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Biomedical subjects

G Hierholzer

Publications and source records attributed to G Hierholzer.

At least 37 records · Page 2Linked to original sources
PubMed1991

Back school for patients with vertebral fractures.

Back school is behavior training for the prevention and treatment of back problems arising from faulty body posture and muscular dysfunction. This paper describes the conception and evaluation of a back school program for patients with vertebral fractures. The curriculum includes the provision of detailed information as well as physiotherapy, training in the right way to perform activities of everyday life, counseling, relaxation training, and self-monitoring. From October 1987 to June 1990 214 patients with vertebral fractures completed the back school program. The effectiveness of the program was measured by a knowledge test and a behavior test. The results suggest that this back school is an effective addition to conventional concept using physiotherapy exclusively.

Adolescent↗
PubMed1991

[The fibula-pro-tibia operation--indications, results].

We report on 21 cases with combined soft tissue and far reaching bone defects of the lower leg. The bone defects were bridged by the fibula-pro-tibia-operation. In eleven patients the restoration of the full weightbearing leg was achieved. Five patients have to use a supporting walking splint at the end of the medical treatment. In four cases we found fistulas without secretion. Five amputations of the lower leg were unavoidable.

Bone Transplantation↗
PubMed1991

[Analysis of the collective term "periarthritis humeroscapularis"].

The functional and anatomical consideration of the shoulder joint in relation to the clinical aspects can differentiate the general term of "scapulohumeral periarthritis". The most frequently pathological findings are seen in the rotary cuff and the long head of the biceps muscle. Significant causes are further arthrosis of the acromioclavicular joint, the instability of the shoulder joint and the frozen shoulder. The exact diagnosis of the disease makes on operative therapy possible.

Acromioclavicular Joint↗
PubMed1991

[Indications for a bridging plate osteosynthesis of compound femoral shaft fractures].

We performed the clinical and radiological follow-up of 29 comminuted fractures of the femoral shaft treated by bridging plate osteosynthesis. Complete bone healing in 6 open fractures took place within 33 weeks, in 15 closed fractures within 22 weeks. We had to meet 5 postoperative complications: 2 cases of osteomyelitis following open fractures, 1 early wound infection and 2 haematomas. Primary cancellous bone grafting we found unnecessary in all of the 29 fractures. We recommend the technique of bridging plate osteosynthesis for the stabilization of comminuted fractures of the femur especially under the clinical circumstances as follows: 1. Polytrauma, 2. Metaphyseal or condylar fracture, 3. Open fracture, 4. Redisplacement, 5. Fracture in children.

Adolescent↗
PubMed1991

[Incidence and causes of typical injuries in popular sports].

The increasing participation in extensive athletics and leisure time activities correlates with increasing sport injuries. The surgeons tasks include being involved in preventing sport injuries and ensuring a correct diagnosis, as well as providing adequate surgical therapy. After sport injuries, the true diagnosis can be obscured by functional compensation. Therefore the case history and analysis of the trauma mechanism are important for an adequate surgical therapy.

Adolescent↗
PubMed1990

Significance of postoperative stability for bony reparation of comminuted fractures. An experimental study.

The significance of postoperative mechanical stability to bone repair of comminuted fractures was investigated in an animal experimental study comparing four commonly employed operative methods of fracture stabilization: 1. Plate osteosynthesis combined with lag screw fixation; 2. Bridging plate osteosynthesis; 3. External fixation; 4. Static interlocking intramedullary nailing. As fracture model, a triple wedge osteotomy of the right sheep tibia was used. In regard to biomechanical strength, the method which gave best postoperative stability, plate osteosynthesis in combination with interfragmentary lag screws, did not result in the best bone repair. In this experimental setup, stabilization by bridging methods, inducing bone healing by secondary intention, gave better bone regeneration in the experimental fractures.

Animals↗
PubMed1990

[Standardized bone model for incorporation of bone, bone ceramics or other materials into the implant bed].

