W. Friedl

University of Leuven, Louvain, Flemish, Belgium

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Publications (76)61.01 Total impact

  • Source
    W. Friedl · J. Gehr

    Preview · Article · Feb 2013 · Injury
  • Source
    W. Friedl · M. Rinner

    Preview · Article · Feb 2013 · Injury
  • Source
    W. Friedl · M. Rinner

    Preview · Article · Sep 2012 · Injury
  • Source
    W. Friedl · J. Gehr

    Preview · Article · Sep 2012 · Injury
  • J. Gehr · A. Schmidt · W. Friedl
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    ABSTRACT: Die Kalkaneuspseudarthrose ist eine klinische Rarität. Wir konnten in der Literatur bisher noch kein Fall finden. Um so interessanter scheint es, daß durch die Autoren innerhalb weniger Wochen 2 Fälle einer Kalkaneuspseudarthrose versorgt werden mußten. Dabei soll besonders auf die möglichen anatomischen Strukturen und Lokalisationen, sowie die biomechanischen Ursachen eingegangen werden. Die klinische Versorgung der beiden Patienten mit Kalkaneuspseudarthrose wird dargestellt. The calcaneus pseudathrosis is rarly seen in clinical workday and we coundnit find any case be reported. In two casese the authors present the diagnosis and therapie of a non-union after a calcaneus fracture. The authors point especially at anatomical characteristics and biomechanical reasons and their meaning for aetiology of pseudathrosis after a calcaneus fracture.
    No preview · Article · May 2012 · Der Unfallchirurg
  • Source
    W. Friedl · J. Gehr

    Preview · Article · Sep 2011 · Injury
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    ABSTRACT: Plates with angular stability (monoaxial or polyaxial) are competing for indications in periarticular fractures of the long bones, consisting, according to most authors, the ideal treatment at present time. However, the best option for screw locking is controversial and insufficient investigated. The authors present their personal experience regarding angular stability plate osteosynthesis for the fractures of the proximal humerus, distal radius, distal femur, proximal tibia. Results for the treatment with internal fixator plates are much better than the results for classic implants osteosynthesis (mainly in fractures on osteoporotic bones), accounting for construct stability, lack of secondary displacements, early rehabilitation. Polyaxial locked plates has the advantage of screw pathway adjustment (their positioning being adapted to a specific fracture). The large case distribution in different hospital services and good results following this treatment lead to the conclusion that locked plates represent the unique issue in complex periarticular fractures and in osteoporotic fractures. Close cooperation between orthopaedic surgeon, biomechanics and robotics specialist, and the departments of cell biology and pathology will contribute to the creation of the ideal internal fixator.
    No preview · Conference Paper · Aug 2010
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    W. Friedl · J. Gehr
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    ABSTRACT: Pilon fractures and distal metaphyseal fractures of the tibia are associated with a high rate of soft tissue and bone healing problems, especially in type C fractures. From July 2000, the authors started to use XS and XXS nail, first for fibula and then for pilon and ankle fractures. Material and methods: the XS nail is a 4.5mm and the XXS a 3.5mm straight nail which is locked by threaded wires which are placed with an aiming device and allows also dynamic fracture site compression with a set screw. The fibula is fixed percutaneously and after distal locking with traction of the aiming device also tibia length and axis can be restored and fixed with the proximal locking. The tibia is than fixed with one nail introduced from the medial malleolus and if necessary a second from proximal medial to distal lateral so that stable fixation is obtained. The authors have studied 26 pilon fractures (with follow-up of 13 patients) and 214 ankle fractures with reevaluation after 6 months of 91 patients. Results. The results were evaluated according to the Ovadia score (clinical and radiological). All articular and fibula fractures healed without problems except 3 delayed unions for metaphyseal fractures that required bone grafting. In no case osteomyelitis occurred. In one case compartment syndrome required surgical decompression. According to the Ovadia Score after one year the results were very good or good in the subjective criteria in 69% of the patients and 61% in the objective criteria. For ankle fractures we have observed two hematoma (with revision surgery) and two proximal fractures of the fibula due to the oblique nail insertion. In no case infection of the bone was seen, in no case fracture or implant dislocation occurred. The results were excellent in 71% cases, good in 25% cases, and 3 patients had fair and unsatisfactory results. Conclusion. The minimal invasive stabilization of pilon fractures with the XS nail and the absence of plates on the bone surface reduce s- - ignificantly the healing problems and the rate of severe complications of pilon fractures. The Xs nail is also a new option for ankle stabilization.
    Preview · Conference Paper · Aug 2010
  • Source
    W. Friedl · M. Rinner · M. Simnacher · C. Mathieu
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    ABSTRACT: Distal radius fractures are typical and frequent fracture of elderly woman with reduced bone density. The angle stable plate, often also multidirectional is today the most common stabilisation device. Because of the introduction of bulky and bended implants as the Micro nail or Targon DR which require difficult opening of the bone with awles we decided to test the XS radius (XSR) nail which is a 4,5mm or 3,5mm straight nail and which is introduced after guide wire placement and over drilling with a canulated drill of the same diameter. It is locked parallel to the joint in 3 different directions with angular stability with threaded wires. Material and methods. 16 radius sawbones were osteotomized corresponding to a A3 Fracture and stabilised with a angle stable plate (8) and XS nail (8). The deformation of the XS group however was 20% lower. Results. Both types of osteosynthesis showed good stability The deformation of the XS group was 20% lower. Conclusions. Both angular stable plate and XSR nail can be used in unstable distal radius fracture fixation. The mainly intraosseus position of the nail and saving of the pronator quadratus as well as lower deformation are in favour of the XSR nail.
    Preview · Conference Paper · Aug 2010
  • M. Simnacher · M. Riner · C. Mathieu · J. Gehr · W. Friedl

