[Multiple fractures of the lower extremities].
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Adolescent↗
Biomedical subjects
G Muhr
Publications and source records attributed to G Muhr.
[Prognostic factors for avascular necrosis following talar fractures].
AIM: We performed an investigation of factors for avascular necroses after talus fracture and on the reliability of the Hawkins Sign. METHOD: From 1984 until 1997 a total of 98 patients with 99 talus fractures were surgically treated. Of these, 79 patients with 80 fractures were examined clinically and radiologically. The average postoperative interval was 6 years and 2 months. RESULTS: With respect to the 65 central fractures, the rate of necrosis amounted to 14 %, that of collum fractures to 17 %. Necroses arose solely in dislocated central fractures of the talus, type III and IV according to Marti/Weber fracture classification. The rate of necrosis rose with the degree of dislocation of the fractures. In 24 patients the Hawkins Sign could be retrospectively investigated. It proved to be a relatively reliable sign for vitality since only 1 out of 12 patients with positive or partial positive Hawkins Sign developed avascular necrosis. Neither a short interval between accident and operation, the age at the time of the accident, nor the ipsilateral fracture of the medial malleolus showed a necrosis preventive influence. In 5 out of 9 talus necroses the patients were very or mostly satisfied with the result of their treatment. CONCLUSION: The Hawkins Sign proved to be a relatively reliable sign for vitality of the talus after fracture. Risk for avascular necrosis increases according to the degree of fracture dislocation.
Adolescent↗
[Spinal contusion after trauma to the cervical spine--relevance of the sagittal diameter of the spinal canal].
PURPOSE: The purpose of this study was to analyze the relationship between spinal stenosis and cervical myelopathy. Furthermore it was to investigate whether there is a correlation between spinal stenosis and progression of neurologic symptoms? PATIENTS AND METHODS: Using the Pavlov ratio method, we compared 14 patients with a contusio spinalis with 14 patients who suffered from a distortion of the cervical spine. This ratio is calculated by the sagittal diameter of the spinal canal with the anteroposterior width of the vertebral body. RESULTS: In eight patients with a contusio spinalis, there was a spinal stenosis, while there was none in the distortion group. The remaining patients with a contusio had severe degenerative changes in routine roentgenograms of the cervical spine. The Pavlov ratio was statistically significant reduced in the contusio group. After 8.5 days there was a complete regression of neurologic symptoms, whereas in 4 patients there was no full recovery. CONCLUSION: To conclude we demonstrated that a spinal stenosis promotes a contusio spinalis but there is no evidence that the Pavlov ratio allows statements concerning the progression of the injury.
Adolescent↗
Triangular osteosynthesis of vertically unstable sacrum fractures: a new concept allowing early weight-bearing.
OBJECTIVE: Presentation of a new triangular osteosynthesis technique that permits early weight-bearing in vertically unstable sacral fractures. DESIGN: Retrospective evaluation of a consecutive series. SETTING: Level I trauma center. PATIENTS: Thirty-four patients, twenty-eight of whom were polytraumatized, all with vertically unstable sacral fractures. This group included eight women and twenty-six men, with a mean age of thirty-five years. Average time between trauma and definite operation was thirteen days (range 0 to 28 days). INTERVENTIONS: All patients underwent triangular osteosynthesis using a combination of a vertical vertebropelvic distraction osteosynthesis (pedicle screw system) and a transverse fixation of the sacrum fracture with either iliosacral screws or transsacral plating. Immediate postoperative weight-bearing was permitted postoperatively. RESULTS: Nineteen patients were treated with early progressive weight-bearing and advanced to full weight-bearing, on average, after twenty-three days (range 8 to 70 days). Three of the thirty-four patients (9 percent) experienced loosening of hardware, including two patients (6 percent) who required secondary intervention because of loss of the original reduction. Further complications included one pulmonary embolism (3 percent), one iatrogenic nerve lesion (3 percent), one wound necrosis (3 percent), and two local infections (6 percent). CONCLUSIONS: Triangular osteosynthesis is a demanding procedure that can be performed on vertically unstable sacral fractures to allow early progressive weight-bearing with an acceptable complication rate.
Adult↗
Open reduction and augmentation of internal fixation with an injectable skeletal cement for the treatment of complex calcaneal fractures.
