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Biomedical subjects

A Rüter

Publications and source records attributed to A Rüter.

At least 55 records · Page 3Linked to original sources
PubMed1997

[Approach-related results following acetabular fractures].

Acetabular fractures are severe injuries. Making a diagnosis and deciding on therapy are difficult because of the complexity of the anatomic structure and because of the soft tissues. Choosing the most suitable approach is the most important problem when deciding on the operative treatment. Besides standard approaches (Kocher/Langenbeck, ilioinguinal and extended iliofemoral), the "Maryland approach" has been established in the last few years. Modifying the steps of preparation, it is possible to begin the operation with a Kocher/Langenbeck approach (with variation on where the skin incision is made) and to extend the approach step by step to achieve optimal exposure. Here we describe the results of acetabular fractures treated between 1989 and 1994 (n = 159) in our clinic related to the surgical approach. The "modified Maryland approach" as used in our clinic, starts with exposure of the dorsal column, offering the possibility of a universal exposure.

Acetabulum↗
PubMed1996

Tumorous calcinosis: a disease of its own?

Tumorous calcinosis has been considered as a disease of its own. A survey of the literature shows that only its clinical and radiological appearances are universally agreed upon, while its epidemiology and etiology are still under discussion. A genetic disorder, recurrent soft-tissue microtrauma and terminal renal failure have been put forward as causes. All of them may lead to a localized or generalized disturbance of the calcium-phosphate metabolism, which in turn could produce tumorous calcinosis. Therefore, tumorous calcinosis should be regarded as a rare manifestation of a metabolic disorder rather than a disease of own.

Adult↗
PubMed1996

Overexpression of p53 in tall cell variants of papillary thyroid carcinoma.

BACKGROUND: The tall cell variant (TCV) is a clinically aggressive subtype of papillary thyroid cancer. The aim of this study was to discover the prevalence of mutant forms of p53 protein in this subtype and relate it to clinical outcome. METHODS: Eighteen patients with TCV and a control group with common papillary cancers, matched for age and gender, were studied. The p53 mutations were identified by means of immunohistochemical staining. Data reviewed were overall survival, recurrence, TNM stage, and p53 positivity. RESULTS: p53 mutations occurred in 11 (61%) patients with TCV compared with two (11%) in control group (p = 0.05). In the TCV group two patients died of the disease (11%) and eight (44%) had local recurrences or distant metastases compared with none in the control group. All deaths and 70% of the recurrences occurred in patients with stage III or IV disease. p53 positivity did not correlate with any reduction in survival (7% compared with 9%) but with increased rate of local (23% compared with 4%) and distant (23% compared with 13%) recurrences. CONCLUSIONS: TCV was associated with a significantly higher rate of p53 positivity than common papillary carcinoma. The stage of the disease seemed to be a better prognostic indicator than p53 positivity for overall survival.

Adult↗
PubMed1996

[Tumoral calcinosis--an independent disease?].

Tumoral calcinosis has up to date been considered as an independent disease. The survey of the literature shows that only its clinical and radiological appearance are generally accepted while its epidemiology and etiology are still under discussion. A genetical disorder, recurrent soft tissue microtrauma or terminal renal failure are blamed to cause tumoral calcinosis. All these causes may lead to localized or generalized disturbance of the calcium-phosphate-metabolism which in turn causes tumoral calcinosis. Therefore tumoral calcinosis should be regarded as a rare symptom of a metabolic disorder rather than an independent disease. Clinical appearance and treatment of two cases of tumoral calcinosis are reported followed by a review of the literature.

Adult↗
PubMed1996

[Reichel syndrome. A case report with review of the literature].

In the case report presented, we describe the Reichel syndrome-synovial chondromatosis. The disease is monoarticular, involves no trauma or inflammation, and tends to cause a build-up of floating cartilage. Its prognosis is good. On the basis of a review of the literature, we present its etiology, diagnosis, differential diagnosis and histology. For the initial treatment we recommend resection of the floating cartilage. If the disease occurs, we recommend synovectomy in addition.

Adult↗
PubMed1996

Intraarticular distal humerus fractures. Factors affecting functional outcome.

