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Biomedical subjects

G Muhr

Publications and source records attributed to G Muhr.

At least 217 records · Page 12Linked to original sources
PubMed1994

[Muscle power and shoulder joint function after removal of the latissimus dorsi muscle].

Free transplantation of the latissimus dorsi muscle has become the treatment of choice in extensive soft-tissue defects of the lower leg after trauma. However, neither the ability of the remaining muscles of the shoulder to compensate for the lost function nor the long-term effects of latissimus dorsi removal on the function of the shoulder have been objectively measured. Therefore, the postoperative shoulder function in 23 patients was compared after removal of the latissimus dorsi muscle with 23 control subjects. The evaluation included a questionnaire, physical examination, and instrumented muscle-testing (cybex system). No significant statistical differences in the function of the shoulders of all the patients and control subjects could be verified, with the exception that 16 patients exhibited weakness during isokinetic torque during extension of the shoulder in a 55 to 65 degree flexion (4.2 +/- 1.2%). The latissimus dorsi free flap can therefore be recommended as a procedure for soft-tissue coverage of extensive wounds resulting only in negligible loss of function and a slightly altered appearance of the shoulder-girdle.

Adult↗
PubMed1994

[Mechanical strength and chemical stability of biodegradable block-polymerized and injection molded poly-L-lactide in vitro].

Biodegradable poly-L-lactic acid rods made of block-polymerized material (BP; molecular weight 550,000) and injection-moulded rods with high (SGI; molecular weight 121,000) and low (SGA, molecular weight 118,000) molecular orientation were compared 2, 4 and 6 weeks after incubation in enzyme solutions with high hydrolytic activity (esterase, alpha chymotrypsin and peptidase) and in buffer solution (TRIS buffer). The molecular weight, modulus of elasticity, bending strength (three-point bending test), and cyclic bending load to failure applied to the rods in a newly developed testing machine (1 Hz, maximum 100,000 cycles) were compared. The molecular weight of BP material decreased to 36% after 2 weeks, in contrast to the injection-moulded materials, in which it decreased only to 66% even after 6 weeks. The bending strength of all specimen decreased significantly faster in alpha chymotrypsin than in the other media (MANOVA, P < 0.001). SGI had a significantly higher bending strength than SGA, and SGA a higher strength than BP. There was no difference after incubation in the other two enzymatic solutions. BP lost 80% of its initial bending strength (140 N/mm2) after 6 weeks, and SGI and SGA (120 N/mm2) only 20%. Under permanent cyclic loading BP initially resisted 100,000 cycles with an applied cyclic load of 12.5 N/mm2, decreasing after 6 weeks to only 9,500 cycles, in contrast to SGI and SGA, which resisted to 46,000 cycles. There was, however, no relevant difference in the mechanical characteristics of the two injection-moulded rods. These results confirm that BP is degraded significantly faster than SGA and SGI.(ABSTRACT TRUNCATED AT 250 WORDS)

Biodegradation, Environmental↗
PubMed1993

[Unreamed intramedullary nail or external fixator in complicated tibial fracture? A comparative analysis].

Sixty-seven fractures of the tibial shaft with concomitant soft tissue injury were managed at the "Bergmannsheil" Bochum, University Clinic between May 1, 1991 and March 31, 1993. 33 fractures underwent unreamed nailing whereas 34 fractures were stabilized with external skeletal fixation. There were 20 closed fractures with soft tissue compromise (13 types GII and 7 types GIII (Oestern/Tscherne classification)) and 25 compound fractures (8 grade I, 12 grade II and 27 grade III (Gustilo-Anderson classification)). The grade III open fractures were subdivided by the Gustilo-Mendoza-Williams classification (13 types IIIA, 10 types IIIB and 4 types IIIC). Sixty-five fractures have healed (1 amputation type IIIC, 1 patient died). The mean time to union was 28 weeks in the fixator group and 23.5 weeks in the unreamed nail group (statistically not significant, p < 0.095). Also the infection rate (1 case in each group), the fasciotomies due to compartment syndrome, the number of bone grafts, the number of device change and mesh grafts was not statistically significant in both groups. Only the number of performed flaps for wound coverage was statistically significant higher in the fixator group (p < 0.05). In the unreamed nailing population, breakage of the locking bolts occurred in 4 cases. In 3 cases secondary reamed nailing was necessary (2 delayed unions, 1 avulsion of distal bolts). Two fractures underwent dynamization by removal of the distal locking bolts 6 weeks post initial static nailing. The unreamed nail is a versatile implant for tibial shaft fractures with closed and open soft tissue compromise.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[Compensation behavior after fractures of the thoracic and lumbar spine in children and adolescents].

