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Biomedical subjects

A Weckbach

Publications and source records attributed to A Weckbach.

15 recordsLinked to original sources
PubMed1998

[Solution to the problem of extra-articular, femoral hip fracture by the "sliding screw-nail principle". Results of 2 different systems (classical nail and gamma nail)].

Between January 1993 and December 1995 we treated 109 patients (median age: 75 years) with 112 extraarticular hip fractures including combined trochanteric and shaft fractures using two different "sliding-screw-nail implants" (intramedullary hip screw = classic nail: n = 61; gamma nail: n = 51). Comparing the two systems in detail certain advantages and disadvantages were seen, with both being equivalent. We encountered the following complications: secondary varus malalignment of the collum femoris with "cut out" of the sliding-screw (1.8%) and without "cut out" (1.8%), fissure of the femoral shaft occurring intraoperatively and being treated conservatively (1.8%), femoral perforation by the nail (0.9%), infection (2.7%). Thus, 5 reoperations (4.5%) were necessary. None of these complications were attributable to the principle itself or to the different implants used. Each patient was followed-up for a minimum of 12 months postoperatively. In 59% of all patients the pre-trauma range of mobility could be fully restored. Intramedullary hip screw and gamma nail are excellent and equivalent systems, which fully satisfy the biomechanical needs of above mentioned fractures.

Adolescent↗
PubMed1997

[Injury sequelae and late damage of dislocation fracture of the head of the tibia].

Consequences of injury as well as succeeding joint-impairment after fracture dislocation of the tibial head are analysed. Of 38 patients who had undergone operative therapy for fracture dislocation of the tibial head between 1982 and 1991, 30 were followed up after a mean of 6.3 years. With an average age of 46.8 years and a distribution between sexes of 26 men vs. 12 women, types II (17) and V (14) (classification acc. to Moore) clearly outweighed types III (3) and IV (3) as well as type I (1). Causes of injury were dominated by traffic accidents (22/38), 9 patients suffered from accompanying ipsi-, another 9 from contralateral injuries of their lower extremities. For evaluating follow-up results, both Lysholmscore and IKDC-knee-evaluation-form were employed. The latter qualifies the overall result as "normal", "nearly normal", "abnormal" or "severely abnormal". None of the knee-joints assessed was evaluated normal. There were only 2 patients to be qualified nearly normal, whereas 5 had to be assessed abnormal and 23 severely abnormal. These poor results were mainly due to persistent symptoms (pain, swelling, giving-way) (30/30), limited range of motion (27/30) as well as impairment of joint-stability (25/30). Our results stress the need for sophisticated operative and p.op. therapy of these complex injuries.

Adult↗
PubMed1996

[Extra-articular proximal femur fracture in the elderly--dynamic hip screw or intramedullary hip screw for fracture management?].

Over a 6-year period we treated 119 pertrochanteric fractures using dynamic hip screws (DHS). During the following 3 years we stabilized 112 per-, sub- and intertrochanteric, as well as "trochanter-associated" fractures by means of intramedullary hip screws (IMHS) or gamma nails (GN). Within comparable patient groups we encountered the following complications: DHS vs IMHS/GN: secondary varus malalignment of the collum femoris with "cut out": 1.7% vs. 1.8%; secondary varus malalignment without "cut out": 0.8% vs. 1.8%; infections: 5.0% vs. 2.7%; hematomas needing revision operations: 2.5% vs. 0%; torn out plate: 1.7% vs. 0%; intraoperative fissures of the shaft: 0% vs. 1.8%; intraoperative perforations of the shaft: 0% vs. 0.9%. Thus, the rate of reoperation for complications within the DHS series was 11.8%, while the rate within the IMHS/GN series was 6.3%. For stable pertrochanteric fractures we therefore acknowledge DHS as the ideal implant in our opinion, while for all other extraarticular proximal fractures of the femur we recommend IMHS or GN.

Adolescent↗
PubMed1995

[Resorbable osteosynthesis rods. An experimental study of the biomechanics and degradation of various rods of polyglycolide and poly (-L-lactide)].

