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Biomedical subjects

A Ekkernkamp

Publications and source records attributed to A Ekkernkamp.

At least 73 records · Page 4Linked to original sources
PubMed1998

The motorcyclist: easy rider or easy victim? An analysis of motorcycle accidents in Germany.

This report reviews the findings from 86 motorcycle accidents during a 1-year period at the Trauma Center "Bergmannsheil" in Bochum, Germany. A study of the case histories supplemented by telephone conversations yielded the following results: 90.7% of the patients were men, and the average age was 28.8 years; most of the accidents occurred in the 25- to 30-year-old age group (27.9%). Motorcycle accidents happened mostly during recreational rides on weekends in the summertime. Although there was a high rate of helmet use (98.8%), the head region was affected in 12 victims. Two patients died because of their severe head injuries (2.3%). Lower extremity injuries (46%), especially open tibia fractures (19.7%), were among the most common injuries sustained. Fractures of the distal radius constituted the largest portion of upper extremity injuries (18.8%). The average stay in our hospital was 35.4 days; 23.4% of the patients had to change jobs after the accident. Fifty percent of the crashes happened with motorcycles between 500 and 750 cc stroke volume. Although 34.5% possessed their driver's licenses for more than 8 years, they had not had much experience handling a motorbike. These results underline the fact that motorcycle accidents are sustained by young men in their working prime; as a result, these accidents pose a tremendous burden to individuals and society and every attempt should be made to offer highly qualified surgical and trauma care to minimize the damage to the motorbiker. A plea is made for more prevention measures like driver education, better road conditions, or legislative changes to prevent motorcycle crashes. The wearing of a helmet is strongly advocated.

Accidents, Traffic↗
PubMed1998

[Elastic intramedullary nailing--a concept for treatment of unstable forearm fracture in childhood].

The standard treatment in forearm fractures of children is usually conservative. Unstable fractures of the proximal parts of the forearm often show poor results after nonoperative management, requiring surgical intervention. We report on 30 children from 4 to 14 years of age who were treated by elastic intramedullary nailing. Sixteen patients were treated by intramedullary pinning immediately after the accident; 14 required intramedullary nailing after failure of the conservative treatment and fracture redislocations. At the time of follow-up 6 months later, functional results were "excellent" in 24 children, "good" in 5 and "fair" in one child. There were no serious complications apart from the occurrence of one delayed union. According to these results intramedullary nailing can be recommended for the treatment of unstable fractures of the proximal and middle parts of the forearm in children.

Adolescent↗
PubMed1997

[Monocondylar fractures of the femur. Therapeutic strategy and clinical outcome].

Twenty-nine unicondylar fractures of the distal femur were treated at the Trauma Center "Bergmannsheil", University of Bochum, Germany, between 1981 and 1994. All patients sustained their injuries from severe direct trauma. There were 16 lateral condylar fractures, 7 medial condylar fractures and 6 tangential posterior ("Hoffa-type") fractures. Twenty-eight closed injuries and 1 grade IIIB open fracture injuries to the skeleton. All fractures were treated with open reduction and internal fixation with screws within 8 h of admission. Postoperative management consisted of early continuous passive motion and minimal weight-bearing for 6-8 weeks, progressing to full weight-bearing. The mean follow-up was 68 months (18-120). The therapeutic outcome (clinical result, radiographs) was rated by the Neer score. Twenty-seven patients were available for follow-up examination. Of these, 23 were rated as excellent. 3 achieved satisfactory results, and 1 had an unsatisfactory result. All patients who did not achieve an excellent outcome had had accompanying injuries. Open reduction and internal screw fixation of unicondylar femur fractures provided overall excellent long-term results. The therapeutic outcome was significantly affected by associated injuries of the skeleton.

Adolescent↗
PubMed1997

[The epidemiology of multiple trauma].

Trauma is the leading cause of death for people up to 40 years of age in Germany. Most of the patients were injured in traffic accidents where special injury patterns could be detected: head injuries in bicycle and pedestrian accidents, lower extremity injuries in motorcycle accidents, and chest and pelvis injuries in car accidents. After falls from a height, the most common injuries were fractures of the thoracic and lumbar spine. The treatment of polytrauma patients requires high health care resources and demands sophisticated medical support. It is estimated that every trauma patient costs daily approximately DM 4,700. It is not only the acute medical care that burdens our social system, but also the long period of rehabilitation and reintegration. The number of preventable trauma deaths can be significantly reduced in special trauma centers, and the high costs could be damaging for smaller hospitals. A plea is made for more preventive measures and legislative changes to reduce the number of traffic accidents. The medical care of trauma patients should be in special trauma centers.

Accidental Falls↗
PubMed1997

[Motorcycle accidents in street traffic. An analysis of 86 cases].

