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Biomedical subjects

G Muhr

Publications and source records attributed to G Muhr.

At least 181 records · Page 10Linked to original sources
PubMed1996

[Pseudarthroses in childhood].

Nonunion of fractures in children is rare. It occurs after pathological fractures, post-infection and after incorrect osteosynthesis. Sometimes, delayed union of one bone in the forearm or the lower leg can be observed. Typical cases of nonunion are those of the radial condyle of the humerus and the femoral neck. A different problem is presented by congenital pseudoarthroses. The treatments of choice for nonunion are autogenous bone grafting and external or internal skeletal stabilization. In the radial part of the elbow joint the only indication for operative correction is an irritation of the ulnar nerve (ventralization of the nerve and supracondylar osteotomy). Nonunion of the femoral neck can be avoided by internal screw fixation.

Adolescent↗
PubMed1996

Vertical deceleration injuries: a comparative study of the injury patterns of 101 patients after accidental and intentional high falls.

We analysed the pattern of injury of 101 adult patients who were treated in our Trauma Center after a fall from an average height of 7.2 m between 1987 and 1990. In 62 patients the fall was accidental, and 39 jumped with suicidal intent. The most common injuries were fractures of the thoracic and lumbar spine (83.0 per cent) especially of the thoracolumbar junction. The pattern of limb injuries is towards a significant preference of the metaphyseal and epiphyseal parts of the bones of the distal joints (wrist, elbow, ankle, subtalar). Fractures of the diaphyseal areas and the proximal joints (shoulder, humerus, hip, femur) were rare. The incidence of thoracic (20.8 per cent) and pelvic injuries (30.0 per cent) was relatively lower. Blunt abdominal injury (5.9 per cent) was rare after a fall from a great height. Head injuries occurred in only 27 per cent of our patients who all survived their transport to hospital. There is no significant difference in injury patterns between deliberate and accidental falls, but there is a higher number of isolated injuries in all patients after unsuccessful suicidal jumps.

Accidental Falls↗
PubMed1996

Surgical correction of talipes equinovarus following foot and leg compartment syndrome.

Between 1984 and 1994, 40 patients with a posttraumatic compartment syndrome of the lower leg and foot were treated for talipes equinovarus adductus foot deformity, which subsequently developed. Twenty patients had a wedge osteotomy followed by arthrodesis of the midtarsal joint (Chopart joint). Another 17 patients had an arthrodesis of the midtarasal and subtalar joints. In the remaining three patients, in addition to arthrodesis, lengthening of the tendons of the long flexors and the Achilles tendon was performed. Complications included wound infections (six cases), drill hole infections (three cases), chronic osteomyelitis (one case), and an ankle joint infection (one case). The clinical result was assessed as good in 37.5%, fair in 52.5%, and poor in 10% of the patients. Before the operation, 37 patients required modified footwear. After the operation, only eight patients needed them. Wedge osteotomy of the midtarsal and subtalar joints followed by an arthrodesis is an advantageous treatment modality for the correction of severe postischemic equinovarus adductus foot deformities. In our study, patient satisfaction was high. While complications frequently occur, it is not extraordinary considering the salvage nature of the procedure.

Achilles Tendon↗
PubMed1996

[Elastic intramedullary nailing--a concept for treatment of unstable forearm fractures in childhood].

The standard treatment for forearm fractures in children is usually conservative. Unstable fractures of the proximal parts of the forearm often show poor results after nonoperative management, so that these fractures require surgical intervention. We report about 20 children ranging in age from 6 to 14 years who were treated by elastic intramedullary nailing. Ten patients were treated by intramedullary pinning immediately after their accident; 10 required intramedullary nailing after failure of the conservative treatment and redislocations of their fractures. At the time of follow-up 6 months later, functional results were "excellent" in 16 children, "good" in 3 children and "fair" in one child. There were no serious complications apart from the occurrence of one delayed union. According to these results intramedullary nailing can be recommended for the treatment of unstable fractures of the proximal and middle parts of the forearm in children.

Adolescent↗
PubMed1996

[Surgical treatment of ankle joint fractures with biodegradable screws and plates of poly-l-lactide].

