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Biomedical subjects

E H Kuner

Publications and source records attributed to E H Kuner.

At least 91 records · Page 5Linked to original sources
PubMed1986

[Initial experience using the dynamic hip screw in osteosynthesis of femoral neck fractures].

We report about our first experience in 16 patients with femoral neck fractures, operated upon with the dynamic hip screw. All fractures united within three to six months, early avascular necrosis did not occur. In the concept of treatment of femoral neck fractures osteosynthesis with dynamic hip screw has some advantage, especially compared with the AO-nail plate: Easy correction of the guide wire position, sufficient impaction of the fragments by using the compression screw, low risk of penetration into the acetabulum during fracture healing with shortening of the femoral neck.

Adolescent↗
PubMed1986

[Suction-drainage in the treatment of chronic osteomyelitis].

The instillation drainage is a very important part in the treatment of chronic osteomyelitis (the débridement of necrotic bone and soft tissue cellulitis, the need of stability, the local antiinfectious treatment, and the plastic reconstruction of soft tissue and bone defects). In acute osteomyelitis under stable conditions the instillation drainage helps spontaneous reossification, in most of these cases bone grafting is not necessary. For the local treatment of an intramedullary infection the closed technique of the instillation drainage is recommended. There must be an exact balance of Ringer's solution in the instillation and drainage system. In the open technique no retention of solution is possible. - Antibiotics can be added to Ringer's solution for the first few days, the more important effect of the instillation drainage is the mechanical cleansing of all infected spaces.

Chronic Disease↗
PubMed1986

[Bone banks. Equipment, tissue collection, cold preservation, organization, safety].

A well-organized bone bank for cryoconservation is a proven and safe procedure, which is best suitable for emergency surgery. If the indication is correct and donor selection carefully proved, it is an efficient procedure without great problems. For donor selection, the history of the patient, a clinical examination and serological tests are very important, in addition to an aseptic procurement and continuous maintenance of temperature in the freezer. The freezer temperature must be kept below the eutectic point of bone (-28 degrees C). At this temperature all of the individual bone tissue structures are frozen, and bone can be preserved for 1 year in this way. We prefer a cryoconservation at -39/49 degrees C. In the Department of Traumatology of the University in Freiburg, in the last 16 years more than 1000 homologous bone grafts have been performed. Although in the first weeks consolidation is delayed, the rate of complications after bone transplantations is low. The great advantage is the availability of homologous (allogenous) cancellous bone and cortical bone chips at any time, especially for the treatment of polytraumatized patients.

Accident Prevention↗
PubMed1986

[Surgical therapy of chronic instability of the upper ankle joint using periostal bridle-plasty].

We have used the technique of the autoplastic periostal bridle graft for operative treatment of chronic lateral instabilities of the ankle joint in 78 cases since 1978. Clinical and radiological follow-ups of 55 patients were made at two different intervals of time. In more than 90% of these there was no more evidence of instability and good or very good subjective results were obtained. The substitute ligament can be either fastened via drill holes or fixed to the bone with a screw. The autoplastic periostal bridle graft is a simple, anatomically appropriate and reliable procedure to restore the stability of the lateral ankle joint. Several renowned authors have also reported good results in the meantime.

Adult↗
PubMed1985

[Late results following the surgical treatment of proximal humerus fractures in adults].

In this paper late results of 65 proximal humeral fractures, operated upon between 1970 and 1980 are reported. Fractures were classified according to Neer in two-part-(28), three-part-(15), four-part-fractures (21) and fractures of the articular surface (1). In 34 cases internal fixation was performed by a T-plate. In 15 cases either open reduction without internal fixation or open reduction and minimal internal fixation was done using screws and K-wires. Primary prosthetic replacement of the head was done in 8 patients with four-part-fractures. The follow-up period ranged from 2.5 years up to 13 years with an average of 7 years. The functional results were excellent in 25 patients, good in 14, fair in 10 and poor in 16 patients. Better results were obtained in young patients, isolated shoulder injuries and patients with two- or three-part-fractures. On the contrary the results in aged and polytraumatized patients or patients with four-part-fractures and fracture dislocations were less favourable. Avascular necrosis of the humeral head was encountered in 4 cases of four-part-fractures and fracture dislocations, 3 of them fixed by T-plate and 1 by minimal internal fixation. No case of avascular necrosis of the humeral head was encountered in two- or three-part-fractures, fixed by T-plate. We can conclude, that cases, having a high risk for developing avascular necrosis of the humeral head, i.e. four-part-fractures and fracture dislocations, are better treated with minimal internal fixation avoiding the use of T-plate, for it was found to increase the already present damage.

