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ABSTRACT: We describe the case of a 67-year-old man with an electricity inflicted injury in the left hand and a transscaphoidal perilunear dislocation of the opposite right hand. On admission, the injury was missed on the standard ap-radiogram of the right hand, so the operative reconstruction was delayed. Later on, the lunate showed aseptic necrosis and wrist collapse as consequence.
Der Chirurg 10/2000; 71(9):1172-4. · 0.70 Impact Factor
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ABSTRACT: To improve the technique of intraoperative sonography of the spinal canal, a teaching model of the thoracolumbar spine was developed. It allows to simulate the typical spinal stenosis of a vertebral fracture and the sonographic procedure to detect and measure such a lesion. Moreover, partial laminectomy and modification of a fixateur interne set-up, which are preconditions for successful sonography, can be simulated. Independent of the surgical qualification, a high precision in sonographic localisation and measurement of the spinal canal stenosis was achieved by the training. The results could be validated in the cadaveric model. Thus, sonographic expertise acquired with the teaching model proved to be reliable in the clinical situation.
Archives of Orthopaedic and Trauma Surgery 02/2000; 120(3-4):183-7. · 1.37 Impact Factor
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ABSTRACT: We report on a case of subacromial shoulder dislocation, which resulted from a combination of a cranial glenoid fracture and an acromial fracture. The patient sustained this rare injury while playing handball. The whole implication of the injury was revealed only after extensive workup with CT scan of the shoulder. After reduction of the shoulder dislocation, the glenoid fracture was stabilized by osteosynthesis. The postoperative results showed anatomical reconstruction of the glenoid joint surface. After completion of therapy, the patient has achieved good functional results with a full range of motion (abduction 180 degrees ) and has been able to work full-time again.
Der Chirurg 12/1999; 70(11):1361-3. · 0.70 Impact Factor
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ABSTRACT: To optimise the microsurgical training in our clinic we organized a permanent possibility to practice microsurgical techniques
of vascular anastomosis. This includes stepwise education by means of plastic materials, human placenta and the rat model.
The most important role in this concept is played by the placenta. It supplies a realistic simulation of different in vivo
situations concerning microvascular anastomosis. As to availability, handling and costs the placenta is superior to animal
models and has replaced them almost completely in our educational concept.
Im Rahmen der mikrochirurgischen Ausbildung hat sich in unserer Klinik die Etablierung eines permanenten mikrochirurgischen
Arbeitsplatzes bewährt. Dabei erfolgt eine stufenweise Ausbildung an Plastikmaterialien, der Placenta und dem Rattenmodell.
Der Placenta kommt dabei die größte Bedeutung zu. Sie ermöglicht eine realistische Simulation der unterschiedlichsten klinischen
Erfordernisse im Rahmen mikrochirurgischer Gefäßanastomosen. Bezüglich Verfügbarkeit, Handhabung und Kosten ist sie dem Tiermodell
überlegen und kann dies weitgehend ersetzen.
Der Chirurg 04/1999; 70(1):96-99. · 0.70 Impact Factor
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The Journal of trauma 03/1999; 46(2):346-9. · 2.48 Impact Factor
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ABSTRACT: In a prospective controlled study we analysed the classic nail, a new intramedullary implant for the fixation of peritrochanteric fractures. By means of lateral bending of 4 degrees, unreamed implantation is generally possible. Our collective of 85 patients was characterized by elderly mean age (82.3 years), a predominance of female patients (4.3 : 1), a minor trauma aetiology without relevant additional injuries, and a high rate of concomitant disease (92%). Only 31A-type femur fractures were treated, with a low specific complication rate of 13%, whereby operative revision was necessary in only two patients (3%). A good anatomic reconstruction and full weight-bearing with the osteosynthesis was achieved in the majority of patients. No secondary shaft fractures and only one case of cutting out was observed. The mortality (30 days: 18%, 6 months: 25%) as well as the high rate of unspecific complications (20%) were caused by the patients' multiple morbidity. Deficits in the Merle d'Aubigne score at follow-up after 6 months can be interpreted within the same context. Nevertheless, 85% could return to their former social environment and only 15% became dependent on a nursing institution in connection with the fracture treatment.
