Search PubMed⌕ Search

Biomedical subjects

C Josten

Publications and source records attributed to C Josten.

At least 19 recordsLinked to original sources
PubMed2001

Fracture-dislocations of the elbow joint--strategy for treatment and results.

Between January 1993 and December 1996, 41 patients with fracture dislocation of the elbow joint were treated in our department. In 28 patients (median age 46 years, range 15-77 years; 16 male, 12 female), a clinical and radiological follow-up was obtained after median 34 months (range 12-59 months). In addition to the humero-ulnar dislocation, isolated fractures were present in 13 patients and combined fractures in 15 (all with involvement of the radial head). Primary neurological deficits were found in 7 and open fractures in 3 patients. In 7 patients, primary definitive surgical therapy was carried out by open reduction and internal fixation. A two-step surgical management (initial closed reduction and immobilization, 5 patients with external fixator, 7 with plaster; secondary open surgical procedure) was performed in 12 and conservative treatment in 9 patients. According to the Leipzig Elbow Score, taking subjective, clinical and radiological criteria into consideration, 4 patients achieved 'excellent' and 5 patients a 'good' result. Ten patients were scored 'moderate' and 9 'poor'. The rate of secondary complications necessitating revision was 36%. Poor results were primarily caused by extensive initial soft-tissue damage, delayed definitive surgical therapy, and ectopic heterotopic ossification. In contrast, fracture localization and degree of arthrosis were not of significant importance for the final outcome. In fracture dislocations, the goal is a primary definitive surgical treatment aiming for early postoperative physiotherapy.

Adolescent↗
PubMed2001

Histopathology in rabbit Achilles tendon after operative tenolysis (longitudinal fiber incisions).

The surgical treatment (tenolysis) of chronic Achilles tendinopathy is often successful. However, little is known about the postoperative intratendinous changes after this procedure. The study group consisted of 21 rabbits. Operative tenolysis was done in each case on one Achilles tendon (AT). The ATs of both legs were studied histologically and immunohistochemically using antibodies against collagen types I and III 2, 4 and 6 weeks postoperatively. Nine rabbits without operation served as controls. A significant uniform hypervascularization was noted in the entire operated tendon postoperatively, and this concurred with the contralateral nonoperated AT, but neither side showed changes in collagen fiber structure as judged by immunohistochemistry. We conclude that the tenolysis procedure triggers neoangiogenesis at the AT followed by increased blood flow and improved nutrition in the same. These changes could, at least partly, explain the often seen clinical success in surgically treated tendinopathy.

Achilles Tendon↗
PubMed2001

[Conservative treatment of dislocated proximal humeral fractures].

Between 11/1989 and 6/1998 52 patients (10 m., 42 f., age median 72 years, 31-88) with proximal humeral fractures have been treated by conservative means (angulation of humeral head > 45 degrees and/or shaft displacement > 1 cm and displacement of greater tuberosity > 0.5 cm). In 37 patients (71%, 31 f., 6 m., age median 75 years, 36-88) a clinical and radiological follow-up could be obtained after median 20 months (3-93). According to the Neer-classification, subcapital 2-part fractures were found in 19 cases and 3-part fractures in 12 cases. 4-part fractures were diagnosed in 6 cases. By using the Constant-Score, the final result was scored "excellent" in 10 patients and "good" in 13 patients. In 7 patients each the results achieved were "moderate" or "poor". The underlying cause for the poor results was primarily due to persisting painful impairment in range of motion and loss of strength. Radiologically, persisting axial deviation was present in 23 cases, arthrosis in 14 patients and humeral head necrosis in 8 patients. Most commonly, poor functional and radiological results occurred in 4-part fractures. However, conservative therapy of displaced 2-part and 3-part fractures is a considerable therapeutical option since the final results are predominantly good. In contrast, due to the poor results after conservative therapy 4-part fractures should be treated surgically.

