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H J Egbers

Publications and source records attributed to H J Egbers.

At least 19 recordsLinked to original sources
PubMed2006

[Clinical impact of operative multidisciplinarity for severe defect injuries of the lower extremity].

BACKGROUND: The aim of this study was to examine the impact of our multidisciplinary therapeutical concept (MTC) on the clinical outcome in posttraumatic defect injuries of the lower extremity. PATIENTS AND METHODS: Since 1999, we have performed a free tissue transfer in 37 patients. In group 1 (n = 21), our MTC was started more than two weeks (range: 17 to 83 days) after trauma and in group 2 (n = 16) within two weeks (range: four to twelve days) after trauma. Both groups were comparable with respect to trauma severity. RESULTS: 100 % patients of group 1 and 25 % patients of group 2 had clinical and microbiological manifestations of wound infection after admission in our clinic. Significantly more operations were necessary in group 1 compared to group 2 (7.3 +/- 2.6 versus 2.9 +/- 0.8; p < 0.05), until definitive wound closure could be achieved. The postoperative course was uneventful in 35 cases. All injured extremities could be salvaged. Multistaged bone reconstructions by means of spongious or tricortical bone from the iliac crest were successful in all cases. Hospital stay after admission to our clinic was significantly longer in group 1 compared to group 2 (57 +/- 12 days versus 31 +/- 7 days, p < 0.05). CONCLUSIONS: In our study, the early start of MTC significantly reduced the risk for wound infection, the number of surgical revisions before definite wound closure and time until bone and wound healing was completed.

Adolescent↗
PubMed2002

[Treatment of rare talus dislocation fractures. An analysis of 23 injuries].

METHODS: Between 1980 and 1996 we treated 23 patients for dislocated fractures of the talus. The injury was caused by a car accident in 61% and a high fall in 22%. Five patients had open wounds (22%), two developed compartment syndrome of the foot (9%) at an early stage, and 11 patients had multiple injuries. We used the classifications of Hawkins and Marti/Weber. All fractures were surgically treated by fixation with screw osteosynthesis, percutaneous wire transfixation, and/or external fixation. Fifteen patients with dislocated fractures of the talus underwent clinical and radiological follow-up examinations using the Kiel score. RESULTS: Four patients had excellent and three good results. In five patients with moderate, two with adequate, and one with poor results, we found additional injuries to the ipsilateral foot or leg in 50%. Of those patients, 73% developed peritalar arthrosis and 39% talar necrosis. Due to bony defects, anatomical reconstruction was unsatisfactory in 48%. CONCLUSIONS: Even immediate anatomical reduction and sufficient stabilization cannot always decrease the rate of talar necrosis and peritalar arthrosis.

Adult↗
PubMed2001

[Surgical treatment of injuries of the thoracolumbar transition--3: Follow-up examination. Results of a prospective multi-center study by the "Spinal" Study Group of the German Society of Trauma Surgery].

OBJECTIVES: Prospective, multicenter study addressing late results after operative treatment of acute thoracolumbar spinal injuries. METHODS: 682 patients (T10-L2) were included and 372 (80%) were postoperatively followed for 2 1/4 years (4-61 months). RESULTS: Comparing the initially included patients (n = 682) with the study group (n = 372), no differences were observed and results were assumed to be representative. A C-type lesion or polytrauma significantly prolonged the hospital stay. The method of operative treatment did not affect the length of the rehabilitation period. Neurological improvement was observed in 3 out of 7 patients with complete, and in 44 out of 64 (69%) with incomplete lesion. The operative method did not affect the improvement rate. The physical capacity significantly decreased. After a mean of 1/2 year of disability only 71% returned to work. 48% returned to their preoperative physical level. The mean Hannover Spine Score was 68 points (preoperative 94, p < 0.001), indicating permanent impairment of function. The angle-stable internal fixator was superior in restoration of spinal alignment and best radiological results were noted after combined stabilization. Posterior stabilization lead to high re-kyphosing. No correlations between radiologic and clinical parameters were observed. CONCLUSIONS: All treatment methods under study were appropriate for achieving comparable clinical and functional outcome. The internal fixator is superior in restoration of the spinal alignment. Best radiological outcome is achieved by combined stabilization. Merely by direct reconstruction of the anterior column the postoperative re-kyphosing is prevented and a gain in segmental angle is achieved.

Adolescent↗
PubMed2001

Evaluation of hydroxyapatite implants in vertebral bodies and extremities by contrast-enhanced magnetic resonance imaging.

