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Biomedical subjects

G Schwetlick

Publications and source records attributed to G Schwetlick.

At least 19 recordsLinked to original sources
PubMed2006

[Severe foot deformities in adolescents and adults--techniques after Imhäuser, Lelièvre und Lambrinudi].

Severe contraction deformities of the foot, e.g. after trauma or spasticity, often lead to an inability to walk and can, in part, only be rectified by corrective bone osteotomy of the hind and middle foot. In this article, we discuss hind and middle foot osteotomies in cases of severe foot deformities in adolescents and adults. The surgical techniques of Lambrinudi, Imhäuser and Lelièvre will be considered. The surgical technique of Lambrinudi uses a triple arthrodesis between the talus, calcaneus and navicular bones, and the cuboid bone, in addition to the removal of a bone wedge from the talus for correction of the talipes equinus deformity. Severe contraction talipes calvus can be straightened and capable of loading using Imhäuser's technique with wedge osteotomy and arthrodesis in Chopart's joint. The planigrade position is achieved by the removal of a dorsolaterally based wedge from Chopart's joint. Using Lelièvre technique, severe contraction club foot with hind foot varus can be treated with a wedge from Chopart's joint and the talocalcaneal joint with arthrodesis. For stabilization, a compression clamp system is used. The advantages of the system used by us is that, in comparison with other systems, it can also be used for sclerotic bones as the shank is not hammered in but is introduced after boring. Using the compression clamp system, good stability and a high rate of osseous blood circulation can be achieved using osteotomies and arthrodeses. The aim of surgery is, in all cases, the correction of the deformity, functional improvement and the elimination of pressure points and pain.

Adolescent↗
PubMed2004

[From "wet caries" to controllable complication. History of post-traumatic and postoperative osteitis].

In former times treatment of osteomyelitis was based on very few surgical principles such as incision of the infected region, debridement with sequestrectomy, and continuous drainage to prevent superficial closing of the wound. There were no rules for asepsis, anesthesia, and microbiology in the treatment of bone infection. Therapy improved dramatically when J. Lister introduced and performed antisepsis. With the beginning of the twentieth century it became much more standardized and differentiated. In the 4th decade of the twentieth century, the development of antibiotics changed the regime of osteomyelitis therapy again. Especially systemic intravenous antibiotic therapy was very successful in the treatment of the hematogeneous osteomyelitis. Treatment failed in post-traumatic and postoperative osteitis. Local antibiotic therapy on a delivery system was the breakthrough for these cases. The application of PMMA cement as an antibiotic delivery system led to this new possibility for treating bone infections and is still in use nowadays.

Anti-Bacterial Agents↗
PubMed2002

[History of surgery of the anterior cruciate ligament].

Early comments on the anterior cruciate ligament were found in ancient literature, and the first scientific reports were published in the nineteenth century. The first surgical treatment of a ruptured anterior cruciate ligament was carried out in 1895 by Robson performing a primary suture of the torn ligament. In 1903 F. Lange suggested a complete replacement of the injured ligament using silk ligaments and in 1914 Grekow was probably the first who recommended autogenous transplants by using a fascia lata strip. In 1917 Hey-Groves presented his surgical technique that was the fundament for reconstruction surgery in the following years. Today, the autogenous transplant is accepted to be the golden standard for replacement of the injured anterior cruciate ligament. The bone-tendon-bone transplant of the patellar ligament and the semitendinosus or gracilis tendon are recommended by most surgeons. In the history of anterior cruciate ligament surgery, the surgical technique of the operative procedures has also changed. The evolution started with open arthrotomy followed by mini-arthrotomy and led to arthroscopically assisted replacement of the anterior cruciate ligament.

Anterior Cruciate Ligament↗
PubMed2001

[Pott triad and Schmorl nodules. A historical overview of kyphosis with special reference to tuberculous spondylitis and Scheuermann disease].

