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H J Oestern

Publications and source records attributed to H J Oestern.

At least 19 recordsLinked to original sources
PubMed2002

[Quality and economy--contradictory demands].

Polytrauma treatment (40-60,000,-[symbol: see text]) and trauma killed victims (750,000,-[symbol: see text]) are a severe economical problem. The data of the German Trauma Registry show a significant influence of arrival time of the emergency doctor and lethality. There is also a significant increase of the length of stay at the intensive unit in severe thoracic and abdominal trauma (AIS > 3). The analysis of the audit filter for quality management showed between 1999-2000 a decrease of the time till first CCT from 41 to 31 minutes and for the first thoracic X-ray from 20 to 16 minutes. The German Trauma Registry includes till now more than 10,000 polytraumatized patients. There is an increase of 110% between the years 1998 and 2000.

Cost Control↗
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

[Anatomy of the shoulder joint].

The shoulder joint and its associated joints form one of the most complex joint systems of the human locomotor apparatus. Its large range of motion is made possible by the interplay of 5 joints: sternoclavicular-joint, acromioclavicular-joint, glenohumeral joint, thoracoscapular joint and subacromial joint. The rotator cuff works mostly as an active stabilizer of the shoulder joint. The supraspinatus muscle causes a compression of the humerus in the glenoid mainly, furthermore it effects synergistic the abduction with the delta muscle. On the basis of its lever-arm the supraspinatus works between 0 and 60 degrees abduction the most optimally. With failure of the supraspinatus, the deltoideus can almost completely take its function. The inferior glenohumeral ligament-complex is the main passive stabilizer. The blood supply of the humerus head is ensured mainly by the a. circumflexa anterior and its rami ascendents, by several small branches from the a. circumflexa posterior and over intraosseous anastomoses. The most important vessel of the cap is the intraosseous a. arcuata out of the ramus ascendens lateralis of the a. circumflexa anterior.

Acromioclavicular Joint↗
PubMed2001

[Conclusions and consequences from registries: the Polytrauma Register of the German Society of Trauma Surgery].

In the trauma register of the German society of traumatology until now 5353 patients have been analysed. The mean age was 38.5 years, the proportion of blunt injuries was 94.3%. The mean ISS was 24.8%, the emergency doctor arrived in the middle 22.4 minutes after the accident. The stay of the emergency doctor lasted 32.9 minutes and the transport from the place of accident to the hospital took 18.3 minutes. The rate of intubation through the emergency doctor was 58.3%. The mean stay at hospital was 31.1 days, at the intensive car unit 13.1 days with a mean time of 8.7 days artificial respiration. In comparing the years we saw an improvement of outcome throughout all participating hospitals. Future aims of the trauma register are to increase the quality of life after trauma, to guarantee an adequate quality of treatment, to analyse costs and to include all German hospitals in the trauma register.

Critical Care↗
PubMed2000

[The internal fixation of fractures in children].

The internal fixation of fractures of shaft bones was spread out by a group of surgeons working together with Prevot. The principle of this method is a three point load carrying paragraph sign(entry point, height of fracture and cancellous bone of the metaphysis of the opposite fracture part). From 1996 to 1999 86 children with fractures of the humerus, the fore-arm and the femur were operated in the technique of intramedullary nailing. The fractures affected the humerus to 3.5 %, the fore-arm to 65.1 % and the femoral shaft to 31.4 %. The postoperative duration of stay in hospital after internal fixation of the fore-arm in the proximal and middle third lasted 7.2 days, the duration of immobilisation in a cast took 13.7 days. 96 % of the patients showed very good and good results after operation. The average stay in hospital for patients with femoral shaft fractures was 14.4 days. 17 weeks after operation the intramedullary nails were removed. At the time of first full weight bearing the legs showed an average shortening of 1.2 cm. The fractures of the humerus healed without any restriction of movements. Internal fixation is a minimal invasive operation technique with low risks and small operating trauma. Due to the stability a early mobilisation is possible. The reported results in the literature are all good. The only problem can be caused by too long nails irritating the skin.

Biomechanical Phenomena↗
PubMed2000

Facts about the disaster at Eschede.

On June 3, 1998, at 10:59 a.m., a high-speed train (Intercity Express, ICE) traveling at 200 kilometers per hour collided with a bridge at Eschede, Germany, causing it to collapse. The force of the collision, combined with the speed of the train's rear engine, propelled the rear wagons into the structure. The accident caused 101 deaths and 103 injuries. Four minutes after the accident, the alarm was reported; sixteen minutes after the accident, the first doctor on emergency call was on the scene, arriving from Celle, approximately twenty kilometers away. In the first four hours after the crash, different rescue organizations brought a total of 1,844 people to the accident site, including 461 ambulance personnel and paramedics. Thirty-nine aircraft, including helicopters and army aircraft, were available at the scene. Ninety-five passengers passed away on site. Many of the surviving passengers had multiple injuries and were stuck in the train; although they had to be rescued from the severely damaged wagons, all patients, with one exception, were on the way to hospitals by 12:55 p.m. The casualties were distributed among twenty-two hospitals; two victims later had to be transferred to other hospitals for medical reasons. This paper details the factors that were responsible for the success of the rescue operations at Eschede.

