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Biomedical subjects

H Thermann

Publications and source records attributed to H Thermann.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1997

[New developments in joint surgery].

The treatment of joint injuries has seen a marked development in the last years. The surgical trauma of articular reconstruction was reduced and our deeper understanding of the mechanism of connective tissue healing influenced the rehabilitation program after joint injuries significantly. Indirect soft-tissue sparing reduction techniques can be applied to most joint fractures and improved fixation techniques using intraoperative fluoroscopy or arthroscopy allow to avoid vast exposures of the joint. The process of ligament healing requires joint movement and a certain stress to the healing tissue in order to achieve optimum scar strength, stiffness and remodeling. Immobilisation thus should be avoided completely after ligament injuries and certain lesions can be treated non-operatively with a high success rate (MCL rupture, ankle sprain, elbow dislocation). In other injuries, surgery should stabilize the joint thus allowing functional rehabilitation (cruciate ligament tears, shoulder dislocation).

External Fixators↗
PubMed1997

Treatment algorithm of chronic ankle and subtalar instability.

From 1981 to 1984, 131 reconstructive procedures and 113 Evans tenodesis procedures (1972-1984) were performed for patients with chronic instability of the ankle joint. From 1981 to 1985, 42 Christman/Snook procedures were performed for patients with isolated or combined subtalar instability. Reevaluation was conducted for 223 patients (102 reconstructive procedures, 87 Evans tenodesis procedures, and 34 Christman/Snook tenodesis procedures). The follow-up protocol comprised standard and stress radiograms, subjective patient evaluation, and objective functional data. No patient in either treatment group had clinically important ankle instability. Patients who had undergone the Evans tenodesis had a 3.3 degrees mean less talar tilt than did patients treated with reconstructive procedure. Of 87 patients who underwent Evans tenodesis, 33 had a mean supination deficit of 7.5 degrees. According to the +/- 100 points classification, 90% of the patients in both groups achieved good or excellent results. For subtalar instability, the Christman/Snook techniques resulted in a mean supination deficit of 7.2 degrees in 20 patients. Of 34 patients, 31 were rated good or excellent.

Algorithms↗
PubMed1996

[Screw arthrodesis of the ankle joint. Technique and outcome].

In ankle arthrodeses several clinical and biomechanical studies have shown the superiority of the screw technique over external fixation. As a maximum of stability is a major goal, especially for functional after-treatment or in patients with poor bone stock, the arthrodeses technique at Hannover Medical School is performed with four screws. Two parallel anterior/posterior screws are placed from the tibia to the talus, providing anterior stabilization. One screw posteriomedial has a posterior tension-wiring effect and one screw placed through the fibula to the talus acts against rotational and sagittal translation. From May 1975 to May 1995, 225 ankle arthrodeses with internal or external fixation technique were performed. Complications were found in 47% in the external fixation treatment group (n = 44) and in 10% the patients stabilized with the screw technique (n = 181). Fifty of these 225 patients had a follow-up evaluation after an average of 7.4 years (external fixation, n = 22; screw fixation, n = 28). All patients were examined and scored with three different scoring systems: (1) MHH Score, (2) Clinical Rating System according to Kitaoka et al. (1994) and (3) Outcome Questionnaire for evaluating the overall outcome. The results from the questionnaire were compared to the clinical scores. Retrospective analysis revealed a higher rate of complications for arthrodeses performed by external fixation. The overall results of all three different scoring systems showed a trend in favor of the screw-fixation technique without reaching statistical significance (P > 0.05). The results of the Outcome Questionnaire are statistically as valid as the two clinical scoring systems.

Ankle Joint↗