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P Wendsche

Publications and source records attributed to P Wendsche.

At least 19 recordsLinked to original sources
PubMed2005

[Erectile dysfunction after traumatic pelvic injury].

UNLABELLED: Erectile dysfunction is a serious consequence of pelvic injuries. The aim of the study was to review and assess erectile dysfunction rates in mono and polytraumatized males with the pelvic injury, and to highlight the impotence-type of the pelvic injury relation and to evaluate the therapeutic response of the patients. METHODS: In total, 231 mono- or polytraumatized males with the pelvic injury were mailed a private letter including the HEF-5 International Index of Erectile Function questionnaire. The AO classification was used to assess the relation of the pelvic injury type and the onset of the erectile dysfunctin. The c2 test was used to assess the statistical significance. The peroral treatment with the phosphodiesterase 5 (PDE5) inhibitors was the therapeutical method of first choice. The therapeutical effect was assessed using the IIEF 5 questionnaire. RESULTS: We concluded that the erectile dysfunction affects nearly a third (31.5%) of the males who suffered pelvic injuries. The fact, whether the patient suffered an isolated pelvic injury or a pelvic injury in a polytrauma, has no influence on the erectile dysfuntion onset (p = 0.218), however, the onset of impotence has a significant connection to the type of the pelvic injury. We confirmed a statistically significant increase in the erectile dysfuncion rates in patients with the pelvic ring injury type B and C (p = 0.023). The mean IIEF-5 score prior to the treatment initiation was 11.5. In 85% of the patients the peroral treatment of the erectile dysfunctin using the PDES inhibitors was successful and resulted in achievement of the pair sexual satisfaction. The score of the IIEF-5 questionnaire reached physiological values 23 (22-25) following the treatment. Based on the findings, the authors recommend, during their hospitalization, to inform the males who suffered the type B and C pelvic ring injury about a possibility of their sexual dysfunction, and to advise them to contact a sexual disorders specialist.

Aged↗
PubMed2004

[Isolated fractures of the atlas].

PURPOSE OF THE STUDY: To present the current tends in the diagnosis and management of isolated atlas fractures based on the retrospectively evaluated group of patients with this trauma. MATERIAL: In the period from 1995 to 2002, we treated 486 injuries to the cervical spine at our department. Out of these, 19 patients sustained an isolated fracture of the first cervical vertebra. This group consisted of 12 men and seven women; the average age was 46.6 years. Neurological findings in 18 patients were classified as Frankel E and, in one, as Frankel A. The causes of injury included a fall from height in five patient, a fall in the street in five pedestrians, a car accident in five patients, a dive into shallow water in three and a shooting injury in one patient. METHODS: We treated 16 patients conservatively, using a halo-vest in eight patients and a Philadelphia collar also in eight patients. In two patients with unstable atlas injury, we carried out C1-C2 transarticular stabilization according to Magerl. In the patient who had been shot, we removed the bullet transorally. RESULTS: All patients healed completely without signs of instability. One patient with postraumatic pentaplegia, who died within 24 h of surgery due to septic shock, had not been included in the follow-up. Two patients reported neck pain at rest, three after exercise and 13 were without any pain. The patient after C1-C2 transarticular stabilization had a significant restriction of the range of motion in the cervical spine; the rest of the patients were without limitation. None of the patients showed any deterioration of neurological findings during the treatment, nor was any post-traumatic atlantoaxial instability recorded after the therapy was completed. DISCUSSION: Isolated fractures of the atlas account for 1 to 2% of all spinal fractures. Many fractures may remain unnoticed and, therefore, it is important to X-ray patients with a symptomatic injury to the cervical spine in three standard projection planes (anteroposterior, lateral and transoral). When a fracture of the atlas is suspected, it is necessary to examine them by computed tomography to obtain a more accurate presentation of fracture lines. Views on the method of treating isolated fractures of the atlas, particularly unstable ones, are not consistent. CONCLUSIONS: Isolated fractures of the first cervical vertebra, in terms of therapy, are stable and unstable. Stable fractures heal within 8 to 12 weeks. A Philadelphia collar or halo-vest provide sufficient immobilization. Surgical stabilization or a halo-vest immobilization for a period of 12 weeks are recommended in unstable injuries that are characterized by the lateral mass displacement of more than 7 mm or extension of the space before the dens (predental space) by more than 3 mm, or in which magnetic resonance imaging demonstrated injury to the transverse ligament. After the halo-vest removal, it is necessary to perform functional examination of the cervical spine for detection of potential atlantoaxial instability.

