[Proximal reinsertion in alloplastic replacement of the anterior cruciate ligament. Experimental studies of a modified over the top technique].
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Anterior Cruciate Ligament↗
Biomedical subjects
O Paar
Publications and source records attributed to O Paar.
[Possibilities for using sonography as a diagnostic procedure in fractures during the growth period].
Alzen et al. found that of 2,006 X-rays taken to identify fractures in childhood, only 345 fractures could be verified. To minimize this discrepancy, the traumatology department at the RWTH in Aachen prefers performing ultrasound before taking an X-ray. We call this procedure "osteosonography". If one uses osteosonography, fractures can be recognized, interpreted and, in some cases, immediately treated without taking additional X-rays. Furthermore, it is then possible not to have to X-ray the extremities, resulting in a reduction in the amount of radiation to the gonads and epiphyses. Other advantages of osteosonography are that it is then possible to compare examinations of the contralateral side, interpret bone and tissue at the same time, and do the examination in the presence of the parents. After 180 children had been examined, it became apparent that in 53.3% of all children, the X-ray could be replaced by osteosonography. On the one hand, we had children with no ultrasonographic suggestion of fractures and, on the other, we had fractures with no indications for repositioning or operating (e.g. "bulge fractures"); these could be treated at once with cast. We are of the opinion that our experience with osteosonography justifies generally making this the first diagnostic measure before X-raying children during the growth phase. A this way, radiation can be minimized, resulting in a reduction in X-ray-induced damage.
Adolescent↗
[Free, vascularized, folded fibula transplantation].
A free vascularized folded fibula as possibility for reconstruction of segmental bony defects up to 9 cm is described. Preserving its vascularisation, the fibula is osteotomized and folded into two equal or two vascularized bone transplants of different length with only one arterial and venous pedicle. Folding of the fibula leads to a biomechanically superior stabilisation. This technique was used in a posttraumatic osteomyelitic defect of the tibia after a Pilon tibiale fracture.
Adult↗
The significance of multiple trauma in children.
Accident-related injuries, mainly traffic-connected, are the most serious threat to health and most-frequent cause of death in the pediatric age group. Usually these are multi-system injuries. While the total number of accidents has decreased over the last 20 years, traffic accidents have become more serious. Conventional prognostic scores are not applicable in children with multiple injuries because of their essential pathophysiologic differences with adults. The Pediatric Trauma Score closes this gap. It is simple to use and provides high reliability.
Accidents, Traffic↗
[Long-term follow-up of polytrauma].
While there are numerous scoring systems for assessment of the immediate period after multiple trauma, hardly any studies exist on the long-term sequels of these serious injuries. We interviewed and examined 104 patients who had sustained such an injury 1-6 years previously (median 4.3 years). Our study revealed that the long-term outcome cannot be correlated with the ratings in a typical polytrauma scoring system. Therefore, we suggest a new scoring system that allows assessment of long-term results by taking into account accident-related limitations in three essential areas of everyday life: school/profession; basic abilities; leisure time/hobby/sports.
Activities of Daily Living↗
[Does performance of a stress roentgen image of the upper ankle joint in acute fibular capsule ligament lesion entail an operation? An experimental study].
In an experimental study the sequelae of performing stress films on the ruptured lateral ligaments of the ankle joint are documented. It is shown that stress films may cause further damage on the ankle capsule when there is ligamentous disruption. After performance of stress studies a sufficient realignment of the interrupted ligaments by immobilization of the foot in a neutral (right angle) position can not be achieved. This makes, at least for younger patients, operative therapy after positive stress films advisable.
Ankle Injuries↗
[The polytraumatized child. Pattern of injuries, characteristics of therapeutic management and prognosis].
Accident-related injuries account for a major part of childhood morbidity and mortality. More than 25% of the patients treated at the University Clinic Aachen for severe multiple trauma are below 16 years of age. The younger the children are, the more the pattern of injuries as well as the therapeutic approach differ from the well-known standard in adults. This is due to the anatomic and physiologic differences encountered in children. A reliable and practical triage instrument is needed to overcome the problem of estimating the severity of injuries in a child. The Pediatric Trauma Score seems to fulfill these requirements.
Brain Injuries↗
[Biomechanical effects of intra-articular ankle bone fractures on the ankle joint. An experimental study].
Intraarticular heelbone fractures lead to cartilage damage by way of joint surface incongruence. This causes arthrosis of the lower ankle joint. The influence of a dislocated calcaneus fracture on the upper ankle joint was documented in an experimental study on eight cadaver legs. We performed an osteotomy of the calcaneus to imitate a typical fracture, placed a pressure film into the upper ankle joint and subjected the joint to axial pressure of 850 N. Changes in contact area and pressure pattern were measured in different flexion/extension positions of the foot. Results with respect to total contact area and high-pressure contact zone are discussed.
Ankle Joint↗
[Avulsion fractures of the knee and upper ankle joint. Classification and therapy].
Injuries of the joint surface interfere with joint mechanics. Avulsed fragments should be reattached to prevent development of arthrosis. Of 150 fractures of the knee joint 72% were osteochondral and 28% chondral avulsion. About half of the chondral lesions could be refixed successfully. If replantation is impossible, this cartilage defect has to be smoothed and, when indicated, connected to spongy bone by subchondral drilling.
Arthroscopy↗
[Plate osteosynthesis of the femur in patients with multiple and mono-trauma].
