommended.
Journal of Orthopaedic Trauma
During a 10-year period (1978-1988), 565 patients, aged greater than or equal to 70 years, who su... more During a 10-year period (1978-1988), 565 patients, aged greater than or equal to 70 years, who sustained a fresh pertrochanteric fracture, were treated in the Department of Traumatology at the University Hospitals of Leuven, Belgium. Three hundred eighty-eight fractures were complex and unstable, according to the Evans-Jensen system and the AO system. Special attention was given to the 324 cases of type IC and ID in Evans' system, type A2 in the AO system. The method of treatment changed greatly during the period of study. All patients were followed prospectively during 1 year. Our study showed that for these unstable fractures, fixation with an angled plate or Ender nails should be forsaken. The overall results of the compression hip screw treatment were good (reoperation rate 2%, good functional results in 64%), but as this treatment has a risk for serious collapse and pain in about 80% of all type ID fractures, one could suggest treating these complex multifragment fractures primarily with an endoprosthesis. This treatment need no longer be considered severe intervention, as the danger of mechanical complications is minimal (less than 1%).
Acta chirurgica Belgica
In a first study of 416 polytrauma patients, 49 were aged 65 years or older. These "old ... more In a first study of 416 polytrauma patients, 49 were aged 65 years or older. These "old patients" (mean age 72.1) were compared with the remaining 367 "young patients" (mean age 31.3). In a second study concerning 126 polytrauma patients of 65 and over, the survivors and non survivors were profiled and compared. The typical injured old patient was a pedestrian hit by a car or a motorbike or someone who had simply fallen at home. Despite the fact that the mean Injury Severity Score (ISS) was significantly lower in the old patients' groups (33.2 versus 42.1 degrees) (p < 0.0001) the mortality rate was higher (18% versus 7.6%) (p < 0.05). In old trauma victims multiple system organ failure (MSOF) was responsible for the fatal outcome in 48% of the cases and in 71% of the deaths more than 7 days after trauma. Seventy eight percent of the surviving old patients still living at home pre-injury were able to go back to their normal surroundings. In the old patients groups there was no significant difference in age nor in ISS nor in pre-existing diseases between survivors and non-survivors. On the other hand the Glasgow Coma Scale (GCS) was of important prognostic value, as well as to survival as to functional recovery (p < 0.001). Also the need for early intubation and continued ventilation were predictive of survival (p < 0.001). Nevertheless this need for respiratory assistance was not an indication for withdrawing support as also 9% of the survivors required endotracheal intubation for 5 days or longer.(ABSTRACT TRUNCATED AT 250 WORDS)
Acta chirurgica Belgica
... Is the Belgian VDP prosthesis the best treatment for unstable fractures with severe comminuti... more ... Is the Belgian VDP prosthesis the best treatment for unstable fractures with severe comminution? Broos PL, Rommens PM, Geens VR, Stappaerts KH. ... Our study showed that for these unstable fractures, fixation with an angled plate or Ender nails should be forsaken. ...
Journal of Applied Biomechanics, Aug 1, 2003
The purpose of this study was to present a method for repeated measurement of flexion force of th... more The purpose of this study was to present a method for repeated measurement of flexion force of the hallux in the metatarsophalangeal joint. The reliability of this measurement device was also examined. This device is suitable for situations where weight-bearing is contraindicated or when it is not possible for patients to bear load on their toes, such as hallux valgus patients. Since most such patients are female, the participants in this study were 24 healthy female volunteers. Age, weight, height, and leg dominance were determined for each. Muscle strength was measured using a device with a built-in MicroFET dynamometer. The result for the left hallux was ICC(3,1) .89 (95% CI .77-.95). The result for the right hallux was ICC(3,1) .94 (95% CI .87-.97). In the Bland and Altman plots, the reliability again appeared to be sufficient. The Pearson product-moment correlations gave poor results for the association between body weight, height, age, and mean force of the four trails. The test results indicate good reliability of the measurement device as used in this study. The advantage of this testing device is that it makes it easier to standardize measurements as opposed to the MicroFET used as a hand-held dynamometer. Also, patients can be tested in a nonload situation, which makes it possible to test hallux valgus at any time, and therefore it is possible to monitor variations in progression (or regression).
