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H Tscherne

Publications and source records attributed to H Tscherne.

At least 145 records · Page 8Linked to original sources
PubMed1996

[Feasibility and complications in early enteral nutrition of severely injured polytrauma patients via duodenal tubes].

Early enteral nutrition is widely accepted for its support of organ structure and function ("gut injury hypothesis") and reduction of infectious complications and hypermetabolism in critically ill postoperative or postinjury patients. Nineteen severely injured patients (Injury Severity Score 40.3 +/- 11.6) were studied for the feasibility of early enteral nutrition via a duodenal feeding tube. Despite maxillary fractures, rhinoliquorrhea and blunt abdominal trauma the enteral feeding was mostly started immediately after trauma. Intermittent diarrhea or constipation resolved after reduction of the feeding rate within 1 or 2 days. Total enteral nutrition could not be realized in all cases; a central venous line was always additionally necessary. However, the goal was not complete enteral nutrition but a continuous enteral supply to maintain the integrity of the gut. The study has shown that early enteral nutrition via a duodenal feeding tube is also feasible in severely injured patients. The expenditure to overcome the technical and organizational problems seems to be justified. Enterally fed patients may have a better outcome that those in whom only parenteral is employed.

Adolescent↗
PubMed1996

[Hemi-arthroplasty--primary or secondary measure for 3- and 4-fragment fractures of the proximal humerus in the elderly?].

Successful treatment of three- and four-part proximal humerus fractures is a therapeutic challenge to the surgeon, particularly in the case of elderly patients. Open reduction and internal fixation have been advocated, but have not consistently produced acceptable results. The results of humeral head replacement as a salvage procedure after non-union or failed open reduction and internal fixation are less predictable. The outcome of hemiarthroplasty (Neer II) performed for three- and four-part proximal humerus fractures in elderly patients was studied. The average patient follow-up was 42.9 months (range 5-98). Eighteen women and eight men with an average age of 64.5 years were evaluated according to the UCLA. Constant-Murley and HSS Score. A Visual Score (0-100 points) was also used. Hemiarthroplasty was performed in 11 patients within 4 weeks of trauma and in 15 patients after 4 weeks. Fair, good, or excellent results were achieved in 80% (UCLA and Visual), 73% (HSS) and 46% (Constant-Murley) of the patients, respectively. Ninety-six percent of the patients reported only slight or no pain. The range of motion was limited in almost all cases. The outcome was not significantly influenced by age, sex and follow-up time. However, there was a significant correlation between the outcome and the length of time between injury and humeral head replacement (r = -0.5). The outcome after early hemiarthroplasty was better than after late humeral head replacement (UCLA: 27.1 +/- 4.6 vs 22.5 +/- 5.6 P = 0.04; Constant-Murley: 65.6 +/- 18.5 vs 47.5 +/- 18.6, P = 0.02; HSS: 74.0 +/- 14.4 vs 63.5 +/- 17.6, P = 0.17). Self-assessment did not differ between these two groups. After early hemiarthroplasty, active forward flexion was significantly better. This study indicates that early humeral head replacement for three- and four-part proximal humerus fractures in elderly patients achieved better functional outcome than delayed humeral head replacement. The decision to perform prosthetic humeral head replacement in these cases should be made as early as possible after trauma.

Aged↗
PubMed1996

[Analysis of implantation-induced nail deformation and roentgen morphometric studies as the principle for an aiming device for distal interlocking nailing without roentgen image intensification].