    No preview · Article · Dec 2006 · Journal of Biomechanics
  • Jonas Gehr · Tim Arnold · Florian Hilsenbeck · Wilhelm Friedl
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    ABSTRACT: Introduction: Due to the increase in the incidence of osteoporosis with age and the high biochemical load on the proximal femur, the pertrochanteric femur fracture is the typical fracture of the elderly. The number of different fracture types and the characteristic features of this patient population places high demands on any universally applicable implant. The rotational instability of the head–neck fragment in the case of a trochanter minor defect, in particular, is a significant factor in the care of pertrochanteric femur factures. The object of this study was to show that the gliding nail constitutes a universal implant for the care of proximal femur fractures with constantly maintained stability under load. Material and Methods: Between March 1996 and April 2001, 501 patients with per- and subtrochanteric fractures and an average age of 76 were included in the study. All osteosyntheses were carried out using the gliding nail which has an I-beam cross-section profile blade. 73.2% were treated operatively for closed isolated per- or subtrochanteric femur fractures. Results: All patients were restored to full weight-bearing postoperatively. The combined overall early and late complication rate following gliding nail synthesis was only 5.4%. Neither blade cut-out nor head–neck rotation was observed following gliding nail osteosynthesis. Three-month mortality rose from 2.4% in patients with no complications to 90% in patients with four complications. 92.1% of patients were independently mobile at the time of the follow-up examination. Conclusion: With its low complication rate and the ever-present possibility of full weight bearing, the gliding nail fulfills all the requirements of a modern implant for the treatment of proximal femur fractures. In our opinion, its most advantageous features are the high moment of resistance of the I-beam cross-section profile blade which ensures the possibility of gliding, the minimalized risk of proximal cut-out due to the large surface area with two planes of support in the bone, and its secure rotational stability in terms of both nail and bone. The impaction of the blade, which requires no reaming with its resulting loss of bone substance, is responsible for the excellent bone–implant interface.
    No preview · Article · Dec 2006 · European Journal of Trauma
  • J Gehr · W Friedl
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    ABSTRACT: Fractures of the talus in children are rare. Repeated clinical examination and imaging techniques such as magnetic resonance imaging are often needed to establish a diagnosis. In case of the late recognition of talus fractures, catastrophic results may occur for the hind-foot. This case report presents a 5 year old boy with a non-displaced talus neck fracture with good outcome after minimally invasive osteosynthesis.
    No preview · Article · Nov 2006 · Der Unfallchirurg
  • J. Gehr · W. Friedl
