Biomedical subjects

G Sperner

Publications and source records attributed to G Sperner.

At least 19 recordsLinked to original sources

PubMed2006

[Comparison of open versus percutaneous treatment for humeral head fracture].

BACKGROUND: The hypothesis of this study was that percutaneous techniques lower the risk of post-traumatic avascular necrosis. MATERIALS AND METHODS: In this retrospective study 83 patients were followed up clinically and radiologically for signs of avascular necrosis and nonunion after open or percutaneous treatment of proximal humerus fractures. Mean age was 50 years. Fractures were classified in 22 patients (26.5%) as two part, in 21 patients (25.3%) as three part, in 39 patients (47%) as four part, and in 1 patient (1.2%) as fracture dislocation (Neer classification). Fractures were treated in 12 patients (14.5%) by ORIF (open reduction and internal fixation) and in 71 patients (85.5%) by CRPF (closed reduction and percutaneous fixation). Both groups were statistically equally distributed according to fracture type (Mann-Whitney U, p=0.267) and age (One-way-Annova, p=0.740). The postoperative regime did not differ between the two groups. RESULTS: Patients suffered significantly more avascular necrosis after open treatment [five patients (50%) versus eight patients (12.7%) in the percutaneous group, Mann-Whitney, p=0.004]. The risk for avascular necrosis and nonunion increased with age. Mean age of patients with avascular necrosis was 57 years, and the age of patients with nonunion was 67 years. CONCLUSION: Percutaneous treatment of humeral head fractures seems to be a reliable method for lowering the risk of avascular necrosis in young patients.

Adult↗

PubMed1998

[Post-traumatic ischemia of the talus. Is talus necrosis unavoidable?].

50 patients following talar fractures type Marti 2, 3 and 4 during the years 1972-1993, could be analysed retrospectively. Evaluated factors effecting posttraumatic avascular necrosis of the body of the talus are: type of fracture, age of the patient, additional fracture of the medial malleolus and time of non weight bearing. The Hawkins sign is reliable to show vitality in the body of the talus. We could see vascular impairment in 51% of all Marti 3 fractures and in 100% of all Marti 4 fractures. Patients with a concomitant fracture of the inner malleolus showed positive influence on the blood supply of the talus. In this case the ligamentum deltoideum and the ramus deltoideus of the arteria tibialis posterior remained intact. In addition to this the prognosis was better in young patients. A long period of non weight bearing could not preserve vitality of the talus. Necrosis of the talus did only appear in 34% of the Marti 3 and in 51% of the Marti 4 fractures. This means that early anatomic reconstruction of the talus is necessary. Primary arthrodesis of the ankle joint and talectomie are not up to date.

Adolescent↗

PubMed1998

[Arthroscopic extra-articular Bankart procedure].

The arthroscopic extraarticular Bankart procedure tries to imitate the open Bankart procedure. An anterior-inferior transmuscular approach through the subscapular muscle permits to implant self-locking tacks into the anterior inferior third of the glenoid rim. The extraarticular location of the implants makes a superomedial capsular shift possible, if required. A total of 257 arthroscopic repairs following traumatic recurrent anterior shoulder dislocation have been carried out between 1992 and 1996. 177 patients were treated only with bioabsorbable Suretac device. Clinical and radiological follow up was possible in 165 patients. According to the Rowe score 69.7% were classified as excellent, 10.9% as good, 9.7% fair and 9.7% poor. Postoperative complications: the recurrence rate was 9.7%, allergic reactions representing a foreign body reaction to the synthetic material were seen in 5 cases (3%) and a frozen shoulder in 6 cases 3.6%). 61% of the patients involved in overhead or contact sports returned to their preoperative sport activities.

Accidents↗

PubMed1997

Arthroscopic extra-articular Bankart repair for the treatment of recurrent anterior shoulder dislocation.

