Biomedical subjects
Publications and source records attributed to G Muhr.
A case of dysphagia and hoarseness due to external compression by anterior hyperostosis between the third and fourth cervical vertebra is reported. Immediate relief of the symptoms was accomplished by surgical excision of the hyperostosis through an antero-lateral approach. The pathogenesis of the symptoms with reference to literature is discussed.
Clinical diagnosis of early postoperative complications remains a major issue in patients undergoing total hip replacement. Early diagnosis is essential because (clinical) signs of inflammations as fever or elevated white blood count already reflecting late complications. The goal of our study was to evaluate postoperative monitoring for early detection and treatment of hematoma and abscess following total hip replacement. 308 patients undergoing total hip replacement were postoperatively monitored for the development of hematoma and abscess, comparing routine ultrasound to on demand ultrasound in case of clinical signs of infection. The diagnostic puncture was 6.5% (10/154) in group A (on demand ultrasound) versus 11.7% (18/154) in group B (routine ultrasound). Infections were seen in 5.2% (8/154) of patients in group A compared to 0.6% (1/154) in group B, leading to surgical intervention in 3.3% (5/154) group A, respectively 0.6% (1/154) in group B.
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Recent investigations and new devices allow specific regimens in the management of dislocated femoral neck fractures. Very old, immobile patients with a bad prognosis should be treated with a femoral head prosthesis. Patients with either arthritis, osteopenia, dysplasia or rheumatoid arthritis should receive a total hip prosthesis. The remaining population (age > 65 years) with dislocated femoral neck fractures and intact acetabulum should be managed with a bipolar hemialloarthroplasty. The protrusion rate is not significant.
Open pelvic fractures are rare fractures usually resulting from a severe trauma. Only 4 of 121 patients treated operatively in 1994 for a pelvic trauma showed an open injury. The high lethality is caused by two complications: in the early phase the patient is threatened by bleeding to death and in the following course sepsis determines the lethal outcome. Only an aggressive surgical management prevents or treats such complications. The presented concept comprises in the end the hemipelvectomy and an intensive care management for prophylaxis of septic complications. So the lethality was diminished.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Shoulder arthrodesis definitely results in a restricted range of motion. However, in patients with a painful restricted motion after glenohumeral empyema or arthritis reduction of pain and an improved range of motion in the thoracoscapular joint are achieved with arthrodesis. Glenohumeral arthrodesis is also indicated for the management of paralysis of the rotator cuff if multidirectional stability is present. From 1978 to 1991 shoulder fusion was performed in ten patients in our institute. The mean age of the seven male and three female patients was 49 years. In six cases arthrodesis was necessary because of shoulder infections after internal fixation of humeral head fractures; three were performed because of posttraumatic arthritis and two, because of complete plexus lesions. The followup an average of just over 3 years after arthrodesis revealed acceptable function according to the Neer and Hawkins score. All patients but one reported a significant improvement of function and pain relief after arthrodesis.
There are few references discussing the typical injury patterns of adults after a fall from a height. We present the pattern of injury in 101 adult patients who were treated between 1987 and 1990 at our trauma center after falling from an average height of 7.2 m. In 62 patients the fall was accidental; 39 patients tried to commit suicide by jumping from a height. The most common injuries were fractures of the thoracic and lumbar spine (83.0%) with a preference for the thoracolumbar junction. Fracture of the lower limbs occurred in 45%. The most frequent injuries were fractures of the os calcis (64.4%) and the ankle joint (26.6%). Twenty-five percent of all patients suffered from fractures in the upper limbs with a preference for the distal radius (56.6%) and the elbow (44.0%). There were no differences between the injury patterns after a fall from a height of more than 7 m or less than 7 m. The incidence of thoracic and pelvic injuries (30.0%) increased after falls from more than 7 m. The neurological complications of injuries to the spine corresponded to increasing height. According to our analysis blunt abdominal trauma is an uncommon injury after falling from a great height. Head injuries, which would be expected to be the most common cause of death in all non-survivors in the literature, only occurred in 27% of our patients who all survived their transport to hospital.
The clinical and operative findings of an isolated rupture of the biceps femoris tendon are described. The immediate suture and the initial postoperative treatment with a knee brace limiting extension to 20 degrees and flexion to 70 degrees resulted in a free range of motion and full activity of the biceps femoris.
Twenty-four unicondylar fractures of the distal femur were treated at the Trauma Center "Bergmannsheil," University of Bochum, Germany, between 1981 and 1990. All patients sustained their injuries from severe direct trauma. There were 16 lateral condylar fractures, five medial condylar fractures, and three tangential posterior ("Hoffa-type") fractures. Twenty-three closed injuries and one grade IIIB open fracture are included. Nine patients (37.5%) sustained concomitant injuries to the skeleton. All fractures were treated with open reduction and internal fixation with screws within 8 h of admission. Postoperative management consisted of early continuous passive motion and minimal weight bearing for 6-8 weeks progressing to full weight bearing. The mean follow-up was 62 months (24-120). The therapeutic outcome (clinical result, radiographs) was rated by the Neer score. Twenty patients were rated excellent, three achieved satisfactory results, and one had an unsatisfactory result. All patients without an excellent outcome had accompanying injuries. Open reduction and internal screw fixation of unicondylar femur fractures provides overall excellent long-term results. The therapeutic outcome is significantly affected by associated injuries of the skeleton.
