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Biomedical subjects

G Muhr

Publications and source records attributed to G Muhr.

At least 145 records · Page 8Linked to original sources
PubMed1998

[Loosening of Schanz screws in external fixator montage of the lower extremity].

We analyzed the failure of Schanz pins in 234 patients with fractures of the lower extremity. All patients had the AO external fixator and stainless steel pins (ISO 58/32-1). The mean duration of treatment was 14 weeks. During this time 88 of a total of 1147 pins became loose. The first failures occurred 2 weeks after insertion. Most pins failed after 5-6 weeks. Early loosening was not accompanied signs of local infection, while late failures regularly developed pintract infections. Pins next to the fracture gap exhibited the highest rate of loosening. Intermediate pins had the lowest one. We could not detect an effect of the configuration of the external fixation. Eighty-one percent of the failed pins were exchanged consequently. We conclude that the early occurrence of pin loosening is due to mechanical reasons. Significant factors for this complications were the location close to the fracture gap and the number of pins in that segment.

Adolescent↗
PubMed1998

[Accident-induced pseudarthroses of the dens axis. Etiology, follow-up and therapy].

In a retrospective analysis the significance of internal fixation of unstable and symptomatic non-union of the odontoid was evaluated. In all but one cases a type II fracture of the odontoid was the underlying cause for the pseudarthrosis. The time interval between trauma and definitive diagnosis varied between 6 months and 30 years. All patients asked for medical advice because of acute neck pain; in three cases additional neurological deficits were notified. In all but one case the pseudarthrosis was classified as unstable on flexion-/extension views. The occurrence of neurological deficits showed a positive correlation with the amount of dislocation of the pseudarthrotic odontoid. Nine out of 10 patients underwent internal stabilisation of the non-union. Reoperation because of persistent instability/failure of stabilisation had to be performed in two cases (22.2%). At follow-up all 9 patients were pain-free. The neurological deficits in two patients had improved significantly. According to our experience internal stabilisation in unstable non-union of the odontoid is recommended to achieve significant reduction of the pain level. Also improvement of the neurological deficits can be expected depending on the duration of the symptoms.

Adolescent↗
PubMed1998

[Scapulo-thoracic dissociation. A missed injury?].

The scapulothoracic dissociation (SD) is a complex injury of the shoulder girdle, mostly associated with polytraumatized critically ill patients. This case report of 3 patients shows the variety of possible injuries combined with SD. Diagnosis and therapy in such a rare trauma, which is most likely seen in specialized trauma centres are being described. The 3 patients are presented from trauma to management, with remarks to various possibilities in treatment. Reports of other groups include multicenter studies with small numbers of patients, making it different to look for homogenity or defining standards, whereas current guidelines are being mentioned, including remarks on the management of these mostly polytraumatized and vitally endangered patients.

Acromioclavicular Joint↗
PubMed1998

[Prostheses of the head of the radius. What outcome can be expected?].

We report our results after primary implantation of 30 radial head prostheses in a retrospective study from 1978 to 1996. If there was intraoperatively a remaining instability of the elbow after resection of the radial head, we implanted a prosthesis. The average age of our patients was 40.7 years. The results were evaluated concerning the recommendations of Radin and Riseborough. In 22 patients (73%) we found good to satisfactory results, in 8 patients (27%), there was a free range of motion. Heterotopic ossifications with a remarkable decrease in the range of motion were discovered in 3 patients (10%). The implant had to be removed in three (10%) patients (2 incorrect implantations, one broken prosthesis). To conclude, the primary implantation of a radial head prosthesis after a strict indication improves the clinical benefit for the patient. A correct surgical technique avoids unnecessary complications.

Adult↗
PubMed1998

Major injury induces increased production of interleukin-10 in human granulocyte fractions.