This study describes a new arthroscopic procedure for the stabilization of recurrent anterior shoulder dislocations. The technique involves two important features. The first is the anterior inferior transmuscular approach through the subscapularis muscle, which permits self-locking implants to be inserted into the anterior inferior third of the glenoid rim so that they oppose the direction of pull of the capsule. This approach was studied on 79 cadaveric shoulders before clinical application. The second feature is the extracapsular (extra-articular) location of the self-locking implants, which permits a superomedial capsular shift as required. The technique offers a high degree of capsular stability. Of a total of 318 patients undergoing this procedure, the first 100 shoulders (98 patients) were evaluated postoperatively at an average of 35 months (range, 18 to 62 months). The diagnosis in all cases was traumatic recurrent anterior shoulder dislocation. Repair of the capsule was performed initially with screws and later with absorbable tacks. The overall recurrence rate was 9% (9 shoulders). Excluding the first 30 shoulders to take account of the learning curve, the recurrence rate for the subsequent 70 shoulders was only 5.7%. Limitation of external rotation at 0 degrees abduction averaged 6.7 degrees and 6.1 degrees at 90 degrees abduction for all shoulders; 61% of participants in overhead sports and 70% of participants in contact sports resumed their preinjury activities. The recurrence rate for patients involved in overhead sports was 10% and for collision sports it was 14%. There were no recurrences in the case of patients whose sports involve minimum risk to the shoulder (cycling, jogging). Most recurrences were observed in patients with lax shoulders and small Bankart lesions.

Adolescent↗

PubMed1997

Primary flap closure in complex limb injuries.

Free-tissue transfers enable surgeons to reconstruct or salvage limbs injured or amputated in high-energy traumas which result in extensive damage to soft tissue, bone, tendons, vessels and nerves. Primary free-tissue transfer is performed following debridement, bone fixation, and repair of injured structures within 24 hr after injury. Between 1987 and 1996, 57 patients who had complex extremity traumas were treated with primary free-tissue transfer, or free flaps. Long-term follow-up ranged from 4 months to 9 years (median: 4.5 years). No flap failure or serious wound-healing complication occurred using the protocol. Radical debridement and primary free-flap coverage in extensive extremity injuries can salvage limbs, provide improved functional and aesthetic results, and psychologically benefit patients through lowered morbidity. Other benefits include reduced incidence of free-flap failure, postoperative infection, secondary operative procedures, and invalidity, as well as shorter hospital stays, and lowered medical expenses.

Adult↗

PubMed1996

[Arthroscopic replacement of the anterior cruciate ligament with a double semitendinosus tendon].

At the university hospital of emergency surgery in Innsburck and at the emergency services department of the hospital in Schwaz, anterior cruciate ligament reconstruction was performed in 467 patients between January 1992 and September 1993. In 117 cases, a double semitendinous tendon was used as an autograft. A total of 60 of these patients were followed up at an average of 20 months (13-33) after reconstruction. The results were rated according to the OAK and the Tegner scores. Objective measurements of instability were carried out by a KT 1000 arthrometer. In addition, 21 patients underwent computer-interfaced dynamometer testing using a Cybex 6000. Standardized loading of the thigh muscles was performed at angular velocities of 60 degrees/s (3 repetitions) and 240 degrees/s (30 repetitions): peak torques and total work were analyzed. The mean age was 23.5 years (17-55): 48 were male, 21 female. The main reasons for the ACL ruptures were sports injuries (51 cases). The patients were classified into three groups according to the data of the repair (group 1 reconstruction up to 1 week after trauma-28 patients: group 2: reconstruction between the 2nd and 6th week after trauma-15 patients: group 3: reconstruction 6 and more weeks after trauma-26 patients). In group 1. additional ruptures of the menisci. lesions of the MCL. and chondromalacia were seen in 71.4%. in group 2 in 73.3% and in group 3 in 80.8%. The average rating in the OAK score was 90.16 points: 38 patients (55.70%) had excellent results. 18(26.09%) were good. 9(13.04%) were fair and 4(5.80%) were poor. The Tegner activity score showed a reduction of 0.36 points on average. The largest amount of anterior translation was performed with the KT 1000 manual drawer test (2.29 mm on average compared with the contralateral side). Dynamometer testing showed a statistically significant difference in flexor and extensor mechanism (compared with the non-involved side) in both peak torques and total work. A repeat arthroscopy became necessary in five cases: arthrofibrosis in three and incipient joint infection in two cases.