While working to develop a distal locking device, we analyzed distal nail position with reference to nail deformation and a radiographic-morphometric investigation. The amount and the direction of implant deformation in unslotted stainless steel unreamed tibial nails (Synthes) were analyzed. Measurement of implant deformation (3 translations, 3 angles) in the center of the distal transverse locking hole was performed with a 3D magnetic motion tracker system before and after nail insertion. Unreamed tibial nails (diameter 8 mm, n = 10; diameter 9 mm, n = 10) were inserted in paired human cadaver tibiae. The results showed lateral translations of -4.5 +/- 3.5 mm (mean and standard deviation, range 14.3 mm) and dorsal translations of -7.8 +/- 5.8 mm (mean and standard deviation, range 19.2 mm). Rotational deformations around the longitudinal axis of the nail were 0.3 +/- 0.7 degree (mean and standard deviation, range 2.4 degrees). The results showed, that a simple aiming arm, mounted on the proximal nail end, alone or even in combination with a large working channel (e.g. 10 mm in diameter), was not adequate to the aiming process. A radiographic-morphometric analysis was subsequently performed in 40 tibiae after experimental (n = 20) or clinical (n = 20) implantation of nails 8 mm and 9 mm in diameter. These measurements showed a relatively constant distance between the upper distal transverse hole and the anterior aspect of the tibia (average 12.3 mm and only a narrow range (7.6 mm). These data were the basis for the development of an aiming technique that exploits the relatively constant distance between the 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 the fine tuning is finally resolved by the use of a "working channel' 10 mm in diameter.

Biomechanical Phenomena↗
PubMed1996

[HIV infection caused by cold preserved bone transplants].

We reporting four cases of HIV infection caused by bone allografts from one donor. All transplantations were performed between November 1984 and January 1985. In all, 12 recipients had bone allografts from the HIV-infected donor, 7 of whom are now HIV-negative and 4, HIV-positive. One of the patients died a natural death in her 10th decade. The donor was not been tested before the grafts were harvested, as HIV-antibody detection was not possible at the time (October 1984); no HIV-antibody kits had yet been developed. Subsequent testing of the asservated serum for HIV antibodies gave a positive result. The chronological course of the case is described and the case is discussed in detail.

Adolescent↗
PubMed1996

[Severe pelvic injury with pelvic mass hemorrhage: determining severity of hemorrhage and clinical experience with emergency stabilization].

The blood loss during the acute period after complex pelvic trauma is finally responsible for the high mortality associated with this specific type of injury. Several protocols have been published for optimized management, but up to now comparable data are not available as no exact definitions exist judging the severity of trauma and blood loss. As part of a prospective study 19 patients after unstable pelvic injuries with unstable circulation underwent emergency stabilization by the pelvic C-clamp. Beside standard clinical parameter the initial hemoglobin value was converted into a "blood volume equivalent". 18 of the 19 patients had an injury severity according to group III and IV of the Hannover Polytrauma Score (PTS). Concommitant abdominal injuries were seen in 12 cases (23 injuries), concommitant urological injuries in 12 cases (14 injuries). In 13 cases the pelvis was the major source of bleeding in 9 cases an additional intraabdominal hemorrhage was observed. 11 patients died due to sequelae of their injury, 8 patients survived. Although the initial blood loss was comparable both in the group of the deceased patients and the survivors, a 44% higher subsequent blood substitution (= 10089 ml) was observed in the nonsurvivor group. In conclusion the data proofed that early control of hemorrhage is fundamental for the prognoses after complex pelvic trauma. The estimation of the blood loss may help in indicating aggressive emergency procedures like emergency stabilisation, pelvic clamps, surgical exploration and tamponade. This calculation may be a basis for a more detailed analyses of this devastating injury and judging the benefit of different management protocols.

Blood Loss, Surgical↗
PubMed1996

[Organization of a bone and tissue bank. Consequences for organization of bone and tissue banks after HIV and hepatitis C infections].