UNLABELLED: Spinal column trauma with a fracture of the breast and lumbar spine is with 2-3% relatively uncommon in the pediatric patient population (from birth-16 years). In a review of 22 patients (7-15 years old) treated between 1978-1988 the individual management of treatment is reported. The goal of our study was to describe the absolute indications for the operative treatment and the difference between conservative and operative procedure depending on the age of the patient. The follow-up study after an average of 7 years and 8 months demonstrated an improvement of the neurological status (neurological status of Frankel) of 8 patients and a spontaneous correction of kyphotic angle from 21 degrees after treatment to 3 degrees. THE CONCLUSION: The treatment must be individual and depends on the age of the patient.

Adolescent↗
PubMed1993

[Treatment of collateral ligament ruptures of the knee joint].

Functional treatment of the medial collateral ligaments (grades I and II) gives the best results. Both, experimental results and clinical experience thus far, show that such treatment leads to a short period of morbidity and always gives a good functional result. Any minimal residual instability can be successfully compensated for. Functional treatment is only possible if the cruciate ligaments are intact. Severe ruptures (grade III) can also be treated with functional therapy, but with certain qualifications (not in the presence of axial deviation, cruciate instability or previous meniscectomy). Isolated lesions of the lateral collateral ligaments are very rare; severe combined ruptures of the capsule and ligaments are treated surgically.

Follow-Up Studies↗
PubMed1993

[Negative effects of local tibial muscle flap repair on foot function].

Although local muscle flaps of the lower leg are often used, the functional problems that arise after these reconstructive procedures have not yet been adequately studied. Twenty patients who had undergone a local muscle flap of the lower leg 3 years earlier were studied using a isokinetic muscle test. The isokinetic muscle strength profile during flexion of the foot was reduced by up to 21 +/- 16% after transfer of the m. gastrocnemius and by up to 31 +/- 20% after transfer of the m. soleus at a angular velocity of 120 degrees. The isokinetic muscle strength profile during pronation and supination of the foot at an angular velocity of 120 degrees was reduced by up to 89 +/- 32% after transfer of the m. soleus. Statistically, compound tibia fractures without a local flap for soft tissue therapy showed significantly better results. In view of this functional loss, the use of local muscle flaps, particularly the transfer of the m. soleus, should be restricted in younger patients, and alternative techniques (free flaps) should be used.

Adult↗
PubMed1993

[Complications of intramedullary nailing and their prevention].

Interlocking nailing technique offers a wide variety of indications which are associated with an increased risk of complications. A consecutive series of 208 cases were analyzed and possible complications, how to avoid them and recommendations for treatment are given. The complications were divided into common complications--like infection, pseudarthrosis, malrotation, compartment-syndrome, disorders of the arterial and venous system, neurological deficts and fat embolism--as well as into specific complications--like malreduction of the fracture, malpositioning of the guide wire, splitting fragments and problems with nail insertion and with the locking bolts. There was a 8.7% common complication rate. Specific complications occurred intraoperatively in 3.5% and postoperatively in 11% of call cases. This seems to be a high rate which is decreasing by progressive experience of the surgeon. In many cases of shaft fractures interlocking nailing technique is the method of choice.

Adult↗
PubMed1993

[Conservative or surgical treatment of metacarpal fractures].

A total of 146 patients with 150 closed metacarpal fractures were treated between 1980 and 1981, and 109 patients with 113 metacarpal fractures (75%) were followed up (follow up 7.3 years). After conservative treatment, the functional results were good to excellent in 92.7%, while 5.8% had satisfactory and 1.5% poor functional results. After operative treatment 81.5% had good or excellent functional results, 14.8% satisfactory results and 3.7%, poor functional results. The radiological result did not correspond with the functional result. Angulation of the Ist-IVth metacarpal bones by up to 20 degrees of the Vth metacarpal bone by up to 50 degrees, and even shortening by up to 8 mm had no detrimental influence on the functional results. Axial rotational deviation of the Vth metacarpal bone by up to 15 degrees was tolerated. Joint fractures with a 1 mm step could also be treated by conservatively means.

