Biomedical subjects
Publications and source records attributed to G Hierholzer.
The technique of bridging plate osteosynthesis in closed comminuted fractures of the femoral shaft is described. With regard to clinical and radiological results as well as to complications in the postoperative course a group of 17 fractures stabilized by the bridging technique is compared with a group of 16 femoral fractures fixed by plate osteosynthesis after anatomical reduction.
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There are good results in the functional conservative treatment of the primary stable lesion of the thoracic and the lumbar part of the spine. Late results show that traumatic deformation can be compensated by the spine and by trained muscles. Segmental mobility can be generally neglected. Real late instabilities are very seldom. Static complaints caused by left deformation are important especially if the spine was previously damaged. Then, primary or early secondary operative reposition, replacement and segmental spondylodesis are indicated.
In the literature widely differing statements are found as to the extent of the radiographically seen tilt of the talus after rupture of the fibular ligaments. Our studies on cadavers showed that there can be no exact correlation between the instability found on X-ray investigation and the intraoperatively ascertained damage of the ligamentous structures. The intraoperatively found damage is usually greater than presumed on X-ray investigation. The main reason for these findings is to be seen in the various anatomical shapes of the fibular ligaments. We have certified this in our studies on 20 amputated feet. For clinical purpose it is not of interest which of the ligaments is damaged, but it is of great importance to know whether there is a rupture or not. Anamnesis and clinical state may be important in deciding whether to operate or not.
Correlation has previously been observed between the incidence of metal hypersensitivity (Ni, Cr, Co) and the incidence of infection after internal fixation of bone fractures. As there is no doubt that exposure to high concentrations of metal can cause allergy, metal levels (Cr, Ni, Mo, Co) were analyzed in implant contact tissues by ASS. Both the absolute concentration of the ions and the Ni:Cr ratio in the tissues adjacent to metal implants is greater in infected cases than in non-infected. Thus infection as a cause of allergy has to be considered. In view of the resulting problems perhaps consideration could be given to the use of a different alloy for metal implants.
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The results of the analysis of 339 pseudarthroses in 326 patients are reported. We reviewed the aetiology and previous therapy of patients with pseudarthroses, their X-ray, case reports and assessed them clinically. We noticed instability as an important aetiological factor for development of non union, especially in combination with a bone infection. The evidence of failures due to a inadequate implant or due to an inadequate surgical technique is shown. Further aetiological factors are discussed. Our principles of treatment of pseudarthroses are outlined. The first principle is to achieve stability by operative procedure. The second is to indicate correctly bone grafting. The third principle concerns infected non unions in which extensive surgical revision is necessary. By carrying out this therapy we achieved bone healing in 95.4% of non infected pseudarthroses and in 86.8% of infected pseudarthroses.
Differentiation between damage due to internal deterioration (degeneration) and damage by external causes (trauma) is the cardinal problem of expertizing for the national accident insurance in cases of injuries of the tendons and meniscus. In contrast to recognition of a disease as an occupational disease, recognition of the sequels of an on-the-job accident does not provide any relief from the burden of proof. The onus lies with the insured person in all respects, because German law does not recognize "formulae" representing a set sequence of events occurring during an accident. The article points to the essential medical and legal questions involved in writing an expertize.
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It has become necessary to improve the technical properties of external fixation. To achieve this we tested different constructions based on the tubular system of ASIF for external fixation. By axial centric and eccentric loading we investigated the displacement of the bone fragments, the degree of bending of Steinmann nails and the pressure transmitted to the tubes. According to the investigations, certain basic rules and technical aspects have to be considered in external fixation. Knowledge of the pathophysiology of the damaged area is also a precondition in using this operative technique. Classification of different methods of osteosynthesis and their indications is proposed.
Corrosions of metallic implants can lead to demonstrable accumulation of implant-specific metals in the tissue surrounding the implant. This can give rise to metal sensitization after activation of cellular immune mechanism of the body. A connection between metal sensitization and bone infection morbidity after insertion of metallic implants is thus conceivable. In our investigations to clarify this question, we were able to obtain the following results using the leukocyte migration inhibition test for cobalt, chromium and nickel on various investigation groups after statistical analysis: 1. Patients bearing metallic implants without infection show the same rate of metal allergy as persons without implants. 2. Patients bearing metallic implants with infection show an increased rate of allergy to cobalt and nickel compared to persons without implants and to patients bearing metallic implants without infection. They are sensitive to one of the three tested metals more than twice as frequently as patients with aseptic osteosynthesis. Furthermore, this study has addressed the question of causality: Does metal allergy cause an inflammatory reaction or does infection cause sensitization, e.g. via increased corrosion of metallic implants following infection.