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Biomedical subjects

D Buck-Gramcko

Publications and source records attributed to D Buck-Gramcko.

At least 37 records · Page 2Linked to original sources
PubMed1991

[Ischemic contracture of the forearm and hand. Staging and indications for surgical treatment].

Results of long-term follow up of 66 patients with ischemic contracture of the forearm and hand, all surgically treated in the "Unfallkrankenhaus Hamburg)) between 1961 and 1982, are presented. Whereas ischemic contracture of the forearm flexors resulted mainly from fractures, ischemic contracture of the intrinsic muscles of the hand was most often seen after pressure injuries. All patients in this study presented to us with fully established ischemic contractures. Muscle and nerve damage was retrospectively evaluated according to operative notes, and the degree of damage could be classified into four groups. Most frequently, neurolysis, scar excision and muscle-sliding operations were performed; furthermore, tendon lengthening, tendon transpositions, wrist arthrodesis and nerve grafting were indicated. Results were judged according to twelve separately measured functions, each measurement giving a possible score of three to six points. Muscle-sliding operations result in an improved score regardless of ischemic contracture stage. For a stage 2 contracture, a 20 point improvement can be expected. In stage 1 contracture--presenting with extension deficiency of four or more points--, complete recovery can be expected following a muscle-sliding operation. For isolated muscle injuries, tendon lengthening is recommended. For stage 2 contracture, the transposition of superficial to deep flexor tendons results in the same score as a muscle-sliding operation; however, the transposition procedure should be reserved for special indications. In stage 3 contracture, the muscle-sliding operation is the treatment of choice, with secondary procedures such as tendon transpositions and nerve grafts often being necessary. In stage 4 ischemic contracture, muscle-sliding operations may improve extension deficiency; however, wrist arthrodesis, especially in combination with extensor tendon transpositions, may be beneficial. No experience with free muscle transplantation was made during the study period.

Adolescent↗
PubMed1990

Proximal toe phalanx transplantation for bony stabilization and lengthening of partially aplastic digits.

In congenital malformations the lengthening of partially aplastic digits, by on-top plasty of a bone graft or the bony stabilization of finger stumps consisting of soft tissues without skeletal elements, is extremely difficult. The usual bone graft, taken from the iliac crest or the fibula, will undergo resorption and will have disappeared a few months postoperatively. Experience has shown that the proximal toe phalanx will with-stand any resorption if it is taken whole, covered by its periosteum. Another advantage is the possibility of the construction of a new joint between the metatarsophalangeal articular surface of the toe phalanx and the distal end of the recipient bone in the hand, which is usually covered by cartilage. Flexor and extensor tendons exist in most cases. Between 1976 and 1988, 69 transplantations of proximal toe phalanges were performed in 43 children. The indications were: boneless digital stumps or partial absence of digits in symbrachydactyly and ring constriction syndrome. Follow-up examinations of 40 patients with 63 transplanted phalanges at an interval of 36 months (12 to 160 months) has shown a 100% take of the bone graft provided it had not been split and the periosteum was undamaged. The earlier in life the operation was performed, the more postoperative growth was recorded. A joint construction was attempted in 46 digits with variable results; active mobility ranged from 0 degrees to 90 degrees. With the use of a tendon interposition, there is a less degree of shortening of the toes.

Adolescent↗
PubMed1990

The role of nonvascularized toe phalanx transplantation.

