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Biomedical subjects

E Brug

Publications and source records attributed to E Brug.

At least 55 records · Page 3Linked to original sources
PubMed1991

[Bundle nailing of forearm fractures. Indications and results].

Hackethal developed the nailing procedure named after him in 1959. The rationale of Hackethal nailing is an elastic jamming, which can only be achieved by obeying four rules: jamming of the nails in the cortical window, jamming then 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. We confined Hackethal nailing to closed and first-degree open fractures of the 2nd-5th sixth of the shaft of the forearm. If closed reduction and nailing were impossible, we performed a plate fixation (AO), in second- or third-degree open fractures we treated with fixators (Orthofix). In a 13-year period we performed Hackethal bundle nailing in 65 patients with 115 fractures. In 54% 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 we needed a plaster of Paris, we achieved rational stability. On average, the nails were removed after 11.5 months. The healing and complication rates were assessed by follow-up examination of 49 patients. The results were excellent and good in 71.5% patients, satisfactory 11.4% and poor in 17.1%. Complications consisted of a 2.1% infection rate (osteitis), 3.1% non-union, 2.1% with a synostosis, 1% refracture (during removal of the nails) and 3.1% migration of nails, combined with tendon rupture. We have seen 1 case with metallosis. In conclusion with our confined spectrum of indications Hackethal nailing is a low-risk method, which leads to a rational stability and early bone healing.

Adult↗
PubMed1991

[Traumatically-induced thrombosis of the distal ulnar artery. Case report and review of the literature].

The authors report on a patient who fell and struck his right hypothenar against a sharp edge. He had immediate pain and reduced circulation in his ring and little fingers. The neurological findings revealed paraesthesia in the two ulnar fingers and loss of abduction strength in the little finger. Treatment was at first conservative, but the symptoms persisted. Four weeks after injury, the patient was referred to our unit. Doppler ultrasound and angiography of the brachial artery were performed, showing an occlusion of the ulnar artery just distal to the space of Guyon. Operative revision was carried out and a 20 mm thrombus removed. Recovery was then uneventful, and all previous symptoms disappeared. A review of the literature is presented and typical symptoms, diagnostic and therapeutic approaches discussed. The need for an early diagnosis and operative revision is demonstrated.

Angiography↗
PubMed1991

[Injury of the pelvic ring and abdominal trauma].

Fractures and disruptions of the pelvic ring are usually found in multiply injured patients and exacerbate the life-threatening character of the concomitant injuries. The main prognostic factors are haemorrhagic complications, abdominal trauma and associated injuries of the urogenital tract. All patients admitted to the Department of Surgery of the University of Münster between July 1985 to December 1989 were analysed with particular reference to pelvic ring instability and the accompanying pelvic and abdominal lesions. Of 27 patients with unstable displaced lesions of the pelvic ring, 9 were female (33.3%) and 18 male (66.7%); the average age was 35.1 years. Multiple trauma was present in 25 patients (92.6%). Associated pelvic or abdominal injuries were found in 15 cases (55.6%) [multiple entries]. In 9 patients (33.3%) there were lesions of the urogenital tract. Injuries to pelvic blood vessels were diagnosed in 3 patients (11.1%). In 2 patients (7.4%) there were lesions of the perineum. A ruptured spleen was found in 4 patients (14.8%), lesions of the liver in 3 patients (11.1%), lacerations of the mesentery in 2 patients (7.4%). Bleeding into the mesentery, lacerations of serosa of the sigmoid colon and contusion of the pancreas were each seen in 1 case (3.7%). In 12 patients (44.4%) laparotomy was performed: The mortality in this series was 22.2% (6 patients). The authors propose a procedure for immediate diagnosis of these associated pelvic and abdominal injuries. The key factor for a favourable outcome is the differentiation between intraabdominal and retroperitoneal bleeding. A treatment algorithm is described. The value of laparotomy, interventional radiology and primary anterior stabilization of the pelvic ring with an external frame is discussed.

Abdominal Injuries↗
PubMed1991

[Heterotopic ossifications from the trauma surgery viewpoint].

A heterotopic ossification is a non-neoplastic bone formation located in the soft tissues (so-called myositis ossificans). Important aspects of this condition, which is not uncommon after trauma or surgical procedures, are discussed from the trauma surgeon's viewpoint. The results of treatment of heterotopic ossifications are frequently unsatisfactory. Therefore, the importance of preventive measures is emphasized.