Patients with severe trauma or polytrauma frequently acquire alterations in immune functions which are correlated to dysbalanced cytokine synthesis. In these settings the role of polymorphonuclear neutrophil granulocytes (PMN) as cytokine-producing cells is less well characterized. The immunosuppressive role of interleukin (IL)-10 is well known, and increased systemic IL-10 levels are related to the severity of injury and to posttraumatic complications. We determined concentrations of IL-10 in culture supernatants of 30 individual PMN fractions isolated from 18 severely traumatized patients (15 polytraumata, Injury Severity Score: 18-41, 3 severely burned patients) admitted to intensive care units. IL-10 was analyzed by ELISA (R&D Systems, Wiesbaden, Germany). PMN were isolated from EDTA-anticoagulated peripheral blood employing a one-step procedure based on a discontinuous double Ficoll gradient. The cells [1 x 10(6)/ml RPMI 1640 supplemented with 10% fetal calf serum and 25 mM N-(2-hydroxyethyl)-piperazine-N'-(2-ethanesulfonic acid] were stimulated with 0.05% heat-killed Staphylococcus aureus (Pansorbin, Calbiochem-Novabiochem, Bad Soden, Germany) for 24 h using cell culture conditions. Our results show that PMN fractions of traumatized patients produce significantly (P<0.008) higher amounts of IL-10 (354+/-95 pg/ml, n = 30) than normal healthy donor cells (125+/-95 pg/ml, n = 7). IL-10 release from PMN fractions exceeded the release from isolated patients' peripheral blood mononuclear cells induced by similar stimulation or by stimulation with toxic shock syndrome toxin-1 (10 ng) and concanavalin A (2 microg). Our results provide evidence that PMN fractions play an active role in the development of posttraumatic immunosuppression by autocrine or paracrine mechanisms, for example, by suppressing one's own antimicrobial activities or determining the development of T-cell responses via their ability to release IL-10.

Adolescent↗
PubMed1998

The motorcyclist: easy rider or easy victim? An analysis of motorcycle accidents in Germany.

This report reviews the findings from 86 motorcycle accidents during a 1-year period at the Trauma Center "Bergmannsheil" in Bochum, Germany. A study of the case histories supplemented by telephone conversations yielded the following results: 90.7% of the patients were men, and the average age was 28.8 years; most of the accidents occurred in the 25- to 30-year-old age group (27.9%). Motorcycle accidents happened mostly during recreational rides on weekends in the summertime. Although there was a high rate of helmet use (98.8%), the head region was affected in 12 victims. Two patients died because of their severe head injuries (2.3%). Lower extremity injuries (46%), especially open tibia fractures (19.7%), were among the most common injuries sustained. Fractures of the distal radius constituted the largest portion of upper extremity injuries (18.8%). The average stay in our hospital was 35.4 days; 23.4% of the patients had to change jobs after the accident. Fifty percent of the crashes happened with motorcycles between 500 and 750 cc stroke volume. Although 34.5% possessed their driver's licenses for more than 8 years, they had not had much experience handling a motorbike. These results underline the fact that motorcycle accidents are sustained by young men in their working prime; as a result, these accidents pose a tremendous burden to individuals and society and every attempt should be made to offer highly qualified surgical and trauma care to minimize the damage to the motorbiker. A plea is made for more prevention measures like driver education, better road conditions, or legislative changes to prevent motorcycle crashes. The wearing of a helmet is strongly advocated.

Accidents, Traffic↗
PubMed1998

[Liberation of interleukin 12 (IL12) after trauma and polytrauma].

We determined concentrations of IL-12 (p70), IL-12 (p40) and concomitantly of IL-10 in plasma and partly in culture supernatants stimulated peripheral blood mononuclear cells (PBMC) of 30 traumatized patients (ISS: 17-57; APACHE II: 7-45; during their course on the intensive care unit. Our results showed that individually systemic IL-12 could be extremely increased post trauma (p70 > 1000 pg/ml and p40 > 2500 pg/ml). Patients who succumbed to sepsis/multi organ failure, partly exhibited subnormal systemic IL-12-values. The capacity to synthesize IL-12-p40 from SAC-stimulated PBMC in vitro was individually increased in non-septic patients and correlated to respective plasma values.

APACHE↗
PubMed1998

[Prospective study of the significance of contact sensitization caused by metal implants].

