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H W Stedtfeld

Publications and source records attributed to H W Stedtfeld.

At least 19 recordsLinked to original sources
PubMed2003

[Results on treatment of anterior cruciate ligament rupture of immature and adolescents].

Between 01.01.1994 and 31.12.2000 we have operated 45 patients in our clinic with open growth plates. Cruciate ligament injuries are seldom found by children with open growth plates.Nevertheless, if the injury is left untreated it is liable to injure the meniscoid and the cartilage severely and may even lead to a loosening of the tertiary stabilizers. Therefore we do refixation of anterior cruciate ligament for tibial bony rupture and Refixation in Marschall technique or a replacement for the anterior cruciate ligament using Hamstring ligaments and fixated them by using the transfix technique.Up till now, none of the patients showed any signs of ill-functioning growth plates. Though it may be necessary to point out that the patients had not fully grown out by the time the subsequent check ups were held. The knees we revised were all stable and after relating our results to the IKDC-Score we found that our treatment reflected a good to very good result (Group A and B). Results of Marschall-Technique are very poor, results after bony refixations are good, result of our prospective study encourage us to recommend the surrogate of the anterior cruciate ligament by using the transfix technique in cases where the growth plates are still open. Therefore we can recommend reconstruction on transfix technique and refixation of bony ruptures.

Adolescent↗
PubMed2003

[Arthroscopy of the talocrural articulation].

Arthroscopy of the ankle joint meanwhile enjoys widespread use in those departments that perform arthroscopy so that the application of arthroscopic techniques can be considered a standard procedure also for the talocrural articulation. Various indications have become generally accepted and further areas of application will emerge. As is the case for the knee joint, arthroscopy of the ankle joint solely for diagnostic purposes has become obsolete and due to improved preoperative methods for diagnosis is no longer necessary as the sole procedure. The diagnostic work-up is normally followed by arthroscopic or open treatment. The multitude of clinical examinations and imaging techniques currently available enables noninvasive clarification of pathological conditions in the ankle joint to the greatest possible extent, making detailed preoperative planning possible in most cases. The present article describes the technique, indications, complications, and perspectives for arthroscopy of the talocrural articulation.

Ankle Injuries↗
PubMed2003

[Arthroscopy of the talocrural articulation].

Arthroscopy of the ankle joint meanwhile enjoys widespread use in those departments that perform arthroscopy so that the application of arthroscopic techniques can be considered a standard procedure also for the talocrural articulation. Various indications have become generally accepted and further areas of application will emerge. As is the case for the knee joint, arthroscopy of the ankle joint solely for diagnostic purposes has become obsolete and due to improved preoperative methods for diagnosis is no longer necessary as the sole procedure. The diagnostic work-up is normally followed by arthroscopic or open treatment. The multitude of clinical examinations and imaging techniques currently available enables noninvasive clarification of pathological conditions in the ankle joint to the greatest possible extent, making detailed preoperative planning possible in most cases. The present article describes the technique, indications, complications, and perspectives for arthroscopy of the talocrural articulation.

Ankle Injuries↗
PubMed2002

[Arthroscopic management of tibial plateau fractures].

Since the mid 1980 s the arthroscopically and radiologically controlled management of tibial plateau fractures is an established part of arthroscopic surgery of the knee. The aim of this study is to analyse the results of this method in our patient population. Between January 1, 1994 and December 31, 1998 59 patients were operated under arthroscopic and radiologic control. Of the 59 tibial plateau fractures there were concomitant ligamentous injuries in 21 cases. In 34 cases an additional arthroscopic procedure was performed (partial meniscectomy 19 times, a meniscal repair 7 times. An arthroscopic procedure was necessary because of chondral lesions 14 times, and in 10 cases a rupture of the ACL was found, which was treated by resection). None of the 8 patients with lateral wedge fracture had a concomitant intraarticular lesion. The intraoperative use of Endobon provided good mechanical stability, but it is not always necessary. The negative aspect of Endobon, however, is the high cost. The number of complications in our series was low (3 intra- and 6 postoperative complications). The average follow-up interval was 48 months. According to the Lysholm-Score, 41 patients investigated obtained an average of 84 points. Because of its good results this procedure can be recommended when conducted by an experienced arthroscopic surgeon. However, the range of indications is limited to special tibial plateau fractures. In case of intraoperative problems or complications we recommend an early change to conventional methods of internal fixation of tibial plateau fractures.

Adult↗
PubMed2002

[Revision of the anterior cruciate ligament in TransFix(R)- and OATS(R)-technique].

