Search PubMed⌕ Search

Biomedical subjects

M Blauth

Publications and source records attributed to M Blauth.

102 records · Page 6Linked to original sources
PubMed1989

[Injuries of the acromio- and sternoclavicular joint--surgical or conservative treatment?].

At the acromioclavicular (AC) joint we distinguish between horizontal instability caused by damage to the AC ligament from vertical instability caused by damage to the coracoclavicular liagments. The most common mechanism of injury is direct force resulting from a fall onto the point of the shoulder. The injury is classified according to the amount of damage brought about by a given force. Horizontal and vertical instability have to be evaluated by special radiographic views. Types I and II are treated by a sling worn for a few days and the application of ice bags. In type III injuries the patient's age, job and acitve pursuits determine whether or not surgery is indicated. In type IV-VI injuries we always perform the operation. We use a resorbable cerclage between the clavicle and the coracoid process and suture all torn ligaments. In the sternoclavicular joint too, the ligamentous stability is of the utmost importance. The sternoclavicular ligament limits the ante- and retroversion of the clavicle, while the costoclavicular ligament limits the upward movement. The direction of subluxation or luxation has to be evaluated by means of an oblique view X-ray with a cephalic tilt of the tube through 40 degrees or by a computed tomogram. In the case of an acute injury closed reduction should always be attempted. Open recuction should only be performed in cases of persistent posterior luxation, because of the numerous complications that are possible in such cases.

Acromioclavicular Joint↗
PubMed1989

[The surgical treatment of injuries of the cervical spine].

The authors' ideas on the management of acute and chronic cervical spine injuries are presented. Unstable fractures and dislocations of the lower cervical spine should be reduced as soon as possible. Most frequently, the authors use the anterior approach and the Smith-Robinson technique with the addition of a H-shaped plate. Posterior fusion is mainly indicated for the release of irreducibly locked facets. Unstable odontoid fractures, especially those in group II according to Anderson and d'Alonzo, are stabilized by internal fixation with a screw. Between 1971 and 1987, 263 patients with lesions of the cervical spine were treated operatively: of these, 169 had acute and 32 chronic injuries; 47 patients had primary tumors or metastases; 15 suffered from arthritis, spondylodiscitis or congenital deformity. The findings in 92 patients (group I) with acute and 24 (group II) with chronic injuries at follow-up are reported. Among the 53 patients in group I with neurologic failure, an improvement was noted in 45 (85%); in 30 cases there was complete restoration of function and 72% of the injured patients became symptom-free. In 71% of those with acute and 58% of those with chronic injuries normal mobility was observed. Regardless of neurologic failure, 89% of patients in group I were able to work after 5 months. The rate of pseudarthrosis was 2%. The risks involved in anterior interbody fusion in the cervical spine are small when a careful and standardized operation technique is used. This allows early functional treatment and shortens the rehabilitation time.

Adolescent↗
PubMed1987

Therapeutic concept and results of operative treatment in acute trauma of the thoracic and lumbar spine: the Hannover experience.

A therapeutic concept for the treatment of acute thoracolumbar spinal injury includes an early closed reduction as the first step. In cases with a surgical indication in the lower thoracic area as well as in the lumbar spine, the posterior approach is preferred. Following decompression of the spinal cord, a transpedicular lifting of the upper endplate is done and the fractured vertebra is filled with corticocancellous bone chips. Stabilization is achieved with an internal fixator usually over two motion segments only. Subsequently, autologous corticocancellous bone is added between lamina and between the transverse processes. In the thoracic spine proper, the anterior approach is more advantageous. Following spondylectomy (removal of the vertebral body whole or in part), an intercorporal spine arthrodesis is performed utilizing a solid bone graft and plates. Seventy-six patients with 78 fractures and subluxations of the thoracolumbar spine were reexamined for an average of 3 years and 4 months after their operation. Of the patients with an incomplete cord injury (Frankel B-D) 60% improved at least one Frankel grade and an additional nine patients improved within their group. Clinical deterioration did not occur. Irrespective of the localization, the radiologically determined loss of correction following an anterior approach was an average of 7 degrees whereas the settling after posterior approach averaged 9 degrees. The sagittal index of the affected vertebra improved from 0.59 preoperatively to 0.80 postoperatively. All spinal arthrodeses healed with osseous reorganization. Twelve postoperative computer tomographies were analyzed (11 after a posterior decompression), and showed a decrease of the spinal canal compromise from 65% preoperatively to 11% following surgery.

Adolescent↗
PubMed1987

[Primary reconstruction of injuries of the capsular ligament of the knee joint].

Whether operative or conservative treatment is indicated for acute knee ligament injuries depends on the lesions of the cruciate ligaments: complex instability with rupture of one or both cruciate ligaments and injuries to the lateral or medial ligamentous structures should be treated by operation. Surgical treatment of an isolated rupture of the anterior cruciate ligament is recommended only for the young active patient. Surgery is performed by way of a single anterolateral incision with standard medial and if necessary, lateral arthrotomies. Ruptures of the cruciate ligaments are reconstructed with absorbable sutures, which are passed through bone channels. Augmentation with an absorbable allograft is used in most reconstructions of the cruciate ligaments. A knee brace with limited range of motion is used for postoperative rehabilitation. Our long-term results after operative reconstruction of acute instabilities of the knee joint show that ligamentous stability was achieved in most cases, but the functional results were impaired by pain and limited range of motion.

Adult↗
PubMed1984

Light- and electron-microscopic studies in congenital pseudarthrosis.