This pilot study evaluated hydroxyapatite (HA) implants (Endobon) into bone with magnetic resonance imaging (MRI). Nineteen patients (median age 57 years; range 18-67 years) have been evaluated. Eight received granulated HA into vertebral bodies after trauma, while 11 received HA blocks into extremity bones after trauma (n = 8) or fibrous dysplasia (n = 2). In a 1.5-T MR scanner, transversal T1-weighted, flash, 2-dimensional images were obtained. Signal intensities were measured in regions of interest (ROI) from the centre and periphery of HA, trabecular bone, fat and air before and after gadolinium (Gd) contrast enhancement, and the signal-to-noise ratio (SNR) was calculated. After Gd application the SNR in HA increased significantly, peripherally (11.7 without vs 18.2 with Gd, P = 0.003) more than in the centre (7.9 without vs 11.9 with Gd, P = 0.007). The SNR of the HA was higher in patients with block implants compared with granulated HA (P > 0.008). After Gd application, granulated HA enhances significantly less than HA blocks. During insertion of HA, the granulated form is compressed more and is therefore more compact than the HA block. This might hinder integration into the bone structure and the blood supply. SNR of the HA margin was higher than centrally, which might be due to granulomatous tissue after trauma and/or operation or beginning marginal integration.

Adolescent↗
PubMed1998

[Pelvic ring injuries].

PURPOSE: Analysis of the trauma patient of fractures of the pelvic ring and classification according to AO/Tile. METHODS: 125 unselected patients (43 females, 82 males) were evaluated retrospectively by conventional x-ray, and CT examinations included follow-studies. RESULTS: Type-A fractures were seen in 36 (29%), Type-B fractures in 58 (46%), and Type-C fractures in 31 (25%) cases. Type-B and Type-C fractures mainly occurred in patients with traffic accidents and falls from great height. Type-A fractures were seen most often in patients with accidents at home or at work. However, in patients with complex fractures a classification concerning Type-B or Type-C fractures was difficult. SUMMARY: Based on CT criterias, in most patients a statement concerning the applied forces, the stability of the pelvic rim and the fracture type can be made.

Fractures, Bone↗
PubMed1997

Quality of life after pelvic ring injuries: follow-up results of a prospective study.

A follow-up after 2 years on average could be done in 43 cases of pelvic ring injuries. Seven were type A, 8 type B and 28 type C lesions. Every type A lesion was treated non-operatively. External fixation and non-operative management were used with type B injuries. As well as non-operative treatment, both internal and external surgical techniques were employed for type C fractures. While group A hardly mentioned pain in the follow-up, groups B and C suffered dorsal pelvic pain of comparable intensity irrespective of the therapeutic measures taken. Anatomic reduction does not guarantee freedom from pain. We also rated hip joint flexibility and ability to walk according to the Merle D'Aubigné score. Because of their pelvic injuries 50% of the type C patients changed their profession. The sequelae of the accident on sports and leisure time activities will be considered as well as the subjective contentment evaluated. Unstable and dislocated pelvic ring injuries permanently interfere to a high degree with the quality of life. It is remarkable that many of the traumatic lesions which interfere with the quality of life are caused by the traumatic violence itself and cannot be influenced by the manner of surgical stabilization.

Adolescent↗
PubMed1997

[CT morphology of fractured thoraco-lumbar vertebrae after transpedicular spongiosaplasty and use of internal fixator].

PURPOSE: An analysis of the CT morphology of fractured thoraco-lumbar vertebrae after treatment with internal fixation and transpedicular spongiosaplasty (SP). MATERIAL AND METHOD: 30 patients were examined following trauma and surgery after about 12 and 30 months by means of CT. The following were evaluated: width of the spinal canal; height of the vertebra and intervertebral space; degree of kyphosis; position, size and appearance of the SP and of the vertebral body. RESULTS: The width of the spinal canal was reconstituted in 91%; in 83% the anterior vertebral margin and in 35% the intervertebral space was reduced. A kyphosis of 8.9 degree was found on the followup examination. The SP showed a reduction in size (18/30) or could no longer be defined (6/30). Hypodense areas (28/30) with cavitation (12/30) were found in the vertebral body and the SP could be identified by a sclerotic margin (22/30). CONCLUSION: Treatment by this form of therapy was successful, reaction of the vertebral body against the spongiosaplasty could be identified.

Adolescent↗
PubMed1996

[Pelvic fractures: epidemiology, therapy and long-term outcome. Overview of the multicenter study of the Pelvis Study Group].