Adult↗
PubMed1993

[The effect of hydroxylapatite coating of AO/ASIF screws on bonding strength in bones].

Bonding strength of hydroxyapatite-coated (HA) 4.5 mm AO/ASIF screws and of conventional AO/ASIF screws to bone has been compared in an animal experiment. A 5-hole AO/ASIF compression plate was fixed to the tibia in ten beagle dogs. The cortex beyond the central hole of the plate was resected up to the half of the diameter of the tibial shaft and over a length of 10 mm. In the holes immediately proximal and distal to the central hole either HA-coated or conventional screws were inserted with standardized force. Two conventional screws were inserted into the two holes at the ends of the plate. These screws were removed after 2 weeks. Four animals were sacrificed after 4 and 8 weeks and one animal after 16 and 26 weeks. The removal torque of HA-coated screws was 385.50 +/- 49.1 Ncm, compared with 29.50 +/- 7.62 Ncm for the conventional screws (P < 0.0001; T-test). The fluorescence and morphometric data confirmed new bone formation immediately under the HA surface without any bone resorption or intervening fibrous tissue. At the bone-implant interface of conventional screws, however, extensive bone resorption was observed and a thick intervening layer of fibrous tissue. Bone resorption of 13.6% was observed in the cortical areas under the thread of the AO/ASIF screws, in contrast to 1.9% under the surface of the HA-coated screws. These histological and biochemical data support the clinical use of HA-coated screws if early loosening of the screws is otherwise expected or removal of implants is not intended.

Animals↗
PubMed1993

[Ultrasonographic monitoring of conservative-functional treatment of rupture of the Achilles tendon].

Rupture of the Achilles tendon has become more common in recent years. Operative repair is the treatment generally used but non-surgical therapy is being accepted by an increasing number of surgeons because of the reports of good results with conservative treatment. Ultrasonographic examination not only allows an exact diagnosis to be made in muscle and tendon injuries, but also observation of the healing processes. Therefore, conservative functional treatment of rupture of the Achilles tendon can be used with more success, which is a very comfortable concept for these patients. We present a series of 22 subcutaneous ruptures of the Achilles tendon treated non-operatively to emphasize the value of conservative functional therapy with ultrasonographic monitoring. After immobilization of the lower leg by a walking cast in the equinus position for 3-6 weeks, the functional treatment follows using a decreasing heel lift and physiotherapy. Ultrasound examinations were performed frequently to recognize new diastasis early. We observed complete healing in all patients, absence of complications and excellent functional results. The morbidity of the patients was lower than with operative treatment and no hospital stay was needed. In conclusion, in our opinion ultrasound-controlled conservative functional treatment of rupture of the Achilles tendon should be used more frequently in future.

Achilles Tendon↗
PubMed1993

[Arterial vascular injuries in fractures or dislocations of the lower extremity. Therapeutic concept and results].

Combinations of fractures or dislocations with vascular damage of the leg have a high incidence of amputation or severe functional deficit. With this type of lesion 22 patients were treated at "Bergmannsheil" from 1986 to 1991. Using a pre-, intra- and postoperative protocol, the amputation rate decreased to 18%. More than 80% of the patients had a good function of their leg with only minor joint restrictions.

Anastomosis, Surgical↗
PubMed1992

[Arthroscopy of the wrist and elbow joint].

Arthroscopy of the wrist and elbow is a helpful diagnostic procedure in patients with chronic disability not demonstrated by clinical and radiological examinations. At the wrist, especially triangular fibrocartilage, chondral or ligamentous defects can often not be demonstrated by other tests. Arthroscopy of the wrist allows examination of more than a dozen separate articular surfaces and the function of eight discrete joints. The geometry of the elbow joint limits intra-articular inspection and the use of instruments. The risk of neurovascular injuries is great and depends on exact puncture sites and portals. Its efficiacy is not yet proven.

Adult↗
PubMed1992

[Continuously alternating prone and supine positioning in acute lung failure].

