Publications (22)33.72 Total impact
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Article: Epiphysenfraktur der proximalen Tibia
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ABSTRACT: Frakturen der proximalen Epiphysenfuge der Tibia sind seltene Verletzungen im Wachstumsalter. Anhand des Fallberichts einer simultanen bilateralen proximalen Epiphysenfraktur eines 13-jährigen Jungen werden dieses Krankheitsbild sowie die erforderliche Diagnostik und die adäquate Therapie dargestellt. Die Verletzung ereignete sich beim Weitspringen: Während des Absprungs kam es zu einer Salter-Harris-Typ-II-Fraktur der rechten proximalen Tibia, bei der Landung zu einer Typ-III-Fraktur der linken Tuberositas tibiae. Auf der rechten Seite wurde die Verletzung geschlossen reponiert und mit Kirschner-Drähten stabilisiert, die linksseitige Avulsionsfraktur wurde offen reponiert und mittels Zugschraube und einer McLaughlin-Schlinge versorgt. Proximal tibial epiphyseal injury is a rare finding in adolescents. We report the case of a 13-year-old boy with simultaneous epiphyseal fractures of both proximal tibiae to illustrate appropriate diagnosis and treatment of this condition. The injury occurred while performing a long jump: a Salter-Harris type II fracture of the right proximal tibia was sustained at take-off and a Salter-Harris type III avulsion fracture of the left tibial tuberosity upon landing. Closed reduction and internal fixation using K-wires were performed on the right side, whereas open reduction and internal fixation were done on the left side, using a lag screw and additional McLaughlin wiring.Der Unfallchirurg 04/2012; 111(9):740-745. · 0.61 Impact Factor -
Article: [Comment on the article: "Intramedullary nail removal in the upper and lower limbs. Should we recommend this operation?"]].
Der Unfallchirurg 09/2009; 112(9):827; author reply 828. · 0.61 Impact Factor -
Article: Epiphysenfraktur der proximalen Tibia: Literaturübersicht und Fallbericht einer simultanen bilateralen Fraktur bei einem 13-jährigen Jungen
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ABSTRACT: Frakturen der proximalen Epiphysenfuge der Tibia sind seltene Verletzungen im Wachstumsalter. Anhand des Fallberichts einer simultanen bilateralen proximalen Epiphysenfraktur eines 13-jährigen Jungen werden dieses Krankheitsbild sowie die erforderliche Diagnostik und die adäquate Therapie dargestellt. Die Verletzung ereignete sich beim Weitspringen: Während des Absprungs kam es zu einer Salter-Harris-Typ-II-Fraktur der rechten proximalen Tibia, bei der Landung zu einer Typ-III-Fraktur der linken Tuberositas tibiae. Auf der rechten Seite wurde die Verletzung geschlossen reponiert und mit Kirschner-Drähten stabilisiert, die linksseitige Avulsionsfraktur wurde offen reponiert und mittels Zugschraube und einer McLaughlin-Schlinge versorgt.Der Unfallchirurg 08/2008; 111(9):740-745. · 0.61 Impact Factor -
Article: [Epiphyseal fracture of the proximal tibia: review of the literature and report of simultaneous bilateral fractures in a 13-year-old boy].
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ABSTRACT: Proximal tibial epiphyseal injury is a rare finding in adolescents. We report the case of a 13-year-old boy with simultaneous epiphyseal fractures of both proximal tibiae to illustrate appropriate diagnosis and treatment of this condition. The injury occurred while performing a long jump: a Salter-Harris type II fracture of the right proximal tibia was sustained at take-off and a Salter-Harris type III avulsion fracture of the left tibial tuberosity upon landing. Closed reduction and internal fixation using K-wires were performed on the right side, whereas open reduction and internal fixation were done on the left side, using a lag screw and additional McLaughlin wiring.Der Unfallchirurg 03/2008; 111(9):740-5. · 0.61 Impact Factor -
Article: Correlation of bone mineral density with strength and microstructural parameters of cortical bone in vitro.