The use of non-treated cryopreserved bone allografts has been criticized following the publication of new cases of HIV and hepatitis-C infection caused by such grafts. However, the "new" cases of HIV infection arose in 1984/1985. when HIV testing was not possible. A critical analysis of the German bone bank procedures shows that the official guidelines are not adequate. Furthermore, new sterilization techniques are propagated for clinical use. This leads to a false feeling of security, and does not help to solve the problem of virus transmission by way of bone allografts. It is therefore essential that new guidelines for bone bank management be developed as a matter of urgency, with due consideration for everything known about this problem to date. Our current bone bank procedure is presented and the various points in the official guidelines that need updating are discussed, including the necessity for 6-month HIV and hepatitis testing modified donor screening, and special guidelines for multiple organ donors.

Bone Banks↗
PubMed1996

[Long-term outcome of 57 patients after ventral interbody spondylodesis of the lower cervical spine].

In this retrospective study we present the long-term results in 89 patients who underwent anterior interbody fusion of acute cervical spine injuries in our institution between 1972 and 1983. There were 23 dislocations, 50 fracture-dislocations and 16 burst fractures without significant posterior lesions. Only 20 patients showed no neurologic symptoms. In all 79 patients who were treated initially in our trauma department, closed reduction was performed as soon as possible. No aggravation of the neurologic conditions by this manoeuvre was observed. The mean time between injury and operation was 7 days (range 0-110 days). In 79 patients an H-plate or one-third-tubular plate was used, and in 10 patients fusion was performed only by bone grafting according to the technique of Robinson [40]. Severe complications, i.e. persistent instability with kyphosis or sagittal dislocation, were found in only 2 of these 10 patients secondary to technical problems. The radiologic results demonstrated a high fusion rate, with fusion in 78 out of the 79 patients. Of the 79 patients treated with plate spondylodeses, 7 devices had to be removed without loss of correction: 6 owing to loosening and 1 to breakage of the plate. Only in one additional case after early hardware removal because of loosening was a loss of correction detected. Of the original 89 patients, 17 had died of causes unrelated to the operation. The mean age of the surviving 72 patients at the time of injury was 36 years (14-83 years). A further 15 patients were lost during follow-up, so that 57 (79%) could be included in the study with a mean follow-up of 11 years, 9 months (10-19 years). The functional results were as follows: Active range of motion was limited between 25 and 50%. 40 patients had no pain at rest, 38 only during motion without need for treatment. A significant correlation between pain and fused segments could not be found. Spontaneous fusion and spondylophytes in adjacent motion segments were seen in 27 patients, again without significant correlation to residual pain. No hypermobility of adjacent motion segments in functional X-rays was seen. 46 patients returned to their former work, 7 were not able to work again secondary to the injury, 4 patients received old-age pension. Improvement of the neurologic deficits in the 37 symptomatic patients was observed in 30 cases (81.1%) according to the "Sunnybrook Cord Injury Scale" [49]; according to the ASIA Neurological Impairment Scale [5] 25 (67.6%) of them improved of at least 1 degree. No correlation could be found between the interval injury to operation and neurologic improvement. With regard to the early stage of the procedure of anterior interbody fusion for traumatic lesions this study shows promising data with high fusion rates and low morbidity, especially for the combination with plate fixation. Further improved within the last 12 years this method offers an excellent alternative for operative treatment of most acute lower cervical spine injuries. Using devices which are not angle stable, special attention should be given to precise bicortical screw fixation.

Adolescent↗
PubMed1996

[Pseudarthrosis].

Explore the source record for details and available documents.

Fracture Healing↗
PubMed1996

[Diaphyseal pseudarthroses. Epidemiology and outcome].

From 1971 to 1993, a total of 759 cases of nonunion of both the upper and lower extremities were treated. In recent years the frequency of these cases of nonunion has clearly declined. Analysis of patient data shows a positive trend particularly for nonunion in the lower arm and leg while at the same time nonunion in the upper arm and leg remained essentially constant. Moreover, the proportion of aseptic to septic manifestations has shifted towards the aseptic forms in a ratio of 1:0.5. The treatment results of a representative, randomly chosen group (n = 107 out of a total of 392) from 1981 to 1993 are satisfactory with little statistical deviation for the upper extremity. The least pleasing results were seen in nonunion of the lower leg, which differed from the somewhat better results for the upper leg on the OLERUD score, with a statistical significance of P < 0.05. This study shows a very interesting development in clinical results.