In the laboratory an ulnar osteotomy was performed in 10 cadaveric specimens, which included 5 distal-third junctions and 5 middle-third junctions. The interosseous membrane was left intact. Each specimen was rotated through full pronation and full supination. Displacement less than half shaft width was considered stable. The interosseous membrane was subsequently released 2 cm proximal and 2 cm distal to the osteotomy. Repeated pronation and supination range of motion documented gross displacement greater than half of the width of the shaft and was diagnosed as unstable. To evaluate this hypothesis, a clinical trial of 30 stable ulnar shaft fractures of the middle and distal thirds were treated with functional bracing between 1984 and 1990. A simple protocol was followed: A long arm cast was applied for approximately 5-7 days until the patient experienced only mild pain. At 5-7 days, a prefabricated forearm brace was fitted and the patient began physical therapy, advancing the upper extremity to full functional use. The bracing was continued until radiographic union had occurred. Twenty-nine clinical cases were evaluated to fracture union. The mean time to union was 7.3 weeks (range: 6-9 weeks). One delayed union was reported in the series. At 16 weeks surgical intervention was recommended and an open reduction and internal fixation with cancellous bone grafting was performed. Twenty-nine patients regained full range of motion, and one had limited supination/pronation due to a previous injury of the radial head. In conclusion, functional bracing of stable ulnar shaft fractures leads to a high incidence of fracture union and achieves good to excellent functional results.(ABSTRACT TRUNCATED AT 250 WORDS)
A case of a solitary metastatic lesion of the talus from an occult histologically confirmed bronchogenic carcinoma is reported. Clinical, radiologic, histological, and laboratory manifestations are described. Four months after complete resection of the talus and consecutive internal and external fixation of the ankle joint a below-knee amputation was done because of progressive infiltration. A review is given on reports in the literature of rare cases of solitary metastatic deposits of malignant tumors below knee and elbow. This unusual cause of foot pain should be taken into account concerning differential diagnosis in elderly patients. A mistake for a septic osteolysis is possible.
Eight patients with sacrum fractures combined with pelvic ring fractures type C were treated using a triangular osteosynthesis after reduction of the fracture. The additional vertical stabilization between the lumbar spine and the posterior iliac crest caused the stability, which is necessary for immediate mobilization of patients. Perfect reduction, correct positioning of the hardware, gentle soft tissue treatment, as well as early mobilization of the patient, increases the early and late prognosis considerably, and compensates the operative trauma completely. We observed no infections or redislocations. The described operative treatment is state of the art at our institution.
The removal torque and the loosening and infection rates of AO/ASIF 4.5 mm Schanz screws (MS) have been compared with those of hydroxyapatite-coated (HA) and hydroxyapatite/silver phosphate-coated (HA/P) AO/ASIF Schanz screws in vivo. In sheep, the left tibia was fixed after a midshaft osteotomy by means of unilateral fixator with 6 Schanz screws in an antero-lateral position. The osteotomy gap was filled with bone wax to avoid bony overgrowth. After operation, the animals were allowed to walk around immediately. The loosening rate was 2.8% at the site of the two HA-coated screws and 36% at the site of the metal screws. The removal torque after 2, 4 and 6 months was 6.2 +/- 2.8 MPa for HA/P, 4.7 +/- 2.7 MPa for HA screws and 1.2 +/- 1.1 MPa for metal screws. Histological and fluoroscopic evaluation revealed intimate bone-HA contact at the cortex near to the fixator, whereas at the site of the metal screws a fibrous tissue layer was constantly found. Only in the cortex opposite to the external fixator a direct bone-metal interface was observed. Fluoroscopic analyses confirmed new bone formation next to the HA surface especially in the cortex adjacent to the fixator, whereas such phenomena were not detected adjacent to the surface of the metal screws. Furthermore, bony resorption around the metal screws (21%) was significantly greater than around the two coated screws (2%). These experimental data suggest that pin loosening can be reduced in external fixators by coating the screws with hydroxyapatite, especially if a long-term fixation is indicated.
In 10-20% of patients undergoing total hip replacement bilateral replacement is necessary. This is usually done in two stages. The aim of our study was to investigate the influence of the interoperative period in bilateral hip replacement. We performed a retrospective study of 96 patients in whom bilateral hip replacement had been performed between 1974 and 1984; 72 of these patients were followed up. Assessment on follow up was based on a mobility scale, the survival time of the first prosthesis implanted was elicited from all patients. Consideration of mobility of the patients and survival time of the first prosthesis implanted revealed that the best results were obtained with an interoperative interval of between 1 and 3 years. When the interval had been shorter the mobility was less good, while patients with an interoperative period of more than 3 years had progressively less good mobility and shorter survival times of the first prosthesis. Although the range of indications for total hip replacement is not influenced by these results, the indications for replacement of the contralateral hip must be reconsidered in view of the importance of the interoperative interval.
Acute Achilles tendon ruptures are mostly related to recreational activities. Therefore, these patients intend to return to sports as soon as possible with no functional deficiency. This is the first study, comparing functional results after functional treatment to those after surgery. According to sonographic examinations of the tendon gap, primary functional treatment with heel supported shoes or surgery were suggested. Between 2/1991 and 12/1992, 22 patients with acute Achilles tendon rupture were treated without operation (group 1) and in 10 patient the rupture was sutured (group 2). 6 months later, 27 patients underwent standardized clinical examination: one leg standing for one minute, measurement of the circumference of the calf. The actual activities were assigned to Tegner Activity Score. 19 patients had isokinetic cybex testing with 60 degrees/s. There were 3 re-ruptures in group 1 and no comparable complications in group 2. At this time, clinical examination and Tegner Activity Score showed no relevant differences. Force of flexion was 30.4% lowered in group 1 and 2.4% in group 2. Additional training of the calf muscles improved the results after 6 weeks in group 1. We concluded that individual management of acute Achilles tendon rupture is possible according to sonographic tendon gap. Functional treatment is effective, but the rate of re-ruptures has to be reduced by careful selection of patients (rupture gap < or = 2 mm, high cooperation).