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Biomedical subjects

H Thermann

Publications and source records attributed to H Thermann.

At least 19 recordsLinked to original sources
PubMed2000

[Quadriceps and patellar tendon ruptures].

Ruptures of the quadriceps as well as the patellar tendon occur in low frequency, but cause major functional deficits of the leg. These injuries usually require operative treatment. Acute quadriceps tendon ruptures are treated by suture repair, using heavy sutures guided through bone tunnels in the patella. Chronic defects and neglected cases require a local tendon transfer, either by a quadriceps tendon turn-down or by a V-Y-plasty of the quadriceps tendon. Ruptures of the patellar tendon are treated by suture of the tendon stumps plus an reinforcement procedure protecting the tendon and avoiding secondary patella alta. Patello-tibial fixation may be achieved by a cerclage technique using wire or an autologous tendon strip, alternatively a patello-tibial external fixator can be applied. In chronic and neglected cases, patellar tendon reconstruction is performed with autologous tendon grafts or with soft tissue allografts. The graft must be protected by a patello-tibial fixation for the first weeks.

Acute Disease↗
PubMed2000

[Achilles tendon rupture].

The treatment of acute of Achilles tendon rupture experienced a dynamic development in the last ten years. Decisive for this development was the application of MRI and above all the ultrasonography in the diagnostics of the pathological changes and injuries of tendons. The question of rupture morphology as well as different courses of healing could be now evaluated objectively. These advances led consequently to new modalities in treatment concepts and rehabilitation protocols. The decisive input for improvements of the outcome results and particularly the shortening of the rehabilitation period came with introduction of the early functional treatment in contrast to immobilizing plaster treatment. In a prospective randomized study (1987-1989) at the Trauma Dept. of the Hannover Medical School could show no statistical differences comparing functional non-operative with functional operative therapy with a special therapy boot (Variostabil/Adidas). The crucial criteria for therapy selection results from the sonographically measured position of the tendon stumps in plantar flexion (20 degrees). With complete adaptation of the tendons' ends surgical treatment does not achieve better results than non-operative functional treatment in term of tendon healing and functional outcome. Regarding the current therapeutic standards each method has is advantages and disadvantages. Both, the operative and non-operative functional treatment enable a stable tendon healing with a low risk of re-rupture (1-2%). Meanwhile there is consensus for early functional after-treatment of the operated Achilles' tendons. There seems to be a trend towards non-operative functional treatment in cases of adequate sonographical findings, or to minimal invasive surgical techniques.

Achilles Tendon↗
PubMed1999

[Subtalar fusion after conservative or surgical treatment of calcaneus fracture. A comparison of long-term results].

In a long-term follow-up we evaluated 40 patients out of 55 (73%) with a subtalar fusion. The operations took place from 5/84 to 5/91. In all cases the indication for the fusion was a post-traumatic arthritis after an intra-articular os calcis fracture. The evaluation of the overall results was carried out with three different scoring systems: a. The Hannover Scoring System. b. The Outcome-questionnaire, rating patient's complaints and the functional status based on the severity-symptom scale and functional status described for Carpaltunnel-syndrome by Levine et al. c. The clinical rating system (CRS) described by Kitaoka et al. The statistical evaluation was performed by analysis of variance (ANOVA). Level of significance was based on P = 0.05 and calculation of Pearson's correlation coefficient. The Os calcis fracture was the cause for the subtalar arthritis in all 40 patients (33 males and 7 females). The primary treatment of the calcaneal fracture was conservative (cons.) using a plaster in 23 patients (57.5%), while 17 patients (42.5%) underwent open reduction and plate fixation (op.). The interval between trauma and subtalar fusion averaged 3.5 years (3 months to 20 years). The interval between subtalar fusion and follow-up averaged 5.2 years (4-14 years). The mean age at the time of reexamination was 47 years (26-61 years). In the present study, complete pain relief could be achieved in 21 (52.5%; 58% op., 50% cons.) patients. A relevant restriction in the range of motion in the ankle joint was found in 26 (65%; 76% op., 58% cons.). In 23 patients (62%; 65% op., 59% cons.) the radiological evaluation revealed a grade 1 degree arthritis of the ankle joint, in the talonavicular joint in 17 patients (42.5%; 41% op., 45% cons.), and in the calcaneo-cuboid joint in 14 patients (35%; 47%., 27% cons.). The statistical analysis revealed a better outcome in the operative group compared with the conservative group, although the operated os calcis fractures in the majority were the more severe fracture types. In all evaluation systems a score between 61 and 69 points could be achieved with no significant difference between the operatively and conservatively treated groups and between the newly developed questionaire and the clinical-radiological scoring systems. For the questionaire this fulfills the requirements for a reliable outcome evaluation.