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ABSTRACT: The aim of this study was to evaluate the influence of microstructural parameters, such as porosity and osteon dimensions, on strength. Therefore, the predictive value of bone mineral density (BMD) measured by quantitative computed tomography (QCT) for intracortical porosity and other microstructural parameters, as well as for strength of cortical bone biopsies, was investigated. Femoral cortical bone specimens from the middiaphysis of 23 patients were harvested during total hip replacement while drilling a hole (dia. 4.5 mm) for the relief of the intramedullary pressure. In vitro structural parameters assessed in histological sections as well as BMD determined by quantitative computed tomography were correlated with yield stress, and elastic modulus assessed by a compression test of the same specimens. Significant correlations were found between BMD and all mechanical parameters (elastic modulus: r = 0.69, p < 0.005; yield stress: r = 0.64, p < 0.005). Significant correlations between most structural parameters assessed by histology and yield stress were discovered. Structural parameters related to pore dimensions revealed higher correlation coefficients with yield stress (r = -0.69 for average pore diameter and r = -0.62 for fraction of porous structures, p < 0.005) than parameters related to osteons (r = 0.60 for osteon density and average osteonal area, p < 0.005), whereas elastic modulus was predicted equally well by both types of parameters. Significant correlations were found between BMD and parameters related to porous structures (r = 0.85 for porosity, 0.80 for average pore area, and r = 0.79 for average pore diameter in polynomial regression, p < 0.005). Histologically assessed porosity correlated significantly with parameters describing porous structures and haversian canal dimensions. Our results indicate a relevance of osteon density and fraction of osteonal structures for the mechanical parameters of cortical bone. We consider the measurement of BMD by quantitative computed tomography to be helpful for the estimation of bone strength as well as for the prediction of intracortical porosity and parameters related to porous structures of cortical bone.Bone 07/2002; 31(1):90-5. · 4.02 Impact Factor -
Article: First histological observations on the incorporation of a novel calcium phosphate bone substitute material in human cancellous bone.
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ABSTRACT: Calcium phosphates are frequently used as bone substitute materials because of their similarity to the mineral phase of bone, absence of antigenicity, and excellent osteoconductivity. However, in most currently available mineral substitutes, resorption occurs slowly if at all. In contrast, calcium phosphate cements have shown rapid resorption and remodeling in animal studies. In two prospective studies, a novel amorphous calcium phosphate cement (Biobon) was implanted in human patients for the first time. After 2-12 months, ten biopsies were obtained from nine individuals during secondary surgical interventions, for example, for implant removal. In all specimens, partial replacement of the material by new bone was observed, while residues of the cement were still visible. Undecalcified sections revealed extensive bone formation in immediate contact to the cement without fibrous interface. Polynucleated cells and superficial lacunae were indicative of resorptive activity, but inflammatory tissue response was absent. The new bone displayed regular trabecular and osteonal patterns. The histologic findings are in accordance with the excellent biocompatibility observed in the clinical follow-up. Though still incomplete, the resorbability of this cement appears superior to sintered calcium phosphates in these biopsy specimens. Presumably this is due to its amorphous crystalline structure. Biobon merits further studies as a promising substance for bone defect reconstruction in non-stress-bearing areas.Journal of Biomedical Materials Research 06/2001; 58(3):329-34. -
Article: Predictive value of Singh index and bone mineral density measured by quantitative computed tomography in determining the local cancellous bone quality of the proximal femur.
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ABSTRACT: The purpose of this study was to assess the predictive value of the Singh index as well as quantitative computed tomography for the in vitro local mechanical competence of the cancellous bone of the proximal femur. An experimental study examining the relation between mechanical properties and bone mineral density of the femoral neck determined in vitro and the clinical estimated Singh index on X-rays. Evaluation of the predictive value of the Singh index, an inexpensive and simple technique for the mechanical properties of the cancellous bone of the proximal femur. The bone quality of the proximal femur of 34 patients undergoing total hip replacement was estimated by roentgenography using the Singh index. Bone mineral density was quantified by quantitative computed tomography using cylindrical cancellous bone biopsies harvested during the total hip replacement procedure by a new biopsy method. The mechanical properties of the bone specimens (Young's modulus, strength and maximum energy absorption E(max)) were measured by mechanical testing of the bone biopsies. A strong correlation of the Singh index versus material properties of cancellous bone was noted (r=0.66 for Young's modulus, r=0.73 for strength and r=0.69 for E(max), P<0.0001). The correlations of bone mineral density measured by quantitative computed tomography versus Young's modulus, strength and energy absorption E(max) were significant. Strength was predicted best (r=0.82; P<0.0001), followed by E(max) (r=0.79; P<0.0001) and Young's Modulus (r=0.73; P<0.0001). We conclude, that assessment of bone mineral density by quantitative computed tomography is a reliable and precise method for the estimation of cancellous bone material properties. The Singh index provides a rough estimate for the mechanical competence of the proximal femur. It is inexpensive, simply to assess and can in some cases replace the measurement of bone mineral density, notably in cases of marked decrease in bone density.Clinical Biomechanics 04/2001; 16(3):257-62. · 2.07 Impact Factor -
Article: Prediction of strength of cortical bone in vitro by microcomputed tomography.