This report provides an overview of the history of the different types of kyphosis (arcuated and angulated forms). Especially tuberculous spondylitis and Scheuermann's disease are pointed out from among the large group of kyphotic diseases. Therefore, Beckhterew's disease, the combination of rickets and kyphosis as well as the dysraphic diseases and constitutional kyphosis caused by faulty posture are only mentioned. These two special types of kyphosis (Scheuermann's disease and tuberculous spondylitis) are presented from the first description with diagnostic findings, the ideas of pathogenesis and aspects of treatment through to the different periods of medical history. This article describes the way of thinking and discussing of opinion leaders at the beginning of the century and the influence of new techniques and developments (asepsis, antisepsis, anesthesia, bacteriology, X-ray, antibiotics) on the differential diagnosis and therapy. It is impossible to give a complete overview of all aspects during the centuries concerning tuberculous spondylitis or arcuated kyphosis. The authors of this article have focussed their studies on developments from the first descriptions until World War II, based mainly on literature from German journals and historical books from the library of the German Museum for Orthopedic History and Science.

Eponyms↗
PubMed2001

Treatment of femoral head necrosis with vascularized iliac crest transplants.

The development of microsurgical methods has allowed for the use of vascularized bone transplants in the treatment of femoral head necrosis, particularly for Stages II, III, and IV according to the Association Internationale de Recherche sur la Circulation Osseuse classification system. Eighty patients with avascular necrosis of the femoral head were treated with vascular pedicled iliac crest transplant, perfused by the circumflexed ilium profunda artery between 1988 and 1996. On average, the postoperative followup was 5 years. Evaluation was based on the Harris hip score, and clinical and radiologic examination. Clinical results according to the Harris hip score were good or excellent in 86.6% of the patients. Radiologic appearance during the followup remained stable in 56.1% of the patients according to the classification system of the Association Internationale de Recherche sur la Circulation Osseuse. These findings are compatible with the findings of other studies in which vascularized bone transplants were used and approximately 50% of the patients with Stages II, III, and IV, according to the classification of the Association Internationale de Recherche sur la Circulation Osseuse had an unchanged stage of disease 5 to 6 years after the procedure.

Adult↗
PubMed1998

[Microsurgery in lumbar disk operations. Possibilities, methods and results].

The frequency of lumbar disc hemiation amounts to 5.1% with the male and 3.7% with the female population. Because of the often long-time pain-conditional impairment of the patients as well as the varied therapy-possibilities, the treatment of the ruptured lumbar intervertebral disc represents a special challenge. The indication to the operation for the lumbar disk-herniation results from the malfunctions of the nerve roots, the pains, as well as the temporal course of the symptoms. New and important developments have given the introduction of micro-surgical operation-techniques into the orthopedics. This development has led to it that many orthopedists and neurosurgeons the micro-surgical operation-technique prefers. Important for the micro-surgical lumbar discectomy is the operation-microscope, a good preoperative diagnostics as well as a particular micro-surgical operation-instrument. Through the different enlargement-possibilities of the operation-microscope, all anatomical structures can increase and are done visibly for the surgeon as well as the assistant. Intraoperative injuries of the dura as well as the spinal-nerves are certainly avoided hereby. The micro-surgical discectomie requires no longer time like the conventional operation of the disk. The postoperative stay in the hospital as well as the time of the work-incompetence is reduced. Postoperative inflammations of the disk-area as well as renewed operations are rarer with the microchirurgischen technique. If an operation is necessary, so this should not be out-hesitated too long in order to avoid bed results.

Female↗
PubMed1997

[Femur head necrosis in the adult. Diagnosis, therapy, legal aspects for insurance medicine].

Early recognition and adequate therapy of necrosis of the head of the femur in adult patients in increasingly gaining importance since they considerably influence the permanent loss of function and reduction of the earning capacity of people of working age. Presently, MRT examination is the most conclusive method for the early stage of necrosis of the head of the femur. After the introduction of microsurgical methods, new therapeutic measures for avascular necrosis of the head of the femur are available, apart from conventional surgical methods to relieve the necrotic areas and the so-called metabolic irritation drilling. Direct vascular-supply, autologous, heterotopic, corticospongiose transplants in the necrotic head of the femur are suited to re-establish circulation in the necrotic area. This involves a considerable operative scope of work.

