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Biomedical subjects

G O Hofmann

Publications and source records attributed to G O Hofmann.

At least 19 recordsLinked to original sources
PubMed2007

[Treatment of bilateral distal tibial nonunions. Use of an intramedullary compression nail and a modified locking compression plate osteosynthesis].

Operative treatment of distal tibial fractures remains a challenge for the surgeon even today. The soft tissues demand atraumatic operative techniques, although an anatomical reduction of the articular fracture component is mandatory. The nonunion rate increases with disturbed local blood supply, widened fracture gap, unstable fixation. If a nonunion occurs, an individual treatment concept is required, so that even difficult situations can be successfully managed, as described in our case with bilateral tibial nonunions.

Adult↗
PubMed2006

[Sudden blindness following operative care of a multiply traumatized patient: posterior ischemic optic neuropathy].

A 32-year-old man had fallen from an 8-m high scaffolding and had suffered multiple traumatic injuries, such as compression fractures of the thoracic vertebrae (TV) 5-7 without incarceration of the spinal canal plus a distal femoral fracture. During surgery on the day of the accident, spondylodesis and dorsal stabilization of TV 4-7 using an internal fixator were carried out and the distal femoral fracture was stabilized with a dynamic condylar screw (DCS). On the day following the accident, the malposition of a pedicle screw located at the height of TV 4 and the borderline malposition of a pedicle screw of TV 7 were corrected. Between the day of the accident and day 8 after, the patient developed impaired vision and in the further course amaurosis associated with fixed pupils. No organopathy could be noticed which could have explained the sudden vision loss. A study of the literature was done, using the keywords "blindness" and "spine surgery." Only very few cases describing a connection of spine surgery and postoperative vision loss could be found. This article aims to elaborate on the few connections worked out in these investigations.

Adult↗
PubMed2005

[Psychoreactive disorders after motor vehicle accidents. Is it possible to predict the development of psychoreactive disorders after motor vehicle accidents?].

The aim of this study was to assess common risk factors for the early development of psychoreactive disorders during traumatological treatment and to estimate their predictive potential. The sample consisted of 126 consecutive patients with accidental injuries recruited in an emergency room of the university hospital. We assessed this population 1 week (T1) and-on average-8 months following the accident (T2). At T1 34.5% of all patients indicated moderate and 26.4% strong symptoms of an acute stress disorder; 26.7% of all patients assessed at T2 suffered from severe post-traumatic symptoms. Linear regression analysis, using morbidity status at T2 as the dependent variable, allowed the explanation of 46.2% of the variance. The degree of early acute stress symptoms, injury, and pain intensity contributed significantly to the predictive model. We conclude that a substantial proportion of severely injured accident victims that will develop PTSD can be screened to some degree by the assessment of early stress disorder, the degree of their injury, and pain intensity, enabling secondary prevention of trauma-dependent symptomatology.

Accidents, Traffic↗
PubMed2005

[Emergency room management of multiple injured patients. A multislice computed tomography orientated treatment algorithm].

INTRODUCTION: In the treatment of the seriously injured patient, time is crucial. Clarke et al. showed that in the hypotensive patient with blunt abdominal trauma and bleeding a delay in the surgical treatment over 90 min increases mortality of 1 % every 3 minutes. So called trauma algorithms are used as systematic approach to the seriously injured patient that can be easily reviewed and practiced. One impact of this algorithm is to shorten time in the emergency room and may improve outcome of the patient. The patient outcome is directly related to the length of time between the injury and the beginning to proper definitive care. OBJECTIVE: Are improvements still necessary and possible in the care of the seriously injured patient? New technical developments like multislice-CT are able to shorten time until definitive care. The practicability of an multislice-CT orientated treatment algorithm was evaluated. METHODS: After integration of an multislice-CT into the emergency room the treatment of the seriously injured patient (ISS >16) was changed. Therefore an algorithm which puts the CT diagnostics in the first minutes of the clinical care was developed. RESULTS: 50 patients were treated following the new algorithm. The time in the emergency room decreased from 87 min to 36 min. CONCLUSION: This algorithm requires a differing from previous surgical standards, but it proved to be timesaving, effective and practicable. It makes the beginning of the definitive care possible within the first 40 min after patient arrival in the emergency room.

Algorithms↗
PubMed2004

[Treatment of MRSA infection in orthopedic surgery].

