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H Tscherne

Publications and source records attributed to H Tscherne.

At least 181 records · Page 10Linked to original sources
PubMed1996

[The pelvic digital image data bank. Experiences after 18 months in clinical practice].

The simultaneous availability of clinical data and radiographs for orthopedic or traumatology studies is still unsatisfactory. The retrieval of radiological files is especially time-consuming and costly. An existing database holding clinical data for about 2200 consecutive patients after pelvic or acetabular fractures (1972-1995) was supplemented by integration of a commercially available picture database. Data acquisition is performed by a digital photo camera, which is easy to use and provides sufficient resolution (1524 x 1012 pixels). The picture data are optimized but not compressed and, for example, an a.p. pelvic view requires only between 800 KB and 1.5 MB of storage room. Mass storage is performed first on magneto-optical discs and later for permanent storage on CD-ROM. "Clinical" and picture databases are linked by a macro, so the search functions of both databases are available. Thus the clinical data for single patients or group of patients can be analyzed parallel to the corresponding radiographs. By the use of a CD changer, more than 4200 radiographs remain in immediate access. So far more than 3000 radiographs for 350 patients have been acquired. The quality was sufficient for even detailed subclassification and reclassification procedures in over 95% of the cases. Using standard formats and interfaces, the pictures can be either printed in photographic quality or processed as slides for presentation. Using a standard format they have complete access to electronic publishing and mailing. The relatively low price (20,000-30,000 DM) for the complete system and the exclusive use of standard, commercially available hard and software components provide an excellent price/quality relationship and make digital radiograph storage now available for smaller working groups and institutions.

Acetabulum↗
PubMed1996

[Development and initial clinical use of an aiming device for distal boring in interlocking nailing without roentgen image intensifier for the unreamed tibial nail].

An aiming technique for an unreamed tibial nail was developed, which uses the relatively constant distance between the first transverse distal nail hole and the anterior aspect of the tibia. This aiming device is set at a distance of 12.3 mm from the anterior cortex, and fine tuning is finally resolved by use of a "working channel" with a 10 mm diameter from the medial side. The aiming system was tested in 20 cases in a video-documented prospective study using the unreamed tibial nail (UTN, Synthes) between July 1993 and March 1995. In all cases (100%) distal locking could be performed without image intensification. With a high percentage (55%) of open fractures (3 O3B fractures) the total operation time was 108 min (median, range 60-180 min). The time for distal locking (always 3 bolts) was 15.5 min (median, range 8.0-39.0 min), while the time for proximal locking (average 1.6 +/- 0.7 bolts) was 4.5 min (median, range 3.0-15.0 min). There were no major intra- or postoperative complications related to the aiming system. The major advantages are that it is not necessary to have image intensification for distal locking, there is a reduction in radiation exposure for the surgeon, and the drill holes are very precise.

Adolescent↗
PubMed1996

[Intestinal cytokine liberation after intestinal ischemia in the rat--studies in the Ussing chamber system].

UNLABELLED: Intestinal ischemia, frequently found in clinical states such as aortic bypass operations or hemorrhagic shock, is associated with loss of gut barrier function. Subsequent translocation of indigenous bacteria and endotoxin have been implicated as a major contributor to a systemic immuno-inflammatory response, which finally leads to multiple organ failure. There is increasing evidence that intestinal injury can result in the gut becoming a cytokine generating organ. This study was designed to show direct evidence of the gut as a major source of proinflammatory cytokines after intestinal ischemia and to further relate this cytokine response to the extent of intestinal ischemia/reperfusion. Additionally the potential role of the altered intestinal barrier function after intestinal ischemia for this cytokine response was investigated. METHODS: Rats were subjected to occlusion of the superior mesenteric artery for 45 min. (SMAO45), 75 min. (SMAO75), SMAO for 45 min. and 30 min. reperfusion (SMAO45/30), or sham SMAO, and then killed. Mucosal membranes from the terminal ileum were mounted in a Ussing chamber. E. coli C25 was added to the mucosal side of the stripped gut epithelium in half of the chambers. TNF and IL-6 levels on mucosal and serosal side of the stripped gut epithelium were assessed serially over 3 hrs. Gut barrier function was assessed by in vitro bacterial translocation (BT) and the transepithelial resistance (TER) of the mucosal membrane. RESULTS: The TNF response was greatest in the SMAO75 group, the IL-6 response in the SMAO75 and SMAO45/30 groups. In the absence of E. coli C25. IL-6 was produced to a greater extent on the serosal side, while addition of bacteria led to a significantly increased TNF/IL-6 response at the mucosal side of the stripped gut epithelium. BT was increased in SMAO75 and SMAO45/30 rats. Baseline TER was decreased in all experimental compared to sham SMAO groups. Although gut barrier function was impaired after intestinal ischemia/reperfusion there was no correlation between intestinal cytokine response and gut permeability. CONCLUSIONS: The gut becomes a cytokine liberating organ alter intestinal ischemia/reperfusion. This cytokine response is affected by certain conditions, but is not directly related to an impaired intestinal barrier function.

