Search PubMed⌕ Search

Biomedical subjects

L Zichner

Publications and source records attributed to L Zichner.

At least 19 recordsLinked to original sources
PubMed2002

[Sports-related injuries of the spine].

Different sports show different patterns and frequencies of injuries, which are discussed in this paper. About 3% of all sports accidents relate to the spine. These injuries often have far-reaching consequences for the patients. A very early and extensive diagnosis of all changes is decisive for the start of an adequate therapy and thus for the prognosis of the injury. Radiological diagnosis is also of decisive importance for the documentation of late injuries and in the question of rehabilitation. Here special focus is put on MRT and CT diagnostics.A healthy spine of humans is normally able to resist all static and dynamic strains of the usual sports. However, anomalies and dysfunctions of the spine can reduce its capacity to resist strain. The recommendations of sporting activities are given according to the extent of deflection and the expected growth. The importance of radiology in primary diagnosis and in the follow-up due to typical changes like scoliosis, Morbus Scheuerman, spondylolysis and spondylolisthesis is discussed here as well.

Athletic Injuries↗
PubMed2001

Hyperbaric oxygenation as a successful therapeutic approach in oral wound dehiscence after operative stabilization of an unstable post-traumatic odontoid non-union.

The non-operative treatment of unstable traumatic Anderson's type II odontoid fractures has a high risk potential to develop non-unions. Even after operative stabilization literature reveals non-union rates up to 20%. Acute life threatening complications are tetraplegia and apnoea. Long-term complications induce chronic myelopathy resulting from persistent myeloradicular compression. We report the case of a patient with a 17-year-old post-traumatic pseudarthrosis of the dens axis following conservative treatment of an unstable type II fracture. By that time, the female patient, then 37 years old, was admitted to our hospital with early signs of cervical tetraplegia. After initial reposition and short-term immobilization with a halothoracic vest we performed a ventrodorsal atlantoaxial spondylodesis. Failure of anterior cervical plate stabilization and autologous graft resorption without a solid segmental fusion instigated a secondary surgical intervention. Postoperative therapy-resistant oral wound dehiscence showed an exposed autograft and osteosynthetic material. The reported positive effect of hyperbaric oxygenation on wound healing in problem cases led us to attempt this means of therapy. With a daily exposure to hyperbaric oxygenation, the dehiscence closed within 25 days. As a result of our experience in this case, hyperbaric oxygenation should be considered as a therapeutic option in postoperative complication management in orthopaedic surgery.

Adult↗
PubMed2001

[Secondary deformities after section of primary bone tumors of the spine in children and adolescents].

Primary bone tumors and tumor-like lesions of the vertebral column are rare in children. After operative tumor resection, 25 children under the age of 17 could be reviewed in a retrospective analysis. Malignant bone tumors occurred only twice in the region of the vertebral body. No deformity was registered in 9 of 16 cases after local tumor resection with and without laminectomy on one level. In contrast, after resection of one or both facets in combination with laminectomy cranial to L4 or thoracal, progressive kyphosis was found within 6-22 months postoperatively in four cases. This required a secondary fusion. After primary fusion and instrumentation, no deformity was registered. In nine cases with a location of the tumor in the vertebral body, only two patients developed a secondary instability of the spine. Both cases had no primary fusion. The other seven patients with initial fusion and instrumentation showed no deformity within 24 up to 127 months postoperatively. These results are compared with data from the current literature.

Adolescent↗
PubMed2000

[The German Orthopedic History and Research Museum. A museum for research and public health].

The German historical museum of orthopaedic surgery was founded 1959 in Würzburg. The main task of this institution is the furtherance of science in medical-history. Since the beginning, 41 years ago, the number of books and exhibits increased continuously. The library of the museum is the biggest public collection in Germany and contains more then 6000 books and publications in orthopaedics. Furthermore the museum includes a big amount of exoprostheses of the upper and lower limb, alloarthroplasties of hip- and knee-joints, traumatologic implants and instruments of orthopaedic surgery. A big number of bone-preparations with pathologic alterations and variations will also be presented. The exhibition and the library is open to the public and is available to those people in the history of orthopaedic surgery. Local requirements in Würzburg were one of the reasons to transfer the place of the museum to Frankfurt/Main. The museum was reopened at 6th of June 1998 at the university of Frankfurt/Main, department of orthopaedic surgery.