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    ABSTRACT: Kindliche Talushalsfrakturen sind seltene Verletzungen. Bei Verletzungen des Fues muss immer an diese Frakturen gedacht und bei geringstem Zweifel eine weitere Diagnostik eingeleitet werden. Sollte eine Talushalsfraktur bersehen werden, kann dies katastrophale Folgen fr den kindlichen Fu bedeuten. In dieser Kasuistik wird der Fall einer Talushalsfraktur dargestellt.Fractures of the talus in children are rare. Repeated clinical examination and imaging techniques such as magnetic resonance imaging are often needed to establish a diagnosis. In case of the late recognition of talus fractures, catastrophic results may occur for the hind-foot. This case report presents a 5year old boy with a non-displaced talus neck fracture with good outcome after minimally invasive osteosynthesis.
    No preview · Article · Sep 2006 · Der Unfallchirurg
  • Jonas Gehr · Wilhelm Friedl
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    ABSTRACT: Reconstruction of the anatomy of the olecranon, while protecting the soft tissue, by an internal stabilization method that is stable under exertion. All olecranon fractures. Very small (< 5 mm) proximal fragments at the point of nail entry. Bony avulsions of the triceps tendon. In the case of displaced olecranon fractures, exposure of the ulnar nerve, open reduction, fracture retention with reduction forceps, introduction of a 1.6 or 2.0 mm thick central guide wire into the medullary cavity in a slightly radial direction, overdrilling with a 3.5- or 4.5-mm cannulated drill bit, introduction of the nail to the aiming arm, and locking with 2.0-mm threaded wires. If the fracture pattern is transverse or slightly oblique, axial compression can be achieved by insertion of a compression screw into the nail. Fragments from the posterior margin or medial/lateral comminuted zones can be fixed more securely to the system via fiber cerclage wires around the threaded wires. After checking by X-ray, shortening of the threaded wires with the bolt cutters. Stable under exertion, splint-free postoperative management for 6 weeks, followed by full load bearing. From May 1999 to December 2002, 80 olecranon fractures were treated using the XS nail. 73 patients (91.3%) were followed up after an average of 15 months. 49 (67.1%) had a multifragmentary or comminuted fracture, and 24 (32.9%) a simple transverse fracture. According to the Murphy Score, results were excellent in 47 cases (64.4%), good in 21 (28.8%), satisfactory in three (4.1%), and poor in two (2.7%).
    No preview · Article · Sep 2006 · Operative Orthopädie und Traumatologie
  • Jonas Gehr · Wilhelm Friedl
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    ABSTRACT: Objective Reconstruction of the anatomy of the olecranon, while protecting the soft tissue, by an internal stabilization method that is stable under exertion. Indications All olecranon fractures. Contraindications Very small (< 5 mm) proximal fragments at the point of nail entry. Bony avulsions of the triceps tendon. Surgical Technique In the case of displaced olecranon fractures, exposure of the ulnar nerve, open reduction, fracture retention with reduction forceps, introduction of a 1.6 or 2.0 mm thick central guide wire into the medullary cavity in a slightly radial direction, overdrilling with a 3.5- or 4.5-mm cannulated drill bit, introduction of the nail to the aiming arm, and locking with 2.0-mm threaded wires. If the fracture pattern is transverse or slightly oblique, axial compression can be achieved by insertion of a compression screw into the nail. Fragments from the posterior margin or medial/lateral comminuted zones can be fixed more securely to the system via fiber cerclage wires around the threaded wires. After checking by X-ray, shortening of the threaded wires with the bolt cutters. Postoperative Management Stable under exertion, splint-free postoperative management for 6 weeks, followed by full load bearing. Results From May 1999 to December 2002, 80 olecranon fractures were treated using the XS nail. 73 patients (91.3%) were followed up after an average of 15 months. 49 (67.1%) had a multifragmentary or comminuted fracture, and 24 (32.9%) a simple transverse fracture. According to the Murphy Score, results were excellent in 47 cases (64.4%), good in 21 (28.8%), satisfactory in three (4.1%), and poor in two (2.7%).