Adult↗
PubMed1997

[Not Available].

Explore the source record for details and available documents.

Journal Article↗
PubMed1993

Acute fracture of the femoral neck: assessment of femoral head perfusion with gadopentetate dimeglumine-enhanced MR imaging.

OBJECTIVE: Evaluation of the perfusion and viability of the femoral head after fracture of the femoral neck is important because the outcome of conservative treatment or joint-preserving surgery is adversely affected by the development of capital osteonecrosis. We evaluated the use of MR imaging, before and after IV administration of gadopentetate dimeglumine, for assessing perfusion of the femoral head in 13 patients with acute fracture of the femoral neck. SUBJECTS AND METHODS: Multiecho (1600/30-240 [TR/TE]) MR images were obtained before contrast administration and gradient-echo (315/14, 90 degrees flip angle) MR images were obtained both before and after contrast administration. MR findings were correlated with findings on superselective digital subtraction angiograms of the vessels supplying the femoral head and with clinical-radiographic follow-up for at least 12 months. RESULTS: Digital subtraction angiography showed impaired blood supply to the femoral head in five patients. On contrast-enhanced MR images of these patients, the femoral head did not enhance and was lower in signal intensity than were the enhancing femoral shaft and neck distal to the fracture and the enhancing femoral head on the unaffected side. In the patients with persistent perfusion, contrast-enhanced MR images showed a uniform increase in signal intensity in the femoral shaft and neck as well as the femoral head; the femoral head on the fractured side showed contrast enhancement similar to that on the healthy side. CONCLUSION: These preliminary results indicate that contrast-enhanced MR imaging may be useful for noninvasive evaluation of femoral head perfusion after fracture of the femoral neck. MR findings also may aid the clinician in deciding between joint-preserving therapy and hip arthroplasty.

Acute Disease↗
PubMed1993

Femoral head perfusion in patients with femoral neck fracture and femoral head necrosis.

Femoral head perfusion in adults was studied by superselective i.a. DSA in 35 normal subjects, in 9 patients with medial femoral neck fracture preoperatively, and in 36 patients with femoral head necrosis before bone grafting, and as therapeutic control after grafting. All patients with femoral neck fracture showed an interruption of the proximal nutrient branches. In 93% of the cases with femoral head necrosis, these branches were rarefied or the medial circumflex femoral artery was interrupted. Postoperative DSA after pedicled pelvic bone graft revealed a regularly perfused graft in 82%. Superselective i.a. DSA is a valuable procedure for the therapeutic decision in selected patients with femoral neck fracture as well as before pedicled pelvic bone grafting and as therapeutic control after grafting.

Adult↗
PubMed1991

[Superselective intra-arterial DSA in femur head necrosis and femoral neck fractures].

The prospective study includes 25 patients without pathology of the femoral head for the evaluation of the normal femoral head perfusion. In addition 34 patients with femoral head necrosis underwent i.a. DSA preoperatively before pedicled pelvic bone grafting. 15 patients after pelvic bone graft operation and 7 patients with medial femoral head fracture were also examined via superselective DSA. In cases with femoral head necrosis a rarefaction or interruption of the rami nutricii proximales, or an occlusion of the medial circumflex femoral artery were observed. Patients with medial femoral neck fracture showed an interruption of the rami nutricii proximales of the femoral head. Postoperative DSA--after pedicled pelvic bone graft--revealed a regular arterial graft perfusion in 82%.

Adult↗
PubMed1990

[The vascularized pedicled flap of superior gluteal artery to hip bone chip--a new concept in the revascularization of hip necrosis in adults].

The development and introduction of microsurgical technique has made possible completely new concept of revascularisation surgery in femoral head necrosis. The bone graft described in this presentation is a pedicled one from the lateral ilium. In five femoral head necrosis a pedicled corticocancellous pelvic graft, supplied by the deep branch of the superior gluteal artery, was transplanted in the femoral head. In all cases it was possible to lift out the pelvic graft from the same side as the affected hip joint. Contrary to the medial iliac bone graft (deep circumflex iliac artery) the lateral iliac bone graft (deep branch of the superior gluteal artery) is inserted into the femoral head dorsally. Preoperatively and postoperatively performed selective angiographies are necessary and presented. In all cases an unimpeded perfusion could be shown three months postoperatively. Advantages and indications of the pedicled bone graft are discussed.