Animals↗
PubMed1996

[New developments in surgery of bone tumors].

Due to advances in adjuvant therapy, the outlook for patients with primary malignant bone tumors has dramatically improved over the last decades. This is true for improved survival and also for increased limb salvage rates. Technical aspects of the standard limb salvage procedures such as Tikhoff Linberg resection in the shoulder region internal hemipelvectomy, proximal and distal femur resection and rotation plasty are demonstrated. The use of soft tissue procedures like flaps and the use of modular implant systems has reduced complication rates. In the future, we hope to further improve the outlook for our patients with risk adapted chemotherapeutic regimes and surgical procedures.

Adolescent↗
PubMed1996

[A new roentgen ray-free aiming technique for distal locking screw boring of the unreamed tibial nail].

A mechanical aiming device for the placement of distal locking screws of the unreamed tibial nail (UTN) has been developed. At the level of the distal nail end, a roughly placed "contact hole" is drilled (diameter, 6.0 mm). An asymmetric spacer is inserted through this contact hole, placed directly onto the nail and connected with the aiming arm. By this re-adjustment, the direction and the plane of both distal transverse holes are defined and can be drilled. A medial spacer re-adjusts the aiming arm for the aphole.

Biomechanical Phenomena↗
PubMed1995

Treatment results of patients with multiple trauma: an analysis of 3406 cases treated between 1972 and 1991 at a German Level I Trauma Center.

The quality and progress of treatment for 3406 multiple trauma patients was reviewed retrospectively. Two periods (1972 to 1981, the first decade, and 1982 to 1991, the second decade) were compared. Sixty-nine percent of patients with multiple trauma had cerebral injuries, 62% thoracic trauma, and 86% fractures (40% open fractures). Concerning injury combinations, there was an increase of head/extremity injuries and thoracic/extremity injuries, whereas all combinations with abdominal injuries decreased. The relation between severity of injury as well as number of injured body regions and the mortality rate was significant. In the second decade prehospital care became more aggressive with an increase in use of intravenous fluid resuscitation (from 80% to 98%), intubation (from 84% to 91%), and chest tube insertion (from 37% to 76%). Rescue times were progressively shortened. For initial clinical diagnosis of massive abdominal hemorrhage, ultrasound (89%) nearly replaced peritoneal lavage (10%) and led to earlier surgical approach. For diagnosis of head injury, CT scan was used more frequently. Primary stabilization of long bone fractures, especially of the lower limb, is recommended. Concerning complications, the change in volume therapy helped to nearly eliminate acute renal failure (from 8.4% to 3.7%), the modification of respirator treatment led to a decrease of pulmonary insufficiency (ARDS; from 18.2% to 12.0%), whereas the rate of multiple organ failure increased. The mortality rate declined from 37% in the first decade to 22% in the second decade. The incidence of lethal multiple organ failure increased from 13.8% in the first decade to 18.6% in the second decade, whereas the mortality rate of ARDS decreased from 32.4% to 15.9%. Further reduction of incidents of death is only possible with causal therapy of posttraumatic organ failure immediately after injury.

Accidents, Traffic↗
PubMed1995

Outcome of tibial shaft fractures with severe soft tissue injury treated by unreamed nailing versus external fixation.