Adult↗
PubMed1999

[Treatment of recurrence of fibular ligament rupture. Results of a prospective randomized study].

Previous studies concerning ruptures of the lateral ligaments of the ankle dealt with acute first ruptures. There are a few articles about chronic instability of the ankle but no prospective investigations have been reported concerning the treatment of recurrent ruptures. Good results were obtained following after non-operative treatment of acute ruptures of the fibular ligaments of the ankle joint. This prospectively randomized study was commenced to test whether recidivations of the rupture of the lateral ligaments can also be treated non-operatively or if they are in need of operative repair. The second question to be answered was whether these injuries should be treated differently depending on the treatment of the first rupture. From December 1986 to November 1989, 109 patients with a recidivation of a rupture of the ankle joint lateral ligaments were included in this prospective trial at the Department of Trauma Surgery, Hannover Medical School. They were divided into two groups depending on the therapy used to treat the first injury: The relapse was classified as a second-stage-rupture in cases where treatment of the first ligament rupture did not involve an operation and as a rerupture if the initial rupture was surgically repaired. Half of each group was treated randomly either with surgical ligament repair or without. A total of 100 patients (92%) at an average age of 24 years (11 to 49 years) was seen for follow-up examination one year after the relapse: The follow-up included the patient's subjective assessment, a clinical examination, and stress radiography. A 70 point score was used for evaluation of the total result. Two wound infections requiring reoperation were observed in the operative treatment groups. The follow-up examination revealed better results in both operative treatment groups (A and C), which was statistically significant (P < 0.05). Patients with a second-stage-rupture showed a significantly higher (P < 0.001) stability by stress radiography after surgical treatment (group A) in contrast to non-operative treatment (group B). In addition, the subjective and clinical results indicated a tendency towards better results which were not statistically significant (P < 0.09 and P < 0.07). In cases of rerupture the patient's subjective assessment revealed significantly more (P < 0.05) complaints after non-operative treatment (group D). Clinical results were comparable, and radiologic assessment showed a tendency towards higher joint stability after surgical treatment (group C), although it was not statistically significant (P < 0.07). Based on the results presented, the authors recommend the surgical repair of ankle joint ligaments in cases of second-stage- or rerupture.

Adolescent↗
PubMed1999

[Treatment of intraarticular calcaneal fractures in adults. A treatment algorithm].

Significant progress has been made in terms of the management of calcaneal fractures. This is reflected in the marked decrease in complication rates associated with the current intervention of these potentially devastating injuries. The treatment priorities that, in the authors opinion, are key to achieve best results in a displaced calcaneal fracture are anatomic reconstruction of the entire calcaneus: articular surfaces, height, alignment, and length, with a function directed postoperative management. The value of these priorities are confirmed by the authors longterm follow-up results as presented here. To reemphasize, conservative treatment should be considered only in cases of extraarticular fractures, minor displaced intraarticular fractures in nonambulatory patients, and in cases where there is a clear contraindication for surgery. Regarding the technical requirements for an anatomic reconstruction, the os calcis fracture should be categorized as a procedure for experts. In two-part fractures, according to the Sanders classification, an anatomical reduction is obtainable in more than 80%-90% of cases. However, in consideration of the articular cartilage damage, a 70% rate of good to excellent clinical results seems realistic. In three-part fractures, anatomic reduction is attainable in about 60% of cases with a 70% rate of good results. These two subgroups comprise about 90% of all calcaneus fractures. It is the authors recent experience to optimize the extended lateral approach using posteromedial and anterolateral windows, so that an anatomic reduction in more than 60% of Sanders Type III os calcis fractures can be achieved. Further scientific work in this area of trauma orthopedics would benefit most from a general consensus on a fracture classification system and on a clinical scoring system, with 5 year follow-up studies using these treatment methods and evaluation systems.

