Biomedical subjects

Ch Sommer

Publications and source records attributed to Ch Sommer.

6 recordsLinked to original sources

PubMed2005

[Arthroscopic surgery].

Although arthroscopy of the knee joint had already been reported during the 1930's, the general dissemination of this method first began in the 1970's. The main reason for the rapid dissemination of this method was especially the fact that in addition to diagnostics, therapeutic possibilities were recognized and immediately implemented. This meant that arthroscopy had great potential and was made well known since the surgery was minimally invasive. Today we can assume that the technological side of the arthroscopic method is very widely developed and new innovations only arise slowly. Innovations are mostly connected with new innovative operating techniques. Surgery of the knee joint was the dominant application of arthroscopy in the beginning. The method was quickly applied to other joints. Today there is practically no joint which is inaccessible to arthroscopy. From surgical and therapeutic perspectives, arthroscopy is most frequently used today for the knee joint, followed by the shoulder joint, ankle joint, elbow joint, hip joint as well as wrist joint. Arthroscopic surgery within the field of joint surgery is regarded as indispensable. This specific surgery needs corresponding ability and skill, which must be individually acquired. Arthroscopic surgery evidently depends on technology and accordingly requires a corresponding fully operational medical infrastructure and knowledge. The big advantage of arthroscopic surgery lies in the minimally invasive technique, which has reduced the primary postoperative mortality significantly. Therefore, with good indicators the patient has decisive advantages as well as good cost to benefit ratios.

Ankle Joint↗

PubMed2005

[Actual relevance of minimal invasive surgery in fracture treatment].

Minimal invasive osteosynthesis (MIO) should belong nowadays in the armentarium of each trauma surgeon. The tendency to minimize the invasivity of every operation is a logical development considering the goal of each surgeon to reduce the iatrogenic damage caused by the operation. The term 'MIO" stands for this criteria: Fracture zone not opened, reduction by indirect manoeuvres or percutaneously by joy-sticks, small approaches for the application of the implants, intraoperative assessment of the reduction by imaging (fluoroscopy, arthroscopy, endoscopy, etc.). Long time before the definition of "minimal invasive surgery" some technologies in trauma surgery as external fixator or intramedullary nailing already fulfilled these criteria. In the nineties of the 20th century first cases of percutaneously inserted plate osteosynthesis have been reported. This technique got a widespread acceptance under the term of MIPO (minimal invasive plate osteosynthesis) during the last five years, especially pushed with the new angular stable screw-plate systems (LISS, LCP). The main problem of the MIPO-technique is and remains the reduction (no direct manipulation possible) and their intraoperative assessment (no direct visualisation). The balance between the degree of invasivity and the achieved quality of reduction and stability is often difficult to define and must be related to several factors (localisation and type of fracture, local soft tissue conditions, quality of the bone, age and wishes of the patient, available implants, experience of the surgeon, etc.). New technologies as improved imaging, intraoperative navigation and percutaneous reduction tools will help to further reduce the invasivity of fracture surgery in the future.

Aged↗

PubMed2003

[Biological internal fixation -- guidelines for the rehabilitation].

The process of fracture healing restores the biological and mechanical state of the bone tissue. In contrast to other tissues, bone has the unique capacity to heal through a real repair process resulting not in a scar but in a regular reconstitution of its original tissue structure. During the last two decades, the understanding of bone biology continuously evolved leading to the new concept that preservation of the viability of the bone fragments is the key to unimpaired fracture healing. The biological fracture management provides environmental conditions that allow the natural healing process to occur as quickly and undisturbed as possible. In comminuted diaphyseal and metaphyseal fractures, the reduction process strives for restoration of proper length and axial and torsional alignment. Thereby, the reduction technique is mainly indirect, i.e. without direct visualization of the fracture area. The primary stability of an osteosynthesis seems to be of secondary importance for achieving sound bone healing. Stabilization can either be performed with an intramedullary nail or a bridging plate. The new biological plating technique imitates the concept of intramedullary fixation. It requires the use of a long implant working with improved leverage. This reduces both, the loading of the screws and the loading of the plate. The good healing capacity of viable fragments and their integration into the fracture callus protects the implant (especially a plate) from fatigue failure. To help to accomplish this new concept of biological plate fixation, new implants such as the Locking Compression Plate (LCP) have been introduced. The mechanical efficiency of this new plate generation is enhanced due to its possibility for angular stability screw insertion; load transfer by friction can be replaced by a load transfer by interlocking (internal fixator), reducing the biological interference of this implant (no contact implant). Functional rehabilitation with painfree mobilization needs to be performed carefully because the loading capacity of the biological plate osteosynthesis is low until radiological signs of bone healing via callus formation is visible. Clinical signs of overload and radiological indicators of potential mechanical failure of the fixation have to be identified by the general practitioners, and the compliance of the patient has to be controlled during the rehabilitation phase to avoid complications after biological internal fixation.