Transplant failure after anterior cruciate ligament-plastic is a typical complication. In larger collectives, revisions amount to about 8-12 % of the reconstructive operations of the anterior cruciate ligament. The number of revisions is also growing in our clinic and makes at present 11 %. There are different reasons of transplant failure. Many mistakes occur as a result of technical pitfalls during the preparation. A new "adequate trauma" is rarely the cause of a rerupture. In this paper a new concept of revision in failed anterior cruciate ligament reconstructions will be presented, which can be frequently performed as one-step technique even in bone tunnel enlargement or sclerosis of the tunnel. Our results in 21 cases will be discussed with the literature. In our opinion the TransFix(R) technique, if necessary in conjunction with the OATS(R) technical equipment, is a reproducable alternative for one step revision surgery and should be recommended.

Adult↗
PubMed2000

[Mid-term outcome of postoperative infections of the shoulder].

Between 1 January 1986 and 31 December 1997, in the traumatology department of Nuremberg hospital, a total of 46 patients with postoperative infections of the shoulder were treated. The primary surgical procedure was carried out for various reasons. The diagnosis of infection was found on clinical parameters such as pain, redness, and swelling, in combination with laboratory parameters and diagnostic aspiration of joint fluid. The period between operation and infection ranged between 4 days and 9 months. The main question was whether a local infection or an infection of the glenohumeral joint, called empyema, was involved. Some cases required diagnostic aspiration. Macroscopic inspection of the fluid was helpful, as was cell counting and analysis of fluid pH [14]. The fluid was given to a gram preparation. In case of infection of the joint, diagnostic arthroscopy was performed with a saline lavage (10-15 l). Local synovectomy was carried out when local synovitis was found. Similar to the therapy of the knee, antibiotic collagen (Sulmycin-Implant) (no PMMA chains as former) was applied. We compared patients who were operated as usual, i.e., by great incision and open wound-drain (group 1, 21 patients), with patients who were operated arthroscopically assisted (group 2, 25 patients). We saw an earlier reconvalescence in the second group. Of the 46 patients, 25 were followed-up for an average of 4 years. The results were rated according to the Constant score. The mean total score of 25 patients was 61 points (range 43-78 points). Positive intra-articular bacterial culture was an important prognostic factor; inspite of an arthroscopical procedure, results were not as good as without joint infection. Generally, the arthroscopic procedure with application of the Sulmycin Implant leads to better results than the open procedure with application of PMMA chains.

Arthroscopy↗
PubMed2000

[Experiences with arthroscopic therapy of chondral and osteochondral defects of the knee joint with OATS (Osteochondral Autograft Transfer System)].

Between 1.6.1997 and 31.12.1998 an osteochondral transplantation with the OATS (Osteochondral Autograft Transfer System) was performed in 18 patients. Indication for OATS was in 9 cases a chondral defect in ACL deficient knees. 3 times we found a fresh chondral defect, in 6 cases we found cartilage damage on the medial femoral condyle at the main weight-bearing area (Outerbridge, type III-IV) in chronic ACL deficient knees. The defect-size in these 9 patients (7 male and 2 female) ranged between 12 mm and 23 mm in diameter and had an average-size of 15 mm. There have been 3 cases with osteochondrosis dissecans, 4 patients had a osteonecrosis at the medial femoral condyle. In the 18 cases an average of 1.8 grafts was needed; more than 3 grafts were used only in exceptional cases, because in such cases the stability between the grafts is reduced. The short outcome in the Lysholm-score showed mainly good results. The average score value during follow-up was 89.5 (range 78-92). This outcome makes hopeful for likewise middle-term-results. The OATS can be recommended for the treatment of chondral and osteochondral defects in the main-weight-bearing area of the knee as a safe procedure for transplantation of hyaline cartilage.

Adult↗
PubMed1998

[The impacted intramedullary nail. Re-discovery of an old problem with a new nail].

Impaction of an intramedullary nail during extraction is an unpredictable and delicate situation. Its problematic nature is unfolded on a report of two cases, one with a Küntscher nail and one with a modern solid titanium nail. This event is caused by ingrowth of new bone formation into the slot or the dorsal flute respectively. The new bone formation is a mechanical barrier which effectively forces the distal part of the nail to jam against the cortex. Both, the slot of the unlocked reamed clover leaf nail and the wider dorsal flute of the solid titanium nail, realize certain therapeutic concepts. Their factual benefit within the concept of interlocking nailing is doubtful.

Adult↗
PubMed1997

[Arterial vascular lesions after total hip joint replacement].

We report on three arterial thromboses of the external iliac artery following total hip replacement. As a result of implanted cement/spongiosa or protrusion of the acetabular component, the iliac vessels were compressed. Furthermore, we report about one intraoperative arterial vessel lesion in a 65-year-old patient during a revision operation. We recommend that in case of acute ischemic syndromes of lower limbs following total hip replacement, an angiography should be performed in order to exclude an extravascular cause of thrombosis. For therapy in those cases extra-anatomic bypasses should be preferred to thrombectomies.

Aged↗
PubMed1997

[Outcome of management of femoral neck fractures with cemented bipolar endoprostheses].