Adolescent↗
PubMed2004

[Traumatic atlanto-occipital dislocation].

The authors present two cases of survival after atlanto-occipital dislocation (AOD). Atlanto-occipital dislocation is in majority of cases lethal and only rarely compatible with life. AOD is often missed mainly in polytrauma in unconscious patients when the life endangering injury detracts attention from the examination of the upper cervical spine. The authors point out to the fact that with the improvement of the work of the rescue service and a fast transport of the patient to the hospital the number of these injuries may be expected to grow.

Adult↗
PubMed2004

[Injuries to the lower cervical spine].

PURPOSE OF THE STUDY: The authors present a retrospective evaluation of a group of patients with injury to the lower cervical spine. The aim of the study is to show current trends in the diagnosis and treatment of this trauma. MATERIAL: Between 1995 and 2003, 363 patients with trauma to the lower cervical spine were treated in our clinic. They included 63 women and 300 men, who fell into age categories as follows:14-19 years, 52 patients; 20-29, 108 patients; 30-39, 76 patients; 40-49, 57 patients; 50-59, 40 patients; 60-69, 22 patients; over 70, 8 patients. Neurological findings were classified as Frankel A in 109 patients, Frankel B in 24 patients, Frankel C in 19 patients, Frankel D in 12 patients and Frankel E in 199 patients. The trauma was due to a car or motorcycle accident in 183 patients, a fall from a height in 67 patients, a dive in water in 57 patients, a fall of the pedestrian in 47 patients and other causes in 9 patients. According to the level of the vertebra injured, fractures of the fifth cervical vertebra and the C6/7 segment were most frequent; fractures of the C7/T1 segment were least frequent. The AO classification showed type A injury in 22 %, type B in 23 % and type C in 55 % of the patients. METHODS: Conservative treatment was carried out in 100 patients, of whom 56 had a halo vest and 44 received a Philadelphia collar. Surgery was performed in 463 patients, most of whom, i. e., 246 patients, were treated from the anterior approach. Monocortical stabilization was used in 228 patients, bicortical fixation in 18 patients. Fifteen patients were treated from the posterior approach and two patients underwent a combined two-stage treatment. RESULTS: In the group of 263 patients treated surgically, there were several complications. Injury to the recurrent laryngeal nerve were recorded in nine patients, an abscess in the operative wound following the anterior approach developed in one patient and a hematoma of the anterior operation wound requiring revision surgery occurred in two patients. Complications involving implants were the following: fracture of the anterior plate in one patient, failure of anterior plate fusion in two patients, failure of posterior plate fusion in one patient and loosening of two anterior, bicortically inserted screws in one patient. Pseudoarthrosis was recorded in one patient with a fracture of the cervical spine locking plate. In the remaining patients (99.8 %) bony union was achieved by 6 months. Of the 363 patients, 164 had a medullary lesion; of these 17 died. Sixteen were classified as having Frankel A lesions and one having a Frankel B lesion. The cause of death was unrelated to the operation. Six patients with neurological deficit were transferred abroad. A patient diagnosed by the neurologist as Frankel A remained included in this group, although an improvement in his neurological status suggested an incomplete medullary lesion. Of the 141 patients with neurological deficit who were followed up for more than one year, 60 showed an improvement in neurological findings. DISCUSSION: The treatment of fractures of the lower cervical spine aims a decompression of the affected nerve structures and at restoration of the correct position and stability of the cervical spine. It is predominantly performed from the anterior approach; the posterior approach is used less frequently, only when indicated. CONCLUSIONS: The diagnosis of injuries to the lower cervical spine is based on the medical history, X-ray images in three basic projections and a CT scan. The necessity of a pre-operative MRI examination has recently been discussed. The use of the anterior approach in treatment of the injured lower spine is safe and effective. It allows us to carry out decompression as well as insertion of a graft and plate under direct visual control. It is associated with a minimum of complications and a high probability of bony fusion. Only immediate decompression will facilitate the regeneration of an injured spinal cord. Key words: cervical spine, spinal injury, anterior fixation.