A retrospective study of 86 motorcycle accidents that occurred in the year 1992 is reported. Examination of the case histories supplemented by telephone conversations yielded the following results: 90.7% of our patients were male and their average age was 28.8 years; the age group between 25 and 30 years was the most frequently involved (27.9%). Most motorcycle accidents happened during weekend trips out in the summertime. Special injury patterns were found for injuries of the upper and the lower extremity. Lower extremity injuries (46%), and especially open tibia fractures (19.7%), were among the most common injuries sustained by motorcyclists in crashes. Injuries of the upper extremity most frequently took the form of fracture of the distal radius (18.8%). The average stay in our hospital was 35.4 days. In 23.4% of cases the patients had to change their job after the accident. More than half the crashes happened with motorcycles with between 500 and 750 cc stroke volume. Over a third (34.5%) of the patients had held their driving licences for more than 8 years. A plea is made for more preventive measures, such as better driving instruction, better road conditions and legislative changes, against motorcycle crashes. From the aspects of cost and the rate of complications it is reasonable to strive for a surgical treatment as soon as possible after the crash.

Accidents, Traffic↗
PubMed1997

[Sports and work capacity after stabilization of recurrent shoulder joint dislocations].

Eighty-one patients (83 shoulder joints) underwent surgical procedures for recurrent shoulder joint dislocations. All patients had an extra-articular osteotomy with subcapital derotation according to Weber's technique. In all, 46% of the patients underwent additional intra-articular reconstructions. After a mean follow-up of 4.6 years, redislocations (6%) were observed only when a singular derotation technique had been used. Complications were minor (2.4%). External rotation of the operated shoulder joints was normal in most patients with a mean of 48.5 degrees. Improvement in sporting activities was seen in 80% and in working activities in 70%. The mean Constantscore was 89.2. Subacromial pain was rare and correlated with reduced scores in functional strain tests postoperatively. There was no postoperative arthritis owing to the derotation technique. Because of unrestricted rotation and early functional therapy, we observed a good indication for an additional derotation technique when a Hill-Sachs defect is evident.

Adolescent↗
PubMed1997

[Missed diagnosis in delayed recognition of bilateral simultaneous rupture of the quadriceps tendons].

In this article we report a very rare case of simultaneous and bilateral rupture of the quadriceps tendon in a 38-year-old patient. The initial diagnosis was "herniated vertebral disk". Although there was an extensive neurological and psychiatric examination in combination with several operations, it took almost 3 months until the real reason was found. In this case report we describe our postoperative treatment of early mobilization and compare it with other therapies.

Adult↗
PubMed1997

[Ossovenography as a diagnostic criterion of post-traumatic femoral head necrosis in internal fixation devices].

Despite advances in the field of orthopedic surgery, necrosis of the femoral head still remains a serious problem. Under normal conditions magnetic resonance tomography (MRT) is the gold standard for early diagnosis. Because of magnetic interference, this technique is not applicable in the diagnosis of posttraumatic necrosis with internal fixation, however. This seems to be an ideal indication for ossovenography: contrast medium is injected into the femoral head under X-ray control and the venous flow is documented. Furthermore, it is possible to get histological samples from suspicious areas. Ossovenography was performed in 12 patients and the results were compared with histological samples. In every patient in whom necrosis of the femoral head was diagnosed by ossovenography (91.6%), we also found necrosis on histological examination. In one patient in whom physiological flow was found, there was a corresponding absence of necrosis in the histological sample. There were no complications during ossovenography. The results suggest that ossovenography is a promising and reliable method for early diagnosis of necrosis of the femoral head in the presence of internal fixation devices.

Adult↗
PubMed1997

[Quality assurance of inpatient care--exemplified by surgery].

Internal quality assurance is natural for hospital physicians. External quality control is undertaken in cooperation with medical societies and sponsors-partly on voluntary basis. Despite considerable efforts in optimizing treatment procedures by classification of injuries and tumor stages, algorithms and tightly scheduled practical medical training, further control mechanisms are demanded; the economic drive is evident. In parallel to the introduction of quality control for services with a case-based flat rate, an interstructural result quality is desired. Hospital certification procedures are no longer utopian. The physician's duty for continuing medical education, which is set down in the professional code, has to be proven. The development of guidelines by scientific societies may help but is in need of a corrective. The medical chambers may play a particular role in this connection. Even if mechanisms of quality assurance differ, it is in the patient's interest that there must be no difference between ambulant and hospital care.

Cost Control↗
PubMed1997

[Guidelines in surgery: from the viewpoint of quality assurance].

The German Society for Surgery takes the AWMF's instructions to create effective guidelines very seriously. International criteria for guidelines are fully accepted, for example, the guidelines for thrombosis prophylaxis. The guide plays a very important part in overall quality management, but it cannot replace further precautions like risk management, second opinions, or external quality control. Despite forensic problems, patients are definitely entitled to diagnostic and therapeutic guidelines.

Forecasting↗
PubMed1997

[Education, postgraduate and continuing education in surgery--data for quality control].

Despite intensive educational training during medical school, there is hardly any occupational group like physicians that tries to keep further education on a very high level. However, under the aspect of quality control, there is a need for different certificates. The education itself needs quality control; the laying down of rules as a rational basis is to advance, but facts that deal with quality control are not easy to find. The analysis of the committee of education of the Ruhr University Bochum must be considered as ideal; the results have to be transferred. Objective medical care results and patient satisfaction are influenced by many factors.