Adult↗
PubMed1985

[Prevention of postoperative infection in accident surgery].

Since the spectrum of surgical procedures has become larger, high attention has to be paid to asepsis. A well defined theatre practice and introduction of ultraclean air in operation rooms are described as "non-infection" measurements. Airborne route of surgical infection has to be excluded especially in operations, where large implants are used and in emergency cases with bad soft tissue conditions. Moreover, surgical technique, choice of method, time of operation, atraumatic surgical procedure are as important as to follow the rules of biomechanics in preventing postoperative wound infections, which remain the principal threat of successful surgery. But it is not only the surgeon and his team, who are responsible for correct asepsis, also the hospital authorities are challenged--not only for forensic reasons--to cooperate in this important task.

Accidents↗
PubMed1984

[Operative treatment of proximal humerus fractures in children and adolescents--indications, technic, late results].

The good prognosis of proximal humeral fractures in children and adolescents is explained by the anatomy of the shoulder and the physiology of the proximal humeral epiphysis. The treatment of these injuries therefore is mainly conservative. Based on the results of 24 patients operated between 1970 and 1980 a therapeutic concept concerning indication, timing and operative technique is proposed.

Adolescent↗
PubMed1984

[The value of homologous spongiosa in en-bloc resection of juvenile bone cysts of the upper arm].

The recurrence rate after excochleation and homogeneous bone grafting of juvenile and aneurysmal bone cysts is high. One of the reasons is the poor vascularisation of the wall of the cyst. En-bloc resection is recommended in cases of recurrence after curettage and bone grafting and in cases of prior conservative treatment after pathological fracture followed by a rapid growth of the cyst. Excellent results of en-bloc resection in 8 cases of humerus bone cyst are reported. Good vascularisation of the juvenile periosteum and the surrounding soft tissue is most important for new bone formation after homogeneous bone grafting.

Adolescent↗
PubMed1984

[Allogeneic bone transplantation. Indications--preservation--results].

For 15 years the University Department of Traumatology Freiburg i.Br. is using deep frozen preserved allogenous bone grafts. Organization and service of the "bone bank" are standardized and simple. Basing on long experience the following indications for this technique have been developed: fresh fractures à deux étages, comminuted and compression fractures of long tubular bones that were stabilized operatively by plate-osteosynthesis showing smaller or bigger osseous defects, furthermore basic defects of the acetabulum with total hip replacement. Suppositions for the transplantation of allogenous cancellous bone are: well vascularized bed without infect, sufficient amount of cancellous bone and no disturbing movement of the bone at the place of transplantation. The results are excellent if one pays attention to these suppositions. Open fractures and local infections are absolute contraindications. As deep frozen preserved cancellous bone is always and sufficient available it is a precious help especially in polytraumatized patients. So the deposits of autogenous cancellous bone can be reserved for special problems. The little prolonged time of consolidation is only observed in the first phase until about the 20th week, after that time there are no significant differences to autogenous cancellous bone.

Bone Diseases↗
PubMed1983

[Treatment of talus fractures. Control study of 262 treated cases].

It is useful to subdivide talus fractures in central and peripheric ones, as serious complications have to be expected only in the first group. Under 207 central talus fractures the feared talus necrosis has been found after operative treatment as well of collum as of corpus-trochlea fractures in about 21% of the cases, after conservative treatment in 11 respectively 19%, while posttraumatic arthrosis appears in over 50% (talus fractures with side injuries). The isolated central talus fracture has a better prognosis. The earlier the exact anatomical reposition is realized, the better are the results. Open talus fractures are threatened by infection. The so called central talus fractures--open or closed--are surgical emergency cases and so they have to be treated.

Adolescent↗
PubMed1982

[Results after surgical treatment of acute injuries to the lateral ligament of the ankle (author's transl)].

105 patients with acute injuries of the fibular collateral ligament were treated surgically. Diagnoses and following treatment were based on X-rays in stressed positions (talar tilt and anterior drawer sign) compared with the other side. More than fifty percent were athletic injuries. After surgical treatment patients wore a below-knee plaster cast for 6 weeks. 90 patients were seen after an average interval of 24 months; another 7 were assessed on the basis of patient's judgement. In 7 cases the X-ray control showed some instability (talar tilt greater than 5 degree and anterior drawer sign greater than 2mm). At physical examination we found in some cases minor differences in mobility, swelling and pain. 14 patients showed hypesthesia on the lateral side of the dorsum of the foot. No patient had to give up his sport activities due to the ligamentous injury, 89 (97 were asked) were content with the result.

Adult↗