MATERIALS: Between 1987 and 1991, 114 fresh tibial shaft fractures with severe soft tissue injury, which met the inclusion criteria, were treated and retrospectively reviewed. There were 48 cases in the unreamed nail (unreamed tibial nail (UTN)) group and 66 cases in the external fixation (EF) group. METHODS: Soft tissue injury was classified by the Gustilo and Tscherne methods. There were 18 AO type A, 56 type B, and 40 type C fractures. There were no significant difference in fracture type, soft tissue injury, age, and additional injury between the groups. Outcome was assessed using the Karlström score after 28 months. RESULTS: There were a significantly higher number of reoperations in the EF group. Mean time to bony healing was 25.8 weeks. In the EF group, there was a 26% rate of pin tract infection, whereas 19% of cases had bolt breakages in the UTN group. In the UTN group, 40% had good results, compared with 27% in the EF group. In the UTN group, there were significantly fewer ante- and recurvatum deformities of more than five degrees. CONCLUSIONS: Treatment of tibial fractures by UTN, compared with EF, gave a lower reoperation rate and better functional outcome.

External Fixators↗
PubMed1995

[Stress and fracture healing].

Stress is an important factor in fracture healing, but it is not the only one. The exact amount of stress, displacement or strain needed or tolerated in fracture healing is not yet clear. There are numerous modifying factors influencing fracture healing like fracture type, soft tissue injury, vitality of fragments, type of osteosynthesis, soft tissue handling, localization of injury, activity level and weight of the patient, local geometry and muscular topography. However, despite our large deficits in knowledge of the process of fracture healing, typical patterns of failure or disturbed healing can be recognized. This could help bringing stress and fracture healing in balance and includes an analysis of pathological stress and our efforts to neutralize, canalize or use it to our advantage.

Bony Callus↗
PubMed1995

[Does initial management of polytrauma patients have an effect on the development of multiple organ failure? Evaluation of preclinical and clinical data of 1,112 polytrauma patients].

The aim of this study was to investigate criteria in the preclinical and early clinical treatment which contribute to the development of posttraumatic multiple organ failure (MOV). In a retrospective study, 1112 primarily treated patients with multiple trauma and an injury severity > 20 on the Hanover Polytrauma Score (PTS) were investigated. The patients were classified according to Goris into groups with MOV (+MOV; 16.8%) and without MOV (-MOV). Patients with MOV had a significantly higher injury severity score (39.1 vs 33.7). A significantly higher proportion of +MOV patients had severe trunk injuries: thorax (85.2% vs 68.9%), abdomen (37.0% vs 26.1%) and pelvis (49.4% vs 35.6%). -MOV patients had significantly more injuries of the extremities (83.6% vs 72.8%). Differences in preclinical management were seen. The proportion of helicopter transports was significantly higher in the -MOV group (67.9% vs 57.8%). A positive effect was seen for early preclinical intubation. Patients who were intubated before arrival at the hospital had the same rate of MOV incidence as late intubated patients, but they had significantly higher (trunk) injury severity. +MOV patients received a significantly higher quantity of fluid replacement. In particular, more blood units and fresh frozen plasma were given in the first 24 h after trauma, possibly in association with the trunk injuries and the consequently increased hemorrhage. The mortality for all patients was 27.2%, in the +MOV group 60.4%. Posttraumatic MOV was the most frequent cause of death (37.5%), and the mean time of death after MOV was 16.7 days.

Adult↗
PubMed1995

Intramedullary femoral nailing in sheep: does severe injury predispose to pulmonary dysfunction?

OBJECTIVE: To find out if intramedullary nailing affects lung function and microvascular permeability whether or not the lung is already injured; if so whether a different method of fixation would diminish the effect; and are the pathogenetic changes related to mechanisms known to precipitate adult respiratory distress syndrome? DESIGN: Experimental study. SETTING: University hospital, Germany. MATERIAL: 29 Adult female merino sheep. INTERVENTIONS: Chronic lung lymph fistulas were created. Two of the three groups (1 and 3) underwent right sided lung contusion and haemorrhage to a mean blood pressure of 50 mm Hg for 2 hours. On day 3 groups 1 and 2 underwent intramedullary nailing, and group 3 had external fixators applied. MAIN OUTCOME MEASURES: Pulmonary arterial pressure, concentrations of triglycerides, chemiluminescence of isolated polymorphonuclear leucocytes (PMN), lymph flow, microvascular pressure, filtration coefficient, and permeability. RESULTS: Intramedullary nailing caused a transient significant increase in pulmonary arterial pressure and triglycerides in groups 1 and 2. Chemiluminescence of isolated PMN decreased in group 1 and increased in group 2. Lymph flow increased 2.5 times in group 1 while microvascular pressure decreased; in group 2 the increase was less but microvascular pressure increased. Filtration coefficient in group 1 was five times that of group 2 and there was a twofold increase in permeability. There were no changes in group 3. CONCLUSION: Intramedullary nailing causes additional damage to lungs after lung damage and haemorrhagic shock in sheep. This can be avoided if (in the presence of additional injuries) alternative methods are used.