In a first clinical protocol 19 ankle fractures have been fixed by plates and screws made of biodegradable polylactic acid. Fracture confirmation was achieved within 6 weeks. 52% of our patients demonstrated an aseptic soft tissue problem caused by delayed clearance of the degrading polylactide particles. In a 2nd protocol with 7 patients volume reduced plates and screws with flat heads were applied. None of these patients had any soft tissue reaction. These results emphasize that the application of plates and screws of polylactic acid is acceptable for fixation of ankle fractures. Soft tissue inflammatory reactions can be avoided by using volume reduced implants.

Adult↗
PubMed1996

[Elbow arthrodesis and its alternative].

Significant functional impairment, increasing pain or joint infection are the indications for arthrodesis of the elbow joint. Six patients underwent a compression arthrodesis with internal and external fixation and an additional bone graft in our institution between 1987 and 1993. Out of this series only one patient developed a non-union due to a fall on the extremity. In a series of nine patients treated with external fixation alone between 1978 and 1987, four patients developed a non-union. Unlike other joints, there is no optimal position for arthrodesis of the elbow and the functional deficit cannot be compensated by the other joints of the upper extremity. Therefore, it should be useful to know if an interposition arthroplasty is possible. With this technique a joint infection can be healed. Ten patients treated with this technique between 1987 and 1993 had no recurrent infection. Two patients had instability. The best results were achieved in post-traumatic joint stiffness. Permanent instability and post-traumatic arthritis are indications for an allo-arthroplasty. Contraindications are a previous joint infection and intensive bone loss, as well as ipsilateral shoulder ankylosis and neuropathic joint disorders. In younger patients, resection arthroplasty is better due to a high loosening rate of the prostheses.

Adolescent↗
PubMed1996

Classification of articular cartilage lesions of the knee at arthroscopy.

Classification systems for articular cartilage lesions in the knee have been based primarily on the appearance and severity of damage to the articular cartilage. Each of these systems has deficiencies in the documentation of articular cartilage abnormalities. This article proposes a new classification system for articular cartilage lesions in the knee. This system incorporates multiple parameters such as appearance, depth of involvement, area, clinical stage, and location of the lesion. A four-sector-mapping system allowing precise documentation of the location of articular cartilage lesions in the femorotibial joint is proposed. One numerical category is used to assess severity of a chondral defect. The use of these categories allows the surgeon to accurately grade and locate damage to the articular cartilage and its relationship to other concomitant intra-articular abnormalities. The proposed classification system has proven advantageous in communicating complex findings.

Arthroscopy↗
PubMed1996

[Perineal injuries in complicated pelvic trauma].

Severe comminuted pelvic ring fractures are often associated by genitourinary and rectal injuries. Because of severe retroperitoneal bleeding, shock management has to be initiated before further diagnosis of the perineal lesions. If normotonic conditions cannot be achieved by volume replacement, a pelvic clamp is indicated providing immediate reduction of the posterior pelvic ring. A subsequent emergency laparotomy has to be considered if stable circulatory conditions cannot be achieved by these emergency procedures. After the initial management of the hypovolemic shock further examination of the rectum by endoscopy and endosonography is performed. Urethral lesions have to be excluded by ultrasound of the bladder, retrograde urethrography and intravenous urography. Urethral and bladder injuries can be initially treated by suprapubic fistula, whereas rectal and pararectal wounds have to be managed by immediate debridement, jet-lavage and wound drainage. Rectal wall and sphincter lacerations are initially restored by suture because delayed reconstructions have poor results. A deviation colostomy is mandatory in cases of colonic and rectal injuries about the internal sphincter.

Colon↗
PubMed1996

[Diagnosis of acute rupture of the anterior cruciate ligament. Value of ultrasonic in addition to clinical examination].

