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Biomedical subjects

H Tscherne

Publications and source records attributed to H Tscherne.

At least 253 records · Page 14Linked to original sources
PubMed1991

Pathological fractures and lytic bone lesion of the femoral neck associated with beta 2-microglobulin amyloid deposition in long-term dialysis patients.

A correlation is demonstrated between chronic hemodialysis using cuprophane membranes (mean duration: 13 years) and pathological fractures (n = 7 in 6 patients) after lytic bone deposits of beta 2-microglobulin amyloid (n = 13 patients). The characteristic symptom complex includes painful impingement syndrome of the shoulder, carpal tunnel syndrome, painful hip and recurrent knee effusions. The first steps of the clinical diagnostic procedure are to demonstrate lytic defects in skeletal radiographs and to verify the presence of beta 2m by biopsy or puncture. Due to reduced regeneration capacity in amyloid bone lesions the resulting surgical therapy should aim at total joint replacement or augmented osteo synthesis. Definitive operative treatment should be aspired even in the absence of manifest fractures, as the natural course of the disease is characterized by progression of the bone destruction and a continuous pain syndrome.

Amyloid↗
PubMed1991

Treatment of femoral shaft fractures in children by external fixation.

Non-operative management is still the treatment of choice for closed fractures of the femoral shaft in children. Indications for operative intervention would include: children with multiple injuries; severe soft tissue damage; cases where reduction is difficult to maintain; and children not suitable for management by traction. Since 1984, 16 children (mean age 10.3 years) have had stabilization of their femoral shaft fractures by external fixation (Monofixateur) in the Trauma Department of the Hannover Medical School. The external fixation remained in place for a mean of 63 days. Of the 16 children, 15 have been reviewed, with a mean follow-up of 28.2 months. No children who were completely managed with this fixation had any clinically relevant malalignment, but six cases had up to 2 cm difference in leg length. Our observations and experience show that external fixation is a useful alternative for the operative management of femoral shaft fractures in children. It produces good stability, is less invasive, and allows early mobilization. In order to avoid differences in leg length, we recommend a good anatomical reduction with the external fixation being carried out as early as possible.

Adolescent↗
PubMed1991

A review of the therapeutic concept and results of operative treatment in acute and chronic lesions of the cervical spine: the Hannover experience.

A therapeutic concept for the treatment of acute and chronic cervical spine lesions is presented. Unstable fractures and dislocations of the cervical spine should be reduced as soon as possible. Most frequently, we employ the anterior approach using the Smith and Robinson technique (37) with the addition of an H-shaped plate. The posterior approach is mainly indicated for the release of irreducible locked facets. Unstable odontoid fractures, especially those in group II of Anderson and d'Alonzo (3), are stabilized by screw osteosynthesis. Between 1971 and 1989, 306 patients with cervical spine lesions were treated surgically. In these cases, there were 205 acute injuries and 52 chronic instabilities. Forty-nine patients had tumors or metastases. Ninety-two patients with acute injuries (group I) and 24 with chronic lesions (group II) were reexamined. Out of 53 group I patients, the neurologic symptoms improved in 45 cases (85%), and in 30 of these (mainly with radicular compression syndromes) a complete recovery was noted. Seventy-two percent of the patients were symptom-free. Seventy-four percent of the acute and 58% of the chronic lesions showed a good or very good result having little or no limitation of motion and minimal or no pain. Irrespective of neurologic deficits, 89% of the acute traumatized patients were able to work after 5 months. The rate of pseudarthrosis was 2%. The risks of an anterior interbody arthrodesis are small when using a careful and standardized operative technique. It allows an early functional treatment and shortens the rehabilitation time.

Acute Disease↗
PubMed1991

Anterior plating in thoracolumbar spine injuries. Indication, technique, and results.

