R Rosso

Universität Basel, Basel, BS, Switzerland

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Publications (27)18.13 Total impact

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    ABSTRACT: Total knee joint transplantation has been performed in animal models and humans. This study investigates the impact of this operation on knee joint function in a dog model. Therefore, replantation was compared to transplantation during a 6-month follow-up period in four dogs in each group. The peak vertical ground reaction force normalized in all legs undergoing replantation and in two of four after transplantation. A third transplant recipient reduced loading from the 4th month due to a local complication, and the fourth succumbed to sepsis 3 months postoperatively. A weight-bearing index (WBI), defined as loading of the grafted divided by loading of both hind-limbs decreased from 0.48 +/- 0.08 preoperatively to 0.13 +/- 0.10 by 1 month after replantation and from 0.53 +/- 0.07 to 0 after transplantation. After 6 months, weight-bearing of all replant recipients was restored, but reduced in two transplant recipients with graft function. Full recovery after replantation, but impaired function after transplantation, was also reflected in the histological results: normal histological pictures of blood vessels, cartilage, bone and soft tissues were found in all replant recipients, but infiltrative vasculopathy indicating chronic rejection was found in the transplanted joints. The results of this animal study confirm that the procedure can lead to satisfactory functional results but also emphasize the need for perfect control of immunosuppression.
    Archives of Orthopaedic and Trauma Surgery 02/2000; 120(7-8):426-31. · 1.36 Impact Factor
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    ABSTRACT: Between 1980 and 1989 71 patients with a femoral neck fracture were treated at the University Hospital of Basel by a Dynamic Hip Screw (n = 54) or by three compression screws (n = 17). Fifty out of 71 patients (70%) were reviewed clinically and radiologically after an average of 116 months. 32/50 fractures (64%) had united. In 18/50 (36%) either avascular necrosis (12) or secondary fracture dislocation (6) had resulted in failure after an average of 29 months following injury. Despite these results, the patients assessment had been very good or good in 44 patients (88%) and fair only in six patients (12%). The cause of secondary dislocation proved to be mainly due to a technical failure at surgery. The incidence of avascular necrosis was significantly higher in displaced fractures compared to non-displaced fractures (p < 0.05), regardless of the quality of the reduction achieved (varus or valgus) or the time delay between accident and operation. However it was interesting to note, that more than one third of all avascular necrosis became apparent more than 3 years (4-10 years) after the accident.
    Swiss Surgery 01/1999; 5(6):257-64.
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    ABSTRACT: To evaluate whether the implantation of the modular trochanter stabilizing plate (TSP) in addition to the dynamic hip screw (DHS) prevents excessive telescoping and limb shortening in four-part and selected three-part trochanteric fractures. Prospective clinical study. The study was conducted at the trauma unit of the Surgical Department of the University of Basel, Switzerland. Forty-six consecutive patients with unstable intertrochanteric fractures were treated with an additional TSP super-imposed on the regular DHS at our institution between July 1991 and July 1993. Five patients died before the first follow-up, one patient was lost to follow-up, and another patient refused follow-up. Thus, thirty-nine patients were followed for at least twelve months (mean 14 months, range 12 to 20 months). The fractures treated were classified according to the OTA classification, which is based on the AO classification. Seventeen were 31-A2.2, seven were 31-A2.3, and fourteen were 31-A3.3 fractures. Lateralization of the greater trochanter was successfully prevented in all fractures. Limited fracture impaction was found in 90 percent (n = 35) of the patients with telescoping of 9.5 millimeters (range 0 to 30 millimeters), resulting in mean limb shortening of 5.37 millimeters (range 0 to 14.9 millimeters). Four patients suffered limb shortening exceeding fifteen millimeters (range 15.6 to 21.3 millimeters). Functional results were excellent and good in 87 percent of patients and fair in 13 percent according to the Salvati-Wilson score. All fractures had healed six months after the operation. Three complications required a secondary procedure: one from not inserting a second screw parallel to the gliding hip screw to prevent rotation of the head-neck fragment ("antirotation screw"), one because of deep infection, and one because of a refracture after premature implant removal. In unstable pertrochanteric fractures with small or missing lateral cortical buttress, the addition of a TSP to the DHS effectively supports the unstable greater trochanter fragment and can prevent rotation of the head-neck fragment. Excessive fracture impaction and consecutive limb shortening was prevented by this additional implant in 90 percent of these patients.
