Biomedical subjects

H P Becker

Publications and source records attributed to H P Becker.

At least 37 records · Page 2Linked to original sources

PubMed1999

Clinical and functional outcome after anatomic and nonanatomic ankle ligament reconstruction: Evans tenodesis versus periosteal flap.

The present study investigated the effects of two different surgical procedures for the treatment of chronic ankle instability. Ten patients treated with an anatomic reconstruction using a periosteal flap were compared with a second group that received an Evans tenodesis. All patients were evaluated before and after surgery with clinical and radiographic examinations as well as dynamic pedobarography. Patient satisfaction and radiographic and functional results were comparable in both groups and revealed a good restoration of joint stability and gait symmetry. Our results indicate that both methods of ankle ligament reconstruction achieve a comparable clinical and functional outcome within 1 year after surgery.

Adult↗

PubMed1999

12-year outcome after modified Watson-Jones tenodesis for ankle instability.

In a retrospective study, the long term outcome of the modified Watson-Jones tenodesis according to Lemberger and Kramer was determined using a questionnaire, clinical examination, radiographic data, including stress views, measurement of plantar pressure distribution, and peroneal reaction times on a tilt board. Twenty-five male patients (mean age, 34 years) with a mean followup of 12 years from surgery were available for examination. Eighteen patients (72%) were classified clinically as having excellent or good results. The higher presence of osteophytes in the surgically treated ankle in comparison with the opposite side indicated the progression of arthrosis with time, but this finding could not be related to the reconstruction method. Anterior drawer and talar tilt were reduced significantly in comparison with the preoperative stress radiographs. No differences in plantar pressure distribution were seen between the patients' surgically treated and nonsurgically treated feet. The peroneal reaction times of the peroneus brevis and peroneus longus muscles were significantly shorter in the surgically treated foot compared with the opposite side. It was concluded that the modified Watson-Jones tenodesis effectively corrected lateral ankle instability with no clinical deterioration with time and no influence on gait.

Adolescent↗

PubMed1998

Tenodeses destroy the kinematic coupling of the ankle joint complex. A three-dimensional in vitro analysis of joint movement.

To study the effect of ligament injuries and surgical repair we investigated the three-dimensional kinematics of the ankle joint complex and the talocrural and the subtalar joints in seven fresh-frozen lower legs before and after sectioning and reconstruction of the ligaments. A foot movement simulator produced controlled torque in one plane of movement while allowing unconstrained movement in the remainder. After testing the intact joint the measurements were repeated after simulation of ligament injuries by cutting the anterior talofibular and calcaneofibular ligaments. The tests were repeated after the Evans, Watson-Jones and Chrisman-Snook tenodeses. The range of movement (ROM) was measured using two goniometer systems which determined the relative movement between the tibia and talus (talocrural ROM) and between the talus and calcaneus (subtalar ROM). Ligament lesions led to increased inversion and internal rotation, predominantly in the talocrural joint. The reconstruction procedures reduced the movement in the ankle joint complex by reducing subtalar movement to a non-physiological level but did not correct the instability of the talocrural joint.

Aged↗

PubMed1997

[Recurrent pneumothorax after surgical resection treatment].

Between 1984 and 1994, 27 men and 4 women with primary spontaneous pneumothorax were treated surgically by excision of the bullae, without pleurectomy. The purpose of the present study was to establish by computed tomography (CT) of the lung whether the excision permanently eliminated the cause of pneumothorax. The median follow-up was 72 (21-127) months. There were two patients with recurrences (6.4%) who were operated on again. Sixteen of 31 patients had new blebs in the apex of the lung as documented by postoperative CT. The study indicates that simple excision of the bullous area cannot prevent the recurrence of blebs.

Adolescent↗

PubMed1997

[Dynamic pedography for assessing functional ankle joint instability].

Chronic functional instability of the lateral ankle may be difficult to distinguish from mechanical instability when radiological stress test reveal only small ligamentous defects. When a decision for or against surgical reconstruction of the ligaments has to be made it can be helpful to use additional information on joint function. Therefore, a prospective study of 65 patients (mean age 24.1 +/- 4.6 years) with long-standing chronic ankle instability was conducted to demonstrate that the dynamic measurement of plantar pressure distribution can identify patients with functional ankle instability. Plantar pressure patterns were measured during gait by means of a capacitive platform, the EMED-SF system. The impulses at eight points of the foot were calculated intraindividually and compared with those in a group of 100 healthy subjects. On the basis of clinical criteria alone, the two groups of patients were distinguished, 35 with functional instability and 30 with mechanical instability. The patients with functional instability showed significantly increased lateral loading of the unstable foot (P = 0.01), whereas the group with mechanical instability tended to walk more on the medial side of the unstable foot. This finding is explained by a deficit or peroneal strength during the stance phase, based on a proprioceptive deficit after trauma. The new technique provides additional information, which is relevant and sufficiently important to help in making decisions about the individual patient with chronic instability.

