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Biomedical subjects

A Ekkernkamp

Publications and source records attributed to A Ekkernkamp.

At least 91 records · Page 5Linked to original sources
PubMed1996

Surgical correction of talipes equinovarus following foot and leg compartment syndrome.

Between 1984 and 1994, 40 patients with a posttraumatic compartment syndrome of the lower leg and foot were treated for talipes equinovarus adductus foot deformity, which subsequently developed. Twenty patients had a wedge osteotomy followed by arthrodesis of the midtarsal joint (Chopart joint). Another 17 patients had an arthrodesis of the midtarasal and subtalar joints. In the remaining three patients, in addition to arthrodesis, lengthening of the tendons of the long flexors and the Achilles tendon was performed. Complications included wound infections (six cases), drill hole infections (three cases), chronic osteomyelitis (one case), and an ankle joint infection (one case). The clinical result was assessed as good in 37.5%, fair in 52.5%, and poor in 10% of the patients. Before the operation, 37 patients required modified footwear. After the operation, only eight patients needed them. Wedge osteotomy of the midtarsal and subtalar joints followed by an arthrodesis is an advantageous treatment modality for the correction of severe postischemic equinovarus adductus foot deformities. In our study, patient satisfaction was high. While complications frequently occur, it is not extraordinary considering the salvage nature of the procedure.

Achilles Tendon↗
PubMed1996

Classification of articular cartilage lesions of the knee at arthroscopy.

Classification systems for articular cartilage lesions in the knee have been based primarily on the appearance and severity of damage to the articular cartilage. Each of these systems has deficiencies in the documentation of articular cartilage abnormalities. This article proposes a new classification system for articular cartilage lesions in the knee. This system incorporates multiple parameters such as appearance, depth of involvement, area, clinical stage, and location of the lesion. A four-sector-mapping system allowing precise documentation of the location of articular cartilage lesions in the femorotibial joint is proposed. One numerical category is used to assess severity of a chondral defect. The use of these categories allows the surgeon to accurately grade and locate damage to the articular cartilage and its relationship to other concomitant intra-articular abnormalities. The proposed classification system has proven advantageous in communicating complex findings.

Arthroscopy↗
PubMed1996

[Quality assurance in trauma surgery--meaning, characteristics and methods].

For trauma surgeons the compliance with and keeping to well organized and planned courses of action is obligatory. This is valid as well for the highly sensitive areas of preclinical emergency treatment, the primary treatment in the hospital and the exceptional management in polytrauma, as for treatment of solitary injuries of the musculo-skeletal system. Despite considerable activities--so far voluntarily--(optimization of courses of action, classification systems for injury grades, algorithms and close-meshed further education) control mechanisms are demanded by politicians and insurance companies. Therefore, comprehensive quality control is strived for in all different types of insurance coverage systems. In spite of justifiable restraints against control mechanisms, which oppose increasingly medical freedom in diagnostics and treatment, only cooperation with and proficient guidance of the often self-appointed quality assurance personnel is useful.

Algorithms↗
PubMed1996

[Ultrasound follow-up of callus distraction--an alternative to roentgen diagnosis?].

In a prospective study 20 patients were regularly monitored with sonograms in four planes and radiographs during distraction osteogenesis of the lower limb. Ultrasonography is more sensitive than radiography in identifying new bone formations during distraction, in measuring the length of the distraction gap, and in detecting early bone healing complications, and can therefore reduce the need for radiographs. Radiographs are necessary to assess the time of fixator removal and the axis of the leg.

Bone Lengthening↗
PubMed1995

Prehospital resuscitation--outcome in an urban area.

All prehospital resuscitations performed by emergency physicians in the city of Bochum, Germany, were recorded and evaluated prospectively from 1 August 1989 to 30 September 1990. Initially successful cardiopulmonary resuscitation (CPR) was achieved in 33.8% (alive at admission), and definitive success in 10.4% (discharged alive). Of the patients who presented with cardiac arrest before the arrival of the emergency physician, 28.4% could be resuscitated initially and 7.6% survived definitively. In patients who suffered circulatory arrest on or after the arrival of the emergency physician, the initial success rate of CPR was 51.7%, and the definitive success rate 11.1%. Although the initial success rate was significantly more favourable, the definitive outcome did not differ statistically between these two groups. Two time periods were compared. During the first period of 5 months only one base with two ambulances staffed with emergency physicians was available. During the second period of 9 months an additional base with a physician-staffed ambulance was established. This reorganization resulted in the reduced call to arrival time falling from 8.5 +/- 2.4 min to 7.6 +/- 2.4 min (univariate variance analysis: f = 8.89, d.f. = 1.31, p < 0.01). This decrease, however did not improve either the initial or the definitive success of CPR. From these results we conclude that further improvement of prehospital resuscitation can only be achieved to a small extent by reducing the call to arrival time of ambulances staffed with emergency physicians. Improvement is more likely to be seen when immediate resuscitation is performed by bystanders present at the scene.