Post-traumatic knee injuries often deteriorate if reuptures of anterior cruciate ligaments (ACL) are not treated adequately. Further diagnostic procedures are required if pain-induced muscle contraction impairs clinical examination. The clinical relevance of sonography, however, for the diagnosis of ACL ruptures is controversial. Within 25 months, 74 patients were preoperatively evaluated clinically and by ultrasound. 58 ruptures of the ACL and 21 lesions of the collateral ligaments were confirmed by arthroscopy or arthrotomy. In 16 cases a menisceal tear was found, four patients had a luxation of the patella, and two had PCL ruptures. The sensitivity of the Lachman test was 93%, of the anterior drawer test 68% and of the pivot shift test 48%. Ultrasound diagnosis revealed 88% of all ACL ruptures (91% if patients with bony ruptures of the ACL were excluded). In 75% of ACL ruptures, a popping sensation was reported by the patients. In the case of uncertain diagnosis, examination with ultrasound could be easily performed before further operative diagnostic procedures are scheduled.

Acute Disease↗
PubMed1996

[Ultrasound follow-up of callus distraction--an alternative to roentgen diagnosis?].

In a prospective study 20 patients were regularly monitored with sonograms in four planes and radiographs during distraction osteogenesis of the lower limb. Ultrasonography is more sensitive than radiography in identifying new bone formations during distraction, in measuring the length of the distraction gap, and in detecting early bone healing complications, and can therefore reduce the need for radiographs. Radiographs are necessary to assess the time of fixator removal and the axis of the leg.

Bone Lengthening↗
PubMed1995

[Epitheloid osteosarcoma. Differential diagnostic problems].

The case of a 23-year-old female patient suffering from a rare variety of osteosarcoma of the distal femur with epithelial differentiation and only traces of osteoid is reported. The tumour cells reacted strongly to antibodies against vimentin. Metastases were found in the fifth rib and the right kidney. There was no response to chemotherapy. One year after implantation of a tumour prosthesis of the knee a thigh amputation was necessary because of a local failure. The patient died 2.5 years after the tumour had initially been diagnosed. Other reports of this rare type of epitheloid osteosarcoma illustrate the difficulties involved in reaching a correct diagnosis. This tumour can be mistaken for a skeletal metastasis of an epithelial tumour.

Adult↗
PubMed1995

Mechanical and histological evaluation of hydroxyapatite-coated, titanium-coated and grit-blasted surfaces under weight-bearing conditions.

Cylindric titanium rods with different surfaces were axially implanted into the femora of sheep. The three surfaces were grit-blasted titanium, plasma-sprayed titanium and plasma-sprayed hydroxyapatite (HA). After 2 months, a 2-cm segment of the femoral shaft was completely resected to load the implant, and the animals were allowed full weight-bearing for 9 months. Biomechanical and histological evaluation of the implants was undertaken 2 months after implantation and 9 months after the segmental resection. The mechanical testings of well-fixed implants were performed 9 months after segmental resection. Loosening of 45% of the titanium-coated implants was observed in the first 3 weeks, but thereafter, no further loosening occurred. The HA-coated implants remained entirely fixed for 3 weeks, but thereafter, a progressively increasing incidence of loosening up to 55% after 9 months of loading was detected as subsidence on X-radiographs. The maximum push-out strength of the titanium-coated implants was 4.9 MPa compared with 2.3 MPa for HA-coated ones. No significant mechanical interlock between the grit-blasted surface and bone was observed. The HA coating was found to be delaminated in all unstable implants, whereas the titanium coating remained completely intact. Morphometric analyses of well-fixed rods showed complete bony ingrowth onto the HA surface, whereas the contact area between the bone and the two titanium surfaces was less than 40%. Concerning clinical significance bony ingrowth with long-term mechanical interlock between the implant surface and the bone cannot be achieved by grit-blasting or HA-coating.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

Prehospital resuscitation--outcome in an urban area.