Archives of Orthopaedic and Trauma Surgery 02/1999; 119(5-6):308-14. · 1.37 Impact Factor
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ABSTRACT: For surgical treatment of the unstable Colles fracture we developed a new form of osteosynthesis, which consists in a modification of the dynamic Kirschner wire fixation described by Kapandji. It allows early motion without the typical risk of palmar dislocation noted with the Kapandji method. We prefer this method in elderly patients with reduced bone quality. The analysis of a collective of 110 fractures including a clinical and radiological follow-up examination of 72 patients revealed good anatomical reconstruction of the distal radius. The loss of motion was minimal on average and consistent with a good wrist function. Major restrictions resulted from stress-dependent pain as a consequence of posttraumatic arthritis or algodystrophy. A minor loss of reduction by dorsal impaction was observed in the follow-up evaluation, but it had no functional relevance. The most frequent complication was paraesthesia within the area of the superficial radial nerve. According to the NYOH score the following results were achieved: excellent 35%, good 50%, fair 10%, poor 5%.
Archives of Orthopaedic and Trauma Surgery 02/1999; 119(3-4):171-8. · 1.37 Impact Factor
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ABSTRACT: In a prospective randomized study, we compared the new intramedullary implant of the gliding nail to the gamma nail in the fixation of 80 unstable trochanteric fractures in elderly patients. The preconditions of both groups were comparable. We found no differences concerning the operation time, blood loss, period of stationary treatment or social situation. Also, the anatomic reconstruction and the long-term function according to the Merle d'Aubigne score were comparable. Regarding postoperative complications, the gliding nail showed a minor tendency of cutting out; this we attribute to the special design of the dynamic blade and regard it as the most favourable advantage of this new implant.
Archives of Orthopaedic and Trauma Surgery 02/1999; 119(1-2):1-6. · 1.37 Impact Factor
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[show abstract]
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ABSTRACT: In a prospective controlled study we analysed the classic nail, a new intramedullary implant for the fixation of peritrochanteric
fractures. By means of lateral bending of 4°, unreamed implantation is generally possible. Our collective of 85 patients was
characterized by elderly mean age (82.3 years), a predominance of female patients (4.3 : 1), a minor trauma aetiology without
relevant additional injuries, and a high rate of concomitant disease (92%). Only 31A-type femur fractures were treated, with
a low specific complication rate of 13%, whereby operative revision was necessary in only two patients (3%). A good anatomic
reconstruction and full weight-bearing with the osteosynthesis was achieved in the majority of patients. No secondary shaft
fractures and only one case of cutting out was observed. The mortality (30 days: 18%, 6 months: 25%) as well as the high rate
of unspecific complications (20%) were caused by the patients’ multiple morbidity. Deficits in the Merle d’Aubigne score
at follow-up after 6 months can be interpreted within the same context. Nevertheless, 85% could return to their former social
environment and only 15% became dependent on a nursing institution in connection with the fracture treatment.
Archives of Orthopaedic and Trauma Surgery 01/1999; 119(5):308-314. · 1.37 Impact Factor
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Der Radiologe 08/1998; 38(7):633-5. · 0.61 Impact Factor
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ABSTRACT: Klinisch zeigte sich eine deutliche Weichteilschwellung am linken Ellenbogen. Die periphere Durchblutung und Motorik waren
unauffällig, die Sensibilität war lediglich an D IV und D V leicht eingeschränkt
Zur weiteren diagnostischen Abklärung wurde eine konventionelle Röntgenaufnahme des linken Ellenbogens in zwei Ebenen angefertigt
(Abb. 1a und b). In der AP-Aufnahme sieht man bei noch offenen Epiphysenfugen des Epicondylus ulnaris und radialis humeri
eine erhöhte Transparenz des distalen Humerus radialseitig. Die Außenkontur des distalen Humerus erscheint intakt, jedoch
erkennt man eine zweite Kontur proximal des hemero-radialen Gelenks. In der Seitenaufnahme sieht man eine halbmondförmige
Struktur ventral in der Ellenbeuge sowie eine Verlagerung der Fettlamelle ventral und dorsal als Hinweis auf einen Gelenkerguß.
Ihre Diagnose ?