Adult↗

PubMed1997

[Surgical treatment of chronic ankle joint instability--many variations in German clinics. Analysis of a 1994 German survey].

A questionnaire was mailed to 400 orthopaedic department chairpersons in Germany listed by the "Deutsche Gesellschaft für Unfallchirurgie" to evaluate the current surgical approach to chronic ankle instability. The aim of the survey was to analyze and to classify the reconstruction method of the individual institution. Questionnaires were returned from 267 hospitals (66.7%). The number of ligament reconstructions performed at individual institutions ranged from 1 to over 100 (mean 17.5). The most frequently used procedures of primary choice for reconstruction of the ligaments are: periosteal flaps (45.3%), anatomical repair (23.6%), different tenodeses (20.6%), and free anatomical implants of autologous or exogenous material (10.5%). 50% of the participants use reconstructions in which the injured ligament is repaired secondarily without augmentation or with periosteal flaps. The remaining part of the German surgeons prefers tenodeses or various other procedures. It is interesting to note that there is a high number of different procedures not namely known in the literature which are considered as individual modifications. With better knowledge of the function of the single ligament and general exposure of the ligaments for simple overlap and direct suture, the rate of primary non-anatomical reconstructions may be decreased in the future.

Ankle Injuries↗

PubMed1997

Functional evaluation of the 10-year outcome after modified Evans repair for chronic ankle instability.

The Evans tenodesis is an operative treatment for chronic ankle instability with good short-term results. The disadvantage of impaired hind foot kinematics and restricted motion has been described, and only few reports of long-term results can be found. No techniques have been used to assess the outcome objectively. We wanted to determine whether a modified Evans procedure led to a satisfactory clinical and functional outcome. Nineteen patients were available at a 10-year follow-up. The clinical examination included a detailed questionnaire and stress radiographs. Foot function was evaluated with plantar pressure distribution measurements during walking and peroneal reaction time measurements elicited on a rapidly tilting platform (recorded with surface electromyography). High subjective patient satisfaction was contrasted with a high rate of residual instability, pain, and swelling. The radiographs showed an increased number of exostoses. The gait analysis revealed reduced peak pressures under the lateral heel and increased values under the longitudinal arch. The reaction times of the peroneal muscles were shorter on the operated side (significant: peroneus longus). The persistent clinical problems as well as the functional changes indicate that the disturbed ankle joint kinematics permanently alter foot function and may subsequently support the development of arthrosis. Therefore, the Evans procedure should only be applied if anatomical reconstruction of the lateral ankle ligaments is not feasible.

Adult↗

PubMed1997

[Military surgery: an additional "emphasis" in surgery?].

The German armed forces and the civilian help organisations need competent and well-trained general surgeons to deal with the specific problems of war or other casualties. This is in contrast to the modern training modalities which are going into extreme specialisation. The term "mission surgery" comprises a very specific training for surgeons under the adverse conditions of war or catastrophe. It is not intended to create a new subset within the different surgical specialties, but to elucidate the skills which are needed for mission surgery. To achieve these objectives, the young surgeon should undergo basic training with a broad clinical spectrum. It is recommended that the requirements of trauma or orthopedic surgery should be fulfilled.

Curriculum↗

PubMed1996

Reduced inflammatory response in minimal invasive surgery of pneumothorax.

OBJECTIVE: To elucidate whether thoracoscopy for surgical therapy of pneumothorax leads to a reduction of inflammatory responses in comparison with standard thoracotomy. DESIGN: A prospective randomized study PATIENTS: Eleven patients (9 men and 2 women; median age, 28 years; range, 21-44 years) were treated by thoracotomy; 10 patients (9 men and 1 woman; median age, 26 years; range, 21-28 years) were managed thoracoscopically. The plasma concentrations of the following were determined: polymorphonuclear granulocyte elastase and C-reactive protein as inflammatory parameters and prostanoids (prostacyclin, thromboxane A2, prostaglandin F2 alpha, prostaglandin M, and prostaglandin E2) as vasoactive parameters. Blood sampling was performed perioperatively and on day 3 after surgery. RESULTS: The thoracoscopy group revealed a shorter hospital stay (5 vs 7 days; P < .05) and a significantly reduced need for intravenous pain medication within 48 hours (1 vs 3 requirements; P < .01) vs the thoracotomy group. The release of inflammatory (C-reactive protein, P < .01) and vasoactive (prostacyclin and thromboxane A2, P < .01) mediators was less during thoracoscopy compared with standard thoracotomy. CONCLUSIONS: The thoracoscopic procedure is less invasive when performing wedge resection of apical blebs. With intracavitary management being equivalent to the conventional technique, the curtailed morbidity after thoracoscopic surgery is considered to be related to the minimal trauma associated with the access to lung tissue and the reduced handling of lung tissue.