INTRODUCTION: Allergies caused by metallic implants are often thought to be a reason for postoperative complications like bone necrosis or loosening of the prosthesis. PATIENTS AND METHODS: In a prospective study, we investigated allergic sensitivity against components of stainless steel implants, including titanium, in 112 patients shortly before surgical operation. The same tests were then repeated in 100 of these patients exactly one year after operation. There were three different kinds of procedures: 1. titanium implants, mainly total hip replacements, 2. regular steel implants, 3. surgery without any implants (control group). Any differences from the process of regular healing were regarded as postoperative complications. RESULTS: A sensitivity against nickel (Ni) was diagnosed in three of these 100 patients (3%) before surgery. These patients, of whom two received a nickel-containing implant and one a titanium arthroplasty, did not show any postsurgical complications. Furthermore, three patients (3%) acquired a new sensitivity against metals during the study-interval of one year. Two of these three patients were women, who developed a postsurgical sensitivity against nickel or chrome but got titanium arthroplasties, which did not contain any nickel. These two women wore metal-containing jewelry, which might be the reason for the newly acquired metal-sensitivities, and both showed postsurgical complications. The third patient, who has developed a postsurgical sensitivity against components of his steel arthroplasty, did not reveal any complications. DISCUSSION: We conclude that the rate of allergic sensitization against metal-components of arthroplasties is low in our patients. Additionally, skin-sensitivity against components of alloys and platings was not associated with a higher rate of postsurgical complications in our patients. We did not see any sensitivity against titanium. In conclusion, metallic implants are not a cause of allergies to a relevant extent, nowadays.

Adult↗
PubMed1998

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

The standard treatment in forearm fractures of children is usually conservative. Unstable fractures of the proximal parts of the forearm often show poor results after nonoperative management, requiring surgical intervention. We report on 30 children from 4 to 14 years of age who were treated by elastic intramedullary nailing. Sixteen patients were treated by intramedullary pinning immediately after the accident; 14 required intramedullary nailing after failure of the conservative treatment and fracture redislocations. At the time of follow-up 6 months later, functional results were "excellent" in 24 children, "good" in 5 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↗
PubMed1997

[Monocondylar fractures of the femur. Therapeutic strategy and clinical outcome].

Twenty-nine unicondylar fractures of the distal femur were treated at the Trauma Center "Bergmannsheil", University of Bochum, Germany, between 1981 and 1994. All patients sustained their injuries from severe direct trauma. There were 16 lateral condylar fractures, 7 medial condylar fractures and 6 tangential posterior ("Hoffa-type") fractures. Twenty-eight closed injuries and 1 grade IIIB open fracture 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 68 months (18-120). The therapeutic outcome (clinical result, radiographs) was rated by the Neer score. Twenty-seven patients were available for follow-up examination. Of these, 23 were rated as excellent. 3 achieved satisfactory results, and 1 had an unsatisfactory result. All patients who did not achieve an excellent outcome had had accompanying injuries. Open reduction and internal screw fixation of unicondylar femur fractures provided overall excellent long-term results. The therapeutic outcome was significantly affected by associated injuries of the skeleton.

Adolescent↗
PubMed1997

[Possibilities and limits of functional conservative therapy of acute Achilles tendon ruptures].

According to sonographic criteria, 55 patients underwent surgical treatment with mobilisation in a lower leg plaster or conservative treatment with early mobilisation in heel pad (3 cm) shoes when an acute Achilles tendon rupture (ATR) was diagnosed. The follow-up period in 51 patients was 2.4 years (operated group = 28 patients, conservative group = 23 patients) with clinical examination and testing of isokinetic muscle strength in knee joint flexion. After surgical treatment, minor wound infections occurred in 10.6%. Reruptures occurred in 13% of the conservative group. Following conservative treatment, the rate of stress-related achillodynia was significantly higher (P = 0.019). In the operated group mean isokinetic muscle strength was 13.7% lower than in the uninvolved leg and decreased significantly with non-operative treatment to 75.3% (P = 0.012). We recommend surgical treatment of acute ATR. The indications for conservative treatment depend on the extent of the rupture (measured by ultrasound in the equinus position), the desired level of daily activity and the patient's degree of compliance.

Achilles Tendon↗
PubMed1997

[The epidemiology of multiple trauma].

Trauma is the leading cause of death for people up to 40 years of age in Germany. Most of the patients were injured in traffic accidents where special injury patterns could be detected: head injuries in bicycle and pedestrian accidents, lower extremity injuries in motorcycle accidents, and chest and pelvis injuries in car accidents. After falls from a height, the most common injuries were fractures of the thoracic and lumbar spine. The treatment of polytrauma patients requires high health care resources and demands sophisticated medical support. It is estimated that every trauma patient costs daily approximately DM 4,700. It is not only the acute medical care that burdens our social system, but also the long period of rehabilitation and reintegration. The number of preventable trauma deaths can be significantly reduced in special trauma centers, and the high costs could be damaging for smaller hospitals. A plea is made for more preventive measures and legislative changes to reduce the number of traffic accidents. The medical care of trauma patients should be in special trauma centers.

Accidental Falls↗
PubMed1997

[Motorcycle accidents in street traffic. An analysis of 86 cases].