Fracture Fixation, Internal↗
PubMed1991

[A return to callus healing using dynamic osteosynthesis procedures. Principles, indications, complications, x-ray diagnosis of interlocking nailing and dynamic monofixators in comparison with conventional bone plates].

A disproportionately high rate of complications such as osteomyelitis, nonunion and refracture after plating have brought about a change in our understanding of the process of fracture healing. Locked nailing and dynamic external Monofixators, however, avoid fracture exposure obviate the necessity of arranging fragments and aim at callus healing of fractures. Fracture hematoma and axial micromovements of these dynamic stabilizing devices are two of the yet known elements to promote callus production.

Bone Nails↗
PubMed1990

A target device for placement of implants in the thoracolumbar pedicles.

Posterior spinal instrumentation with the placement of intrapedicular implants has become an important technique. We have designed a hand-held target device to facilitate the open or percutaneous location and penetration of the thoracolumbar pedicles. A cylindrical pin guide incorporates two metal rings and can be moved under image intensifier control until the rings are superimposed to show correct alignment. The radiation dosage for the surgeon is minimal; the device allowed accurate placement of 106 consecutive pedicle screws.

Equipment Design↗
PubMed1990

[Tuberculosis of the hand].

Skeletal tuberculosis of the hand has become rare. The authors report a 27-year-old female patient with tuberculous osteomyelitis of the middle phalanx of the left ring finger without occupational exposure of the hand and with positive chest roentgenogram. The case shows the diagnostic difficulties of the uncommon manifestation of skeletal tuberculosis in the short tubular bones of the hand. By means of a review of the literature the differential diagnosis, the course and necessary treatment are discussed.

Adult↗
PubMed1990

[Indications for interlocking nailing].

For closed diaphyseal fractures of femur and tibia in adults, medullary nailing with interlocking nails has become the treatment of choice. Their use has been extended to certain intraarticular fractures in combination with shaft fractures, compound fractures with low-grade wound contamination, malunion, non-union and pathologic fractures. Locked nailing should be performed as a closed procedure, and callus bone healing should be expected. Fracture hematoma, drill debris and preservation of periosteal circulation are of particular relevance in achieving this. Dynamization by removal of the locking screw(s) opposite the fracture site accelerates the transformation and ossification of early fixation callus.

Bone Nails↗
PubMed1990

[Principles of secondary soft tissue reconstruction after open fractures of the tibia].

Course and prognosis of open lower leg fractures are significantly influenced by the concomitant soft tissue injury. Selection and timing of therapeutic procedures determine the final outcome. Fracture stabilisation takes priority. Early soft tissue coverage should be achieved by local cutaneous or fasciocutaneous flaps. Exposed bone can be covered by transposed local musculature. Especially in the distal third as well as in extensive soft tissue loss the microsurgical transplantation of free flaps is advantageous. Tissue expansion can provide skin for secondary replacement of instable scars.

Cicatrix↗
PubMed1990

[Differential diagnosis of distortion of the elbow joint].

Distortion of the elbow joint often means a vague diagnosis describing a traumatized joint with no radiological changes, or it means a transient diagnosis until sophisticated examinations can demonstrate what the injury really is. In adults there are only a few injuries that cannot be shown by radiography. In children, however, radiography of the elbow joint is more difficult due to the inhomogeneity during growth. Contrary to adults, fractures misdiagnosed in radiography often result in significant reduction of joint function.

Adolescent↗
PubMed1989

[Use of unilateral external fixation in pediatric femur shaft fracture within the scope of polytrauma].

Femoral fractures in children are mostly managed conservatively. The recommended methods are overhead traction, 90/90 degree traction on a special table (Weber) and skeletal traction in a Thomas splint or on a Brown's frame. This treatment proves cumbersome in most multiply injured children, especially in those with head injury. Due to uncooperative behaviour the fracture is difficult to hold in an acceptable position. Therefore, operative treatment has been favoured by several authors in the past. Over a period of 8 years, 167 adolescent multiple trauma victims were treated in our institution, 48% of whom had sustained femoral fractures. Since June 1985 such fractures have been stabilized with the unilateral De Bastiani external fixator as the primary and definitive treatment. Our first series consists of ten children (eight male, two female) with a total of eleven fractures, aged 3.2-15 years, mean age 8.1 years. Nine fractures were closed and two compound. Nine fractures were fixed on the day of injury and two 2 days after injury. Depending on the patient's age and the level of the fracture, controlled overriding of 10-15 mm was performed to compensate for expected overgrowth. All fractures healed in an average time of 11 weeks. Free hip and knee movement was achieved in all cases 6 weeks after removal of frame. Neither refracture nor deep infection was seen in any of these patients. Compared with internal fixation, use of this device is less invasive and requires a very short operating time. The fixator can be removed as an outpatient procedure with no need for an anaesthetic.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Insertion of distal screws in interlocking nailing using a new free-hand control device].