Electromyography and clinical neurophysiology
Nederlands tijdschrift voor geneeskunde
767 patients over the age of 70 with a fracture of one hip were studied prospectively. The result... more 767 patients over the age of 70 with a fracture of one hip were studied prospectively. The results were compared with the literature. The overall mortality rate within 3 months was 24%. This mortality was significantly influenced by the general health condition of the patient at the time of the injury, his living quarters and the ability to walk again after operation (p less than 0.001). For 38% of the survivors, able-bodied before the injury, the fracture meant an important loss of functional independence. The degree of impairment was closely related to the patient's age and fracture type (p less than 0.05). Of patients living in their own homes before injury only 60% were able to go back home. In predicting the probability of going back home, the functional status before injury and the ability to walk again at the time of discharge from the surgical department were highly important (p less than 0.001).
Nederlands tijdschrift voor geneeskunde
767 patients over the age of 70 with a fracture of one hip were studied prospectively. The result... more 767 patients over the age of 70 with a fracture of one hip were studied prospectively. The results were compared with the literature. The overall mortality rate within 3 months was 24%. This mortality was significantly influenced by the general health condition of the patient at the time of the injury, his living quarters and the ability to walk again after operation (p less than 0.001). For 38% of the survivors, able-bodied before the injury, the fracture meant an important loss of functional independence. The degree of impairment was closely related to the patient's age and fracture type (p less than 0.05). Of patients living in their own homes before injury only 60% were able to go back home. In predicting the probability of going back home, the functional status before injury and the ability to walk again at the time of discharge from the surgical department were highly important (p less than 0.001).
Der Unfallchirurg
Between 1980 and 1990, 81 fractures of the pilon tibial of type B or C in the AO classification, ... more Between 1980 and 1990, 81 fractures of the pilon tibial of type B or C in the AO classification, presenting in 78 patients, were treated operatively in the Department of Traumatology and Emergency Surgery of the University Hospitals of Leuven. One-fourth of the fractures were open, 36 had second- or third-degree soft tissue damage according to the Tscherne classification system. The relationship between the fracture type and soft tissue damage was significant: the more severe the soft tissue damage, the more complex the fracture type. Screw osteosynthesis was performed mostly in fractures without soft tissue damage; plate osteosynthesis was used more frequently than external fixation in fractures with severe soft tissue damage. The number of late complications was much higher when the fracture was combined with severe soft tissue lesions. The number of secondary operative procedures on the soft tissue and bones was especially elevated in fractures primarily stabilized with a plate osteosynthesis. Sixty-four patients were reviewed clinically and radiologically after a mean time of 52.7 months. The subjective and objective end results were classified in accordance to the scales of Ovadia. Of the patients without soft tissue lesions, 86.4% showed excellent or good subjective and 74.6% excellent or good objective end results; 55.6% of the patients with severe soft tissue damage had excellent or good subjective and 48.1% excellent or good objective end results. In pilon fractures with severe soft tissue damage, bony consolidation can only be reached after several operative steps. In the primary procedure, only minimal osteosynthesis, combined with medial external fixation should be performed.(ABSTRACT TRUNCATED AT 250 WORDS)
Acta orthopaedica Belgica
Forearm rotation affects grip strength. In a study with 40 volunteers, an overall decrease in gri... more Forearm rotation affects grip strength. In a study with 40 volunteers, an overall decrease in grip strength was observed when the forearm rotated from pronation to supination. In males grip strength in pronation was significantly lower compared to the neutral and supinated position, with the wrist free as well as in an immobilized wrist position. In females this was only observed with a free wrist position, but with the wrist immobilized, the grip strength was higher in supination compared to neutral and pronation.
International surgery
In a consecutive series of 416 patients with multiple injuries, 49 were aged 65 years or older (m... more In a consecutive series of 416 patients with multiple injuries, 49 were aged 65 years or older (mean age 72.1). This group of "old" patients was compared with the remaining 367 "young" patients (mean age 31.3). In the old patients group, survivors and non-survivors were profiled. In general the injured old patient was a pedestrian hit by a car or a motorbike or someone who had simply fallen at home. Despite the fact that the mean Injury Severity Score (ISS) was significantly lower in the old patients' group (33.2 versus 42.1) (p less than 0.001), the mortality rate was significantly higher (18% versus 7.6%) (p less than 0.05). We found that in the elderly injured the ISS and preexisting diseases were not predictive of survival. However, brain injury with unconsciousness and the need for early intubation followed by long-term assisted ventilation were predictive of survival (p less than 0.001). Seventy-six per cent of the survivors were able to return home aga...
