Papers by francis van glabbeek
Strategies in Trauma and Limb Reconstruction
Case description: A 58-year-old woman suffered an open displaced olecranon fracture with extensiv... more Case description: A 58-year-old woman suffered an open displaced olecranon fracture with extensive soft tissue damage when she was involved in a car accident in Africa. Local doctors performed a debridement of the elbow. Later, she presented in our centre for further treatment. There was a possibility of active infection, for which antibiotics were given and a debridement was performed. We then applied dynamic external fixation to minimize infection risk. Physiotherapy started soon after. External fixation was removed after 2 months. On follow-up, the patient reported no pain and no signs of major instability were present. Therefore, we agreed not to perform additional surgery. Annual follow-up radiographs showed progressive remodelling of the joint. Eleven years after the initial trauma, a reversed elbow has formed. It is a fully functional neoarticulation that is shaped by osteophyte formation and erosion of ulna, radius and humerus. The patient is free of pain and shows intact flexion and supination, while extension and pronation are limited. She has regained good elbow function and can perform most of her daily activities. Conclusion: Invasive reconstructive surgery with implantation of foreign material should be avoided or postponed in heavily contaminated fractures to avoid infection. It could be valuable to consider a watchful waiting strategy, which sometimes results in a good functional end result. Nature can be kind, which has been proven in our case.
The Faseb Journal, Mar 1, 2006
Seminars in Musculoskeletal Radiology, 2016
Acta orthopaedica Belgica, 2014
Hardware prominence after plate fixation for clavicle fracture is a common complication. The aim ... more Hardware prominence after plate fixation for clavicle fracture is a common complication. The aim of the study was to perform a 3D analysis of the prominence of different types of superior clavicle plates. An automated fitting of 3 straight and 10 precontoured plates was performed on 52 3D-CT-scan reconstructed cadaver clavicles. The mean and maximum bone-plate distance and maximum prominence was significant higher with the straight plates compared to the precontoured plates. The mean and maximum boneplate distance was significant higher with the precontoured DePuy-Synthes plates compared to the precontoured Acumed plates but when evaluating the maximum prominence there was no significant difference between the most commonly used 8-holes plates. To conclude, precontoured plates of the clavicula diminish significantly hardware prominence. There exists a difference in hardware prominence between different brands of precontoured plates but this difference is limited and in most cases no...
Archives of Physical Medicine and Rehabilitation, 2015
To systematically review the literature for efficacy of isolated articular mobilization technique... more To systematically review the literature for efficacy of isolated articular mobilization techniques in patients with primary adhesive capsulitis (AC) of the shoulder. PubMed and Web of Science were searched for relevant studies published before November 2014. Additional references were identified by manual screening of the reference lists. All English language randomized controlled trials evaluating the efficacy of mobilization techniques on range of motion (ROM) and pain in adult patients with primary AC of the shoulder were included in this systematic review. Twelve randomized controlled trials involving 810 patients were included. Two reviewers independently screened the articles, scored methodologic quality, and extracted data for analysis. The review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. All studies were assessed in duplicate for risk of bias using the Physiotherapy Evidence Database Scale for randomized controlled trials. The efficacy of 7 different types of mobilization techniques was evaluated. Angular mobilization (n=2), Cyriax approach (n=1), and Maitland technique (n=6) showed improvement in pain score and ROM. With respect to translational mobilizations (n=1), posterior glides are preferred to restore external rotation. Spine mobilizations combined with glenohumeral stretching and both angular and translational mobilization (n=1) had a superior effect on active ROM compared with sham ultrasound. High-intensity mobilization (n=1) showed less improvement in the Constant Murley Score than a neglect group. Finally, positive long-term effects of the Mulligan technique (n=1) were found on both pain and ROM. Overall, mobilization techniques have beneficial effects in patients with primary AC of the shoulder. Because of preliminary evidence for many mobilization techniques, the Maitland technique and combined mobilizations seem recommended at the moment.
Acta orthopaedica Belgica, 2011
The amount of bony support by the glenoid can be determined using the glenohumeral index, i.e. th... more The amount of bony support by the glenoid can be determined using the glenohumeral index, i.e. the maximum anteroposterior (AP) diameter of the humeral head divided by the maximum AP dimension of the glenoid. This index has been described theoretically, but has never been validated in practice. In this study we used 20 cadaver shoulders to determine the glenohumeral index in two different ways. One method evaluated the glenohumeral index on a CT scan of the shoulders. The second method determined the anatomical glenohumeral index of the same shoulders by direct measurement of anatomical specimens using a digital caliper. All CT and caliper measurements were repeated by three different investigators. We used the Wilcoxon Signed Rank Test, to calculate the statistical significance of intra-observer and inter-observer differences in measurements on CT and with the caliper. Statistical analysis showed no significant differences between CT scan and caliper measurements for each investiga...