While it is technically easy to introduce the proximal screw in interlocking nailing, the torsion of the nail being driven into the medullary canal can make distal locking more difficult. There are two approaches to the insertion of the distal screws: the c-arm-mounted device and the free-hand technique. The Grosse-Kempf c-arm device was introduced in 1978, but it requires modification of the fluoroscopy unit and is time consuming. The free-hand technique has certain disadvantages because of involuntary movement during the change from aiming to drilling. Furthermore, the bulky power drill makes monitoring of the path of the drill bit impossible, and the radiation time can be considerable. A new free-hand distal aiming device for the interlocking nail was therefore designed in our department. The main objectives were to provide a simple, yet precise instrument with few parts that would allow monitoring of the direction during process of penetrating the nail hole. The device consists of two metal rings on both ends of an X-ray translucent cylinder with a central 4-mm hole in it. A pin with a sharp tip (diameter 4 mm, length 160 mm) is inserted through the hole. Using the image intensifier, the device is then placed so that the sharp tip of the pin points to the bone. The device is moved until the two metal rings are superimposed on each other and give the impression of one ring with the nail hole in the middle. On the screen the pin then appears as a dot inside the nail hole.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Nails↗
PubMed1989

[Current indications for intramedullary bundle nailing].

Hackethal developed the nailing procedure named after him in 1959. The original method consisted in two steps: a non-sterile step in which mechanical reduction was performed with a traction device and a sterile step, i.e. nailing. The rationale of Hackethal nailing is an elastic jamming, which can only be achieved by obeying four rules: jamming of the nails in the cortical window, jamming then 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. Hackethal believed it was possible to achieve an elastic jamming in all transverse and short oblique fractures of the shaft. He used his technique in fractures and non-unions of femur, tibia, humerus, radius and ulna. Extensive indications led to overuse of the method and resulted in a major rate of complications. Meanwhile, plating of shaft fractures has proved to involve an unexpectedly high rate of complications, and locking nails and new types of fixators have enlarged the surgeon's armamentarium for stabilization of fractures. Therefore, it seemed important to determine the present indications for Hackethal nailing. We confined Hackethal nailing to fractures of the middle third of the shaft in the upper extremity. All second- and third-degree open fractures were treated with fixators. In a 13-year period we performed Hackethal nailing of the humerus in 53 cases, of the radius in 20, of the ulna in 17, and in both of the forearm simultaneously in 12 cases. Plating and Hackethal nailing were combined for the treatment of forearm fractures in 10 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Plates↗
PubMed1988

[Polytrauma and femoral fracture].

From 1976 to 1986 1.003 polytraumatized patients were treated at our institution. 88% had suffered fractures of spine, pelvis and limbs. Of particular relevance are the femoral fractures (36% of all cases) in the management of those patients. In not adequately immobilized femoral fractures the rate of general and local complications in this group is elevated. Impaired microcirculation and the required high doses of analgesics can lead to an increased risk of eventually lethal ARDS. From 1976 to 1983 we used the conventional approach and stabilized femoral fractures using plates and IM nails. Due to the time required for the operation, the eventual blood loss and the invasiveness of the operation, we could operate only on 44% of the femoral fractures within the first 24 hours. In 1984 we introduced the DAF device in our service and used it in compound femurs and unstable patients with femoral fractures. In the other cases the locking nail (GK Nail) was used. With this concept we managed to increase the rate of surgery of femoral fractures in polytrauma victims within the first 24 hours to 80%. Further assessment of the date showed a significant drop of 27.3% in mortality, mainly due to a decreased rate in late ARDS-related deaths. The advantage of the DAF concept in the stabilization of these fractures in polytrauma victims we see in the less time consuming fixation, the minimal blood loss, easier ICU care and fewer local complications. The DAF device is used as a definitive management tool and does not generally require a change to another method of fixation.

Bone Nails↗