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Biomedical subjects

C Josten

Publications and source records attributed to C Josten.

At least 73 records · Page 4Linked to original sources
PubMed1994

[Therapy of unstable sacrum fractures in pelvic ring. Results of of osteosynthesis with early mobilization].

Eight patients with sacrum fractures combined with pelvic ring fractures type C were treated using a triangular osteosynthesis after reduction of the fracture. The additional vertical stabilization between the lumbar spine and the posterior iliac crest caused the stability, which is necessary for immediate mobilization of patients. Perfect reduction, correct positioning of the hardware, gentle soft tissue treatment, as well as early mobilization of the patient, increases the early and late prognosis considerably, and compensates the operative trauma completely. We observed no infections or redislocations. The described operative treatment is state of the art at our institution.

Adult↗
PubMed1994

[Sports fitness after functional conservative versus surgical treatment of acute Achilles tendon ruptures].

Acute Achilles tendon ruptures are mostly related to recreational activities. Therefore, these patients intend to return to sports as soon as possible with no functional deficiency. This is the first study, comparing functional results after functional treatment to those after surgery. According to sonographic examinations of the tendon gap, primary functional treatment with heel supported shoes or surgery were suggested. Between 2/1991 and 12/1992, 22 patients with acute Achilles tendon rupture were treated without operation (group 1) and in 10 patient the rupture was sutured (group 2). 6 months later, 27 patients underwent standardized clinical examination: one leg standing for one minute, measurement of the circumference of the calf. The actual activities were assigned to Tegner Activity Score. 19 patients had isokinetic cybex testing with 60 degrees/s. There were 3 re-ruptures in group 1 and no comparable complications in group 2. At this time, clinical examination and Tegner Activity Score showed no relevant differences. Force of flexion was 30.4% lowered in group 1 and 2.4% in group 2. Additional training of the calf muscles improved the results after 6 weeks in group 1. We concluded that individual management of acute Achilles tendon rupture is possible according to sonographic tendon gap. Functional treatment is effective, but the rate of re-ruptures has to be reduced by careful selection of patients (rupture gap < or = 2 mm, high cooperation).

Achilles Tendon↗
PubMed1993

[Unreamed intramedullary nail or external fixator in complicated tibial fracture? A comparative analysis].

Sixty-seven fractures of the tibial shaft with concomitant soft tissue injury were managed at the "Bergmannsheil" Bochum, University Clinic between May 1, 1991 and March 31, 1993. 33 fractures underwent unreamed nailing whereas 34 fractures were stabilized with external skeletal fixation. There were 20 closed fractures with soft tissue compromise (13 types GII and 7 types GIII (Oestern/Tscherne classification)) and 25 compound fractures (8 grade I, 12 grade II and 27 grade III (Gustilo-Anderson classification)). The grade III open fractures were subdivided by the Gustilo-Mendoza-Williams classification (13 types IIIA, 10 types IIIB and 4 types IIIC). Sixty-five fractures have healed (1 amputation type IIIC, 1 patient died). The mean time to union was 28 weeks in the fixator group and 23.5 weeks in the unreamed nail group (statistically not significant, p < 0.095). Also the infection rate (1 case in each group), the fasciotomies due to compartment syndrome, the number of bone grafts, the number of device change and mesh grafts was not statistically significant in both groups. Only the number of performed flaps for wound coverage was statistically significant higher in the fixator group (p < 0.05). In the unreamed nailing population, breakage of the locking bolts occurred in 4 cases. In 3 cases secondary reamed nailing was necessary (2 delayed unions, 1 avulsion of distal bolts). Two fractures underwent dynamization by removal of the distal locking bolts 6 weeks post initial static nailing. The unreamed nail is a versatile implant for tibial shaft fractures with closed and open soft tissue compromise.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[Complications of intramedullary nailing and their prevention].