Six different polyglycolide and poly(-L-lactide) rods were tested biomechanically: native, in vitro and in vivo. They were Biofix-C and Biofix-CG rods and 4 poly(-L-lactide) rods with a molecular weight between 70,000 and 700,000. Their flexual strength and elasticity module were determined by the 3-point flexion test. A total of 70 pins were implanted in the soft tissue and intramedullary to splint tibial osteotomies of 30 rabbits. The Biofix rods' flexural strength was high. There was no difference due to coating (346 to 402 N/mm2). In vitro experiments showed a rapid loss strength by 75 and 90%, equivalent to 2 to 3 weeks' implantation. The initial strength of the lactide pins was about 60% lower than that of the polyglycolid rods. The stability of the former after implantation decreased at a lower rate, with 25% of the initial strength being retained after 14 weeks. The histological findings were commensurate with the loss of flexural strength.

Animals↗
PubMed1994

[Differential indications for intramedullary nailing of the tibia with the reamed and unreamed technique].

The principle of unreamed intramedullary nailing in tibial fractures is theoretically convincing: regarding the almost fully maintained endosteal blood supply, this concept of biological osteosynthesis implies a lower rate of postoperative complications such as non- or malunion and infection. In our clinic, 89 patients underwent intramedullary nailing of the tibia since August 1988 using the "AO-Universal-Nagel" in 63 and the Russell-Taylor unreamed nail in 26 cases. With primary data (type of fracture and grade of soft tissue injury) being comparable, we found an almost identical rate of infection for both techniques. In RT nailing, however, rates were significantly higher for non- or malunion (AO 10.3%, RT 27.6%) and implant complications such as interlocking screw or nail breakage (AO 6.2%, RT 17.2%). Thus indicating less mechanical stability, for RT- nail we allowed full weight bearing after 6-8 weeks only, whereas for AO-nail this was performed approximately 14 days p. op. after satisfying soft tissue conditions had occurred. Subsequently, this worse mechanical properties of an unreamed nail mean loss of comfort for patients, which is not fully equalized by biological advantages in all cases. We therefore champion a differentiated indication for the unreamed technique, determined by the grade of soft tissue injury: treatment of Gustilo type II and III a and b open tibial fractures by either primarily performing biological osteosynthesis or early changing from external fixation. Finally, unreamed nailing has been established as monorail procedure treating defect fractures by means of segmental transport.

Adult↗
PubMed1994

[Complications of plate osteosynthesis of the femur shaft. An analysis of 199 femoral fractures].

From January 1982 to June 1987 a total of 189 patients with 199 fractures of the femoral shaft were treated by internal plate fixation. Aseptic complications were found in 41 osteosyntheses (20.5%) and were due variously to implant deficiencies (11%: loosening 2.5%, deformation 1.0%, implant fracture 7.5%), delayed union (3%), non-union (4.5%), axial deformities (2.5%) and differences in femoral length (5%). Septic complications were seen in 2.5%. There are three main ways of limiting the rate of aseptic complications: (1) restrictive indications for internal plate fixation or femoral shaft fractures; (2) a precise surgical technique taking account of local biomechanical and biological needs; and (3) generous application of bone grafting.

Adolescent↗
PubMed1993

[Tumorous calcinosis (Teutschländer disease)].

A case report on tumoral calcinosis (Teutschländer disease), a comparatively rare clinical entity, is presented. The localization of these painful, mostly periarticular soft tissue calcifications as well as their aetiology in connection with chronic renal failure, longstanding hemodialysis or secondary hyperparathyroidism are stressed. The surgical approach as the primary therapeutic option is compared with the more traditional conservative management.

Acromioclavicular Joint↗
PubMed1992

[Thrombosis prevention in outpatients with lower limb injuries].

The antithrombotic effect of a low molecular weight heparin was examined in a prospective randomized trial of 204 outpatients (121 men, 83 women, mean age 34.7 [16-76] years) who required immobilization with a plaster cast because of injury to the lower limb. Subjects in group I (n = 99) received a daily subcutaneous injection (36 mg) of heparin fragment calcium throughout their period in plaster (mean of 15.6 [7-66] days), while group II subjects (n = 105, mean period in plaster 15.7 [7-41] days) acted as untreated controls. Thrombosis was diagnosed by compression sonography, and positive findings were confirmed by phlebography. Thrombosis occurred in 24 patients altogether, 6 in group I (6.1%) and 18 in group II (17.1%) (P less than 0.05). While patients with thromboses had a mean of 1.96 risk factors overall, those in group I had a mean of 2.6 risk factors. Patients without thrombosis had a mean of 1.24 risk factors. The rate of thrombosis was higher in patients with fractures (4 out of 27 in group I; 10 out of 35 in group II) than in those with ligament and soft-tissue injuries (2 out of 72 in group I; 8 out of 70 in group II). The severity of trauma is apparently an important thrombogenic factor.--General thrombo-prophylaxis seems advisable for surgical outpatients requiring immobilisation treatment with a plaster cast.

