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Biomedical subjects

H Zwipp

Publications and source records attributed to H Zwipp.

At least 91 records · Page 5Linked to original sources
PubMed1991

[Surgical treatment and late results of foot compartment syndrome].

From 1982 to 1988 a total of 29 patients with compartment syndrome of the foot were treated by fasciotomy. The most common causes were fracture dislocations of the Lisfranc (n = 14) and Chopart joints (n = 4). Since these injuries lead to a severe damage to soft tissue structures--joint capsules, ligaments, fasciae--the muscular compartments often communicate and decompression can be achieved by a longitudinal dorsal incision of the skin and fasciotomy of the fascia dorsalis pedis and the retinacula extensorum superior and inferior. Subsequent measurement of intracompartmental pressure dictates whether blunt dissection of the interosseous muscles and separate fasciotomy of the medial, lateral and plantar compartments have to be performed. Follow-up was possible in 18 patients: half had good results, while 9 patients had limited motion of their toes and/or paresthesia. It is impossible to know whether these negative findings are caused by the compartment syndrome itself or by the severe soft tissue damage resulting from the initial trauma.

Adolescent↗
PubMed1991

[Reconstructive measures for the foot after compartment syndrome].

Following severe indirect and/or direct trauma to the foot, compartment syndrome can easily develop in this foot. Untreated, the compartment syndrome results in a complex post-traumatic deformity--the "short foot syndrome." This may manifest itself as a contracted pes equinovarus foot with clawing of the toes. Isolated compartment syndrome of the foot due to local injury may result in the formation of hammer toes. During childhood and adolescence, severe soft tissue injuries to the lower leg or foot, with subsequent compartment syndrome of the foot or a neurovascular injury to the lower limb, may result in an alteration in growth of the affected region or may involve the foot. Radiological assessment of this contracted "short foot" using sonography or MRI demonstrates scarred, necrotic musculature mainly involving the muscles of the posterior tibia, the flexor hallucis and the flexor digitum. Muscular imbalance due to long-standing muscle palsies, or chronic post-traumatic osteitis of the tibia contribute to the development of rigid equinus foot and ankle. Treatment of the contracted foot includes complex soft tissue release, muscle and tendon transfer, tendon-lengthening procedures, and intrinsic releases to correct the toe deformities. In the adult with a severe post-traumatic pes equino-varus deformity, triple arthrodesis is recommended.

Arthrodesis↗
PubMed1991

[Malunited juvenile fractures in the foot region].

Between 1971 and 1990 we treated 121 juvenile patients up to 14 years of age with fractures of the ankle joint and foot in the department of trauma surgery at Hannover Medical School. A total of 128 fractures were treated in these patients, excluding toe fractures. The distribution of fractures as referred to the anatomical-functional planes was as follows: Tibia-talar joint 69; talus 8; calcaneus 6; Chopart joint 5; Lisfranc joint 4 and metatarsal area 36. Clinical and radiological follow-up investigations were possible a mean of 8.7 years post trauma for all talar and calcaneal fractures, for 7 out of 9 Chopart/Lisfranc injuries and for 7 out of 35 of metatarsal fractures. In the case of talus fractures our results suggest that it is to restore the original length of the talus bone (medial column); this is important to prevent collapse of the longitudinal arch with subsequent early arthritis. The rare cases of sustained intraarticular damage to calcaneal fractures should be treated as in adults, i.e. by open, anatomical reconstruction. In children, Chopart/Lisfranc 2 fracture dislocations only occur if high-energy trauma is present (runover trauma in 4 out of 9 cases). Optimal treatment again is comparable to that in adults: open, anatomical reduction with Kirschner-wires followed by temporary, tibio-tarsal transfixation; this is important since no compensatory mechanisms develop if a subluxation is present after reduction. Metatarsal fractures often occur along the first and fifth rays and have a good prognosis. Conservative treatment is justified, since, according to our results, even in intraarticular fractures of the metatarsal head good remodeling to fragments occurs.

Adolescent↗
PubMed1991

[Sinus tarsi and canalis tarsi syndromes. A post-traumatic entity].