Animals↗
PubMed1995

[Rockwood capsulorrhaphy in shoulder instability. A clinical follow-up study].

Rockwood described a capsulorrhaphy technique for operative treatment of multidirectional shoulder instability with anterior dislocation. We have used this technique mainly in patients with severe multidirectional instability and now have 8 years' experience with it, which is reported below. The surgical technique involves refixation of the Bankart lesion with transosseous suture and double breasting of the anterior capsule. No transposition of the subcapularis muscle was performed. A functional rehabilitation program without immobilization was used in all patients. The daily activity level, the degree of discomfort upon shoulder-related activities and the subjective assessment of outcome were recorded for each patient. General outcome was determined with reference to Rowe's score. A clinical examination was performed as well as radiography. Strength was evaluated by standardized bilateral dynamometry. Follow-up examination was possible in 73 out of 82 patients. The mean age at follow up was 32.7 +/- 4.1 years, and the mean follow-up time, 4.3 years. The reason for surgery was recurrent dislocation in 81% of patients, pain in 4% and both pain and dislocation in 15% of patients. In 8 patients (10.9%) multiple (up to 4) previous surgical attempts by various methods had been unsuccessful. Postoperatively 59% (n = 44) were able to take part in sports without restrictions, 27.4% could take part only in sports not involving the shoulder, and 13.5% (n = 10) did not engage in any sports postoperatively. The redislocation rate was 12.3% (n = 9), and there was 1 traumatic redislocation. A deficit in abduction/elevation by 10-60 degrees was found in 4 patients (5.4%) and by > 60 degrees in 2 patients (2.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Nonreamed interlocking nailing of closed tibial fractures with severe soft tissue injury.

Closed tibial shaft fractures with severe soft tissue trauma require urgent surgical treatment to minimize complications such as soft tissue necrosis, infection, compartment syndrome, and nonunion. Although time to union and complications are similar to open tibial fractures, these injuries often are treated as low energy closed fractures. The method of internal fixation depends not only on the fracture pattern, but also on the condition of the soft tissues. Unlike plate osteosynthesis, the authors believe that virtually all complex closed tibial fractures may be treated with an unreamed tibial nail if proximal and distal interlocking is possible. With severe closed soft tissue trauma (Grades 2 and 3), an unreamed nail may have biologic and mechanical advantages. In a prospective study, 21 closed tibial shaft fractures with severe soft tissue trauma (Grades 2 and 3) were treated with an unreamed nail. The mean followup was 29 months. All fractures healed in an average time of 23 weeks. However, 3 patients required a bone graft, and in 3 patients the fixation was revised. One infection occurred after an exchange reamed nailing. Because of the low infection and low nonunion rate, the authors recommend unreamed interlocking tibial nails for closed tibial shaft fractures with severe soft tissue trauma.

Adolescent↗
PubMed1995

[Results of follow-up of surgical treatment of complicated acetabulum fractures with extended approaches].

Extended approaches are indicated for complex acetabular fractures. The advantage of extended approaches is the simultaneous exposure of both columns of the acetabulum; disadvantages are the wide exposure of the soft tissue and a high rate of heterotopic ossification. Muscle weakness and necrosis of the muscle have been described. Although there is good exposure with an extended approach, the indication for it is restricted. Between 1972 and 1993, 688 patients with acetabular fractures were treated at the Trauma Department of the Hannover Medical School; 322 had open reduction and internal fixation. Thirty-five patients (10%) were treated with an extended approach. In a retrospective study of 24 patients treated with an extended approach between 1985 and 1993, perioperative data, long-term clinical outcome and radiological outcome were investigated. The aim of the study was to compare the outcome of two groups treated using either the classical extended iliofemoral approach or the Maryland modification. Eleven patients were treated with the extended iliofemoral approach, 13 with the Maryland approach. There were no significant differences in age, type of accident, fracture classification, time to operation, time of operation and blood loss. The postoperative X-ray was anatomic or nearly anatomic in 22 cases; 2 patients had a dislocation of more than 2 mm. The main complications were hematomas and seromas. In both groups we found one thrombosis and one nerve injury with partial recovery. Twenty patients were followed up at least 2 years after trauma, 8 after extended iliofemoral approach and 12 after Maryland approach.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗
PubMed1995

[A standardized large animal model of multiple organ failure after severe trauma].