Adult↗
PubMed2003

[Traumatic spondylolisthesis of the axis].

PURPOSE OF THE STUDY: The study presents a group of patients with traumatic spondylolisthesis of the axis. Views on the treatment of different types of spondylolisthesis vary. The aim of this study was to carry out a retrospective evaluation of the group of patients with this traumatic condition. MATERIAL: In the period from 1995 to 2002, 26 patients with traumatic spondylolisthesis of the axis were treated. They accounted for 5% of all patients admitted to our department for cervical spine injuries. Three types of traumatic spondylolisthesis were distinguished according to the Effendi classification. Type I was diagnosed in seven, type II in 18 patients and type III in one patients. METHODS: Type I traumatic spondylolisthesis was, as a rule, treated conservatively. A halo vest was used in four and a Philadelphia collar in three patients. Patients diagnosed with type II spondylolisthesis were treated surgically from the anterior approach (16 patients) or with a halo vest (two patients). The only patient with a type III fracture was operated on from the anterior approach. RESULTS: Osseous healing was achieved in all patients. No pseudoarthrosis developed and no repeat surgery for infection or osteosynthesis failure was needed. No deterioration of neurological findings was recorded. The range of motion in the cervical spine after healing was not affected. DISCUSSION: Views on the classification and therapy of traumatic spondylolisthesis of the axis are diverse. The greatest diversity is associated with making a decision on whether the injury is unstable and requires surgical treatment or not. Further arguments are related to the use of the most suitable approach. Treatment from the anterior approach is prevailing. Type III fractures are rare and must always be treated surgically. CONCLUSIONS: Methods for treatment of traumatic spondylolisthesis of the axis are currently a topic of dispute. The decisive factor for therapy is whether the injury is stable or unstable. When instability is present, anterior C2-3 spondylodesis completed with plate osteosynthesis is the method of choice. Stable injuries are treated by the application of a halo vest or Philadelphia collar.

Adolescent↗
PubMed2003

Reconstruction of functional handgrip in traumatic tetraplegia--case study.

The objective of this study is reconstruction of functional handgrip in tetraplegic patients, using transfers of the forearm tendons. Authors present two case studies of tendon transfers--the first case introduces reconstruction of fingers and thumb extension--the second case introduces reconstruction of fingers and thumb flexion. The two case studies explain basic principles of tendon transfers and assessment criterions. The aim of this study is to point out the possibility to create functional unit from a plegic hand by surgical intervention, and to improve significantly quality of patients' lives.

Adult↗
PubMed2002

[Post-traumatic corrective osteotomy of the distal radius with a new plate].

