Search PubMed⌕ Search

Biomedical subjects

H Thermann

Publications and source records attributed to H Thermann.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Functional treatment of acute rupture of the Achilles tendon. An experimental biomechanical study].

In 84 adult rabbits the biomechanical properties of healing Achilles tendon rupture were examined 2, 4, 8 and 12 weeks (21 each group) after the injury. For the first time a mop-end-tear was performed. The following treatment modalities were applied (7 rabbits in each subgroup): (a) operative functional treatment (resorbable suture; Kleinert techniques); (b) operative functional treatment (fibrin glue); (c) primary functional treatment (conservative). The functional after treatment in all groups was performed with a specially developed orthesis, which was taped to the limb. For biomechanical testing a newly developed fixation technique (cryo-clamp) was applied, which guaranteed secure intratendineal rupture. After 2 weeks the fibrin glue-treated tendon ruptures showed the best results with regard to stiffness, tensile stress and max. rupture force. These results and a higher tensile stress of the sutured tendons were significantly different from those in the conservatively treated groups. After 4 weeks the stiffness in the fibrin group and the energy and rupture force in the suture group were significantly higher than in the group treated conservatively. The 8-week results revealed comparable biomechanical properties. The only significant difference was a higher energy in the fibrin glue group than in the conservative treatment group. The experiment revealed no significant biomechanical differences after 3 months. Compared with the results recorded for plaster immobilization in the literature, the functional treatment resulted in a significantly faster course of healing.

Achilles Tendon↗
PubMed1995

[Functional treatment concept of acute rupture of the Achilles tendon. 2 years results of a prospective randomized study].

Ultrasonography and MRI are highly reliable and reproducible methods of determining the separation of a ruptured Achilles tendon and the degree of tendon repair in the course of healing. While MRI is expensive, it can be restricted to research and special indications. In a randomized trial a operative treatment and a conservative/functional treatment with a newly developed boot were compared in 50 patients (22 of whom underwent operative treatment and 28, conservative treatment). In this trial there were no significant differences either in the functional results or in the course of healing. Functional treatment in both groups allowed shorter periods of rehabilitation, and acceptance of the boot was particularly high in all patients.

Achilles Tendon↗
PubMed1995

[Various therapy concepts in severe fractures of the tibial pilon (type C injuries). A comparative study].

Between 1982 and 1992, 79 pylon fractures were treated with internal fixation as the primary treatment at the trauma department of the Hannover Medical School. In a retrospective study 71 patients were evaluated, and 51 of them were re-examined clinically and radiographically an average of 68 months after injury. The purpose of this study was to compare these different forms of surgical management concerning their long-term results: 1. Minimal invasive internal fixation for reconstruction of the joint with external transfixation of the ankle joint and/or plaster cast until bony healing occurred. 2. Primary internal fixation with plating of tibia and fibula following the AO techniques. 3. Internal fixation with a plate applied in a second step after initial reconstruction of the joint with minimal internal fixation and short-term external transfixation. Evaluation was based on the infection rate, the development of posttraumatic arthritis and the range of motion in the ankle joint as objective criteria. Subjective criteria were pain, swelling, and restrictions of working or leisure activities. Although only closed fractures were treated primarily by internal fixation with plating no significant differences between the three groups were found in the classification of fractures and soft tissue damage. All but 4 fractures were type-C lesions according to the AO classification, and 19 patients sustained open injuries. The infection rate for minimal invasive internal fixation was significantly lower with a two-step procedure (group 3) than with the one-step procedure according to a suitable statistic test (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

[Biomechanical studies of human Achilles tendon rupture].

The biomechanical properties of human Achilles tendon are described with a computer-controlled material-testing machine. With an optimized fixation device for the muscle-tendon-calcaneus system the rupture was intratendineal. The tendons were compared for different rupture speed (1000 mm/min vs 100 mm/min), sex and age ( < 35 years vs > 35 years). The tendons ruptured at 1000 mm/min had better results in terms of maximum rupture force, stiffness and tensile stress, while the results for elongation and energy were less good. None of these differences were statistically significant. Significant differences were found between the sexes: male tendons had higher maximum rupture force and stiffness and a larger cross-sectional area. In the younger tendons significantly higher tensile rupture stress and lower stiffness were found.

Achilles Tendon↗
PubMed1993

[Diagnostic possibilities of sonography: ankle joint, foot and Achilles tendon].

In patients with soft tissue swelling and pain of the foot and ankle, ultrasonography is a simple and reliable diagnostic procedure to demonstrate joint effusions or a tendovaginitis which may have caused the symptoms of the patient. The diagnostic puncture of a joint is only necessary to determine the kind of effusion. The diagnostic workup of patients with acute and chronic instability of the proximal ankle joint benefits from the sonographic measurement of the talus tilt and of the anterior drawer. As the diagnostic performance is equal to the radiologic stress test, X-ray exposure can be avoided. As the anatomic structure of the achilles tendon causes the typical fibrillary sonographic pattern, structural changes due to tendinitis or tendon rupture can easily be diagnosed.

