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M Wildner

Publications and source records attributed to M Wildner.

At least 37 records · Page 2Linked to original sources
PubMed1999

An indirect method for the estimation of osteoporotic fractures from injury and fracture profiles.

Study objective was to develop a valid epidemiological method for the estimation of osteoporotic fracture risk, using administrative databases and accounting for variable baseline risks of injury. Design is the secondary analysis of inpatient and outpatient utilization data. A baseline injury risk was estimated by the incidence of primary utilization of medical services for soft tissue injuries (ICD-9 diagnostic codes 910-929), and the risk profile was compared after normalization with the overall primary utilization rate for fractures (ICD-9 diagnostic codes 800-829). The setting is a county with approximately 100,000 inhabitants in the former East Germany. Participants were all inhabitants of the county who had a physician contact (inpatient or outpatient) during 1987-1988, as well as hospital inpatients for all of Germany in 1989. The number of fractures increased with age, especially in women, when compared to the number of fractures expected from the incidence of soft tissue injury. Similar patterns were identified in hospitalization data from East and West Germany. Estimating the prevalence of osteoporosis directly from certain "osteoporotic" fracture types associated with higher age is potentially biased, since it neglects the underlying risk of injury. Our model distinguished the osteoporotic fracture risk as the excess risk over an expected injury-related fracture risk for a given age and sex, and may allow a more valid quantification of osteoporotic fractures in different populations.

Adolescent↗
PubMed1999

A secular trend in hip fracture incidence in East Germany.

The central Inpatient Register of the former German Democratic Republic was used to study the population-based epidemiology of hip fractures among 16.5 million East Germans. Incidence rates for hospital discharges for proximal femoral fractures for the age group 60 years and over were calculated for the years 1971 to 1989, the year before unification. Incidence rates for 1989 are similar to figures reported from the UK and The Netherlands, but lower than Scandinavian rates. A decrease in the admission rate was noted from 1971 to 1974 of 4.5% each year on average, and an increase from 1974 onwards of 4.4% on average. This change was observed to a different extent in all age groups. The female:male ratio of the standardized discharge incidence was stable at 2.3:1 and the female:male ratio of manifest cases increases from 4.1:1 in 1971 to 5.1:1 in 1989. An exponential increase in the incidence rates was observed with age. This apparent rate overestimated both the rate for true incident cases (by about 25-30%, if adjustments are made for readmissions and transfers) and their trend. Adjusted estimates for incident fractures show an increase of 2% annually. Cohort effects due to changed selective forces appear to be one reasonable causal explanation.

Aged↗
PubMed1999

[Examples and proposed solutions for methodological problems in hospital appropriateness assessment].

Inappropriate hospital care has become a recurring theme since the publication of the results of the model project on the appropriateness of hospital care (Section 275 a SGB V) by the medical service of the National Associations of Health Insurers (MDS) in Spring 1997. Nationwide, an increased number of appropriateness assessments have since been conducted by the medical service of the health insurers (MDK). The basis for an objective assessment of the appropriateness of hospital care is a diligent, comprehensive, and methodologically valid examination of the actual situation. At first, it was unknown to what extent current methods in Germany conformed to international scientific standards in Epidemiology, Biometry, and Health Services Research. Following a thorough scientific examination of several typical methodologies, it became clear that current methods are insufficient, and hence do not allow valid conclusions regarding inappropriate hospital admissions or hospital days. This statement does not deny that inappropriate hospital use is very likely, but our current assessment tools do not permit further conclusions to be drawn. The purpose of this article is to identify typical mistakes in the fundamental aspects of a valid assessment based on selected examples. Proposals are made regarding methodology and the presentation of results that follow from this critical examination.

Germany↗
PubMed1998

[Disparities in hospital mortality after proximal femoral fractures in East Germany 1989].

The revised and pseudonymized data set of the hospital discharge diagnoses of East Germany (German Democratic Republic, GDR) for 1989 was analyzed regarding the in-hospital case fatality of closed hip fractures (ICD-9 820.0, 820.2, 820.8). The case fatality of 20.2% during an average hospital stay of 60 days including between-ward and between-hospital transfers is high when compared to international data and data for West Germany. Apart from the expected influence of age, fatality was reduced for cervical (intracapsular) fractures, female sex, and for a location of the treating hospital within East Berlin. This reduction of the case fatality within East Berlin by nearly two thirds after adjustment for age, sex, and type of fracture compared to other regions is most likely explained by better medical treatment facitilities within East Berlin, the former capital of the GDR. The regional disparities that were observed during our model analysis give a hint towards the influence that medical care can have on the fatality associated with this on a population level relevant disease.