Adolescent↗

PubMed1996

[Ultrasound diagnosis of the shoulder].

Sonography of the shoulder joint is a well-established technique in the hands of the experienced examiner, when using a standardized protocol. It has proved invaluable in assessing pathological soft tissue changes, especially after trauma. The static evaluation of anatomy and dynamic assessment of function are especially helpful in both preoperative staging and postoperative follow-up. The normal anatomy, examination techniques, including our own variations, and pathological conditions are discussed. The findings and various classifications of impingement syndrome, rotator cuff injuries, biceps tendon lesions and inflammatory changes are examined. Review of the major articles in the literature shows excellent correlation with our results, the overall sensitivity in the case of rotator cuff lesions being over 90%. A well-performed ultrasound examination in most cases obviates the need for the more invasive arthroscopy and the more cumbersome and expensive MRI examinations.

Adolescent↗

PubMed1995

[Role of the subacromial space on development of the impingement syndrome. I].

In the first part of the study reported in this paper the anatomy of 150 scapulae was studied to find out whether variation in the subacromial space might cause impingement syndrome. Sixteen different parameters, including various angles, size and shape of the acromion and the coracoid process, and length of the coracoacromial ligament and the acromion, were measured. Soft tissue was completely removed from the bone, so that no statement on the rotator cuff was possible. The data were processed using the Tukey LSD test. A statistically significant correlation between the size of the shoulder blade and the length of the acromion and the coracoacromial ligament was found. The shape of the coracoid process showed more individual variations, and no correlation with the size of the bony scapula was found. The shape of the subacromial space was obtained by using four different bony landmarks (acromial angle, tip of the anterior rim of the acromion, tip of the coracoid process and supraglenoid tubercle). Three different types were found: a "rhomboid" in 103 cases, an approximate "kite" shape in 35 cases, and a triangle in 12 cases. The rhomboid form means a larger plane surface, so that the rotator cuff can glide more smoothly than with the other types. The different shapes of the subacromial space did not influence the slope of the acromion in the scapular plane.

Acromion↗

PubMed1995

[Role of the subacromial space on development of the impingement syndrome. II].

Twenty-five patients with suspected impingement syndrome on the basis of clinical examination were evaluated by magnetic resonance imaging (MRI). In paracoronal and parasagittal planes, different measurements of bony structures of the subacromial space and of the glenoid joint were performed, as in the anatomical study reported in the companion paper. A healthy, age-and sex-matched group of 25 persons underwent the same MRI-procedure and the results were compared with those in the patients. Ruptures of the rotator cuff were excluded by means of standard X-rays, physical examination, and ultrasound. The comparison revealed a highly significant difference between the sizes of the subacromial space. Healthy persons had a space that was larger by more than one third than that of the patients. Other parameters did not differ significantly between the two groups. In a further part of the study the insertion zone of the coracoacromial ligament into the undersurface of the acromion was histologically studied in 24 autopsy specimens. Different staining techniques were used to find out whether microscopic changes occur during different stages of life. Cartilage without bone formation of the acromion was found in children. In adult specimens bony projections of the undersurface of the acromion and thickening of the surrounding fibrocartilage were found, but there was no correlation between ageing and these changes. However, in patients suffering from impingement syndrome the subacromial space is reduced. Acromioplasty enlarges the space by resection of the anterior part of the acromion. Bony spurs on the acromion and a thickening of the fibrocartilaginous layer are not degenerative changes, but they are caused by increased tensile strength of the coracoacromial ligament and are not influenced by age.

