Biomedical subjects

A Biewener

Publications and source records attributed to A Biewener.

At least 19 recordsLinked to original sources

PubMed2006

[Percutaneous dorsal versus open instrumentation for fractures of the thoracolumbar border. A comparative, prospective study].

STUDY DESIGN: A prospective clinical study. OBJECTIVE: To evaluate whether a percutaneous dorsal instrumentation of thoracolumbar fractures prevents irreversible damage to the spinal muscles. METHODS: A total of 57 patients with thoracolumbar fractures (Th12-L4) were divided into two groups, comparable in terms of gender, fracture level, classification and surgical concept. In the first, 24/57 patients were treated using an open procedure (OP-G); in the second, 33/57 were treated via percutaneous dorsal instrumentation (PER-G). Fracture localisation and classification, accuracy of pedicle screw placement, perioperative blood loss, OR- and image converter time as well as muscle damage (needle-EMG) were evaluated. RESULTS: OR- and image converter time as well as the accuracy of pedicle screw placement were not statistically different between groups. The difference in perioperative blood loss [43 (10-90) ml (PER-G) vs [870 (570-1,200 ml (OP-G)] was statistically significant (P <0.005). Needle EMG revealed no muscle damage, and the physiological activity and muscle potentials were normal (PER-G). In the OP-G, polyphasic EMG signals were most common (80%), a sign of the drop-out of numerous motor units. CONCLUSIONS: The open procedure caused permanent and significant damage to the strongest extensors of the autochthonus back musculature, the m. multifidus, which results from multisegment combined damage to the r. posterior nervi spinalis and muscle fibres. In contrast, percutaneous placement of an internal fixative reduces perioperative access morbidity causing little iatrogenic damage to back muscles and only a minor perioperative blood loss.

Adult↗

PubMed2006

[Traumatic hemipelvectomy].

With an incidence of only 0.6% of all pelvic injuries, traumatic hemipelvectomy is a rare event. It is defined as open or closed avulsion of one hemipelvis with occlusion or disruption of the main vessels and lengthening or disruption of the nerves, often complicated by urogenital or anorectal injuries. The mechanism of injury in this case is a typical one with extreme abduction and external rotation of the leg, causing sacroiliac joint disruption and symphysis separation. Two other mechanisms described are avulsion when the leg becomes entangled in a piece of machinery or a massive crushing at the groin. After a fast treatment in the field, the patient described was treated with immediate open revision, tamponade and stabilization of the pelvis. Upper leg preservation by reconstruction of the femoral vessels with vascular prostheses was attempted. Because of a broad necrosis of soft tissues, early completion of the hemipelvectomy was performed. The patient recovered well. Miction and bowel evacuation as well as sexual function could be preserved. The resulting quality of life is high and the patient is socially reintegrated without problems.

Adolescent↗

PubMed2006

[Distal radius fracture. Correlation between radiological and functional results].

BACKGROUND: The purpose of the present study was to investigate the influence of the radiological parameters on the functional outcome of patients with a fracture of the distal radius and to find out to which extent a deformity can be tolerated. PATIENTS AND METHODS: A total of 344 patients with an isolated fracture of the distal radius were treated during a 3-year period; 211 of them were evaluated at an average of 16 months after the accident according to the score of Gartland and Werley as modified by Sarmiento. Furthermore, we developed our own score for evaluating the influence of radiological parameters on the functional outcome. RESULTS: According to the AO classification, there were 20 patients with an A2, 71 an A3, 11 a B, 35 a C1, 44 a C2, and 30 a C3 fracture. Of 211 patients, 28 (13%) had a step-off in the articular surface of over 1 mm, resulting in a 24% reduction of the range of motion compared to the non-injured wrist (p<0.05). Patients with a radial shortening of more than 3 mm (n=12) had a 21% reduction of pro- and supination compared to the non-injured side (p<0.05). The radial tilt and the palmar inclination did not have a direct influence on the functional outcome. Patients treated with K-wire pinning and with an initial palmar inclination of less then -15 degrees had a significantly higher secondary loss of palmar inclination of 9 degrees compared to all others (p<0.05) at the final follow-up. CONCLUSION: The main radiological factors influencing the functional outcome of fractures of the distal radius are radial shortening and a step-off in the articular surface.

