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Biomedical subjects

G Giebel

Publications and source records attributed to G Giebel.

At least 19 recordsLinked to original sources
PubMed2005

The arteries of the humeral head and their relevance in fracture treatment.

Bone vascularisation has gained increased interest in relation to the blood supply of bone fragments during treatment of fractures. In the current study the pattern of vascular supply of the proximal humerus was studied in six cadavers by the corrosion technique. Furthermore, the effect of fractures on the vascular supply was also investigated. In all preparations the intraosseous arteries of the humeral head arose from the circumflex arteries, which surrounded the humerus and dispatched branches towards the proximal end. The main vessel was the branch of the anterior circumflex artery, penetrating the major tubercle in six of six cases. Due to the intraosseous arch shape of this vessel it is referred to as the arcuate artery. Besides other smaller vessels, there was also a vascular network arising from the posterior circumflex artery. Their branches penetrated medially at the cartilage bone interface in five of six preparations. The medial bone arteries appear to gain distinctive importance in humeral head fractures by their impact on the vascularisation of the fracture fragments. After disruption of the arterial supply from the arcuate artery, the vascularisation of the head fragments is most likely ensured by this group of vessels. Therefore, necessary repositioning manoeuvres during open reduction of the fracture should be conducted with care in order to preserve these arteries.

Aged↗
PubMed2005

[The arteries of the humerus and their relevance in fracture treatment].

BACKGROUND: The purpose of the current work was to study the arterial blood supply of the humerus to evaluate impairments of the blood supply after humeral fractures and different methods of fracture treatment. METHODS: Arterial blood supply of the humerus was studied by corrosion injection technique in 6 cadaver preparations and is compared with the existing literature. RESULTS: Humeral head arteries originate from the circumflex humeral arteries. The major vessel enters the greater tubercle. Another group of vessels accesses the head from medially. The nutrient artery for the shaft enters into the medial third of the shaft. At the distal humerus there are multiple anastomoses with penetrating branches into both condyles and proximal to the radial, coronoid, and olecranon fossae. CONCLUSIONS: Fragments of a proximal humeral fracture usually have an independent blood supply. The medial vessels to the head gain high importance in fractures of the anatomical neck. The nutrient artery lies regularly medial to the humeral mid-shaft and is at risk at open reduction of this region. The abundant vessels at the entire distal humerus ensure sufficient vascularization of the fragments after fracture.

Arteries↗
PubMed2004

[Arthroscopically assisted refixation for avulsion fracture of the intercondylar eminence with Fiber-Wire cerclage].

Avulsion fracture of the intercondylar eminence is a rare knee injury. It is found either isolated or connected to other bone or intra-articular injuries. Arthroscopically assisted treatment is nowadays the most common procedure. The refixation of the fragment is technically sophisticated and usually requires a longer period of immobilization. In two patients we used a suture cerclage with extreme tensile strength (Fiber-Wire, Arthrex Inc.) placed through a tibial guide. Using this procedure we combined the advantages of easy implantation, sufficient retention, and thereby the possibility of forced follow-up treatment. The present results are promising.

Adolescent↗
PubMed2001

[Compartment syndrome of the triceps brachii muscle after intramedullary nailing].

We report a case of a humerus fracture with rare acute compartment syndrome of the triceps muscle after intramedullary nailing. Clinical (neurological) symptoms and measuring of the subfascial pressure of both triceps lead to early diagnosis. After immediate dermatofasciotomy we obtained full recovery of the radial nerve function.

Adult↗
PubMed1998

[High energy shock wave treatment of the painful heel spur].

Extracorporal shock wave application (ESWA) has been used in the treatment of stones located in kidneys, bile, pancreas and the glandula parotis. In the last 2 years several studies have shown the benefit of the ESWA on the treatment of soft tissue disorders. The aim of this study was to explore the effect of high energy extracorporal shock waves in patients with painful calcaneus spurs. 83 patients who underwent medicophysical treatment without benefit were treated with 3000 impulses of 0.30 mj/mm2. Follow-ups after 12 weeks and 12 months showed that 51 of 83 patients became pain-free and 20 patients improved from the treatment. The results are showing the benefit of the high energy extracorporal shock wave application in the treatment of chronic plantar fasciitis.

Calcaneus↗
PubMed1997

The arterial supply of the ankle joint and its importance for the operative fracture treatment.