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ABSTRACT: The aim of this study was to evaluate the predictive value of bone mineral density and intracortical porosity measured by microcomputed tomography for the strength of cortical bone biopsies. Experimental study comparing the predictive value of bone mineral density and of intracortical porosity determined in vitro by microcomputed tomography for the mechanical properties of cortical bone cylinders. The assessment of cortical bone strength might be relevant for the prediction of fracture risk or the choice of suitable therapy strategies in orthopaedic surgery. The predictive value of cortical density for the mechanical properties is discussed controversially. The relevance of intracortical porosity measured by histomorphometry has been established, but the predictive value of porosity determined by microcomputed tomography remains to be explored. Femoral cortical bone specimens from the mid diaphysis of 24 patients were harvested during total hip replacement procedure at the location, where a diaphyseal hole (diameter 4.5 mm) was drilled in order to reduce the intramedullary pressure. In vitro intracortical porosity and bone mineral density measurements by microcomputed tomography were compared with strength and elastic modulus assessed by a compression test transverse to the Haversian systems of the same specimens. Significant negative correlations were found between porosity measured by microcomputed tomography scans and yield stress, stiffness and elastic modulus (P<0.001), however, the positive correlations between bone mineral density and mechanical parameters were stronger (P<0.0001). The mechanical parameter best predicted by mineral density as well as by porosity was yield stress (r=0.72,P<0.0001;r=-0.64,P<0.001). Bone mineral density determined by microcomputed tomography imaging in vitro may be a potent method to predict mechanical properties of cortical bone non-destructively. The application in vivo remains to be explored.Clinical Biomechanics 04/2001; 16(3):252-6. · 2.07 Impact Factor -
Article: Predictive value of bone mineral density and morphology determined by peripheral quantitative computed tomography for cancellous bone strength of the proximal femur.
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ABSTRACT: Peripheral quantitative computed tomography (pQCT) is an established diagnostic method for assessment of bone mineral density in the diagnosis of osteoporosis. However, the capacity of structural parameters of cancellous bone measured by high-resolution computed tomography remains to be explored. In 33 patients, bone mineral density (BMD) of the proximal femur was measured in vitro by pQCT using cylindrical biopsies from the intertrochanteric region harvested before the implantation of an artificial hip joint. By digital image analysis of CT scans, parameters derived from histomorphometry describing the microarchitecture of cancellous bone were measured. The biopsies were also loaded to failure by an uniaxial compression test to determine the biomechanical parameters, Young's modulus, strength, and maximum energy absorption (E(max)). Strong correlations were found for BMD vs. mechanical parameters (r = 0.73 for Young's modulus, r = 0.82 for strength, and r = 0.79 for E(max); p < 0.001, n = 29). The morphological parameters, bone volume per trabecular volume (BV/TV), apparent trabecular thickness (app.Tb.Th), apparent trabecular separation (app.Tb.Sp), and trabecular number (Tb.N), correlated significantly with all mechanical parameters. The combination of morphological parameters with BMD in a multivariate regression model led to an overall, but only moderate, increase in R(2) in all cases. Our data confirm the high predictive value of BMD for the mechanical competence of cancellous bone of the intertrochanteric region. However, quantification of cancellous bone structure by image analysis of CT scans may provide additional qualitative information for the analysis of bone strength.Bone 02/2001; 28(1):133-9. · 4.02 Impact Factor -
Article: Grading of tumors and tumorlike lesions of bone: evaluation by FDG PET.
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ABSTRACT: Clinical diagnosis of skeletal tumors can be difficult, because such lesions compose a large, heterogeneous group of entities with different biologic behaviors. The aim of this prospective study was to assess the value of PET in grading tumors and tumorlike lesions of bone. Two hundred two patients with suspected primary bone tumors were investigated using FDG PET. Uptake of FDG was evaluated semiquantitatively by determining the tumor-to-background ratio (T/B). All patients underwent biopsy, resulting in the histologic detection of 70 high-grade sarcomas, 21 low-grade sarcomas, 40 benign tumors, 47 tumorlike lesions, 6 osseous lymphomas, 6 plasmacytomas, and 12 metastases of an unknown primary tumor. All lesions, with the exception of 3 benign tumors, were detected by increased FDG uptake. Although sarcomas showed significantly higher T/Bs than did latent or active benign lesions (P < 0.001), aggressive benign lesions could not be distinguished from sarcomas. Using a T/B cutoff level for malignancy of 3.0, the sensitivity of FDG PET was 93.0%, the specificity was 66.7%, and the accuracy was 81.7%. FDG PET provides a promising tool for estimating the biologic activity of skeletal lesions, implicating consequences for the choice of surgical strategy.Journal of Nuclear Medicine 10/2000; 41(10):1695-701. · 6.38 Impact Factor -
Article: [Therapy of aneurysmal bone cyst].