OBJECTIVES: To describe the surgical handling, potential complications, and remodeling of an injectable, osteoconductive calcium phosphate cement (Norian SRS) for joint depression-type calcaneal fractures in humans, and to illustrate the clinical efficacy of this cement with special reference to early postoperative full weight bearing. DESIGN: Prospective cohort study. SETTING: Level I trauma centers in Bochum and Leipzig, Germany. INTERVENTION: Thirty-six joint depression type calcaneal fractures in thirty-two patients were augmented with the calcium phosphate cement after standard open reduction with internal fixation. Postoperative full weight bearing was allowed progressively earlier, and as the study progressed, the last patients were bearing full weight as early as three weeks postoperatively. Biopsies for histologic analysis were performed at time of hardware removal after one year (seven biopsies) or in case of infection at time of debridement (five biopsies). MAIN OUTCOME MEASURES: Clinical outcome was evaluated according to a calcaneal scoring system. Data were compared and statistically analyzed between patients with postoperative full weight bearing after eight to twelve weeks and three to six weeks, respectively. Histologic findings are described. RESULTS: Cement injection averaged ten cubic centimeters and could easily be performed under fluoroscopic control. Progressively earlier full weight-bearing was achieved without loss of reduction. There was no statistical difference in clinical outcome scores in patients with full weight bearing before or after six weeks postoperatively. The infection rate was 11 percent, possibly related to the skin incisions. The biopsies from clinically satisfactory cases showed nearly complete bone apposition, areas of vascular penetration, and reversal lines illustrating progressive cycles of resorption and new bone formation. Biopsy specimens from infected cases showed bone and cement surrounded by either fibrous tissue or acute inflammation without extensive bone apposition. CONCLUSIONS: Calcium phosphate cement augmentation of standard open reduction with internal fixation in joint-depression type calcaneal fractures allows postoperative full weight bearing as early as three weeks postoperatively. The injectable bone cement can easily be handled surgically under fluoroscopic control and has proved to be remodelable.
Adult↗
[Histologic and histomorphometric follow-up observations of osseointegration of corundum-blasted BMP-3 coated titanium test implants (Ti6Al4V) at orthotopic site in the giant rabbit].
AIM: To establish whether the additional coating of titanium implants with Bone Morphogenetic Protein-3 (BMP-3) might enhance osseous integration. METHOD: Each of 15 cylindrical titanium test implants (Ti-6AI-4V) was coated using 230 micrograms porcine BMP-3. A further 15 implants with identical (corundium-blasted) surface served as negative controls. An uncoated and a BMP-3-coated test object were implanted into the femurs of 15 adult giant rabbits. New formation of bone around the implants was examined microscopically and histomorphometrically on postoperative days 14, 35 and 56. RESULTS: Coated implants revealed superior osseointegration with statistical evaluation using the t-test for matched samples showing a significantly higher volume of new bone 5 weeks after surgery. Microscopic examination revealed osseointegration with no connective tissue membrane around the surface of the implants. CONCLUSIONS: Our results indicate that composite metal implants are suitable carriers for BMP-3 and that improved fixation of the implants can be achieved.
Alloys↗
Opinion of the Economic and Social Committee on occupational cancer.
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Carcinogens, Environmental↗
Comminuted trochanteric femoral fractures in geriatric patients: the results of 231 cases treated with internal fixation and acrylic cement.
Instability, osteoporosis and the requirement of early mobilization are the main problems in comminuted trochanteric fractures in elderly patients. Correct reduction and the use of acrylic cement as an adjunct to internal fixation provide the stability for immediate weightbearing and subsequent bone union. In 213 patients there was no evidence of femoral head necrosis or non-union.
Aged↗
Elastic intramedullary nailing: a minimally invasive concept in the treatment of unstable forearm fractures in children.
The standard treatment in 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 usually require surgical intervention. We report 30 children (ages, 4-14 years) who were treated by elastic intramedullary nailing. Sixteen patients were treated by intramedullary splinting immediately after their accident; 14 children required intramedullary nailing after failure of conservative treatment and fracture redisplacement. At the time of follow-up 6 months later, functional results were excellent in 24 children, good in five children, and fair in one child. There were no serious complications other than one delayed union. According to these results intramedullary nailing can be recommended for the treatment of unstable fractures of the proximal and middle thirds of the forearm in children.
Adolescent↗