The operative exposure of a fracture causes disturbances in the blood supply, which may lead to a prolonged healing process or even to bone necrosis, especially when using the complex and complicated methods of osteosynthesis at the ankle. In order to damage the supplying vessels as little as possible, position, direction and penetration of the bone arteries of the talocrural joint were examined by corrosion preparation. The tibial nutrient artery arises from the posterior tibial artery or from the popliteal artery and penetrates constantly from posterior at the level of the proximal third. The fibular nutrient artery, coming from the peroneal artery, penetrates more distally from medial into the middle third of the diaphysis. In one specimen it did not exist at all. Distal tibia and fibula are supplied by the perimalleolar arterial ring, which is connected with the three arteries of the leg. The talus is supplied by numerous very small vessels, which are provided with extraosseous anastomoses and penetrate the whole non-articular surface. Implications for the operation will be explained.

Adult↗
PubMed1997

Arterial supply of forearm bones and its importance for the operative treatment of fractures.

The operative exposure of a fracture in an osteosynthesis causes disturbances in the blood supply, which often leads to a prolonged process of healing or even to healing problems, a fracture non-union, which is frequently located at the forearm. In order to damage the supplying vessels as little as possible, the position, direction and penetration of the arteries of radius and ulna are demonstrated and systematised in this study. Near the elbow arteries, coming from large adjoining vessels, penetrate the area of the capsular insertion. The nutrient arteries enter both bones in the second proximal quarter of diaphysis, at the radius from anterior to medial, at the ulna from anterior to anteroradial. Small vessels, which penetrate closely proximal to the articular surface in order to supply the distal forearm bones, come from an anastomosis between the radial, the interosseous and the ulnar arteries. In this study access vessels, choice and position of implants will be discussed.

Aged↗
PubMed1996

[Callus distraction in tibial defect fractures].

Lower leg fractures with an osseous defect can be treated effectively with the callus distraction technique by Bier-Ilizarov. Because osteocytes are cultivated at the site of the defect, a real biological system is working-in contrast to other methods. Especially in lower leg fractures with a denuded tibia, the technique of primary shortening to cover the soft-tissue defect with subsequent compensatory lengthening by callus distraction is valuable. This technique does not need special hospitals but skillful surgeons. A closed surgeon-patient relation ship is required because most treatments are done on an outpatient basis. The cosmetic and functional results are good.

Bone Lengthening↗
PubMed1996

[Shockwave treatment of therapy refractory soft tissue pain].

Extracorporal shock-wave application (ESWA) has been used in the treatment of stones located in the kidneys, bile, pancreas and the glandula parotis. In the last 2 years several studies have shown the benefit of ESWA in the treatment of soft-tissue disorders and tendinosis calcarea. To date, the exact mechanism is unknown. Local hyperemia following damage or afferent inhibition is discussed. The possibilities and indications of ESWA with respect to several syndromes are presented. The results show the benefit of ESWA in the treatment of chronic soft-tissue disorders without severe side effects. Some patients showed small subcutaneous hematomas and erosion of the skin when energies about 20 mJ were used. Forty-seven of 84 of the patients obtained complete relief; 24 patients showed a marked reduction in their complaints. In only 13 of 84 cases was the treatment unsuccessful.

Adult↗
PubMed1996

[Magnetic resonance tomography study of ankle joint fractures. A prospective pathologic-anatomic study].

The imaging findings in 21 patients with ankle fractures were evaluated prospectively to determine the value of MRI in diagnostics of bone, cartilage, ligament and soft tissue lesions. A total of 17 female and 4 male patients aged from 25 to 60 years (mean age 50 years) underwent an MRI examination 2-14 h after trauma. Axial, sagittal and coronal T1-weighted SE and T2-weighted GE images were performed using an extremity coil. We found 2 type A (A 1.2 and A 1.3), 17 type B (3 B 1.1, 3 B 2.1 3 B 2.2, 1 B 2.3, 5 B 3.2 and 2 B 3.3) and 2 type C (C 1.1) fractures. MRI was capable of detecting bone fractures not visible in a conventional X-ray, cartilaginous damage, ligamentous injury and subtle soft tissue lesions. We conclude that the coronal and axial planes are essential for optimal visualization of the major ligaments. The injury patterns found in this examination are identical to those described by Weber. MRI appears to be a useful examination method in special cases, but it is not a suitable screening method because of the high costs and time required.

Adult↗
PubMed1995

[Callus distraction].