    Journal of Orthopaedic Trauma 09/1998; 12(6):392-9. · 1.75 Impact Factor
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    ABSTRACT: The reconstruction of massive osteochondral defects extending to weight-bearing joints remains a surgical challenge. Total knee joint transplantation has been performed experimentally, but these studies lacked prospective evaluation of functional outcome, graft vascularization, and graft viability. Replantation and transplantation of vascularized knee joints was performed in dogs (n=4 per group), comparing functional and morphological results during a 6-month follow-up. All replant recipients and three transplant recipients survived the 6-month follow-up period. At this time, duplex sonography and angiography revealed patent anastomoses in all animals. Increases in volumetric flow rates and vascular collateralization were observed in allografts, as compared with replanted joints (100+/-16 ml/min vs. 31+/-15 ml/min at 6 months after transplantation). Bone fusion at the graft-host interface was verified by fluorography in all animals at 3 months after transplantation. Six months after transplantation, microradiographies and computerized tomographies revealed spongialization of the cortical bone and filling of the medullary space by trabecular bone in transplanted joints. Such alterations were not detectable in replanted joints. Chondrocyte viability exceeded 80% in all but one transplanted joint. Lymphocyte infiltration of synovia and arterial walls was detected in all transplanted joints, suggesting the presence of chronic rejection. Weight-bearing capacity recovered in all replanted animals (weight-bearing index before transplantation: 0.499+/-0.080; 6 months after transplantation: 0.38+/-0.16) but only in two of four transplanted animals (weight-bearing index 6 months after transplantation: 0.37, 0.28, and 0.00). These data demonstrate the potential of joint grafting and the critical dependence of allotransplantation on the control of rejection.
    Transplantation 07/1997; 63(12):1723-33. · 3.78 Impact Factor
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    ABSTRACT: Transplantation of vascularized knee joints has become technically feasible, but graft rejection as well as failures of the vascular anastomoses remain critical hazards. We therefore tested the potential of repetitive non-invasive duplex sonography to detect changes of the arterial blood flow following canine knee joint transplantation. Four transplantations and, as controls, 4 replantations of intact canine knee joints were performed. The follow-up was 6 months. During this period, repetitive duplex sonography measurements as well as tests of knee joint function were performed. Six months postoperatively, angiographies were performed and all joints were explanted for histological investigation. The luminal diameters of the implanted popliteal artery remained constant in the transplanted animals (preop. 2.6 +/- 0.2 mm, 6 months postop. 2.7 +/- 0.2 mm) but decreased in the autografted controls (preop. 2.9 +/- 0.3 mm, postop. 2.0 +/- 0.3 mm). The time-averaged velocity of the popliteal artery blood flow decreased in both groups 1 month postoperatively. Subsequently, blood flow velocity recovered in transplanted animals but remained low in replanted controls. Significant arterial wall thickening was also detected in transplanted animals as compared to controls. Six months postoperatively, hypervascularization of transplanted joints was confirmed by angiography and thickening of the arterial wall by histology. Furthermore, histology identified mild to chronic allograft rejection in all transplanted joints in spite of controlled cyclosporin A trough level immunosuppression. Chronic rejection of transplanted vascularized knee joints appears to be associated with vessel wall thickening and hypervascularization rather than with vascular rarefaction (picture of the 'arbre mort') that is characteristic of the rejection of most parenchymatous organs. Duplex sonography appears to be sensitive in detecting the corresponding changes of blood supply.