Adolescent↗
PubMed1991

[Results following the surgical treatment of acromioclavicular joint dislocations. A comparison of direct trans- and extra-articular fixation].

During the years 1985-1988, a total of 41 patients were treated for acromioclavicular dislocations. 25 (61%) were followed postoperatively for an average of 21 months. Two different methods of direct fixation of the AC-joint were compared: in 13 patients the transarticular fixation with two Kirschner wires and a 7.5 mm biodegradable Polydioxanon band (group I); in 12 patients an extraarticular fixation with PDS-band alone (group II). In both groups the ruptured ligament were sutured. In the first group physiotherapy was instituted immediately with limitation in abduction range to ninety degrees. After six weeks the Kirschner wires were removed under local anaesthesia and physiotherapy progressed to full range of motion. The shoulders of the second group patients were immobilized for 4 weeks. All of the patients were evaluated at follow-up on a subjective (pain, stiffness), objective (strength, range of motion, stability of the AC-joint) and roentgenographic (degree of displacement, posttraumatic arthritis, calcifications around the injured ligaments) basis. In both groups we saw good and satisfying results in more than 90%. A significant difference exists only as far as rehabilitation time is concerned. It was shorter in group I. In spite of the complications we observed with the metallic implants, which didn't have any negative influence on the results, we prefer the transarticular fixation method, because an immobilization postoperatively is not necessary and the time of rehabilitation is shortened.

Acromioclavicular Joint↗
PubMed1990

[Alloplastic ligament replacement. A study of the biological fixation of 5 non-resorbable materials].

The long-term stability of alloplastic ligament prostheses depends on various parameters, on including the quality of the biologic fixation in the bone tissue. Biomechanical and histological tests were therefore performed to examine the stability obtained with five different alloplastic and non-resorbable ligament substitute materials following stress-free implantation into the distal femur and proximal tibia of Wistar rats. The materials were: a filament of the PTFE ligament prosthesis, PTFE suture material (Goretex), polyethylene terephthalate (Mersilene), polyethylene (Braun-Dexon) and polybutylene terephthalate (Miralene). The materials used were all of USP-1 quality. Extraction trials of the implants 32 weeks later did not show any differences between the PTFE materials, such as polyethylene and polyethylene terephthalate, whereas a significantly lower value was found for polybutylene terephthalate. The fixation involved connective tissue exclusively with all the materials tested except for PTFE. PTFE not only induced tight and direct bony contact externally, within the material itself extensive formation of new bone was also found. PTFE was found to be the most histocompatible material, while polyethylene terephthalate led to the most pronounced foreign-body-type reactions.

Animals↗
PubMed1989

[Method of treating femur head dislocation fractures].

The fracture and dislocation of the head of the femur is still an uncommon accident, however, involving many complications. To avoid secondary damage a closed reduction should be obtained as soon as possible and with great care. Osteosynthesis of the femur head fragments is desireable for congruency of the joint surfaces and to prevent post traumatic arthrosis. Only this treatment allows for functional physical therapy. Type 3 fractures in patients over 65 and also multiple fractures of the femur head should be treated with a prosthesis implant. In young people primary reconstruction of the joint should be attempted in every case.

Adult↗
PubMedDate not supplied

[Proteases and their inhibitors in posttraumatic knee joint effusion].

Humoral aspects are being discussed in development of arthrosis. Punctuate of 144 traumatized knee joints has been investigated. Proteolytic enzymes elastase and cathepsin D were assessed. Furthermore, protease inhibitors alpha 1-antitrypsin and alpha 2-macroglobulin were determined. Activity of chondrolytic enzymes elastase and cathepsin D clearly correlates with the clinical severity of injuries. At the same time, primary inhibitory mechanisms for compensation seem to be non-sufficient, however.

Cathepsin D↗