A retrospective study of 86 motorcycle accidents that occurred in the year 1992 is reported. Examination of the case histories supplemented by telephone conversations yielded the following results: 90.7% of our patients were male and their average age was 28.8 years; the age group between 25 and 30 years was the most frequently involved (27.9%). Most motorcycle accidents happened during weekend trips out in the summertime. Special injury patterns were found for injuries of the upper and the lower extremity. Lower extremity injuries (46%), and especially open tibia fractures (19.7%), were among the most common injuries sustained by motorcyclists in crashes. Injuries of the upper extremity most frequently took the form of fracture of the distal radius (18.8%). The average stay in our hospital was 35.4 days. In 23.4% of cases the patients had to change their job after the accident. More than half the crashes happened with motorcycles with between 500 and 750 cc stroke volume. Over a third (34.5%) of the patients had held their driving licences for more than 8 years. A plea is made for more preventive measures, such as better driving instruction, better road conditions and legislative changes, against motorcycle crashes. From the aspects of cost and the rate of complications it is reasonable to strive for a surgical treatment as soon as possible after the crash.

Accidents, Traffic↗
PubMed1997

[Sports and work capacity after stabilization of recurrent shoulder joint dislocations].

Eighty-one patients (83 shoulder joints) underwent surgical procedures for recurrent shoulder joint dislocations. All patients had an extra-articular osteotomy with subcapital derotation according to Weber's technique. In all, 46% of the patients underwent additional intra-articular reconstructions. After a mean follow-up of 4.6 years, redislocations (6%) were observed only when a singular derotation technique had been used. Complications were minor (2.4%). External rotation of the operated shoulder joints was normal in most patients with a mean of 48.5 degrees. Improvement in sporting activities was seen in 80% and in working activities in 70%. The mean Constantscore was 89.2. Subacromial pain was rare and correlated with reduced scores in functional strain tests postoperatively. There was no postoperative arthritis owing to the derotation technique. Because of unrestricted rotation and early functional therapy, we observed a good indication for an additional derotation technique when a Hill-Sachs defect is evident.

Adolescent↗
PubMed1997

[Missed diagnosis in delayed recognition of bilateral simultaneous rupture of the quadriceps tendons].

In this article we report a very rare case of simultaneous and bilateral rupture of the quadriceps tendon in a 38-year-old patient. The initial diagnosis was "herniated vertebral disk". Although there was an extensive neurological and psychiatric examination in combination with several operations, it took almost 3 months until the real reason was found. In this case report we describe our postoperative treatment of early mobilization and compare it with other therapies.

Adult↗
PubMed1997

[Corrective soft tissue interventions for equinovarus deformity. Foot deformities after tibial compartment syndrome].

Sixty-three patients with rigid equinovarus contractures of the foot following ischemic episodes in the lower leg were treated at our institute from 1983 to 1994 by lengthening the Achilles tendon and the tendon of the m.tibialis posterior, release of the tendons of the m.flexor digitorum longus and the m.flexor hallucis longus and release of the dorsal capsule of the ankle joint. Patients with an equinus deformity greater than 20 degrees, with an additional hind foot varus deformity of more than 5 degrees and/or malrotation of the midfoot were not eligible for this procedure. The initial equinus deformity ranged from 7 degrees to 20 degrees (mean 14 degrees). The clinical and radiological results of 41 patients were evaluated retrospectively with a minimum follow-up of 1 year (mean 3.4 years). The overall results were evaluated according to a modified score of Angus and Cowell. Results were good in 60.9%, fair in 29.3% and poor in 9.8%. The range of motion of the ankle joint and the subtalar and midtarsal joints could not be improved. Postoperative complications were observed in 8 patients, one intraoperative lesion of the posterior tibial artery occurred, one avulsion fracture of the anterior tibial metaphysis and one compression syndrome of the tibial nerve. One patient had an initially incomplete correction with a remaining equinus deformity of 10 degrees, and two recurrences of the foot deformity after initially correct position were observed. Furthermore, two hematomas and two soft-tissue infections required surgical revision. These complications may have been due to the preoperatively scarred soft tissue at the medial aspect of the hind foot and a residual postoperative soft-tissue defect after the correction of the foot deformity had been achieved. In conclusion, the technique described is effective in correcting mild pes equinovarus deformities after ischemic episodes in the lower leg. If the pes equinus deformity is greater than 20 degrees, corrective osteotomies of the hind foot should be performed instead.

Adult↗