The Journal of bone and joint surgery. American volume, Jan 20, 2014
When a surgeon uses a percutaneous volar approach to treat scaphoid waist fractures, central scre... more When a surgeon uses a percutaneous volar approach to treat scaphoid waist fractures, central screw placement is complicated by the shape of the scaphoid and by obstruction by the trapezium. In this study, we used radiographs and biomechanical tests to compare the standard volar percutaneous approach with the transtrapezial approach, with regard to central screw placement at the distal pole of the scaphoid. Fourteen matched pairs of cadaveric wrists were randomly assigned to two treatment groups. Under fluoroscopic control, a guidewire was drilled into the scaphoid, either through a transtrapezial approach or through a standard volar approach that avoided the trapezium. Guidewire position was measured in the coronal and sagittal planes. A transverse osteotomy was performed along the scaphoid waist, and this was followed by the insertion of the longest possible cannulated headless bone screw. Each specimen was placed into a fixture with a pneumatically driven plunger resting on the su...
Acta orthopaedica Belgica, 2009
A biomechanical in vitro study was performed on 16 fresh frozen cadaver forearms to investigate t... more A biomechanical in vitro study was performed on 16 fresh frozen cadaver forearms to investigate the role of the transverse carpal ligament (TCL) in carpal stability. The distance between the scaphoid and hamate was measured, as a reference for the length of the TCL. Distances were recorded in both loaded and unloaded conditions after gradual sectioning of the transverse carpal ligament, the palmar scapholunate, long radiolunate ligament and radioscapholunate ligament. The largest increase in spread of the carpal bones (55.3% of total spread) was noted after loading with the ligament intact. Thereafter, sectioning of the TCL resulted in a further 32.9% increase in the distance between the scaphoid and the hamate. We conclude that the intact carpal bones-ligament complex displays some elasticity. Progressive sectioning of the TCL ligament under loading further opens the palmar arch. Nevertheless it appears that the carpal arch will still retain reasonable intrinsic stability even with...
The Journal of bone and joint surgery. American volume, 2004
1. Subscribe/Register | Help | About | Feedback. Google Sign Out. Home; Current Issue; All Issues... more 1. Subscribe/Register | Help | About | Feedback. Google Sign Out. Home; Current Issue; All Issues: By Year; By Article Type. Browse by: Basic Science; Education & Training; Elbow; Ethics; Foot & Ankle; Hand & Wrist; Hip; Infection; Knee; ...
Acta orthopaedica Belgica, 2000
We report our experience with the floating radial head prosthesis of Judet for comminuted fractur... more We report our experience with the floating radial head prosthesis of Judet for comminuted fractures of the radial head. We present the results in 15 patients with a mean follow-up of 25.2 months. Thirteen prostheses were inserted for acute Mason III fractures of the radial head, and 2 were inserted for chronic problems after radial head fracture. According to the Mayo Elbow Performance Index there were 7 excellent, 3 good, 1 fair and 2 poor results in the group with acute injuries. In this group, one prosthesis was removed after 8 months for severely decreased elbow function. In the group with chronic problems, there were 2 fair results. There were no dislocations or prosthesis fractures. None of the prostheses showed signs of loosening. Three patients in the acute group developed wrist pain, and in one patient in the chronic group, preexisting wrist pain disappeared after insertion of the radial head prosthesis. Our short-term results suggest that the floating radial head prosthesi...
Operative Elbow Surgery, 2012
The Journal of Bone and Joint Surgery (American), 2005
The Journal of Bone and Joint Surgery (American), 2009
Foot & Ankle International, 2011
The Scarf valgus inducing osteotomy of the calcaneus is an operative technique to correct varus d... more The Scarf valgus inducing osteotomy of the calcaneus is an operative technique to correct varus deformity of the hindfoot. It is versatile with significant corrective power; however, the neurovascular structures are in close proximity on the medial side and thus may be harmed during the osteotomy. Moreover, because this type of osteotomy can cause a great lateral translation, traction of the medial neurovascular structures is possible. We performed an anatomic study to evaluate the medial soft tissues after a lateralizing Scarf-type calcaneal osteotomy. The osteotomies were carried out on ten fresh-frozen cadaver specimens. We performed the osteotomy and induced valgus. Then we performed a medial dissection to identify the important medial structures: the medial and lateral plantar nerve (MPN , LPN) and the posterior tibial artery (PTA). We noted their relation to the osteotomy and their integrity. In several cases, one or more of the structures were sectioned. In five cases, all the structures crossed the osteotomy, four of which even a transection of one or both of the plantar nerves occurred. Although the PTA crossed the osteotomy in eight specimens, there was no transection of this structure. Scarf osteotomy of the calcaneus is a highly corrective osteotomy. However, caution must be exercised when performing as the medial neurovascular structures cross the osteotomy lines and transection can occur. When performing the osteotomy one should keep in mind that vigorous sawing and large displacement can cause damage to the medial neurovascular structures.