Achilles Tendon↗
PubMed1993

[Standardized ultrasound diagnosis of instability after dislocation of the upper ankle joint].

The anterior drawer was evaluated sonographically under standard conditions (150 N load, 7.5 MHz linear scanner) in 95 patients with severe ankle sprain. A simple geometric construct of subsidiary lines set up with the help of a goniometer on the videoprints (enlargement 1.5 X) enabled a standardized interpretation of the anterior drawer (pathologic > or = 3 mm). Thus, the definition of poorly reproducible reference points for sonographic measurements became avoidable. In 60 patients a rupture of the lateral ankle ligaments was diagnosed, in 35 patients the findings were recorded as severe ankle sprains without ligament rupture. Compared with the radiological anterior drawer and talar tilt, the dynamic sonographic measurement of the anterior drawer showed the better values from the aspects of sensitivity, specificity and accuracy (> or = 0.93). In our own practice sonographic measurement of anterior drawer has replaced stress radiograms in diagnosis of ankle joint instabilities after severe ankle sprains.

Adolescent↗
PubMed1993

Osteosynthesis of displaced intraarticular fractures of the calcaneus. Results in 123 cases.

The operative treatment of intraarticular calcaneal fractures has three principal aims: restoration of height, length, and width of the calcaneus, reconstruction of the subtalar and calcaneocuboid joint surfaces, and stable osteosynthesis using an H-plate or screws. In 68% of the cases, the sustentacular fragment was the key to open reduction, making the medial approach mandatory. In complex fractures, a lateral approach is added. In "blow-out" fractures or cases with comminution of the sustentacular fragment, an extended lateral approach only is used. For precise preoperative planning of roentgenograms in three planes, four Brodén's views and axial plus coroneal or three-dimensional computed tomography scans are required. From July 1983 to July 1990, 157 intraarticular calcaneal fractures were treated by open reduction. The results in 123 cases are 61% good or excellent, 32.5% satisfactory, and 6.5% poor. The following early complications occurred: superficial wound edge necrosis (8.3%), hematoma (2.5%), nonunion (1.3%), and infection (1.9%). Four patients (3.3%) in the follow-up group have developed degenerative changes severe enough to require subtalar fusion. To facilitate the comparison of results, new fracture classification and follow-up scoring systems have been devised.

Adolescent↗
PubMed1992

The use of ultrasonography in the foot and ankle.

Ultrasonography of the soft tissue has achieved an increasing importance in the last years. Since sonography of the shoulder, knee, muscles, and tendons has become a routine method, there is less application of ultrasound in foot and ankle pathology. Since 1985, ultrasonography has been the routine examination technique in the Trauma Department of Hannover Medical School, Hannover, Germany. We now have a series of more than 4000 sonographic examinations. This paper gives a comprehensive overview of the possibilities in application and technique of ultrasonography in foot and ankle disorders. The sonographic patterns of the pathological changes of the main structures are described.

Ankle Joint↗
PubMed1992

[Primary sonographic diagnosis and follow-up of muscular and tendon injuries of the lower extremity].

Ultrasound examination has become an important diagnostic method in muscle and tendon injuries. In addition dynamic ultrasound examination allows evaluation of the course of healing from various aspects. Starting with the sonoanatomy, the pathologic ultrasound patterns typical for injuries to muscle and to Achilles, patellar and quadriceps tendons are demonstrated. As complement to clinical examination, ultrasonography enables appropriate adaptation of the therapy concept to the course of healing. In the hands of experienced operators, ultrasound examination has reached a high level of sensitivity and specificity in these injuries and can justifiably be routinely performed.

Achilles Tendon↗
PubMed1991

Rupture of the ankle ligaments.

A prospective randomised trial of treatment of ruptured ankle ligaments was carried out at our institute. Two hundred patients were randomly assigned to 4 treatment groups. The results at 1 and 2 years after injury showed that functional treatment with a newly designed brace appeared to be the method of choice. This gives good mechanical stability, a shorter time off work and the ability to resume full sporting activity within 3 months of injury. Operation is only indicated for dislocations of the ankle and foot, ankle ligament rupture with additional intraarticular damage and second stage injuries or re-ruptures.

Adolescent↗
PubMed1990

[Synovectomy in knee infection. Late results].