    European Surgical Research 02/1997; 29(6):455-64. · 0.75 Impact Factor
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    ABSTRACT: MHC class II determinants are the restriction elements involved in antigen-specific activation of helper T lymphocytes and interaction with CD4 molecules. They are typically expressed on a limited number of cell types, mostly endowed with antigen-presenting capacity. Recently, expression of HLA-DR has been detected on granulocytes stimulated "in vitro" with GM-CSF. However, no evidence of "in vivo" expression in humans has been presented so far. We report here that class II determinant expression is detectable in vivo on peripheral blood granulocytes of polytraumatized patients upon intravenous administration of rhGM-CSF. Expression of these molecules appears to be an early effect of rhGM-CSF treatment, independent from endotoxemia or endogenous production of IL-6 or TNF-alpha, and rapidly declining upon discontinuation of therapy. Thus, this treatment might increase the number of cells potentially capable of presenting class-II-restricted antigens in these patients.
    Human Immunology 06/1995; 43(1):45-50. · 2.30 Impact Factor
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    ABSTRACT: Functional and morphological results of transplantation (n = 3) and replantation (n = 4) of vascularised total knee joints were compared in a canine model. Follow up time was 6 months. All vascular anastomoses remained patent and all osteotomies healed. Replanted animals displayed normal static weight bearing in contrast to the transplant recipients, which showed reduced weight bearing after 6 months compared to preoperative values. Mild to moderate signs of chronic allograft rejection were detected in all transplanted animals. Functional results were correlated with morphological outcome demonstrating the relevance of adequate control of rejection.
    Swiss Surgery 02/1995;
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    ABSTRACT: Experimental transplantation of vascularized canine knee joints has so far been associated with high complication rates in both auto- and allografts. We have now compared 4 autografts and 4 allografts that were successfully performed at our institution. This report details our surgical technique. Stable internal fixation enabling immediate postoperative weight bearing, microsurgical end-to-end anastomoses of popliteal artery and vein and postoperative control of immunosuppression in transplanted animals are crucial. Thus, an interdisciplinary approach of experts in microsurgery, orthopedic and trauma surgery and immunologists appears to be a prerequisite for successful joint transplantation.
    Helvetica chirurgica acta 01/1995; 60(6):1015-9.
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    ABSTRACT: We treated 49 patients at an average age of 80 years (75 to 90) with distal mostly intraarticular humeral fractures by open reduction. There were 8 class A, 13 class B and 28 class C fractures on Müller's classification. The patients were reviewed at a postoperative average of 18 months. The patients' assessment of the result was very good in 31%, good in 49%, fair in 15% and poor in 5%. The flexion-extension range was very good in 41%, good in 44% and fair in 15%. The incidence of implant failure, pseudarthrosis of the olecranon osteotomy and ulnar nerve lesion was no higher in these elderly patients than in younger patients. Old age is not a contraindication to open reduction and internal fixation; it is important to restore full function.
    Journal of Bone and Joint Surgery - British Volume 10/1994; 76(5):793-6. · 2.69 Impact Factor
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    ABSTRACT: The treatment of displaced comminuted fractures of the radial head type III of the Mason classification is still controversial. The restoration of anatomy including additional lesions with a stable fixation is a prerequisite of early mobilisation. Removal of the radial head, in case of severe comminution, and complete separation of the fragments from the radial neck remain the exception. Insertion of a prosthesis as a spacer is only recommended if there is a remaining instability of the elbow after resection of the radial head. With this treatment modality we have 22/29 good to very good results evaluated by the Morrey score after a follow-up period of 8 years (4-11 years).
    Helvetica chirurgica acta 08/1994; 60(5):681-5.
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    ABSTRACT: The pinless external fixator, introduced into clinical practice for open tibial fractures, suggested itself for use as a traction substitute because of its pinless frame. The aim of this feasibility study was to replace the conventional calcaneal pin traction by a joint-bridging pinless fixator, inserted under local anesthesia. 10 patients with 6 malleolar dislocation fractures, 3 pilon tibial and 1 open distal tibial fracture were immobilised by a joint-bridging pinless fixator during 10.4 days (5-16 days) till swelling had subsided and definitive fracture treatment, consisting of plate fixation, took place. The implantation of the joint-bridging pinless fixator in local anaesthesia was well tolerated by all patients. This traction substitute offered good patient comfort and easy care. Although the provided stability was less than a conventional fixator, all patients were able to lift up their fractured extremity without pain.
