Search PubMed⌕ Search

Biomedical subjects

B Wippermann

Publications and source records attributed to B Wippermann.

At least 19 recordsLinked to original sources
PubMed2006

Joint position awareness and sports activity after capsulolabral reconstruction in the overhead athlete.

A total of 24 overhead athletes with posttraumatic, chronic anterior shoulder instability underwent surgery. Twenty-two patients were examined after an average follow-up of 2.8 +/- 0.7 years. On average, a Constant-Score and Constant-Murley-Score of 93.7 +/- 5.3 points and an ASES-Score of 95.0 +/- 5.1 points were achieved. The redislocation rate was 9 %. The study demonstrated, that despite the good clinical results, only 12 out of 22 (55 %) of patients were able to return to their previous sports activity level. This relevant problem is in agreement with other similar studies [ ], so it was further addressed by determination of joint position awareness (JPA) and electromyographic muscle activity. Postoperatively, a persisting deficit of JPA, as well as an altered EMG pattern, was found with a significant reduction in activity of the deltoideus muscle on the operated side. The analysis of the data of each patient showed that there was a significant relation between the restitution of JPA and ability to return to the previous sports activity level. In contrast, the relation between EMG pattern and full recovery to completely unrestricted shoulder function was not significant. The anterior capsulolabral reconstruction enables a reliable restoration of shoulder stability and a low rate of complications. The problem that a relatively high percentage of overhead athletes can not return to their previous performance level is based on an impaired joint position awareness.

Adolescent↗
PubMed2005

[Sensorimotor deficit after capsulolabral reconstruction in chronic instability of the shoulder. A clinical experimental study].

The anterior capsulolabral reconstruction technique described by Jobe is a modified Bankart repair. The capsular shift is performed in a horizontal direction via a subscapularis split approach avoiding any incision of the muscle. Of 43 patients with posttraumatic anterior shoulder instability treated by anterior capsulolabral reconstruction, 35 were examined after 3.7+/-1.4 years, and of these, 29 (82.9%) had no pain; the external rotation deficit was 4.1+/-2.9 degrees . The average Constant-Murley score was 92.4+/-7.1 and the average ASES score was 93.3+/-8.4. The reluxation rate was 7.7%. This technique was shown to provide good clinical results, but only 69% of the patients were able to return to their prior sporting activity level. This particular problem was addressed by investigating the joint proprioception and the activity of the periarticular muscles. The results confirmed a persistent deficit of proprioception as well as a pathologic EMG pattern after anterior capsulolabral reconstruction, which may explain the problem of incomplete restoration of the function of the shoulder joint.

Adolescent↗
PubMed2005

[PMMA pulmonary embolism and post interventional associated fractures after percutaneous vertebroplasty].

A 78-year old woman with osteoporotic collapse of the Th12 and L4 vertebrae was treated by percutaneous vertebroplasty (pVp) with PMMA (polymethylmethacrylate). Postoperatively, the Th11 and L1 vertebrae collapsed so that a second vertebroplasty was performed. Postoperatively, the patient developed a severe pulmonary embolism which was treated conservatively. In this report, the complications of pulmonary embolism, perivertebral leakage of PMMA and of additional vertebral collapses after pVp are discussed.

Aged↗
PubMed2005

[Capacity for sport and the sensorimotor system after stabilization of the shoulder in overhead athletes].

The anterior capsulolaboral reconstruction according to Jobe is a modification of the Bankart operation, performing the capsular shift via a subscapularis-split approach avoiding any incision into the musculature. A total of 24 overhead athletes with posttraumatic, chronic anterior shoulder instability underwent surgery. Twenty-two patients were examined after an average follow-up of 2.8 +/- 0.7 years. On average, a Constant-Murley-Score of 93.7 +/- 5.3 points and an ASES-Score of 95.0 +/- 5.1 points were achieved. The relaxation rate was 9 %. The study demonstrated, that despite the good clinical results, only 12 out of 22 (55 %) of patients were able to return to their previous sports activity level. This relevant problem is in agreement with other similar studies so that it was further addressed by determination of proprioception and electromyographic muscle activity. Postoperatively, a persisting proprioceptive deficit as well as an altered EMG pattern was found with a significant reduction in activity of the deltoideus muscle on the operated side. The analysis of the data of each patient showed that there was a significant relation between the restitution of proprioception and ability to return to the previous sports activity level. In contrast, the relation between EMG pattern and full recovery to completely unrestricted shoulder function was not significant.