Der Radiologe 04/1998; 38(7):633-635. · 0.61 Impact Factor
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ABSTRACT: Because this disease is so rare the optimum treatment of pigmented villonodular synovitis (PVNS), in particular the diffuse form differs in the literature. The most important surgical procedures are arthroscopic and open synovectomy. The prevention of disease progression, as well as joint destruction and dysfunction, depends upon the early diagnosis of PVNS. During 1994 and 1995, we treated four cases of PVNS surgically and followed the patients for a time period of more than 12 months. Two patients were treated with complete synovectomy, one patient underwent partial synovial resection, and in the final case an arthrodesis was performed. Our results indicate that an MRI is essential for diagnosis and treatment planning. For the localized form of PVNS, it appears that a partial synovectomy is appropriate. However, in the event of diagnostic uncertainty or obvious diffuse involvement of the synovium, a total synovectomy is indicated because of the high recurrence rate. In our study, all four patients had disease involving secondary bony lesions and, in one case, joint destruction. Based on our findings, it is clear that early surgical therapy is the only recommended curative intervention. The decision regarding the surgical approach, arthroscopic versus open, depends on the form of PVNS, the extent of the disease and secondary changes of the joint.
Der Chirurg 04/1998; 69(3):284-90. · 0.70 Impact Factor
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ABSTRACT: Die Therapie der pigmentierten villonodulären Synovitis (PVNS), insbesondere der diffusen Form, wird weiterhin unterschiedlich
beurteilt aufgrund der geringen Incidenz dieser Erkrankung. Die wichtigsten operativen Verfahren stellen die arthroskopische
oder offene Synovektomie dar. Zur Vermeidung von Gelenkdestruktionen und funktionellen Einschränkungen ist die frühe Erkennung
der PVNS entscheidend. In den Jahren 1994 und 1995 haben wir 4 Fälle operativ behandelt und in einem Zeitraum von mehr als
12 Monaten nachuntersucht. In 2 Fällen wurde die komplette Synovektomie, in einem Fall die partielle Resektion der Synovia
und in einem weiteren Fall die Gelenkresektion und Arthrodese als offene Verfahren durchgeführt. Anhand unserer Ergebnisse
ließ sich zeigen, daß das MRT unverzichtbar in der Diagnostik und der operativen Therapieplanung ist. Liegt ein lokaler Befall
der Synovia vor, so scheint die partielle Synovektomie ausreichend. Bestehen aber Zweifel in der Einschätzung oder zeigt sich
klar das Bild eines diffusen Befalls, sollte die komplette Synovektomie, aufgrund der hohen Rezidivrate der diffusen PVNS,
bevorzugt werden. Es zeigte sich weiterhin, daß bei allen unseren Patienten sekundäre ossäre Läsionen auftraten bis hin zur
Gelenkdestruktion bei einem Patienten. Daher ist die frühzeitige operative Therapie als z. Z. einzig kausale Behandlung zu
empfehlen. Inwieweit arthroskopisch oder als offenes Verfahren vorgegangen werden kann, ist abhängig von der Form der PVNS,
dem Ausmaß des Tumorbefalls und sekundären Gelenkveränderungen.
Because this disease is so rare the optimum treatment of pigmented villonodular synovitis (PVNS), in particular the diffuse
form differs in the literature. The most important surgical procedures are arthroscopic and open synovectomy. The prevention
of disease progression, as well as joint destruction and dysfunction, depends upon the early diagnosis of PVNS. During 1994
and 1995, we treated four cases of PVNS surgically and followed the patients for a time period of more than 12 months. Two
patients were treated with complete synovectomy, one patient underwent partial synovial resection, and in the final case an
arthrodesis was performed. Our results indicate that an MRI is essential for diagnosis and treatment planning. For the localized
form of PVNS, it appears that a partial synovectomy is appropriate. However, in the event of diagnostic uncertainty or obvious
diffuse involvement of the synovium, a total synovectomy is indicated because of the high recurrence rate. In our study, all
four patients had disease involving secondary bony lesions and, in one case, joint destruction. Based on our findings, it
is clear that early surgical therapy is the only recommended curative intervention. The decision regarding the surgical approach,
arthroscopic versus open, depends on the form of PVNS, the extent of the disease and secondary changes of the joint.
Der Chirurg 02/1998; 69(3):284-290. · 0.70 Impact Factor
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ABSTRACT: Three biomechanical examinations of the double-T blade of the gliding nail were performed. Under alternating load, also after 100,000 cycles and 2000 N load, no instability occurred after gliding nail osteosynthesis. The best relationship between the introduction forces of the blade (1.771-1.329 N) and the extraction forces (1.474-477 N) was seen after glass pearl treatment of the blade surface. Displacement of the plate in a sow bone femor head after 1000 cycles at 1500 N was 1.0-4.00 mm for a double-T blade, but 4.0-8.0 mm for a 10 mm screw like the gamma-nail screw.
Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress 02/1998; 115:1224-6.
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ABSTRACT: The treatment of 85 patients with pertrochanteric femoral fractures (average age 82.3 years) with the Richards classic nail allowed full weight-bearing in 94.1% and unreamed implantation in 91.8%. In the follow-up period (11.2 months post-operatively) few complications (1.2% infections, 1.2% cutting out) could be documented. The Sanders and Regazzoni score revealed that 66% of the patients reached their preoperative status again. Statistical analysis showed a negative influence of patient age and fracture type on the postoperative walking ability.
Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress 02/1998; 115:1191-3.
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ABSTRACT: Measurements of bone mineral density (BMD) are useful for the assessment of fracture risk in osteoporosis. First prospective studies showed that quantitative ultrasound as measured at the calcaneus also predicts future hip fracture risk, independently of BMD and as accurately as BMD. The aim of this study was to compile a reference population for a new ultrasound device that determines amplitude-dependent speed of sound (AD-SOS) through the proximal phalanges of the hand and to prove its ability to distinguish between health volunteers and osteoporotic patients. In a case-control study we examined 139 healthy women aged 21-94 years and a group of 24 female patients aged 69-94 years with recent hip fractures. In the healthy reference population additional BMD measurements were performed with dual-energy X-ray absorptiometry (DXA) and quantitative ultrasound measurements at the calcaneus were carried out. In vivo precision of AD-SOS measurements through the phalanges was 0.52% CV. Simple regression analyses showed a negative correlation with age (r = -0.73, p < 0.001); modest significant correlations with BMD of the lumbar spine (r = 0.36, p < 0.001) and BMD of the femoral neck (r = 0.37, p = 0.002) as measured with DXA were shown. The comparison with another ultrasound device measuring SOS and broadband ultrasound attenuation (BUA) through the calcaneus showed correlation with SOS (r = 0.50, p < 0.001); no significant correlation was found with BUA measurements. Furthermore a dependency of AD-SOS values in anthropometric factors such as body mass index (r = 0.37, p < 0.001), height (r = 0.40, p < 0.001) and weight (r = 0.23, p < 0.05) was shown. First study results on 24 clinically diagnosed osteoporotic patients, defined as patients with recent (< 1 week) pertrochanteric or femoral neck fractures, showed a good separation between age- and sex-matched controls and osteoporotic patients (Z = -2.0 SD). Receiver operating characteristic (ROC) curves showed an area under the fitted curve of 0.83 +/- 0.06. These results are powerful for a device measuring AD-SOS through the proximal phalanges of the hand, and further prospective studies have proven the capability of phalangeal ultrasound in fracture risk assessment.
Osteoporosis International 02/1998; 8(5):393-8. · 4.58 Impact Factor
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ABSTRACT: Age, high physiological load and the great number and different fracture types of the proximal femur are the main challenges for implants used in the management of these fractures. For use in these types of fracture with immediate restoration of full weight-bearing capacity and for reduction of the intra- and postoperative complication rate, the gliding nail was developed. The development is based on a large number of experimental and clinical examinations of per- and subtrochanteric fractures. The advantages of an intramedullary implant and the gliding screw systems are combined with increased moment of resistance of the double-T femor-neck blade profile. We performed a prospective clinical evaluation of the first 186 patients with per- and subtrochanteric fractures who were treated between 15 September 1994 and 29 February 1996 in the Aschaffenburg Trauma Department with a follow-up examination at least 3 months after the operation. The intraoperative complication rate was 1.1%. The postoperative complication rate was 4.9%. Change of the blade because of fracture impaction and tractus iliotibialis problems was the most frequent problem with 2.2%. The most severe complication (1.1%) were caused by subchondral placement of the blade in the cranial one-third of the femur head. In these cases reosteosynthesis was indicated. Ninety-three percent of the survivors were able to return home. The rate of bed-ridden patients (7.7% and 11.7%) was not very different before or after the operation. However, many patients do not reach the condition they had before the fracture and they are one step worse in mobility and social independence.