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ABSTRACT: The aneurysmal bone cyst represents a tumor-like lesion, which does not occur frequently. Every site of the skeleton may be involved. Although it can be observed at any age, it distinctly predominates from 10 to 20 years of age. Distinction of aneurysmatic bone cysts from certain benign or malignant bone tumours requires subtle imaging techniques and an experienced bone tumour pathologist. Since the lesion shows a heterogeneous biological behaviour and typically occurs in the growing skeleton, a wide range of surgical procedures must be provided concerning tumour resection and defect reconstruction. In the current retrospective study results of 41 surgically treated aneurysmal bone cysts, thereof 5 latent, 31 active, and 5 aggressive lesions, were investigated. While morbidity due to the therapeutic measures was comparatively low even in extended lesions and demanding reconstructions, a recurrence rate of 19.5% had to be observed in our series. Taking into consideration the biological activity of the lesion, analysis of the recurrences revealed inappropriate surgical margins had been chosen at the primary operation in all of these patients. Since the risk of a local relapse is linked both to aggressiveness of the primary lesion and to surgical radicality, therapy of aneurysmal bone cyst requires preoperative staging and stage-dependent surgical procedures.Der Unfallchirurg 03/2000; 103(2):115-21. · 0.61 Impact Factor -
Article: Die Therapie der aneurysmatischen Knochenzyste
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ABSTRACT: Die aneurysmatische Knochenzyste ist eine seltene tumorähnliche Erkrankung, die jeden Skelettabschnitt involvieren kann und sich überwiegend im Kindes- oder Jugendlichenalter manifestiert. Differentialdiagnostische Schwierigkeiten bei der Abgrenzung gegenüber bestimmten benignen und malignen primären Knochentumoren erfordern neben dem Einsatz differenzierter bildgebender Verfahren häufig die histopathologische Beurteilung durch ein Knochentumorregister. Bedingt durch eine sehr heterogene biologische Aktivität und den Umstand, daß die Erkrankung überwiegend das wachsende Skelett betrifft, muß bei der chirurgischen Therapie sowohl hinsichtlich der Resektion als auch der Defektrekonstruktion auf ein breites Spektrum an Behandlungsmaßnahmen zurückgegriffen werden können. In einer retrospektiven Studie wurden die Behandlungsergebnisse bei 41 operierten Tumoren, davon 31 aktive und jeweils 5 latente bzw. aggressive Läsionen, untersucht. Während die therapieassoziierte Morbidität auch bei ausgedehnteren Destruktionen sowie aufwendigeren Rekonstruktionen vergleichsweise gering war, lag die Rezidivrate bei 19,5%. Die Analyse der Lokalrezidive zeigte, daß– unter Berücksichtigung der biologischen Aktivität des Primärtumors – jeweils ein inadäquates Resektionsverfahren zu Grunde lag. Der Umstand, daß das Lokalrezidivrisiko sowohl mit der Aggressivität der Primärläsion als auch mit der chirurgischen Radikalität korreliert, macht ein präoperatives Staging und eine stadiengerechte Therapie erforderlich. The aneurysmal bone cyst represents a tumorlike lesion, which does not occur frequently. Every site of the skeleton may be involved. Although it can be observed at any age, it distinctly predominates from 10 to 20 years of age. Distinction of aneurysmatic bone cysts from certain benign or malignant bone tumours requires subtle imaging techniques and an experienced bone tumour pathologist. Since the lesion shows a heterogeneous biological behaviour and typically occurs in the growing skeleton, a wide range of surgical procedures must be provided concerning tumour resection and defect reconstruction. In the current retrospective study results of 41 surgically treated aneurysmal bone cysts, thereof 5 latent, 31 active, and 5 aggressive lesions, were investigated. While morbidity due to the therapeutic measures was comparatively low even in extended lesions and demanding reconstructions, a recurrence rate of 19.5% had to be observed in our series. Taking into consideration the biological activity of the lesion, analysis of the recurrences revealed inappropriate surgical margins had been chosen at the primary operation in all of these patients. Since the risk of a local relapse is linked both to aggressiveness of the primary lesion and to surgical radicality, therapy of aneurysmal bone cyst requires preoperative staging and stage-dependent surgical procedures.Der Unfallchirurg 01/2000; 103(2):115-121. · 0.61 Impact Factor -
Article: [Bacterial coxitis caused by Salmonella enteritidis. Case report and differential diagnostic considerations].