Adult↗
PubMed1998

[Development of an epidemiologically based health reporting system].

It is the aim of an epidemiologically sound health reporting to present concisely relevant health data in a manner similar to that of management information systems and to comment and interpret them for rational action. Its goal is to deliver the right information at the right time at the right place and in suitable form. Health reports render facts transparent by information and evaluation in the health care sector, help decision makers to act competently by guiding and orientating them in respect of recognising the underlying problems, and thus contribute to coordination and, to setting priorities. Today's health reporting supplements the usual health statistics by primary data collection focussed on current health problems in a population. Computer-assisted telephone interviews provide an equally good coverage as the traditional methods. All this enables to record behavioural changes nearly as sensitively as a seismograph and also to monitor prevention and corrective action in their effects almost in real-time, and, moreover, for a long time (i.e. longitudinally). This approach could be a model for a scientific modernisation of Public Health Service information services.

Disease Notification↗
PubMed1995

[NMR tomographic measurement of femoral ante-torsion and tibial torsion].

PURPOSE: A new MRI method for the measurement of femoral torsion and tibial torsion is presented. METHODS: Axial images were generated using a standard gradient echo sequence (FLASH 2D). Otherwise measurement of femoral and tibial torsion was performed according to an established CT method. RESULTS: The torsion angles measured using MRI were in accordance with the angles measured using the CT method. The MRI method was not more time-consuming than the CT method. CONCLUSION: In respect of radiation exposure, MRI determination of femoral and tibial torsion should be considered particularly in children and patients who have to undergo repeated torsion measurements.

Adolescent↗
PubMed1994

Osteoarthritis after the Eden-Hybbinette-Lange procedure for anterior dislocation of the shoulder. A 15 year follow up.

We have quantified the rate and severity of osteoarthritis after the Eden-Hybbinette-Lange procedure. With a mean follow up of 15 years, 44/56 (79%) of operated shoulders showed osteoarthritic changes on radiographic review. Of the contralateral non-operated shoulders the rate of osteoarthritis was 8/60 (8%). Only shoulders in the operated group demonstrated severe osteoarthritis. In our hands the rate of osteoarthritis for the Eden-Hybbinette-Lange procedure is higher than for the Eden-Hybbinette procedure or for rival operations for recurrent dislocation. We recommend careful evaluation of the Eden-Hybbinette-Lange procedure. The high rate of late osteoarthritis indicates that other operations with an equally low rate of redislocation may be of greater long term benefit to the patient.

Adolescent↗
PubMed1993

Late results of the Keller-Brandes operation for hallux valgus.

Evaluating the late results of the Keller-Brandes operation for hallux valgus in 100 feet on average 5.5 years after surgery, these were functionally and cosmetically satisfying to the patient in 90% of cases. In 97% pain was relieved completely or partially. On examination, however, 23% of the feet still had a clinical hallux valgus angle of more than 30 degrees. A dorsal extension-contracture which was found together with 50% or more of phalangeal resection was present in 6%. The power of plantar flexion of the big toe decreased with the extent of resection of the proximal phalanx. Resection of more than half of the proximal phalanx seems to be disadvantageous and should be avoided.

Adult↗
PubMed1992

Complications of high tibial osteotomy and internal fixation with staples.

Osteotomy for osteoarthritis of the knee has established itself well since its first description by Jackson and Waugh [8, 9]. Internal fixation with staples allows early functional treatment with only a minimum of operative intervention. Removal of the metal is optional. In the 5-year period from 1986 to 1990, 182 high tibial osteotomies were performed at the Orthopaedic Department of the University Hospital of Freiburg. In four cases internal fixation was done with plates; in 178 cases two or more staples were used; in 3 cases a screw was additionally inserted for better hold. The staples became loose intraoperatively in eight cases (4.5%); only once did a dislocated staple have to be reoperated on post-operatively. Further complications which are independent of the method of internal fixation are summarized in the article. Complications of surgery on the long bones of the leg are inevitable, but with only one postoperatively dislocated staple and one case of non-infected pseudarthrosis (i.e. a method-related complication rate of 1.1%), internal fixation with staples for high tibial osteotomy presents itself as a reliable and safe procedure.

Adolescent↗