Search PubMed⌕ Search

Biomedical subjects

H Zwipp

Publications and source records attributed to H Zwipp.

At least 109 records · Page 6Linked to original sources
PubMed1989

[Intra-articular fracture of the calcaneus. Classification, assessment and surgical procedures].

Our experience with open reduction of calcaneus fractures and internal stabilization without joint transfixation (n = 83) has shown us that the following features are mandatory in order to obtain normal postoperative foot statics and dynamics, normal joint mobility, and normal foot function: (1) restoration of the normal height, length and width of the calcaneus; (2) reduction of all joint surfaces and (3) stable screw- or H-plate osteosynthesis, allowing functional treatment later. Our own fracture classification (X-fragment/Y-joint fracture) allowed us to determine the type of fracture, its severity, and the prognosis, as well as the choice of operative treatment. A detailed +/- 200-point follow-up scoring system assured operative quality control and comparability of results. The complications were: 9 cases of superficial wound-edge necrosis (8%), 2 hematomas requiring revision, and 1 deep bone infection (1.2%). During our first operative period (1983-1985, mostly unilateral medial approach and trans-articular K-wire fixation), we had only 50% good-to-excellent results. During the second period (1986-1988, bilateral, extended lateral approach and stable screw/H-plate osteosynthesis), 76.5% (29 of 51 patients) had good-to-excellent results. Our experience thus indicates that our operative treatment principles can be recommended for patients who are either professionally active or active in sports.

Ankle Injuries↗
PubMed1989

[Dislocation fractures of the Chopart and Lisfranc joint].

Dislocation fractures of Chopart's and Lisfranc's (mediotarsal) articulation result from the effects of impact and, because there are many possible complications, require a high level of experience on the part of the treating traumatologist. To avoid residual joint incongruities and intra-articular osteochondral fragments with subsequent early arthrosis and the corresponding complaints, the indications for open reduction and functionally stable osteosynthesis should be broad. The osteosynthesis can be achieved by transfixation with adjustable screws and 3.5 or 2.7 mm screws suitable for small fragments. This permits postoperative treatment to be carried out with a walking cast rather than a full plaster cast. In emergency patients with multiple injuries, dislocation fractures in the tarsal region require immediate and definitive treatment in order to avoid grave consequences and pain severe enough to influence the quality of life.

Adolescent↗
PubMed1989

[Combination of cancellous bone grafts and free microvascular bone transplantation in large osseous defects].

Fourteen autogenous vascularized fibular bone grafts have been performed. The indications for surgery were segmental bone defects 17 cm in length on average, seven times because of radical tumor resection (three malignant, two locally aggressive tumors) and seven times because of primary or secondary bone loss in trauma patients. Two free vascularized fibular grafts were done in the upper extremity, four in the femur and eight in the tibia. The results with a follow-up from one half to seven years show that all extremities could be saved with no recurrence of tumor or infection. All vascularized fibular grafts healed with a good functional result. With stable osteosynthesis (AO-plates and external fixateur) partial weightbearing was possible after three weeks, full weightbearing after 8 to 12 months. For the femur a plate or interlocking nail should be used and for the tibia an external fixateur. Additional cancellous bone grafting should be done in two stages.

Adolescent↗
PubMed1986

[Therapy of fresh fibular ligament ruptures].

In a prospective, random study carried out at the Casualty Clinic of the University Hospital of Hannover from 15 April 1986 to 31 July 1986, 200 patients were randomly selected from four treatment groups, according to treatment: operative-immobilized (group A, n = 52), operative-functional (group B, n = 50), conservative-immobilized (group C, n = 48) and conservative-functional (group D, n = 50). Follow-up examinations were made in 92.5% of patients after 3 months and 64% after 12 months. At the 3-month and 1-year follow-ups, no statistically significant differences were found in the total evaluation (100-point checklist) Moderately significant instability (6 degrees -10 degrees talar tilt and 6-10 mm anterior talar dislocation) in the conservative groups C and D was observed only in the clinical-radiological instability test. This statistically significant difference is, however, only evident in stress tenographically confirmed dual-ligament lesions. No functional physiological differences can be found after 12 months; on average, the period of incapacitation is 3 weeks shorter than with primary functional treatment, but so far there are no long-term results. Until late results are available, we conclude that conservative treatment, even for professional athletes, can be recommended as the procedure most free of risk and most economical; if at all, operative therapy should only be carried out when the instability is very serious.

