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Biomedical subjects

D Höntzsch

Publications and source records attributed to D Höntzsch.

At least 19 recordsLinked to original sources
PubMed2005

Fractures of the distal tibia treated with closed reduction and minimally invasive plating.

INTRODUCTION: The treatment of fractures of the distal tibia can be problematical because of the thin soft-tissue covering. Bridging slide-insertion plate osteosynthesis is performed by indirect, axially correct reduction of the fracture and stabilization without opening the soft tissue at the fracture site. Stripping of the periosteum is thus avoided, the fragments remain integrated into the soft tissue, and healing occurs spontaneously by way of callus formation. MATERIALS AND METHODS: Seventy-one patients treated by slide-insertion plate osteosynthesis were followed up over at least 2 years. As would be expected in this anatomical region, the proportion of C fractures and fractures with concomitant soft-tissue damage was high. The majority of patients were treated by application of an external fixator on the day of the accident; the definitive osteosynthesis with the slide-insertion plate was performed at a later date after healing of the soft tissues. RESULTS: In 68 patients, fracture healing was achieved within 2 years. In 80% of the cases, the final X-ray follow-up showed no or tolerable axis deviations (<5 degrees) in the varus/valgus plane or in the recurvation/antecurvation plane. A deviation >10 degrees requiring a correcting osteotomy was found in only 1 patient. Postoperative complications were rare occurrences. Five patients required an additional cancellous bone graft to deal with inadequate bone healing. System-related complications (instability, malalignment) due to intraoperative technical errors only had to be corrected in revision operations in 2 patients. CONCLUSION: Closed reduction and minimally invasive plating offers the combined advantages of minimal soft-tissue damage with stable fracture fixation.

Adult↗
PubMed2001

Minimally invasive fracture stabilization of distal femoral fractures with the LISS: a prospective multicenter study. Results of a clinical study with special emphasis on difficult cases.

The LISS-DF (Less invasive stabilization system-distal femur) is a new type of implant system for the treatment of distal femoral fractures according to the principles of "Minimally Invasive Surgery". A plate, pre-contoured to the anatomy, is inserted through a minimally invasive incision into the epiperiosteal space by means of an aiming device after indirect, closed fracture reduction. The implant is stabilized by insertion of screws which lock into the plate holes and prevent tilting. This is performed with the aid of an aiming device and through stab incisions. It is not necessary for a large area to be exposed at the fracture site. As part of an AO prospective multicenter study, the new system was applied to 112 patients with 116 fractures. The time to follow-up was on average 13.7 months (minimum 7 months, maximum 33 months). Fractures treated were distal femoral shaft and supracondylar femoral fractures. Eight patients died during the study of causes unrelated to the implant. Of the remaining 104 patients with 107 fractures, 96 patients with 99 fractures were available for complete follow-up (93% follow-up rate). In 90% of all cases treated and followed up, the fracture had consolidated during the period of observation. Twenty-three revision operations were necessary in 21 patients. In two cases, implant failure occurred as the result of a pseudarthrosis. The complications can be attributed in nearly all cases to the severity of the trauma and/or a lack of experience when applying the new style implant to a wider range of indications. The results of the study show that with a sound knowledge of the operative technique and careful preoperative planning this system represents an excellent, safe procedure for the treatment of almost all distal femoral fracture types including periprosthetic fractures of the distal femur. There is generally no need for primary cancellous bone grafting.

Adolescent↗
PubMed2001

[Distal femoral fracture--technical possibilities].

The fractures of the distal femur are classified as extra-articular fractures (type A), partial articular fractures (type B), and complete articular fractures (type C). The aims of operative treatment are anatomical reconstruction of the articular surfaces, restoration of rotational and axial alignment, stable fixation of the condyles to the shaft of the femur and early functional aftercare. Techniques and implants for treating intra-articular fractures lies in the reduction of the joint fragments and fixation with lag screws. For the treatment of the extra-articular fractures different approaches, techniques and implants have proven to be reliable and effective: direct-indirect reduction, open-minimal invasive approaches, open-slipped techniques. Implants: condylar plate, dynamic condylar screw (DCS), condylar buttress plate, anterograde nailing, retrograde nailing, internal fixators (Low Invasive Stabilisation System--LISS) and external fixation.

External Fixators↗
PubMed1999

[Computer-assisted performance documentation. Effects in orthopedics and trauma surgery on budgets and reimbursement].