In the past various attempts have been made to develop a standardized animal model of multiple organ failure (MOF). Until now there has been no large animal model, that imitates the clinical situation of multiple trauma patients up to MOF. In a manner similar to the pathophysiological sequence in multiple trauma patients, the combination of damaging mechanisms in the early phase (hemorrhagic shock, operating trauma, application of endotoxin (ET; 0.75 microgram/kg body weight) and zymosan-activated plasma (ZAP; 20 ml) every 12 h on days 1-5) leads to sequential irreversible damage to several organs in the late phase (> day 6) in sheep (n = 10). In this animal model representative organ parameters showed a similar course to that in MOF after multiple trauma in humans. The cardiac index increased significantly in the late phase (day 1: 6.47 +/- 0.41 ml/min x m2; day 10: 10.36 +/- 0.79 ml/min x m2), arterial oxygen pressure declined significantly (day 1: 103.1 +/- 1.6 mmHg; day 10: 89.8 +/- 4.2 mmHg). Liver function was impaired, bilirubin levels showed a significant increase (day 1: 2.94 +/- 0.34 mumol/l; day 10: 7.19 +/- 0.91 mumol/l). Creatinine clearance was low on day 1 (54.3 +/- 7.4 ml/min), increased up to day 5 and deteriorated again significantly in the late phase over the entire period (day 2: 104.3 +/- 26.8 ml/min; day 10: 53.1 +/- 17.6 ml/min).

Animals↗
PubMed1995

[Pulmonary complications following intramedullary stabilization of long bones. Effect of surgical procedure, time and injury pattern].

Early operative treatment of femur fractures is recommended in multiple trauma patients regardless of the pattern of injuries. However, in our clinical experience primary (< 24 h) reamed nailing of a femur shaft fracture in multiple trauma patients is associated with an unusually high number of pulmonary complications, especially in the presence of additional chest trauma. Based on these subjective observations, two clinical studies were done: (1) retrospectively (766 multiple traumatized patients), a higher ARDS incidence in patients with thoracic trauma and primary intramedullary nailing was found; (2) in a prospective clinical study patients submitted to femoral reaming showed a significant increase in pulmonary arterial pressure during the reaming phase, as well as transient worsening of pulmonary function (PaO2/FiO2). The changes were less pronounced in a group of patients undergoing femur nailing by an unreamed procedure. The presence of additional pulmonary trauma predisposes to the development of ARDS. Likewise, injuries associated with severe bleeding are known to predispose to capillary damage, resulting in pulmonary edema. In this group of patients, additional insults to the lung by operative procedures do not appear justified. Primary (< 24 h) reamed nailing has potentially negative effects on the lung and should be avoided if additional chest trauma is present in a polytrauma patient.

Adolescent↗
PubMed1995

[Chronic treatment refractory osteomyelitis of long tubular bones--possibilities and risks of intramedullary boring].

Osteomyelitis of long bones is a severe complication of fracture healing. If on-going infection occurs despite reoperation and if antibiotic treatment is of no benefit, reaming of the medullary canal has been considered beneficial. We investigated long-term follow-up (minimum 2 years) in patients submitted to reaming of the medullary canal to evaluate the efficacy of this method. Criteria for success were: no recurrence and no further antibiotic treatment necessary. Of 37 patients, 32 were followed up (mean duration after reaming, 3.7 years). The mean number of surgical operations for osteomyelitis prior to reaming was 3.2. In 88% of patients a full range of motion was observed upon reexamination, while in the others stiffness attributable to articular injuries that had been sustained preoperatively was still present. We found that 84.3% of patients were working in the same profession as prior to the fracture, 72% were involved in sport again, and 97% of patients were pain free. One otherwise healthy patient suffering from sclerosing osteitis (Garré) died of bone marrow embolism into the lung during reaming of the femur. Reaming of the medullary canal has a high cure rate in osteomyelitis even after several previous treatment attempts with surgical revision and/or antibiotic medication. The mechanism is most probably based on improvement of local perfusion. During surgery care must be taken not to provoke pulmonary embolization. Intraoperative monitoring by pulmonary artery catheter should be performed; reaming should be discontinued immediately, if a rise in of pulmonary artery pressure occurs.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
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↗