The selection of surgical approach for patients suffering from acute thoracolumbar spinal trauma is presently imbued with great controversy. The surgical method chosen depends on the type of fracture, anatomic and biomechanical factors, and the habits and experience of the surgeon involved. Due to new techniques for the posterior approach and the use of internal fixators, the indications for the anterior approach must be reassessed. The primary indication for anterior decompression and grafting is narrowing of the spinal canal with neurologic deficits that cannot be resolved by any other approach. Additional indications are seen in patients with vertebral body fractures with complete comminution and dislocation, noncorrectable burst fractures, and late misalignments. After removal of vertebral body and intervertebral disc fragments, autogenous bone should preferably be used for interposition. Different plates can be used for instrumentation. While anterior plates most often offer complete stability for the thoracic spine and a dorsal plating in this region can turn out to be quite difficult, in the lumbar spine, especially with destruction of additional posterior structures, one must think of subsequent surgical intervention for increased stability and compressive posterior fusion with short-armed internal fixators. So far, we have gained experience from treating 39 patients with anterior decompression and stabilization. One of 19 patients with Frankel Grades A and B and 50% of the remaining 20 patients had improved one Frankel grade. Only a few of the patients with incomplete neurologic symptoms had back pain. All except for one returned to work. According to radiologic examinations, the average loss of correction amounted to 7%.

Adult↗
PubMed1991

[Unreamed tibial nail in tibial shaft fractures with severe soft tissue damage. Initial clinical experiences].

In a prospective study, since March 1989, 55 tibial shaft fractures have been treated with a new, unreamed solid tibial nail (UTN). This nail was initially designed as a temporary implant. The first 33 cases with second or third degree soft tissue damage were reviewed 6 months or more after the operation. Fractures were classified according to Müller: 6 type A (18.2%), 15 type B (45.5%), and 12 type C (36.7%). In 9 cases (27.3%), there was GII (n = 4) or GIII (n = 5) closed soft tissue damage according to Tscherne's classification. The 24 open fractures (72.7%) comprised 11 OII, 3 OIIIA and 10 OIIIB fractures (Gustilo classification). 24 patients (72.7%) were polytraumatized, the mean PTS (Hannover Polytrauma Score) was 18 points (range: 8-65 points). All fractures were stabilized without reaming. The implant diameter was 8mm (n = 14) or 9 mm (n = 19). Static locking was performed in 31 cases. Dermatofasciotomy was necessary because of compartment syndrome in 14 cases. In 1 grade IIIB open fracture soft tissue coverage was performed with a latissimus dorsi myocutaneous free flap 4 days after nailing. In 32 of the 33 cases the use of an additional cast or brace was not necessary during the follow-up treatment; 1 patient had a cast for 8 weeks for the treatment of accompanying injuries. Full weight-bearing was achieved in 5 cases within 3 weeks, in 16 cases within 12 weeks, and in 30 cases within 26 weeks. In 16 cases (48.5%) the interlocking screws were removed after 5-26 weeks (mean: 10 weeks).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[Modern techniques in pelvic fractures including acetabulum fractures].

Unstable Fractures of the pelvic girdle should be stabilized as soon as possible. Use of standardized protocols for primary assessment and operative procedures can minimize complications and help to optimize clinical results after pelvic or acetabular fractures. The different methods of internal stabilization are not yet ideal but new developments are under way. A trend towards screw fixation can be seen in both pelvic and acetabular surgery, as well as a tendency to "localized" stabilization using small fragment implants to avoid unnecessary transfixations of pelvic joints.

Acetabulum↗
PubMed1991

[Age, activity and strength of knee ligaments].

The cruciate ligaments of older persons are thought to have diminished biomechanical properties. On the other hand, joint immobilization also leads to similar functional losses in ligaments. It can be difficult to differentiate between these factors in older and immobile persons. The anterior and posterior cruciate ligaments of six younger (average age 30 years) and six older (average age 64.7 years) donors with similar levels of activity were subjected to biomechanical testing. Each sample had to meet the following conditions: appropriate age, no chronic vascular and cardiopulmonary disease found on autopsy, no signs of osteoarthrosis and no knee injuries. The material properties of maximum stress (e.g. ACL: young/old 24/21N/mm2), elastic modulus (e.g. ACL: young/old 144/129 MPa), and strain (e.g. ACL: young/old 25/28%), did not differ significantly (p less than 0.05). This indicates that older persons who are active do not necessarily show functional losses in the cruciate ligaments. Other data found in the literature can be ascribed to immobilization influences. In this data many of the older test persons had chronic vascular insufficiency, cardiopulmonary disease or malignancies.