In multiple trauma patients successful treatment of femur shaft fractures depends more on timing of osteosynthesis than on choosing a specific type of fracture stabilization. Because of theoretical and practical reasons early osteosynthesis within 24 to 48 hours seems to be advantageous. In our experience it led to a significant decrease in complications. However, concomitant thorax trauma mandates special consideration. The two fatalities in our study belonged to this subgroup. With adequate indication for therapeutic intervention, correct operative technique and consideration of the patient's general status good results can be expected with every type of fracture treatment available (external fixation, plate fixation, intramedullary nailing).
Adult↗
[Fatigue fracture of the tibia following osteosynthesis. An interesting case].
Stress-fractures most often affect healthy bones, in the majority of cases the tibia. We report a case of a young man who had a stress-fracture 18 months after osteosynthesis of a lower leg-fracture. Under biomechanical aspects an oscillation-fracture is mostly probable because the angle of the fracture is exactly 45 degrees to the longitudinal axis of the tibia.
Adult↗
[Results of meniscus sutures in the framework of reconstruction in combined injuries of the knee joint: clinical aspects, arthrosonography, arthrography and computerized tomography].
In spite of encouraging experimental results of suturing menisci in the not-vascularised area, even today in most of these cases subtotal resection will be done. The results of meniscal reconstruction in 15 patients with a longitudinal tear of the degeneration area as consequence of a combined injury of the knee joint are discussed. Only one patient suffered a postoperative rerupture. The others did not show any signs of continuing tears of the menisci during a study period of 18.7 months. Whereas in arthrography only in a few cases superficial notches, sign for a physiological recessus, were found, CT-scan as well as arthrosonography showed in large degree of correspondence change of density in the region of suture, which can be interpreted as a process of scar transformation. Thus it is recommendable to use suture of meniscus next to stabilizing measurements of injured knee-joint, even in the zone of degeneration.
Adult↗
[Strategy of the interdisciplinary early intervention in unstable pelvic injuries and concomitant urogenital lesions].
Among our polytrauma patients, 36.3% suffered combination injuries of the pelvic ring and the urogenital tract, and 8 of the patients with this type of lesion underwent orthopedic and urological surgery in a single session on the day of the accident. One patient died of multiple organ failure, but otherwise we did not observe any complications; in particular, no infections occurred. By an average of 11 months after the operation, all patients were continent for urine and had normal urethrocystograms. In 3 cases the pelvic ring lesion was treated by plate fixation and in a further 3 cases by plate fixation with additional temporary external fixation. Definitive stabilization was achieved in all cases by an average of 2 weeks postoperatively.
Bone Plates↗
[Therapy and prognosis of medial ligament injury of the knee joint].
We tried to classify the potential lesions of the medial ligament of the knee joint with regard to the therapeutic and prognostic background elements. We analyzed 354 lesions of the medial ligament and report the therapeutic alternatives. In addition, we made an attempt to correlate some of the lesion forms and their locations with the sport causing the injury.
Adult↗
[Displacement of the tibial tuberosity in retropatellar cartilage damage and recurrent patellar dislocation].
In our hospital in the years 1980 till 1986 37 displacements of the tuberositas tibiae were performed in chondropathia patellae and recurrent luxation of the patella. The follow-up examination took into consideration the radiological and clinical findings, the subjective complaints and the ability of going in for sports. These clinical experiences and pressure measurements in the femoro-patellar joint show the best results after the displacement of the tuberositas tibiae according to Blauth. Additionally we recommend an accurate indication for chondropathia patellae and recurrent luxation of the patella and accompanying surgical measures.
Adolescent↗
[Comparative clinical and arthroscopic study of the knee joint in chondromalacia patellae].
It is not easy to perform clinical diagnosis of chondromalacia patellae. Many cases take a clinically silent course and are discovered by chance only. Analysis for 275 arthroscopies resulted in almost complete agreement between clinical and arthroscopic diagnosis if the damage to the cartilage was diagnosed before arthroscopy. On the other hand, in chondromalacia that remained clinically silent, damage to the cartilage was present in 67% of the cases as detected by arthroscopy. The authors offer detailed comments on the problem of localisation of cartilaginous changes.
Adolescent↗
[Meniscus preserving interventions of the knee joint].
A meniscal lesion is the most frequent injury of the knee joint. Several experimental and clinical studies of the past 15 years pointed to the importance of the meniscus for the biomechanics of the knee joint. In particularly the posterior horn of the medial meniscus plays an important role regarding the stability of the joint. On the one hand, a total resection of the meniscus raises the risk of arthrosis, whereas on the other hand it increases the relative insufficiency of the medial capsule and collateral ligament. Because of these findings, nowadays the aim is to preserve most parts of the meniscus in case of injury. Apart from meniscopexia, longitudinal tears of the vascularised meniscus layer near the base, as well as of the so-called degeneration area, are sutured. Arthrographies performed postoperatively revealed smooth contours of the meniscus without any penetration of contrast fluid, which would have been a sign for a persistent lesion.
Humans↗
[Recurrent shoulder dislocation. On the sports capacity following surgical therapy].
The traumatic dislocation is one of the most seen dislocations of great joints. In 70% it happens to patients during sports and between 20 and 60% of cases are followed by instability of the shoulder. An explorative study informs about case history, postoperative course and sports participation after surgical treatment of recurrent dislocations of the shoulder. Good results of sports participation can be achieved with early diagnostic and therapeutic procedures.
Adolescent↗