Adolescent↗
PubMed1996

[Pseudarthrosis of the proximal ankle joint].

Nonunion of the ankle malleoli is extremely rare these days. This is probably due to the fact that primary osteosynthesis is performed in ankle fractures instead of the conservative treatment given up to 20 years ago. Today nonunions of the malleoli are seen, if at all, is infected cases after surgical procedures. Noninfected, stable and painless nonunions usually do not need any surgical correction. In painful cases, small fragments, especially of the medial malleolus, should be resected; larger fragments should be stabilized with two 3.5-mm cancellous screws. Alternatively, the tension banding technique, especially after Weber A fracture, produces high compression in the area of nonunion. In cases of additional bony defects, a local upside down cortical-cancellous bone graft should be performed in addition. In summary, the therapeutic approach requires exact remodeling, bone-grafting and stabilization. Infected nonunions with loss of bone mass should be treated according to the guidelines for osteitis therapy.

Adult↗
PubMed1996

Pattern of organ failure following severe trauma.

Multiple organ failure (MOF) is considered to be the leading cause of death after severe trauma. Although there is extensive literature on MOF, little is known about the pattern, sequence, and onset of this clinical syndrome. The first goal of this clinical study was to define MOF; the second was to assess the typical onset, sequence, and pattern of MOF; and the third was to define certain risk factors for the development of MOF in 342 multiple trauma patients. Patients with an Injury Severity Score (ISS): > 20 (mean 35.7) were included. Three well established MOF scoring methods were used to give strict definitions of MOF: 11.4% of the total patient population developed MOF, and 88.6% did not. Respiratory failure was most frequent in patients developing MOF (74.4%), and these patients had the highest mortality rate (65.5%) compared to patients with failure of other organ systems (liver, cardiovascular system). Generally, the lung is the first organ to fail after injury (failure after 3.7 +/- 2.8 days). Significant renal failure and the need for dialysis decreased to < 5%; other signs of organ dysfunction (gastric, central nervous system) are difficult to verify. Typical risk factors for the development of MOF after severe trauma are the severity, type, and distribution of injury as well as the indicators of prolonged hemorrhagic shock (elevated lactate levels). The main therapeutic efforts, therefore, should be the effective treatment of traumatic hemorrhagic shock during the initial phase, adequate resuscitation, optimal oxygenation, and early surgical treatment.

Adolescent↗
PubMed1996

Rehabilitation and reintegration of multiply injured patients: an outcome study with special reference to multiple lower limb fractures.

In this study a group of 104 multiply injured patients (mean ISS = 34) was examined for physical status and social reintegration. Essentially it was noted that 76 per cent of all patients were able to return back to work, although this appears to be age dependent. Open fractures of the leg seem to be the dominating prognostic factor for reintegration resulting in a disability rate of between 20 and 50 per cent. Disability of more than 80 per cent was only due to major head injury. Apparently reintegration is linked to the pattern of injury and is less related to the overall injury severity. We conclude that trauma care is economically cost effective but also needs further standardization and subsequent outcome analysis.

Adolescent↗
PubMed1996

Unreamed intramedullary nailing of femoral shaft fractures: operative technique and early clinical experience with the standard locking option.

