Biomedical subjects

B Roetman

Publications and source records attributed to B Roetman.

13 recordsLinked to original sources

PubMed2006

[Pelvic stabilization in cases of septic instability. Triangular osteosynthesis in case of infection related vertical pelvic ring instability].

The combination of transiliac screws and lumbopelvic distraction osteosynthesis is usually an appropriate procedure to treat vertical pelvic ring instabilities under the condition of full weight bearing. In this case, due to the extent of septic destruction of the dorsal portion of the iliac bone, the common triangular fixation method using conventional pedicle screws was not possible. Using the transiliac dorsoventral screw position with special long screws, we achieved high mechanical triangular stability sufficient for pelvic ring fusion despite the large bony defect.

Adult↗

PubMed2006

[Long-term results after acetabular fractures with respect to heterotopic ossifications].

BACKGROUND: Arthrosis, necrosis of the femoral head and heterotopic ossification (HO) tend to decline the outcome of acetabular fractures despite of good fracture reduction. In this study functional outcome and degree of HO were analyzed due to fracture type and surgical approach. The aim of this study is to delineate wether minimization of soft tissue damage increases the functional outcome. PATIENTS AND METHODS: 55 patients with surgically treated acetabular fractures (mean age: 40.4 (20-81) years, male 43, female 12) where retrospectively evaluated with a mean follow-up of 7.7 (4.4-12.3) years. Fractures were classified according to the Orthopaedic Trauma Association (OTA), functional outcome was scored by D'Aubigné-Postel and the degree of HO was defined by Brooker's classification. RESULTS: Following the OTA the distribution of fractures was: A-24 (44 %), B-23 (42 %) and C-8 (15 %). Mean D'Aubigné Index (max. 18 points) was 15.2, distributed to fracture type: A-15.9, B-15.0 and C-13.6. 32 % of all heterotopic ossifications were classified as Brooker 0, 10 % as Brooker 1, 29 % as Brooker 2 and Brooker 3 each, whereas Brooker 4 ossifications were not observed. 2/3 of the severe ossifications were observed using extended approaches or in case of type C fractures. The iliofemoral approach showed the tendency of fewer ossifications compared to extended approaches. CONCLUSION: Decrease of soft tissue damage during acetabular surgery plays an important role to improve outcome. Due to the higher risk of wrong implant position and insufficient reduction using a soft tissue sparing approach, we recommend a CT scan postoperatively to evaluate reduction and osteosynthesis.

Acetabulum↗

PubMed2003

[Complex fractures of the humeral head: which long-term results can be expected?].

BACKGROUND: Although improved techniques of internal fixation and prosthetic replacement were introduced successfully in the field of operative fracture care, treatment of complex fractures of the proximal humerus also involving the humeral head remains to be a challenge to the trauma surgeon. We therefore investigated clinical and radiological long-term results after humeral head preserving procedures. METHODS: 41 patients with a three or four part fracture of the humeral head were evaluated on average 6.6 years (min. 4.4 y; max. 9.0 y) after the trauma. The evaluation was based on the Constant- and HSS score clinically and on the Neer score radiologically. Nine patients were treated conservatively (group A), 13 patients had primarily an operative treatment (group B) and another 19 were operated upon after failure of conservative means. 24 of the patients were female and 17 male, with an average age of 52 years (min. 14.4 y; max. 71.2 y). According to Neers 's fracture classification of humeral head fractures we saw 14 type IV, 25 times a combination of type IV and V and in another 2 cases a type VI fracture. RESULTS: In group A (conservative) the Constant score showed on average 82.0 points for the injured and 95.3 points for the contralateral shoulder, the HSS score revealed 73.6 points and Neer's x-ray score 5.6 points. Group B (operated) showed also good results on average according to a Constant score of 72.1 points (fractured humerus) compared with 98.1 points of the contralateral shoulder. HSS score was 64.7 points. The radiological results reached 4.0 points. Group C (conservatively failed, secondary operation) achieved 68.2 points for the injured side and 95.8 points for the contralateral side according to Constant and 59.5 points according to HSS score. The x-ray evaluation showed 5.3 points. Fracture type did not influence the outcome in any of the groups. There was no humeral head necrosis in group A, one in group B (2.4 %) and four in group C (9.8 %). CONCLUSION: These data show that regarding to clinical and radiological long-term results also complex fractures of the humeral head should be treated by head preserving procedures.

