Biomedical subjects
Publications and source records attributed to E Brug.
One hundred years ago, Fritz de Quervain first described the surgical treatment of tendovaginitis of the first dorsal compartment. Since then, various ways of treatment have been pointed out. In a series of 72 patients treated surgically, 82% recovered completely. Postoperative complaints included irritations of the superficial branch of the radial nerve.
Between 1976 and 1993 we have operated 253 patients with 350 fractures of the radius-and/or ulna. 180 fractures were stabilized with a plate (ASIF) or external fixation. In 100 patients with 170 fractures Hackethal's bundle nailing was performed, including 23 times nailing of one bone and external fixation or plating of the other bone. Our indications for Hackethal's bundle nailing of forearm fractures are closed and 1 degree open A and B-fractures of the 2. to 5. sixth of the radius and/or the ulna. 83 of 100 patients, stabilized with bundle nailing, were followed up clinically and radiologically after a mean of 6.8 years. For evaluating follow-up results, the score by Oestern and Tscherne was employed. Very good and good results were found in 74.7%, satisfying and poor results in 25.2% of the cases. Injuries of the same extremity, e.g. fractures of the humerus, arterial- or nerve lesions interfered with the results. We found a low complication rate after bundle nailing: 1 osteomyelitis (0.59%), 3 non-unions (1.76%), 1 refracture (0.59%), 5 synostoses (4.12%, incl. 2 patients (1.18%) with a combination of bundle nailing and plate osteosynthesis or external fixation). In the mentioned indications the stabilization of forearm fractures by Hackethal's bundle nailing is a low-risk method with fast bone healing and short operation time.
The aim of outpatient surgery is to reduce costs in the health service. However, the number of surgeons working in a surgical department is dependent upon the numbers of occupied beds. This creates an existential conflict in which, by reducing the occupancy of beds in order to take on more outpatient cases, surgeons are putting their own jobs on the line. Possible solutions are here discussed.
A 59-year-old patient underwent endoscopic carpal tunnel release by Chow's two-portal technique. He developed a pyogenic tenosynovitis and an infection within the ulnar and radial bursae, an abscess in the middle palmar, thenar and Parona's space, and a pyogenic wrist arthritis. Surgical treatment included a wide exposure of the infected region, débridement, irrigation, application of a resorbable collagen sponge containing gentamicin, insertion of two drains and primary wound closure. The infection was brought under control and hand function restored.
Within a period of 6 years we operated on 109 patients with De Quervain's disease. Of the patients 82% recovered completely, 18% had slight residual complaints, e.g. stress-dependent discomfort and irritations of the superficial radial nerve. The operative technique is presented in detail and the frequency of anatomical variations of the first extensor tendon compartment is emphasized.
We report here on the treatment with intramedullary nailing or gamma nailing of 23 pathological femoral shaft fractures, 14 patients having tumors or metastases. Thirteen (13/14) tumor patients were treated palliatively and one patient radically. The results were that 10 patients were able to walk after the operation, all patients gained considerable relief from pain and nursing was facilitated. Intramedullary nailing or gamma nailing offers, in the given indications, a good alternative to the other osteosynthesis procedures.