Adolescent↗
PubMed1995

Periacetabular and intertrochanteric osteotomy for the treatment of osteoarthrosis in dysplastic hips.

The results of periacetabular osteotomy, with and without intertrochanteric osteotomy, performed between January 1984 and December 1990, were reviewed for forty-two patients who had osteoarthrosis in a congenitally dysplastic hip. There were eight male and thirty-four female patients. The average age of the patients at the time of the operation was thirty-seven years (range, eleven to fifty-six years). Ten patients had combined periacetabular and intertrochanteric osteotomies. The preoperative severity of the osteoarthrosis, according to the criteria of Tönnis, was grade 1 in fifteen patients, grade 2 in eighteen, and grade 3 in nine. The average duration of follow-up was four years (range, two to eight years). Complications included heterotopic ossification in fourteen patients (33 per cent), non-union of the pubic osteotomy in two patients (5 per cent), and pain related to the hardware that led to its removal in nine patients (21 per cent). There were no major neurovascular complications. One patient had dysesthesias in the area supplied by the lateral femoral cutaneous nerve. Six patients had a subsequent total hip arthroplasty and three patients had an additional intertrochanteric osteotomy. five of the nine patients who had a second major operation had had grade-3 osteoarthrosis before the periacetabular osteotomy. The Harris hip score improved from an average of 62 points (range, 33 to 95 points) preoperatively to an average of 86 points (range, 29 to 100 points) postoperatively (p < 0.0001, paired t test). The result was excellent or good for thirty-two of the thirty-three patients who had had grade-1 or 2 osteoarthrosis. Eight of the nine patients who had had grade-3 osteoarthrosis had a Harris hip score of less than 70 points at the latest follow-up evaluation.

Acetabulum↗
PubMed1995

[Treatment of supracondylar femoral fracture proximal to a knee joint endoprosthesis by retrograde interlocking nailing].

A case of a supracondylar femoral fracture proximal to a total knee prosthesis is reported. This difficult fracture was managed with retrograde intramedullary locked nailing. The time to union was 6 weeks. Cancellous bone grafting was not necessary. At final follow up the patient had a knee score of 90 and a functional score of 80 points. This was equal to the result after joint replacement prior to the injury.

Aged↗
PubMed1995

[Extracorporeal shock wave therapy--an alternative concept for the treatment of epicondylitis of the humerus and radius?].

In a prospective study, 16 patients with chronic, painful epicondylitis humeri radialis were treated with extracorporal high-energy shock waves. A complaint-free period of 3 months was achieved in 13 patients. In 2 of them complete release from pain was achieved for more than 3 months. We conclude that release from the symptoms is achieved by local hyperemia in the area of tendinitis. In contrast to the encouraging observations of other authors, our results suggest that a critical view of extracorporal shock waves for the treatment of chronic epicondylitis radialis of the elbow is reasonable.

Adult↗
PubMed1995

[Femoral neck fracture in the elderly--differential procedure].

Recent investigations and new devices allow specific regimens in the management of dislocated femoral neck fractures. Very old, immobile patients with a bad prognosis should be treated with a femoral head prosthesis. Patients with either arthritis, osteopenia, dysplasia or rheumatoid arthritis should receive a total hip prosthesis. The remaining population (age > 65 years) with dislocated femoral neck fractures and intact acetabulum should be managed with a bipolar hemialloarthroplasty. The protrusion rate is not significant.

Aged↗
PubMed1995

[Various possibilities for managing subtrochanteric fractures].

Subtrochanteric fractures are highly unstable. For treatment, open reduction and internal fixation are the method of choice. The 95 degrees condylar plate is widely used for stabilization of these fractures. Alternative devices are the gamma nail and the recently developed intramedullar nail with a twisted plate which allows immediate postoperative weight bearing. The reported complications of the gamma nail restrict its general application, whereas preliminary reports of the intramedullar nail with the twisted plate are encouraging. Further clinical data are necessary before its general application can be recommended.

Adolescent↗
PubMed1994

[Optimal timing of wound closure in severe open fractures with temporary coverage by skin substitute].

In a consecutive series of 1085 open fractures treated at the University of Louisville Level I Trauma Center from May 1983 to July 1992, 381 severe compound fractures in 335 patients were managed with the antibiotic bead pouch technique. There were 27 grade I (marked swelling, compartment syndrome), 115 grade II and 239 grade III open fractures (94 type IIIA, 114 type IIIB and 31 type IIIC). These fractures were managed with early administration of broad spectrum antibiotics, copious wound irrigation, serial debridements and external skeletal stabilization. Tobramycin-PMMA-beads were placed in the wound and porous plastic film (Opsite) covered the soft tissue defect. This dressing was changed every 48 to 72 hours until wound coverage/closure could be obtained. Infection rate either on an acute or chronic basis was 2.6% in grade II open fractures and 8.4% in grade III compound fractures. There was no infected wound or bone in the grade I category. Those fractures which did not develop an infection were closed at a mean time of 7.6 days; those which developed an infection were closed at a mean time of 17.9 days. The difference was statistically highly significant (p < 0.001). When severe open fractures are managed with the antibiotic bead pouch technique, wound closure should be obtained within one week to prevent infectious complications.