Ankle Injuries↗
PubMed1986

[Diagnosis and therapy of acute and chronic ligament instability of the lower ankle joint].

At the Casualty Clinic of the University Hospital in Hannover, from 1981 to 1985, a total of 35 patients were treated operatively for chronic instability of the transverse tarsal joint: combined instability of the ankle and transverse tarsal joints (n = 15), isolated instability of the subtalar joint (n = 17), and isolated instability of the pretalar joint (n = 3). A simple technique of radiological positioning permits easy and certain diagnosis of isolated anterolateral rotary instability of the subtalar joint. Modified Elmslie tendosis (n = 32), used as an indirect replacement for the interosseus talocalcaneal ligament, had good and very good results in 25 of 27 cases followed up after 3 years.

Ankle Injuries↗
PubMed1986

[Acute ligamentous injuries of the Chopart and Lisfranc joint line].

The foot is a complex structure with numerous articular surfaces. As there are many potential complications (severe edema, compartment syndrome of the intrinsic foot musculature, bone and soft tissue necrosis, joint abnormalities, limitation of movement, deformities, etc.), traumatic surgeons must have a detailed knowledge of the relevant functional anatomy and treatment procedures. If there are multiple injuries, in the context of management, early definitive treatment for the injury is to be stressed. One requirement is an exact clinical and radiological diagnosis. As a rule, closed reduction is therapeutically successful. In a stable injury, immobilization can be achieved with a cast; in open wounds and malalignment of joint surfaces, an operative procedure is indicated. Particular attention must be paid to injuries of the tarsal bones in children to avoid delayed failure of growth, as the results of radiological investigations are often difficult to interpret. The diagnosis, techniques of management, and principles of follow-up are presented.

Casts, Surgical↗
PubMed1984

[Errors and dangers in the treatment of fractures and pseudarthroses of the clavicle].

The rate of pseudarthrosis in 726 conservatively treated fractures of the clavicula was 0.69%. The danger of hyperporoses lies in neurovascular compression. Errors in treatment pertain to wrong operative indications and inadequate osteosyntheses. Surgery should be performed only in 2nd and 3rd degree open fractures and/or concomitant neurovascular lesions (2.06%), in distal fracture dislocations with instability of the AC-joint (1.6%) and in cases of painful pseudarthrosis (n = 46). The implant of choice is the 3.5 DCP. Six cortical contacts must be achieved in each fragment.

Clavicle↗
PubMed1984

[Medullary reaming in chronic osteomyelitis of the stable femur and tibia shaft].

Ten patients with chronic osteomyelitis of the femur or tibia shaft without bone instability were operated by intramedullary reaming. All patients but one had previous surgery, up to 12 operations with the average duration of the disease 10.5 years. After intramedullary reaming all patients received systemic antibiotics for 8 days and in 6 cases the intramedullary cannal was filled with gentamicin-PMMA chains which were removed in local anaesthesia 10 days after surgery. Eight patients who had severe pain at rest were promptly relieved by the operation. In 3 cases of chronic fistulation only one exacerbation was seen. This was because of insufficient reaming, the patient was subsequently reoperated with reaming from a distal approach. During the observation periode from the month 12 to 32 in no case was there a recurrence of pain or infection.

Adult↗
PubMed1981

[Results of a muscle-activated M. peroneus brevis graft [author's transl)].

The article introduces a new method of reconstruction of the lateral ligaments of the ankle. This is a modification of the well-tried tenodesis according to Evans, by which half of the tendon of the short peroneal muscle is retained as a dynamic stabilizer of the ankle. In this method, the tendon of the short peroneal muscle is cut in half about five fingers' breadth above the ankle, the incision being effected as a J-shaped cut behind the fibula; the incision goes distally beyond the proximal retinaculum of the peroneal muscle. A hole of 4.5 mm. is drilled diagonally forwards and downwards at an angle of about 50 degree. The half of the tendon is pushed forwards through this hole in the bone and sutured onto itself below the superior peroneal retinaculum, the foot being held in slightly eversed position. Like many non-anatomical methods of repair, this method is used with good results. 91 reconstructions of the lateral ligaments of the ankle have been performed from 1972 to 1980 in the Medical College Hannover. Of the 76 patients checked in follow-up examinations, 68 showed good results, while the balance of 8 patients was classified as satisfactory.

Adolescent↗