Nailing techniques have changed in recent years in ways which are not just limited to omitting the reaming process. These changes concern positioning patients, techniques of reduction and selecting implants. Techniques of approach and exposure have been modified to new, less-invasive procedures to fulfill technical, functional and cosmetic requirements. In addition, techniques have been developed to avoid fragment diastasis, rotational and sagittal malalignment, and leg-length discrepancy. Finally, simple algorithms have been elaborated for the management of specific fracture patterns (bilateral shaft fractures, ipsilateral tibial fractures or associated femoral neck fractures) and to determine the number and location of locking bolts. We developed these algorithms, techniques and procedures in a series of 133 femoral shafts, which were stabilized with the AO unreamed femoral nail (URFN) in a prospective study between 1991 and 1994. Of these, the first 57 cases with a mean follow-up of 17.9 months (range, 5-44) after injury were reviewed. Fractures were classified according to Müller's 1990 system: 12 type A, 29 type B and 16 type C. Closed soft-tissue injuries were classified by our classification of 1982: 17 type C 0/I, 42 type C II. Of 15 open fractures, six were OI, six OII, two OIIIA and one was OIIIB by Gustilo's classification of 1984. The major complications were two broken locking bolts, one nail breaking after 9 weeks, one case of osteitis and one of intra-operative lung embolism.

Adolescent↗
PubMed1996

Biomechanical study of nine different tibia locking nails.

We compared different nail types within the Bone/Implant-Complex to look for differences in stiffness for axial load, bending and torsion of the System. We simulated comminuted mid shaft fractures by a 2-cm defect osteotomy in paired human cadaver tibiae. We fixed tibiae with one of nine different interlocking nails [AO Unreamed Tibial Nail 9 mm (UTN9), AO Unreamed Tibial Nail 8 mm (UTN8), Russell & Taylor Delta Tibial Nail 9 mm (RTD), Russell & Taylor Reconstruction Tibial Nail 11 mm (RTR), Brooker & Wills Tibial Nail 11 mm (B&W), Grosse & Kempf Tibial Nail 11 mm (G&K), AO Universal Tibial Nail 11 mm (AOU), Klemm & Schellmann Tibial Nail 11 mm (K&S), and Börner & Mattheck Tibial Nail 11 mm (B-M)] according to the manufacturer's recommendations. In torque testing the unslotted nails (UTN9, UTN8, RTD, RTR, B&W) showed significantly higher stiffness compared to the slotted nails (G&K, AOU, K&S, B-M). Compared to intact bone, both groups of nails were significantly less stiff. In axial load testing large diameter nails interlocked by large diameter interlocking bolts (G&K, K&S, B-M) showed significantly higher stiffness. For A-P bending no significant differences between implants were found, but isolated bones showed significantly higher A-P bending stiffness. In varus-valgus bending large diameter nails (RTR, G&K, K&S, B-M) showed significantly higher bending stiffness compared to low diameter (UTN8, B&W) implants.

Adult↗
PubMed1996

Fatal pulmonary embolization after reaming of the femoral medullary cavity in sclerosing osteomyelitis: a case report.

Reaming of the medullary may be used in cases of sclerosing osteomyelitis (type Garré), refractory to other methods. We report a case of fatal intraoperative complication related to this procedure. An otherwise healthy young patient died during reaming using a machine-driven reamer of the femoral medullary canal due to pulmonary bone embolism. The technique and the indication for this procedure as well as the intraoperative monitoring options are discussed.

Adult↗
PubMed1996

[Outcome evaluation after unstable injuries of the pelvic ring].