Acromion↗

PubMed1994

[The treatment of fresh anterior cruciate ligament ruptures in relation to age and level of sports activity].

Due to its exposure as well as a lack of securing muscles the knee is the human joint with the higher incidence of traumatic injury. The aim of this retrospective study was to illustrate our five-year results following conventional and surgical therapy and to relate these results to the extent of sports activity enjoyed by the accident victim. Assessment was made according to subjective, objective and functional criteria. The surgical group consisted of 52 patients and the conventionally treated group 31 patients. Subjective assessment of the surgical group showed 65.5% of the patients to have very good or good results, as opposed to 32% for the conventionally treated group. When related to average overall sports activities and when using the Innsbruck Scors a significant change was seen in both groups. Surgical patients who participated in competitive or leisure sports showed better results.

Adolescent↗

PubMed1993

[The value of sonography in ruptures of the rotator cuff].

In 375 patients ultrasonography of the rotator cuff was carried out before operation. All the patients underwent acromioplasty, either alone or with additional repair of a full-thickness tear. The ultrasound findings were then compared with the intraoperative findings. Two hundred and seventy-two tears of the rotator cuff were seen on ultrasonography, and in 262 cases this was confirmed at operation. In 103 patients no rupture was diagnosed by ultrasound, but in 26 of these cases a full-thickness tear was detected on operation. These figures yield sensitivity of 91%, specificity of 89% and accuracy of 90%; the positive predictive value was 96%, the negative predictive value 75%. In most cases of incorrect evaluation the size of the tears was underestimated by ultrasonography.

Adult↗

PubMed1992

The effects of alcohol and benzodiazepines on the severity of ski accidents.

Urine samples from 402 victims of ski accidents were analyzed for the presence of benzodiazepines (BZD) and alcohol. Eighty-one (20%) samples were positive for alcohol; BZD were detected in 34 (8.5%) cases. Ten of the samples (2.5%) were found to be positive for both alcohol and BZD. Subjects who were positive for either alcohol or BZD or both were older than the other persons examined. The prevalence of alcohol was significantly higher among male accident victims. BZD intake could be demonstrated to have a significant influence on the severity of injuries. Besides an increased awareness of the need for skier education regarding drug use, heightened attention of medical caregivers is warranted to inform their patients about potential accident hazards in sport activities when BZD are prescribed.

Adolescent↗

PubMed1992

[Arthroscopic and percutaneous bone screw techniques with a new screw system].

A new screwdriver is presented with which small titanium screws can be introduced into a joint under arthroscopic guidance. The screws are centrally cannulated, 2.7 mm thick (thread diameter), and available with and without a washer (5 mm in diameter, serrated and convex, flexible but not removable). The screwdriver has a special screw-holding device which allows the screw to be grasped and released making it possible to remove a screw already implanted in the joint at an earlier time. This arthroscopic screwing system has been used in 81 cases to date. In 59 patients with shoulder instability, arthroscopic refixation of the detached labrum-capsule complex was performed. In the first 32 of these cases an intra-articular screwing technique was used and in the following 27 cases an extra-articular screwing technique was applied. In addition, in 9 patients a fractured and displaced greater tuberosity was reduced and fixated percutaneously under the guidance of an image intensifier by means of this screwdriver. Other fields of application were the knee joint (type III fracture of the intercondylar eminence in 5 patients) and the ankle (displaced fracture of the talus in 2 patients and osteochondritis dissecans in 1). Complications were seen only in the patients with shoulder instability who were treated by the intra-articular screwing technique (screw loosening in 4 patients). This was the reason why the intra-articular technique was replaced by the extra-articular method. Since that time no further complications caused by the screws have been seen. Redislocation of the shoulder joint occurred in 1 case 7 months after operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthroscopes↗

PubMed1991

[Growth in length after femoral shaft fracture in childhood].

