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Biomedical subjects

D Havemann

Publications and source records attributed to D Havemann.

At least 19 recordsLinked to original sources
PubMed1999

[Internal knee injuries in children].

Although children are injured everyday through accidents, road traffic, leisure or sports activities, internal lesions of the knee joint due to the trauma are rare. Diagnose and therapy follow rather empirical than analytical patterns. A retrospective, controlled study evaluates and recommends ways of treatment. Traumatic internal lesions of the knee where analysed in 76 children up to age 16. The pattern of injury changed with increasing age, the trauma remaining the same. Most common where injuries to the anterior cruciate ligament (ACL). Main cause where sports activities. Operative treatment seems to be the appropriate treatment. Osseous avulsions of the cruciates and collateral ligaments showed good results after transosseous refixation with a suture. Suturing of intraligamentous ACL-ruptures as well as patellar ligaments plasty showed unsatisfactory results. Secondary lesions due to instability of the knee where also observed in children. Children cannot self estimate the severity of the injury so subjective statements are insecure. Trauma, surgery, pain and immobilisation cause a marked malfunction of the sensor-motor system which is effectively treated by physiotherapy.

Adolescent↗
PubMed1998

[Pelvic ring injuries].

PURPOSE: Analysis of the trauma patient of fractures of the pelvic ring and classification according to AO/Tile. METHODS: 125 unselected patients (43 females, 82 males) were evaluated retrospectively by conventional x-ray, and CT examinations included follow-studies. RESULTS: Type-A fractures were seen in 36 (29%), Type-B fractures in 58 (46%), and Type-C fractures in 31 (25%) cases. Type-B and Type-C fractures mainly occurred in patients with traffic accidents and falls from great height. Type-A fractures were seen most often in patients with accidents at home or at work. However, in patients with complex fractures a classification concerning Type-B or Type-C fractures was difficult. SUMMARY: Based on CT criterias, in most patients a statement concerning the applied forces, the stability of the pelvic rim and the fracture type can be made.

Fractures, Bone↗
PubMed1997

Quality of life after pelvic ring injuries: follow-up results of a prospective study.

A follow-up after 2 years on average could be done in 43 cases of pelvic ring injuries. Seven were type A, 8 type B and 28 type C lesions. Every type A lesion was treated non-operatively. External fixation and non-operative management were used with type B injuries. As well as non-operative treatment, both internal and external surgical techniques were employed for type C fractures. While group A hardly mentioned pain in the follow-up, groups B and C suffered dorsal pelvic pain of comparable intensity irrespective of the therapeutic measures taken. Anatomic reduction does not guarantee freedom from pain. We also rated hip joint flexibility and ability to walk according to the Merle D'Aubigné score. Because of their pelvic injuries 50% of the type C patients changed their profession. The sequelae of the accident on sports and leisure time activities will be considered as well as the subjective contentment evaluated. Unstable and dislocated pelvic ring injuries permanently interfere to a high degree with the quality of life. It is remarkable that many of the traumatic lesions which interfere with the quality of life are caused by the traumatic violence itself and cannot be influenced by the manner of surgical stabilization.

Adolescent↗
PubMed1995

[Results of follow-up of conservatively and surgically treated injuries of the pelvic ring within the scope of a prospective study].

Follow-up was possible after an average of 23.4 months in 26 cases of pelvic ring injury. These were made up of 7 type A, 8 type B, and 11 type C injuries. Every type A lesion was treated conservatively. External fixation and conservative management were used with type B injuries. Besides conservative treatment both internal and external surgical procedures were applied for correction of type C fractures. While patients treated for type A injuries reported hardly any pain at follow-up, those with types B and C reported dorsal pelvic ring pain of comparable intensity regardless of the treatment given. All patients with a poor outcome following unstable pelvic ring injuries reported dorsal pelvic pain as a principal symptom. Radiological evaluation revealed that the greater the dorsal displacement the more acute the dorsal pain must be expected. An anatomical reduction does not guarantee freedom from pain, however. Besides pain we also rated hip joint flexibility and ability to walk according to the Merle D'Aubigné score. Trauma-related damage and postoperative injuries were distinguished in the neurological evaluation showing a high incidence of lesions of the lateral cutaneous nerve of the thigh following external pelvic fixation. Because of their pelvic injuries 6 patients (23%) were completely or partly disabled and thus unfit for work. The follow-up examinations showed good results in 20 (76%) of the cases. While type B pelvic ring injuries can heal completely when treated by means of a supra-acetabular pelvic fixator, reliable retention cannot be achieved in the case of type C lesions.