Adolescent↗

PubMed2003

[Primary hemiarthroplasty after complex fracture of the humeral head--functional late results].

UNLABELLED: Treatment of complex fractures of the humeral head remains an obviously unsolved problem. Under consideration of the problems of head preserving methods, the development of the last years tended towards the hemiprosthetic replacement. As the discussion about the methods and implants continues to be controversial, long-term results of Neer-II-replacement of humeral head in own trauma cases are presented here. PATIENTS AND METHODS: 46 patients were investigated, in whom a cemented Neer II hemiprosthesis was implanted between 1983 and 1996 due to complex fracture patterns. Median age was 60.2 years, 74 % of patients were female. 59 % had a luxation fracture type Neer VI, 22 % presented a concomitant nerval lesion. Follow up was performed 5 years on average after the operation. 38 patients were investigated clinically according the score of Constant and Murley, 36 had a x- ray control. Additionally an individual questionnaire was completed by 46 patients. RESULTS: Average Constant-score was 66.2 points, whereas in 76.3 % a satisfactory or better result was achieved. In 23.9 % the outcome was poor. In one patient (2.2 %) explantation of the hemiprosthesis and shoulder fusion due to pain was necessary. Conditions for a good result were a patient aged 50 years and younger (75.9 pts. versus 64.2 pts.), an early hemiprosthetic replacement within 4 weeks after the trauma (71.7 pts. versus 55.3 pts.) and a patient without an earlier operation and nerval lesion (76.8 pts. versus 53.9 pts.). No correlation was found between the date of the follow-up and the interval of time since the operation. CONCLUSION: After complex fractures of the humeral head satisfactory long-term results can be obtained by the cemented Neer II hemiprosthesis. Thus, implants of the newer generation can not yet whitness their superiority under consideration of functional aspects. Refixation and reintegration of both the tubercula after trauma still seems to be an unsolved problem and requires further development.

Adult↗

PubMed2002

[Eccrine spiradenocarcinoma with unusual histiocytic giant cell components. Case report and review of the literature of a rare sweat gland tumor].

We report the case of a spiradenocarcinoma (malignant eccrine spiradenoma), a rare variant of a malignant sweat gland tumor, which occurred in the scalp of a 63-year-old woman. Some years before the current tumor occurred, a tumour of unknown histology had been excised from the same localization. The new tumor presented with rapid growth and exulceration. Malignant eccrine spiradenoma is characterized by the coincidence of a benign and a malignant portion within one specimen. We report case example 47 of this entity. The peculiarity of this case is the enormous heterogeneity with foci of atypical histiocytes like an atypical fibroxanthoma and an extensive foreign body reaction with cholesterol needles as in a xanthogranuloma. Static DNA cytophotometric analysis revealed different degrees of aneuploidy in the three tumor portions. The follow-up of 23 months is without recurrent tumor. A review of the literature is given.

Adenocarcinoma↗

PubMed2000

Ultrasound and bronchoscopic controlled percutaneous tracheostomy on trauma ICU.

Tracheostomy is a common surgical procedure performed in long-term ventilated patients in intensive care. Since the role of percutaneous dilatational tracheostomy (PDT) on Intensive Care Unit (ICU) has become steadily more important in the last few years, a prospective study was started to evaluate the economic efficiency and to show the minimization of the complication rate of this procedure. In 72 patients we performed PDT as a bedside procedure. Initially the thyroid gland and the subcutaneous vessels were studied by ultrasound in every patient. The puncture of the trachea, the dilatational procedure and the insertion of the tracheal cannula were executed under bronchoscopic monitoring. Finally, a bronchoscopic control view followed via the new cannula to detect intratracheal complications. Mechanical ventilation was maintained during the procedure and controlled by continuous pulse oximetry. According to prior ultrasound findings the place to puncture the trachea was changed in 24% of the patients, in one case tracheostomy was performed as an open conventional procedure. The following complications could be observed: one case involving perforation of a cartilaginous ring, one case with venous bleeding of a small subcutaneous vein and two cases with punctures of the bronchoscope. There were no cases of miscannulation, penetration of the posterior tracheal wall or major bleeding requiring intervention or conversion. The followup study revealed that there was no sign of further complications in any patient. In addition, cost analysis demonstrated that there was a significant economical advantage of PDT in comparison with open standard tracheostomy. Standardized ultrasonographically and bronchoscopically controlled PDT turns out to be a safe, simple and cost effective bedside procedure on ICU. Because of ultrasound examination performed before the procedure, and bronchoscopic surveillance during the procedure, safety of this procedure can be enhanced, thus minimizing the rate of complications.