When short-term conventional treatment of pyogenic knee-joint infections does not relieve the symptoms, in most cases the patients can be cured with an synovectomy within a few weeks. In this procedure, the infected site, the synovial membrane, is excised. Immediately after the operation, functional treatment starts to improve joint mobility and cartilage nutrition. Of 17 synovectomies followed up after an average of 9.5 years, 10 were free of pain, 13 patients were able to walk without restriction, 12 could flex their knee more than 120 degrees, and 9 knees showed no radiographic signs of osteoarthritis. This 10-year follow-up shows that early synovectomy and functional treatment can lead to good long-term results. Therefore, this procedure can be recommended.

Adult↗
PubMed1989

[Ultrasound sonography in the diagnosis and follow-up of Achilles tendon rupture].

In addition to allowing definite diagnosis of Achilles tendon rupture and localization of the rupture site, ultrasonography also enables the examiner to grade the rupture and the course of healing for quantity and quality. Twenty patients with subcutaneous achilles tendon rupture were examined in a prospective study that is still in progress. In this trial an operative and a conservative-functional treatment with a newly developed shoe were compared. The dynamic examination revealed adaptation of the tendon in plantar flexion in two-thirds of the patients. After 2 weeks continuity of the tendon was restored in all patients. A remarkable increase in the regeneration of the tendon at the rupture or suture site was observed from the 4th to the 12th week. The variations in tendon structure were assessed, and a classification is presented.

Achilles Tendon↗
PubMed1989

[Achilles tendon rupture].

Whereas Achilles tendon rupture is usually treated operatively in central Europe, conservative treatment is felt to be indicated in Britain, North America and the Scandinavian countries. In a prospective randomized trial we compared conservative functional treatment and operative functional treatment with a newly developed boot. Forty-four patients (19 with operative, 25 with conservative treatment) were entered in the study. The initial evaluation included dynamic ultrasonography and MRI in a neutral position and at 20 degrees of plantar flexion to determine the amount of tendon diastasis. Follow-up clinical examination and ultrasonography revealed, no significant differences between the two groups. After 25 months all patients in both groups had complete healing with no rerupture. Functional treatment allows an earlier return to work and earlier resumption of active sport. We observed stable tendon healing, optimal functional results, and a high level of patient satisfaction. Primary functional treatment does not appear to be inferior to operative functional treatment when no more than 5 mm tendon diastasis is observed on the initial ultrasonography in the neutral position.

Achilles Tendon↗
PubMed1989

[Rupture of the fibular ligament of the upper ankle joint].

A prospective randomized trial was performed to compare conservative functional treatment and operative functional treatment for rupture of the lateral ankle ligament. On the basis of the results observed 1 and 2 years after injury, primary functional therapy with a orthetic support appeared to be the method of choice. In a 100-point clinical check-up scale we were not able to find any statistical differences between the treatments. This type of conservative treatment gives a high degree of mechanical stability, a shorter time off work and the ability to take a full, active part in sports within 3 months in all cases. Operative treatment is indicated only in cases of dislocation of the foot and ankle, ankle ligament rupture with additional osteochondral talus fracture, and second-stage injuries or reruptures.

Adult↗
PubMed1989

[Rupture of the Achilles tendon. Results of 10 years' follow-up after surgical treatment. A retrospective study].

From 1972 to 1980, 153 patients with acute rupture of the Achilles tendon were treated operatively in the Trauma Department of Hannover Medical School, 127 of whom were assessed postoperatively according to the Trillat scale at an average of 9.8 years after injury. Consideration of the tendon ruptures showed that 80% had occurred during sports activities, 86% were in males, and the highest incidence was in the age group 31-40 years (45%). In 67% an indirect trauma was present, and 35% of the patients had a history of antecedent pain and discomfort. In 77 patients the tendon was examined histologically within 24 h of injury. There was no histological evidence of antecedent pathology or degenerative condition in those cases with direct/indirect trauma, whereas in 11 of 13 cases without a history of trauma degenerative changes were observed. The operative procedure of the primary simple end-to-end suture with absorbable material showed fewer wound complications (8.4%) than were seen in the other group, in which non-absorbable sutures were used or secondary reconstructive procedures applied (3 of 8). The results obtained with primary operative tendon suturing were evaluated according to the Trillat scale as excellent in 68.8%; as good, in 20.8%; as satisfactory in 8.8%; and as poor in 1.6%. During a 10-year follow-up after primary tendon suture rerupture occurred in 2% of cases.

Achilles Tendon↗
PubMed1988

[Ultrasonic morphology of the normal Achilles tendon and pattern of pathological changes].

The anatomical structure of the Achilles tendon causes a fibrillary echo texture with fine, parallel echogenic lines. The peritendineum outlining the tendon can be delineated. Achilles tendon ruptures can easily be detected by ultrasound, as can the structural changes in achillodynia. The typical sonographic patterns of rupture of the Achilles tendon and achillodynia are demonstrated.

Achilles Tendon↗