PURPOSE OF THE STUDY: Purpose of the study was to present the advantages of intramedullary nailing of long bones for treatment of fractures of the forearm. These advantages are 1) preserving the fracture-hematoma and 2) non exposure of bone. This technique is based on the technique of bundle nailing developed by Hackethal (1959). MATERIAL AND METHODS: In a 16-year period we performed Hackethal bundle nailing in 94 patients with 159 fractures. Hackethal developed the nailing procedure named after him in 1959. The rationale of Hackethal nailing is based on elastic jamming, which can only be achieved by following four rules: jamming of the nails in the cortical window, jamming then in the waist of the medullary cavity, spreading the bundle of nails in the metaphysis and filling up the conus of the medullary cavity with short nails. We confined Hackethal nailing to closed and first-degree open fractures of the midshaft of the forearm. If closed reduction and nailing were impossible, we performed a plate fixation (AO). Second- or third-degree open fractures were treated with external fixators. RESULTS: In 62.8 per cent patients surgery was performed within the first 8 hours following admission. We used two or three nails passing the fracture and one short nail. Except for 1 case, in which a cast was necessary, we achieved rotational stability. On average, the nails were removed after 11.5 months. The healing and complication rates were assessed by follow-up examination of 77 patients. The results were excellent and good in 75.3 per cent patients, satisfactory 14.3 per cent and poor in 10.4 per cent. Complications consisted of a 0.74 per cent infection rate (osteitis), 2.2 per cent non-union, 1.5 per cent with a synostosis, 0 per cent refracture and 2.2 per cent migration of nails, combined with tendon rupture. We have seen 1 case with metallosis. DISCUSSION: There are four important benefits of this treatment. First with this principle bone healing is achieved after 2.6 month, but with the plate fixation it lasts 7.5 month. Second, the rate of non-union goes down from almost 6 per cent to 1.5 per cent. Third, the postoperative infection rate is reduced (0.74 per cent) and fourth joint motion is preserved. Our bad results are mainly caused by the polytraumatic conditions of some patients. CONCLUSION: In conclusion with our confined spectrum of indications Hackenthal nailing is a low-risk method, which leads to rotational stability and early bone healing.
During a period of 13 years we performed 56 extensor indicis proprius (EIP) transpositions for reconstruction of the ruptured or severed extensor pollicis longus tendon. The open injuries (n = 9) involved failed primary repair or untreated tendon injuries. The subcutaneous ruptures occurred after distal radius fractures (n = 17) or other closed injuries of the wrist (n = 10), without trauma in 14 patients and in 6 patients by rheumatoid synovialitis or collagenosis. 35 patients returned for follow-up examination 8 months to 10.5 years after operation. According to the evaluation scheme suggested by Geldmacher et al. we report 13 excellent, 19 good and 3 satisfactory results. Although several authors prefer EPL reconstruction with an intercalated tendon graft, we recommend the EIP transposition as a simple procedure with predictable satisfactory results.
The principles of bundle nailing--jamming of the nails in the cortical window, jamming in the waist of the medullary cavity, spreading the bunch of nails in the metaphysis and filling up the conus of the medullary cavity with short nails-should be observed. Then this method of intramedullary osteosynthesis is of diaphyseal fractures with slight damage to the soft tissues is indicated ideally in the second to fifth sixth of the humerus. The complication rate is low. If there is a primary traumatic lesion of the radial nerve or if there are open fractures and/or multiple fractures in case of polytraumatized patients, operative stabilization is mandatory using plate osteosynthesis or external fixation.
The evaluation of 174 humeral shaft fractures treated operatively in our institution and a literature review are used to illustrate the indications for operative treatment. For some indications, the authors prefer Hackethal's bundle nails. A simple operative technique and a small approach incision far distant from the fracture site, which prevents the fracture hematoma, and the very low complication rate are the advantages of this method, making it an alternative to plating and even to bracing. Operative treatment is clearly indicated for compound fractures grades II and III. As the humerus--unlike the tibia--has a good soft tissue envelope, plating can be carried out without the danger of insufficient soft tissue coverage. Complete radial palsy is also an indication for primary operative nerve revision, followed by stable osteosynthesis, preferably with plate. In our series primary radial palsies were observed in 47 (27%) of cases; on revision we found 5 cases of nerve division and 2 of impingement between fragments. Further absolute indications are the rare injuries to the brachial artery, bilateral fractures, and combination with a forearm fracture ("floating elbow"). Closed fractures without concomitant injuries can generally be managed conservatively. We have treated 84 of these fractures with Hackethal's nails. The only serious complications were one non-union (1.2%) and one deep infection (1.2%).