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ABSTRACT: Secondary haematogenous joint involvement is seen in less than 1% of patients with Salmonella infections. These atypical infections are frequently encouraged by pre-existing local or systemic disease. We present a case of a patient with known alcohol abuse who developed a septic infection of her right hip requiring resection of the femoral head. Histologic analysis showed signs of pre-existing osteonecrosis probably induced by alcohol intake. Cartilage and bone were invaded and destructed by an aggressive granulation tissue. Initially, a biopsy evaluated without knowledge of the positive bacteriological result had been interpreted as indicative of a tumour. The onset, clinical course, diagnosis and therapy of joint involvement by Salmonella are discussed with regard to our case and the relevant literature. This case illustrates the necessity for clinicians to share all their information about the patient with the pathologist.Der Unfallchirurg 01/2000; 102(12):967-71. · 0.61 Impact Factor -
Article: Evaluation of neoadjuvant therapy response of osteogenic sarcoma using FDG PET.
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ABSTRACT: According to the current treatment protocol of the Cooperative Osteosarcoma Study (COSS), monitoring preoperative chemotherapy response and estimating grade of tumor regression in patients with osteosarcoma is mandatory before surgical removal of the tumor, particularly if a limb salvage procedure is intended. In addition, response to neoadjuvant chemotherapy is considered as an important prognostic indicator. The aim of this prospective study was to assess the usefulness of 2-(18F) fluoro-2-deoxy-D-glucose (FDG) PET in the noninvasive evaluation of neoadjuvant chemotherapy response in osteosarcoma. In 27 patients with osteosarcoma, we determined tumor-to-background ratios (TBRs) of FDG uptake with PET, before and after neoadjuvant chemotherapy according to COSS 86c or COSS 96 protocols, respectively. We compared changes in glucose metabolism of osteosarcomas with the histologic grade of regression in the resected specimen, according to Salzer-Kuntschik, discriminating responders (grades I-III; n = 17) and nonresponders (grades IV-VI; n = 10). The decrease of FDG uptake in osteosarcomas expressed as a ratio of posttherapeutic and pretherapeutic TBRs showed a close correlation to the amount of tumor necrosis induced by polychemotherapy (P < 0.001; Spearman). With a TBR ratio cutoff level of 0.6, all responders and 8 of 10 nonresponders could be identified by PET. In addition, lung metastases of osteosarcoma were detected with FDG PET in 4 patients. FDG PET provides a promising tool for noninvasive evaluation of neoadjuvant chemotherapy response in osteosarcoma. This could imply consequences for the choice of surgical strategy, because a limb salvage procedure cannot be recommended in patients nonresponsive to preoperative chemotherapy unless wide surgical margins can safely be achieved.Journal of Nuclear Medicine 11/1999; 40(10):1637-43. · 6.38 Impact Factor -
Article: Fluorodeoxyglucose positron emission tomography of soft tissue tumours: is a non-invasive determination of biological activity possible?
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ABSTRACT: Since musculoskeletal tumours comprise a large heterogeneous group of entities with different biological behaviour, clinical diagnosis of such lesions can be very difficult. The aim of this prospective study was to assess the usefulness of 2-[F-18]-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) in the non-invasive evaluation of soft tissue tumours. One hundred and two patients with suspected soft tissue neoplasms were investigated by FDG-PET. The uptake of FDG was evaluated semiquantitatively by determining the tumour to background ratio (TBR). All patients underwent biopsy, resulting in the histological detection of 39 high-grade sarcomas, 16 intermediate-grade sarcomas, 11 low-grade sarcomas, 25 benign tumours, 10 tumour-like lesions such as spontaneous myositis ossificans (n = 6) and one non-Hodgkin lymphoma. All lesions except for two lipomas disclosed an increased FDG uptake. Sarcomas showed significantly higher TBR values than latent or active benign lesions (P<0.001) and aggressive benign lesions (P<0.05). Using a TBR cut-off level of 3.0 for malignancy, sensitivity of FDG-PET was 97.0%, specificity 65.7% and accuracy 86. 3%. From our data there are three main conclusions: (1) Except for patients with pseudotumoral myositis ossificans, lesions with a TBR >3 were sarcomas (91.7%) or aggressive benign tumours (8.3%). (2) Tumours with a TBR <1.5 were latent or active benign lesions, exclusively. (3) The group with intermediate TBR values (<3 and >1. 5) comprised primarily latent or active benign lesions, but also four aggressive benign tumours and two low-grade sarcomas. Our data suggest that FDG-PET represents a useful tool for the evaluation of the biological activity of soft tissue neoplasms.European Journal of Nuclear Medicine 06/1999; 26(6):599-605. -