All prehospital resuscitations performed by emergency physicians in the city of Bochum, Germany, were recorded and evaluated prospectively from 1 August 1989 to 30 September 1990. Initially successful cardiopulmonary resuscitation (CPR) was achieved in 33.8% (alive at admission), and definitive success in 10.4% (discharged alive). Of the patients who presented with cardiac arrest before the arrival of the emergency physician, 28.4% could be resuscitated initially and 7.6% survived definitively. In patients who suffered circulatory arrest on or after the arrival of the emergency physician, the initial success rate of CPR was 51.7%, and the definitive success rate 11.1%. Although the initial success rate was significantly more favourable, the definitive outcome did not differ statistically between these two groups. Two time periods were compared. During the first period of 5 months only one base with two ambulances staffed with emergency physicians was available. During the second period of 9 months an additional base with a physician-staffed ambulance was established. This reorganization resulted in the reduced call to arrival time falling from 8.5 +/- 2.4 min to 7.6 +/- 2.4 min (univariate variance analysis: f = 8.89, d.f. = 1.31, p < 0.01). This decrease, however did not improve either the initial or the definitive success of CPR. From these results we conclude that further improvement of prehospital resuscitation can only be achieved to a small extent by reducing the call to arrival time of ambulances staffed with emergency physicians. Improvement is more likely to be seen when immediate resuscitation is performed by bystanders present at the scene.

Adolescent↗
PubMed1995

[Long-term results of cemented total endoprostheses of the hip joint].

211 Müller-Charnley resp. Müller-Straight-Stem prostheses have been implanted from 1974 to 1984 in our Department for Trauma-Surgery. They were evaluated 11.8 years after implantation by clinical and radiological examination. 24 (12.8%) prostheses have been replaced because of aseptic loosening. Patients have been further evaluated by means of a new score, which emphasizes the mobility of the patients after total hip replacement. Mobility decreases significantly in patients over 70 years.

Activities of Daily Living↗
PubMed1995

[Treatment of supracondylar femoral fracture proximal to a knee joint endoprosthesis by retrograde interlocking nailing].

A case of a supracondylar femoral fracture proximal to a total knee prosthesis is reported. This difficult fracture was managed with retrograde intramedullary locked nailing. The time to union was 6 weeks. Cancellous bone grafting was not necessary. At final follow up the patient had a knee score of 90 and a functional score of 80 points. This was equal to the result after joint replacement prior to the injury.

Aged↗
PubMed1995

[Biomechanical study of the initial stability of various arthrodesis methods for the upper ankle joint].

Arthrodesis of the ankle joint is commonly, performed to treat severe arthritis. Three different techniques have been biomechanically evaluated for initial stability: fusion with three isolated tibio-talar lag screws (type I), which was inaugurated by Wagner; a second fusion technique with two isolated tibio-talar lag screws and an anterior tibio-talar three-hole 3.5 mm AO compression plate (type II); and type-II fusion with an additional lag screw through the center hole of the anterior plate (type III). Ten fresh cadaver ankles were used for biomechanical evaluation. Bone stock quality was compared before fusion by CT scan and osteodensitometry. Osteopenic ankle joints (bone density less than 80% of the median density) were excluded. Each ankle fusion was stressed with 15 Nm in a universal testing machine (UTS 10, Ulm, Germany) in antero-posterior and medio-lateral directions and in a rotational torque technique. The movements at the fusion gap were recorded by computer-assisted image analysis. A video camera recorded the displacement of four active markers on both sides of the fusion line during loading in real time. A computer-assisted calculation of the dislocation at the fusion gap was performed. This technique provides comparable results except for systemic failure induced by the fixation device of the testing machine. The results revealed comparable initial stability with types I (0.063 mm/Nm) and III (0.074 mm/Nm; P = 0.95) ankle fusion. Type-II fusion was significantly less favorable concerning initial stability (0.14 mm/Nm; P < 0.01, Duncan's test for multiple comparisons). Our biomechanical results advertise isolated lag screws for ankle fusion.

Ankle Joint↗
PubMed1995

[Extracorporeal shock wave therapy--an alternative concept for the treatment of epicondylitis of the humerus and radius?].

In a prospective study, 16 patients with chronic, painful epicondylitis humeri radialis were treated with extracorporal high-energy shock waves. A complaint-free period of 3 months was achieved in 13 patients. In 2 of them complete release from pain was achieved for more than 3 months. We conclude that release from the symptoms is achieved by local hyperemia in the area of tendinitis. In contrast to the encouraging observations of other authors, our results suggest that a critical view of extracorporal shock waves for the treatment of chronic epicondylitis radialis of the elbow is reasonable.

Adult↗