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Biomedical subjects

E Morscher

Publications and source records attributed to E Morscher.

At least 73 records · Page 4Linked to original sources
PubMed1986

Analysis of 75 operated thoracolumbar fractures and fracture dislocations with and without neurological deficit.

Seventy-five surgically treated patients with thoracolumbar fractures and fracture dislocations, operated on between 1978 and 1982 at the Orthopedic Department of the University of Basel, were analyzed. The follow-up ranged from 18 months to 6 years. There were 45 men and 21 women, and 60% of the patients were not more than 30 years old. Additional injuries were common: 30% of the patients had craniocerebral injuries and 20% were polytraumatized. Ninety-six percent of all patients reached a hospital within 6 h, but only 23% initially presented at a center for spinal surgery. Sixteen patients had anterior surgery (fusion alone or with plating), and two of these had laminectomy as a second operation. Fifty-seven patients had posterior surgery, in 34 cases combined with a laminectomy. The Harrington instrumentation was used 45 times (29 distraction, 14 compression, and two combinations of distraction and compression rods). Luque rods with segmental sublaminar wiring was used seven times, the locking-hook distraction-rod system of Jacobs twice, and miscellaneous procedures five times. A total of 24 patients (greater than 30%) presenting neurological deficits improved postoperatively. None of the 18 patients with normal neurological findings deteriorated during the operation. Neurological improvement was seen more frequently after early than after delayed surgery, but the difference was not statistically significant. Laminectomy had no statistically significant effect on postoperative neurological status. Twenty-two patients required reoperation because of insufficient or failed instrumentation. Luque instrumentation had the highest rate of reoperations. Anterior surgery did not prove superior to posterior procedures. Hospitalization and immobilization time was significantly reduced with surgery for the neurologically normal or minimally damaged patients, but not for completely or incompletely paraplegic patients. Postoperative back pain occurred in 22 patients, of whom 14 had nonanatomic postoperative reductions. Complications directly due to the surgery were rare. It is our conclusion that the instrumentation used in this series was not good enough to be proposed for standardized use. These technically unsatisfactory results induced the development of the internal fixator system in the senior author's (E.M.) department.

Adolescent↗
PubMed1986

[Anterior plating of the cervical spine with the hollow screw-plate system of titanium].

A hollow screw-plate system made of titanium for osteosynthesis of the cervical spine is presented. This system is designed to achieve a stable fixation for fusion of the vertebra. The posterior corticalis of the vertebral body need not and indeed cannot be perforated by the screws. Loosening of the screws is not longer possible because of growth of bone into the lumen of the screw and direct attachment of bone to the surface of the screw.

Bone Plates↗
PubMed1986

[Combined lateral ligament-plasty and calcaneus osteotomy in recurrent foot dislocation].

The risk of a supination trauma is particularly high in patients with pathological calcaneus varus as opposed to physiological calcaneus valgus. If in these patients only the lateral ligaments are operatively treated after a trauma, there is a high incidence of recurrence, as the abnormal position of the calcaneus means that the supinating forces acting laterally have a stronger effect than in normal cases. We therefore suggest a combination of fibulotalar syndesmoplasty with osteotomy of the calcaneus according to Dwyer in such cases. In the last 7 years we have carried out this operation eight times with no recurrence in any of these patients so far. In four patients, a gait analysis was performed. It was established that the abnormal floor reaction forces seen in the presence of calcaneus varus normalize following the operation.

Adolescent↗
PubMed1986

Indication, surgical technique, and results of 100 surgically-treated fractures and fracture-dislocations of the cervical spine.