Adult↗
PubMed1999

[Os trigonum syndrome].

The os trigonum syndrome is an entity causing posterior ankle pain and occurs mostly with typical sports activities. Diagnosis and differential diagnosis are presented. Typical complaints and therapeutic procedure are demonstrated in one case. Therapy includes different non-operative methods, resistance to non-operative procedures is an indication for excision of this ossicle.

Adolescent↗
PubMed1999

[Fractures of the foot region of car drivers and passengers. Occurrence, causes and long-term results].

During 1973 and 1989, 6,378 car accidents with 8,931 injured persons were evaluated in the area of Hannover. 3,267 car drivers and passengers sustained fractures overall and 148 (4.5%) fractures of the foot. A major role in the etiology of the foot fractures evolves from the deformation of the foot room. Driver and front seat passenger showed similar injuries. Among the 286 single fractures, the forefoot was affected most often (45%), followed by ankle (38%), midfoot (11%) and hindfoot (6%). 5% were open fractures. The long term results were estimated upon the limitation of working ability caused by the foot injury in relation to the entire working ability. The evaluation concludes that the foot fractures especially in combination with other injuries were frequently not recognized within the primary examination and therefore underestimated. The long-term outcome leaded to a high degree of impairment due to foot fractures.

Accidents, Traffic↗
PubMed1999

[Functional treatment of acute Achilles tendon rupture. A histological, immunohistological and ultrasonographic analysis of the animal model].

In 105 rabbits the course of healing was examined at 1, 2, 4, 8 and 12 weeks (21 rabbits per group) after an experimental Achilles tendon rupture. The following treatment modalities were compared: a. operative functional treatment (resorbable suture, Kleinert technique) b. operative functional treatment with fibrin glue c. primary functional treatment. For the functional (after)-treatment a special orthosis was applied. A 7.5 MHz Ultrasound probe was used for the ultrasonographic evaluation. The histological specimens were stained after Masson-Goldner with Azan. Collagen Type III was depicted immunohistologically with polyclonal antibodies. A semiquantitative fibrocytes count was performed. The histological results showed a smooth healing in the prim. functional treatment group reaching parallel orientation of collagen fibers at 12 weeks. In the fibrin glue-group the fibrin was resorbed after 4 weeks without essential influence to the course of healing. In the suture-group a secondary gapping of the tendon stumps was detectable. At 12 weeks the histological evaluation in all groups showed approximately normal tendon pattern. Immunohistochemically all groups showed cell-associated positive reactions for type III-collagen after 1 week with a maximum after 2 weeks. The semiquantitative fibrocyte count in the primary funct. group showed a maximal number after 1 week, in the fibrin glue- and suture-groups the maximal number could be found after 2 weeks. Sonographically an increase in tendon thickness was detectable up to the 4th weeks in all groups. The secondary gapping of the tendon stumps in the suture group could be detected sonographically. The echogenicity of the tendon during the course of healing showed increasing homogeneity and parallelism in all groups. At 12 weeks the echogenicity was comparable in all groups. The experiment could prove the equivalence of the primary functional treatment to operative therapy in Achilles tendon rupture.

Achilles Tendon↗
PubMed1999

[Augmented tenoplasty in a case of tibialis anterior tendon rupture].

A tendon transfer or interposition tendon graft is usually recommended for treatment of late diagnosed ruptures of the tibial anterior tendon. A new operative technique using augmented tenoplasty is described in one patient. After 3 years the patient was asymptomatic and showed normalized function. The operative method has the advantage of no additional loss of function in comparison with other methods.

Adult↗
PubMed1999

Long-term results of subtalar fusions after operative versus nonoperative treatment of os calcis fractures.