Adult↗
PubMed2000

[Retropatellar autologous cartilage-bone transplantation. A treatment option in severe cartilage damage].

In a 32 years old professional handball layer, the micro-traumata typical of this game led to retropatellar cartilage lesion, which became sympthomatic following an distortion-impact trauma. Since the patient remains symptomatic after initial conservative treatment as well as arthroscopic chondroplastic, osteo-chondral transplantation was performed. There was a good functional result 6 months after surgery.

Adult↗
PubMed2000

[Proximal and distal humerus fractures in advanced age].

In contrast to distal humeral fractures, humeral head fractures represent a common injury to the old patient. For both fracture localizations osteoporosis and multi-morbidity are of significant importance. The classification for humeral head fractures in one-, two-, three- and four-part fractures is generally accepted. Valgus impacted head fractures as well as head-splitting fractures are considered a separate entity. In none or minimally displaced fractures good functional results are achieved by conservative means. Although numerous therapeutical procedure are offered in the treatment of displaced fractures of the proximal humerus the result are often disappointing. Generally, minimal invasive surgical procedures should be preferred. However, in dislocated multi-part fractures a primary humeral head replacement is often the treatment of choice. In patients with multifarious morbidity a conservative treatment is always to be included into the therapeutical considerations. Distal fractures of the humerus are classified into extraarticular, intraarticular uni-condylar and intraarticular bi-condylar fractures. The therapeutical recommendations, also in the elderly, is relatively homogeneous: primary open reduction and internal fixation (ORIF) should be carried out aiming for an early postoperative functional treatment. Depending from soft tissue conditions and accompanying injuries the functional results are often good or moderate and are generally comparable to those of younger patients. Following a correct indication for surgical intervention the main priority for both distal and proximal humeral fractures is an early definitive surgical treatment.

Aged↗
PubMed1999

[Pertrochanteric pseudarthrosis. Implant failure - technical error - destiny?].

Pain is not always the leading symptom of a failed union. High primary stability often allows full weight bearing in spite of fracture instability. The difficult diagnosis of a pseudarthrosis is a reason for late intervention. Implant failure and implant breakage are typical signs of surgical underestimation. Finally, the diagnosis "pseudarthrosis" is a fluent one and is defined as a failed fracture healing despite implant stability. Recognition of biological and biomechanical failure, this demands correct evaluation of the global situation and extensive experience in revision surgery on the part of the surgeon.

Biomechanical Phenomena↗
PubMed1999

[Segment transport].

Explore the source record for details and available documents.

Fracture Fixation, Internal↗
PubMed1999

[Bilateral posterior fracture-dislocation of the shoulder caused by an epileptic seizure - diagnostic, treatment and result].

The case of an 39-year-old man is presented, who sustained a bilateral locked fracture dislocation of the shoulders occurring during an epileptic seizure. Radiographs demonstrated a compression-fracture of the anteromedial aspect of the humeral head bilaterally (reversed Hill-Sachs-lesions). Additionally, fractures of the lesser and greater tuberosity were diagnosed at the right site. Open reduction and internal fixation was performed in both shoulders within 12 hours. 6 months later the patient has no complaints with a free range of motion. Diagnostics, treatment and result are discussed in context with the literature.

Adult↗
PubMed1999

[Traumatic spondylolisthesis of the axis].

In common the traumatic spondylolisthesis is not a life threatening injury. An exact diagnosis is mandatory as well as a differentiated therapy. Especially the correct decision about the therapy (operative vs conservative) including the technical demanding operative procedures is based on an experienced surgeon. These patients should be transferred to a specialised centre.

Axis, Cervical Vertebra↗
PubMed1999

Open MR imaging in spine surgery: experimental investigations and first clinical experiences.