In our hospital 334 patients were treated with a bipolar prosthesis for medial femoral neck fracture in the years 1990 and 1991. After an average of 54 months (minimum 48 months) informations about function could be obtained by examination and x-ray from 19 patients (5.7%), from 42 patients (12.6%) a questionnaire was analyzed. No function of the hip was described as poor, 2/3 of the patients had no pain, nearly 50% walked without crutches or other tools. No protrusio acetabuli or acetabular erosion was seen. Together with further follow-up examinations from another 230 patients out of 1365 patients treated with a bipolar prosthesis up to now, these results support the statement that bipolar prostheses play an important role in treatment of medial femoral neck fractures in the elderly.

Aged↗
PubMed1993

[Seat-belt syndrome. Is "securing" children in back seats of cars exclusively with a lap belt defensible?].

In automobile accidents the "seat belt syndrome" describes a combination of injuries involving the thoraco-lumbar vertebrae and intraabdominal organs. This may result from wearing of only a pelvic seatbelt. Children are often involved. Analysis of two separate cases showed the "assurance" of children as passengers on the backseat with a pelvic belt to be dangerous and not longer justifiable. Anatomical proportions and posture in childhood necessitate backseats especially designed for children. They should include the possibility of installing a three point safety belt system.

Abdominal Injuries↗
PubMed1993

[Fracture management in elderly patients. A technically and ethically challenging responsibility].

The accident surgeon is increasingly being confronted with typical fractures of old age. These differ from those seen in other phases of life in that they characteristically occur in a situation of reduced mental performance, and coordination, and are associated with structural bone weakness. Also typical is the fact that there is usually no external causal factor involved. Many patients are polymorbid. Treatment of lower-limb fractures concentrates on early re-mobilization. Uncontrolled full weight bearing cannot be avoided, and medullary nailing is therefore preferable to plating. In the case of comminuted fracture of the humerus head or medial femoral head fractures, the chances of reconstruction with preservation of bone vitality are poor and the use of an endoprosthesis permits early functional recovery. Rehabilitation facilities tailored to the needs of elderly trauma patients are required. In the acute trauma unit, the increasing demands being made by geriatric trauma care make staff and structural changes necessary.

Aged↗
PubMed1992

[Hemi-arthroplasty of the hip joint: concentric or positive eccentric (self-centering) dual head prosthesis? A retrospective comparison].

In femoral neck fractures in the elderly, the least traumatic operative treatment is hemiarthroplasty. In our Trauma Unit, from August 1986 to December 1986 we implanted 22 concentric bipolar cups. During follow-up this cup proved to be associated with an unjustifiably high failure rate: system-caused interprosthetic dislocation in 4 patients (18%), and extraprosthetic dislocation in a further 3 (13%). In one of the latter, interprosthetic disconnection occurred during closed reduction. In all of these, i.e., in 31% out of the 22 patients, conversion to a total hip arthroplasty became necessary. Since March 1987 we have used a positive eccentric, self-centering bipolar head. Up to September 1990 322 such prostheses were implanted. Bearing in mind the reduced general physical condition of the patients, the complication rate is considered to be low (dislocations 3.4%, conversion to total hip arthroplasty 0.9%, deep wound infections 3.1%).

Aged↗
PubMed1991

[Polytrauma in automobile drivers--on the coincidence of adolescents and the elderly].

In traffic severe accidents accompanied by polytraumata reach more and more importance to traumatology. We explored our own patients with regard to the coincidence of such accidents with juvenile and senior age and found out a very high risk in the age groups between 16 and 25 years. The causes could be little experience, readiness for risks and overrating their own talent. Elder persons driving motor vehicles are also very often involved in traffic accidents. In this group polytraumata however are not so frequent compared to many accidents without severe consequences. Polytraumatisized patients are very important as to the costs in the health and social system. In any case they cause a considerable economical loss.

Accidents, Traffic↗
PubMed1991

[Is there a noticeable temporary protective function of homologous skin grafts of variable thickness in deep burns against the effect of atmospheric oxygen?].

The injurious influence of atmospheric oxygen upon healing of large wound areas for instance of burn wounds is well known, in differently thick skin grafts different protective functions can be demonstrated. Experiments show the isolation functions of the full-thickness on the one and split skin grafts on the other hand in burn wounds by measuring the subcutaneous pO2: under temporary full-thickness grafts there are with regard to the atmospheric oxygen clearly lower oxygen partial pressures than under split skin grafts.

Animals↗
PubMed1990

[Interlocking nailing of fractures of the proximal tibial shaft].

The anatomic construction of the proximal part of the tibial shaft induces high ventral traction forces. Consequently, the mechanical requirements for stability of any internal fixation system are also high. Therefore, interlocking nailing of fractures of the proximal tibial shaft demands a meticulous operative technique as far as the incision, implantation of the nail and the final interlocking are concerned. Typical complications in this area are axis deviation, loosening of the interlocking screws and delayed union. Particular attention should be paid to the risk of hitherto unnoticed fissures ascending into the tibial head.

Adult↗