Article: Bakterielle Koxitis durch Salmonella enteritidis
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ABSTRACT: Sekundäre hämatogene Gelenkinfektionen werden bei weniger als 1 % aller systemischen Salmonellosen beobachtet. Lokale Gewebeschädigungen oder systemische Grunderkrankungen begünstigen das Zustandekommen dieser atypischen Infektionen. Wir stellen den Fall einer alkoholabhängigen Patientin dar, bei welcher eine Salmonellenkoxitis auf dem Boden einer ischämischen Knochennekrose des Hüftkopfes entstand. Die weit fortgeschrittene Zerstörung des Gelenks erforderte eine Resektionsarthroplastik. Histologisch fand sich eine destruierende Invasion von Knorpel und spongiösem Knochen durch zellreiches Entzündungsgewebe. In Unkenntnis des bakteriologischen Befundes war zunächst der Verdacht auf eine neoplastische Veränderung geäußert worden. Entstehung, Verlauf, Diagnostik und Therapie der Salmonellenarthritis werden anhand dieses Falles und der Literatur diskutiert. Die erfolgreiche Befundung einer Knochenbiopsie ist auf eine gute Kommunikation zwischen Kliniker und Pathologe angewiesen. Secondary haematogenous joint involvement is seen in less than 1 % of patients with Salmonella infections. These atypical infections are frequently encouraged by pre-existing local or systemic disease. We present a case of a patient with known alcohol abuse who developed a septic infection of her right hip requiring resection of the femoral head. Histologic analysis showed signs of pre-existing osteonecrosis probably induced by alcohol intake. Cartilage and bone were invaded and destructed by an aggressive granulation tissue. Initially, a biopsy evaluated without knowledge of the positive bacteriological result had been interpreted as indicative of a tumour. The onset, clinical course, diagnosis and therapy of joint involvement by Salmonella are discussed with regard to our case and the relevant literature. This case illustrates the necessity for clinicians to share all their information about the patient with the pathologist.Der Unfallchirurg 01/1999; 102(12):967-971. · 0.61 Impact Factor -
Article: [Color Doppler controlled needle biopsy in diagnosis of soft tissue and bone tumors].
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ABSTRACT: In a prospective study we investigated 168 patients with musculoskeletal tumors, including 71 sarcomas, by core needle biopsy using the high-speed device Autovac. Monitoring with colour-coded duplex sonography allowed a well-aimed puncture of smaller or deeply localized lesions and also permitted the discrimination of necrotic and viable parts of the tumor. Adequate material for histologic diagnosis including grading and determination of tumor subtype was obtained from soft tissue sarcomas, soft tissue metastases, malignant lymphomas, plasmacytomas, and osteolytic skeletal secondaries. In contrast, in benign soft tissue and bone tumors the diagnosis could be established in only 66% of cases. Although skeletal sarcomas were identified as malignant mesenchymal lesions, a complete histologic classification of tumor subtype frequently was not possible due to an insufficient tissue specimen. With an accuracy of 97% for the diagnosis of malignancy and of 94% for the diagnosis of soft tissue sarcoma the results of core needle biopsies were comparable to those of incisional biopsies, the reference standard in the diagnosis of musculoskeletal tumors. Regarding the known disadvantages and the oncological risks of incisional biopsies, needle biopsy should replace the open procedure as the primary means of diagnosis in soft tissue and osteolytic bone tumors.Der Chirurg 11/1998; 69(10):1059-67. · 0.70 Impact Factor -
Article: Die farbdopplersonographisch gesteuerte Nadelbiopsie in der Diagnostik von Weichteil- und Knochentumoren
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ABSTRACT: Im Rahmen einer prospektiven Studie an 168 Patienten mit Weichteil- oder Knochentumoren, darunter 71 Sarkomen, wurde unter farbdopplersonographischer Kontrolle eine Vollschnittbiopsie mit dem Hochgeschwindigkeitssystem Autovac® gewonnen. Das Ultraschallmonitoring erlaubte eine gezielte Punktion auch von kleinen oder tiefer gelegenen Läsionen und ermöglichte im Falle des Vorliegens von Nekrosen das Aufsuchen vitaler Tumoranteile. Eine adäquate histologische Beurteilung einschließlich Tumortypisierung und Grading war bei der großen Mehrzahl der Weichteilsarkome, Weichteilmetastasen, malignen Lymphome, Plasmocytome und osteolytischen Skelettmetastasen möglich. Benigne Weichteil- und Knochentumoren waren dagegen nur zu 66 % diagnostizierbar. In der Gruppe der ossären Sarkome war trotz histologischem Malignitätsnachweis eine exakte Tumortypisierung aufgrund zu geringer Materialmenge häufig nicht möglich. Mit einer Genauigkeit von 97 % für das Kriterium Malignität und von 94 % für die Diagnose Weichteilsarkom liefert die