Search PubMed⌕ Search

Biomedical subjects

T Pohlemann

Publications and source records attributed to T Pohlemann.

79 records · Page 5Linked to original sources
PubMed1992

[Classification and management of complex pelvic trauma].

Complex pelvic traumas are pelvic fractures accompanied by pelvic soft tissue injuries. Mortality in major pelvic fractures with associated soft tissue injuries is high, and these injuries can pose a more complex range of therapeutic problems. Uncontrolled bleeding and septic complications are the main causes of death. There has been extensive work on grading pelvic ring fractures, but less attention has been paid to grading the accompanying soft tissue damage. Therefore, a grading system for pelvic injuries was developed that takes the soft tissue damage into account more than the fracture classification did when used alone. It is a point system that considers the fracture itself, the soft tissue injuries, including lesions in the pelvic organs, vessels and nerves, and the general concomitant injuries. From 1972 to 1990 the clinical course and outcome of 132 patients with complex pelvic traumas were reviewed. The mortality was 34.8%. Eighty-three of the patients (62.9%) underwent immediate laparotomy and in 68 patients (51.7%) open reduction and internal fixation of the unstable pelvic ring were performed. For better primary treatment of patients with complex pelvic injuries, a trauma algorithm is introduced. It leads to important therapeutic steps after brief clinical, ultrasonic and radiological assessments. The major questions in the flow chart take the pelvic ring and hemodynamic instability into account. Immediate laparotomy, surgical control of hemorrhage, and open reduction and internal fixation of an unstable pelvic ring represent the most important requirements for successful treatment.

Adolescent↗
PubMed1992

[Determining indications and osteosynthesis techniques for the pelvic girdle].

1566 patients with fractures of the pelvis were treated at the Department of Traumatology of the Hannover Medical School between 1972 and 1990: 1350 patients had fractures of the pelvic ring, 216 isolated acetabulum fractures, 398 combinations of pelvic ring fractures and acetabular involvement; 718 of these patients were admitted with severe polytrauma. For 1254 patients a complete file was available for clinical and radiological evaluation of fracture distribution, classification (Tile and anatomical location) and concomitant injuries. During the observation period, significant increase in the severity of the trauma, the severity of the pelvic fractures and the rate of internal stabilization, especially of the posterior pelvic ring was observed. The overall mortality after pelvic fractures was 18.1%. This mortality depended significantly on the Hannover Polytrauma Score (PTS) and the associated pelvic and extrapelvic blunt trauma. Internal fixation of pelvic fractures was performed in 195 patients. This experience has now led to standardized procedures for the different fracture locations. With the task of minimizing soft tissue trauma and reducing the implant size, more differentiated treatment of sacral fractures is now applied. Adapted small fragment implants ("local osteosyntheses") can be applied, with an unilateral longitudinal dorsal incision providing an excellent overview over the fracture line. For internal fixation of sacral fractures, involvement (penetration by screws, transfixation) of the sacroiliac joint is avoided whenever possible. In our experience early open reduction and internal fixation of pelvic fractures facilitates the management of these severely injured patients.

Adolescent↗
PubMed1991

[Modern techniques in pelvic fractures including acetabulum fractures].

Unstable Fractures of the pelvic girdle should be stabilized as soon as possible. Use of standardized protocols for primary assessment and operative procedures can minimize complications and help to optimize clinical results after pelvic or acetabular fractures. The different methods of internal stabilization are not yet ideal but new developments are under way. A trend towards screw fixation can be seen in both pelvic and acetabular surgery, as well as a tendency to "localized" stabilization using small fragment implants to avoid unnecessary transfixations of pelvic joints.

Acetabulum↗
PubMed1989

[Management of sonography in blunt abdominal trauma].

A standardized management of sonography in blunt abdominal trauma has replaced peritoneal lavage in our department. The sonographic evaluation is performed simultaneously with additional diagnostic and therapeutic procedures in the emergency room. The primary goal is the exclusion of intraabdominal bleeding. The management and the results of the diagnostic procedure are presented with reference to a consecutive series of 314 patients with blunt abdominal trauma or polytrauma. In 71 patients, laparotomy was performed because the sonographic findings were felt to indicate it. Only in two cases was the sonographic assessment incorrect (false-positive). Frequent sonographic and clinical controls are required especially when sonography cannot totally exclude intraabdominal bleeding during the initial assessment. If any discrepancies between negative or uncertain sonographic and suspect clinical findings remain, further high-tech diagnostic methods or exploratory laparotomy become necessary.

Abdominal Injuries↗
PubMedDate not supplied

[The importance of roentgenological and scintigraphic studies in patients with and without thigh pain following cementless PCA hip endoprosthesis].

Persisting postoperative thigh pain is a common problem in cementless total hip prostheses occurring in a rate of about 15-20% of the patients. The reason for that phenomenon has not become clear so far. In a clinical, radiological and scintigraphic study 70 patients with 81 PCA cementless total hips were randomized in groups with (n = 34) and without significant thigh pain (n = 36). All patients underwent clinical examination including a standardized questionnaire, x-ray and 3-phase bone scintigraphy. Quantitative assessment of Tc-99m-MDP uptake was made. In the group of patients with persisting thigh pain the scintigraphic analysis showed an significantly increased uptake at the tip and the medial and lateral femur. These findings could not be correlated with clinical loosening of the prosthesis. Slight or moderate uptake in the area of the greater and lesser trochanter as well as the tip was a common finding in PCA prosthesis in all patients. In the radiological analysis no difference between both groups was evident. The study showed that patients with thigh pain after cementless PCA total hip prosthesis have specific regions of significantly increased uptake in scintigraphic examination (tip, medial and lateral femur), which cannot be correllated with clinically or radiologically signs of loosening. The morphologic reasons for the thigh pain remain unclear.

Adult↗
PubMedDate not supplied

Accuracy study of computer-assisted drilling: the effect of bone density, drill bit characteristics, and use of a mechanical guide.

OBJECTIVE: This study was designed to determine the clinical relevant accuracy of CT-based navigation for drilling. DESIGN: Experimental model. SETTING: Laboratory. METHODS: Twelve drills of varying lengths and diameters were tested with 2 different set-ups. Group 1 used free-hand navigated drilling technique with foam blocks equipped with titanium target points. Group 2 (control) used a newly developed 3-dimensional measurement device equipped with titanium target points with a fixed entry for the navigated drill to minimize bending forces. One examiner performed 690 navigated drillings using solely the monitor screen for control in both groups. The difference between the planned and the actual starting and target point (up to 150 mm distance) was measured (mm). STATISTICS: Levene test and a nonpaired t test. Significance level was set as P < 0.05. RESULTS: The core accuracy of the navigation system measured with the 3-dimensional device was 0.5 mm. The mean distance from planned to actual entry points in group 1 was 1.3 (range, 0.6-3.4 mm). The mean distance between planned and actual target point was 3.4 (range, 1.7-5.8 mm). Free-hand navigated drilling showed an increased difference with increased length of the drill bits as well as with increased drilling channel for drill bits 2.5 and 3.2 mm and not for 3.5 and 4.5 mm (P < 0.05). CONCLUSIONS: The core accuracy of the navigation system is high. Compared with the navigated free-hand technique, the results suggest that drill bit deflection interferes directly with the precision. The precision is decreased when using small diameter and longer drill bits.

Bone Density↗