Pelvic fractures are rare injuries (3-8%) when compared to fractures in other body regions. They are accompanied by high mortality (5-20%), and the survivors suffer from severe pain and pelvic-related handicaps. The German Pelvic Group (German Chapter of the AO-International & German Trauma Society) started a prospective multicenter study, including ten major trauma centers for collecting a high number of data in a short period of time (1991-1993). All pelvic injuries were documented consecutively using a special set of evaluation sheets. The study closed with 1,722 patients. A 2-year follow-up was completed for 486 patients injured in 1991 and 1992 after type B and C injuries, complex pelvic trauma, acetabulum fractures and a random 25% of A-type injuries (overall follow-up rate 73%). The follow-up included special "out-come" criteria. Of the pelvic ring injuries without significant peripelvic soft tissue involvement, 63.6% were A-type fractures, 21.0% B-type injuries and 15.5% C-type injuries. The rate of operative stabilization was 3.9% after A-type injuries, 37.3% after B-type injuries and 54.3% after C-type injuries. In isolated acetabular fractures ORIF was performed in 38.6%. The total lethality was 7.9% with a significant difference between "complex" pelvic trauma (21.3%) and patients without concomitant peripelvic injuries (7.2%). In 0.9% the pelvic injury was reported as the main cause of death. Pain at follow-up was observed in every classification group, the rate of completely "pain-free" patients being 55% after A-type, 41% after B-type and 27% after C-type fractures. Malfunction of micturia was reported by 7.6% of all patients, sexual malfunction by 11.6% of the males ("erectile dysfunction") and 2.2% of the female ("dysparneuria"). Scaled by the recently developed "outcome score", the radiological result showed anatomical healing after 90.8% of the B-type and 74.6% of the C-type injuries. On the other hand, the clinical result was rated as good or excellent in only 70% of the B-type and 54% of the C-type injuries. Although progress in indications and treatment techniques has shown improved radiological results after unstable pelvic ring injuries when compared to earlier studies, the clinical result still remains unsatisfactory. Further analyses and studies must be conducted to identify the prognostic factors for the late sequelae. Whether it is possible influence these factors by additional surgical intervention cannot be answered at present.

Acetabulum↗
PubMed1995

[Results of follow-up of conservatively and surgically treated injuries of the pelvic ring within the scope of a prospective study].

Follow-up was possible after an average of 23.4 months in 26 cases of pelvic ring injury. These were made up of 7 type A, 8 type B, and 11 type C injuries. Every type A lesion was treated conservatively. External fixation and conservative management were used with type B injuries. Besides conservative treatment both internal and external surgical procedures were applied for correction of type C fractures. While patients treated for type A injuries reported hardly any pain at follow-up, those with types B and C reported dorsal pelvic ring pain of comparable intensity regardless of the treatment given. All patients with a poor outcome following unstable pelvic ring injuries reported dorsal pelvic pain as a principal symptom. Radiological evaluation revealed that the greater the dorsal displacement the more acute the dorsal pain must be expected. An anatomical reduction does not guarantee freedom from pain, however. Besides pain we also rated hip joint flexibility and ability to walk according to the Merle D'Aubigné score. Trauma-related damage and postoperative injuries were distinguished in the neurological evaluation showing a high incidence of lesions of the lateral cutaneous nerve of the thigh following external pelvic fixation. Because of their pelvic injuries 6 patients (23%) were completely or partly disabled and thus unfit for work. The follow-up examinations showed good results in 20 (76%) of the cases. While type B pelvic ring injuries can heal completely when treated by means of a supra-acetabular pelvic fixator, reliable retention cannot be achieved in the case of type C lesions.

Adult↗
PubMed1993

[Pelvic fractures in the Kiel trauma surgery clinic. A one-year evaluation].

48 injuries to the pelvis were treated from January 1991 through December 1991. We found 45 fractures of the pelvic ring with associated acetabular fractures in 15 cases and three isolated acetabular lesions. 19 injuries were caused by car accidents, 18 fractures resulted from a fall, especially in older patients. Isolated fractures of the pelvis occurred in 18 cases. The average total severity of the injuries was 19.7 points according to the Hannover Polytrauma Score (PTS). Every fracture was classified using the Tile-classification. There were 15 (33%) Tile A lesions, 18 (40%) Tile B fractures and twelve (27%) type C pelvic ring injuries. In 18 cases surgery was the method of treatment. Seven out of 18 injuries to the acetabulum were treated with open reduction and internal fixation. In ten patients the unstable pelvic ring was fixed by means of an external fixator. To do so, a pair of 6 mm diameter pins were placed on both sides in the supraacetabular region of the iliac bone directed towards the sacroiliac joints. We used a triangular form of external fixation. An open reduction and internal fixation (ORIF) was necessary in five cases, one injury required a combination of external and internal procedures. There were 14 cases in which we found sacral fractures as an additional dorsal lesion. Nine of 14 sacral fractures were recognized only by CT examination. In eleven cases the conventional radiographs showed simple anterior pelvic ring fractures while the CT examination revealed an additional lesion of the sacroiliac joint in nine of these cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗
PubMed1993

[Plaster-free, early functional after-care of surgically managed Achilles tendon rupture].