    Helvetica chirurgica acta 08/1994; 60(5):833-8.
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    ABSTRACT: 57 fractures of the femoral shaft, treated with an AO femoral interlocking nail, have been analysed in a retrospective study. 40 nails have been implanted primarily, 17 as secondary procedures following different operations. In the group of primary nailing 35/40 reached a good or very good result, 8 of them however, following secondary operations. In the group of the secondary nailing, 9/17 patients had a good or a very good result. 3 pseudarthroses persisted. The AO femoral interlocking nail therefore appears to be an adequate implant for the treatment of femoral shaft fractures, but a precise implantation technique is a prerequisite for the successful outcome.
    Helvetica chirurgica acta 10/1993; 60(1-2):231-4.
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    ABSTRACT: The aim of this retrospective analysis was to evaluate the adequacy of internal fixation of distal humerus fractures in patients over 75 years of age. 49 patients were evaluated. The mean age was 80 (75-93) years. The fractures were classified as 28 C-, 13 B- and 8 A-types according to the AO-system. Primary stable fixation was followed by early assisted mobilisation. The mean average follow-up time was 18 months. Excellent and good functional results were observed in 85%. 66% of all patients have no pain. There were 6 sensible ulnar nerve lesions, one deep wound infection, one pseudarthrosis of the distal humerus and one non union of the olecranon osteotomy. We conclude from our results that open reduction and internal fixation is indicated also for patients over 75 years with distal intraarticular humeral fractures.
    Helvetica chirurgica acta 10/1993; 60(1-2):219-24.
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    ABSTRACT: Undue delay between hospital admission and the beginning or urgent operative procedures is considered as a major mortality risk for polytraumatized patients in any trauma center. As part of a quality control study at our institution (Kantonsspital, University of Basel), the time spent for early resuscitation and diagnostic procedures was therefore prospectively recorded in 20 patients (mean age 38 years) with a mean ISS of 26.9 (range: 13 to 43). Time spent in the resuscitation room averaged 31.4 min (range: 10 to 50 min). Conventional radiographic diagnostic procedures took 34.7 more min (range: 20 to 60 min). An additional CT scan was performed in 15 patients requiring 19.5 min per region (head/thorax/abdomen/spine). Four patients underwent angiography necessitating 28 more min (mean). Time elapsed between admission and arrival of the patient in the OR or the ICU respectively accounted for an average of 89 min (range 22 to 200 min). For comparable injury severities this interval was shorter during the day than during the night (77 and 103 min respectively). Diagnoses established during this period were both accurate and comprehensive, as detectable from the low rate of missed diagnosis (three minor fractures). Although our results match favorably with figures reported in the literature we feel that further improvements could be achieved by performing the conventional radiographic procedures simultaneously with the early resuscitation in the resuscitation room. At present time, for reasons of X-ray protection, this is not possible in our institution.
    Helvetica chirurgica acta 10/1993; 60(1-2):201-4.
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    ABSTRACT: In recent years quality assurance is gaining increasing importance in all parts of medicine. In this article, different quality control measures in the field of operative fracture treatment are reviewed and illustrated. As in most other therapeutic specialties, the most commonly used measures are sporadic quality control studies. The Documentation Center of the association for the study of internal fixation [AO] offers in addition to all its contributing clinics an extraordinary measure for a continuous control of their treatment results. So far only a few instances of cost-benefit analysis have been published. Besides direct comparison of costs of different treatment options, improved quality of life may be calculated as well, using the method of Quality-Adjusted Life Years [QALY].
    Therapeutische Umschau 08/1993; 50(7):518-22.