Adolescent↗

PubMed2005

[Impact of rescue method and the destination clinic on mortality in polytrauma. A status report].

BACKGROUND: The aim of this study was to document the present knowledge from the medical literature on (1) efficacy of aeromedical evacuation (helicopter emergency medical service, HEMS) and (2) influence of the level of the first receiving hospital on mortality of patients. METHODS: Systematic review of the literature between 1970 and 2003; identification of studies with an evidence level of at least III and included control group; own results. RESULTS: (1) 17 studies concerning the efficacy of HEMS were included into the review. No single study yielded shorter rescue times with the use of HEMS. 11 of 17 studies showed a significantly higher survival rate (8.2 to 52%) with the employment of HEMS especially with mid-degree polytrauma. (2) All 6 relevant studies dealing with hospital level found a considerable lower mortality rate (19 to 42%) for patients treated primarily at a level 1 trauma center or comparable institution. CONCLUSIONS: The analyzed studies showed a trend toward decreased mortality rates with the employment of HEMS. Considering the comparable hospital level and even longer rescue times with HEMS, these differences can be explained with higher quality of initial diagnosis and treatment of the HEMS rescue team. Furthermore, mortality rates can be lowered significantly through primary treatment at a level 1 trauma center. Thus, the more flexible choice of the first receiving hospital represents a specific, clinically relevant advantage of HEMS in emergency medicine.

Air Ambulances↗

PubMed2005

[Foot injuries in the polytraumatized patient].

Foot injuries in polytraumatized patients are not critical for survival but for the later quality of life. Closed fractures or dislocations of the foot are frequently overlooked or misinterpreted in association with polytrauma, which leads to severe functional impairment in those patients who survive. Repeated clinical examinations and early radiographic examinations are essential in the unconscious patient after resuscitation. Emergent indications for surgery even in the presence of multiple injuries are open injuries, incarcerated soft tissues, manifest compartment syndrome of the foot, and neurovascular injury. The decision on limb salvage or amputation has to be individualized with respect to the patient's overall condition and the severity of local trauma to the foot. The "life before limb" principle has to be respected. Emergent reduction of fracture dislocations of the talus, calcaneus, Chopart's and Lisfranc's joints via direct approaches and temporary transfixation with K-wires should be attempted in a first step whenever possible. Additional external fixation facilitates wound care and prevents soft tissue contractions until definite internal fixation becomes feasible. Early soft tissue coverage is always sought in order to avoid infection.

Amputation, Surgical↗

PubMed2004

[Advantages of minimally-invasive reposition, retention, and Ilizarov-(hybrid)fixation for pilon-tibial-fractures fractures with particular emphasis on C2/C3 fractures].

Between October 1993 and September 1999 a total of 62 tibial pilon fractures in 59 patients were treated at the Clinic for Trauma and Reconstructive Surgery, University Hospital Carl-Gustav-Carus, Technical University Dresden. In a retrospective study 49 patients with 50 tibial pilon fractures (81%) could be examined an average of 28 months after injury. The purpose of this study was to compare clinically and radiographically the healing results obtained after using the Ilizarov technique in combination with minimally invasive internal fixation (group I) with those after a conventional surgical procedure (internal fixation with a plate, external fixation with or without minimally invasive internal fixation, and screw fixation exclusively, group II) and to evaluate the efficacy of the Ilizarov technique. Data analysis showed a significantly higher incidence of 43 C2/C3 fractures in Ilizarov group I (73%) than in group II (33.3%). Severe soft tissue injuries and particularly open injuries had a significantly higher incidence in Ilizarov group I (100%) than in group II (38%). Despite the high incidence of C2/C3 fractures and severe soft tissue injuries in group I, there was no incidence of pseudarthrosis or osteitis in the further course and there was no need for arthrodesis during the long-term course. After therapy with a conventional surgical technique, the incidence of osteitis was 5% and of delayed union of a fracture 2.5% and arthrodesis was necessary in 8%. A disadvantage of the Ilizarov system was the relatively frequent incidence of pin infection (45%) necessitating surgical debridement in 18%. The efficacy of the treatment of 43 C2/C3 fractures with the Ilizarov technique was obvious by a statistically significantly better Maryland Foot Score in comparison with group II. More than 87% of the patients treated with the Ilizarov technique and only 38% of the patients treated with a conventional surgical procedure obtained a very good or good score. According to these findings, the Ilizarov technique in combination with minimally invasive internal fixation is an effective method to treat complicated tibial pilon fractures with severe soft tissue trauma.