Adolescent↗
PubMed2002

Plantar impact causing midfoot fractures result in higher forces in Chopart's joint than in the ankle joint.

PURPOSE: Force effect (impact, extent of foot compartment deformation) and result (fracture pattern) for midfoot fractures in car occupants is known. An analysis of the processes in the foot was intended to improve car safety. MATERIALS AND METHODS: Eleven fresh, unfrozen, unpreserved intact human cadavers (age: 36.8 (16-61) years, gender: male, race: Caucasian) were studied 24-72 h after death. In 3 cadavers (5 feet) the experimental design was established: entire cadaver fixed on a special tray in supine position, pendulum with bar impactor hitting the foot plantar to Lisfranc's joint. A custom-made pressure sensor was inserted in the ankle (A), talonavicular (TN) and calcaneocuboid (CC) joints (resolution: 1 cm2, sampling rate: 500/s). RESULTS: Sixteen feet were measured: midfoot fractures were induced in 11 feet. The maximum pressure amounted to 1.22-2.55 MPa (2.04+/-0.412) at 0.005 0.195 s (0.067+/-0.059) after impact. The maximum pressure occurred in 8 (50%) cases in the ankle, in 7 (44%) of the TN and 1 (6%) of the CC joints. A comparison of the first 200 pressure samples after impact of all sensor fields resulted in higher forces in Chopart's joint than in the ankle (t-test: p < 0.001). These force differences were higher in cases with midfoot fractures (mixed model analysis of variance: p = 0.003). CONCLUSION: Due to considerable forces in Chopart's joint we recommend a modification of the actual crash test dummy lower extremity model with an additional load cell that detects forces in the longitudinal direction of the foot axis.

Adolescent↗
PubMed2001

[Post-traumatic osteoid osteoma. Case report and review of the literature].

Osteoid osteoma is a painful benign bone neoplasm that is rarely described after trauma but should be suspected. A case of osteoid osteoma 19 years after a tibial fracture is presented. The patient had pain in the tibia for 6 years before the osteoid osteoma was confirmed. He had been operated on twice for suspected osteomyelitis although the clinical symptoms suggested an osteoid osteoma. The radiographic appearance as well as a bone scan confirmed the diagnosis. Removal of the nidus resulted in immediate pain relief. A precise preoperative diagnosis of the lesion based on clinical findings, standard radiographs, high-resolution CT, and bone scan is mandatory. It is important to recognize this uncommon entity to avoid morbidity associated with a prolonged delay in diagnosis.

Adult↗
PubMed2001

Foot fractures in restrained front seat car occupants: a long-term study over twenty-three years.

OBJECTIVES: To analyze the mechanism of injury for foot and ankle fractures resulting from automobile accidents to create a basis for developing an improved design for protection. DESIGN: Retrospective. SETTING: Level I trauma center with accident research unit. PATIENTS: Automobile accident reports and medical records of individuals injured in the accidents. MAIN OUTCOME MEASUREMENTS: Technical indicators (collision type, impulse angle, deltav, and extent of vehicle deformation) and clinical data (injury location and severity [abbreviated injury scale and injury severity score] and long-term outcome). RESULTS: From 1973 to 1996, 15,559 car accidents were analyzed. Two hundred sixty-one front seat occupants sustained fractures of the foot and ankle (ankle, 41 percent; forefoot, 29 percent; midfoot, 20 percent; and hindfoot, 10 percent). Seventy-five percent of the fractures were classified abbreviated injury scale(foot) 2. The incidence, location, and abbreviated injury scale(foot) category of fractures were similar between driver (n = 210) and front seat passenger (n = 51). Fifty percent of the fractures occurred in head-on collisions and 34 percent occurred in accidents with multiple collisions. The deltav ranged in 82 percent of car crashes between fifteen and sixty kilometers per hour. The deltav and extent of foot compartment deformation correlated with the abbreviated injury scale. During our investigation, deltav increased; the injury severity score decreased; and the extent of deformation did not differ significantly. CONCLUSIONS: Although overall car passenger safety has improved, the relative incidence of foot and ankle fractures has increased. Comparing drivers and front seat passengers, the foot pedals, steering wheel, or the asymmetric design of the dashboard did not influence injury incidence, mechanism, or severity. Foot fractures are mainly caused by the foot compartment deformation in head-on collisions, and therefore improvements in foot compartments are essential for fracture prevention.