Adult↗
PubMed1995

[Injury analysis of pediatric talus fractures].

Fractures of the talus are very rare in children. The present paper analyzes the treatment and long-term follow-up of 11 talus fractures in children over a period of 20 years (1974-1994). There were 5 fractures of the talus neck, 3 flake fractures, 1 depressed fracture of the talus head, and 2 lesions at the trochlea of the talus. Two fractures not previously described in the literature are presented. Treatment was conservative in all nondisplaced fractures. The displaced lesions were treated by compression screws and K-wire fixation of articular surface fractures. In 9 of the 11 fractures healing with good functional results, though arthrosis of the talocalcanean joint was present in 6 and partial necrosis of the talus, in 2. There is no difference between children and adults in the diagnosis and selection for operative treatment.

Adolescent↗
PubMed1994

[Functional treatment of surgically treated empyema of the knee joint].

Knee-joint empyema requires prompt surgical management. After debridement the joint needs to be irrigated for several days. Functional follow-up treatment with electromotive splints according to the CPM concept should begin soon after surgery. Follow-up examination of patients treated in this way for knee-joint empyema showed a protracted course with worse results for empyemas subsequent to arthrotomy, while joint infections after less severe injuries (skin lesions, puncture) healed successfully.

Adolescent↗
PubMed1993

[Pelvic fractures in the Kiel trauma surgery clinic. A one-year evaluation].

48 injuries to the pelvis were treated from January 1991 through December 1991. We found 45 fractures of the pelvic ring with associated acetabular fractures in 15 cases and three isolated acetabular lesions. 19 injuries were caused by car accidents, 18 fractures resulted from a fall, especially in older patients. Isolated fractures of the pelvis occurred in 18 cases. The average total severity of the injuries was 19.7 points according to the Hannover Polytrauma Score (PTS). Every fracture was classified using the Tile-classification. There were 15 (33%) Tile A lesions, 18 (40%) Tile B fractures and twelve (27%) type C pelvic ring injuries. In 18 cases surgery was the method of treatment. Seven out of 18 injuries to the acetabulum were treated with open reduction and internal fixation. In ten patients the unstable pelvic ring was fixed by means of an external fixator. To do so, a pair of 6 mm diameter pins were placed on both sides in the supraacetabular region of the iliac bone directed towards the sacroiliac joints. We used a triangular form of external fixation. An open reduction and internal fixation (ORIF) was necessary in five cases, one injury required a combination of external and internal procedures. There were 14 cases in which we found sacral fractures as an additional dorsal lesion. Nine of 14 sacral fractures were recognized only by CT examination. In eleven cases the conventional radiographs showed simple anterior pelvic ring fractures while the CT examination revealed an additional lesion of the sacroiliac joint in nine of these cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗
PubMed1993

[Plaster-free, early functional after-care of surgically managed Achilles tendon rupture].

The widely used treatment of Achilles tendon rupture by operation and postoperative plaster is more and more controversially discussed. The disadvantages of plasters with thrombosis and joint stiffness and recent results about tendon healing makes it worth while to illucinate an immediate functional physiotherapy. Our study consists of two groups of patients who were operated for tendon rupture. Postoperative one group (n = 24) was treated with a plaster for six weeks. The second group (n = 17) was immediately treated by physiotherapy without any immobilisation. After a mean time interval of 19.8 months the joint movement and tendon flexibility was evaluated. Furthermore soft tissue ultrasound was performed to measure the tendon tissue density and gliding movement. Our data showed that 1. Early functional treatment resulted in minor problems (35%) than immobilisation (46%). 2. Plaster-free treated patients had higher tendon density values (grade II 41%, grade III 47%, grade IV 12%), which depicts a higher tensile strength than the comparable group (grade II 29%, grade III 58%, grade IV 13%). 3. Plaster-free treated patients showed significant lesser adhesion formation to the Achilles tendon (grade I 29%, grade II 53%, grade III 18%) than immobilisation (grade I 4%, grade II 59%, grade III 37%).