In intraarticular fractures of the distal humerus, full functional recovery is difficult to obtain. Even if stable anatomic reconstruction of the articular surface is achieved by open reduction and internal fixation, nerve lesions, joint stiffness, and heterotopic bone formation may spoil the functional result. Ninety-nine consecutive fractures were treated by open reduction and internal fixation and studied retrospectively to determine factors influencing outcome. Followup examination of 77 cases showed 52% excellent and good late results. Twenty-six patients had nerve injuries. The rate of heterotopic bone formation was 49%. Open fractures and polytraumatized patients had less favorable results. Early operations within 24 hours resulted in significantly less heterotopic bone formation and better overall function that did delayed treatment. Careful examination of nervous deficits and early stable internal fixation with routine exposure of the ulnar nerve is therefore recommended in the management of this injury.

Adolescent↗
PubMed1995

[Dislocation fracture of the head of the tibia. I. Results of surgical treatment].

Moore's classification of fracture dislocation of the tibial head gives us some clues of concomitant ligament injuries. We did a follow-up of 64 patients with fracture dislocations operated between 1982 and 1991. With these complex injuries we found overall unsatisfactory results regarding subjective and objective stability. We were able to correlate certain patterns of instability with specific Moore types. So a complete assessment of this complex knee-injury can be made from the X-ray and a stability check-up.

Adult↗
PubMed1995

[What are the advantages of UTN (unreamed tibial nail) in open tibial fractures?].

The AO-unreamed tibial nail (UTN) is an alternative to external fixation in the treatment of open tibial fractures. In order to compare the two implants we did a retrospective study. 70 unselected cases of open tibial fractures were treated by either method. 35 patients with primary UTN were compared to another 35 patients with primary external fixator. Demographic data, localisation and classification of fractures and soft tissue trauma showed no differences between the two groups. The main complications in UTN-group were hardware problems, in external fixator-group infections. Following UTN-treatment duration of first hospital stay and whole fracture treatment were shortened with earlier full weight bearing and fracture healing. Our study shows advantages in the treatment of open tibial fractures using the UTN compared to the external fixation.

Adolescent↗
PubMed1995

[Dislocated intra-articular calcaneus fractures. Long-term follow-up after open reposition and osteosynthesis].

A series of 98 patients with a total of 105 intra-articular fractures of the os calcis were operated on during a 10-year period between 1983 and 1992. We were able to follow up 60 patients with 64 fractures an average of 44 months (range, 18-105 months) postoperatively. At the time of follow up, 83.9% of patients had been back to work, 78.6% with the same employer as before. Five of the patients followed up had had to retire from work; each of these had one or more severe coexisting injuries. A compromising nerve injury occurred postoperatively in 3 out of 58 patients with closed fractures, in all cases following surgery with a medial or bilateral approach. In only 1 of the 58 patients followed up after closed fractures did a deep infection requiring arthrodesis occur. One patient had sympathetic reflex dystrophy (Sudeck). A good functional result in the lower ankle joint correlated with a good outcome. In contrast, postoperative improvement of the tuber angle and the degree of arthrosis seen radiographically did not. We conclude that operative repair of intraarticular calcaneal fractures is a procedure that can safely be procedure used to restore the ability to work in the majority of patients. The medial approach should preferably not be used, nor should the metal be extracted from the medial approach if this can be avoided.

Adolescent↗
PubMed1995

[Pediatric femoral shaft fracture: effect of treatment procedure on results with reference to somatic and psychological aspects].

When treating femoral shaft fractures in children both somatic (axial/rotational misalignment) and psychological sequelae of the treatment have to be taken into consideration. We performed a retrospective study on the somatic and psychological outcome in 38 children under the age of 10 years with femoral fractures from 1989 to 1991. Twenty-four were treated conservatively (i.e. by traction), while 14 had surgery. Average time in hospital was significantly shorter in the operative group (9 days) than in the conservative group (37 days). The rate of rotational misalignment > 10 degrees was 14% after operation and 45% after traction. Psychological evaluation revealed a positive influence on intellectual development in 21% of conservatively treated children but there were disturbances in motor development (37%), family environment (17%) and general health (25%) in this group. Operative treatment was superior in causing no adverse effects in these fields. We therefore recommend surgery for femoral fractures in children older than 3 years.

Adaptation, Psychological↗
PubMed1995

[Closed tibial fracture--reamed or unreamed intramedullary nailing. A clinical study].