Adult↗

PubMed2004

Foot function after subtalar distraction bone-block arthrodesis. A prospective study.

Subtalar distraction bone-block arthrodesis for malunited calcaneal fractures was performed in 31 patients (26 men, five women), with a mean age of 38.5 years. The mean time from injury to arthrodesis was 36 months. There were no cases of nonunion. One patient had an early dislocation of the bone block requiring a repeat arthrodesis, and one had a soft-tissue infection. The mean AOFAS hindfoot score improved significantly from 23.5 before operation to 73.2 at a mean follow-up of 33 months (p > 0.001). Compared with the unaffected side, the talocalcaneal height was corrected by 61.8%, the talus-first metatarsal axis by 46.5%, the talar declination angle by 38.5% and the talocalcaneal angle by 35.4%. Dynamic pedobarography revealed a return to normal of the pressure distribution during roll-over and a more energetic gait. The distribution of local transfer of load correlated well with the AOFAS score. The amount of correction of the heel height correlated with a normal pattern of pressure transfer on the heel (p < 0.05).

Adult↗

PubMed2003

[Calcaneus fractures. Open reduction and internal fixation].

AIM OF THIS STUDY: Critical analysis of the medium-term results of open reduction and internal fixation (ORIF) of displaced intra-articular calcaneus fractures with a standardized protocol in a greater patient cohort. METHODS: From October 1993 to December 1999 314 patients (mean age 42.3 years) with 348 calcaneus fractures were seen at the Dresden University Hospital. 41 fractures were open, 4 with 1st degree, 28 with 2nd and 9 with 3rd degree soft tissue damage. 275 displaced intra-articular fractures were treated with ORIF, 262 (95.3 %) with plate osteosynthesis via an extended lateral approach. 169 patients could be evaluated at a mean of 18 months (range 10-47 months) postoperatively with an extended protocol of questionnaire, physical and radiographic examination. RESULTS: The Maryland Foot Score after 18 months follow-up averaged 80.8/100, the mean Zwipp score averaged 146.4/200. The functional result with the Merle d'Aubigné score was judged good to excellent in 86% of cases. Rates of deep infection and superficial wound edge necrosis increased significantly with open fractures and delay in surgery of more than 2 weeks after injury in closed fractures. Clinical results were adversely affected by even minor residual steps in the posterior facet (1-2 mm) as judged by CT or Brodén views (p < 0.001). Böhler's tuberosity-joint-angle had an impact on the final result when falling short compared to the unaffected contralateral side by more than 30% (p < 0.001). CONCLUSIONS: Management of intra-articular calcaneus fractures with a standardized protocol of ORIF and early mobilization leads to reproducible good or excellent clinical results in a majority of patients. New approaches like an interlocking calcaneus plate, the use of subtalar arthroscopy, early soft tissue coverage for complex open injuries and percutaneous screw fixation for selected fractures should further improve prognosis.

Adult↗

PubMed2002

[Clinical trial with the distal femoral nail].

METHODS: The clinical results after DFN-osteosynthesis of n = 56 AO-classification 33A-fractures (32%), 33C-fractures (43%), 32X-fractures (21%) and treatment of non-union (4%) are presented. RESULTS: Follow-up was available for 54 fractures (96%) after a mean of 1.2 years (range 0.2-2.8 years). 95% of patients showed full-weight-bearing with a knee flexion of 120 (60-140) degrees. Extension-deficit > 10 degrees was observed in 5.4%. All fractures were consolidated. One soft-tissue infection, one partial loss of reduction and one implant failure were observed. A significant axial malalignment was found radiologically in 17%, a loosened spiralblade or locking screw in 7.4%. In 91% of cases the result was judged as good to excellent by patients. CONCLUSION: The mechanical stability of the implant allows a save osteosynthesis of unstable supracondylar and complete articular femoral fractures without additional bone grafting. Mechanical stability and minimal invasive operative technique permit a safe bone healing without major complications.

