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Biomedical subjects

A Ekkernkamp

Publications and source records attributed to A Ekkernkamp.

At least 55 records · Page 3Linked to original sources
PubMed2001

[Knee joint endoprosthesis].

Total knee replacement is increasing in number due to increased life expectancy and improved implants. [figure: see text] Degenerative changes (arthritis) and joint destruction based on polyarthritis and posttraumatic deformities are the common indications. There are basically four modes for knee replacement: Unicompartimental prosthesis, non-constrained, semi-constrained (posterior stabilized) and constrained total knee arthroplasty. Of major importance in knee alloarthoplasty are restitution of the correct limb axis, sufficient lateral ligaments and the restoration of the patellofemoral joint. Therefore particularly in cases with deformities an extensive soft tissue release is mandatory. A meticulous operative technique and versatile implants lead to good clinical outcome. Possible complications are still septic and aseptic implant loosening as well as wound infections.

Arthroplasty, Replacement, Knee↗
PubMed2001

[Shoulder joint endoprosthesis in the treatment of multiple fractures of the humeral head. Development and value].

Fractures of the humeral head are still challenging to decisions of indications, surgical skills and physiotherapy. 3- and 4-part-fractures of the humeral head in younger adults are still dominated by reconstructive osteosynthesis. New developments in osteosynthesis materials allow the surgeon to make use of minimal invasive techniques more often. Treatment of elderly patients with these injuries has changed within the last years. When it is obvious that the goal of a stable osteosynthesis can not be reached, shoulder prosthesis has become a primary treatment in elderly patients. New designs in shoulder prosthesis seem to lead to better functional results.

Aged↗
PubMed2001

[The infected endoprosthesis with the example of the hip joint endoprosthesis. An increasing danger to patient and society].

Because of demographic factors there is an increase in the numbers of total joint replacement operations each year. Deep infection after joint replacement remains one of the major complications in orthopedic surgery. The economic consequences for society are enormous. The treatment of such infections usually means a long and difficult course for the patient. In most cases multiple operations, including removal or exchange of the prosthesis are required. Concepts of treatment are very different and vary from debridement and keeping the prosthesis, resection arthroplasty to one- and second-stage exchange procedures. It is essential to know the special advantages and disadvantages of each concept to be able to choose the right strategy of treatment. Even getting the right diagnosis may be difficult since only about 2/3 of all cases go along with a positive microbiology. By the example of the infected hip prosthesis, the aim of the article is to give recommendations on the bases of current literature and our own experience. The strategy of treatment of infections used in our hospital is reported.

Arthroplasty, Replacement, Hip↗
PubMed2001

[Emergency diagnosis and emergency care in trauma resuscitation].

Adequate primary and preclinical evaluation of thoracic trauma is the basic for effective therapy. The first intention must be to understand the mechanism of trauma and injury. Severe thoracic trauma is predominantly the result of high energy trauma and mostly combined to multiple injuries (polytrauma). The intention of emergency care medicine is to reduce the number of lethal complications due to trauma. Early intubation and ventilation in preclinical management is accepted as a gold standard. Nevertheless, there is a high percentage of nonintubated and undertreated polytraumatised patients that reach the clinic. To investigate the reason for and problems of undertreatment we have to initiate basic research in accident and polytrauma research.

Adult↗
PubMed2000

[Benign tenosynovial giant cell tumor in the region of the upper ankle joint. A rare differential diagnosis of a soft tissue tumor of the foot].

The giant cell synovioma is a benign neoplasia classically located in the fingers. It mostly rises from tendon sheaths, sometimes from the synovia. Other locations than the fingers are rare. Making a differential diagnosis to lipomas, gangliomas or even malignant soft tissue tumors can be very difficult especially in rare locations. We report the case of a 21 years old man suffering from a giant cell synovioma in the area of the right ankle joint. The clinical, radiological and patho-morphological findings are documented. The tumor was excised totally, other foci were not found. The problems of making the right diagnosis are described.

Adult↗
PubMed2000

[Rotational dislocation of the cervical spine].

Unilateral cervical dislocations are less common and have fewer accompanying neurological complications than bilateral. A case of unilateral rotational dislocated facet has been described. Postoperatively, all deficts were improved. According to the literature, the diagnosis of this entity is often missed and the treatment is controversial.

Cervical Vertebrae↗
PubMed2000

[TQM--demands and reality--what's going on? Or quality and the elephant].

Healthcare is undergoing fundamental changes. New diagnostic and therapeutic techniques, the Internet, information technology and a new generation of purchasers and providers will face a proactive consumer's culture. The key to success for those managing healthcare facilities is the ability to perceive future trends and integrate them into quality management strategies. The aim of those strategies is to create quality management as a controlling and navigation tool in a "New-Economy-based" healthcare system where speed and connectivity are the new values.