INTRODUCTION: Infection with methicillin-resistant Staphylococcus aureus (MRSA) remains a major challenge both therapeutically and hygienically. METHODS: Between January 2000 and January 2002, 27 patients with MRSA infections were treated and evaluated in a prospective clinical study. For effective wound management, operative revisions were performed every 3rd day. Following debridement, the wounds were vacuum sealed and specific i.v. antibiotics were administered. Wound closure was performed if three consecutive wound samples submitted for bacterial culture remained negative. RESULTS: All patients with MRSA infections were treated successfully until signs of infection disappeared and bacterial cultures were negative. An average of 7.3 operations per patient was required to eradicate MRSA infection. Follow-up of patients revealed recurrence of infection in four patients. CONCLUSION: Prevention of further spreading and successful treatment of MRSA infections in reconstructive orthopedic surgery is possible with appropriate surgical and hygienic concepts. In almost every second patient complex revision procedures were required.

Adolescent↗
PubMed2004

[Bronchial rupture combined with luxation fracture of the thoracic spine following direct trauma].

Tracheobronchial injuries in blunt thoracic trauma are very rare (incidence: under 1%), with potentially devastating consequences. Appropriate pre-, intra-, and postoperative management is mandatory to ensure the patient's survival and maintain lung function. We report the case of a 62-year-old male patient hit by a tree over the chest while cutting down trees, suffering a rupture of the right bronchus and a tear of the trachea combined with a luxation fracture of the thoracic spine between Th2 and Th3 (without neurological deficit). With immediate suture of the torn bronchus and trachea and stabilization of the spine fracture on the following day, we achieved a successful outcome in this patient. To our knowledge, this is the first description in the literature of the combination of both injuries.

Anastomosis, Surgical↗
PubMed2002

[Retrograde intramedullary nailing of knee para-articular fractures in paraplegic patients].

INTRODUCTION: Patients with spinal cord lesions suffer injury even by marginal trauma, especially in the area of the knee joint. Because of lost sensitivity and proprioception, the treatment of the fracture has to be minimally invasive but stable enough for physiotherapy. METHODS: There were 18 patients with 20 fractures near the knee: 15 fractures of the supracondylar femur were treated with a retrograde intramedullary GSH nail and 5 fractures of the proximal tibia with a new retrograde nailing technique. RESULTS: At review all patients had a good motion range of the knee joint (> 100 degrees), and ankle joint motion was free. CONCLUSION: We saw in this study that the GSH nail is an excellent method for stabilizing supracondylar fractures of the femur in paraplegic patients because the treatment is minimally invasive and the fracture is stable enough for physiotherapy. The retrograde nailing of proximal fractures of the tibia is a good alternative method for treatment of patients with spinal cord lesions.

Adult↗
PubMed2001

3-phase bone imaging and SPECT in the follow up of patients with allogenic vascularized knee joint transplants.

UNLABELLED: Vascularized allotransplantation of knee joints under immunosuppression is a novel approach in orthopedic surgery. During the postoperative course immunosuppressive management depends on perfusion and viability of the graft. AIM: Evaluation of different diagnostic tools in regard to their usefulness and reliability to provide information about microvascularity and viability of vascularized knee joint allografts. METHODS: Four patients with allogenic knee joint transplants were studied up to 26 months after transplantation with 3-phase bone scans and SPECT. The results were compared with duplex sonography, angiography, and histology. RESULTS: Two cases without complications were characterized by adequate perfusion in duplex sonography, angiography and early bone scans. Late bone scans demonstrated increased bone metabolism of the transplant. Corresponding biopsy revealed viable bone cells. In one case with partial thrombosis and one case with complete thrombosis of the transplant vessels rapidly decreasing or missing perfusion was detected by duplex sonography, angiography, and bloodpool scintigraphy. Late bone scans showed reduced or absent bone metabolism. Biopsy demonstrated necrotic bone tissue. Due to the advantage of a tomographic technique SPECT allowed a more reliable assessment of graft viability as compared to planar imaging. CONCLUSION: Our findings confirm bone scintigraphy as a valuable diagnostic tool in patients with allogenic vascularized knee joint transplants. In contrast to other diagnostic approaches, scintigraphy provides reliable information on both viability and perfusion of the transplant within a single non-invasive clinical investigation.

Adolescent↗
PubMed2000

Clinical experience in allogeneic vascularized bone and joint allografting.