Germany↗
PubMed2000

[History of meniscus surgery. From excision of joint loose bodies to meniscus suture].

In comparison with other operative procedures, the history of meniscal-surgery offers some particular differences. Over a long period of time injuries of the semilunar-cartilages of the knee-joint were not generally recognised. In the 18th century only was the clinical picture roughly outlined. There is evidence, that parts of the meniscus were removed much earlier than we have historic proof of. These meniscal fragments were generally mistaken for "loose bodies" in the joints, not knowing the exact etiology. Operative interference with joints was afflicted with a very high incidence of infections and thus complications. Due to this reliable standards of sterility were imperative to obtain reproductive and satisfactory results in surgery of the knee-joint and this is why the discovery and implementation of antiseptic and aseptic principles play such an important role in joint- and, in particular, in meniscal-surgery. The development of meniscal-surgery is dominated by a lengthy discussion about the way in which the injuries of the semilunar cartilages should be dealt with operatively. Fundamental techniques such as fixation of the cartilage by sutures, limited or total removal of the meniscus were established as early as 1895. Over a long period they existed concurrently and their adequate application remained cause for a highly controversial discussion until the end of the 20th century. Not before more detailed knowledge was gained about the exact morphology of the meniscus and the rising of arthroscopic surgery offered new surgical perspectives, it was possible to establish a widely accepted standard of meniscal surgery.

History, 18th Century↗
PubMed2000

Effects of revisional ACL surgery in semi-professional athletes in "high-risk pivoting sports" with chronic anterior instability of the knee.

This is a retrospective study of semi-professional athletes in "high-risk pivoting sports" after repetitive injuries of the anterior cruciate ligament (ACL) with chronic anterior instability of the knee. Effects of revisional ACL surgery on the progression of osteoarthritis, sport capacity, and knee pain were observed. Twenty-four patients, with an average age of 25.5 years, were examined on average 36.9 months postoperatively. Compared with the preoperative findings we noted a significant increase in the Lysholm and the Tegner activity score (P < 0.001). Sixteen patients (67%) were able to continue their sporting career; 17 patients (71%) were completely satisfied with the operative result. Nevertheless, 15 patients (63%) complained of persistent pain caused by sport activity. According to the Fairbank scale, 15 patients (63%) showed an increase in osteoarthritic signs between the preoperative and follow-up roentgenograms. Furthermore, there was a highly significant correlation (P < 0.001) between progression of osteoarthritis and continuous sport activity. We conclude that, after stabilization with a "bone-tendon-bone" autograft, athletes have a good chance to return to their sport. In most patients, the knee pain persisted and progression of osteoarthritis was detected. In individuals who play sport continuously, we recommend an annual follow-up with clinical examination and roentgenographic or magnetic resonance imaging examinations.

Adult↗
PubMed2000

Hip and knee replacement after longstanding hip arthrodesis.

This study determined whether patients with severe knee disease below a hip arthrodesis can be treated successfully with total knee replacement alone or whether such patients require total hip arthroplasty followed by knee replacement. Eighteen patients who had hip arthrodesis for a mean of 33 years underwent total hip replacement alone, total knee replacement alone, or a combination of both. The Harris hip score improved from a mean of 55.3 to a mean of 86.9 points at 45 months after total hip arthroplasty. The Hospital for Special Surgery knee score improved from a mean of 33 to a mean of 78 points in patients who had total knee replacement after total hip arthroplasty. The Hospital for Special Surgery knee score improved from a mean of 35 to a mean of 44 points in patients having total knee replacement alone below a hip arthrodesis. The followup after total knee replacement averaged 53 months. These data suggest that a knee replacement alone in a patient with a fused hip is unlikely to provide a satisfactory result. Patients with severe knee disease below hip arthrodesis require total hip arthroplasty followed by knee replacement. This applies even when severe osteoarthritis of the knee is the primary complaint.