Adult↗

PubMed1996

Unusual development of acute exertional compartment syndrome due to delayed diagnosis. A case report.

Our report describes the case of a 20 year old man who developed an acute exertional anterior tibial compartment syndrome after playing soccer for five minutes. No trauma was reported. Correct diagnosis was delayed for 18 hours, because pain was misinterpreted as resulting from acute muscular tetanic spasm induced by hyperventilation. Fasciotomy was contributed. After one year, the patient complained of early fatigue. Electromyographically the reinnervation had not yet been completed. This case illustrates the necessity for careful observation of non-trauma related acute tibial anterior pain appearing even at the beginning of strenuous exercise. It is important to recognize the possibility of a very acute onset of exertional compartment syndrome that does not subside with rest. Only early diagnosis and fasciotomy can prevent severe complications of an acute exertional compartment syndrome.

Acute Disease↗

PubMed1996

[Functional disorders of the foot after tenodeses: is the method still currently acceptable?].

On the basis of biomechanical and clinical studies, this article discusses the relevance of tenodesis in the operative treatment of chronic lateral ankle instability. Considering the experimental results, it is evident that any tenodesis leads to restriction of inversion according to the course and the tightness of the graft. It has been shown that the lateral peroneal reconstruction has a negative influence on the kinematic coupling of the ankle joint complex. The data of the clinical studies reflect the biomechanical results. Despite a high rate of satisfaction, up to 50% of the patients reveal a restriction of inversion. Some authors, particularly those who report on a 10-year follow-up, showed that the degree of arthrosis increased and that deterioration of the clinical result occurred over the time. The measurement of plantar pressure distribution during gait proved the alteration of foot biomechanics. The biomechanical and clinical data available on tenodesis and the good results of the anatomical repair suggest that tenodesis is presently only the method of last choice.

Ankle Injuries↗

PubMed1996

Tenodesis versus carbon fiber repair of ankle ligaments: a clinical comparison.

To compare the clinical and functional outcomes after using different reconstruction methods for chronic ankle instability, the authors followed 2 groups of patients after 69 and 72 months, respectively. Thirty patients (mean age, 28; range, 23-39 years) were treated with modified Evans tenodesis. Twenty-three patients (mean age, 32.2; range, 22-39 years) underwent total replacement of the lateral ankle ligaments by carbon fibers. The protocol of the retrospective study included a questionnaire, clinical examination, radiographic stress diagnostics, and gait analysis with use of the EMED-SF system. Dorsiflexion and inversion were significantly restricted after tenodesis in contrast to the carbon fiber replacement. Although radiographic stability was improved after surgery for both groups, progress of the arthrosis could not be stopped. After tenodesis, the measurement of plantar pressure distribution revealed a 20% increase of midfoot loading as compared with the opposite foot, whereas symmetrical loading of both feet was found after carbon fiber replacement. Additionally, the tenodesis feet had a significantly increased loading of the medial side of the foot. It was concluded that tenodesis and anatomic reconstruction of ankle ligaments lead to subjectively similar results. Foot function and range of motion, however, were less influenced after anatomic repair.

Adult↗

PubMed1996

Long-term results of the modified Evans repair for chronic ankle instability.

We treated 19 patients for chronic ankle instability with a modified Evans procedure. All patients were evaluated after an average follow up of 128 months with detailed questionnaire, clinical examination, and stress radiographs. Although the subjective results were reported as 8 excellent, 7 good, and 4 fair, residual pain was reported by 11 patients. There was a significantly increased number of osteophytes in the treated ankle joint. Stress radiographs demonstrated significantly improved stability in the operated ankle joint. Range of motion was significantly reduced in hindfoot inversion. The results showed that the modified Evans procedure achieved sufficient joint stability at the expense of inversion range of motion. This reconstruction method apparently did not prevent the development of arthrosis.

Adult↗

PubMed1996

[Endoscopic extraperitoneal hernioplasty in comparison with conventional surgical procedures--a prospective controlled study].

This study compares the extraperitoneal endoscopic hernia repair (TEP, n = 96) with the technique according to Shouldice (n = 128). Intraoperatively, the rate of complications increased during the first TEP procedures, whereas the conventional procedure showed no complications. However, the TEP patients' showed significantly more comfort compared to the Shouldice technique, meaning less pain and earlier return to normal activity.

Adult↗

PubMed1995

[Current status of diagnosis and therapy of chronic collateral ligament instability of the ankle joint: results of a survey of 267 German clinics in 1994].