    No preview · Article · Jul 2006 · Operative Orthopädie und Traumatologie
  • Jonas Gehr · Wilhelm Friedl
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    ABSTRACT: Reconstruction of the anatomy of the ankle joint while protecting the soft tissue, and osteosynthesis to maintain stability for function and weight bearing. Distal fractures of the fibula, bimalleolar fractures, and isolated fractures of the medial malleolus. Very small (< 5 mm) distal fragments (if fixation of the fragments is not possible using a small XXS nail) and very narrow (< 2.5 mm) medullary cavity (conversion to plate fixation). With displaced fibula fractures, open reduction should be performed with fracture retention using wide-armed reduction forceps, insertion of a central guide wire into the medullary cavity, use of a cannulated drill bit, introduction of the nail using an aiming arm and locked fixation with threaded wire. After checking the position using X-ray, the wire should be shortened using the bolt cutters. POSTOPERATIVE MANAGEMENT (Depending on the Weber classification): Full weight bearing for all isolated distal fractures of the fibula (Weber types A and B) and isolated fractures of the medial malleolus. For distal fractures of the fibula (Weber types A and B) with additional fracture of the medial malleolus or involvement of the medial ligament partial weight bearing of 20 kp for 4 weeks, followed by full weight bearing. For all Weber C fractures and/or additional Volkmann fracture only 10 kp of partial weight bearing with a rocker-sole orthosis should be allowed for 6 weeks followed by full weight bearing. No weight bearing for 6 weeks until the screws are removed is only recommended, if positioning screws have been used for Weber C fractures. In the period from 05/2000 to 01/2002, 194 ankle fractures were treated with the IP-XS-Nail((R)). Follow-up examinations were conducted on 162 patients with an average age of 51.2 years after an average of 15 months. 62 Weber B fractures (38.3%) and 45 Weber C fractures (27.7%) were evaluated. There were bimalleolar fractures in 55 cases (34.0%). According to the Olerud Score (clinical and radiologic score), 95 patients (58.6%) had an excellent, 54 (33.3%) a good, nine (5.5%) a moderate, and four (2.4%) an unsatisfactory result.
    No preview · Article · Jul 2006 · Operative Orthopädie und Traumatologie
  • Jonas Gehr · Wilhelm Friedl
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    ABSTRACT: ZusammenfassungOperationsziel Weichteilschonende Wiederherstellung der Anatomie des Sprunggelenks und funktions- sowie belastungsstabile Osteosynthese.Indikationen Distale Fibulafrakturen, bimalleolare Frakturen und isolierte Innenknchelfrakturen.Kontraindikationen Sehr kleine (Operationstechnik Bei dislozierten Fibulafrakturen offene Reposition und Frakturretention ber Repositionszangen mit breiten Branchen, Einbringen eines zentralen Fhrungsdrahts in den Markraum, berbohrung mit einem kanlierten Bohrer, Einfhren des Nagels am Zielbgel und Verriegelung mit Gewindedrhten. Nach Rntgenkontrolle der Lage Krzen der Gewindedrhte mit der Bolzenschneidezange.Weiterbehandlung (Einteilung nach der Weber-Klassifikation) Vollbelastung bei allen isolierten distalen Fibulafrakturen (Typ Weber A, B) und isolierten Innenknchelfrakturen. 