Adult↗
PubMed1990

[Corrective osteotomy of the femoral and tibial shafts using the interlocking nail].

The indication for nailing a femur or tibia fracture has been extended by the method of interlocking up to the meta/diaphyseal zone. For the stabilisation of osteotomies in these regions, the nail was used in 19 cases of femur and 23 of tibia corrections between 1983 and 1988 in the Orthopedic University Clinic Berlin. The osteotomies were done with a small skin incision in open way. Although there were three infections, bone consolidation was succeeded in all but one patient with the planned axis. The first achieved gain in length could not be hold in five cases after removing the interlocking screws in order to give full weight bearing to the leg for callus formation. In situations of non-unions with wrong position or refracture of biologically troubled bones after plating the method of interlocking nail is stable and enables bone recovery after grafting by drilling. The possibility of early full weight bearing is a great advantage for the rehabilitation of patients, who had been suffering from delayed fracture healing before. The nail itself preserves the right position of the bone in two dimensions, even if there are not exact fitting osteotomy fragments, and the interlocking screws secure the shorter part of diaphysis against malrotation.

Adolescent↗
PubMed1990

[Vascular pedicled pelvic bone span. Value of digital subtraction angiography in pre- and postoperative diagnosis].

The pedicled pelvic bone graft is a new operative technique for the treatment femoral head necrosis. 29 femoral head necroses were examined by i.a. DSA before a pedicled pelvic bone graft was implanted. 11 pedicled pelvic bone grafts were investigated postoperatively. The pre- and postoperative findings are presented. I. a. DSA is a valuable method for the evaluation of the vascularisation of the femoral head before and after surgery.

Adult↗
PubMed1989

[The femoral neck pseudarthrosis following medial femoral neck fracture. An indication for the vascularized pedicled iliac crest transplant].

Revascularisation surgery was performed in six cases following medial femoral neck fracture with femoral head necrosis and non-union of the femoral neck. A corticospongiosis pelvic graft supplied by the deep circumflex iliac artery was implanted as an autologous heterotopic pedicled transplant. The operative procedure was the same in all cases, since it was possible to lift out the pelvic graft from the same side as the affected hip joint, thus making a microvascular anastomosis unnecessary. Follow-up examination after 15-27 months revealed that, in all cases, osseous consolidation of the pseudarthrosis had been achieved and that further segmental collapse of the contour of the femoral head had been prevented. The angiographic studies performed during the examination demonstrated unimpeded circulation in the pedicle of the transplants in five of the six cases, as long as 3 months after the operation. For the first time it was possible in these five cases, by means of a transplant angiograph, to demonstrate integration of the graft into the biologically weak post-traumatic transplant region.

Bone Transplantation↗
PubMed1988

[20 years of subcapital osteotomy of slipped upper femoral epiphysis. Indications and results].

Between 1945 and 1985, 570 patients with a slipped upper femoral epiphysis were treated at our hospital. During the last two decades a subcapital osteotomy was performed if the degree of slip exceeded 50 degrees. Twenty two such operations were carried out in 21 patients. In five hips complete avascular necrosis of the epiphysis occurred, and in another hip there was partial necrosis. The success of the operation depends upon careful preoperative planning and a meticulous surgical technique.

Adolescent↗
PubMed1988

[What significance does superselective angiography of the hip joint have in femur head necrosis of the adult before and after management with a vascular pedicled ileal crest graft?].

The use of microsurgical techniques in orthopaedics makes it possible to revascularize the necrotic femoral head in adults. Superselective angiography improves preoperative planning. Furthermore, using this method postoperative perfusion control of the pedicle bone graft can be carried out. This paper reports on a special way of positioning the pelvis, as well as on the results of angiography in various functional positions of the hip joint.

Adult↗