Biomedical subjects

B Wertheimer

Publications and source records attributed to B Wertheimer.

13 recordsLinked to original sources

PubMed2000

Quadricepsplasty after war fractures.

Knee movements after fractures caused by explosive devices, as well as after intra-articular fractures of the knee, are often inadequate. This paper presents the results of quadriceps-plasty performed in 10 patients with the purpose of improving knee function. All of the patients were treated by the external fixation method, either after femoral fractures caused by explosive devices or for intra-articular knee fractures. All of them manifested markedly decreased knee flexion (15-70 degrees, with an average of 32 degrees). After quadricepsplasty and physical therapy, the achieved knee flexion was enough for normal walking (80-130 degrees, average 97.5 degrees). Mean knee mobility was increased 65.5 degrees. Our paper presents indications, methods, results, and complications for quadricepsplasty performed after war injuries.

Adult↗

PubMed1999

Wartime amputations.

This paper outlines the causative factors, incidence, and localization of extremity amputations of wounded persons treated at the Osijek University Hospital (Eastern Slavonia) during 1991 and 1992. The medical documentation of 5,024 patients was analyzed. Of these, 1,560 patients were treated in the hospital (31.0%). A total of 1,916 extremity injuries were found in hospitalized wounded patients. Injuries of the lower extremities were found in 1,226 patients and injuries of the upper extremities in 690 patients. Gunshot-explosive fractures of the extremity bones were diagnosed in 1,122 patients (71.9%): 735 (47.1%) in the lower extremities and 387 (25.8%) in the upper extremities. In 90 cases (4.6%), amputation of the extremities (including the fingers) using an open circular or flap technique was performed. Large amputations (above the wrist and ankle joints) were performed on 40 patients (2.6%). Amputation of the upper extremities was performed on 53 patients (58.9%), and amputation of the lower extremities was performed on 37 patients (41.1%). Injuries of the major blood vessels were treated with primary reconstruction in the upper extremities in 44 patients and in the lower extremities in 96 patients. Unstable gunshot-explosive fractures of the long bones were stabilized with external fixation, and fractures of the short bones were stabilized by means of minimal osteosynthesis or external fixation. Secondary amputations (on the lower extremities) were performed on 2 patients because of vascular insufficiency. Not a single secondary amputation procedure was performed because of infection, secondary uncontrolled hemorrhage, or gas gangrene. Amputation is a radical and irreversible intervention, and indications for amputation must be determined by those with great surgical experience and good knowledge of military-surgical doctrine.

Amputation, Surgical↗

PubMed1997

Ballistic trauma in 1991/92 war in Osijek, Croatia: shell fragments versus bullets.

During 18 months of the 1991/92 war against Croatia, 4,545 injured were treated at the Department of Surgery of Osijek Clinical Hospital. Some, 2,544 (55.9%) sustained shell fragment injuries and 807 (17.8%) bullet injuries. Shell fragments lead to a higher number of polytraumatized patients than did bullets (6.8% versus 5.3%). The postoperative complication rate for fragment injury (5.8%) was significantly higher than that for bullet injury (4.1%). Mortality rate did not differ significantly (3.9% versus 4.5% respectively).

Adolescent↗

PubMed1997

Tourniquet occlusion technique for lower extremity artery reconstruction in war wound.

Reconstruction of blood vessels after war injuries is mandatory for life and limb salvage. In an effort to prevent prolonged major bleeding and make reconstruction quicker and technically more comfortable, thigh pneumatic tourniquet occlusion was performed pre- and intraoperatively in eleven of 53 wounded with injuries of the arteries of the lower extremities during 1991/92 war against Croatia at the Department of Surgery, Osijek Clinical Hospital. This method benefits life and limb salvage under war conditions.

Adult↗

PubMed1996

Reconstruction of major arteries of lower extremities after war injuries. Long-term follow up.

During 18 months' period of war in northeastern Croatia 38 wounded with injuries of lower extremity arteries were operated on in Osijek Department of Surgery demanding the use of substitute conduit for vascular reconstruction; 26 synthetic prosthesis and 12 vein grafts were applied. Ankle-brachial index and life-table method were used for the construction of the initial and cumulative limb salvage rate at 40 months. Cumulative graft patency and limb salvage rates for synthetic grafts was 87.67% +/- 6.9 and for vein grafts 91.67% +/- 8.0 respectively and did not differ significantly for both synthetic prosthesis and autologous vein grafts.

Adult↗

PubMed1995

External fixation as a primary and definitive treatment of open limb fractures.

This paper analyses the medical records of 5024 injured persons treated and operated on at the Surgical Clinic of the Clinical Hospital in Osijek, during the war against Croatia (1991 and 1992). There were 1653 (33.0 per cent) admitted, while the rest were treated as out-patients. Of the admitted patients 82.7 per cent (1372) had limb injuries. In 760 (15.0 per cent) of the wounded, 1320 limb fractures caused by explosives were diagnosed, out of which 856 were of the lower and 464 of the upper limbs. One hundred and ninety-two (3.9 per cent) were treated by external fixation. External fixators were applied to 147 lower and 68 upper open long bones, respectively. Adequate reconstructive operations were performed on 106 (2.1 per cent) patients with associated injuries to important blood vessels. The stabilization of the open and unstable external fractures was achieved by external fixation, mostly at one level, regardless of the wound size. The importance of good wound cleaning has been particularly stressed as well as bone fragment reposition. Special attention has been given to the preoperative and intra-operative assessment of the limbs. In 20 patients (9.3 per cent) treated with external fixation, osteitis occurred. Twenty-one more patients (9.7 per cent), because of bad fracture healing after external fixation, were submitted to secondary internal bone fixation combined with bone grafts. Out of these, nine (42.8 per cent) developed osteitis as a consequence of the additional treatment.