20-kp-Teilbelastung bei distalen Fibulafrakturen (Typ Weber A, B) mit zustzlicher Innenknchelfraktur oder Innenbandbeteiligung fr 4 Wochen, danach Vollbelastung. Bei allen Weber-C-Frakturen und/oder zustzlichen Volkmann-Frakturen Abrollen fr 6 Wochen (10 kp), danach Vollbelastung. Komplette Entlastung fr 6 Wochen lediglich bei Verwendung von Stellschrauben bei Weber-C-Frakturen bis zur Schraubenentfernung.Ergebnisse Im Zeitraum 05/2000–01/2002 wurden 194 Sprunggelenkfrakturen mit dem IP-XS-Nagelversorgt. 162 Patienten mit einem Durchschnittsalter von 51,2 Jahren konnten durchschnittlich 15 Monate postoperativ nachuntersucht werden. 62 Weber-B-Frakturen (38,3%) und 45 Weber-C-Frakturen (27,7%) kamen zur Auswertung. In 55 Fllen (34,0%) lagen bimalleolare Frakturen vor. Nach dem Olerud-Score (klinischer und radiologischer Score) wiesen 95 Patienten (58,6%) ein exzellentes, 54 (33,3%) ein gutes, neun (5,5%) ein miges und vier (2,4%) ein unbefriedigendes Ergebnis auf.
    No preview · Article · Jun 2006 · Operative Orthopädie und Traumatologie
  • J Gehr · W Friedl
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    ABSTRACT: The two cases presented are fractures of ankylosed elbow joints with severe soft tissue damage. Closed reduction and percutaneous osteosynthesis were performed using the IP-XS-nail system to prevent further soft tissue damage. By implanting two parallel XS-nails between the humerus and ulna and humerus and radius, we achieved a situation allowing early functional treatment of the weight bearing joints. There were no complications.
    No preview · Article · Dec 2005 · Der Unfallchirurg
  • J. Gehr · W. Friedl
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    ABSTRACT: Bei den vorliegenden 2 Kasuistiken handelt es sich jeweils um eine vorbestehende Ankylose des Ellbogengelenks mit frischer Fraktur und starker posttraumatischer Weichteilschädigung. Zur gedeckten Versorgung wurde das IP-XS-Nagelsystem herangezogen, um eine weitere Weichteiltraumatisierung zu vermeiden. Durch die Versorgung mit jeweils 2 parallel eingebrachten Nägeln zwischen Humerus und Ulna sowie Humerus und Radius konnte eine übungsstabile Situation erreicht werden. Der Verlauf war in beiden Fällen komplikationslos.
    No preview · Article · Nov 2005 · Der Unfallchirurg
  • J. Gehr · F. Hilsenbeck · W. Friedl

    No preview · Article · May 2005 · Osteosynthesis and Trauma Care

Publication Stats

461 Citations
61.01 Total Impact Points

Institutions

  • 2013
    • University of Leuven
      Louvain, Flemish, Belgium
  • 2012
    • University Hospital RWTH Aachen
      Aachen, North Rhine-Westphalia, Germany
  • 2004-2010
    • University of Wuerzburg
      Würzburg, Bavaria, Germany
  • 1998-2010
    • Klinikum Aschaffenburg-Alzenau
      Auscheffenburg, Bavaria, Germany
  • 1999
    • evaplan at the University Hospital Heidelberg
      Heidelburg, Baden-Württemberg, Germany
  • 1991-1999
    • Universität Heidelberg
      • • Department of Spine Surgery
      • • Department of Trauma and Reconstructive Surgery
      Heidelburg, Baden-Württemberg, Germany
  • 1996
    • Hannover Medical School
      • Department of Plastic, Hand and Reconstructive Surgery
      Hanover, Lower Saxony, Germany