When comparing the unreamed tibial nail (UTN) with the external fixator in the treatment of open tibial fractures the UTN has shown advantages. Whether we can find these advantages also in the treatment of closed tibial fractures using the UTN instead of a reamed system should be clarified in the following study. We compared 35 UTN treated patients with 35 patients that were treated with a reamed A0-universal tibial nail. Both groups showed no differences in age, sex, etiology and severity of trauma. The fractures were classified by the A0-classification of fractures and the soft tissue damage by the classification of Tscherne and Oestern. The length of mean hospital stay, the time of partial weight bearing and the duration of fracture healing, were shorter using the UTN. 5 of 9 complications using the UTN were immanent to the system (deformation of the locking screws). The other complications were 2 axis shifts, 1 compartment syndrome and 1 pseudarthrosis. The other group showed 1 hematoma, 1 axis shift, 1 compartment syndrome, 2 thromboembolic complications, 2 infections and 3 cases of pseudarthrosis. We think that there is an advantage to use an UTN instead of a reamed nailing system in treatment of closed tibial fractures.

Adult↗
PubMed1994

[Can unreamed tibial nailing replace external fixators in management of open tibial fractures?].

The recently developed unreamed tibial nail (UTN) offers a new possibility for biological osteosynthesis by intramedullary stabilization for tibial fractures including those with severe closed and open soft tissue damage. In a retrospective study we compared the well established method of external fixation with unreamed intramedullary nailing for open tibial shaft fractures. The data of our first 15 cases treated primarily by UTN (Group 1) and another 15 cases comparable in etiology, severity of trauma, fracture classification, open soft tissue damage and the rate for myocutaneous flaps and skin-grafts, treated initially by external fixation (Group 2) were reviewed. Septic complications were only seen in group 2 and made necessary a lot of following additional operations. One angular deformity was seen in each group. Group 1 showed a mean hospital stay of 26.3 days compared to 75.7 days in group 2. Full weight-bearing was achieved after 1.8 months (group 1) whereas it took 4.5 months in group 2. The first clinical experience using the UTN shows an obvious advantage in comparison to fracture management by external fixation mainly due to a low complication rate and a much shorter over all surgical treatment period.

Adolescent↗
PubMed1994

[Callus distraction with the AO tubular fixator--principles, techniques and clinical examples].

Callus distraction in segmental transport for closure of traumatic or operative bone defects can be performed with the AO tubular fixator in various ways. Depending on the soft tissue situation and personal preference segmental shifting may either be achieved by tension wires running through the soft tissues (Augsburg model) or by percutaneous Schanz' screws (Basel model). Transportation along an intramedullary nail has certain advantages but also specific draw-backs. To be able to apply the optimal technique to a given situation it is necessary to be familiar with each of these methods. A hybrid system under development at this moment will facilitate anchorage in short epiphyseal segments. We are also going to have a clamp which can turn in itself for correction of axial malalignment.

Adult↗
PubMed1994

[Is there a classification of pelvic ring injuries, which takes the trauma mechanism, morphology and stability relations into consideration and thereby gives references for subsequent therapy?].

In contrast to earlier classifications, Tile's classification of pelvic ring disruptions considers mechanism of injury, clinical and x-ray evaluations and is therefore almost universally accepted. We propose a more comprehensive classification which gives a guide for treatment of these complex injuries. Moreover it can be used to compare results from different authors. We classify types A-D pelvic injuries according to stability. Type A consists of fractures of the pelvis not involving the ring, type B of stable rotational injuries. Type C and D encompass the unstabile injuries: C is purely rotational and D has a combined rotational and vertical instability. The location of injury is indicated by adding numbers 1-9 (1: rupture of symphysis pubis; 2: transpubic fracture; 3: acetabular fracture; 4: iliac wing fracture; 5: sacroiliac fracture-dislocation; 6: sacroiliac disruption; 7: sacral wing fracture; 8: transforaminal sacral fracture; 9: central sacral fracture). These numbers are arranged in increasing order, one hemipelvis after the other. Thus, in case of a complex pelvic injury with rotational instability on one side and vertical instability on the other each hemipelvis may be classified separately.

Fracture Fixation, Internal↗