The posttraumatic sinus tarsi syndrome is a clinical entity induced by supination trauma of the hindfoot. In pathomorphological terms this is due neither to a ligament rupture nor to an osteochondral lesion. Clinically, local pain in the sinus tarsi is associated with pain during supination or pronation, pain during walking, especially on uneven ground, and "giving way" without signs of mechanical instability. A more severe variant of this syndrome, in which the patient complains of pain on the medial aspect of the hindfoot in conjunction with the typical pain of the sinus tarsi syndrome is described. This medial symptom complex has been identified as the "canalis tarsi syndrome". Injection of a steroid and local anaesthetic agent into the tarsal sinus or tarsal canal will relieve the pain if the underlying pathology is that of a tarsi syndrome, depending on which side the injection is given. An arthrogram of the subtalar joint in a patient with a confirmed sinus tarsi syndrome demonstrates a sac-like anterior bulge of the capsule. Performed on a non-pathologic tarsal sinus, this procedure would demonstrate a corrugated appearance of the capsule anteriorly, without this anterior protrusion. At the Medical School in Hanover, 95 patients with a sinus tarsi syndrome were assessed between 1981 and 1989. In all patients a conservative regimen of repeated injections (6 or fewer) of a steroid and local anaesthetic agent into the tarsal sinus was instituted. In addition, 3 of these patients were identified as having a canalis tarsi syndrome, and injections were simultaneously given into their tarsal canals.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[Injuries to the superior ankle joint from the viewpoint of accident surgery].

The treatment of bony, osteochondral, and ligamentous injuries of the tibio-talar joint requires precise preoperative planning by radiological investigation. This is essential to a correct understanding of the underlying pathology and will allow a proper classification of the injury, which is the basis of treatment. Conventional radiography using anteroposterior and lateral X-rays with comparative views of the noninjured side and, if necessary, rotated spot views and tomography are of high value especially in osteochondral fractures of the talus. Intraoperative control images in both planes after osteosynthesis are mandatory. For evaluation of the postoperative course and severity of arthrosis formation, the classification system of Bargon has proved its worth. In addition, tomography of the tibio-talar joint in two planes is useful especially in tibial pilon fractures, some malleolar fractures, and peripheral talar fractures. In talar fracture dislocations with concomitant compartment syndrome an emergency CT scan can be helpful to determine the optimal surgical approach. In these cases a 3-D reconstruction also might be of assistance. If there is evidence of partial or total talar necrosis, magnetic resonance imaging can be extremely helpful. However, in most cases implants considerably limit the validity of the image obtained. Ultrasonography offers a noninvasive, reproducible, and very inexpensive alternative and should be performed in cases of chondral-osteochondral talar rim avulsions and juvenile osteochondral ligament ruptures. It can also be used as a dynamic method for stress examination in fibular ligament ruptures and soft tissue injuries such as dislocation of the peroneal tendons. The use of Arthrography, stress tenography, and Arthro-CT scan nowadays has become extremely limited.

Ankle Injuries↗
PubMed1991

[Compartment syndrome in popliteal artery injury].

Between 1973 and 1988 50 patients with injuries of the popliteal artery were treated at the Medical School of Hannover University. While 26 patients with dislocations of the knee joint had mild soft tissue injuries, most of the 24 patients with periarticular fractures of the tibia and/or femur showed excessive soft tissue damage. In both groups 11 patients who were admitted with prolonged ischemia had to undergo amputations. Primary amputations were performed according to the recommendations of. The mean duration of ischemia was 5.5 h (range 2.2-9 h) in patients with knee dislocations (n = 21); fasciotomy was performed in 14 patients (67%). In patients with popliteal artery injuries combined with fractures (n = 18) the average duration of ischemia was 6.5 h (3-13.5 h); in 16 cases in this group (89%) fasciotomy had to be performed. Fasciotomy was always necessary in patients with combined injuries of the popliteal vein and artery. Moreover, all patients with ischemia of more than 6 h duration required fasciotomy. It can be concluded that fasciotomy will probably be necessary in patients with injuries of the popliteal artery and (a) severe soft tissue damage of the thigh and/or lower leg with compartment pressure of more than 30 mmHg; (b) ischemia of more than 6 h duration; (c) combined injuries of the popliteal vein and artery; (d) reconstruction of severely injured extremities. In general, fasciotomy should always be considered after reconstruction of the popliteal artery.

Amputation, Surgical↗
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↗
PubMed1990

[Reconstructive surgery of malunited joint fractures of the foot].

Innovative diagnostic methods such as the CT scan, MRI and 3rd-dimensional models of the foot and free-flap surgery to improve the soft tissues in the foot have all introduced new dimensions in reconstructive foot surgery. Of the foot bones only intra-articular fractures of the astragalus should be corrected because of its key position and the involvement of three joints. In double and triple arthrodesis, the axes and lengths of the medial and lateral columns should be corrected to prevent arthritis at the higher or lower joint level. Pan-talar arthrodesis can be worse than a well-done amputation below the knee. Cannulated 6.5 cancellous screws in double and triple arthrodesis and 3.5 corticalis screws in Lisfranc fusions allow stable fixation and function early after treatment.

Calcaneus↗
PubMed1990

[Significance and mechanism of thoracic and lumbar spine injuries in traffic accidents].