Delivery of Health Care↗
PubMed2000

[Evaluation of the tracer diagnosis "femoral neck fracture". A report of 5 years external quality assurance].

A report card system for fractures of the femur neck has been established at the department of external quality assurance of the chamber of physicians of Westphalia-Lippe since 1993. Since then several indicators of good quality have significantly changed: conservative treatment decreased from 6.8% 1993 to 4.2% in 1997, lethality decreased from 6.9% to 5.4%, average length of stay before operation decreased from 2.6 to 2.1 days, the frequency of operations on weekends increased, complications in wound healing increased from 4.9 to 6.0%, cardiopulmonary complications decreased from 11.2% to 7.8%. Between 1993 to 1997 54.3% could be dismissed to their homes; the percentage of patients being sent to rehabilitation facilities after acute care rose from 8.3% in 1993 to 20.1% in 1997. Operative treatment was performed in more than 90% of all fractures in all counties of Westphalia-Lippe. However, there was a wide and significant geographical variation in the choice between osteosyntheses and hip replacement: the percentage of hip replacement differed between 57% and 82% among different counties.

Aged↗
PubMed1999

[Fracture of femoral neck: analysis of the results of external quality assurance. A report on 22,556 patients].

Since 1993 a report card system for fractures of the neck of the femur has been established in the Department of External Quality Assurance of the Chamber of Physicians of Westphalia-Lippe. Several indicators of good quality have changed significantly since then: conservative treatment decreased from 6.8 % in 1993 to 4.2 % in 1997, lethality decreased from 6.9 % to 5.4 %, average length of stay decreased from 30.9 days to 24.9 days, average length of stay before operation decreased from 2.6 to 2.1 days, the frequency of operations on weekends increased, complications in wound healing increased from 4.9 to 6.0 %, and cardiopulmonary complications decreased from 11.2 % to 7.8 %. Between 1993 and 1997, 54.3 % were dismissed to go home; the percentage of patients sent to rehabilitation facilities after acute care rose from 8.3 % in 1993 to 20.1 % in 1997. The most frequent and still increasing procedure was implantation of hemiprosthesis/bipolar prosthesis (from 38.8 % in 1993 to 41.0 % in 1997) followed by total hip replacement (decreasing from 37.4 % in 1993 to 34.2 % in 1997). Operative treatment was performed in more than 90 % of all fractures in all counties of Westphalia-Lippe. However, there was a wide and significant geographical variation in the choice between osteosynthesis and hip replacement: the percentage of hip replacements differed between 57 % and 82 % among different counties. Average length of stay before the operative procedure for patients undergoing reduction and rigid internal fixation of the fracture is still too long (1.6 days in 1997).

Aged↗
PubMed1999

[Pediatric forearm fractures: indications, technique, and limits of conservative management].

Although several "minimal invasive" techniques for the operative management of pediatric forearm fractures have been developed recently, conservative treatment still remains the option with the lowest risk for small patients. We present the results of our clinical and radiological follow-up after an average of 52.4 months (4-112) in 102 pediatric patients. All fractures were treated conservatively. There were 68 fractures (66.7 %) of the distal third of the forearm, 30 fractures (29.4 %) of the midshaft area, and four fractures (3.9 %) in the proximal third of the shaft. Greenstick fractures were seen in 58 cases (56.8 %), complete fractures with displacement of both corticalices in 26 patients (25.5 %), and folding fractures in 18 cases (17.7 %). With the exception of one fracture with the necessity of remanipulation after redisplacement in the cast, all fractures healed uneventfully without any further intervention. Functional results were excellent with a free range of motion of the wrist and elbow and without any signs of muscular atrophy in 96 children (94.1 %) at the time of follow-up. Six patients, however, showed a significant loss of forearm rotation of an average of 25 degrees (15 degrees -50 degrees ). In four of these six patients, the fracture had been situated in the proximal and midshaft area. Thus, two out of four fractures of the proximal forearm (50.0 %) showed a poor functional outcome. On the basis of our data we recommend conservative management for (closed) pediatric fractures of the distal and midshaft area. Operative treatment is indicated in forearm fractures close to the elbow.

Adolescent↗
PubMed1999

Ipsilateral fractures of the pelvis and the femur--floating hip? A retrospective analysis of 42 cases.

A consecutive series of 40 patients, who sustained 42 ipsilateral pelvic and femoral fractures, is reported. There were eight (26.6%) traumatic neurological deficits and three open femoral fractures. Two multiply injured patients died in the postraumatic period because of the severity of their injuries. No associated vascular injuries could be identified. All but two fractures of the femur, 8 of the 15 fractures of the pelvic ring and 17 of the 30 fractures of the acetabulum were treated by internal fixation. In 26 patients internal fixation was performed on both fracture components (in 17 patients this was done under the same period of anaesthesia). Postoperatively, a deep venous thrombosis in three patients, one deep wound infection and five (18.5%) iatrogenic neurological deficits had to be notified. In this series we could not identify any specific associated injuries and complications as known for the floating knee or the floating elbow. The term floating hip is inprecise and misleading, and its use is not recommended. The treatment of this fracture-combination follows the guidelines established for the individual lesions.