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    ABSTRACT: The increasing incidence of trochanteric fractures renders their treatment a challenging task concerning both medical and increasingly socio-economical questions as well. The majority of these fractures occurs in elderly patients compromised by various preexisting medical problems. The primary goal of treatment therefore has to be early mobilisation to avoid secondary complications. This can only be achieved by operative treatment. Regarding the perioperative management an antibiotic as well as an antithrombotic prophylaxis is advisable. Recent data also suggest to add an enteral nutritional supplement during the postoperative period. The social reintegration depends however primarily upon the rapid restoration of the walking capacity. In this concern the Dynamic Hip Screw (DHS) is an optimal implant for ORIF, since it allows early full weight-bearing and shows a lower complication rate than static implants (e.g. the condylar blade plate).
    Helvetica chirurgica acta 07/1993; 59(5-6):955-63.
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    ABSTRACT: The DHS-implant system is a technically simple and widely used operative treatment modality for pertrochanteric fractures of the femur. In unstable 4-part fractures rotation of the head and neck fragment around the lag screw and significant impaction might lead to lateralisation of the greater trochanter and therefore to marked shortening. To prevent these effects we treated 17 patients with 4-part fractures with a prototype of a modular trochanteric DHS buttress plate. With this additional implant lateralisation of the greater trochanter could be prevented in all cases. This also leads to a limitation of telescoping, with less shortening even with immediate full weight bearing.
    Schweizerische medizinische Wochenschrift 05/1993; 123(13):566-8. · 1.68 Impact Factor
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    ABSTRACT: The DHS-Implant system is a technically simple and widely used operative treatment modality for pertrochanteric fractures of the femur. In unstable 4 part-fractures rotation of the head and neck fragment around the lag screw and a significant impaction might lead to a lateralisation of the greater trochanter and therefore to an important shortening. To prevent these effects we treated 17 patients with 4 part-fractures with a prototype of a modular trochanteric DHS buttress plate. With this additional implant the lateralisation of the greater trochanter could be prevented in all cases. This also leads to a limitation of the telescoping, with less shortening even with immediate full weight bearing.
    Helvetica chirurgica acta 04/1993; 59(4):521-5.
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    ABSTRACT: During a one-year period starting January 1991, 17 tibial shaft fractures have been treated with the new AO unreamed tibial nail in a prospective study. Fractures were classified according to the AO classification: 10 type A, 6 type B, one type C. 7 fractures were closed. Out of those 3 showed marked soft tissue contusions and 2 required a fasciotomy because of a concomitant compartment syndrome. The open fractures were classified according to the Gustilo classification: 3 grade I, 5 grade II, 1 grade III B and 1 grade III C injury. There were 5 polytraumatised patients (ISS 27-34). The nailing procedure was preformed on the day of admission in 11 cases and in a delayed fashion (2-14 days after the accident) in 6 cases. There were no specific technical problems encountered intraoperatively. The only perioperative complication consisted of 1 case of fat embolism syndrome. 1 fracture required secondary plate osteosynthesis because of a unacceptable valgus deformity 6 weeks postoperatively. There was 1 too long nail implanted at the initial surgery, which then had to be changed during the rehabilitation period because of pain in the region of the knee. In 3 cases the interlocking bolts broke and 3 other cases required secondary dynamisation. There was a complete follow-up in all cases of at least 6 months. There were no infections. All fractures are healed. Full weight bearing was allowed at a mean of 10 weeks for closed fractures and 14 weeks for open fractures, respectively. All but one fracture (valgus 8 degrees) healed in a correct axial alignment without shortening.(ABSTRACT TRUNCATED AT 250 WORDS)
    Helvetica chirurgica acta 04/1993; 59(4):665-8.
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    ABSTRACT: We compared two groups of patients with acute appendicitis, from whom the first one had been operated conventionally, the second group by laparoscopy. There was no difference between the two groups regarding length of hospital stay, local and general complications. Only the operating time was quite longer in the laparoscopic group. In our experience laparoscopic appendectomy is an easy and safe procedure which can allow young surgeons to be properly trained in laparoscopic techniques.
    Helvetica chirurgica acta 04/1993; 59(4):567-9.