Methode Ergebnisse, die denen der Incisionsbiopsie, dem Standardverfahren bei Weichteil- und Knochentumoren unklarer Dignität, vergleichbar sind. In Anbetracht der bekannten Nachteile und onkologischen Risiken des offenen Verfahrens stellt die Nadelbiopsie – bei Einhaltung der für die Incisionsbiopsie geltenden Kautelen – für Weichteiltumoren und osteolytische Skelettläsionen die Methode der Wahl dar. In a prospective study we investigated 168 patients with musculoskeletal tumors, including 71 sarcomas, by core needle biopsy using the high-speed device Autovac. Monitoring with colour-coded duplex sonography allowed a well-aimed puncture of smaller or deeply localized lesions and also permitted the discrimination of necrotic and viable parts of the tumor. Adequate material for histologic diagnosis including grading and determination of tumor subtype was obtained from soft tissue sarcomas, soft tissue metastases, malignant lymphomas, plasmacytomas, and osteolytic skeletal secondaries. In contrast, in benign soft tissue and bone tumors the diagnosis could be established in only 66 % of cases. Although skeletal sarcomas were identified as malignant mesenchymal lesions, a complete histologic classification of tumor subtype frequently was not possible due to an insufficient tissue specimen. With an accuracy of 97 % for the diagnosis of malignancy and of 94 % for the diagnosis of soft tissue sarcoma the results of core needle biopsies were comparable to those of incisional biopsies, the reference standard in the diagnosis of musculoskeletal tumors. Regarding the known disadvantages and the oncological risks of incisional biopsies, needle biopsy should replace the open procedure as the primary means of diagnosis in soft tissue and osteolytic bone tumors.Der Chirurg 04/1998; 69(10):1059-1067. · 0.70 Impact Factor -
Article: [Injury classification and surgical approach in hip dislocations and fractures].
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ABSTRACT: During the last few decades, traumatic injuries of the hip joint have significantly increased in number, and traffic accidents have also increased. Depending on the speed, direction of the forces and the position of the femur at the moment of impact, different patterns of injury occur. Basically, they are classified as hip dislocations, dislocation fractures and acetabular fractures. These injuries have in common a high rate of concomitant lesions. Several classification systems have been developed for these injuries. Commonly, Stewart and Milford's or Levin's classification is used for dislocations and dislocation fractures. For acetabular fractures, Judet and Letournel's classification and its newer version developed by Helfet (AO classification) are generally accepted. Fractures of the femoral head, though included in these classifications, are typically described by separate classifications like the one presented in 1957 by Pipkin. The multitude of injuries occurring in the hip joint requires vast knowledge of various operative approaches. No single approach exists that would permit the treatment of all injuries in an ideal fashion. Approaches are either considered limited (Kocher-Langenbeck, ilioinguinal iliofemoral) when they permit access only to a restricted segment of the joint, or extended (extended iliofemoral, Maryland, Ruedi) when they allow all-round visualization of the hip joint. The choice of the best approach for an individual patient depends on the type of injury and also on patient variables like age, preexisting disease, and concomitant injuries. The decision is further influenced by the timing of surgery, the kind of fracture stabilization intended and by complications typically seen with certain approaches. The indication for extended procedures is only seen in patients with complex injury patterns involving both the anterior and the posterior column or in delayed cases undergoing surgery more than 3 weeks after trauma. Extended approaches permit excellent visualization of the fracture, but the extent of the soft tissue trauma is reflected in a high rate of postoperative complications. After a phase in which extended procedures were favored, recently a trend towards more limited approaches can be recognized because of their lower complication rate. This is facilitated by modern fracture-reduction methods using indirect techniques.Der Orthopäde 05/1997; 26(4):304-16. · 0.51 Impact Factor -
Article: Injury classifications and operative approaches in hip dislocation and fractures