Fibroblast networks that form collagen and connect the two ends of bone develop in the haematoma after corticotomy. This regenerative tissue is vascularized and distracted. Even during the lengthening, mineralization starts. This starts at the ends created by the osteotomy, in the form of conical bony columns 200 microns thick, which grows towards each other in a manner reminiscent of stalagmites and stalactites, until the central, fibrous inner zone (growth zone) formed during distraction is completely mineralized. Connective tissue and bony bars are arranged lengthwise. As a rule, intramembranous callus formation takes place during distraction osteogenesis with no intermediate cartilaginous step.

Bone Lengthening↗
PubMed1993

Rat model for limb lengthening by callus distraction.

Limb lengthening and treatment of bone defects by using the method of callus distraction has become very important in traumatology and orthopedics. Despite increasing clinical use and ongoing research, many questions still remain unanswered. The biochemical processes that occur during matrix-induced bone formation have been elucidated, while the mechanisms of bone formation induced by callus distraction are still unclear. This study details the development of a new animal model in which rats undergo limb lengthening by callus distraction, offering the possibility of using modern immunological, and molecular biological techniques, which have already been developed for this animal species. The application of limb lengthening by callus distraction in this animal model has proven to be a practicable, reproducible, and economical procedure, which can increase our understanding of the callus distraction process.

Animals↗
PubMed1993

[Equestrian accidents in children].

In a retrospective study we reviewed 262 horse riding related injuries in children younger than 16 which were treated between 1975 and 1989 at the Section of Traumatology in the Department of Surgery, University Hospital Homburg/Saar. In 155 of these accidents, detailed information was gained via a questionnaire. The typical patient profile was that of young female equestrians with little experience and little weekly riding practice, without practicing falling-exercises and warming up often using different horses. At the time of the accident only 59% were wearing a head protection. Most accidents happened in the summer months in the afternoon during leisure riding on a large familiar horse in the riding hall. Apart from the typical accidents like falling of the horse (64.9%) and falling with the horse (5.7%) accidents in handling the horse were of special significance: Kick by horse's hoof (11.8%), being stepped by horse (3.8%), horsebite (7.3%) and injuries of horse's bridle had their own pattern of injuries. Injuries of the distal parts of the upper extremity are preeminent in falling of the horse, whilst in falling with the horse head injuries and shoulder injuries are preeminent. Remarkably often injuries of kick by horse's hoof were causing sometimes even dangerous head injuries (41.6%). Overall in horse riding related injuries in childhood superficial soft tissue injuries (48.6%) and fractures (30.6%) were predominant. Fractures of the clavicle which are well known as a riding injury proved to be typical for a fall with the horse, whilst a fractured vertebra was only seen once amongst the 262 children treated. The severity of the injuries was lower than expected: In 85.1% of all the injuries only one body region was injured, 90.1% could be assigned to an injury severity score (ISS) of 1-3. Ponyriders had less severe injuries than riders of large horses. One fatal accident happened in handling a horse, in these situations preventive measures are often disregard. Active (better education, warming up, falling practice) an passive (head protection!) safety measurements are recommended for prevention of injuries in young riders in particular.

Adolescent↗
PubMed1991

[Reconstruction of large foot sole areas with microsurgical tissue transfers].

In 14 patients with microsurgically reconstructed areas of the sole videografic gait analysis was performed. The best results are reached after reconstruction of the forefoot. Loss of more than two thirds of the sole leads to functional impairment. For all reconstructed areas and all types of flaps gait is improved significantly by shoe adaptation: elevation of the shoe under the reconstructed part of the sole directs the main load to the opposite side of the foot and by this relieves the reconstructed area. Even bone corrections can reduce load on a circumscribed area.

Foot↗
PubMed1991

[Resection debridement of the lower leg with compensatory callus distraction].

In fractures with severe soft tissue defects and exposed bone, so much bone is resected in the fracture zone that the soft tissue defect can be closed with shortening of the lower leg. Subsequent osteotomy of the compact layer and callus distraction (Ilizarov method) at another level restores the tibia to its former length. Ten patients were treated, with an average healing time of 39 days per centimeter of lengthening. In all cases healing was achieved. Five patients had complications but none had any permanent sequelae. The hypermetabolism of the cell organelles in all kinds of tissue during the distraction period has a good effect on the healing of wounds and osteomyelitis. The healing process is short, so that patients are only in hospital for a relatively short time.

Adult↗