Adolescent↗
PubMed1994

Long term results of unicondylar fractures of the femur.

Twenty-four unicondylar fractures of the distal femur were treated at the Trauma Center "Bergmannsheil," University of Bochum, Germany, between 1981 and 1990. All patients sustained their injuries from severe direct trauma. There were 16 lateral condylar fractures, five medial condylar fractures, and three tangential posterior ("Hoffa-type") fractures. Twenty-three closed injuries and one grade IIIB open fracture are included. Nine patients (37.5%) sustained concomitant 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 62 months (24-120). The therapeutic outcome (clinical result, radiographs) was rated by the Neer score. Twenty patients were rated excellent, three achieved satisfactory results, and one had an unsatisfactory result. All patients without an excellent outcome had accompanying injuries. Open reduction and internal screw fixation of unicondylar femur fractures provides overall excellent long-term results. The therapeutic outcome is significantly affected by associated injuries of the skeleton.

Adolescent↗
PubMed1994

Bracing of stable shaft fractures of the ulna.

In the laboratory an ulnar osteotomy was performed in 10 cadaveric specimens, which included 5 distal-third junctions and 5 middle-third junctions. The interosseous membrane was left intact. Each specimen was rotated through full pronation and full supination. Displacement less than half shaft width was considered stable. The interosseous membrane was subsequently released 2 cm proximal and 2 cm distal to the osteotomy. Repeated pronation and supination range of motion documented gross displacement greater than half of the width of the shaft and was diagnosed as unstable. To evaluate this hypothesis, a clinical trial of 30 stable ulnar shaft fractures of the middle and distal thirds were treated with functional bracing between 1984 and 1990. A simple protocol was followed: A long arm cast was applied for approximately 5-7 days until the patient experienced only mild pain. At 5-7 days, a prefabricated forearm brace was fitted and the patient began physical therapy, advancing the upper extremity to full functional use. The bracing was continued until radiographic union had occurred. Twenty-nine clinical cases were evaluated to fracture union. The mean time to union was 7.3 weeks (range: 6-9 weeks). One delayed union was reported in the series. At 16 weeks surgical intervention was recommended and an open reduction and internal fixation with cancellous bone grafting was performed. Twenty-nine patients regained full range of motion, and one had limited supination/pronation due to a previous injury of the radial head. In conclusion, functional bracing of stable ulnar shaft fractures leads to a high incidence of fracture union and achieves good to excellent functional results.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

[Functional healing of compartment syndrome of the tibia. An analysis of follow-up results].

In a retrospective review 78 compartmental syndromes, treated between 1980 and 1988, were analyzed. The mean follow-up was 42 months. 43 patients (53%) suffered an traffic accident. Direct trauma forces predominated (66 patients). The functional results after crush injuries had been worser than after contusion injuries or direct trauma forces. The functional results depended from the posttraumatic interval of decompression. The later the fasciotomy the worser the functional results had been. A wide fascial decompression is necessary. Two cases of rebound compartmental syndromes after unilateral fasciotomy reveal the skin as an important limiting factor in severe cases of compartmental syndrome.

Amputation, Surgical↗
PubMed1993

[Stabilization of 150 unstable spinal injuries with the Cotrel-Dubousset instrument--analysis of results].

The present study is a retrospective analysis of spinal fracture treatment with the Cotrel-Dubousset instrumentation technique. 150 unstable injuries of the spine were treated with the CD implant at the University of Louisville--Level I Trauma Center--between February 1985 and March 1989. There were 67 burst fractures, 48 compression fractures and 21 fracture dislocations, 8 flexion distraction fractures and 6 flexion rotation injuries. Ninety-three patients underwent anterior cord decompression and strut grafting followed by posterior CD instrumentation and posterolateral fusion. Fifty-seven patients had posterior CD instrumentation and fusion alone. No neurological deterioration after the procedure was observed, 33 patients improved neurologically. Hospital stay ranged between 7 and 60 days (mean 20 days). 114 patients had a minimum follow up of 6 months (range 6-52 months). The mean follow up was 17.7 months. At final follow up 77.8% of the patients had returned to work and 84.2% of the patients were almost painfree. The mean loss of correction in the sagittal plane was 6.2 degrees (range: 0 and 42 degrees) at final follow up. As technical complications there were four hook cut outs (2.6%) of which two underwent reosteosynthesis and two did not effect the clinical or radiographic result. The high stability of the device provides a decreased risk of neurological deterioration, a decreased risk of posttraumatic kyphosis and early rehabilitation.

Adolescent↗