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Biomedical subjects

P Hertel

Publications and source records attributed to P Hertel.

At least 19 recordsLinked to original sources
PubMed1992

[Clinical experience with collagenous wound dressing in severe traumatic soft tissue injuries].

We treated 34 patients during 1987-1990 with a collagen wound dressing. Eleven patients had traumatic soft tissue defects, 10 patients had 3 degrees-grade open fractures, 7 patients had infected soft tissue wounds and 6 patients had deep 2 degrees and 3 degrees-degree burns. Our clinical experience confirmed the excellent clinical experimental results of collagen wound dressings. In all cases after 4 until 6 days of treatment good granulation and vascularisation of the wound bed was obtained, so that a skin transplant could be performed, which in all cases healed primarily. Moreover, the wound dressing had a good antibacterial effect and integrated actively in the wound healing process.

Adolescent↗
PubMed1992

[Volar plate osteosynthesis in typical and atypical distal radius fractures].

28 patients with a fracture of the distal end of the radius were treated by a T-plate osteosynthesis through the volar approach. There were 7 unstable distal metaphyseal fractures and 21 dislocated intra-articular fractures. 21 patients were investigated 6 months to 8 years after operation according to the scheme of Sarmiento. 17 patients had a good or excellent result, 4 patients a fair or poor result. 2 patients developed a Sudeck's dystrophy (Algodystrophy), one of them with a radial-ulnar bone bridge. The volar application of the plate is indicated for flexion and extension fractures. In cases with compression of the dorsal cortex a bone graft is indicated to improve a stable osteosynthesis. A conventional tomography on two views helps to diagnose exactly an intra-articular fracture and to decide whether to use a plate or pins and external fixation after open reduction. Remanipulation or an operation 2 weeks after trauma increases the risk of a Sudeck's dystrophy and leads to a poor result.

Adult↗
PubMed1992

[Magnetic resonance tomographic diagnosis of internal lesions of the shoulder following luxation. A comparison with arthroscopic findings].

Fifteen patients with a recurrent dislocation of the glenohumeral joint were preoperatively investigated by MRI. We created a special protocol with axial T1-, T2-, proton-density- and sagittal T1-weighted images. MRI findings such as defects of the glenoid labrum and Hill-Sachs compression fractures proved to be correct during surgery. In the chosen protocol the diagnostic imaging of rotator cuff lesions was not specific. In 10 cases lesions were seen but in only 5 patients did these findings prove to be correct during surgery. However, MRI imaging of glenohumeral joints is a reliable non-invasive diagnostic method.

Adult↗
PubMed1991

[True Madelung's deformity and traumatic pseudo-Madelung. An exemplary differential diagnosis of the deformity in the forearm of children].

This article describes the differential diagnosis between hereditary Madelung's deformity and acquired posttraumatic Pseudo-Madelung's deformity. Three cases of posttraumatic Pseudo-Madelung's deformity were reported. Aspects of aetiology, clinical radiological appearance of hereditary Madelung's deformity and acquired Pseudo-Madelung's deformity are discussed. Differential diagnostic criteria for the discrimination between both forms are also discussed. A rare case of acquired posttraumatic "reversed" Madelung's deformity is also reported.

Adolescent↗
PubMed1991

[The malunited juvenile fracture--Monteggia defect].

Late reconstruction after neglected Monteggia lesions in children is discussed. On the basis of the literature (20 cases) and 2 personal cases it is deduced that open reduction of the radial head should be combined with osteotomy of the ulna according to the pathophysiology of the lesion. Details of the operative procedure are given. Reconstruction of the annular ligament is the least important part. Reconstruction is indicated in children under the age of 10-12 years even if the dislocation has been present for years. Unfavorable conditions for operative reconstruction are long-lasting dislocations in older children, deformation of the radial head, and imminent skeletal maturity.

Adolescent↗
PubMed1991

[Traumatic partial paralysis caused by injury of the R. profundus nervi radialis. Nerve reconstruction and tendon transfer surgery].

Traumatic lesion of the deep branch of the radial nerve (posterior interosseous nerve) causes paralysis of the finger and thumb extension while wrist extension is maintained. There is no sensory disturbance. The lesion can be caused by knife injury, by Monteggia lesions and iatrogenically by procedures at the proximal radius. Traumatic disconnection of the posterior interosseous nerve is a good indication for early surgical exploration of the nerve; microsurgical reconstruction should then be carried out. When nerve repair has not been done or has been unsuccessful, finger and thumb extension can be achieved by various methods of tendon transfer. No transfer is necessary for the wrist. In two cases with fresh discission of the deep branch of the radial nerve (one after knife injury and one due to plate osteosynthesis of the radius) a microsurgical reconstruction was done. In two other cases with an old lesion after procedures on the proximal radius and unsuccessful nerve reconstruction a tendon transfer was done. In the two cases of acute microsurgical intervention the recovery was complete. In the two cases of tendon transfer good restoration of the finger and thumb extension was achieved.