Adult↗
PubMed1999

Effectiveness of glenoid osteotomy in atraumatic posterior instability of the shoulder associated with excessive retroversion and flatness of the glenoid.

In this investigation, patients with atraumatic posterior instability of the shoulder were appraised in order to evaluate the effectiveness of glenoid osteotomy in the correction of excessive retroversion and flatness of the glenoid. In a series of 32 patients, 17 with posterior instability had no history of trauma. Posterior glenoid osteotomy was performed to correct excessive retroversion and to deepen the glenoid; 95% were re-examined after 5 years. In 81% the results were rated as good or excellent (Constant-Murley and Rowe scores), only 12.5% having had a recurrence. The glenoid could be deepened and on average the angle could be altered from -9.35 degrees to -4.62 degrees. In comparison, 50 volunteers had average angles of -4.4 degrees, thus differing significantly from the preoperative group. Twenty-five per cent of the patients showed postoperative degenerative changes in the glenohumeral joint. The study shows that excessive retroversion and flatness of the glenoid in persons with atraumatic posterior instability can be successfully treated by a posterior glenoid osteotomy. Nevertheless, the high rate of postoperative degenerative changes must be taken into account.

Anthropometry↗
PubMed1997

[In-vivo wear of the slide combinations ceramics-polyethylene as opposed to metal-polyethylene].

The present study deals with long-term dimensional changes in cemented Müller-type total hip endoprostheses. Creep and wear contribute to different extents to the dimensional changes in polyethylene. The total amount of polyethylene wear is represented by the displacement of the femoral head into the socket. Within the first postoperative years, the head shifts up to a relatively high rate of about 0.5 mm per year. This rate diminishes after 5 years to an average of about 0.1 mm (ceramics) and 0.2 mm (metal) per year. Values exceeding 0.2 mm per year for the shift of the femoral head are considered to be unfavourable with regard to a probable loosening of the prosthesis. In this study we determined the orientation of the centre of the prosthetic head in relation to the wire marker of the polyethylene cup, comprising in all 369 total hip prostheses. After an average of 77 months, 96% of the prostheses with ceramic heads (n = 109) had a wear rate of less than 0.2 mm per year. Using metal heads (Protasul-2 and Protasul-10) this rate could only be measured in 71% (n = 109) of the prostheses (61.5 months). The combination ceramics-polyethylene produces half of the total amount of wear produced by metal-polyethylene. Younger patients should preferably be treated with a ceramic ballhead.

Biocompatible Materials↗
PubMed1995

[Hip diseases in pregnancy].

Transient osteoporosis and avascular femoral head necrosis represent rare but typical complications in the third trimenon of pregnancy. On the basis of five cases we report on the diagnosis, course and treatment of these diseases which are rarely mentioned in German literature.

Adult↗
PubMed1995

[Intraoperative localization of metastases with a hand-held gamma probe].

A 50-y-old male patient with prostate cancer showed two suspicious lesions in bone scintigrams. They were assessed to be bone metastases by biopsy of the os ilium. After i.v. injection of 99mTc-HMDP a probe-guided localization permitted optimal surgical treatment. A bone metastasis in the os ilium was confirmed. The intraoperative detection with a hand-held gamma probe permitted accurate and complete excision of the tumour; the bone defect could thus be reduced to a minimum.

Bone Neoplasms↗
PubMed1994

[Natural course in lumbar disk prolapse].