Acta chirurgica Belgica
Between 1978 and 1982 154 femoral shaft fractures were treated in 145 adults in our department of... more Between 1978 and 1982 154 femoral shaft fractures were treated in 145 adults in our department of general surgery and traumatology. 52 fractures were nailed intramedullary. We reserved the intramedullary nailing for ideal cases like the transverse and the short oblique fractures in the middle 3/5 of the shaft. 102 fractures were treated by a dynamic compression plate applying the AO principles correctly. Condylar plates were not included in this study. 88 patients with 95 FSF were followed up. In our prospective study a significant relationship was found between the types of fractures, the consolidation, the rehabilitation (including walking), the hospitalisation time and the full weight-bearing results. The prognosis for simple fractures was better than for comminuted fractures. Polytrauma patients showed a significantly slower limb rehabilitation, a longer hospitalisation and a worse clinical result than patients with isolated fractures. A significant relationship was shown betwee...
International surgery
Two hundred and forty-one hip fracture patients over 70 years of age still living at home at the ... more Two hundred and forty-one hip fracture patients over 70 years of age still living at home at the moment of the accident were followed prospectively until three months postoperatively. The patients were admitted to the department over a five year period (1978-1983). One hundred and forty-four patients returned home. In order to predict whether an elderly hip fracture patient will be able to return home within three months, the following prognostic factors will have to be taken into account: pre-operative functional status (p = 0.0001), ambulatory capacity at discharge (p = 0.0001), age (p = 0.001), presence of relatives at home to return to (p = 0.02) and general medical postoperative complications (p = 0.0006). In this respect it was noted that sex, fracture type or mechanical complication with possible operation do not significantly influence the home-going rate within three months after surgery (p greater than 0.05).
Der Unfallchirurg
The long-stem, long-neck endoprosthesis is used in the treatment of pertrochanteric hip fractures... more The long-stem, long-neck endoprosthesis is used in the treatment of pertrochanteric hip fractures in the elderly. Between 1978 and 1984, 157 patients 70 years of age and over were treated at our clinic for fresh unstable pertrochanteric hip fractures. Fifty-five patients had internal fixation. Because of the high incidence of mechanical complications, the long spherostem endoprosthesis became the treatment of choice between 1980 and 1984. Thus, 102 patients were treated with this type of arthroplasty. They were compared with the 55 patients treated with osteosynthesis, and we concluded that: (1) in comparison with osteosynthesis, the procedure of endoprosthetic replacement is no more extensive and the mortality is no higher; (2) the incidence of mechanical complications is significantly lower in the endoprosthesis group; (3) even if the dynamic hip screw is now the treatment of choice for pertrochanteric fractures, the long spherostem endoprosthesis is still indicated in arthrotic h...
Der Unfallchirurg
The long-stem, long-neck endoprosthesis is used in the treatment of pertrochanteric hip fractures... more The long-stem, long-neck endoprosthesis is used in the treatment of pertrochanteric hip fractures in the elderly. Between 1978 and 1984, 157 patients 70 years of age and over were treated at our clinic for fresh unstable pertrochanteric hip fractures. Fifty-five patients had internal fixation. Because of the high incidence of mechanical complications, the long spherostem endoprosthesis became the treatment of choice between 1980 and 1984. Thus, 102 patients were treated with this type of arthroplasty. They were compared with the 55 patients treated with osteosynthesis, and we concluded that: (1) in comparison with osteosynthesis, the procedure of endoprosthetic replacement is no more extensive and the mortality is no higher; (2) the incidence of mechanical complications is significantly lower in the endoprosthesis group; (3) even if the dynamic hip screw is now the treatment of choice for pertrochanteric fractures, the long spherostem endoprosthesis is still indicated in arthrotic h...