To investigate the regeneration of human bone in a good and firm layer, a new model is introduced. It has been developed by us because of therapeutical necessity, but then is continued in the course of further investigations independent from further therapeutical procedure. We use the iliac crest as a bony layer for implants that are the object of research. For the therapy in cases of delayed bone healing, pseudarthrosis, bony defect or corrective osteotomy, the cancellous bone is removed. The empty iliac crest is then filled up with material we intend to investigate. On the occasion of further operations that became necessary because of the underlying bone disease, we had an opportunity to obtain sample of bone and material by hole-drilling through the iliac crest. The bony cylinder can be examined by histological technique. We used this procedure on 105 patients up to now. There were no specific complications caused by this technique at the iliac crest. 37 biopsies could be taken and will now be examined. In future it may be possible to incorporate new bone in this layer for a further therapy and to fill up the lost donor sites.

Bone Regeneration↗
PubMed1990

[Indications, technique and preventable errors in conservative therapy of distal radius fracture].

The guidelines for conservative or operative treatment of fractures of the distal radius have been standardized for years. To decide whether conservative treatment is indicated the following factors are important: 1. the amount of metaphyseal impaction, 2. the presence of a joint surface, and 3. the remaining bony buttress. Conservative treatment is indicated in cases in which there is a chance to ensure retention. The difficulty of conservative treatment does not lie in special sophisticated steps of procedure. It is more important to consider the standardized technical procedures of reduction, adequate immobilization and surgical control.

Casts, Surgical↗
PubMed1990

[Significance of primary diagnosis of carpal instability].

In general the dislocation of the carpal bones with subsequent carpal instability is rare. The diagnosis depends on a correct interpretation of the X-ray. In a follow-up study 25 patients with closed carpal instabilities were examined. In 14 the carpal instability had been established in the primary diagnosis and treated adequately. The functional results were good. 11 patients, in whom the dislocation of the carpal bones had been overlooked, did not receive primary therapy and had unsatisfactory function of the hand.

Carpal Bones↗
PubMed1990

[Dorsal plate osteosynthesis of the tibial shaft. Results of a collective study of the German section of the International AO (Study Group for Osteosynthesis Problems)].

This collective study was conducted by the German section of AO International to work out the indications for fixation of the tibial shaft by means of dorsal plating. Primary dorsal plating was done in 70 cases. Most of the patients had second- or third-degree open fractures with severe ventral soft tissue injuries or closed fractures that could not be reduced and fixed conservatively. In 72 patients, secondary dorsal plate fixation was performed. The main reason for the dorsally positioned plate was persistent instability or axial malalignment after previous external or internal fixation, but failed conservative treatment constituted a further reason. Most of these patients had such severe damage following fractures that dorsal plating was the last chance of avoiding amputation. The high rate of complications (12 infections and 7 non-unions and breakages of implants after primary dorsal plating; 20 infections and 11 non-unions and breakages of implants after secondary dorsal plating) has to be considered in the light of the extraordinary indications for the dorsal plating of the tibial shaft in especially severe fractures or disastrous sequelae. In cases with extremely severe conditions before fixation, dorsal plating of the tibial shaft for secondary operative treatment yields adequate results.

Adult↗
PubMed1990

[The significance of postoperative stability for osseous repair of a multiple fragment fracture. Animal experiment studies].

The significance of postoperative mechanical stability for bony repair of a comminuted fracture was investigated in an animal experimental study comparing four commonly applied operative methods of stabilizing fractures: (1) flate osteosynthesis combined with lag screw fixation after reduction of the fragments; (2) bridging plate osteosynthesis; (3) external fixation; (4) static interlocking intramedullary nailing. As the fracture model, a triple-wedge osteotomy of the right sheep tibia was used. The results of in vitro testing of stiffness (N/mm) of each of the four osteosyntheses was as follows: anatomical plate: 746 N/mm; bridging plate 434 N/mm; external fixation 625 N/mm; nailing 416 N/mm. Eight weeks after the operation, the tibiae were explanted and the contralateral tibiae of six sheep were taken as a control group. The three-point bending test revealed no significant difference in bending deviation: anatomical plate 47.58 +/- 22.57 microns; bridging plate 33.93 +/- 7.67 microns; external fixation 33.83 +/- 8.02 microns; nailing 33.0 +/- 17.23 microns. However, it was noted that there was a slightly higher tendency towards stiffness of the bones after bridging plate osteosynthesis, external fixation and interlocking intramedullary nailing and that the amount of stiffness resembled that in non-operated control animals (25.56 +/- 6.66 microns). On the other hand, anatomical plate osteosynthesis showed less stiffness. To assess the tensile strength at the osteotomy area, bone samples were prepared and tested for failure on a material testing machine. The tensile strength of the bone samples showed a distinct difference in all experimental groups according to their anatomical location.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Post-traumatic osteomyelitis. Pathophysiology and management.

