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Biomedical subjects

E H Kuner

Publications and source records attributed to E H Kuner.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Changes in the perioperative venous hemodynamics and after immobilization of the lower extremity].

In a prospective study we examined 60 patients with lower limb injuries preoperatively, every 2nd day after operation, and at 6 and 12 weeks after trauma with the Doppler and Duplex methods. We distinguished between patients with an above-knee plaster and those with a below-knee plaster after operation. We were able to measure blood flow velocity, transverse width of the deep femoral vein and the volume of flow in this vein. Both legs were measured and compared. The results show a significant reduction of blood flow velocity during immobilization, with a small increase of blood volume passing through the vein. We also saw significant dilatation of the vein by up to 20%. These changes were measured not only on the traumatized leg but also on the normal side. The changes were greater with an above-knee plaster than with the below-knee plaster. The venous haemodynamics had still not returned to normal 6 weeks after trauma in the traumatized limb.

Adolescent↗
PubMed1994

[Ender nail with interlocking mechanism or dynamic hip screw in pertrochanteric fractures? A prospective study extending its limits].

In a prospective study on 148 patients with trochanteric fractures of the hip we compared the results of two implant-systems: the Ender-nailing modified by the dynamical interlocking method of Kempf and Bitar, and the dynamic hip screw (DHS) of the AO-ASIF. The Ender-method had the shorter operation time, earlier weight-bearing and less septic complications. Fracture consolidation was complete after three months in all cases. But in 8% reosteosynthesis because of hip joint perforations of nails was necessary. The method leads in less cases to anatomical reduction (85%), more often relevant varus (9%) and rotationary (14%) malpositions and functional deficits in hip (25%) and knee joints (9%), compared with the DHS. The DHS had less implant complications, reosteosynthesis was necessary in 4%. Technical failures were seldom. In 96% anatomical reduction could be achieved and the function of the hip was in 87% good to excellent. The Ender-nailing with dynamic interlocking is a system for internal fixation of trochanteric fractures in elder patients. The DHS-system has better functional results. Both systems need to be performed in a very careful, exact surgical procedure, to avoid complications.

Adult↗
PubMed1994

[Epidemiology and treatment of fractures in old age].

The frequency of fractures in the elderly has risen dramatically and will increase further in the future. This is partly a socio-economic problem and is familiar both to surgeons and to the general population. Fractures in such patients have clinical and pathomechanical implications, with unassociated conditions needing treatment. It is necessary to standardize treatment, including operative procedures, which can be performed in every hospital. The therapeutic measures available involve close cooperation between the surgeon, the geriatrician and ancillary workers. For some fractures in the elderly there are already operative procedures that ensure efficient rehabilitation and reintegration into society. Osteoporosis can make osteosynthesis problematic. Radiological measurements of bone density are of diagnostic rather than therapeutic value. Operative procedures and their effectiveness in common fractures in the elderly (hip, distal radius, shoulder) are discussed. It is stated that surgical treatment is very important in mastering this challenge, but other aspects, particularly ethical considerations, are paramount.

Aged↗
PubMed1994

[Use of ultrasound in acute and follow-up diagnosis of septic accident surgery].

In 50 patients with infections of soft tissue, bone and joints, ultrasound examination was the first diagnostic procedure performed after clinical and X-ray examination. In 22 soft tissue infections the liquid portion of the infection area could be differentiated. Deep subfascial infections were detected in 7 cases before they were clinically apparent. The results of the ultrasound examination had an influence on the operation performed in 10 cases. In 18 patients with bone infections with abscesses the linkage of the fluid zone to the bone was demonstrable, and in 6 of these cases we saw extramedullary sequestrae as total reflecting parts. Empyema was diagnosed by ultrasound in association with clinical and laboratory parameters in 10 cases, including 3 in which clinical examination had not yet led to a firm suspicion. Real-time sonography influenced the operative treatment (time of intervention, approach) in 36% of all these cases was helpful in the diagnosis in all.

Abscess↗
PubMed1994

Ligamentotaxis with an internal spinal fixator for thoracolumbar fractures.