Stabilization of boneless finger stumps or lengthening of partially aplastic digits in congenital malformations is difficult, because the bone graft, placed on top of the existing bone, will undergo resorption. Only the periosteum-covered proximal toe phalanx will withstand resorption and show a complete take. With the toe phalanx, including the plantar plate and the collateral ligaments of the metatarsophalangeal joint as a half-joint, it is possible to construct a new joint with the cartilage-covered distal end of the recipient bone (metacarpal or proximal phalanx) as the proximal half-joint. Flexor and extensor tendons exist in almost all cases. Between 1976 and 1990, 97 toe phalanx transplantations were performed in 57 children. The indications were boneless digital stumps with partial absence of digits and large bone defects in fingers in symbrachydactyly and ring-constriction syndrome. Follow-up examinations of 44 patients with 69 transplanted toe phalanges (95% of the patients operated on by March 1989) have shown a 100% take of the bone graft, provided it had been unsplit and the periosteal cover undamaged. The earlier in life the operation was performed, the more postoperative growth was recorded. The shortening of the donor toe was less because a tendon interposition was used. A joint construction was attempted in 64 digits with variable results. The range of active motion varied between 0 (fusion) and 90 degrees.

Bone Transplantation↗
PubMed1990

[Results of treatment of semilunar bone necrosis. A study of 91 patients].

The results of nine different methods for treating patients with lunate necrosis were investigated in a retrospective study. The study included seventy-eight of eighty-two operated patients with an average follow-up of five years and thirteen of thirty-five patients conservatively treated were examined at an average follow-up time of nine years. Treatments used were: shortening of the radius, lengthening of the ulna, pisiform transposition, prosthetic replacement, tendon interposition arthroplasty, STT-arthrodesis (scaphotrapezio-trapezoid arthrodesis), denervation of the wrist, wrist arthrodesis, and conservative therapy. The most important criteria for rating the results were pain relief, range of motion, grip strength, and X-ray findings. In the early stages of lunate necrosis with a minus variant of the ulna the best results were obtained by shortening of the radius. In intermediate stages good results could be achieved by tendon interposition arthroplasty. Denervation and STT-arthrodesis can be performed at any stage of the disease and may be combined with other methods. Despite some good results, a search for even better operative methods should continue, because the available techniques, especially in cases of advanced necrosis, do not always lead to satisfactory results.

Adolescent↗
PubMed1989

[Classification of polydactyly of the hand and foot].

The authors present a classification for polydactyly of the upper and lower limb based on a follow-up examination of 177 patients with 336 polydactylies. The malformations are described in longitudinal and transverse directions. In the transverse axis the affected rays are designated with Roman numbers from I to V. The longitudinal axis from distal to proximal is used to differentiate the rays into ten types according to their duplication assessed both anatomically and radiologically. Triphalangism, rudimentary forms, and trifid rays can also be described by this system, so they can be correlated. Evaluation of the patient group according to this classification shows that the marginal rays of hand and feet are most affected. In the longitudinal axis the metacarpo- metatarsal joint type predominates in the upper and lower limb. Using this classification it seems possible to relate different forms of polydactyly to each other and to compare therapeutic procedures and their results.

Fingers↗
PubMed1988

[Injuries of the flexor and extensor tendons of the hand and forearm and their treatment].

The general principles of treatment of injuries of the flexor and extensor tendons in the hand and distal forearm are mentioned. For the extensor tendons the different types of treatment performed for injuries in the different areas, the finger, the back of the hand, and the wrist, are briefly discussed. Knowledge recently acquired from experimental and clinical studies, especially that of the anatomy, the blood supply, the nutrient pathways, and the healing of the flexor tendons, is discussed, and its applications in our daily clinical work are shown.

Forearm Injuries↗
PubMed1988

[Finger joint arthrodeses with intraosseous wire suture and Kirschner wire. A comparative study of 309 operations].

In this study the results of digital arthrodeses with intraosseous wiring and Kirschner-wire were compared with other operative techniques. The report is based on 309 operations performed between 1979 and 1982. The indications were mostly traumatic and posttraumatic joint lesions. Here the best results were obtained with the technique of intraosseous wiring and Kirschner-wires. On an average, it took seven weeks to full radiological and clinical bony union. Also the functional results after digital arthrodeses with different techniques were studied. With a mean total active range of motion of 76.8% compared with normal, this technique showed good results. Compression screw arthrodeses, tension-band arthrodeses and digital arthrodeses with crossed Kirschner-wires were performed only for special indications during the period covered by the report.