Adult↗

PubMed1996

[A dynamic shoulder model for biomechanical measurements of shoulder specimen].

The article discusses a dynamic shoulder model capable of simulating the forces generated by the rotator cuff and the deltoid muscle, and elevation movements of the glenohumeral joint using, a computer-aided servohydraulic unit. In 10 cadaver shoulder specimen, the effects of the loss of function of the supraspinatus muscle on maximum elevation was determined with an ultrasound system. Changes in the so-called impingement pressure below the coracoacromial arch were determined with the aid of capacitive pressure sensors. With the supraspinatus muscle inactive/ absent, the maximum elevation of the humerus showed a decrease of 6% (p < 0.05), which, however, was overcome by an increase in deltoid power of only one-third of the supraspinatus muscle power loss. For a simulated isolated supraspinatus defect, the subacromial pressure below the coracoacromial arch decreased by 8% (p > 0.05). These results confirm clinical investigations showing that isolated lesions affecting the supraspinatus tendon often fail to produce symptoms and thus require no surgical reconstruction.

Adult↗

PubMed1995

A dynamic shoulder model: reliability testing and muscle force study.

This study introduces a dynamic shoulder model, where forces were applied to individual muscles in ten cadaveric specimens. The model provided reproducible glenohumeral joint motion and thereby allowed the investigation of active, glenohumeral joint mechanics. Forces were created by servo-actuated hydrodynamic cylinders and applied to the deltoid muscle and to the rotator cuff through wire cables. Computerized regulation initiated precise, time controlled cycles of glenohumeral joint motion. The position of the glenohumeral joint in all spatial orientations was measured and recorded using an ultrasonic sensor device. Reproducibility of glenohumeral joint motion was demonstrated on the basis of five cycles of glenohumeral joint elevation. Repeatability variance of position measurements for five cycles of elevation averaged 0.80 degrees for abduction, 0.75 degrees for anteflexion and 1.36 degrees for internal rotation. Arm weight and force distribution at the shoulder musculature were estimated according to the literature. In comparison to estimated physiologic conditions, a one third increase of arm weight led to a significant (p < 0.05) decrease of elevation of 20%, a one third decrease of arm weight to an average increase of elevation of 18% (p < 0.05). Exclusion of the supraspinatus muscle caused a significant (p < 0.05) 6% decrease of elevation of the glenohumeral joint. Without force applied to the subscapularis and infraspinatus/teres minor muscles, elevation decreased 16% (p < 0.05). A decrease of glenohumeral joint elevation of 25% resulted when force was applied to the deltoid muscle alone (p < 0.05).

Adult↗

PubMed1994

Function of the supraspinatus muscle. Abduction of the humerus studied in cadavers.

We evaluated the function of the supraspinatus tendon with a dynamic shoulder model. Active glenohumeral joint motion was simulated in 10 cadaveric shoulder specimens with hydrodynamic cylinder forces at the deltoid muscle and at the rotator cuff. Computerized regulation initiated standardized cycles of glenohumeral joint motion, where the isolated effect of the supraspinatus muscle could be studied. The efficacy of the supraspinatus muscle on elevation of the glenohumeral joint was measured with an ultrasonic sensor system. Pressures underneath the coracoacromial vault were recorded with capacitive sensors, as an indicator of the impingement at the shoulder. Elimination of force of the supraspinatus muscle led to a 6 percent decrease in elevation of the glenohumeral joint. The deltoid muscle was able to reverse this loss of elevation by a force increase of one third of the lost supraspinatus force. If no force was applied to the supraspinatus muscle, average pressures underneath the coracoacromial vault decreased 8 percent. It was concluded that the supraspinatus produces less torque and more glenohumeral joint compression than the deltoid. However, the supraspinatus has no effect on depression of the humeral head during elevation. The clinical consequence of our observations is that operative closure of supraspinatus tendon defects is not mandatory.

Adult↗

PubMed1994

[Function of the supraspinatus muscle in a dynamic shoulder model].