The allotransplantation of vascularized femoral diaphyses and total knee joints is a novel approach in orthopedic surgery. Allogeneic femoral diaphyses were transplanted into three patients suffering from chondrosarcoma or posttraumatic defects. Total knee joints allografts were transplanted in five patients with large bone defects of the knee and loss of the extensor apparatus caused either by major trauma alone or infection after a major trauma. Bone segments and total joints were harvested from multi-organ donors, perfused with UW-solution and transplanted within cold ischemia times of 18-25 h. Patients were immunosuppressed postoperatively primarily with cyclosporine (Cyclosporin A) and azathioprine. Two allografts (1 femur, 1 knee) were lost due to infections. Seven of the eight patients are able to walk with full weight-bearing posttransplant. Two of the patients with transplanted joint allografts subsequently received total knee arthroplasty implantations. Vascularized bone and joint allotransplantation may serve as a last line of defense treatment before considering lower limb amputation.

Adult↗
PubMed2000

Vascularised knee joint transplantation in man: the first two years experience.

OBJECTIVE: To describe our early experience with a new technique for restoring destroyed knee joints to give reasonable functional results. DESIGN: Observational clinical trial. SETTING: Level-1-Trauma centre, Germany. SUBJECTS: 5 patients with large bone defects of the knee and loss of the extensor apparatus caused either by serious injury alone, or infection after serious injury. INTERVENTIONS: Transplantation of fresh and perfused knee joints with a vascular pedicle from multiorgan donors under immunosuppression. MAIN OUTCOME AND MEASURES: Ability to walk, need to remove one transplanted joint. RESULTS: Four patients are able to walk, the range of movement being from 50 degrees-120 degrees. The first patient additionally had to be provided with a total knee joint arthroplasty. In the third patient the graft became infected and had to be removed. She finally had an arthrodesis and bone lengthening by the Ilizarov technique. CONCLUSIONS: Transplantation of the knee joint may be an alternative to bone lengthening or amputation for patients with total loss of the extensor apparatus.

Adult↗
PubMed1999

[Allogeneic vascularized transplantation in cases of bone and joint defects].

This paper presents preliminary results of allogeneic vascularized transplantations of three femoral diaphyses and four total human knee joints. Grafts were harvested from multi-organ-donors and immediately transplanted. Osteosyntheses were performed employing intramedullary nails. Vascular pedicles of the grafts were anastomosed in end-to-side technique. Immunosuppression mainly based on Cyclosporine and Azathioprine. Grafts' perfusion was demonstrated by DSA and Duplex-sonograms, bone metabolism by SPECT-scintigraphy. Five months following transplantation osteotomies demonstrated consolidation in conventional X-rays. Biopsies of the grafted bone revealed intact osteocytes and arthroscopy demonstrated intact synovial, chondral and ligamentous structures. From the technical aspect vascularized transplantation of the femoral diaphyses and total knee joints is feasible. The main problems are of immunologic nature. Transplantations were performed respecting the ABO-compatibility but with a large HLA-mismatch. Acute and chronic rejection crises may damage the grafts. At least in synovial joints live-long immunosuppression of the recipients seems to be unavoidable.

Adult↗
PubMed1999

Use of three-phase bone scans and SPET in the follow-up of patients with allogenic vascularized femur transplants.

The vascularized allotransplantation of femoral diaphyses under immunosuppression is a novel approach in orthopaedic surgery. To evaluate which method provides the best information about microvascularity and viability of the transplant, we compared different diagnostic approaches used in transplant surgery. Three patients were investigated four times over a period of 1 month (on days 2, 7, 15 and 30 post-transplantation) and 6 and 12 months later with planar 99Tcm-MDP three-phase bone scintigraphy and SPET. The results were compared with duplex sonography, angiography and intraoperative biopsies. Rejection and thrombosis of the transplant were associated with decreased or missing perfusion detected by duplex sonography, angiography and blood pool scintigraphy. In these cases, late bone scans showed reduced or absent bone metabolism while biopsy revealed necrotic bone tissue. In cases without complications, blood pool scans revealed hyperaemia of the graft indicating excellent perfusion and patency of vascular anastomoses and transplant vessels. Late bone scans demonstrated increased bone metabolism. The corresponding biopsies showed viable bone cells. We conclude that bone scintigraphy is a valuable diagnostic tool in vascularized femur allotransplantation, since it provides reliable information on both viability and perfusion of the transplant within a single non-invasive investigation.

Adult↗
PubMed1998

Allogenic grafting of vascularized bone segments under immunosuppression. Clinical results in the transplantation of femoral diaphyses.

