Biomedical subjects

C Josten

Publications and source records attributed to C Josten.

78 records · Page 5Linked to original sources

PubMed1986

[Functional treatment of fractures of the upper and lower extremities. Results of 3 years' experience].

The use of plastic boxes in functional treatment of bone fractures has satisfactorily helped to speed up non-invasive reintegration of patients to their normal environment. The time of treatment can thus be considerably reduced. Correct indication, short-interval follow-up checks in the initial phase, and the patient's cooperative attitude are essential to good success. Brace treatment of upper arm fractures, ulnar fractures, and closed tibial fractures have been three of many indications suggested by Sarmiento which have proved to yield good results at "Bergmannsheil Bochum".

Arm Injuries↗

PubMedDate not supplied

[Isolated rupture of the subscapularis tendon in the overhead athlete - the result of chronical overuse?].

The case of a 27-year-old overhead athlete with chronic shoulder pain because of an isolated subscapularis tear without trauma is described. Arthroscopy has proven to be the appropriate method for detailed visualisation of the injury and facilitates the operative planning. Furthermore, arthroscopy closes the problem of a "diagnostic gap". In the presented case, the results at the two year follow-up are excellent. The authors conclude that an operative approach is also justified in non-traumatic isolated ruptures of the subscapularis muscle.

Adult↗

PubMedDate not supplied

[Differentiated therapy in necrotizing fasciitis of three extremities].

AIM: Here we present the clinical symptomatology of and therapy for necrotizing fasciitis. METHOD: The case of a 35-year-old female patient with sustaining fractures of the 5 (th) and 10 (th) thoracic vertebrae and a pulmonary contusion and without any skin lesions is presented. RESULTS: Conventional x-rays and computed tomography revealed stable spine fractures not necessitating surgical intervention. Fifteen days after the accident the patient developed septic conditions. An interdisciplinary search (surgical, neurological, urological, internal medicine) for the septic focus first remained negative. After demarcation of necrotic skin areas at the upper left arm, bilateral necrotizing fasciitis was diagnosed at both thighs and at the lower left leg, necessitating continuous optimisation of the therapeutic strategy. CONCLUSION: Local aggressive surgical therapy in combination with systemic antibiotic administration is the therapy of choice in treatment of the necrotizing fasciitis. It should be performed according to the principle "life before limb". In the presented case the patient recovered and good functional results could be achieved.

Adult↗

PubMedDate not supplied

[Revision possibilities after failed unicompartmental knee arthroplasty--an analysis of 116 revisions].

AIM: A major advantage of the unicompartmental knee arthroplasty (UKA) is the quick rehabilitation, small traumatisation of tissue and the mostly uncomplicated revision to a total knee arthroplasty. The aim of the study is to examine whether the conversion to the total endoprosthesis, as is frequently is recommended at present in cases of defect of the sleigh system, is always necessary or whether a revision can have good chances of success with use of the unicondylar system under certain conditions. METHOD: 116 revisions were studied after unicompartmental knee arthroplasty at the first appearance of problems and during the follow-up of 45 months (range: 10-86 months) using the Knee Society Score and analyses of the various additional procedures as well as the anterior cruciate ligament substitute, the correction of slope etc. Revisions, with exchange of components or a conversion to a total arthroplasty, were included. RESULTS: In 60.3 % of all cases a revision could be performed within the unicompartmental knee system, with a mean score of 167.4 (range: 144-173). The outcome score corresponded to the outcome of primary UKA implantations and to conversion operations to total endoprosthesis in the literature (p < 0.05 Wilcoxon test). CONCLUSION: Under critical contemplation of the low case number and this short- to medium-term examination, individual revision solutions seem to have their entitlement within the unicondylar system as also do conversion operations to the TKA. Long-term results and larger case numbers are absolutely necessary prior to further judgment.

Adult↗

PubMedDate not supplied

Triangular osteosynthesis of vertically unstable sacrum fractures: a new concept allowing early weight-bearing.

OBJECTIVE: Presentation of a new triangular osteosynthesis technique that permits early weight-bearing in vertically unstable sacral fractures. DESIGN: Retrospective evaluation of a consecutive series. SETTING: Level I trauma center. PATIENTS: Thirty-four patients, twenty-eight of whom were polytraumatized, all with vertically unstable sacral fractures. This group included eight women and twenty-six men, with a mean age of thirty-five years. Average time between trauma and definite operation was thirteen days (range 0 to 28 days). INTERVENTIONS: All patients underwent triangular osteosynthesis using a combination of a vertical vertebropelvic distraction osteosynthesis (pedicle screw system) and a transverse fixation of the sacrum fracture with either iliosacral screws or transsacral plating. Immediate postoperative weight-bearing was permitted postoperatively. RESULTS: Nineteen patients were treated with early progressive weight-bearing and advanced to full weight-bearing, on average, after twenty-three days (range 8 to 70 days). Three of the thirty-four patients (9 percent) experienced loosening of hardware, including two patients (6 percent) who required secondary intervention because of loss of the original reduction. Further complications included one pulmonary embolism (3 percent), one iatrogenic nerve lesion (3 percent), one wound necrosis (3 percent), and two local infections (6 percent). CONCLUSIONS: Triangular osteosynthesis is a demanding procedure that can be performed on vertically unstable sacral fractures to allow early progressive weight-bearing with an acceptable complication rate.

Adult↗

PubMedDate not supplied

Open reduction and augmentation of internal fixation with an injectable skeletal cement for the treatment of complex calcaneal fractures.

OBJECTIVES: To describe the surgical handling, potential complications, and remodeling of an injectable, osteoconductive calcium phosphate cement (Norian SRS) for joint depression-type calcaneal fractures in humans, and to illustrate the clinical efficacy of this cement with special reference to early postoperative full weight bearing. DESIGN: Prospective cohort study. SETTING: Level I trauma centers in Bochum and Leipzig, Germany. INTERVENTION: Thirty-six joint depression type calcaneal fractures in thirty-two patients were augmented with the calcium phosphate cement after standard open reduction with internal fixation. Postoperative full weight bearing was allowed progressively earlier, and as the study progressed, the last patients were bearing full weight as early as three weeks postoperatively. Biopsies for histologic analysis were performed at time of hardware removal after one year (seven biopsies) or in case of infection at time of debridement (five biopsies). MAIN OUTCOME MEASURES: Clinical outcome was evaluated according to a calcaneal scoring system. Data were compared and statistically analyzed between patients with postoperative full weight bearing after eight to twelve weeks and three to six weeks, respectively. Histologic findings are described. RESULTS: Cement injection averaged ten cubic centimeters and could easily be performed under fluoroscopic control. Progressively earlier full weight-bearing was achieved without loss of reduction. There was no statistical difference in clinical outcome scores in patients with full weight bearing before or after six weeks postoperatively. The infection rate was 11 percent, possibly related to the skin incisions. The biopsies from clinically satisfactory cases showed nearly complete bone apposition, areas of vascular penetration, and reversal lines illustrating progressive cycles of resorption and new bone formation. Biopsy specimens from infected cases showed bone and cement surrounded by either fibrous tissue or acute inflammation without extensive bone apposition. CONCLUSIONS: Calcium phosphate cement augmentation of standard open reduction with internal fixation in joint-depression type calcaneal fractures allows postoperative full weight bearing as early as three weeks postoperatively. The injectable bone cement can easily be handled surgically under fluoroscopic control and has proved to be remodelable.

Adult↗