Clinical Rheumatology, 2012
Ulnar neuropathy at the elbow is the second most common entrapment neuropathy. Ulnar nerve entrap... more Ulnar neuropathy at the elbow is the second most common entrapment neuropathy. Ulnar nerve entrapment has several causes. A case report is presented with the presence of the M. anconeus epitrochlearis at both sides. The patient contacted our department with chronic, diffuse bilateral elbow pain irradiating into both forearms. She experienced typical nocturnal paresthesias involving digit IV and V of both hands. Tinel's sign was present just proximal to the medial epicondyle. A bilateral ulnar nerve entrapment was clinically suspected. An electromyographic (EMG) investigation revealed slowing of the motor conduction velocity in the ulnar nerve across the elbow. An ultrasound and MRI investigation demonstrated the presence of an anomalous muscle, called the M. anconeus epitrochlearis, at both sides. Treatment consisted of bilateral surgical excision of the muscle and retinacular release, followed by physical therapy. The outcome was favourable.
Clinical Anatomy, 2013
The clavicle has a complex osteologic structure that makes morphological analysis extremely diffi... more The clavicle has a complex osteologic structure that makes morphological analysis extremely difficult. A three-dimensional study was conducted to examine the anatomical variations and characteristics of the bone. Sixty-eight human cadaver clavicles were dissected, CAT-scanned, and reconstructed. An automated parameterization and correspondence shape analysis system was developed. A new length, designated as centerline (CL) length, was defined and measured. This length represents the true length of the clavicle. The endpoint length was measured as the distance between two endpoints. The width and curvature were measured in the axial (AX) and frontal (FR) plane and defined along the CL. Next gender and side characteristics and variations were examined. The mean CL length was 159.0 ± 11.0 mm. The mean endpoint length was 149.4 ± 10.3 mm, which was statistically significantly shorter than the CL. The male clavicle was significantly longer (166.8 ± 7.3 mm vs. 151.0 ± 8.2 mm), wider (14.6 ± 1.5 mm vs. 12.7 ± 1.3 mm lateral FR plane, 25.9 ± 4.1 mm vs. 23.5 ± 3.0 mm lateral AX plane and 24.7 ± 2.8 mm vs. 22.8 ± 2.8 mm medial AX plane), and more curved (10.8 ± 2.8 mm vs. 8.6 ± 2.3 mm medial and 10.5 ± 3.3 mm vs. 9.1 ± 2.5 mm lateral) than the female one. Left clavicles were significant longer (159.8 ± 10.9 mm vs. 158.0 ± 11.2 mm) than right clavicles. A novel three-dimensional system was developed, used and tested in order to explore the anatomical variations and characteristics of the human clavicle. This information, together with the automated system, can be applied to future clavicle populations and to the design of fixation plates for clavicle fractures.
Clinical Anatomy, 2012
The aim of this anatomical study was to find out if total denervation of the elbow joint is techn... more The aim of this anatomical study was to find out if total denervation of the elbow joint is technically feasible. The endbranches of the brachial plexus of eight fresh-frozen upper arm cadavers were dissected with optical loupe magnification. All major nerves of the upper limb (except the axillary and the medial brachial cutaneous nerve) give some terminal articular endbranches to the elbow. The articular endbranches arise from muscular endbranches, cutaneous endbranches, or arise straight from the main nerves of the brachial plexus. A topographic diagram was made of the different nerves innervating the elbow joint. The ulno-posterior part of the elbow is innervated by the ulnar nerve and some branches of medial antebrachial cutaneous nerve. The radial-posterior part of the elbow is innervated exclusively by the radial nerve. The ulno-anterior part of the elbow is innervated by the median nerve and the musculocutaneous nerve. The radio-anterior part of the elbow is innervated by the radial nerve and the musculocutaneous nerve. These elbow innervation findings are relevant to both anatomical and clinical field as they provide evidence that the total denervation of the elbow joint is impossible. Nevertheless, partial denervation, like denervation of the lateral epicondyle or the ulnar part of elbow, is technically possible.
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Papers by francis van glabbeek