Capitate fractures are serious and rare carpal injuries. A case of a closed, isolated capitate fracture is presented. The largest fragment of the capitate, which was fractured at its waist, was dislocated with the wrist twisted in an ulnodorsal orientation. The supposed traumatic cause of the capitate fracture was a fall onto the outstretched and ulnar-deviated hand. After open reduction, osteosynthesis with K-wires was performed. Immobilization for 6 weeks in a plaster-of-Paris cast followed. The excellent functional result (according to the modified evaluation scale of Pechlaner/Beck) obtained after 15 months is demonstrated. Diagnosis and subsequent therapy should be as aggressive as in the case of scaphoid fractures. Different modalities and possible complications of an operative treatment are discussed.
Fractures of the distal humeral diaphysis are rare and have not been reported very often in the literature, although therapeutic management is more difficult than that of midshaft humeral fractures. As they are so near to the elbow, these fractures are not suitable for bracing, because pro/supination movements cannot be eliminated. Muscular forces, especially of the pronator teres muscle, force the fracture into a varus position with every supination movement. From 1974 to 1990 we treated 174 fractures of the humeral diaphysis by operative means; 31 of these were located in the distal third. According to the AO classification, 8 were graded as less difficult type A fractures, 15 as type B and 7 as type C fractures. In 22.6% of the patients primary radial palsy was present. In all, 15 fractures were treated by plating, 9 with Hackethal's bundle nails and 6 with monolateral fixators. These last patients had sustained either multiple trauma or severe soft tissue injury or both. The plated cases included 1 with non-union and with superficial infection, both in type C comminuted fractures. In 1 case the fracture was not suitable for plating, and in the other case technical errors led to failure. In the 9 cases treated with Hackethal nails there were no complications. The advantage of the method is that the nails are inserted far distant from the fracture site. Anatomical reduction is not necessary, which means there is no danger of devitalizing fragments; the technique is also quick. In the "fixator" group, we saw 1 case of non-union and 1 of refracture, both following compound fractures.(ABSTRACT TRUNCATED AT 250 WORDS)
Complete disruptions of the posterior pelvic ring are rotationally and vertically unstable [type C according to the Tile/AO (ASIF) classification (1991)]. Usually operative treatment is required. The data on 24 patients over a 5-year period were analyzed. Thirteen patients were female (54.2%) and 11 male (45.8%); the average age was 32.8 years. Multiple trauma was present in 20 patients (83.3%). In most cases operative stabilization of the posterior pelvic ring was performed by lag screws from the ilium into the body of the sacrum. The mortality in this series was 16.7% (4 patients). One patient had a thrombosis of the femoral and pelvic veins. In 2 patients we had to perform a second operative procedure because of lag screws that had not been precisely placed or had dislocated. Two incisions healed secondarily. On the postoperative radiographs in 3 patients a slight deformity of the pelvic ring was visible; in another patient the reduction of the injured hemipelvis was not sufficient. The 20 survivors had a clinical and radiological examination on average 27.5 months after their injury. Eleven patients were without pain, while 9 complained of low back pain. Gait disturbances were found in 8 patients; in 2 of them this was due to associated injuries. Five patients were unable to work. Eight patients had neurological deficits, some of them minor. Additional complications were impotence (3 patients), urinary (2 patients) or fecal incontinence (1 patient), and dystocia requiring a cesarean section (1 woman) [multiple entries].(ABSTRACT TRUNCATED AT 250 WORDS)