We assessed narrowing of the spinal canal in 39 burst fractures and fracture-dislocations of thoracolumbar vertebrae treated by the AO Internal Spinal Fixator, using CT preoperatively and at various stages postoperatively. Computer-aided planimetry was used to measure the narrowing, and its restoration shortly after instrumentation, or at 15 months. The mean initial reduction of canal area was to 63.7% +/- 18.8% of normal; this was restored to a mean of 95.4% +/- 21.2% of normal when measured either soon after surgery or at 15 months (p < 0.001 for both groups). There was more improvement in cases assessed later. For fractures from D12 to L3, the mean canal area was restored to 99.4% of normal; but at L4 or L5 the mean restitution was to only 60.9% (p < 0.05). We found no correlation between preoperative loss of area and amount of restoration, or severity of neurological deficit. Nor was there any correlation between the delay before surgery and the improvement achieved. The mechanism of fracture reduction appears to be a combination of distraction ligamentotaxis and forced hyperextension.

Adolescent↗
PubMed1993

Influence of humate on calcium hydroxyapatite implants.

Implanted bovine apatite is highly osteoconductive, since it serves the host tissue as a "guide-line" for the deposition of newly developing bone tissue. It is well tolerated, but it showed no signs of being resorbed during the course of the experiment. Previous impregnation of the bovine hydroxyapatite with a low molecular humate substance obviously encourages its resorption. This is most easily explained by the known ability of humate to induce the activation of leucocytes. The occasional over-resorption of the apatite is dependent (1) upon the preparation of the implant (granulate) and (2) the local concentration of the humate. Future research is being directed towards the production of a satisfactorily usable form of humate and apatite and the investigation of its HIV blocking action on heterologous cancellous bone.

Animals↗
PubMed1993

[Tibial intramedullary nailing without open drilling].

By means on the basis of a prospective study of 33 osteosynthesis with the unreamed tibia nail (UTN) the following conclusions were found: 1. A technical simple, intramedullary solid strength bearing device in only two diameters is available, therefore costs for stock keeping are low. Systematic interlocking of the nail is necessary. Regarding the multiplicity of indication as well as the mechanical character the UTN is close to the principle of the internal fixator. 2. As a result of its solid constitution remarkable hollow cavities do not exist, so that retention of hematoma or secretions is limited (prophylaxis of infection). 3. In case of a closed nailing procedure the less rigid fracture fixation is favourable for the biology of the bone healing (fracture hematoma, less traumatic procedure without reaming of the medullary cavity, etc.). 4. The frequently observed breakage of interlocking bolts leads spontaneously to a dynamisation favourable as to time and therefore to a better bone healing process (callus formation). 5. Time intervals of bony fractures consolidation are significantly shorter compared to the exclusive osteosynthesis with the external fixator [3]. 6. The unreamed tibia nail is an implant for both primary stabilisation of closed diaphyseal fractures of the tibia with soft tissue injury and for secondary procedure/treatment for example after external fixator osteosynthesis or initial non-operative treatment. Early change of procedure seems to be of importance.

Adult↗
PubMed1993

Hip dislocation without fracture: traction or mobilization after reduction?

In all, 41 patients with traumatic dislocation of the hip, without associated acetabular or femoral fracture, were treated by two different methods after closed reduction, performed on average 2 h after injury. Patients in group A (N = 20) were subjected to skeletal traction for 2 weeks, followed by non-weight bearing for 3 months. Those in group B (N = 21) were mobilized a few days (average 9 days) after injury and allowed partial weight bearing. They were fully weight bearing at 3 months. The 31 patients were followed up for an average of 7.6 years and showed comparable long-term results in both groups. No early complications occurred in group B. There were no cases of avascular necrosis in either group. There were three cases of post-traumatic arthritis in group A and one in group B, and two cases each of heterotopic ossification. Early mobilization was concluded to be a safe and more comfortable method of after-treatment. Earlier return to work was a significant benefit in Group B.

Adolescent↗