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ABSTRACT: During the last few decades, traumatic injuries of the hip joint have significantly increased in number, and traffic accidents have also increased. Depending on the speed, direction of the forces and the position of the femur at the moment of impact, different patterns of injury occur. Basically, they are classified as hip dislocations, dislocation fractures and acetabular fractures. These injuries have in common a high rate of concomitant lesions. Several classification systems have been developed for these injuries. Commonly, Stewart and Milford's or Levin's classification is used for dislocations and dislocation fractures. For acetabular fractures, Judet and Letournel's classification and its newer version developed by Helfet (AO classification) are generally accepted. Fractures of the femoral head, though included in these classifications, are typically described by separate classifications like the one presented in 1957 by Pipkin. The multitude of injuries occuring in the hip joint requires vast knowledge of various operative approaches. No single approach exists that would permit the treatment of all injuries in an ideal fashion. Approaches are either considered limited (Kocher-Langenbeck, ilioinguinal iliofemoral) when they permit access only to a restricted segment of the joint, or extended (extended iliofemoral, Maryland, Ruedi) when they allow all-around visualization of the hip joint. The choice of the best approach for an individual patient depends on the type of injury and also on patient variables like age, preexisting disease, and concomitant injuries. The decision is further influenced by the timing of surgery, the kind of fracture stabilization intended and by complications typically seen with certain approaches. The indication for extended procedures is only seen in patients with complex injury patterns involving both the anterior and the posterior column or in delayed cases undergoing surgery more than 3 weeks after trauma. Extended approaches permit excellent visualization of the fracture, but the extent of the soft tissue trauma is reflected in a high rate of postoperative complications. After a phase in which extended procedures were favored, recently a trend towards more limited approaches can be recognized because of their lower complication rate. This is facilitated by modern fracture-reduction methods using indirect techniques. Traumatische Verletzungen des Hüftgelenks haben ebenso wie die Verkehrsunfälle in den letzten Jahrzehnten deutlich zugenommen. Abhängig von Geschwindigkeit und Richtung der einwirkenden Kraft einerseits und Stellung des Femurs andererseits entstehen unterschiedliche Verletzungsformen. Im wesentlichen unterscheiden wir die Hüftluxation, die Hüftluxationsfraktur und die Acetabulumfraktur. Allen gemeinsam ist der hohe Anteil an Begleitverletzungen. Zur Erfassung und Bewertung dieser Verletzungen sind unterschiedliche Klassifikationen gebräuchlich. Am bekanntesten sind die Einteilungen der Hüftluxation bzw. Hüftluxationsfrakturen nach Stewart und Milford sowie Levin, bzw. der Acetabulumfrakturen nach Judet und Letournel und deren Weiterentwicklung nach Helfet (AO-Klassifikation). Obwohl in diesen Klassifikationen enthalten, sind für die Hüftkopffrakturen, die in charakteristischen Verletzungsformen vorkommen, seit langem eigene Einteilungen gebräuchlich. Am weitesten verbreitet ist die bereits 1957 von Pipkin angegebene Klassifizierung. Die zahlreichen möglichen Verletzungsformen erfordern die Kenntnis verschiedener operativer Zugangswege zum Hüftgelenk. Aufgrund der anatomischen Gegebenheiten ist kein einzelner chirurgischer Zugang ideal zur Versorgung aller Verletzungen. Grundsätzlich unterscheidet man limitierte Zugänge (Kocher-Langenbeck, ilioinguinal, iliofemoral), die nur einen bestimmten Bereich des Hüftgelenks zugänglich machen und erweiterte Zugänge (erweiterter iliofemoraler Zugang, Maryland Zugang, Zugang nach Rüedi), die meist eine vollständige Darstellung des Hüftgelenks erlauben. Bei der Wahl des geeignetsten Zugangs müssen neben der Verletzungsform auch Patientenfaktoren (Alter, Grunderkrankungen, Begleitverletzungen) und Behandlungsfaktoren (Zeitpunkt der Operation, geplante Stabilisierungstechnik, zugangsspezifische Komplikationsmöglichkeiten) berücksichtigt werden. Die Indikation für erweiterte Zugänge muß streng gestellt werden und besteht, wenn gleichzeitig komplexe Verletzungen des hinteren und vorderen Pfeiler vorliegen oder bei Rekonstruktionen nach über 3 Wochen. Dem Vorteil der ausgezeichneten Darstellung steht die ausgedehnte Weichteilexposition mit entsprechend höheren postoperativen Komplikationen gegenüber. Auch durch verbesserte indirekte Repositionstechniken ist in den letzten Jahren wieder zunehmend der Trend zu den komplikationsärmeren limitierten Zugängen festzustellen.Der Orthopäde 03/1997; 26(4):304-316. · 0.51 Impact Factor
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Institutions
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2008
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Orthopädische Universitätsklinik Friedrichsheim
Frankfurt am Main, Hesse, Germany
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1996–2000
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Universität Ulm
- Clinic of Trauma, Hand, Plastic and Reconstructive Surgery
Ulm, Baden-Wuerttemberg, Germany
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