Adolescent↗

PubMed2002

[Clinical evaluation of the distal femoral nail].

METHOD: The clinical results after DFN-osteosynthesis of n=56 AO-classification 33A-fractures (32%), 33C-fractures (43%), 32X-fractures (21%) and pseudarthrosis treatment (4%) are presented. RESULTS: Follow up was available for 54 fractures (96%) after a mean of 1.2 years (range 0.2-2.8 years). 95% of patients showed full-weight-bearing with a knee flexion of 120 (60-140) degrees. Extension-deficit >10 degrees was observed in 5.4%. All fractures were consolidated. One soft-tissue infection, one partial loss of reduction and one implant failure were observed. A significant axial malalignment was found radiologically in 17%, a loosened spiralblade or locking screw in 7.4%. In 91% of cases the result was judged as good to excellent by patients and surgeons. CONCLUSION: The mechanical stability of the implant allows a save osteosynthesis of unstable supracondylar and complete articular femoral fractures without additional bone grafting. Mechanical stability and minimal invasive operative technique permit a safe bone healing without major complications.

Adolescent↗

PubMed2002

[Retrograde locking nail osteosynthesis of distal femoral fractures with the distal femoral nail (DFN)].

Non-operative treatment with immobilization or isometric traction has been abandoned as treatment for fractures of the distal femur at the end of the 1960ies. The technique of open reduction and internal fixation with a condylar plate as suggested by the AO has been the golden standard since the 1970ies. However, anatomic reconstruction of the condylar region with interfragmentary screw fixation and axial realignment of the femur shaft with a plate are challenging procedures especially in the presence of severely compromised soft tissues and put periosteal blood supply at risk. Soft tissue complications, axial malalignment and delayed fracture healing times led to the consideration of alternative techniques, such as intramedullary nailing which has been practiced with success since the 1940ies by Gerhard Küntscher and colleagues for femoral shaft fractures with minimal complication rates and improved results after closed reduction. The era of retrograde femoral nailing began with the systematic approach through the intercondylar notch by Green. This paper reviews the biomechanical properties, indication, technique as well as potential hazards and pitfalls of fracture management with the AO "distal femoral nail" (DFN). With appropriate application this technique is suitable for all fractures of the distal third of the femoral shaft including highly instable bicondylar fractures without damage to the soft tissues and the knee joint.

Biomechanical Phenomena↗

PubMed2002

[Intramedullary nail placement with percutaneous Kirschner wires. Illustration of method and clinical examples].

Unreamed nailing is an established method for internal fixation of femoral und tibial shaft fractures. The interlocking technique allows the stabilization of metaphyseal fractures, too, but the risk of malalignment increases. The "palisade method" presented here allows the precise positioning of the nail in the marrow cavity and works as a tool for successful minimally invasive nailing in the meta/epiphyseal region. The method is easy to use and suited particularly in combination with the UFN and UTN, but is in principal applicable to other nails, too. In contrast to the "Poller Screw" method developed by Krettek et al., no biomechanical augmentation of the osteosynthesis remains.

Adult↗

PubMed2002

Healing of Achilles tendon, an experimental study: part 2--Histological, immunohistological and ultrasonographic analysis.