At the Innsbruck Trauma Department a total of 75 children with closed femoral shaft fractures were reviewed with reference to length discrepancy. The femurs were measured radiologically two times within four years to find out, if overriding of the fragments is useful to prevent overgrowth of the broken limb. In 60 patients conservative treatment and in 15 cases operative treatment was performed. The cases may be divided in two age groups: one ten years of age or younger, the other eleven years to 15 years. Shortening of the fragments shows no evident advantage preventing overgrowth of the broken limb, but in elder children it may provoke a persisting shortening of the limb. As a matter of fact anatomical reduction in conservative treatment of femoral shaft fractures, especially in elder children, should be performed. After operative treatment the children ten years of age to 15 years showed not even more lengthening of the femur than the patients with conservative treatment.

Adolescent↗

PubMed1991

[Effect of alcohol and benzodiazepines on the severity of ski accidents].

Urine samples from 402 victims of ski accidents were analyzed for the presence of alcohol and benzodiazepines. In a second stage of the investigation, patients were asked to fill in a questionnaire evaluating among other things the consumption of alcohol and the use of benzodiazepines during the last 24 hours before the accident. 81 (20.1%) samples were found to be positive for alcohol, in 34 cases (8.5%) benzodiazepines were detected by urinalysis. 10 samples were positive for both alcohol and benzodiazepines. Subjects positive for alcohol and benzodiazepines presented with significantly more severe injuries than the negative controls. Native accident victims were significantly less frequently positive for alcohol than were subjects from foreign countries. Accidents most commonly occurred early in the afternoon, the positive urine samples, however, were evenly distributed over the whole day. The questionnaire was answered and returned by 76.6% of the study population. 80% of the patients with urine samples positive for alcohol reported having consumed alcohol before the accident, whereas none of those who had been positive for benzodiazepines admitted having ingested tranquilizers.

Adolescent↗

PubMed1991

[Early and intermediate results of conservatively and surgically treated lateral clavicular fractures].

Between 1986 and 1988 67 patients with distal clavicular fracture were treated at the trauma hospital in Innsbruck. Depending on type of fracture conservative treatment (using a spica or other bandages) was performed in those cases without dislocation. Operation was necessary if coracoclavicular ligament was ruptured and dislocation of the distal clavicular end was found in X-rays. The most common practice was the use of K-wires and wire-loops. Plate fixation was necessary in one case of delayed fracture healing. No pseudarthrosis was seen in X-rays, mobility of the shoulder girdle was good and symptoms of pain were rare.

Acromioclavicular Joint↗

PubMed1990

[Pathology, diagnosis and therapy of patellar dislocation].

Patella dislocation in sports trauma is a common injury and is influenced by minor alterations or derangements of dynamic or static factors. The sulcus angle should not exceed 138 degrees and the Q angle should not be more than 15 degrees. Patella alta has some influence on the dislocation tendency, and so has weakness and atrophy of the musculus vastus medialis obliquus, causing muscular imbalance. Diagnosis is made via x-ray in tangential as well as a.p. and lateral view. Clinical examination of the patella reveals in lateral dislocation or redislocation can be provoked after positioning. Tenderness is present along the medial retinaculum associated with haemarthrosis in most of the cases. Conservative treatment includes evaluation of haemarthrosis and physiotherapy especially with regard to strengthening the vastus medialis obliquus. Surgery includes lateral release and medial capsular plication or transposition of the patellar tendon for correction of the Q-angle.

Adolescent↗

PubMed1990

[Late results in patellar fracture].

This article surveys a follow-up of 31 patients suffering from a patella fracture 6 to nearly 9 years ago. Patients complaints are compared with objective circumstances. Conservative treatment only was exercised in fractures without displacement and in longitudinal ones, which had an intact extensor mechanism. Results after patellectomy are not satisfactory. Most of fractures are treated with tension cerclage combined with K-wires or with screws. Partially difference was realized between patient's feelings and medical evidence.

Bone Screws↗