Abbreviated Injury Scale↗
PubMed2001

Fractures and fracture dislocations of the midfoot: occurrence, causes and long-term results.

Etiology and outcome of 155 patients with midfoot fractures between 1972 and 1997 were analyzed to create a basis for treatment optimization. Cause of injuries were traffic accidents (72.2%), falls (11.6%), blunt injuries (7.7%) and others (5.8%). Isolated midfoot fractures (I) were found in 55 (35.5%) cases, Lisfranc fracture dislocations (L) in 49 (31.2%), Chopart-Lisfranc fracture dislocations (CL) in 26 (16.8%) and Chopart fracture dislocations (C) in 25 (16%). One hundred and forty eight (95%) of the midfoot fractures were treated operatively; 30 with closed reduction, 115 with open reduction, 3 patients had a primary amputation. Seven (5%) patients were treated non-operatively. Ninety seven (63%) patients had follow-up at an average of 9 (1.3-25, median 8.5) years. The average scores of the entire follow-up group were as follows: AOFAS - sum of all four sections (AOFAS-ET): 296, AOFAS-Midfoot (AOFAS-M): 71, Hannover Scoring System (HSS): 65, and Hannover Questionnaire (Q): 63. Regarding age, gender, cause, time from injury to treatment and method of treatment no score differences were noted (t-test: p>0.05). L, C or I showed similar scores and CL significantly lower scores (AOFAS-ET, AOFAS-M, HSS, Q). The highest scores in all groups were achieved in those fractures treated with early open reduction and operative fixation. Midfoot fractures, particularly fracture dislocation injuries, effect the function of the entire foot in the long-term outcome. But even in these complex injuries, an early anatomic (open) reduction and stable (internal) fixation can minimize the percentage of long-term impairment.

Adolescent↗
PubMed2000

[Effect of needle acupuncture on pain perception and functional impairment of patients with coxarthrosis].

OBJECTIVES: The effectiveness of acupuncture treatment in patients with osteoarthritis of the hip was tested. DESIGN: This is a prospective, randomized, controlled patient and examiner blinded clinical trial. PATIENTS AND SETTING: The study was performed at a university department for physical medicine and rehabilitation. Sixty-seven patients were separated into two treatment groups. INTERVENTIONS: Group 1 (treatment) had traditional needle placement and manipulation, whereas in group 2 (control) needles were placed away from classic positions and not manipulated. In both groups needles were placed within the L2 to L5 dermatomes. Endpoints were pain (VAS), functional impairment (hip score), activity of daily living (ADL) and overall satisfaction before treatment, 2 weeks and 2 months post-intervention. RESULTS: For all endpoints there was a significant improvement in both groups 2 weeks and 2 months following treatment versus baseline, but no significant difference between the two treatment groups. CONCLUSIONS: We conclude from these results that needle placement in the area of the affected hip by itself improves symptoms of osteoarthritis. It appears to be less important to follow the rules of traditional acupuncture techniques.

Activities of Daily Living↗
PubMed2000

Free flap to the arteria peronea magna for lower limb salvage.