Interlocking nailing technique offers a wide variety of indications which are associated with an increased risk of complications. A consecutive series of 208 cases were analyzed and possible complications, how to avoid them and recommendations for treatment are given. The complications were divided into common complications--like infection, pseudarthrosis, malrotation, compartment-syndrome, disorders of the arterial and venous system, neurological deficts and fat embolism--as well as into specific complications--like malreduction of the fracture, malpositioning of the guide wire, splitting fragments and problems with nail insertion and with the locking bolts. There was a 8.7% common complication rate. Specific complications occurred intraoperatively in 3.5% and postoperatively in 11% of call cases. This seems to be a high rate which is decreasing by progressive experience of the surgeon. In many cases of shaft fractures interlocking nailing technique is the method of choice.

Adult↗
PubMed1992

What's new in exogenous osteomyelitis?

By the increase in road and occupational accidents during the past few decades posttraumatic osteomyelitis has become not only the most important type of exogenous but of all inflammatory bone processes. The major morphologic, bacteriologic and immunologic studies about posttraumatic bone inflammation will be outlined in this survey. The histologic classification of chronic osteomyelitis has proved useful for the observation of the course and for the selection of the treatment in 1,500 patients. Detailed morphological studies have shown that posttraumatic osteomyelitis often begins with a necrosis of the outer tangential lamella of the tubular bone partly promoted by partial periosteal retrogression, possibly followed by a necrosis of the fracture ends caused by a disturbance of the medullary blood circulation. Type and extent of osteomyelitis are determined by several traumatic, therapeutic and endogenous factors. Bacteriologically an infection with staphylococcus aureus is still prevailing. Comparative studies about the causative agents shortly after the trauma and during the following osteomyelitis have basically shown an identical range of causative agents. Immunologic studies with monoclonal antibodies in the actual site of inflammation have on the one hand found a decrease in the number of T-lymphocytes and the T-helper cells and on the other hand an increase in the T-suppressor cells, natural killer cells, macrophages in the osteomyelitic site. The impact of these findings on the therapy of osteomyelitis can presently not be estimated. However, they will become important after immunohistochemical studies of the bone and soft tissue Lager in osteosynthetic material after aseptic bone surgery have been carried out.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents↗
PubMed1992

[The epaulette flap: replantation of osteomyocutaneous forearm segments in interscapulo-thoracic amputation].

Despite sophisticated artificial limb devices available today, forequarter amputation following trauma or tumor resection will lead to severe impairment of function. To close the posttraumatic or oncologically required extended defects and to improve prosthetic supplementation coverage of the thoracic wall should be performed by sparing the whole forearm as an osteomyocutaneous flap. In cases of concomitant serial rib resection radius and ulna will serve as stabilizators of the thoracic wall, thus avoiding a flail chest. Indications, technical details and clinical outcome of three salvage replantations after interscapulo-thoracic ablation will be discussed.

Amputation, Surgical↗
PubMed1992

[A cellular quantitative immune deficiency in chronic post-traumatic osteomyelitis].

The specific cellular host defence in patients with chronic post-traumatic bone infection was analyzed in a prospective study. The study included 120 patients with chronic post-traumatic osteomyelitis and 60 healthy volunteers. The number of CD-5, CD-4, CD-8, natural killer cells and the CD-4/CD-8 ratio were significantly decreased. The immunodeficiency seems to be trauma-induced and reinflammation seems to be due to other immunodeficient factors. The potential key role of a defect in cytokines is discussed.

Adolescent↗
PubMed1991

Impairment of specific host defense mechanisms in patients with chronic post-traumatic osteomyelitis.

We studied both in vivo and in vitro specific host defense mechanisms in patients suffering from chronic post-traumatic osteomyelitis (n = 26). The cell-mediated immunity in vivo was impaired as indicated by the reduced reactivity in the delayed type hypersensitivity skin test. The concanavalin A or phytohemagglutinin-induced T-cell proliferation in vitro was markedly decreased in comparison to healthy donors. In contrast, B-cell proliferation stimulated by Staphylococcus aureus Cowan I was not altered. While the absolute lymphocyte counts and the percentage of T, B, and O cells were within the normal range, nine out of the 26 patients showed a significantly diminished ratio of CD4+ and CD8+ T cells. Humoral immunity in the patients was less affected as assessed by the unchanged serum levels of immunoglobulins (Ig). However, the T-cell dependent polyclonal Ig synthesis after in vitro stimulation with pokeweed mitogen was suppressed. Our results provide evidence that cell-mediated immune functions are predominantly impaired in patients with post-traumatic osteomyelitis which may contribute to the persistence of the localized bone infection.