Since 1995 German health maintenance laws require hospitals to document and code all referrals, admissions and discharges using the 4-digit ICD. Operative procedures are documented and coded using the ICPM. Beginning in January 1996, reimbursement for health services requires a diagnosis-related billing and payment for special procedures. The decision for billing is based on documented diagnosis and therapy. This extended request for documentation makes an online access to diagnosis and therapy with a computer-assisted coding system advisable. In 1996 in our hospital each diagnosis and operation was manually documented and coded on a form. Since the beginning of 1997, documentation and coding has been exclusively computer-assisted. On the basis of documented diagnosis and therapy the computer provides the route of reimbursement. Retrospectively we evaluated the number of charged diagnosis-related billings and payments for special procedures from January to April of 1996 and 1997. It became evident that with computer-assisted documentation and coding the number of detected and charged diagnosis-related billings and payments for special procedures was significantly increased in comparison with the previous year.

Budgets↗
PubMed1998

[Epiperiostal, percutaneous plate osteosynthesis. A new minimally invasive technique with reference to "biological osteosynthesis"].

Conservation of bone perfusion, protection of the soft tissue envelope and reduction of systemic stress by strengthening the host defence mechanism are general and essential aspects of a biological osteosynthesis. The minimal invasive operating techniques with the use of technical aids and tricks form the necessary presupposition for successful bone healing with a low complication rate. For an epiperiosteal, percutaneous plate osteosynthesis, the technique using a sliding tip and a manipulation handle is demonstrated.

Arm Injuries↗
PubMed1997

[Efficient ambulatory and post-discharge thromboprophylaxis with fully automated pens].

Efficient prophylaxis of deep vein thrombosis is very important during and after hospitalisation as well as for outpatients. In a prospective randomised trial, a new automatic pen for subcutaneous injections of low molecular heparin was studied with 489 injections in 51 patients. The automatic pen with a covered needle allows a safe and standardised subcutaneous administration of low-molecular heparin with good patient comfort and at no additional costs.

Adolescent↗
PubMed1996

[External fixation of bones (fixateur externe) in fracture treatment].

In traumatology, we differentiate between conservative and surgical treatment. External fixation of the bone lies somewhere between the two. When deciding on the most appropriate treatment for each patient, the advantages and disadvantages must be carefully evaluated. However, there are a series of single or multiple injuries which can't be optimally treated with conservative procedures nor with invasive surgery. External fixation has become the treatment method of choice in many of these cases. The fragments to be stabilised are fixed with (so-called Schanz screws) or with (Steinmann pins) or with wires. The section which lies outside the body are attached to longitudinal rods. External fixation is a noninvasive, surgical method of fracture stabilisation with many advantages is easy to handle, has a low complication rate, can be taught anywhere, and can be used everywhere. There are great advantages in cases of soft tissue damage, in polytraumatised patients and in septic orthopedic surgery.

Equipment Design↗
PubMed1996

[Traumatic damage to the lower cervical spine--a diagnostic problem?].

Even today fractures and dislocations of the lower cervical spine are usually not recognized, or the interpretation of the results of the diagnostic procedures is not correct. These diagnostic failures are often caused by an incomplete representation of the cervical spine in the conventional radiograms, particularly in the lateral projection. Beyond that, the interpretation of the results of the neurological examination of patients with motoric or sensoric deficits after spine injury can be incorrect. Ignorance of the distribution of the segmental innervation of the upper extremities could lead to the wrong diagnosis of paraplegia in a tetraplegic patient. Two patients with injuries of the lower cervical spine are reported, in whom these problems led to an incorrect diagnosis. With regard to these cases we propose a standard diagnostic procedure for the clinical and radiological emergency examination of patients with neurological deficits after spine injury. The technical possibilities of obtaining correct radiographs of the lower cervical spine are described in detail.

Adult↗
PubMed1994

[Indications, technique and results of muscle flaps in decubitus ulcers of the pelvic region in paraplegic patients].

Over a period of 10 years 57 pelvic pressure sores of 47 para- and tetraplegic patients were covered operatively with a muscle flap at the Co-Operative Trade Association Hospital for Accidents, at Tübingen, Germany. 39 patients with 49 muscle flap-covered decubiti were seen in a follow-up examination. Despite many postoperative complications--not uncommon for septic patients--there was a high rate of complete healing (94%) of the pressure sores within a short period of rehabilitation. Indeed one cannot prove the superiority of the muscle flaps over cutaneous and fasciocutaneous flaps because of the missing statistical comparability and correlation capability of the results with other studies. In our opinion muscle flaps in the pelvic area seem to be advantageous to cutaneous and fasciocutaneous flaps.

Adult↗
PubMed1994

[A new open universal clamp for the external fixator tube system of the AO].

A new open universal clamp has been developed for the external fixator tube system of the ASIF. This new clamp is fully compatible with the previous system. All mechanical properties are at least comparable with those of the hitherto successful clamps, whereas in some cases they are even distinctly superior. The obvious advantages are: The clamp can also be pushed subsequently laterally onto the tubes and arbon fibre rods. The clamping plate for the Schanz screws can take 4-6 mm screws. It is thus possible to use this system alongside with the 4 mm system. The clamp replaces 2 of the previous clamps. An open tube-to-tube clamp can also be positioned. The clamps have been used with success and with full utilisation of all their advantages in their first clinical application.