From 1984 to 1994, 40 patients with a subtalar fusion were reexamined in long-term follow-up. The evaluation of the overall results was carried out with three different scoring systems. The calcaneal fractures were primarily treated nonsurgically in 23 patients (57.5%), and 17 patients (42.5%) had undergone ORIF. Complete pain relief was achieved in 52.5% of patients; 65% revealed a restriction in a range of motion in the ankle joint, and in 62% a grade 1 arthritis of the ankle joint was found. The statistical analysis could only reveal a tendency for a better outcome in the operative group compared with the nonsurgical group, although within the operated group, the majority of the os calcis fractures were more severe than in the nonsurgical group.

Adult↗
PubMed1999

[Process fractures. A diagnostic problem in ankle injuries].

Peripheral talar fractures are frequently overlooked and should be considered in the differential diagnosis of patients with acute and chronic ankle pain. Early diagnosis allows specific treatment options to prevent long-term complications and enables better overall results. Computertomography is obligatory for definite evaluation of the pathology and to determine the need for conservative or operative treatment. Conservatively treated displaced fractures lead to pain and decreased range of motion from ongoing arthrosis of the subtalar joint. Large or displaced fragments require, according to the scare literature, open reduction and internal fixation. Comminution or small fragments are best addressed by surgical excision, although alteration in the biomechanics of the subtalar joint may occur.

Ankle Injuries↗
PubMed1998

[Fractures of the pediatric foot].

Some 13% of fractures in children are in the foot. Of these fractures, 50% involve the metatarsals and the phalanges. These are treated conservatively and do not cause therapeutic problems in general. In contrast, fractures and dislocations of the midfoot and hindfoot occur very rarely, so profound therapeutic expertise is lacking. The present paper takes stock and provides a critical assessment of the therapeutic concepts presented hitherto and new approaches to different problematic fractures. The long-term results of the literature and our own follow-up of dislocated intraarticular talus and calcaneus fractures which were not reduced anatomically has shown important problems in terms of pain, limited range of motion and malalignment in adolescence. In contrast to the findings in adults, no arthrosis was apparent in the radiological examinations. The findings were similar in mishealed Chopart dislocation and Lisfranc dislocation. The treatment of complex foot trauma is a multidisciplinary team approach. These challenging injuries should be treated only in centers where vascular and plastic surgeons are constantly available. The precise scientific assessment of foot fractures in children is confronted with the problem that so far too few cases have been evaluated. Rare problematic fractures (i.e. talus, calcaneus) require scientific work-up to establish a "gold standard" for operative and conservative treatment. This can only be accomplished in a multicenter study.

Adolescent↗
PubMed1998

Management of calcaneal fractures in adults. Conservative versus operative treatment.

Significant progress had been made in the management of calcaneal fractures. This is reflected in the marked decrease in complication rates associated with the current intervention of these potentially devastating injuries. The treatment priorities that are key to achieve best results in a displaced calcaneal fracture are an anatomic reconstruction of the entire calcaneus including articular surfaces, height, alignment, and length, with a function directed postoperative management. The value of these priorities is confirmed by long term followup results. Conservative treatment should be considered only in cases of extraarticular fractures, in cases of minor displaced intraarticular fractures in patients who are nonambulatory, and in cases where there is a clear contraindication for surgery. An anatomic reconstruction of an os calcis fracture is difficult to obtain. In two-part fractures, according to the classification described by Sanders et al, an anatomic reduction is obtainable in more than 80% of cases. However, if the articular cartilage damage that is typically present is considered, a 70% rate of good to excellent clinical results is more realistic. In three-part fractures, anatomic reduction is attainable in approximately 60% of cases with a 70% rate of good results. These two subgroups comprise approximately 90% of all calcaneal fractures. It has been put into practice recently to optimize the extended lateral approach using posteromedial and anterolateral windows, so that an anatomic reduction can be achieved in more than 60% of os calcis fractures considered as Type III according to the classification described by Sanders et al. Additional scientific work in this area of trauma orthopaedics would benefit most from a general consensus on a fracture classification system and on a clinical scoring system, with 5-year followup studies using these treatment methods and evaluation systems.

Algorithms↗