Bone Plates↗

PubMed2003

[Relevance and advantages of new angular stable screw-plate systems for diaphyseal fractures (locking compression plate versus intramedullary nail].

Intramedullary nailing still remains the golden standard for the treatment of diaphyseal fractures of the long bones in adults. The operative technique is standardised and usually minimal invasive, the primary healing rate is high, and complications arise rarely. However, for problem zones (meta-diaphyseal region), in poor bone quality and in other relative contraindications for nailing (narrow medullary canal, fractures in adolescents and polytrauma) the new angular stable screw-plate-systems (LISS, LCP) offer an excellent alternative for the operative stabilisation. The high primary stability in combination with newly developed minimal-invasive techniques (MIPO = minimal invasive plate osteosynthesis) are the bases for a functional after treatment and a rapid bony consolidation with a low complication rate.

Adolescent↗

PubMed2003

[Open reduction and internal fixation of a displaced transverse fracture of the sacrum with a locking compression plate].

Isolated fractures of the distal sacrum are usually caused by direct trauma. Undisplaced fractures are easily missed on conventional X-ray films. CT scans can disclose the full extent of the fracture. Undisplaced, or minimally displaced fractures can be treated conservatively with analgesics and a restriction to seat for six weeks. In cases of major displacement or neurological symptoms, a digital transanal reduction of the fracture under local or regional anaesthesia can be attempted. If this manoeuvre fails, open reduction and internal fixation are required. Stabilisation is challenging because of the thin bone and the complex shape of the sacrum. In a 15 year old girl with major horizontal displacement and comminution of S4, following a snowboard accident, we achieved sufficient and stable fixation with the new LCP (Locking Compression Plate) system. For six weeks after the operation, the patient was not allowed to sit down. Thereafter, she was free of pain and unrestricted in daily activities and sport. The LCP system has a number of advantages in the fixation of fractures in osteoporotic or thin bone, but clinical experience/skill and careful planning of the operation are crucial.

Adolescent↗

PubMed2003

[How often do surgical residents operate in a category A non-university post-graduate teaching hospital?].

INTRODUCTION: After introduction of the new postgraduate training program for general surgery the completion of the operation list still represents the most important step. Based on our number of operations we examined whether residents would carry out the requested interventions at our non-university teaching hospital (category A). METHOD: For eight tracer operations we retrospectively counted the number of cases of the non private patients from 1998-2002 and took account of the postgraduate education status of the operator. In this period the team consisted of 51 residents (71 education years), of whom 18 candidates for general surgery who carried out the interventions (35 education years, inclusive rotation in ICU, emergency room and special surgical disciplines). RESULTS: Regarding all tracer operations, the amount of interventions per year and candidate which are necessary to accomplish the goal for the first four years of education are reached: appendectomy 8.9, laparoscopic cholecystectomy 7.3, open inguinal hernia repair 9.4, varicose veins operation 12.1, open colon sigmoideum resection 3.2, hip and malleolar fracture 6.9, hemithyreoidectomy 5. CONCLUSION: Completion of the operation list as the major training goal was reached at our institution. Following our structured education program the demands regarding postgraduate education will be met also in future. Further studies however, must examine the impact of the new resident's work contracts dictating a reduction of the weekly working hours.

Clinical Competence↗