Resorbable polyglycolic acid (PGA)- and poly-L-lactic acid (PLLA) cylinders were investigated in vitro to explore their properties as an antibiotic deposit (Ciprobay, Bayer Leverkusen) with prolonged release. PGA cylinders sized 3.2 x 5 mm, 4.5 x 5 mm and 4.5 x 7 mm respectively were shaped in monofil and polyfil technique. The Ciprofloxacin concentration varied from 0.5 mg to 5.0 mg of each cylinder. The cylinders were eluated in phosphate buffer, pH-value of 7.4, at 37 degrees C. The daily antibiotic release was measured by high performance liquid chromatography. Best combinations we could find demonstrated an initial delivery of Ciprofloxacin in vitro of 67 mg/l. The average daily release was about 16 mg/l during the first 36 days. After complete hydrolysis of the PGA carriers the recovery of Ciprofloxacin reached up to 6.5% and 11.6% respectively. For 40 bioactive cylinders (size phi 3.5 mm x 5 mm, containing 4 mg Ciprofloxacin) were eluated with phosphate buffer (pH 7.4 at 37 degrees C) respectively fresh human blood plasma and tested under various conditions. A gentamicin-polymethylmetacrylate (PMMA) chain (Septopal, E. Merck, Darmstadt) was exposed to equal test conditions for comparison. The quantities of released Ciprofloxacin and Gentamicin were analysed by a microbiological method (bioassay). Initially released rates of Ciprofloxacin were measured very high (up to 180 mg/l) but decreased rapidly within the first 5 days (4.2-22.5 mg/l). The release of Gentamicin produces an initial sharp decrease in concentration during the first 3 days (from 227.5 mg/l to 77.5 mg/l); this is then followed by an almost constant release over a long period of time (about 20 mg/l).(ABSTRACT TRUNCATED AT 250 WORDS)
Resorbable poly-L-lactic acid (PLLA) cylinders (3.5 mm diameter, 5 mm in length) carrying 6% of weight ciprofloxacin (Ciprobay, Bayer AG, Leverkusen, FRG) were investigated in vitro to explore their properties as a slow-release antibiotic deposit. Forty bioactive cylinders stored in test tubes were covered with phosphate buffer (pH 7.4 at 37 degrees C) and 40 with fresh human blood plasma and tested under various conditions. For comparison a gentamicin-polymethylmethacrylate (PMMA) chain (Septopal, E. Merck, Darmstadt, FRG) was exposed to similar test conditions. The quantities of ciprofloxacin and gentamicin released were analysed by a microbiological method (bioassay). The concentrations of ciprofloxacin released were analysed by a microbiological method (bioassay). The concentrations of ciprofloxacin released from 40 cylinder were initially very high (up to 180 mg/l) but they decreased rapidly within the first 5 days (4.2-22.5 mg/l). Early release of gentamicin reached up to 227.5 mg/l but dropped to of 22 mg/l on the 14th day. Complete degradation of the PLLA-cylinders was not seen in the observed period of 92 days. The mean loss of mass was 8.4%. The recovery of incorporated ciprofloxacin was 6.5% on average.
The treatment of choice in ipsilateral femoral shaft fractures in patients with hip prosthesis depends on the location of the fracture lines and the observation of loosening of the prosthesis. Either a change of prosthesis, if necessary in combination with refixation of the greater trochanter or simple open reduction with internal fixation (ASIF) along with autologous and/or homologus spongiosa are the used techniques. The rate of complications in peri- or subprothetic fractures is high. Lack of motion in hip and knee joint occurs frequently.
The closed rupture of the distal digital extensor tendon at its attachment on the terminal phalanx the so-called mallet finger - is seen very often in ball games ("basketball finger", "baseball finger"). Closed rupture with and without a bony fragment can be distinguished. We demonstrate a rational and anatomy related way of treatment.
This study covers treatment and after-treatment of 95 extensor tendon injuries of the DIP-joint in 94 patients over a period of 3 years. Tendon injuries were classified into 4 types according to Suckert et al. and the final results were evaluated using a modified Riedeberger and Zeumer scale. In recent subcutaneous tendon injuries conservative therapy is indicated, depending on the primary extension deficit (less than 20 degrees = modified Stack splint, greater than 20 degrees = Mommsen plaster of Paris or special dressing). Chip fractures should be stabilized by pull-out suture.