This study reports on 74 patients with lumbar nucleus prolapse (NP) and nerve root symptoms. In all patients the clinical diagnosis was confirmed using a CT-Scan. After 1.7 y a clinical follow-up was performed. Four patients have required surgery in the meantime. Ninety percent of the patients treated conservatively experienced marked pain relief and generally appreciated the results of conservative treatment. Nevertheless, 67% had some complaints. The neurological findings showed essential improvement even in cases of severe paresis. Follow-up CT scans performed in 35 of these patients and in a control group of 23 patients showed partial regression of the prolapse at an average of 48.3% and 50.4%, respectively. The NP disappeared in 3 with no regression in 2 cases. If regression occurred, it apparently took place during the first 6 months. Regression of NP and clinical improvement showed no positive correlation. The investigation demonstrated fair results with conservative therapy even in cases with minor regression.

Adult↗
PubMed1993

[Corrections of and within the athletic shoe].

The footprint is unique to every human. Because of this, the ideal shoe should be constructed in such a way as to afford the foot enough space. Many sportsmen become problems in the lower extremities that can lead to stress fractures because the industrially made sportshoe is made for the average person. In order to reduce or even avoid these problems, corrections can be made on the shoe parts such as on the sole, the heel, the pad or the high-tops. According to the measurements we have made of the foot with the hydraulic principle according to Ernst and the use of a special innersole (F-Scan, produced bei Tenscan Inc.). These have shown that at lower speeds (9 km/h) the shock absorption from the foot is such as to relieve the tension of the orthostatic system. Where as at higher speeds (14 km/h) the absorbtion produces more tension leading to an overload on the foot. This can be measured through the innersole tension and form, so that even through manipulation compensation cannot be achieved.

Athletic Injuries↗
PubMed1992

[Postoperative treatment, rehabilitation and expert assessment of patients with endoprostheses of the hip joint].

The main demands on a total hip replacement are to reduce pain or achieve painlessness and to recover or improve mobility and walking ability. Today more younger patients were operated replacing a destroyed hip joint: the reintegration in professional and sportive activities is a major part of the rehabilitation process. The postoperative management especially in physical therapy can be standardized inspite of the use of various models. Usually full weight bearing is accepted after 3 months. A review of consecutive treatment methods and professional and sportive rehabilitation measures are presented. Hip replacement leads to restrictions in activity in general. The evaluation, in relation to the different indemnifying, is differentiated.

Disability Evaluation↗
PubMed1989

[Bosworth management of acromioclavicular joint dislocation].

It is reported on 26 cases of acromioclavicular joint dislocation, which were treated by the Bosworth-method of coraco-clavicular screw-fixation. 21 patients were followed up for an average period of 27 months. In spite of osteoarthritis in 44% and calcification in 83% all patients had free mobility. 67% were painfree, 33% had little pain. A fully professional and sporting rehabilitation was achieved in 91% respectively 86%.

Acromioclavicular Joint↗
PubMed1988

[Therapy of bone and joint changes in renal osteodystrophy in adulthood].

The renal osteoarthropathy in patients with chronic renal disease undergoing hemodialysis is characterized by increased bone turnover. This is the consequence of secondary hyperparathyroidism and leads to fibro-osteoclasia and osteomalacia. Mineralization of the atypical bone fibers is diminished and the collagen texture is altered. The biomechanical properties of such bone are reduced, which means that the incidence of fractures is increased and fracture healing seems to be disturbed. Therapy given for renal failure leads to segmental necrosis of the epiphyses. In the growing skeleton longitudinal growth is diminished and deviations in the axes of long bones are often observed. Corrective osteotomies, treatment of fractures and artificial joint replacements are therefore necessary in patients with renal failure. Observations recorded in 13 patients (aged 16-67 years) with chronic renal insufficiency who underwent 21 surgical interventions and were followed up for 6 years have led to formulation of the following general recommendations. Corrective osteotomies should only be performed when they are absolutely essential; the rate of nonunions is very high. The same is true for fixation of fractures with plates and nails. When joint replacements are inserted because of segmental necrosis and fractures the course is almost the same as in patients without renal osteoarthropathy when bone cement is used for fixation.

Adolescent↗