A 36-year-old woman sustained an amputation of her right leg at the thigh level and a degloving injury of her left foot and ankle region in an accident during a suicide attempt. Primarily, her left foot was covered with a split skin graft, resulting in a soft-tissue defect at the medial malleolus and at the calcaneus bone. Reconstruction was planned with a free latissimus dorsi muscle flap. Preoperative examinations revealed an arteria peronea magna with a hyperplastic peroneal artery solely providing arterial blood supply to the foot. The arteria peronea magna divided into two branches proximal to the upper ankle joint, replacing the dorsal pedis artery and the medial plantar artery. Tibial posterior and tibial anterior arteries were hypoplastic-aplastic. Microvascular end-to-end anastomoses of the flap vessels to the medial branch ("medial plantar artery") of the arteria peronea magna and its concomitant vein at the medial malleolar bone level were successfully performed. The postoperative course was uneventful. Four weeks postoperatively, the patient started walking assisted by a prosthesis on her right thigh stump. This experience demonstrates that even in a case of arteria peronea magna, free flap surgery for lower limb salvage is a reliable and worthwhile method.

Adult↗
PubMed1999

The influence of hydroxyapatite granules on the healing of a segmental defect filled with autologous bone marrow.

Hydroxyapatite(HA) ceramics are frequently used as a bone graft substitutes for the filling of bony defects. The addition of autologous bone marrow to HA ceramics does improve defect healing. There is conflicting evidence in the literature whether autologous bone marrow transplantation alone is as effective as the combination of HA ceramics and bone marrow combined. It was the purpose of this study to identify the role of additional HA ceramic granules on the healing of a sheep tibia segmental defect filled with autologous bone marrow. After permission of the local animal rights committee was obtained, a 3 cm segmental defect in the midshaft of 31 adult sheep was stabilized with an unreamed tibia nail. The animals were divided into 4 groups according to the mode of defect filling: HA plus autologous bone marrow (HA + MAR) (n = 8), autologous bone marrow (MAR) (n = 9), empty defect (DEF) (n = 6), cancellous bone graft (CAN) (n = 8). After three months follow up animals were sacrificed and analysed for the key parameters of union and maximum torque at failure. One nonunion was present in each of the HA + MAR, MAR, and CAN groups. Four of the six animals in the DEF group developed a nonunion. Maximum torque at failure was reported as percentage of the intact contralateral tibia: HA + MAR 39% +/- 24%, MAR 26% +/- 17%, DEF 22% +/- 13%, CAN 41% +/- 20%. The difference between the groups was statistically significant, but appeared to be relevant. We conclude from our data, that HA ceramics do improve healing of a segmental defect in the sheep tibia filled with autologous bone marrow. The results of this combination are comparable to cancellous autograft.

Animals↗
PubMed1997

[Malignant bone tumors].

Owing to advances in adjuvant therapy, the outlook for patients with primary malignant bone tumors has improved dramatically in recent decades. This applies both to improved survival and to increased limb salvage rates. The diagnostic strategies and a staging system for malignant bone tumors are outlined. Technical aspects of the standard limb salvage procedures, such as Tikhoff-Linberg resection at the shoulder, internal hemipelvectomy, proximal and distal femur resection and rotation plasty are presented. The use of soft tissue procedures such as flaps and the use of modular implant systems has reduced the complication rates of limb salvage procedures. In the future we hope to further improve prognosis and quality of life for such patients by the application of risk-adapted strategies for chemotherapy and surgery.

Adolescent↗
PubMed1996

[New developments in surgery of bone tumors].

Due to advances in adjuvant therapy, the outlook for patients with primary malignant bone tumors has dramatically improved over the last decades. This is true for improved survival and also for increased limb salvage rates. Technical aspects of the standard limb salvage procedures such as Tikhoff Linberg resection in the shoulder region internal hemipelvectomy, proximal and distal femur resection and rotation plasty are demonstrated. The use of soft tissue procedures like flaps and the use of modular implant systems has reduced complication rates. In the future, we hope to further improve the outlook for our patients with risk adapted chemotherapeutic regimes and surgical procedures.

Adolescent↗