Adolescent↗
PubMed1991

[Fracture and dislocation fracture of the os pisiforme].

Four cases of pisiform fracture are presented. In one case the largest fragment of the pisiform bone with the articular surface was dislocated. After open reduction, osteosynthesis with K-wires was performed. Two patients had an isolated fracture without fragment dislocation. They had their lower arms immobilized with a plaster of Paris cast for 4 weeks. In the fourth case the fracture of the pisiform bone was associated with an intraarticular distal radial fracture and wrist dislocation. The typical traumatic cause of pisiform fracture is a fall onto the outstretched hand. Immobilization for 4 weeks results in functional recovery. In cases with dislocation of the pisotriquetral joint open reduction and osteosynthesis are necessary. Excision of the pisiform bone is not indicated in a fresh injury.

Adult↗
PubMed1990

[A NMR tomographic follow-up assessment of the replacement plastic repair of the anterior cruciate ligament with an autologous ligamentum patellae transplant].

Reconstruction of the anterior crucial ligament can be performed by using an autogenous transplant from the patellar ligament. Employing postoperative MR investigation, reaction of the non-vascularised tendon was studied. In 16 patients 20 knees were investigated by applying a 1.5 tesla magnet with T1-weighted (TR 500 ms, TE 15 ms) and a T2*-weighted (FISP 3D: TR 30 ms, TE 10 ms, flip angle 40 degrees). Postoperative MR follow-up showed an increase in signal intensity and diameter in T1-weighted images. This represents revascularisation of the transplant.

Anterior Cruciate Ligament↗
PubMed1990

[Reconstruction of the proximal insertion of the anterior cruciate ligament. Studies on the accuracy of a non-instrumental method].

The isometry of the femoral and tibial insertion is of decisive importance for the stability of a prosthetic anterior cruciate ligament. A large number of techniques and instruments have been developed to determine the point of isometric femoral insertion. Experiments with 20 cadaveric knees show that the proximal insertion of the anterior cruciate ligament is accurately reconstructed by means of the surgical procedure briefly presented in this paper; the use of positioners is not necessary.

Anterior Cruciate Ligament↗
PubMed1990

[Repeat arthroscopy].

Repeat arthroscopy was done in 82 patients from 1984-1988 (2.5%) 18 months after the first arthroscopy. Eighteen of the repeat arthroscopies were planned operations, 35 were necessary due to continuous complaints, and 20 were done because of new complaints. Nine were done after a new accident. In 4 cases, at repeat arthroscopy a meniscus remmant was excised that had been insufficiently treated at the first operation. In four cases, a new meniscal lesion had occurred. An extension lag after ACL reconstruction was another reason for repeat arthroscopy. In those cases sometimes a synovial tumor in the intercondylar notch was excised. In these repeat arthroscopies, 84% were done by the two most experienced arthroscopists in the department.

Adult↗
PubMed1979

[Microsurgical plastic reconstruction of the explosion-damaged hand].

During the last two years, 16 severe explosion injuries of the hand have been treated with plastic microsurgery in our hospital. The injury had arisen in seven cases from the mixture sugar + sodium chlorate (C12H22O11 + NaClO3). This substance mixture may already be caused to explode by slight vibrations and the warmth of the hands. In explosion injuries, there is mechanical, chemical and thermal tissue damage. The postoperative course is therefore complicated in almost all cases. However, by meticulous removal of the disseminated foreign particles, excision of necrotic tissue and extensive reconstruction of the interrupted vascular and nerve supply, it is possible in a few cases to preserve functionally important parts of the hand. Later plastic procedures are made more difficult by tissue fibrosis and foreign body granulomas.

Adolescent↗
PubMed1977

[Experimental studies on the pathophysiology of knee ligament lesions (author's transl)].

The cruciates and the collateral ligaments of the knee compare well with a crossed four-joint chain. In surgery of the ligamentous lesions of the knee it is essential to reinsert the ligaments exactly at their anatomic position. Studies of cadaver knees have demonstrated that the medial collateral ligament ensures medial rotational stability to a greater degree than the meniscofemoral and meniscotibial bands. In every stage of medial and anterior ligamentous lesions, external rotation in 90 degrees of flexion shows the same amount of anterior laxity of the medial tibial condyle as the test of Slocum. In contrast to Nicholas the pivot point in anteromedial complex instability is situated posterolaterally.

Biomechanical Phenomena↗