Search PubMed⌕ Search

Biomedical subjects

C Josten

Publications and source records attributed to C Josten.

At least 55 records · Page 3Linked to original sources
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↗
PubMed1996

[Infected pseudarthrosis].

Sequestrectomy, fragment fixation, wound treatment and bone grafting are the old principles of infected non union surgery. Today these principles are the frame, which contents a more aggressive treatment. Sequestrectomy is a radical excision of the complete infected bone-soft-tissue-scar, the resulting defects are covered by one of the various techniques (skin-traction, flap surgery, bone shifting, etc.). Out of 71 infected non unions, treated by radical resection and bone segment transport, healing rate without recurrence of infection was 94%, in 3 additional patients (4%) amputation was performed. For bone fragment fixation, a non devastating implant, like external fixateur, is preferred. To close the wound, the law of avoiding a dead space is used. Defects are closed by muscle flaps, by fragment shortening or by a antibiotic spacer temporarily. The skin is closed by skin-traction techniques or with flap surgery. After soft tissue healing, small bone defects are filled by autografts, defects of more than 3-4 cm with transported segments. Previous limb shortening to close bone defects, with a lengthening later in a "healthy" region, is also possible. Local antibiotic wound treatment cases a significant reduction of the contamination rate, improved dressing techniques support wound healing free of infection. This therapeutic techniques are comparable to open fracture treatment, where by similar surgery a very low infection rate can be achieved.

Amputation, Surgical↗
PubMed1996

[Ilizarov procedure in pseudarthrosis].

The treatment of nonunions has made an important development through the work of Ilizarov describing the principles of compression and distraction by using the ring-fixator. While local compression is sufficient in hypertrophic nonunions, the treatment of choice for atrophic infected nonunions with bony defects is a corticotomy followed by a segmental transport, especially in case of an osseous defect larger than 3 cm. Primary shortening poses a better starting point both for soft-tissue reconstruction and for early docking. External fixation systems are the ring-fixator, the unilateral fixator and hybrid systems combining both fixation methods. The use of a ring-fixator makes a shorter time of osseous consolidation possible when compared to a unilateral system (25,8 d/cm - 35,8 d/cm). Soft-tissue reconstruction before initiation of transport also shortens the time of osseous consolidation compared to later soft-tissue coverage. A docking-region in the metaphyseal area is supported by minimal internal fixation and cancellous bone graft. Segmental transport is complicated by local infection, regenerate failure (4.3% and regenerate fracture (2.9%).

Adult↗
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

[Perineal injuries in complicated pelvic trauma].

Severe comminuted pelvic ring fractures are often associated by genitourinary and rectal injuries. Because of severe retroperitoneal bleeding, shock management has to be initiated before further diagnosis of the perineal lesions. If normotonic conditions cannot be achieved by volume replacement, a pelvic clamp is indicated providing immediate reduction of the posterior pelvic ring. A subsequent emergency laparotomy has to be considered if stable circulatory conditions cannot be achieved by these emergency procedures. After the initial management of the hypovolemic shock further examination of the rectum by endoscopy and endosonography is performed. Urethral lesions have to be excluded by ultrasound of the bladder, retrograde urethrography and intravenous urography. Urethral and bladder injuries can be initially treated by suprapubic fistula, whereas rectal and pararectal wounds have to be managed by immediate debridement, jet-lavage and wound drainage. Rectal wall and sphincter lacerations are initially restored by suture because delayed reconstructions have poor results. A deviation colostomy is mandatory in cases of colonic and rectal injuries about the internal sphincter.

Colon↗