Open reduction followed by internal fixation is the method of choice after unstable pelvic ring fractures and gives better results than either conservative treatment or external fixation alone. Even after anatomic reconstruction of the pelvic ring, however, a high incidence of late sequelae is reported, especially after C-type fractures (translational instability). The purpose of the study reported in this paper was evaluation of a new scoring system for the rating of the long-term outcome after pelvic fractures. In all, 28 B-type fractures and 27 C-type fractures (Tile) were subjected to surgical stabilization in 1985-1990 (both external and internal stabilizations). These patients were followed up clinically and radiologically an average of 28 months after injury. The results were summarized in a new pelvic outcome score. The scoring included the radiological result (I = max. 3 points) and the clinical result with rating of function, neurological, urological and sexual deficits (II = max. 4 points). The "critical value" for the radiological evaluation was a 5-mm residual posterior displacement or a 15-mm anterior displacement in the pelvic ring defining a "poor" result (1 point). Social reintegration, an overall reflection of all accident-related sequelae, was rated independently (III = max. 3 points). I + II were summarized as "pelvic outcome," with 7 points rated as excellent, 6 points as good, 5 and 4 points as moderate, and 3 and 2 points as a poor result. Freedom from pain was achieved in 89% of the patients who had B-type injuries, and in 30% of those with C-type injuries. Neurological deficits were seen in 32% after B-type (only sensory) and 70% after C-type fractures (33% motor nerve, 37% sensory). The maximum radiological rating was given to 86% of the patients after B-type and 27% after C-type injuries. The clinical rating was maximum (4 points) in 18% after B-type and 7% after C-type fractures, resulting in a good or excellent rating for "pelvic outcome" in 79% after B-type and only 27% after C-type injuries. The maximum rating for social reintegration was given to 57% after B-type and 44% after C-type injuries. Even after anatomical reconstruction of the pelvic ring in C-type fractures (3 points) 20% of the patients were clinically rated as "poor" (1 point). The study showed that anatomic reconstruction of the pelvic ring is an important factor in a good or excellent clinical result, but even when this goal is met, other parameters (sacral fractures, SI dislocations, primary neurological/urological injuries) can lead to an unsatisfactory result. The new rating system is comprehensive and easy to apply and allows a clear differentiation of typical late sequelae after pelvic injuries; it will therefore be used for further long-term studies.

Female↗
PubMed1996

[Traumatic hemipelvectomy. Experiences with 11 cases].

With further improvements of the prehospital rescue systems, an increasing number of patients with extreme injuries such as traumatic hemipelvectomy are admitted to trauma centers alive. The accepted definition of traumatic hemipelvectomy is: unstable ligamentous or osseous hemipelvic injury with rupture of the pelvic neurovascular bundle (open or closed integuments). A review of the literature up to 1995 yielded on 48 surving cases with such an injury. A review of 2002 consecutive patients after pelvic fractures treated from 1972-1994 at the Medical School Hannover, resulted in the identification of 11 traumatic hemipelvectomies with four survivors. The purpose of the study was the analysis of the early clinical course of the patients after traumatic hemipelvectomy and the evaluation of the late outcome of the survivors. All accessible clinical and radiological data were reviewed for the preclinical and primary clinical treatment, concomitant injuries, cause of death and complications. The survivors are under continuous follow-up at our institution and were evaluated on average 5.5 years (range 2-7 years) after trauma. All patients were managed with early and aggressive shock therapy by an emergency physician, hemorrhage control with manual compression of the wound and a short transit time to a trauma center. Immediate surgical hemostasis was attempted in all cases. Despite this, four patients died within the first 4 h secondary to uncontrollable bleeding. Another three died between 2 days and 5 weeks after accident from complications of septic or hemorrhagic shock. In four patients a limb-saving procedure was attempted. Three of these died early, and in the remaining case secondary hemipelvectomy was necessary due to sepsis and paralyses. After primary surgical completion of the hemipelvectomy, three of four patients survived. The late result was good in two children and moderate in one adult (ambulatory and socially reintegrated). A bad result occurred in one male after secondary surgical completion of the hemipelvectomy (social deterioration and drug abuse). A strict protocol has to be set for the primary treatment of a traumatic hemipelvectomy. It includes immediate prehospital hemostasis by local pressure, advanced shock therapy and prompt transfer to a trauma center. In-hospital procedures include immediate surgical hemostasis and debridement. When the criteria or traumatic hemipelvectomy are fulfilled, surgical completion of the hemipelvectomy is mandatory. Limb-saving procedures endanger the patient's life. Early and frequent second-look operations minimize wound healing problems. Early psychological support for the patient and family is advantageous for personal well-being and social reintegration.

Adolescent↗