Acetabulum↗
PubMed1999

Arthrodesis of the infected ankle and subtalar joint: technique, indications, and results of 45 consecutive cases.

OBJECTIVE: To analyze the results of 45 patients after ankle arthrodesis in the presence of joint infection. METHODS: Arthrodesis was performed with two compression screws and an anterior plate in 29 patients and with two compression screws only in 16 patients. In all patients, additional stabilization with external fixation was used. In 29 patients, isolated fusion of the ankle joint was performed; in 13 patients, the ankle and subtalar joints were fused, and in 3 patients, isolated arthrodesis of the subtalar joint was performed. RESULTS: In 39 of 45 patients (86.6%), solid fusion was obtained. Nonunions occurred in 6 patients (13.4%). A below-knee amputation was necessary for one patient. Full weight-bearing was achieved after 21.6 weeks on average. Thirty-two patients returned to work after 35.5 weeks on average. Five of the six patients with failed ankle fusion needed special shoes; in one patient, a below-knee amputation was performed. A total of 33.3% of failed ankle fusions were associated with systemic disorders such as diabetes mellitus, and other concomitant diseases compromising local arterial blood supply and proprioception. CONCLUSION: Our results prove that limb salvage is possible even in complex ankle and subtalar pathology by thorough fusion by using a number of different techniques.

Adult↗
PubMed1999

[Minimally invasive therapeutic concepts in fracture surgery].

Recent publications show a clear tendency towards minimally invasive procedures for fracture care in trauma patients. Intramedullary stabilization has become the first choice in reconstructing axis and length of the diaphyseal fractures of the long bones. Indications for intramedullary nailing have become wider with the development of unreamed or retrograde nailing. Essential modifications of plate osteosynthesis from limited contact implants to percutaneous plating and the development of an internal fixator have made this procedure minimally-invasive as well. Techniques of closed reduction and percutaneous osteosynthesis or arthroscopically-assisted procedures have become more important in the stabilization of metaphyseal fractures. Although long term results of some of the mentioned procedures are unknown by now, minimally-invasive techniques appear to have positive influence on functional outcome in most patients. However problems of intraoperative control of axis and rotation in long-bone fractures as well as the surgeon's high exposure to radiation remain unsolved problems in minimally-invasive traumatology.

Bone Nails↗
PubMed1998

[Ankle para-articular tibial fracture. Is osteosynthesis with the unreamed intramedullary nail adequate?].

In a prospective study, 53 fractures of the distal fifth of the tibia were stabilized by unreamed nailing. Additional involvement of the ankle joint occurred in 18 patients. 50 patients returned for follow-up. In 30 patients tibia and fibula were fractured at the same (distal) level; in 20 patients the fracture of the fibula was located more proximally. In 12 patients the fractures extended into the tibial pilon. Severe soft tissue damage was seen in 24 fractures (18 open, 6 closed). Ninety percent of all fractures healed uneventfully without further surgical intervention after unreamed nailing. In two patients the unreamed nail had to be exchanged for a reamed tibial nail. Bone grafting and secondary dynamization of the nail by removal of a proximal interlocking bolt were performed in one case each. Thirty-one fractures healed in anatomical position. Valgus or varsus angulation of less than 5 degrees occurred in 18 patients. One fracture healed with rotatory angulation of 15 degrees. The highest rate of complications (22%) was seen in patients with distal fractures of the fibula without additional plating (of the fibula). There was no deep infection. Tibial fractures close to the ankle joint can be managed by unreamed nailing. Distal fractures of the fibula should be stabilized by additional plating. Because of the unreamed technique of implantation this procedure can also be used in grade II or III open fractures.

Adult↗
PubMed1998

[Os odontoideum. Etiology, clinical aspects, therapy].

The etiology of os odontoideum is still controversial. In most patients, it is found by accident because of neurological symptoms and/or painful range of motion of the cervical spine. Upon recognition of the os odontoideum, it is unknown whether or not immediate surgery is beneficial. This is in contrast to an "unstable" os odontoideum, which could result in atlantoaxial instability or compression of the myelon. In this study, we present the results of our treatment of four patients with an unstable os odontoideum. In all four cases, a C1-2 fusion was performed (3 x Magerl/Seemann, 1 GallieBrooks). Postoperatively, we found a complete regression of neurological symptoms in three patients and one was significantly improved. The range of motion of the cervical spine was free of pain in all patients. As a result, we strongly support immediate surgical treatment of an unstable os odontoideum in order to prevent severe and life-threatening neurological complications.

Adult↗