INTRODUCTION: The latest open MRI technology allows to perform open and closed surgical procedures under real-time imaging. Before performing spinal trauma surgery preclinical examinations had to be done to evaluate the artifacts caused by the implants. METHODS: The MRT presented is a prototype developed by GE. Two vertically positioned magnetic coils are installed in an operation theater. By that means two surgeons are able to access the patient between the two coils. Numerous tests regarding the material of instruments and implants were necessary in advance. The specific size of the artifact depending on the pulse sequence and the positioning within the magnetic field had to be examined. RESULTS: The magnifying factors of the artifact in the spin echo sequence regarding titanium are between 1.7 and 3.2, depending on the direction of the magnetic vector. Regarding stainless steel they are between 8.4 and 8.5. In the gradient echo sequence the factors are between 7.5 and 7.7 for titanium and between 16.9 and 18.0 for stainless steel. The tip of an implant is imaged with an accuracy of 0 to 2 mm. Since September 1997 16 patients with unstable fractures of the thoracic and lumbar spine have been treated by dorsal instrumentation in the open MRI. Percutaneous insertion of the internal fixator has proven a successful minimally invasive procedure. The positioning of the screws in the pedicle is secure, the degree of indirect reduction of the posterior wall of the vertebral body can be imaged immediately. The diameter of the spinal canal can be determined in any plane. DISCUSSION AND CONCLUSION: The open MRI has proven useful in orthopedic and trauma surgery. The size and configuration of the artifacts caused by instruments and implants is predictable. Therefore exact positioning of the implants is achieved more easily. Dorsal instrumentation of unstable thoracolumbar fractures with a percutaneous technique has turned out safe and less traumatic under MR-imaging. Real-time imaging of soft tissue and bone in any plane improves security for the patient and allows the surgeon to work less invasively and more precisely.

Artifacts↗
PubMed1999

[Acute and chronic osteochondral lesions of the talus].

Osteochondral lesions of the talus are often not or delayed diagnosticated. They mostly are related to traumatic lesions of the upper ankle joint, where by traumatic distorsion are most common among. The degenerative change classified as osteochondrosis dissecans tali shows in the most cases also an originally traumatic generic. The classification by osteochondrosis dissecans tali in four stages by Berndt and Harty is nowadays accepted. These can be distinguished by means of several diagnostic methods. They are regarded as state-of-the-art of therapy and prognosis. Basically for diagnostic purposis the conventional X-ray in two planes with the right feet-allignement is sufficient. Despite the fact, that Szintigraphy and Computertomography for particular questions are the right tools, the MRI gives the highest amount of information. In the case of low levels of defects (Stage I and II) the conservative therapy is appropriate. In more serious cases (Stage III and IV) the surgical intervention has to be used. Beside the open surgical approach the arthroscopy has a growing importancy. In 60% of cases good long term results can be achieved. Beside some advantage there are some limits compared to the arthrotomy. The efficiency of new therapeutic methods like bone-cartilage-transplantation and chondrocyte-transplantation compared to the conventional wound toilet, microfractures and fragmentrefixation has to be proved by long term studies. The results depend on the stage and the localisation of the osteochondral lesion. In the developed stages III and IV surgical actions as wound toilet, removement of dissecate with microfragmentation respectivaly refixation are indicated, since conservative therapy methods lead undoubtedly to worse results. Generally mostly good and very good results connected with painless and weight bearing could be achieved.

Acute Disease↗
PubMed1998

[Supramalleolar corrective osteotomy].

The general aspects for the analysis of malalignment of the low tibial region in the three-dimensional space are discussed. Recommendations of clinical and radiological diagnostics prior to low tibial osteotomies are given. Closing wedge, opening wedge, dome-shaped, distraction, rotational and step-shaped osteotomies as well as combined procedures are described. The possibilities of these techniques are pointed out for malalignment after lower leg, pilon and ankle fractures, as well as after trauma of the distal epiphysis of the tibia. Arthroscopy of the ankle is an additional tool for detailed planning of the adequate surgical procedure. The importance of determining an early correction cannot be underestimated.