Aged↗
PubMed1991

[Multiple organ failure. Reflection of generalized cell damage of all organs following severe trauma].

Multiple organ failure (MOF) is presently recognized as the most severe, and often lethal, complication after multiple trauma. Causal factors and pathomechanisms remain unclear, however. Generalized inflammatory cell tissue injury with a subsequent increase in permeability in all organs has been suggested. For this reason, 38 polytraumatized patients were examined in a prospective study. Organ function was analyzed, and specific clinical and histological studies were performed to check for generalized cell tissue damage and increased respiratory permeability. In all organs we found signs of tissue damage immediately after trauma. Disturbances of organ function were seen consistently, starting precisely from day 4. It was not possible to confirm an influence of blunt organ trauma on organ function during follow-up. The severity of injury (especially intrathoracic and intraabdominal) and massive bleeding increases the risk of MOF. MOF was not always associated with the onset of sepsis, and no temporal dependence could be shown. Histological studies demonstrated an inflammatory change in organ tissues, which is probably the result of toxic substances (endotoxin, TNF, oxygen radicals, proteases and eicanosoids) released into the blood circulation after trauma. Insufficient neutralization of these toxic metabolites leads to generalized permeability damage and consequently to progressive organ failure. Therefore, even with optimized initial treatment of multiple trauma patients, MOV and mortality can only be reduced with a causal approach to therapy.

Adolescent↗
PubMed1991

[Heart contusion as an unusual cause of shock in severe polytrauma].

The reported incidence of myocardial contusion after blunt chest trauma is 7-17%. Only one third of these patients present with significant morbidity. The polytrauma is generally dominated by hypovolemic and traumatic shock. Other causes of hypotension are less common, and may thus be ignored. The standard algorithm of care in multiple trauma care, however, leads to the diagnosis even in these cases, as illustrated by a case of prolonged shock induced by blunt myocardial trauma.

Adult↗
PubMed1991

[Liver failure as part of multiple organ failure following polytrauma].

In the last few years there has been increasing evidence that adult respiratory distress syndrome is only part of a much more complex syndrome called multiorgan failure (MOF). Since renal and lung failure have become rare because of our increased understanding of the pathomechanisms involved and the treatment changes, liver dysfunction has been noted more often. In a clinical trial with 38 patients with severe trauma, we investigated liver function using ordinary parameters like the transaminases, bilirubin, etc. To define one group with MOF and one without we used the Goris MOF Score. In both groups glutamate dehydrogenase (GLDH) was increased initially up to 14 U/l, indicating hypoxia of the liver cells right after trauma. From day 6 on, a second increase up to 12 U/l of GLDH in the MOF group was evidence of liver cell dysfunction. The glutamine oxalacetic transaminase (GOT) level remained normal in both groups after an initial increase of up to 60 U/l in both groups. As 30% of serum GOT is released by muscle cells, the initial peak values could be due to direct muscle trauma, because an initial increase was noted even in the creatinine kinase. A decrease in clotting factor V down to 30% on day 8 in the MOF group indicated that the metabolic synthesis activity of the liver was lower. Bilirubin increased in the MOF group from day 5 on up to 240 mumol/l on the day 14. As this increase was not parallel to the gamma glutamyl transferase (Gamma BT) level, the reason for the bilirubin increase may be dysfunction of the liver cell membrane.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Initial clinical experience with osteosynthesis of femoral shaft fractures with a newly developed intramedullary implant (claw interlocking nail)].