Acute respiratory failure is still one the main problems in surgical intensive care. Unknown pathophysiological mechanisms permit only symptomatic therapy. Today ventilatory strategies by using PEEP und IRV are established to improve gas exchange and FRC by recruiting collapsed alveoli, decreasing intrapulmonary shunting and returning V/Q matching to normal. Furthermore different studies have shown the effects of supine and lateral decubitus posture in patients with acute respiratory failure. There are only rare reports on using the prone position, which doesn't require two-lung ventilation in difference to lateral position. We have studied 16 patients with acute respiratory failure by using continuous changing between prone and supine position under mechanical ventilation. All were male, aged 41.3 years in the middle and showed an average "Injury Severity Score" of 30 (13-50). 15 were trauma patients with blunt chest trauma in 11 cases. We have used prone position on threatening or manifest ARDS. In all patients we observed an increment of PaO2 during prone position on to 48 mmHg so that FiO2 could be reduced on an average of 0.2 within the first 48 h since changing patient's position. Posture changing depends on blood gas analysis, specifically on decreasing PaO2 after previous increment. Patients remained in prone and supine position at a mean of 6.3 (4.5-20) h and posture changing was proceeded over a period of 15.4 (7-32) days. No problems recording to blood pressure or mechanical ventilation appeared during prone position. 11 of 16 patients survived (68.8%), 5 died of cardiac (2) and multi organic failure (3) in connection with sepsis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[External fixator in complicated tibial fracture. Effect of various fixation systems on fracture healing and rate of complications].

In a retrospective analysis 93 external fixations with different rigidity after open tibial shaft fractures have been reviewed and compared concerning complications and healing time. Fracture consolidation was attained in fixation with unilateral frame after 14 weeks, with bilateral v-shaped fixator after 19 weeks and with triangular configuration in about 28 weeks. Subsequent internal fixation or extension to v-shaped fixation was necessary in about 33% after initial unilateral half-pin frame, whereas 90% of the two rigid systems could be left in situ until fracture consolidation was achieved. Cancellous bone grafts were performed in 58% after triangular, in 40% after v-shaped, and 28% after unilateral fixation. Pin infections were observed in 36% after triangular, 25% after bilateral v-shaped, and in 15% after unilateral fixation.

Adult↗
PubMed1992

[What modifies the outcome of abdominal trauma? An analysis of 558 patients].

A consecutive series of 558 patients with abdominal trauma were treated at "Bergmannsheil" Trauma Center in Bochum between 1974 and 1989. The most common patient group was traffic casualties with an age of up to 30 years a total of 218 (31.1%) patients underwent surgery, in which can the diagnosis was made only by surgeons. Isolated injuries were predominantly in the spleen (33%), liver (29%), mesenterium (16.1%), bowel (14.2%), and bladder and urethra (10.1%). Eighty-three of the patients who were operated on had multiple intra-abdominal injuries; 208 (37.3%) patients were included with polytrauma. Despite the increasing number of patients with multiple injuries mortality decreased from 27.1% between 1974 and 1979 to 19.7% between 1980 and 1989. This emphasizes the progress that has been made in diagnostic methods, surgical intensive care and the improved education of trauma surgeons.

Abdominal Injuries↗
PubMed1992

Surgical treatment of persistent elbow epicondylitis.

From 1978 through 1987, 86 patients with epicondylitis were admitted for surgery after failed conservative treatment. The Wilhelm technique was performed either alone or in combination with an intraarticular procedure. The Wilhelm technique involves denervation of the epicondyle. The intraarticular procedure described by Bosworth or Boyd involves a one-third resection of the orbicular ligament and resection of a synovial fold. Before surgery a local anesthetic was injected at the sore spot of the epicondyle. After almost complete pain relief after injection, a sole Wilhelm procedure was performed at the lateral epicondyle in 34 patients and at the medial epicondyle in 17 patients. For 27 patients in whom the pain persisted after the injection, a combined Wilhelm and intraarticular procedure using the Bosworth or Boyd method was used. Degeneration of the orbicular ligament or a redundant synovial fold was reported in 77% of the intraarticular operation reports. At a follow-up examination, a minimum of two years and an average of four years nine months after surgery, 85% had good and excellent results after lateral and medial Wilhelm and 56% after combined surgeries while the poor results were 3% and 7% respectively. The results of combined surgery worsened from discharge to follow-up examination, and they show fewer good results than those where a sole Wilhelm procedure was performed. Therefore, intraarticular surgery should be considered for patients with incomplete pain relief after a test injection, but it should not routinely be performed.

Adult↗