This study presents the results of light- and electron-microscopic and enzyme histochemical investigations in ten cases of congenital pseudarthrosis of the lower limb. At the time of surgery, six of the ten patients had not been operated on previously. The characteristic histological feature of the "sclerotic type" of congenital pseudarthrosis was a marked fibromatous reaction consisting of cellular connective tissue. The constituent cells were arranged in bundles and had elongated nuclei. The number of nuclei per visual field was considerably higher in pathological specimens than in specimens from the uninvolved leg. In places, the histological appearance resembled somewhat that of palmar fibromatosis (Dupuytren's disease). Destruction and absorption of bone were always found. Electron-microscopic analysis showed that a large number of the cells represented myofibroblasts. These findings were supported by the positive reaction of the cells for the enzyme diaminopeptidase IV, a marker enzyme for myofibroblasts [30]. As yet it is not possible to decide whether the constriction of the pseudarthritic bone is caused by a thickened myofibroblast-containing periosteum [40] or by the aggressive osteolytic component of the fibromatosis [12, 19, 41]. Furthermore, the relationship of congenital pseudarthrosis to fibrous dysplasia of bone is still unknown. Obviously, there are histological similarities between the two diseases, including the presence of osteolytic fibrous tissue in the medullary cavity and C-shaped bone trabeculae. However, the pattern of bone involvement and prognosis are different. Irrespective of the type of congenital pseudarthrosis, focal angiomatous hyperplasia was noted in some cases. This proliferation of blood vessels is most likely a reactive change.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone and Bones↗
PubMed1983

Stressing on the human femoro-patellar joint. I. Components of a vertical and horizontal tensile bracing system.

Horizontal and vertical tensions act on the femoropatellar joint. In both knee joints of 60 human corpses the muscles and ligaments participating in the tensile bracing of the knee joint were studied macroscopically. While the structures acting in the vertical direction are very constant, the components participating in horizontal tensile bracing show large variations. Components of vertical tensile bracing are the quadriceps femoris muscle, the ligamentum patellae as well as the vertical patellar retinacula. The active part of horizontal tensile bracing consists of the medial and lateral vastus muscles. The passive components of this system are arranged in three layers. The superficial layer is formed by the fascia lata. The middle layer consists of the horizontal retinacula. A medial horizontal retinaculum was present in one third of our cases. It passes from the medial margin of the patella towards the medial femoral epicondyle. A lateral horizontal retinaculum is demonstrable in all cases studied. It passes horizontally from the lateral margin of the patella and inserts into the deep layer of the iliotibial tract. Insertion of the lateral horizontal retinaculum into the lateral femoral epicondyle was not observed in our material. The third layer is formed by ligaments supporting the joint capsule. These originate from the medial and lateral margin of the patella and pass towards their respective meniscus as well as variably towards the femoral or tibial condyle. These structures are found both medially and laterally in two thirds of the cases studied.

Adult↗
PubMedDate not supplied

Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques.

OBJECTIVE: To determine whether long-term results of one of three different management protocols for severe tibial pilon fractures offer advantages over the other two. DESIGN: In a retrospective study, patients were examined clinically and radiologically after internal fixation of severe tibial plafond fractures (i.e., 92 percent Type C fractures according to the AO-ASIF classification). SETTING: Department of Traumatology, Hanover Medical School. Level I trauma center. PATIENTS: Fifty-one of seventy-seven patients treated between 1982 and 1992 were examined clinically and radiologically at an average of sixty-eight months (range 13 to 130 months) after injury. INTERVENTIONS: The patients were treated in three different ways: primary internal fixation with a plate following the AO-ASIF principles (n = 15), which was reserved for patients with closed fractures without severe soft tissue trauma; one-stage minimally invasive osteosynthesis for reconstruction of the articular surface with long-term transarticular external fixation of the ankle for at least four weeks (n = 28); and a two-stage procedure entailing primary reduction and reconstruction of the articular surface with minimally invasive osteosynthesis and short-term transarticular external fixation of the ankle joint followed by secondary medial stabilization with a plate using a technique requiring only limited skin incisions (a reduced invasive technique) (n = 8). MAIN OUTCOME MEASUREMENTS: Objective evaluation criteria were infection rate, amount of posttraumatic arthritis, range of ankle movement, and number of arthrodeses. Subjective criteria were pain, swelling, and restriction of work or leisure activities. RESULTS: Because only closed fractures were treated by primary internal fixation with a plate, there was a statistically significant difference (p < 0.005) in the distribution of open fractures between the three treatment groups. Fracture classification in these groups were not significantly different. All but four fractures were classified as Type C lesions according to the AO-ASIF system. The soft tissue was closed in 63 percent (n = 32) and open in 37 percent (n = 19). No significant relationship could be found between the soft tissue damage and degree of arthritis or between the type of surgical treatment and extent of posttraumatic arthritis. However, none of the patients who required secondary arthrodesis (23 percent of all cases) were in the group who had undergone two-step surgery (p < 0.05). The range of ankle movement was much greater in the two-step group than in the others; these patients also had less pain, more frequently continued working in their previous profession, and had fewer limitations in their leisure activities. These differences did not reach statistical significance. The incidence of wound infection did not differ significantly among the three groups. CONCLUSIONS: On the basis of our results, we now prefer a two-step procedure for the treatment of severe tibial pilon fractures with extensive soft tissue damage. In the first stage, primary reduction and internal fixation of the articular surface is performed using stab incisions, screws, and K-wires. Temporary external fixation is applied across the ankle joint. After recovery of the soft tissues, the second stage entails internal fixation with a medial plate using a reduced invasive technique.

Adolescent↗