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Biomedical subjects

G Blatter

Publications and source records attributed to G Blatter.

At least 55 records · Page 3Linked to original sources
PubMed1995

[The anterior cruciate ligament, an important structure of the knee joint].

The anterior cruciate ligament (ACL) is a crucial structure for a normal kinematic of the knee joint. Its rupture has been thought to present the initiation of a sequel leading to secondary damage of the meniscus and finally to osteoarthritis. Diagnosis of an ACL rupture is based on the history as well as on the physical examination. A positive Lachman-sign is diagnostic for an ACL lesion. The question whether an ACL rupture should be operated or not must be decided individually and is based on the demands of the patient. Conservative treatment includes rigorous physical therapy emphasizing strengthening exercises of the hamstrings and the gastrocnemius muscles as well as prorioceptive training. The indication for reconstruction is given, should instability persist. The timing of the operation is important for the outcome. This paper presents an overview of the literature including the rehabilitation program and a diagnostic concept used by the authors.

Anterior Cruciate Ligament↗
PubMed1994

The use of 2-deoxy-2-trichloroacetamido-D-glucopyranose derivatives in syntheses of oligosaccharides.

3,4,6-Tri-O-acetyl-2-deoxy-2-trichloroacetamido-alpha-D-glucopyran osyl trichloroacetimidate and its O-benzylated analogue were tested as glycosyl donors in the reaction with a set of sugar acceptors unsubstituted on O-3 and O-4, typically encountered in the synthesis of oligosaccharides. Glycosides were obtained in good to excellent yields with only a slight excess (1.1-1.2 equiv) of the donor, and with a high degree of 1,2-trans stereoselectivity. The corresponding 2-(trichloromethyl)oxazolinium ion was postulated to be the major reactive intermediate. The N-trichloroacetyl groups in the disaccharide products were easily transformed into N-acetyl under neutral conditions by reduction with tributylstannane.

Carbohydrate Conformation↗
PubMed1994

Primary femoral shortening osteosynthesis in the management of comminuted supracondylar femoral fractures.

Supracondylar fractures are most often the result of high-energy vehicular trauma in the young population, and the result of low-energy injuries in the elderly. Therefore, these fractures are generally associated with comminution or osteoporosis. Anatomic reconstruction with stable medial buttressing is often not possible. Utilization of AO principles and techniques with anatomic reduction and internal fixation often fails to yield sufficient stability. We have developed a technique for the treatment of these distal femoral fractures which involves shortening by impaction. Rather than achieving anatomic reduction, the femur is shortened by telescoping the fragments to reestablish inherent stability of the bone prior to internal fixation. Over a 20-year period we treated 25 comminuted supracondylar femoral fractures with primary shortening osteosynthesis in 24 patients. Sixteen patients were available for review at an average follow-up of 10 years (range 4-24 years). Ninety-four percent of the patients demonstrated complete radiographic consolidation by 14 weeks after the operative intervention. One patient required secondary bone grafting and reached consolidation at 30 weeks. Primary cancellous grafting was utilized in only 25% of the patients. One-third of the patients in review were given a heel lift; the average shortening in these patients was 2.6 cm (range 2.1-5 cm). Two-thirds of the patients did not require a heel lift, the average shortening in this group of patients being 1.2 cm (range 0.8-2.0 cm). At follow-up the average range of motion of the knee was 114 degrees (range 90 degrees-130 degrees).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Treatment of subtrochanteric fractures of the femur: reduction on the traction table and fixation with dynamic condylar screw.

In the subtrochanteric region of the femur high tensile forces are active in the lateral cortex and even higher compressive forces in the medial cortex. Subtrochanteric fractures are often comminuted. The implant of choice for osteosynthesis of subtrochanteric femoral fractures is the condylar plate. Usually the various fragments are dissected intraoperatively and the medial cortex is reconstructed anatomically for improved abutment. This devitalizing of fragments leads to disturbed healing, so that failure are frequent despite cancellous bone grafting. The osteosynthesis technique introduced by Mast and Ganz of indirect reduction by distractor without dissection of the fragments and the medial cortex allowed the complication rate to be reduced to 0%. We have modified this technique in that we performed closed reduction on the traction table rather than using the distractor to achieve axial and rotational alignment, after which the fracture is stabilized with dynamic condylar screw (DCS) under image intensifier control. The proximal femur is dissected only laterally and only in so far as in necessary to place the DCS. We never use cancellous bone grafting. From 1988 to 1990 this technique was used in 12 patients. All fractures had healed uneventfully after 4 months.