Adolescent↗
PubMed1991

[Aggressive volume therapy for prevention of acute renal failure in multiple trauma patients].

Immediate fluid resuscitation is of the utmost importance for patients with multiple trauma. Evaluation of this form of treatment for the prevention of acute renal failure was the purpose of this study. Of 262 patients with multiple trauma, 112 were in shock on admission. The patients were treated with large volumes of Ringer's lactate and sodium bicarbonate until urine production was 60-100 ml/h. Hemoglobin and electrolytes were substituted according to the laboratory findings. There were 32 patients who developed renal complications, such as bacteriuria (13), hematuria (7), reduction of renal function (3), and acute renal failure (9). The renal failure did not develop during the first 24-48 h but during treatment in the intensive care unit, mostly in the course of multiple organ failure. Death supervened in 35 of the 262 patients (13.5%). Thus, immediate rapid fluid replacement with large volumes of crystalloid solutions can prevent acute renal failure.

Blood Volume↗
PubMed1991

[Immunostimulation with ibuprofen in chronic osteitis. An experimental study].

The present investigation shows that chronic posttraumatic osteitis is associated with markedly elevated prostaglandin E2 (PGE2) serum levels. Synthesis of PGE2 is inhibited by nonsteroidal antiinflammatory drugs, such as ibuprofen, which block cyclooxygenase. Osteitis patients showed significantly decreased PGE2 serum levels during treatment with ibuprofen (1200 mg/day). In addition, a significant increase in soluble interleucin-2 receptor serum levels was observed. PGE2 has significant immunosuppressive effects on cell-mediated immunity. On the other hand, soluble interleucin-2 receptor is a reliable indicator of immune system activation. Ibuprofen seems to be a potent immunostimulating agent for the treatment of chronic posttraumatic osteitis, which is characterized by depression of cell-mediated immunity.

Dinoprostone↗
PubMed1990

[Quantitative immunohistological analysis of cell-mediated immunity in osteomyelitic bone tissue].

The present investigation allows an exact identification and quantification of cell populations involved in local cell-mediated immunity of osteomyelitic bone tissue. Determinations of systemic immunity carried out in osteomyelitis patients indicated the distribution of immunogenic cells in the osteomyelitic focus only indirectly. The method described combined with simultaneous determination of the systemic immunity and cell mediators can lead to a quantitative description of cell-mediated immunity and in turn to a better understanding of the interaction of cells and transmitters involved in osteomyelitis.

Adult↗
PubMed1990

[Arthroscopic abrasion arthroplasty of the upper ankle joint. Long-term results in osteochondrosis dissecans].

From January 1984 to June 1987, a total of 27 patients received arthroscopic treatment to the ankle to remove cartilage fragments and curet the osteochondral bed, and control arthroscopy was possible after 4 months in 4 cases. Particular attention is paid in this report to 11 patients with a total of 13 lesions of the talar dome (stage III/IV according to Brandt/Harty), with discussion of the etiology, the treatment and the long-term postoperative results. On follow-up at 2 years, the results were assessed both subjectively and objectively as good in 7 and fair in 4 of these patients. The advantages of arthroscopic treatment over open surgery and arthrotomy are less severe traumatism, a lower complication rate and faster rehabilitation.

Adult↗
PubMed1987

[Arthroscopic diagnosis of the wrist joint].

Arthroscopy of the wrist is a helpful diagnostic procedure. The technique of the arthroscopy of the wrist is described. Initial experience in 22 diagnostic arthroscopies of the wrist is recounted. In six cases operative procedures followed the diagnostic arthroscopy.

Arthroscopy↗