Clinical Competence↗
PubMed1997

[Distal tibial fracture--an indication for osteosynthesis with the unreamed intramedullary nail?].

In a prospective study, 50 fractures of the distal fifth of the tibia with additional involvement of the ankle joint in 18 patients were stabilized by unreamed nailing. In all, 90% of all fractures healed uneventfully without further surgical intervention after unreamed nailing, the highest ratio of complications (22%) being seen in all patients with distal fractures of the fibula without additional plating (of the fibula). Tibial fractures close to the ankle joint can be managed by unreamed nailing; distal fractures of the fibula should be additionally stabilized by fibular plating.

Adult↗
PubMed1996

[Retrograde interlocking nailing of distal femoral fractures with the intramedullary supracondylar nail].

Between June 1993 and September 1995, 18 distal femoral fractures were treated using the supracondylar intramedullary nail. There were 8 type A fractures and 10 type C fractures (AO classification). The operative technique involved retrograde insertion of an unreamed supracondylar nail through the intercondylar notch. Follow-up was available on all patients and averaged 18.3 months (range 6-32 months). All fractures healed with an average time to union of 12.4 weeks (range 8-16 weeks). Bone grafting was not necessary in any case. Sixteen patients achieved almost the same ROM as they had had before the injury. One patient developed a varus malignant and underwent correction with a supracondylar osteotomy 20 months post trauma. There were no infections or nonunions. The retrograde supracondylar nail is an excellent alternative to plate osteosynthesis in the management of dia- and supracondylar femoral fractures.

Adult↗
PubMed1996

[Ultrasound follow-up of callus distraction of the tibia. Technique, possibilities and limits].

In a prospective study 20 patients were monitored with serial sonograms and radiographs during distraction osteogenesis at the lower limb. All sonograms were obtained in four planes using a 7.5 MHz transducer. The distraction gap was seen as a sonolucent area in all patients after corticotomy. At an average of 20.7 (14-28) days after the beginning of the distraction, echogenic foci occurred and showed increasing longitudinal alignment with further distraction. Radiographical signs of beginning mineralization were seen an average of 48.3 days after the start of the distraction. Exact measurement of the distraction gap was possible in all patients during lengthening. Bone healing complications and hematoma could be detected by ultrasound. A rapid increase of bone mineralization was seen after the distraction was stopped. With increasing cortication of the regenerate bone, sonograms showed a hyper-reflecting solid line so that further mineralization and the time of removal of the fixator could not be assessed by ultrasound. Ultrasound is more sensitive than radiography in identifying new bone formation during distraction, measuring the length of the distraction gap, and detecting early bone-healing complications and can therefore reduce the need for radiographs.

Adult↗
PubMed1996

[Infected pseudarthrosis].

Sequestrectomy, fragment fixation, wound treatment and bone grafting are the old principles of infected non union surgery. Today these principles are the frame, which contents a more aggressive treatment. Sequestrectomy is a radical excision of the complete infected bone-soft-tissue-scar, the resulting defects are covered by one of the various techniques (skin-traction, flap surgery, bone shifting, etc.). Out of 71 infected non unions, treated by radical resection and bone segment transport, healing rate without recurrence of infection was 94%, in 3 additional patients (4%) amputation was performed. For bone fragment fixation, a non devastating implant, like external fixateur, is preferred. To close the wound, the law of avoiding a dead space is used. Defects are closed by muscle flaps, by fragment shortening or by a antibiotic spacer temporarily. The skin is closed by skin-traction techniques or with flap surgery. After soft tissue healing, small bone defects are filled by autografts, defects of more than 3-4 cm with transported segments. Previous limb shortening to close bone defects, with a lengthening later in a "healthy" region, is also possible. Local antibiotic wound treatment cases a significant reduction of the contamination rate, improved dressing techniques support wound healing free of infection. This therapeutic techniques are comparable to open fracture treatment, where by similar surgery a very low infection rate can be achieved.

Amputation, Surgical↗
PubMed1996

Vertical deceleration injuries: a comparative study of the injury patterns of 101 patients after accidental and intentional high falls.

We analysed the pattern of injury of 101 adult patients who were treated in our Trauma Center after a fall from an average height of 7.2 m between 1987 and 1990. In 62 patients the fall was accidental, and 39 jumped with suicidal intent. The most common injuries were fractures of the thoracic and lumbar spine (83.0 per cent) especially of the thoracolumbar junction. The pattern of limb injuries is towards a significant preference of the metaphyseal and epiphyseal parts of the bones of the distal joints (wrist, elbow, ankle, subtalar). Fractures of the diaphyseal areas and the proximal joints (shoulder, humerus, hip, femur) were rare. The incidence of thoracic (20.8 per cent) and pelvic injuries (30.0 per cent) was relatively lower. Blunt abdominal injury (5.9 per cent) was rare after a fall from a great height. Head injuries occurred in only 27 per cent of our patients who all survived their transport to hospital. There is no significant difference in injury patterns between deliberate and accidental falls, but there is a higher number of isolated injuries in all patients after unsuccessful suicidal jumps.

Accidental Falls↗