Der Chirurg 02/1998; 69(2):191-7. · 0.70 Impact Factor
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ABSTRACT: Das hohe Alter, die hohe Belastung des proximalen Femurendes und die Vielzahl der Frakturformen stellen hohe Anforderungen
an Implantate zur Versorgung per- und subtrochanterer Femurfrakturen. Zur universellen Anwendung bei diesen Frakturformen
und zur Verminderung der Komplikationsrate bei sicherer primärer Belastungsstabilität wurde auf Grund umfangreicher experimenteller
und klinischer Untersuchungen der Gleitnagel entwickelt. Er vereinigt die Vorteile eines intramedullären Implantats mit Laschengleitprinzip
mit denen das Doppel-T-Klingenprofils des Schenkelhalskraftträgers. Die prospektive klinische Analyse der ersten 186 Patienten,
mit einer Nachuntersuchung frühestens 3 Monate nach Operation, die vom 15. 9. 1994 bis zum 29. 2. 1996 im Klinikum Aschaffenburg
behandelt wurden, zeigte eine intraoperative Komplikationsrate von 1,1 %. Die postoperative Komplikationsrate betrug 4,9 %,
wobei ein Klingenwechsel bei starker Einstauchung und Tractusreizung mit 2,2 % die bei weitem wichtigste Ursache darstellte.
Die schwerwiegendsten Folgen hatte die subchondrale Plazierung der Klinge im cranialen Kopfdrittel (1,1 %), wo eine Reosteosynthese
erforderlich war. In 93 % konnten die überlebenden Patienten in ihr prästationäres Umfeld entlassen werden. Die Rate bettlägeriger
Patienten (7,7 bzw. 11,7 %) und auf Pflege angewiesener Patienten (14 bzw. 18,3 %) war prä- und postoperativ annähernd gleich.
Viele Patienten weisen jedoch eine Gangqualitätsverschlechterung und soziale Selbständigkeitseinschränkung um eine Stufe auf.
Age, high physiological load and the great number and different fracture types of the proximal femur are the main challanges
for implants used in the management of these fractures. For use in these types of fracture with immediate restoration of full
weight-bearing capacity and for reduction of the intra- and postoperative complication rate, the gliding nail was developed.
The development is based on a large number of experimental and clinical examinations of per- and subtrochanteric fractures.
The advantages of an intramedullary implant and the gliding screw systems are combined with increased moment of resistance
of the double-T femor-neck blade profile. We performed a prospective clinical evaluation of the first 186 patients with per-
and subtrochanteric fractures who were treated between 15 September 1994 and 29 February 1996 in the Aschaffenburg Trauma
Department with a follow-up examination at least 3 months after the operation. The intraoperative complication rate was 1.1
%. The postoperative complication rate was 4.9 %. Change of the blade because of fracture impaction and tractus iliotibialis
problems was the most frequent problem with 2.2 %. The most severe complication (1.1 %) were caused by subchondral placement
of the blade in the cranial one-third of the femur head. In these cases reosteosynthesis was indicated. Ninety-three percent
of the survivors were able to return home. The rate of bed-ridden patients (7.7 % and 11.7 %) was not very different before
or after the operation. However, many patients do not reach the condition they had before the fracture and they are one step
worse in mobility and social independence.
Der Chirurg 01/1998; 69(2):191-197. · 0.70 Impact Factor
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ABSTRACT: Hernias of the obturator foramen are rare. They are described mostly in elderly female patients in poor health. Often the correct diagnosis is stumbled upon as a result of surprising intraoperative findings. Surgical therapy is indicated often by the clinical symptoms of an incarcerated hernia. Herniation of the entire urinary bladder with hemorrhagic infarction has never been described before. For an anatomical reduction of the hernia it was necessary to resect the superior pubic ramus. For plastic reconstruction a marlex mesh was used.
Der Chirurg 01/1998; 68(12):1301-3. · 0.70 Impact Factor
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ABSTRACT: The following experimental study was conducted to develop biocompatible methods of osteosynthesis in fractures of the distal radius and to evaluate their stability. A model of dorsal wedge osteotomy in the distal radial metaphysis was used to develop the surgical technique and to test the stability of the alternative methods of osteosynthesis. The concept for this model was based on commercially available materials which were either biodegradable or osteoconductive. Four different forms of biocompatible osteosynthesis were compared to combined Kirschner wire osteosynthesis (KWO), our preferred method of treatment of unstable Colles fracture. Biocompatible osteosynthesis was achieved with an invasivity and stability comparable to that of KWO. In conclusion, injection osteosynthesis exceeded the other biocompatible methods of osteosynthesis in all respects. Regarding the recent developments in injectable materials for osteosynthesis it offers the best perspective for clinical application.
Der Chirurg 12/1997; 68(11):1137-45. · 0.70 Impact Factor