Trauma surgery lack, substitute, for the reconstruction of large defects of the long bones. Encouraged by the promising results of bone allotransplantation in animal models, we successfully performed vascularized bone transplantation in humans. Vascularized femoral diaphyses were allogenically transplanted into three patients suffering from chondrosarcoma or post-traumatic osteomyelitis with postoperative immunosuppression. The bone segments were harvested from multi-organ donors and perfused with UW solution. After back-table preparation, the grafts were transplanted into the defect zone. Interlocking devices were used in these operations. Vascular anastomoses were performed in end-to-side technique. The early clinical course of the patients was not free of anatomical, technical, or immunological complications. However, all patients are currently free of malignancy and infection. They are also free of pain and full weight bearing. We conclude that allogenic grafting of vascularized bone segments has the potential to become an alternative for the replacement of large bone defects.

Adult↗
PubMed1998

Vascularized knee joint transplantation in man: a report on the first cases.

Four transplantations of an allogeneic vascularized human knee joint were performed at the Trauma Center Murnau between April 1996 and July 1997. The indication for the procedure was the total loss of the knee joint including the extensor apparatus due to severe trauma. These were the first transplants of this type. Management of patients started with closure of soft-tissue defects. After successful completion, stabilization was achieved with femoral and tibial nails plus a temporary arthroplasty. AB0 compatibility and a negative cross-match were the main criteria for selecting patients for transplantation. Interlocking compression nails were used for osteosynthesis. Vascular anastomoses between graft and recipient vessels were established by the end-to-side technique. Immunosuppression was started as a quadruple induction therapy for 3 days, then reduced to a two-drug maintenance therapy with cyclosporine and azathioprine. Six months posttrans-plantation the osteotomies were bridged by callus and the patients became completely mobile. Radiographic and histological examinations revealed vital graft tissue.

Adolescent↗
PubMed1998

Allogeneic vascularized grafting of human knee joints under postoperative immunosuppression of the recipient.

Vascularized knee joint transplantations have been performed in various animal systems. Up to now no allogeneic vascularized transplantation of a fresh and perfused human knee joint has been realized. This paper reports on the first four grafted human knee joints, performed between April 1996 and July 1997 at the Trauma Center Murnau. The indication for transplantation of a human knee joint is total loss of the joint, including the extensor apparatus, following severe trauma. Management of this defect is first to effect closure of the soft tissue defect combined with external transfixation and bone cement spacers. For the second phase the external stabilization is switched to internal stabilization using femoral tibial nails and a temporary knee joint prosthesis manufactured of polyethylene. The transplantations are performed with respect to ABO compatibility, ignoring the HLA system after a negative crossmatch. Osteosyntheses are employed by femoral and tibial nails. The vascular anastomoses are established in an end-to-side technique between the recipient's superficial femoral vessels and the graft vascular pedicles. Immunosuppression starts as quadruple induction therapy for 3 days. Subsequently it is reduced to a two-drug maintenance protocol with cyclosporin A and azathioprine. We utilize radiography, digital subtraction angiography, duplex sonography, scintigraphy, and arthroscopy for graft monitoring. Six months after transplantation the osteotomies were bridged with callus, and the patients were completely mobilized. The motion in the transplanted knee joint ranges from complete extension to 110 degree flexion.

Adolescent↗
PubMed1998

Importance of arterial blood supply to the femur and tibia for transplantation of vascularized femoral diaphyses and knee joints.

The role of the periosteal and intraosseous blood supply to the femur and the proximal tibia was investigated to improve the operating technique for transplantation of allogenic vascularized femoral diaphyses and knee joints in humans. Altogether 48 limbs were injected with gelatin, red latex milk, or Revertex and macroscopically prepared; 41 limbs were studied for the variation and division of the truncus profundo-circumflexus. In 200 femurs and 200 tibias the location of the nutrient foramen was determined. The arteries supplying the periosteum of the distal femur and the proximal tibia have defined nutritive areas. The following technique should be followed: If the femoral artery alone is prepared as the vascular pedicle, the optimal section for resection of the femur in knee joint transplantations is 6 to 12 cm above the level of the femur condyles and 5 to 7 cm below the tibial plateau. For the transplantation of femoral diaphyses, the deep femoral artery can be used if the lateral femoral circumflex artery is protected. The Proximal line of resection is defined between the greater and lesser trochanter. For shorter grafts one must consider the number and location of nutrient foramens. For longer grafts the distal branches of the femoral artery must be respected as the intraosseous blood supply reaches distally down to the level of about 8 cm above the femoral condyles. In all these operations of the variation of the truncus profundo-circumflexus and the trifurcation of the popliteal artery must be considered.

Aged↗