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Biomedical subjects

H Bereiter

Publications and source records attributed to H Bereiter.

32 records · Page 2Linked to original sources
PubMed1991

Results of operative treatment for intra-articular fractures of the calcaneus.

Since 1980 our treatment of displaced intra-articular calcaneal fractures consists of open reduction with distractor, bone grafting, and internal fixation. Thereby no splints are applied and early postoperative movement is possible. For precise preoperative planning a CT scan is required. Proper timing and careful preoperative planning are essential to prevent soft-tissue complications. In a total of 16 fractures good clinical and radiologic results were achieved in 50% of the cases; results were satisfactory in 25% and poor in 25%. The patients returned to work after an average of 5 months. Only three patients (19%) received disability compensations, which compares favorably with nonoperative treatment. We believe that a majority of comminuted intra-articular fractures of the calcaneus profit from open reduction and internal fixation and that more reliable functional results are achieved than with conservative therapy.

Adult↗
PubMed1990

[Post-traumatic osteitis. The acute infection].

The acute infection is defined as bacterial growth within the surgical wound, that may occur within days to weeks after initial surgery but before bone union. The chances of complete recovery after an acute soft tissue inflammation are closely related to the interval between initial surgery and first signs of infection, the early recognition of the complication, the type of bacteria involved and the therapeutic measures. The first symptoms of an impending infection are the classical clinical ones of any inflammation: tenderness, swelling and reddening. All imaging procedures are of little or no value. The therapy consists of very aggressive and, if required, repeated wound revisions with debridement of all necrotic tissue, removal of loose bone fragments or loose implant material, wash-outs with antiseptic solutions (e.g. Taurolin) or even deposition of gentamycin beads. Systemic antibiotics may be added temporarily. The in- or external fixation devices must provide stable fracture fixation and the bone as well as the soft tissue envelope must be well vascularized.

Acute Disease↗
PubMed1990

[Infected prosthesis of large joints].

The problems related to infections of hip- and knee-prostheses are generally known. The aim of the operation- a mobile and painless joint is jeopardized. The best therapeutic measure has to be evaluated individually by a differentiated diagnostic procedure. The health condition of the patient, type and localization of the infection, bacteriology and resistance of the microbes as well as the biomechanical condition of the artificial hip joint and the trophic quality of bone and soft tissue play an important role. The different therapeutic concepts we can dispose of should take these factors into account, so that a successful healing may be expected in 80 to 90% of the cases.

Combined Modality Therapy↗
PubMed1989

Cementless press-fit cup. Principles, experimental data, and three-year follow-up study.

The concept of the press-fit cup includes an operative defect as small as possible, achievement of intrinsic stability by press-fit, and surface coating by an orderly, oriented wire mesh coating. The design is a modified hemisphere with flattening in the pole area and oversized cup diameter. A first series of press-fit cups were fitted with titanium nitride-coated stainless steel mesh. The manufacturing of such chemically pure titanium has only recently become feasible. Animal experiments using mountain sheep have shown an increase in the stability of the press-fit cup within the acetabulum with time and progressive bony ingrowth; this was verified in cups retrieved at autopsy. Three hundred eighty-seven first-generation titanium nitride-coated stainless steel mesh implants have been reviewed with a follow-up time of 12 to 39 months (average, 16.6 months). There were no intraoperative complications related to the cup. The roentgenographic follow-up study of 330 (85.1%) hips showed only a single case with a radiolucent line in all zones (1-3) as a roentgenographic sign of loosening, i.e., fibrous ingrowth. Two cups had to be revised due to insufficient primary stability and tilting.

Acetabulum↗
PubMed1989

[Initial results with the new tibial interlocking nail of the Orthopedic Study Group].

The new AO universal tibia nail with interlocking possibility has several new features. The wall thickness has been increased from 1.0 to 1.2 mm. In order to give the stiffer nail smoother insertion properties and better cortical contact, the overall design has been altered with the help of computer calculation. Proximally there are 3 holes for locking purposes in the frontal plane, while distally we find two holes in the frontal and one in the sagittal plane to accommodate the locking bolts. The new nail has been applied in 17 clinical cases with overall good results. The indications were deliberately pushed to the extremes and even 5 open fractures were nailed after minimal remaining. There were 2 major perioperative complications: one proximal blow-out of the anterior cortex due to a wrong point of insertion and several other technical mistakes. The situation was salvaged with an external fixator. In an 85-year-old multiple injured lady with a 3-degree open tibia, the initial fixateur externe was replaced after 3 weeks by a 10 mm universal nail. Due to severe porosis and rather proximal extensive cortical comminution, the locking bolts and therefore the nail did not find a good hold in the tibia plateau. After uneventful healing of the soft tissues and additional splinting, the fracture, however, consolidated within 4 months. There were two superficial soft tissue infections early postoperatively, but no cases of osteitis. Healing of the fractures seems to progress without delay.(ABSTRACT TRUNCATED AT 250 WORDS)

Follow-Up Studies↗
PubMed1989

[Plate osteosynthesis in humeral shaft fractures. Indications and results].