Disasters↗
PubMed1999

[Management of polytrauma patients in an international comparison].

Worlwide there will be an increase in polytraumatized patients. The number of death after trauma will increase from 5.1 Mill. to 8.4 Mill. The reason is the technical progress in the third world. In western countries there was a decrease in trauma death, in Germany below 8,000 due to traffic accidents in 1998. In most countries the paramedic system and ATLS are established (USA, South Africa). Long rescue times and inadequate shock treatment preclinically are the biggest problems in Russia and Greece. Worldwide the institution of trauma centers (Level I, II, III) has brought much better results comparing to nontrauma centers but is economically expensive. The annual number of polytraumatized patients (Level I 600-1,000 severe trauma, > 65 personal experience) is essential for the success rate. Infrastrucure, Algorithmus and the personal experience of the trauma leader are the keys for optimal results. One parameter for Quality measurement is the number of potentially preventable deaths. Retrospective analysis of treatment protocols and pathological results by an expert team is the best practical way. The results of level I trauma teams reach between 1 and 2% preventable deaths. A further instrument of quality improvement are Trauma registers like in US and England (MTOS) and the German Trauma register of the German Society of Trauma. The Trauma register in Germany contents till now 2.069 polytraumatized patients. The lethality is 18.6% (ISS 21 +/- 13), comparing to MTOS (ISS 12.8 +/- 11.3, lethality 9.2%). The differences in injury pattern show in the US three times more penetrating injuries than in the German Traumaregister (21.1% versus 7.2%).

Cross-Cultural Comparison↗
PubMed1998

[Facts regarding the Eschede catastrophe].

On 3 June 1998 a high-speed train (Inter City Express, ICE) collided with a bridge at a speed of 200 km/h. The bridge collapsed and the rear wagons of the train were pushed into it with the power of the rear engine. The accident caused 101 deaths and 103 injuries. Four minutes after the accident the alarm was raised, and 16 minutes after the accident the first doctor was on the scene, arriving from Cells, approx. 20 km away. In the first 4 hours after the crash 1844 people from different organisations were at the site of the accident; 461 of these were ambulance personnel and paramedics. 39 aircraft (incl. helicopters and army aircraft) were available at the scene. Many passengers with multiple injuries were stuck in the train and had to be rescued from the severely damaged wagons. Nevertheless all patients with one exception were on the way to hospitals or in the trauma centers 2 hours after accident. 95 passengers passed away on site. The casualties were distributed among 22 hospitals, 2 of them had to be transferred to other hospitals later on for medical reasons. This speaks for the correct selection of hospitals. There were many reasons for the quick rescue and the success of Eschede, namely good weather conditions, the time of the accident (normal working day) the availability of rescue by air, the great number of doctors, ambulance personnel, paramedics and search and rescue teams on site, as well as the excellent cooperation between the different organisations, mainly fire brigades, police, army, border patrol, technical assistance teams and search and rescue coordinators).

Accidents, Traffic↗
PubMed1997

[The classification of the severely and multiply injured--what has been established?].

Among the numerous scores available for the quantitative evaluation of injury severity, only few have proved themselves effective in clinical practice. The "Revised Trauma Score"--based on physiological variables--is the most widespread in preclinical use. The "Injury Severity Score"--based on anatomical data--is the most accepted for defined indices. However, a combination of the two, known as the "Trauma and Injury Severity Score (TRISS)", represents an international standard for quality control. Recent experience with TRISS in central Europe has shown that an increasing number of patients cannot be registered due to missing data. One reason for this is the intense preclinical treatment and its influence on physiological variables. The practicability of this method for quality control--combined with additional efforts--must be questioned in Germany. A score system based, for example, on the obligatory score of the "International Classification of Diseases", might be a good alternative with less effort required for each patient. Further investigations are necessary, however, before any final decisions are made.

Acute Disease↗
PubMed1997

[The potentials of minimally invasive surgical measures in the knee joint].

The treatment of knee joint injuries has seen marked development in the last few years. The surgical trauma of intra-articular fracture reconstruction has been reduced significantly. Retrograde nailing, percutaneous plating and specific exposures to distal femur and proximal tibia fractures have been established. Percutaneous osteosynthesis controlled by arthroscopy or fluoroscopy is widely used for B-fractures of the tibial plateau. Injectable bone mineral cement adds to reduced trauma of surgical treatment of these fractures. In all knee ligament procedures, arthroscopy is obligatory for diagnosing and conducting meniscus surgery. Ligament reconstruction should be performed either arthroscopically or by a limited arthrotomy, the results being comparable at present.

Femoral Fractures↗