The implantation of distal interlocking screws in interlocking nailing can be difficult and time-consuming. With the AO Universal Femoral Nail as the basis, an implant was designed with which distal interlocking is accomplished from the inside of the nail by means of a simple claw mechanism. Instrumentation and interlocking are possible from the proximal standard approach, so that an additional operation adjacent to the knee (which is necessary when interlocking bolts are used) is superfluous; neither for the insertion nor for the removal of the interlocking mechanism is an image intensifier necessary. We stabilized 24 femoral shaft fractures with this new interlocking nailing device [20 fresh fractures, 3 refractures and 1 pathologic fracture caused by tumor metastasis from chronic myeloid leukemia (CML)]. The mean age of the patients concerned was 34.8 years (18-57 years). Fractures were classified according to the Müller classification with 11 type-A fractures (45.8%), 9 type-B fractures (37.5%) and 4 type-C fractures (16.7%). There were only 2 cases (8.3%) with open fractures. In 11 cases (45.8%) the fracture was located in the midshaft region, in 6 cases (25.0%) in the proximal shaft, and in 7 cases (29.2%) in the distal femoral shaft. Multiple trauma was present in 11 patients (45.8%), while in 8 patients (33.2%) the femoral shaft fracture was the only major injury. Full weight-bearing was allowed after a mean of 4.4 weeks (0.7-8.2 weeks). In 1 case we saw a deep venous thrombosis with pulmonary embolism obvious on clinical examination and scintigraphy. Two patients died of their multiple trauma, and of cachexia the patient with the CML metastasis died 6 weeks after stabilization.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[Experimental study of the classification of intra-articular calcaneus fractures].

Improvement of the diagnostic techniques applied in calcaneus fractures, particularly the increased use of computed tomography, calls for a detailed fracture classification. Thirty lower leg cadaver specimens were submitted to axial loading. Fracture lines could be divided into a relatively constant primary fracture, running from the posterior subtalar joint surface to the tuber calcanei, and highly variable secondary fractures. In order to classify the fracture specimens, the calcaneus was divided into four segments: the sustentacular segment, the posterior subtalar joint segment, the segment of the anterior process, and the tuberosity segment. In addition, the following joints were identified at the calcaneus: the posterior subtalar joint, the anterior subtalar joint, and the calcaneo-cuboid joint. Each specimen was classified by the number of segments (x) and the number of joints (y) affected, and accordingly labelled as x-segment, y-joint fracture. The addition of both numbers was used to grade the severity of the fracture. This classification was easily applicable to all 25 experimental fracture specimens, and also to 33 clinical cases.

Adult↗
PubMed1991

The role of supplemental lag-screw fixation for open fractures of the tibial shaft treated with external fixation.

Ninety-nine open fractures of the tibial shaft were treated with unilateral external fixation with or without supplemental lag-screw fixation. We compared the results in forty-four fractures in which only external fixation was used (control group) with those in fifty-five fractures that were stabilized with lag-screws and external fixation, and we found no statistically significant differences between the two groups with respect to the time to full weight-bearing, the time to union, or the rates of delayed union, osteomyelitis, malunion, superficial or deep pin-track infection, or loosening of the pins. The limbs in which the fracture was treated with external fixation and supplemental lag-screws had more than twice the rate of refracture of the control limbs (11 compared with 5 per cent), and the percentage of fractures having supplemental lag-screw fixation that needed bone-grafting to achieve union was more than twice that in the group treated with external fixation alone. We concluded that the routine use of supplemental lag-screw fixation is not indicated in patients who have an open fracture of the tibial shaft that has been stabilized with external fixation.

Adolescent↗
PubMed1990

Alveolar cell pattern and chemiluminescence response of blood neutrophils and alveolar macrophages in sheep after endotoxin injection.

In order to study the pathomechanisms of the Adult Respiratory Distress Syndrome in an acute animal model, we monitored the alveolar cell pattern and the stimulatory chemiluminescence responses of blood neutrophils and alveolar macrophages in sheep after Escherichia coli endotoxin injection (2 micrograms/kg of body weight). Using appropriate bronchoalveolar lavage techniques, thereby avoiding local inflammation, it was demonstrated that endotoxin injection did not cause any recruitment of neutrophils into the alveoli for a period of up to 24 hours. Following endotoxin injection, blood neutrophils showed a maximal stimulatory response after 5 minutes, and alveolar macrophages after 4 hours. It is concluded that if neutrophils are responsible for initiating the increase in microvascular permeability, then this action must be purely intravascular.

Anesthesia↗