The widely used treatment of Achilles tendon rupture by operation and postoperative plaster is more and more controversially discussed. The disadvantages of plasters with thrombosis and joint stiffness and recent results about tendon healing makes it worth while to illucinate an immediate functional physiotherapy. Our study consists of two groups of patients who were operated for tendon rupture. Postoperative one group (n = 24) was treated with a plaster for six weeks. The second group (n = 17) was immediately treated by physiotherapy without any immobilisation. After a mean time interval of 19.8 months the joint movement and tendon flexibility was evaluated. Furthermore soft tissue ultrasound was performed to measure the tendon tissue density and gliding movement. Our data showed that 1. Early functional treatment resulted in minor problems (35%) than immobilisation (46%). 2. Plaster-free treated patients had higher tendon density values (grade II 41%, grade III 47%, grade IV 12%), which depicts a higher tensile strength than the comparable group (grade II 29%, grade III 58%, grade IV 13%). 3. Plaster-free treated patients showed significant lesser adhesion formation to the Achilles tendon (grade I 29%, grade II 53%, grade III 18%) than immobilisation (grade I 4%, grade II 59%, grade III 37%).

Achilles Tendon↗
PubMed1992

[Stabilizing the pelvic ring with the external fixator. Biomechanical studies and clinical experiences].

Experimental studies were performed on anatomic pelvis specimens. In different series of experiments the positioning of the screws and the assembly of the external fixator were changed. We tried fixing the external fixator to the screws at varying distances from the body surface. For stabilisation of the fractured pelvic girdle a self-constructed "bow fixator", fixed to supra-acetabular screws with proximal compression and distal traction showed the best results. Homogeneous distribution of the pressure could be achieved on the unstable dorsal pelvic ring structures. In clinical routine we used the triangular external fixator, which in the experimental situation yielded results close to those of the bow fixator. External fixation of the pelvic girdle has been performed 128 times since 1977, in January 1991 a prospective study was started. For Tile type B injuries the external fixator itself represents an effective, minimally invasive system, but type C fractures often require an additional internal fixation of the dorsal lesion.

Acetabulum↗
PubMed1991

[Early functional treatment of the injured shoulder supported by an active shoulder bandage].

The following study shows the results of treatment of 29 patients suffering from rotatory cuff lesion and of 20 patients with tendinosis. The results of functional physiotherapy of the patients with rotatory cuff lesion correspond to the results of post-operative treatment described in other studies. As a result of early functional physiotherapy backed up by an active shoulder support, the treatment was both improved and shortened considerably. The accompanying pain relief achieved an earlier usability of the shoulder joint in both groups of patients. Four patients with rotatory cuff lesions were resistant to physiotherapy and finally had to undergo surgery.

Bandages↗
PubMed1989

[External fixators in treatment of severe fractures of the pelvis].

The use of external fixation for pelvic injuries is mainly determined by the type of pelvic girdle fracture and by the severity of the general injury. Exact diagnosis of the extent of injuries can be made with a pelvic X-ray a.p. Pennal's technique and CT imaging. The iliosacral joint can be repositioned by transduced compression via Schanzscrews inserted above the acetabulmum and directed toward the iliosacral joints. Triangular compression frame construction is applied along the plane of the pelvic inlet. The advantages include easier intensive care, early functional mobilization, minimised trauma and decreased blood loss. Disadvantages are the risk of pin tract infection and patient discomfort. Of 92 patients treated thus, these were 11 cases of ankylosis of the iliosacral joint, two malunions and two persistent instabilities of the pelvic girdle.

External Fixators↗
PubMed1982

[Primary operative repair of acute knee joint ligament injuries; results (author's transl)].

From 1978 to 1980 43 patients suffering from ligament injuries of the knee-joint immediately underwent definitive surgical repair. The follow-up of 31 patients showed 8 patients with excellent results, 13 with good results, 7 with satisfactory results, 2 with poor results, and 1 with a bad one. Instability could be found in the antero-medial compartment of 15 patients, in the antero-lateral compartment of 7 patients, in the postero-medial compartment of 2 patients. There was 1 case of instability in the postero-lateral compartment. We recommend to perform the repair as soon as possible and in the postoperative period as well as early mobilisation under supervision of an experienced physiotherapist.

Adult↗