Active glenohumeral joint motion was simulated in ten cadaveric shoulder specimens with hydrodynamic cylinder forces at the deltoid muscle and at the rotator cuff. Computerized regulation initiated standardized cycles of glenohumeral joint motion in which the isolated effect of the supraspinatus muscle could be studied. The effect of the supraspinatus muscle on the elevation of the glenohumeral joint was measured with an ultrasonic sensor system. Pressures underneath the coracoacromial arch as an indicator of the 'impingement' at the shoulder were recorded with capacitive sensors. Elimination of force of the supraspinatus muscle led to a significant 6% decrease in elevation (p < 0.05). The deltoid muscle was able to reverse this loss of elevation by an increase in force equal to only one third the force lost at the supraspinatus muscle. When no force was applied to the supraspinatus muscle average pressures under the coracoacromial vault decreased by 8% (p > 0.05). In conclusion, the supraspinatus muscle produces less torque and more glenohumeral joint compression than the deltoid muscle. However, the supraspinatus muscle has no significant effect on the centering of the humeral head on the glenoid during elevation.

Acromioclavicular Joint↗

PubMed1994

Biomechanical data concerning the shoulder impingement syndrome.

This study evaluates forces underneath the coracoacromial vault during elevation of the arm, using a dynamic shoulder model. Muscle forces at the glenohumeral joint were simulated with hydrodynamic cylinders and applied to the deltoid muscle and to the rotator cuff through wire cables in ten anatomic specimens. Computerized regulation initiated precise, time-controlled cycles of glenohumeral joint motion. The position of the arm in all spatial orientations was measured with an ultrasonic device. Forces underneath the coracoacromial vault were recorded with capacitive sensors. The mean force during one cycle of elevation averaged 13.9 N +/- 12.5 N underneath the acromion, 0.43 N +/- 0.51 N underneath the coracoacromial ligament, and 3.44 N +/- 4.37 N underneath the coracoid process. The peak force averaged 37.8 N +/- 33.2 N underneath the acromion, 3.03 N +/- 2.62 N underneath the coracoacromial ligament, and 6.93 N +/- 7.38 N underneath the coracoid process. Forces under the coracoid process exceeded forces under the acromion in some specimens. A marked increase in forces was observed at the final stage of arm elevation and during early reverse-elevation in most specimens. The authors believe that these force values represent the pathomechanics of the shoulder impingement syndrome.

Acromioclavicular Joint↗

PubMedDate not supplied

Coracoacromial pressure recordings in a cadaveric model.

A dynamic shoulder model was used to determine the pressure distribution under the acromion, the coracoacromial ligament, and the coracoid process with simulated active glenohumeral joint motion in cadaveric specimens. Computerized regulation of servo-actuator forces initiated controlled cycles of glenohumeral joint motion. Pressures were recorded by using capacitive sensors. Peak pressures averaged 56.6 N/cm2 and were located at the anterolateral border of the acromion in most specimens. Marked pressures were present under the coracoid process. Lack of force of the supraspinatus muscle resulted in an 8% decrease of mean coracoacromial pressures, lack of force on the subscapularis and infraspinatus/teres minor muscles in a significant 61% increase, and lack of force on all rotator cuff muscles in a significant 35% increase. After anterior acromioplasty was performed, mean coracoacromial pressures decreased 5%.

Acromion↗

PubMedDate not supplied

[Biomechanic results in impingement syndrome of the shoulder].

Forces underneath the coraco-acromial vault during elevation of the arm were evaluated with a dynamic shoulder model. The deltoid muscle and the rotator cuff muscles were simulated with a hydrodynamic device, in ten autopsy specimens. Controlled cycles of glenohumeral joint motion were initiated with computerised regulation. An ultrasonic device measured the position of the arm in all spatial orientations. Capacitive sensors recorded forces underneath the coraco-acromial vault. The mean force during one cycle of elevation averaged 13.9 Newton +/- 12.5 Newton underneath the coraco-acromial ligament and 3.44 Newton +/- 4.37 Newton underneath the coracoid process. The peak force averaged 37.8 Newton +/- 33.2 Newton underneath the acromion, 3.03 Newton +/- 2.62 Newton underneath the coraco-acromial ligament and 6.93 Newton +/- 7.38 Newton underneath the coracoid process. The force markedly increased at the final stage of arm elevation and during early reverse-elevation in most specimens, corresponding to the painful arc sign. In some specimens, the force under the coracoid process exceeded the force under the acromion. Osteophytes protruding into the subacromial space may lead to a concentration of force and to high regional pressures.

Adult↗