The results of 100 cervical spinal injuries in 67 men and 33 women (20 upper and 80 lower cervical spinal injuries), which were treated operatively, were analyzed. Fifty-three of the patients were less than 30 years old. The period of observation was a minimum of one year. Ninety-three percent of patients were transported to a hospital where first treatment was given within six hours after the accident. Only 25% of these patients had a closed manual or open reduction within these first six hours. One third of all patients improved neurologically. The majority (75%) of the patients with neurologic improvement were reduced within six hours after the accident. Fifty patients were treated by an anterolateral, 40 by a posterior, and ten by a combined anterior/posterior surgical exposure. Complications attributable to technical difficulties were only occasional and were never of significance for the further outcome. The duration of immobilization was a maximum of six weeks or less in more than 85% of all cases. The duration of hospitalization could not be reduced in the group of tetraplegic patients. Immediate reduction of the injury is more important for the further neurologic outcome than improved surgical techniques.

Adolescent↗
PubMed1985

Cementless acetabular replacement using a pegged polyethylene prosthesis.

Acetabular replacement without cement using three types of pegged polyethylene prostheses was begun as a prospective trial by Morscher (August 1977). Ring (June 1979), and Freeman (January 1980); 1878 hips have been replaced using this technique and are reviewed. Follow-up averaged 2 years (range: 6 months-6 years). Successful pain relief and satisfactory walking ability were present in 97% and adequate flexion in 90%. Radiographic review showed the consistent development of a stable, uniform sclerotic line adjacent to the prosthesis. No component migration could be documented. Ten hips have been revised for obvious femoral loosening, and two acetabula showed slight motion during revision for femoral failure and were revised. Deep infection (0.37%) occurred only in patients not receiving perioperative antibiotics and not operated upon in unidirectional filtered air-flow enclosures. Postmortem histological evaluation of eight hips showed a thin fibrous membrane separating the prosthesis from viable bone. These results are preliminary, but nevertheless at least as good as those in any large series of cemented acetabula with the same follow-up. The advantages of this technique are its reproducible results, low complication rate, limited invasion of the skeleton, and easy revision should failure occur.

Acetabulum↗
PubMed1984

Histological results with cement-free implanted hip joint sockets of polyethylene.

The histological appearance of the implant-bone boundary in eight preparations from seven deceased patients in whom a polyethylene acetabulum socket had been inserted without cement between 3 weeks and 3 years previously is described. In all cases, a good or excellent clinical result had been present up to death. All sockets were firmly anchored macroscopically in the bone of the acetabulum. Three zones were defined in accordance with the mechanical strain on the surface of the cup: (a) zone of compression; (b) zone of transition in which mainly shear forces act; and (c) zone of decompression, which corresponds to the region below the "equator." It was noticeable that a layer of connective tissue separated the implant from the bone over almost the entire surface. This layer was very thin in the region of the pressure transfer layer, and thicker in the decompression zone. At sites at which pressure and shear forces act a fibrocartilaginous tissue was found, and the "subchondral" bone was only occasionally in direct contact with the polyethylene surface. At some sites, but above all in the region of the compression zone, very tiny particles that were birefringent in polarized light were found. Either these derive from very fine grindings from the prosthesis surface or they are to be interpreted as a result of "biodegradation" of the polyethylene. This observation permits the conclusion that the biocompatibility of the implant can be improved further by coating the polyethylene surface.

Aged↗
PubMed1982

[Comparative double blind study of pirprofen, indomethacin, and placebo in the treatment of osteoarthritis of the spine].

137 out-patients suffering from osteoarthritis of the spine were treated for two-weeks by pirprofen (600 mg/day), indomethacin (75 mg/day), or placebo. At the end of the trial, spontaneous pain disappeared in 47% of patients in the pirprofen group, 38% in the indomethacin group, and 17% in the placebo group. The efficacy of pirprofen and indomethacin, compared to the placebo, is demonstrated with respect to both spontaneous pain (p less than 0,01) and functional disorders (p less than 0,05). Side effects, especially digestive, were noted in 29% of patients treated by pirprofen, 33% of those treated by indomethacin and 17% of those on placebo. Tolerance was satisfactory in 86%, 80% and 90% of patients. Pirprofen is thus judged an effective drug for the treatment of osteoarthritis of the spine.

Anti-Inflammatory Agents↗