Adult↗
PubMed1994

The problem of stabilization after sacrectomy.

After sacrectomy, mobilization of the patient is only possible if a stable connection between the spine and pelvis can be obtained. We have developed an instrumentation to fix the pelvis to the spine. Two DHS screws connected to each other were implanted in the pelvis (one DHS screw into each ilium). An internal spine fixator, anchored in L3 and L4 through transpedicular Schanz screws, was attached to these DHS screws. Two patients were stabilized with this implant after sacrectomy. One patient was able to walk with crutches; the other patient was able to walk even without crutches.

Adult↗
PubMed1994

1994 Nicola Cerulli Young Researchers Award. Downhill walking: a stressful task for the anterior cruciate ligament? A biomechanical study with clinical implications.

Accelerated rehabilitation after anterior cruciate ligament (ACL) reconstruction has become increasingly popular. Methods employed include immediate extension of the knee and immediate full weight bearing despite the risks presented by a graft pull-out fixation strength of 200-500 N. The purpose of this study was to calculate the tibiofemoral shear forces and the dynamic stabilising factors at the knee joint for the reasonably demanding task of downhill walking, in order to determine whether or not this task presented a postoperative risk to the patient. Kinematic and kinetic data were collected on six male and six female healthy subjects during downhill walking on a ramp with a 19% gradient. Planar net joint moments and mechanical power at the knee joint were calculated for the sagittal view using a force platform and videographic records together with standard inverse dynamics procedures. A two-dimensional knee joint model was then utilised to calculate the tibiofemoral shear and compressive forces, based on the predictions of joint reaction force and net moment at the knee. Linear envelopes of the electromyographic (EMG) activity recorded from the rectus femoris, gastrocnemius and biceps femoris muscles were also obtained. The maximum tibiofemoral shear force occurred at 20% of stance phase and was, on average, 1.2 times body weight (BW) for male subjects and 1.7 times BW for female subjects. The tibiofemoral compressive force was 7 times BW for males and 8.5 times BW for females during downhill walking. The hamstring muscle showed almost continuous activity throughout the whole of the stance phase.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[A comparison of 2 methods of plastic cast fixation in treatment of loco classico radius fracture. A prospective, randomized study].

The purpose of this study was to compare the functional and radiological result of two different positions of the wrist in a plaster cast following Colles' fracture. For this prospective study, each of 50 patients with type A 2.2, A 3.3, C 1.2 or C 2.2 (AO classification) fractures of the radius was randomly assigned to one of two groups. Both groups were treated in the same way as far as anaesthesia and reduction were concerned. The only difference in treatment lay in the position of fixation in plaster. In group 1 the wrist was immobilized in neutral flexion-extension. In group 2 the wrist was dorsiflexed 20 degrees, while the carpus was pushed in a volar direction by an impression in the plaster cast. At review 2-7 years after the accidents, the two groups were compared with reference to symptoms, range of motion at the wrist, power of first closure and radiographic appearance. In group 1 there were 5 patients with significant disability, compared with only 1 in group 2. A significant difference was found in the range of movement between the two groups for flexion and ulnar abduction (p < 0.01). The loss of power of first clenching (difference between injured and healthy hand) was 6.2 mmHg for group 1 and 3.8 mmHg for group 2 (not significant). The radiographic examination showed significant differences both in sagittal inclination (p < 0.001) and in radial shortening (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Kasabach-Merritt syndrome. Intraoperative heparin therapy with follow-up combination therapy of heparin and ticlopidine for the control of intravascular coagulation].

A 39-year-old woman with Kasabach-Merritt syndrome (cavernous vascular malformations with disseminated intravascular coagulation) sustained a displaced fracture of the femoral shaft. Despite pronounced hypofibrinogenemia (< 0.1 g/l) there was no significant bleeding. The concentration of D dimer was raised to > 32 < 64 mg/l and that of prothrombin fragments F1 and F2 to > 10 nmol/l. The platelet count was 102,000/microliters and other coagulation parameters were normal or only slightly abnormal. The consumption coagulopathy was successfully controlled by continuous intravenous infusion of heparin (17,000 I.U./d) without need for clotting factor replacement, and was subsequently stabilized by combined treatment with low molecular weight heparin (5,000 I.U./d s.c.) and ticlopidine (250 mg twice daily by mouth). Oral therapy with acetylsalicylic acid alone or in combination with ticlopidine proved insufficient, being rapidly followed by a renewed fall in fibrinogen level and platelet count. The findings suggest that fibrin formation in the abnormal vascular territories was the principal pathogenetic factor in this case.

Abdominal Neoplasms↗