A questionnaire was mailed to the heads of 400 German orthopaedic departments listed by the "Deutsche Gesellschaft für Unfallchirurgie", with the aim of evaluating the diagnostic and therapeutic approaches to chronic ankle instability that were current in 1994. The questionnaire was structured to focus on diagnostic imaging techniques, conservative and surgical management, and postoperative treatment. Evaluable questionnaires were returned from 267 hospitals (66.7%). The number of ligament reconstructions performed per institution ranged from 1 to over 100 (mean 17.5). Radiographic stress investigations and clinical examination were considered by 71.6% of the surgeons to be the most important criteria for surgical therapy. The methods most frequently used for primary reconstruction of the ligaments were: periosteal flaps (45.3%), anatomical repair (23.6%), different tenodeses (20.6%), and free anatomical implants of autologous or exogenous material (10.5%). Half the respondents used reconstruction procedures involving secondary repair of the injured ligament without augmentation or with periosteal flaps. The other half of the German surgeons preferred tenodeses or various other procedures. Conservative management of chronic ankle instability was considered by surgeons to be less appropriate for young active patients. Postoperative treatment includes casting and orthosis. The duration varied from 2 weeks to 8 weeks. The results of the nationwide survey demonstrate that more objective clinical methods of diagnosis are needed to allow preoperative differentiation between functional and mechanical instability. With better knowledge of the function of individual ligaments and more frequent exposure of the ligaments for simple overlap and direct suture, a lower rate of primary non-anatomical reconstructions may be possible in the future.

Adult↗

PubMed1995

[Ultrastructural findings in pleural cysts in spontaneous pneumothorax].

Lung biopsies obtained by conventional thoracotomy from five patients (mean age 33.6 years, range 21-45) following recurrence of spontaneous pneumothorax were studied by light, scanning, and transmission electron microscopy. The purpose of the study was to define abnormalities that predispose to air penetration through the intact wall of pleural blebs. Two types of blebs were identified either with a complete or with an incomplete layer of mesothelial cells. In those areas where the mesothelial cells were lacking, the walls only consisted of irregular, discontinuous collagen fibers. Increasing intraalveolar pressure may distort the net of collagen fibers and air penetration appears to be possible. The wall of pleural blebs is generally weakened by degenerative changes and may predispose to recurrence of pneumothorax. Therefore, wedge resection of the blebs including the underlying lung parenchyma is suggested for surgical therapy of pneumothorax.

Adult↗

PubMed1995

Gait asymmetry following successful surgical treatment of ankle fractures in young adults.

Forty patients (mean age, 22.8 years) admitted for displaced ankle fracture were observed retrospectively to determine by clinical examination and measurement of plantar pressure distribution whether successful surgical treatment of ankle fractures led to gait symmetry, and whether intraindividual differences were related to fracture type and clinical outcome. The mean followup was 18.5 months (range, 12-36 months). The deviation of gait was quantified using a symmetry index of the total impulse. Using a clinical score, 6 patients had unsatisfactory results, and the remaining 34 had satisfactory results. The symmetry index of the good (-1.1%) and the poor results (-2.3%) decreased in the range of a healthy control group (-0.31%, n = 90), indicating that overall gait symmetry was achieved after trauma. The plantar pressure distribution showed significant load asymmetries. There was increased loading in the lateral forefoot of the injured leg in patients with good results and decreased pressure under the metatarsal heads of patients with bad results. Although those asymmetries were related neither to fracture type nor clinical outcome, the findings may illustrate compensation mechanisms that are used to regain gait symmetry after ankle alteration by trauma.

Adult↗

PubMed1995

[Clinical and roentgenologic 5 year follow-up of modified Evans-plasty in chronic lateral instability of the ankle joint].

Between 1984 and 1989, 108 patients who had chronic lateral instability of the ankle were treated with a modified Evans tenodesis, in which the anterior half of the peroneus brevis tendon was used for reconstruction. Follow up was possible by questionnaire in 75 patients and by clinical examination in 46, after 29-122 months (mean 68 months). Subjectively excellent or good results were achieved in 62 patients (82.6%) while 9 (12%) had fair results and 4 (5.4%) a poor outcome. Pain during physical activity was reported by 27 patients (35%), loss of inversion by 34 (45%) and slight instability by 31 (41%). The X-ray films at follow-up revealed more signs of arthrosis than had been present preoperatively. The stress tests showed an anterior drawer of 7.8 mm preoperatively and 7.0 mm postoperatively (p = 0.03); talar tilt was improved from 7.7 degrees to 4.5 degrees (p < or = 0.01). The outcome reported by the patients and the objective results of the clinical and radiological examinations were at odds. Pain, instability and osteophyte formation after the operation were so frequent because the talus was not fixed when the Evans reconstruction was implemented. Therefore, we suggest that this method should not be used in patients with a high activity level.

Adult↗