Non operative management of humeral shaft fractures is well recognized as the standard of care for uncomplicated injuries. Operative treatment of humeral fractures may be performed when limited indications are present as in patients with multiple trauma including ipsilateral forearm injuries, arterial injury or primary radial nerve palsy. 18 patients with humeral shaft fractures underwent open reduction and internal fixation (ORIF) using the AO plating technique at the Kantonsspital Chur from 1980 to 1986. Follow-up was available for 17 patients of whom 16 suffered from multiple injury trauma. The broad DC plate combined with lag screws was used in most cases. Two brachial artery transections were repaired at the time of primary osteosynthesis by the same surgeons with full functional recovery. Concomitant nerve injuries were repaired primarily in one case and postprimarily in 3 more cases. The overall result was excellent in 9 patients, good in 5 patients, fair in 2 patients and poor in one patient with complete brachial plexus injury. Bone healing was uneventful in all 17 patients. No infection and no delayed union or pseudarthrosis has been observed.

Adult↗
PubMed1989

[After-care in surgical replacement of the ligaments of the knee joint].

Reconstructive surgery of ligamentous injuries of the Knee Joint is often associated with a considerable impairment of its integrity and requires a high standard of surgical technique. The postoperative course, aiming towards normal function, is demanding and bound to biomechanical and biological principles. It therefore has to be built up gradually and lasts basically 12 months - with an individual variety. Up to the 6th postoperative week the healing process is in the foreground. During the second phase, up to the 12th week careful rehabilitation is aimed to improve muscle strength, increase weight bearing and optimize mobility. In the third phase, from the 12th week on, the patient regains full strength, range of motion as well as coordination, and an integrated sport rehabilitation is started.

Humans↗
PubMed1981

[Skeletal scintigraphy as early diagnostic aid in acute haematogenous osteomyelitis in the iliosacral joint (author's transl)].

For the scintigraphic diagnosis of bone disease 99mTechnetium MDP has been shown to be of great value. In acute haematogenous pelvic ostemyelitis scintigraphy is one of the most important early diagnostic aids. The rare and difficult diagnosis with an initial negative X-ray can be confirmed by a high uptake on scintigraphy. Through early selected antibiotic therapy in high doses the development of radiologic changes were prevented which is shown in the two reported cases with acute haematogenous osteomyelitis in the iliosacral joint.

Adolescent↗
PubMed1978

[Surgical treatment of intra-articular calcaneus fractures].

The instable fractures of os calcis are usually treated by conservative methods with early functional mobilization. In a few cases we think that in the Tongue Type and especially in the Joint Depression Type of Essex-Lopresti a surgical treatment may be useful to reestablish the congruence and the geometry of the joint surface.

Calcaneus↗
PubMedDate not supplied

[Relevant differences after post-traumatic and degenerative humeral head replacement (intermediate-term results)].

INTRODUCTION: In a comparative study, mid-term findings after posttraumatic and degenerative hemi-prosthetic shoulder joint replacement were analyzed and compared with current reports in the literature. METHODS: The patient sample in the retrospective study consisted of 20 patients with proximal fractures of the humeral head (x = 64 years) and 6 patients (x = 61 years) with degenerative shoulder joint disease. In 14 patients the humeral head was replaced as a primary procedure at < 4 weeks after the trauma and in 6 patients as a secondary treatment at > 4 weeks. The follow-up period was 38-41 months on average. Evaluation was based on the Constant Score, subjective assessment by the patient, and conventional radiographs. RESULTS: After posttraumatic shoulder replacement, the patients achieved a Constant Score of 65 (+/- 19) and after degenerative replacement 74 (+/- 34) points. In the posttraumatic group, the Constant Score after primary implantation was better than after secondary implantation (68 +/- 16 versus 59 +/- 15 points). After posttraumatic replacement, the only improvement over time was in pain levels (p < 0.05). 92% of all patients were satisfied with the result and would accept the same treatment again. Radiologically, a clinical correlate could be found for the arrosions at the acromion and occasionally for the secondary upwards displacement of the humerus. The results correlated well with data from the literature. CONCLUSIONS: For posttraumatic conditions, hemiarthroplasty led to better results within four weeks and seemed to be a suitable alternative to other procedures, especially in older patients. Patients with primary osteoarthritis and idiopathic humeral head necrosis can expect good to excellent results after hemiarthroplasty. In both groups, the overall results depend mainly upon patient compliance and the state of the rotator cuff.

Aged↗
PubMedDate not supplied

[Replacement of the anterior cruciate ligament combined with valgization osteotomy of the tibia in incipient medial gonarthrosis with anterior cruciate ligament insufficiency].

In 7 patients with chronic, primarily anteromedial instability and incipient medial gonarthrosis a procedure combining valgization osteotomy of the tibia with anterior cruciate ligament replacement was employed. Postoperative examinations after observation periods of between 6 months and 5 years revealed that the results were good to very good, both subjectively and objectively. There was either no recurrence or a definite alleviation of knee joint pain present preoperatively. In view of the good results the authors now regard a combination of valgization osteotomy and anterior cruciate ligament replacement as the treatment of choice in cases with clear insufficiency of the anterior cruciate ligament and simultaneous incipient medial gonarthrosis. The combined procedure improves chances of achieving the goal of therapy. A valgization osteotomy or an anterior cruciate ligament replacement alone ought to be regarded as inadequate treatment in such cases, especially in the longer term.

Adult↗