Ankle Injuries↗
PubMed1998

[Conservative treatment after first traumatic shoulder dislocation].

Between January 1989 and March 1997, 175 patients with traumatic shoulder dislocation were treated by conservative means (median age 41 years, 39 F, 136 M). In 78 patients (17 F, 61 M) a clinical and radiological follow up (median 50 months, range 6-106) could be obtained. Additionally, a diagnostic ultrasound was carried out in all patients. The recurrence rate in the group younger than 30 years (G < 30; n = 35) was 86%; in the group older than 30 years (G > 30; n = 43) it was 21% (P < 0.05). Persisting neurological deficits were found in 6 patients (8%). According to the Rowe score, 16 patients (46%) of the G < 30 achieved excellent or good results, in the G > 30, 29 patients (67%). In 17% of cases, a glenohumeral arthrosis was diagnosed be radiological means. 18% had radiological signs of a previous fracture of the greater tuberosity. Hill-Sachs lesions were identified in 19% of cases. Rotator cuff tears were diagnosed in 9% by ultrasound. No relationship between the duration of immobilization and the recurrence rate was found (P = 0.95). The recurrence rate following primary shoulder dislocation depends primarily on the patients' age.

Adolescent↗
PubMed1997

[Callotaxis--osteogenesis by stretching--a conservative possibility for restoring leg length after post-traumatic primary tibial shortening?].

From 1993 to the beginning of 1996 28 patients (20 male/8 female) with open fractures of the lower leg (classification of Gustilo Type II, Type III) were treated by a primary shortening with a maximum of 5.7 cm (+/- 0.6 cm) after first debridement. After this management 23 patients showed a good soft-tissue cover; 5 patients needed a supplementary musculus latissimus dorsi-transfer to cover the bone. After an average of 22 days (+/- 4.2 days) and the radiologic sign of new callus 8 patients were treated by callotaxis in the fracture gap; 20 patients underwent lengthening by callotaxis of a separate osteotomy after an average of 24 days (+/- 3.6 days). After the mean of 52 weeks (+/- 1 weeks) all patients demonstrated good healing of the fracture and osteotomy. No one showed clinical or radiological signs of osteitis.

Adult↗
PubMed1996

[Plastic soft tissue coverage in defect fractures of the tibia].

Sequential radical debridement and early soft-tissue reconstruction have considerably decreased the amputation rate, length of hospital stay, chronic osteitis, the rehabilitation period and secondary reconstructive procedures in lower leg injuries. The introduction of distraction osteotomy and "biologic osteosynthesis procedures" have led to shorter and safer osteoplastic methods. The indication, tactics and technical pitfalls of current interdisciplinary treatment options requiring modifications in soft-tissue coverage are presented.

Bone Lengthening↗
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

[Is functional conservative treatment of stable lateral ankle fractures justified?].

For Weber type B ankle fractures, operative treatment is generally recommended. Yet, there is no general agreement about the role of functional treatment. In a prospective follow-up study from December 1990 to May 1994, 146 patients were reviewed. The mean follow-up time was 17.3 months for clinical examinations and 19.6 months for X-rays. There were no failures. In all, 85 patients (58%) were treated conservatively (group K). A below-the-knee plaster was applied to 23 patients for 6 weeks, and 62 patients had functional treatment with an ankle brace. According to the Olerud Score, the first subgroup (K-plaster) achieved 89.4 points and the last (K-func.) reached 95.7 points. There were no signs of post-traumatic arthritis. 61 patients (42%) had open reduction and internal osteosynthesis (group OP). In 19 patients a plaster immobilization was necessary, and in 42 patients early mobilization was possible. The first subgroup (OP-plaster) achieved 85.0 points in the Olerud Score; the last (OP-func.) achieved 92.4 points. According to the degree of instability following ankle injuries, a new algorithm for treatment of type B ankle fractures is described, emphasizing early mobilization and functional after treatment.

Adult↗