Arm Injuries↗

PubMed1995

Foot injuries caused by anti-personnel mines.

During 18 months of the 1991-1992 war against Croatia, 14 persons wounded by antipersonnel mines were admitted to the Department of Surgery at Osijek University Hospital. Twelve had injury of the calcaneal region. Kirschner wires were used for minimal osteosynthesis. Delayed wound closure was performed 14 to 21 days after injury. The methods used were delayed direct closure, split skin-thickness graft, or microvascular free flaps. Osteitis did not develop, and all patients walked with full weight after 1 year.

Blast Injuries↗

PubMed1994

War injuries of major extremity vessels.

During the war in Croatia, the surgical department of Osijek Hospital was the place of primary and definitive surgical management of the wounded from the city of Osijek and the entire northeastern region of Croatia. Our surgical experience with the management of war injuries of major extremity vessels, collected from May 2, 1991, through April 12, 1992, is reviewed. During that time, 60 wounded were admitted to the hospital with injuries of major blood vessels of the extremities, all of them directly from the battlefield or from the streets of Osijek. The method of surgical treatment depended on the type of vascular injury and associated injuries. Our methods were arterial injury reconstruction and monitoring of the early results when autogenous vein grafts or synthetic prostheses were used. The results indicate that one should not resist using synthetics for reconstruction of arterial injuries in a highly contaminated area.

Adult↗

PubMed1994

Reconstruction of the popliteal artery after war injury.

During the war against Croatia in 1991-1992, 85 wounded with war injuries of major vessels in the extremities were admitted to the Department of Surgery, Osijek Clinical Hospital. These 85 included 13 (15.3%) wounded with injuries of the popliteal artery. In 12 cases an allograft was used as a substitute conduit. One early thrombosis and two infections occurred. Two amputations had to be performed because of massive soft tissue destruction and infection in the leg tissue. Our experience shows that an allograft is an acceptable choice for popliteal artery reconstruction in a highly contaminated war wound.

Adult↗

PubMed1993

[Radiologic analysis of osseous changes in coxarthrosis].

Morphologic and osteogenetic changes of the hip joint in patients with coxarthrosis were studied. Examination included 224 patients treated and operated on Department of Orthopaedics, Clinic Hospital Osijek. Coxarthrosis was proved in 331 hips, 183 cases (55,29%) referred to a secondary and 148 844,71%) to primary arthrosis. Osteogenetic changes on the head of femur were found in 148 x-rays (44,71%). The upper osteophyte of the head of femur was found in 79 x-rays of the hip (22,36%) but lower osteophyte of the head of femur only in 26 cases (7,85%). In 48 x-rays (14,50%) osteophytes were found both on the upper and lower sides of the head of femur. 217 x-rays of hips (65,56%) proved the existence of medial cervial osteophyte, according to frequency mostly type 1. Osteophyte of the roof of acetabulum were expressed on 158 x-rays (44,73). The double bottom of the acetabulum was studied on several measurement levels and showed from 0,24 to 2,35 mm observed from cranial to caudal measurement levels. The studies proved that the patients with coxarthrosis experienced a number of morphological and osteogenetic changes on the head and neck of femur as well as on the acetabulum. Their features on x-rays will depend on the cause and degree of the development of coxarthrosis.

Acetabulum↗

PubMed1993

The reconstruction of major femoral vessels in a four-year-old girl wounded with shrapnel.

A four-year-old girl who sustained an explosive injury to the femoral artery and vein underwent vascular reconstruction. An allograft was used as a substitute conduit for both the artery and the vein. Eight months after reconstruction there was no pulse deficit and decrease in systolic blood pressure, nor were there any signs of venous obstruction.

Blast Injuries↗

PubMedDate not supplied

Tendon injury repair in a war wound.

During 18 months of the 1991-1992 war against Croatia, 4425 injured were treated at the Department of Surgery, Osijek University Hospital. Among them 46 had tendon injuries, 20 with tendon laceration and 26 with total rupture. In 12 wounded primary repair was performed, 4 of an extensor tendon, 7 of a flexor tendon and 1 of both flexor and extensor. Four patients with primary flexor tendon repair had a good functional result. In other 34 no primary repair was done. Good function was achieved in 18 cases.

Croatia↗

PubMedDate not supplied

[Personal experience in the care of open fractures using external fixation during the hostilities in Osijek and surrounding region].

In the period of aggression of the Federal Army and Serbian paramilitary forces on the City of Osijek and its surrounding, beginning in the summer of 1991, 4036 wounded were treated at the Department of Surgery, Osijek General Hospital. Extremity injuries were documented in 3889 patients, including 959 bone fractures. The majority of patients had wounds caused by highly destructive explosives filled with metal fragments of different shapes and dimensions, and having sharp and uneven edges. One hundred and forty wounded were treated by external fixators. In 102 patients this mode of fixation was applied for gun- and explosive-related long bone fractures of the lower extremities. External fixator for the upper and forearm fractures was used in 38 cases. During this period, different types of external fixators were used and experience in this work has been gained. Stability of both open and unstable bone fractures of the extremities, caused by explosive devices, has been obtained by the external fixation mostly in one plane, regardless of the type of external fixator used. The advantages of use of external fixators of the types Instrumentarija Zagreb 1 and 2 for the treatment of long bone fractures has been emphasized as well as the possibility of the subsequent corrections owing to the technical construction of the bone spike. The usefulness of the longitudinal bar of the AO/ASIF fixator for the healing of fractures of the upper leg with subsequent callus formation is also stressed. The same stability has been achieved by the CMC fixator. The external fixators of a type Zagreb 2 have been a satisfactory treatment for forearm fractures as well.(ABSTRACT TRUNCATED AT 250 WORDS)

Croatia↗