Amputation, Surgical↗
PubMed1988

[Assessment of treatment results of extensor tendon injuries].

Criteria for evaluation of results after extensor tendon lesions are presented, which are easy to apply and based on angular measurements of active joint mobility. The scheme is analogous to the evaluation method for flexor tendon injuries published by Buck-Gramcko et al. in 1976 which is now widely used. A modification was necessary to treat the extension deficits more severely. A comparison is made to the evaluation method proposed by the Group of Erlangen, and both schemes are tested on 68 patients with extensor tendon injuries of different zones, various fingers and combinations. Lesions of the thumb require different criteria.

Adolescent↗
PubMed1987

[Pseudarthrosis of the scaphoid bone. Experiences in 240 cases].

The results after treatment of 197 non-union of scaphoid fractures are reported. The operative technique of Matti-Russe, called also Russe I, has proved successful in cases in which the fracture is located in the middle or distal third of the scaphoid or where there is a viable small proximal fragment. Bone healing depends more on the age of the pseudarthrosis than on the age of the patient. In 86% of 83 cases the technique of Russe I was successful and in this group the period between accident and treatment was no longer than two years. After a period of more than four years after the accident the success rate is only 54%. The combination of the technique of Russe I with styloidectomy of the radius diminishes the number of good results. The operative technique known as Russe II assumes a good blood supply of the distal fragment of the scaphoid. In 15 cases, after resection of the necrotic small proximal fragment of the scaphoid, a fungiform bonegraft from the iliac crest was placed in the cavity and the success rate was 80%. The findings after palliative treatment of 43 non-unions of the scaphoid are based on subjective criticisms by the patients. The denervation of the wrist and the wrist arthrodesis were done in 28 cases. After resection of the necrotic proximal fragment, a tendon interposition arthroplasty was performed in nine cases, and in six cases a prosthesis for the proximal part of the scaphoid was implanted.

Bone Transplantation↗
PubMed1987

[Alternative surgical procedure in pseudarthrosis of the scaphoid bone with a small proximal fragment].

The management of non-union of the scaphoid with a Herbert screw assumes a specific size of the proximal pole fragment. In cases of extremely small proximal pole fragments the length of the leading thread of the screw can cause blockage of the proximal pole fragment. In these instances a dorsal approach is used and the Herbert screw is inserted in a proximal-to-distal direction rather than the usual distal-to-proximal insertion. The advantages are a stable internal fixation and an abbreviated period of immobilization in plaster; however, the small number of cases reported does not permit us to draw conclusions regarding indications for use of this technique.

Bone Screws↗
PubMed1986

[Resorbable PDS splints in fracture stabilization and for arthrodeses of the hand].

Small rods of resorbable Polydioxanon (PDS-splints) are suitable for stabilizing fractures of a phalanx, either near the base or the head, be the fracture transverse or comminuted. Such internal splints are especially useful in replantation of clean amputations. Used in combination with intraosseous wiring, osteosynthesis can be achieved that is stable for exercise in all cases. Another use is in arthrodesis of the distal interphalangeal joints and the metacarpophalangeal joint of the thumb. Disadvantages that accompany Kirschner wire fixation are thus avoided. Case descriptions and results are presented.

Adult↗
PubMed1986

[Instabilities of the wrist joint].

Carpal instabilities are caused by traumatic injuries to the bones and ligaments of the wrist joint, or by chronic overstretching of the ligaments due to inflammatory or degenerative diseases; an important factor in their development is the anatomical shape of the bones and their articular surfaces. According to their location, they are classified as radial (lateral), medial, and proximal carpal instabilities. The different types are described, especially with regard to their radiological signs; static and dynamic instabilities are distinguished. The common therapeutic strategies are reconstruction of ligaments, intercarpal arthrodesis, or correction osteotomy of the radius.

Biomechanical Phenomena↗