In 105 rabbits the course of healing was examined at one, two, four, eight and 12 weeks (21 rabbits per group) after an experimental Achilles tendon rupture. The following treatment modalities were compared: A) primary functional treatment; B) operative functional treatment (resorbable suture); and C) operative functional treatment with fibrin glue. For the functional (after)-treatment a special orthosis was applied. A 7.5 MHz Ultrasound probe was used for ultrasonographic evaluation. The histological specimens were stained in Masson-Goldner and Azan technique. Collagen Type III was depicted immunhistologically. A semiquantitative fibrocyte count was performed. The histological results showed a smooth healing in the primary functional treatment group (A), reaching parallel orientation of collagen fibers at 12 weeks. In the suture group (B), a secondary gapping of the tendon stumps was detectable after one week as in all other groups. In the fibrin group (C), the fibrin was resorbed after four weeks without essential influence to the course of healing. At 12 weeks the histological evaluation in all groups showed approximately normal tendon pattern. Immunohistochemically, all groups showed cell-associated positive reactions for type-III collagen after one week with a maximum after two weeks. The semiquantitative fibrocyte count in the primary functional group showed a maximal number after one week. In the fibrin glue and suture groups the maximal number could be found after two weeks. Sonographically an increase in tendon thickness was detectable up to the fourth week in all groups. The secondary gapping of the tendon stumps in the suture group could also be detected sonographically. The echogenicity of the tendon during the course of healing showed increasing homogeneity and parallelism in all groups. At 12 weeks the echogenicity was comparable in all groups. The experiment suggests the equivalence of primary functional treatment to a combination of operative and functional therapy in Achilles tendon rupture.

Achilles Tendon↗

PubMed2001

Healing of the Achilles tendon: an experimental study.

Biomechanical properties of healing ruptures in the Achilles tendon of rabbits were examined after two, four, eight and 12 weeks. Treatment modalities were (n7): a) suture, b) fibrin-glue, c) non-surgical treatment. All animals received a functional aftertreatment consisting of a special orthotic support and free ambulation. For biomechanical testing a fixation-technique was applied that guaranteed intratendinous rupture. After two weeks, the tendons treated with fibrin glue showed better results (stiffness, maximum force to rupture, tensile stress to rupture) compared with the non-surgically treated group. The results for sutured tendons were in between those for the other groups. After four weeks, the results for sutured and for glued tendons were nearly equal and slightly better than the tendons in the non-surgical group. Late results revealed comparable biomechanical properties among all treatment groups and control tendons, suggesting our conclusion that non-surgical treatment is equal to repair using sutures or using fibrin glue as measured by stiffness and tensile stress.

Achilles Tendon↗

PubMed2000

[Effect of logistic and medical emergency resources on fatal outcome of severe trauma].

122 cases of patients who died in sequel of an accident (recruitment period 1993/94, mean ISS 40 +/- 19) in reach of air rescue base Dresden, Germany, were examined. Data were assessed from autopsy protocol and the protocol of the physician who treated on scene. We analyzed the time course of the emergency, the scheduled emergency medical service and the quality of prehospital diagnosis and therapy by the emergency team. The mean response time was 8.1 +/- 5.9 min, the mean distance between EMS bases und incident location 5.9 +/- 5.7 km. In 94.4% of all cases a mobile intensive care unit--with an emergency physician as crew member--was on scene, in 5.6% a paramedic car. Air rescue by helicopter, including an emergency physician, was performed only in 8.7% of all cases although a helicopter was available in 54% of all accidents. Mechanisms of injury were traffic accident (71.4%), fall (14.3), 5.9% accident on building site, shot and stab injuries (5.9%) and burns (1.7%). 82 patients reached the emergency room alive (67.2% mean ISS 37 +/- 18). Only 26% of all patients were transported directly to a level I trauma center. Mean survival time of all 122 patients was 146 +/- 30.4 h. Severe head injury described by autopsy protocol was diagnosed on scene in 82%. Preclinical treatment was:intubation and ventilation (63%), O2 insufflation (17.4%), no specific treatment (19.6%). Severe thoracic trauma was diagnosed in 54%. Preclinical treatment was:intubation and ventilation (64.8%), O2 application (18.8%), no specific treatment (16.2%). Severe thoracic trauma with hemato-pneumothorax (n = 26) was recognized by the emergency physician in 65.6%, specific therapy (application of chest drain) was performed in 7.1%. Preclinical diagnosis rates concerning abdominal trauma were 29% and 27.8% in case of unstable pelvis fracture. Hemorrhagic shock related to these injuries was found in 44.2%, mean resuscitation volume applicated in these cases was 960 +/- 610 ml. Typical faults in diagnosis and treatment were underestimating of severe trunk trauma and non-consistent use of invasive treatment procedures. Primary transport of the severely injured patient to a level I trauma center by helicopter was performed only rarely.

Adult↗

PubMed2000

[Fatal aorto-esophageal fistula as a late complication of traumatic aortic rupture].