Biomechanical Phenomena↗
PubMed1993

[How much are external fixator nuts tightened in general practice].

External fixation is an approved system of treatment in orthopedic surgery. 21 different modalities of assembly--using the AO (ASIF) tubular system--were selected for a clinical trial in 3 major trauma hospitals. It is considered that all nuts of the applied external fixators were tightened properly. In experimental work it was found, that a torque of 8-11 Nm is sufficient and can be recommended. A suitable torque-wrench is available.

Biomechanical Phenomena↗
PubMed1993

[Change in the procedure from external fixator to intramedullary nailing osteosynthesis of the femur and tibia].

Shaft fractures of femur and tibia can be treated successfully by intramedullary nailing. In recent years the use of interlocking nails widened the indication for nailing fractures of the proximal and distal bone and more difficult fractures. There are still limits in polytrauma patients, chain fractures with or without participation of joints and in fractures with severe soft tissue injury (open or closed). In these cases primary treatment with external fixation has proved worthwhile. The main problems and risks of primary nailing osteosynthesis occur in the early phase of treatment, whereas complications in external fixation are more likely to occur in later phases of treatment. In changing from external fixation to intramedullary nailing one can see the advantages of both methods. In the literature only small studies have been made mostly with patient groups below 50 in number. The change of method was rarely standardised and the time period between procedures was either late (more than 3 weeks) or arbitrary. The advantages and disadvantages as well as the risk in changing methods are controversial. In a 2-year prospective study from August 1989 to July 1991, patients with II and III degree open and closed femur and tibia fractures as well as trauma patients with fractures were initially treated by external fixation. A change of method from external fixation to intramedullary nailing was performed at the earliest possible time under exact criteria. 61 femur and 106 tibia fractures were accordingly treated and followed. In comparison to early studies there were no differences in bone healing or in functional results. The infection rate in tibia fractures was 1.9% (2 of 106); no infection was seen in femur fractures. The contamination rate at the time of method change was substantially higher at 14%. The difference between contamination and infection rate can be explained by experience in the technique of nailing, considering biological aspects (no or little reaming), the standardized change of method and the prophylactic use of antibiotics. In a follow-up of additional 37 femur and 58 tibia fractures that were treated accordingly, a total infection rate of 1.9% was achieved (2% in femur fractures [n = 98], 1.8% in tibia fractures [n = 164], 1.9% total [n = 262]). In femur and tibia fractures with open or closed soft tissue damage and in multiple trauma patients the treatment with initial stabilisation by external fixation and secondary change to intramedullary nailing can be recommended under certain conditions.

Adolescent↗
PubMed1993

[Comments on measuring the mobility of the upper ankle joint by the neutral-0-method].

The pivot and axes of the ankle joint not easily determined. Instruction and some experience are required to determine the values by the Neutral 0 Method as accurately and reproducibly as at all possible. The following recommendations are based on theoretical considerations and clinical experience: 1. The experienced physician can measure the correct angle by taking the patient's foot in his hand and asking the patient to raise and lower the foot. From the overall posture and reaction of the foot it is possible to correctly "feel" the neutral 0 position as initial value, and therefrom the raising and lowering. 2. A highly recommended procedure is to examine the patient in recumbent position on the couch with the heal upright as it touches the couch. The foot is then lowered until the sole touches the couch while the knee is bent, a small supporting board serving to determine the axis as the foot is raised. This is a safe method for both the beginners and the experienced. The angles can be determined even better than by the "free" method. 3. In patients who do not cooperate well, lowering and raising of the foot can be checked additionally with the patient standing and bending his knee as well as by standing on tiptoe. In this case the passive forces must be taken into consideration, especially during forward bending of the lower leg. Hence, with this method, it is necessary to distinguish clearly between active and passive function.

Ankle Joint↗
PubMed1993

[What does the new solid unreamed tibia nail (UTN) contribute in open fractures?].

In the field of trauma surgery open fractures of the lower leg remain an injury with a high complication rate. Bone and soft tissues must be treated carefully to avoid further damage, so that uncomplicated healing results. In the past, treatment of open fractures of the lower leg was done primarily by external fixation. Medullary nailing with reaming of the medullary canal has been widely used for shaft fractures without soft tissue damage, but when used in open fractures, the infection rate remained high. Intramedullary nailing without reaming required the development of new implants (i.e. the solid unreamed tibia nail (UTN) by AO). These new implants allow us to perform the nailing technique in open fractures of the lower leg with a low complication rate. This can be done primarily or secondarily after initial treatment with external fixation. Even patients with lower-leg open fractures may benefit from the advantages of early mobilization and partial weight-bearing after osteosynthesis with intramedullary nailing.

Bone Nails↗