PURPOSE OF THE STUDY: Mal-union of distal radius fractures cause functional limitation and progressive degenerative changes of the wrist. The authors evaluate both radiograph and functional outcomes in a group of patients with a post-traumatic deformation of the distal radius treated by corrective osteotomy and fixation by a newly developed T-plate. MATERIAL: A retrospective evaluation covered a group of 13 patients of the average age of 51 years (range, 35-60 years) operated on in 2001 for post-trauma symptomatic mal-union of the distal radius of the Colles type. The group included only patients in which a new implant was used. The time interval between the primary fracture and corrective osteotomy was on average 11 months. METHODS: Corrective osteotomy for Colles deformations was performed in all patients from the dorsal approach with the application of a cortico-cancellous bone graft. Stabilisation was performed by the mentioned plate. Radiograph and functional outcomes were evaluated statistically. RESULTS: The radiographic evaluation proved the restoration of the normal anatomic relationship between the distal radius and ulna as well as statistically significant improvement of the function of the hand as concerns the range of motion and muscular strength Except for one patient, all involved evaluated the outcome as a subjective improvement. DISCUSSION: Corrective osteotomy of the distal radius is a standard surgery performed routinely by plate fixation with the application of a cortico-cancellous bone graft. Despite a perfect coverage of the issues relating to potential consequences resulting from non-anatomic position of the articular surface of the distal radius, this surgery was not very frequent in the past. Nevertheless, recently, there is a growing number of works in the literature dealing with corrective osteotomies for mal-union of the distal radius after fractures not only for the Colles but also Smith type. CONCLUSIONS: Treatment of deformation of the distal radius is a rewarding procedure which brings the patients a significant improvement of the function of the hand. The implant used by the authors proved useful for a plate fixation on the distal radius.

Adult↗
PubMed2002

[A less invasive retropleural-retroperitoneal approach to the thoraco-lumbar spine].

UNLABELLED: Authors describe the technique of anterior less invasive approach to the treatment of thoracolumbar spine. The advantage of the mentioned approach is the treatment of the anterior spinal column without opening the thoracic cavity. MATERIAL: In the period between 1996-2000 the described method was used in 46 patients. The average age of patients was 49 years (range, 22 to 67 years). There were 30 men and 16 women. Most frequently affected was L1-fractures in 29 patients, Th12 was handled in 16 patients and Th11 only in one case. METHOD: The surgical technique is based on the anterior approach to thoracolumbar spine without opening of the pleural cavity. RESULTS: The evaluation included 46 patients. The surgical time ranged between 100 minutes and 180 minutes. Blood losses ranged between 300 and 2000 ml. Pleural cavity was opened in three cases. Thoracic drainage was not applied in any patient from the followed-up group. Neither preoperative nor postoperative complications were recorded. In all cases allograft was used without complications. DISCUSSION: The described method is one of the possibilities of treating the anterior spinal column in the region of thoracolumbar spine in addition to the classic Hodgson approach or thoracoscopic treatment. CONCLUSION: In the given group of patients the authors' department introduced the treatment of the anterior column of thoracolumbar spine without opening pleural cavity and without the necessity of draining the thoracic cavity. It is a less invasive method as compared to the classic Hodgson approach. The alternative to the treatment of the anterior spinal column in the thoracolumbar region is the thoracoscopic method.

Adult↗
PubMed2000

[Injuries of the small intestine in polytrauma].

The authors inform on the increasing number of penetrating abdominal injuries during the last five years, especially in the criminal injuries. Diagnostic methods in a stabilised patient are analysed, diagnostic and therapeutic laparoscopy is preferred to lavage of the abdominal cavity in indicated cases. Urgent surgical revision is recommended in patients in a critical state on account of quickly increasing compartment syndrome, although staged laparotomy is needed. The timing of surgical methods is emphasised in serious associated injuries. Conclusions are illustrated with surgical results.

Adolescent↗
PubMed2000

[Does a pelvic compartment exist? Personal experience].

The authors analyze a group of 7 patients transferred to their hospital for instable fractures of the pelvic circle and lumbar spine. The pelvic compartment was manifested 24-48 hours after injury. Early diagnostics are based on the use of new imaging techniques, spiral CT examination is preferred, and angiography in stabilized patients. Early surgical intervention is aimed at evacuation of haematomas, revision of vessels, release of the ureters and temporary nephrostomy.