We report on a case of a 23 years old man who was polytraumatized in a car accident. He survived with excellent clinical outcome, but 113 days after the accident he collapsed, massive bleeding out of the mouth started and the patient died within a few minutes. A gastric ulcer bleeding was assumed, but autopsy showed the break-in of a posttraumatic aortic aneurysm into the esophagus. The difficulties of in time diagnosis of thoracic aorta lesions are discussed.

Adult↗

PubMed2000

[Injuries of the inferior tibiofibular syndesmosis].

The incidence of isolated distal tibiofibular syndesmotic ruptures in acute ankle sprains lies between 1% and 11%. These injuries are frequently overseen or misdiagnosed as anterolateral rotational instability of the ankle and often become apparent through protracted courses. Although the pathomechanics and extent of syndesmotic injuries have been systematically described by Lauge-Hansen and Weber, no generally accepted guidelines exist as to when these complex injuries are to be treated surgically to ensure sufficient and stable healing of the syndesmosis besides correct alignment of the distal fibula. So far, systematic follow-up regarding syndesmotic injuries in ankle fractures is missing, although it has long been recognized that tibiofibular diastasis secondary to chronic syndesmotic instability leads to external rotation of the talus. In combination with a valgus position of the talus, this instability leads to a decrease in the contact area which results in posttraumatic arthritic changes. This paper reviews the standard diagnostic and therapeutic procedures for acute syndesmotic ruptures in fracture dislocations of the ankle. Among the few corrective procedures advocated for chronic syndesmotic insufficiency are tibiofibular arthrodesis, synthetic ligament substitutes, and tenodesis with the peroneus brevis tendon. A sufficient reconstruction must restore the stability of the ankle mortise and alignment of the fibula in the tibiofibular incisura to ensure limitation of talar rotation. Therefore, a tenodesis was developed which substitutes the three important ligaments of the syndesmotic complex. The Casting procedure for chronic syndesmotic insufficiency was modified with reconstruction of the interosseous tibiofibular ligament in addition to the anterior and posterior tibiofibular ligaments. The resulting three-point fixation of the distal fibula appears more anatomically, physiologically, and biomechanically advantageous. The operative procedure is given in detail. Distal tibiofibular syndesmosis. Persistent instability of the distal syndesmosis. Ankle fractures. Syndesmotic screw.

Ankle Injuries↗

PubMed1999

[Functional treatment of acute Achilles tendon rupture. A histological, immunohistological and ultrasonographic analysis of the animal model].

In 105 rabbits the course of healing was examined at 1, 2, 4, 8 and 12 weeks (21 rabbits per group) after an experimental Achilles tendon rupture. The following treatment modalities were compared: a. operative functional treatment (resorbable suture, Kleinert technique) b. operative functional treatment with fibrin glue c. primary functional treatment. For the functional (after)-treatment a special orthosis was applied. A 7.5 MHz Ultrasound probe was used for the ultrasonographic evaluation. The histological specimens were stained after Masson-Goldner with Azan. Collagen Type III was depicted immunohistologically with polyclonal antibodies. A semiquantitative fibrocytes count was performed. The histological results showed a smooth healing in the prim. functional treatment group reaching parallel orientation of collagen fibers at 12 weeks. In the fibrin glue-group the fibrin was resorbed after 4 weeks without essential influence to the course of healing. In the suture-group a secondary gapping of the tendon stumps was detectable. At 12 weeks the histological evaluation in all groups showed approximately normal tendon pattern. Immunohistochemically all groups showed cell-associated positive reactions for type III-collagen after 1 week with a maximum after 2 weeks. The semiquantitative fibrocyte count in the primary funct. group showed a maximal number after 1 week, in the fibrin glue- and suture-groups the maximal number could be found after 2 weeks. Sonographically an increase in tendon thickness was detectable up to the 4th weeks in all groups. The secondary gapping of the tendon stumps in the suture group could be detected sonographically. The echogenicity of the tendon during the course of healing showed increasing homogeneity and parallelism in all groups. At 12 weeks the echogenicity was comparable in all groups. The experiment could prove the equivalence of the primary functional treatment to operative therapy in Achilles tendon rupture.

Achilles Tendon↗