Osteomyelitis is one of the most severe complications that can arise following operative treatment of bone. It requires a long-term treatment. The patient can never be sure that it heals completely. The pathophysiology depends on: (1) the extent of soft tissue damage and impairment of blood supply; (2) inoculation of bacterial flora; (3) the instability of the fracture area; and (4) the general defensive condition of the organism. The symptoms of acute osteomyelitis are those of acute inflammation. They appear 1 week to 3 months after operation. The diagnosis can only be made on clinical examination by an experienced surgeon. X-Ray findings are lacking. The treatment of acute osteomyelitis involves debridement of soft tissue and bone sequesters, refixation of the fragments, most often by means of an external fixator, and suction drainage or wet dressing. The reconstruction of the bone is done in a second step. The cancellous bone grafting is performed from a medial approach. Closure of the soft tissue follows. In the case of chronic osteomyelitis scarring, fistulas and muddy secretion are present. The function of the bone is disturbed. X-Ray examination shows loosening of the metal and failing structure of the bone. In this case too, the first step is the debridement of soft tissue and bone. All the metal inside is removed. Stabilization is achieved by means of an external fixator. Once the fracture area has been cleaned, cancellous bone grafting is done once, twice, or even more frequently. For wound closure it is necessary to rotate muscle groups, to cover the bone with dermatomic skin, or to use microvascular flaps.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic Disease↗
PubMed1989

[A back rehabilitation school for patients with vertebral fractures].

This paper describes the conception and the evaluation of a back school for patients with vertebral fractures. The school curriculum includes detailed information for the patient as well as physiotherapy, training in the proper way of performing the ordinary activities of the everyday-life, systematic self observation and relaxation training. From October 1987 until July 1989, 136 patients with vertebral fractures have completed the back school program. The effectiveness of the program was evaluated by a knowledge test and by an obstacle course. Both in the pre-post-confrontation as well as in the experimental group-control group comparison we obtained significant differences in the goals. In conclusion, the present results imply that the described back school for patients with vertebral fractures is an efficient addition to conventional programs with physiotherapy only.

Adult↗
PubMed1989

[Reconstruction of large femoral defects in exchange operations following artificial hip replacement].

Loosening of the implant is one of the most serious complication in case of total hip replacement. It is caused by the growth of a secondary cancellous channel and in destroyed bone cement. From 1981 to 1986 we operated 63 patients to exchange a loosened hip prosthesis. With 15 patients we have seen a severe damage of the femur shaft. Big parts of the bone tube were missed. To insert the new stem we had to reconstruct the proximal femur and the calcar region by autogenous cortico-cancellous bone grafts in seven cases. In three cases a large defect of the lateral femur cortex was reconstructed by extended cancellous bone graft. In five cases we found a cominuted fracture of the femur shaft. The osteosynthesis was performed by plating. The screws were inserted through the bone into the stem. They find a very strong grip in the polyacetal material. 14 of 15 patients operated in this manner could achieve a walking ability. Most of them improved one step higher in the evaluation scheme according to Merle d'Aubigne. One patient suffering from a septic loosening showed a severe exacerbation with septicemia and ended in a disarticulation of the hip joint. The so called isoelastic prosthesis gives a chance to reconstruct the femur tube. It allows unhindered calcification of bone graft and acts as a forming model for new bone. With this we are able to restore the movement of hip joint as well as weight bearing and working ability of the limb. Additional osteosynthesis is possible to perform.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