An analysis of 96 persons who sustained injuries to dorsal and lumbar vertebrae during traffic accidents, established that spinal injuries (sustained by 3.8% of the 96 persons) are quite rare. Pedestrians, the elderly, and polytraumatized persons with extensive head injuries as accompanying trauma following particularly serious accidents are at especially high risk. The most frequent spinal injuries are compression fractures, which especially often give rise to the injury pattern found in the spine of motorcycle riders, pedestrians, and car passengers not wearing seat belts. In these cases a so-called "pushing-further" mechanism is quite often assumed as the biomechanical cause. In comparison, ruptures of the transverse process have often been established for car passengers wearing seat belts, which can be attributed causally to a psoas effect resulting from an overstretching movement of the body and muscular strain. Basically three different biomechanical movement patterns were established in this study: sliding mechanism, shearing effect and psoas effect; which of these is are involved depends on the capacity in which the person affected takes part in street traffic. All the spinal fractures examined can be classed as trauma sustained while travelling at high speed. They are not observed following collisions at low or moderate speed.

Acceleration↗
PubMed1989

[Surgical treatment of chronic upper ankle joint instability in childhood].

The Department of Traumatology of the Hanover Medical School treated 347 patients having chronic instability or second stage rupture of the fibular ligament system, by surgery, during 1971 through 1986. Children were represented by one-seventh of the total number of patients only (13%; n = 44); however, in children the preoperative and intraoperative findings are different from normal findings and must be treated surgically in a special way. Whereas in adults old osseous/osteochondral ligament tears are apt to be rare (16% of the cases), they can be seen in children in almost every second case (18 of 44). Surgical approach requires a step-by-step procedure to achieve maximum stability and minimum functional loss. First Choice: Direct reconstruction of the ligament in case of ligaments which are present but have not healed correctly from a biomechanical point of view (e.g. pseudoarthroticosseous ligament tear) or in case of second-stage rupture (n = 20). Second Choice: Double periosteal flap plasty in case of necessary replacement of only one ligament (n = 13). Third Choice: Tenodesis of m. peroneus brevis using only half of the tendon chip while sparing the epiphysis if the condition persists for many years, or if ligaments cannot be reconstructed or replaced intraoperatively or if there is a combined instability of the ankle joint and the talo-calcaneonavicular joint (n = 11). In almost 90% of the cases very good to good results were obtained after five years, assessed according to a 100-point schema.

Adolescent↗
PubMed1989

[Roentgen diagnosis of the foot].

Diagnostic modalities in trauma studies of the foot include conventional radiography, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and digital projection radiography (DR). Several projections and special views of the conventional radiographic technique are shown with special respect to the hindfoot and the subtalar joint. The importance of ultrasound for soft tissue diagnosis is emphasized. Other modalities (CT, MRI, DR) are illustrated.

Foot↗
PubMed1989

[Reconstructive foot surgery following complex trauma of the foot].

Compound post-traumatic foot deformity may follow indirect, direct, or combined trauma. This is demonstrated by a number of case reports. Particularly during adolescence, primary injuries to the soft tissue, with neurovascular injury or compartment syndrome, and post-traumatic skin contractures can cause severe growth deformity at the site of the injury and distal to it. Compression screw arthrodesis, using the 6.5-mm cancellous screw with the triple arthrodesis and the 3.5-mm cortical screw with the Lisfranc arthrodesis, has particular significance. It is stable, it allows functional treatment later, and bone union takes place rapidly. The most important surgical principles in post-traumatic foot surgery are: precise reconstruction of the foot axes, the medial and lateral foot length, and the longitudinal and transverse arches, i.e., restitution of the normal foot anatomy.

Adolescent↗
PubMed1989

[Biomechanics of the ankle joint].

According to Fick, the tree-dimensional patterns of foot motion are best characterized as jawlike movement. Anatomically and biomechanically, this process represents conjoined, synchronous motion within the three mobile segments of the hindfoot: the ankle joint, the posterior subtalar joint, and the anterior subtalar joint. Foot kinematics can be described more completely if the anterior subtalar joint is defined not only as the talocalcaneal navicular joint, but as including the calcaneocuboid joint, thus representing the transverse joint of the tarsus, i.e., the Chopart joint. The axes of these three joints can be defined precisely. In some parts they represent a screwlike motion, clockwise or counter-clockwise, around the central ligamentous structures (fibulotibial ligament, talocalcaneal interosseous ligament, bifurcate ligament). The individual anatomy and structure of these ligaments provide variations in the degree and direction of foot motion. A precise knowledge of foot kinematics is important in surgical ligament and joint reconstruction and in selective foot arthrodeses.

Ankle Joint↗
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↗