Compartment Syndromes↗
PubMed1996

[Associated injuries of the pelvis].

In last three years 27 injured patients were operated in Traumatological hospital Brno for associated pelvic trauma. This trauma was associated with injury of urinary tract in 8 patients, with traumatic lesion in area of the colon in 6 cases and with injured big vessels of the retroperitoneum in 8 patients. The urgent operation was performed in 44%. Authors put stress in diagnostic analysis and early indication of surgical operation on careful anamnestic clinical examination, they utilize the contribution of the sonographic and CT examination with contrast, in indicated cases the selective angiography and retrograde urethrocystography, too. Authors prefer early reconstructional operations.

Abdomen↗
PubMed1991

[Treatment of injuries of the cervical spine].

Injuries of the cervical spine are re-evaluated at present. New surgical procedures and research on the stability, when these procedures are used, caused that surgical treatment is used more frequently. Attention is draw to provisions in the field as well as in hospitals, on the diagnostic approach and classification of these injuries, on the procedure of conservative surgical treatment. The domain of conservative treatment are injuries of the upper cervical spine (C1 and C2); injuries of the lower cervical spine are frequently unstable, and therefore frequently indicated for operation. Attention is drawn to modern views on surgical treatment of comminuted fractures of the atlas and the dens axis. The authors analyzed their own material from 1986 to April 30, 1989 and in case-histories of three patients they draw attention to their therapeutic method. The authors demonstrate their own modified plates for the anterior stabilization of the cervical spine and their modification of the Halo device "Halo Vest". They discuss biomechanical properties of posterior and anterior stabilization methods.

Adult↗
PubMed1989

[Monitoring intracranial pressure in severe craniocerebral injuries. A report of experiences].

Experience so far obtained from epidural brain pressure measurement in the wake of severe craniocerebral trauma is reported in this paper. Measuring equipment according to Gobiet and Schumacher was used. More than 50 measurements were conducted, with case histories and courses being compiled from four of them. Reference is made to indications for intracranial pressure measurement as well as to pathophysiological aspects relating to increase in intrarcranial pressure. Ventriculometry in the context of a wider diagnostico-therapeutic regime on the intensive care unit was found to be conducive to target-oriented brain pressure prophylaxis and therapy.

Adolescent↗
PubMed1989

[Concepts in the treatment of injuries of the thoracic and lumbar spine].

The thoracolumbar connection represents a particular problem in view of the extent and stability of spine damage. A retrospective examination after conservative treatment of unstable injuries has shown unfavourable results. The authors therefore established a new therapeutic concept for this injury. Instable injuries should be surgically treated as early as possible, those with neurological defect are subject for emergency operation. A surgical approach (posterior transpedicular) is described. The urgent operation on the injured persons with medullar lesions enable an early rehabilitation and prevents further complications.

Fractures, Bone↗
PubMed1988

[Treatment of unstable thoracolumbar spinal injuries--determination of its present status and a preliminary report on transpedicular stabilization].

Follow-up checks were made on 19 patients with instabile injuries of the thoracolumbar spine. Poor late results were recorded from eleven of them who had undergone conservative or inadequate surgical treatment. Axial malposition of severe clinical disorders were among the findings. Transpedicular osteosynthesis of instable fractures of thoracic or lumbar regions of the spine has been practised by the authors since 1986, with plate fixation of only two vertebral segments. Pathoneurological disorders are handled by laminectomy or hemilaminectomy followed by H-shaped interspine bone grafting. Posterior rim fragments, burst off the spine, are either reduced or removed. Intraoperative perimyelography is possible. Therapeutic exercises are initiated immediately after the operation. After wound healing, the patient is allowed to get out of bed, supported by a plaster corset. Eleven patients have so far undergone the above surgical treatment. Four of them have resumed their original jobs, whereas three patients with paraplegia have been transferred to a rehabilitation centre.

Bone Plates↗