Achilles Tendon↗
PubMed1993

[Results of treatment of multiple ventral shoulder dislocation and surgical stabilization by Weber rotational osteotomy. 78th Annual Meeting of the Swiss Society of Trauma Surgery and Occupational Diseases 4-5 September 1992 in Olten].

The treatment of recurrent anterior shoulder dislocation with the rotational humeral osteotomie by Weber showed best results in the follow-up of 53 operations when combined with a shortening of the capsule and the musculus subscapularis. Rotational humeral osteotomie alone showed in 20% redislocations. The rate of redislocation could significantly be reduced by additional shortening of the soft tissue.

Adolescent↗
PubMed1992

[Patterns of injuries: a guideline for evaluation of multiple injuries?].

By means of 468 patients with polytrauma the pattern of injuries were analysed. Separated into body regions the combinations of injuries to skeleton/thorax and skeleton/thorax/abdomen were found most often. A high lethality was evaluated for the combination of skeletal and abdominal injuries. 362 patients of the examined collective survived, 106 patients died. Among the deceased patients with head-injuries intracranial bleeding could be seen much more than in the group of survivors. Patients who died had also more ruptures of liver and other gastrointestinal injuries. Concerning the skeletal patterns of injuries they surprisingly had more fractures of shoulder, forearm and lower leg than the survivor-group. The statistic demonstrates clearly that in pattern of head or abdominal injuries the single diagnosis determines the rate of lethality. This correlation could not be seen in skeletal injuries. The pattern of injuries cannot be used as a guideline for the assessment of therapy of the severe trauma patient.

Abdominal Injuries↗
PubMed1992

[Results of surgical management of scapula fractures. 78th Annual Meeting of the Swiss Society of Accident Surgery and Occupational Diseases, 4-5 September 1992 in Olten].

The follow-up of 8 patients with scapular fractures showed a high rate of complications with 3 infections and problems with the osteosynthetic material. This did not effect the results in any case, most results were good. The indication for the operation should be proved restrictively, the following operative treatment should be minimal invasive. CPM-devices were used after operation and had a positive effect.

Adult↗
PubMed1992

[Treatment of gas gangrene. Results of a retro- and prospective analysis of a traumatologic patient sample over 20 years].

From 1970 to 1977 and from 1978 to 1990, the treatment and outcome in 136 patients with gas gangrene were investigated. The prognosis was better in patients with gas gangrene after trauma than in patients with gas gangrene resulting from vascular insufficiency or malignant tumours. In the first group the lethality of gas gangrene was 28.6%, in the second group, 7.1%. This difference is significant (P < 0.05). In 40.5% the infected extremities were saved. Patients with injuries without fractures did not lose limbs because of gas gangrene or die of it. When an operation was performed before or after the first session of oxygenation at high pressure (OHP) lethality was lower (20%) and the rate of saved limbs higher (80%) than with later operation (lethality, 50%; saved limbs, 45.5%). All patients who could not be treated by OHP, or only once or twice, died. From 1970 to 1977 patients who were treated surgically and received OHP for 5 days survived, and since 1978 this has applied to patients treated for 4 days. In general, the lives of patients with gas gangrene are no longer in danger by the 5th day of therapy. The use of checklists for diagnosis and therapy has been practised since 1978, and this is assumed to be one factor in the better outcome.

Adolescent↗
PubMed1992

[Is penicillin G the drug of choice in gas gangrene? Results of a prospective documentation of clinical, microbiological and animal experiment data].

Between 1978 and 1990 98 patients with gas gangrene were treated in the departments of general surgery and traumatology of the University of Kiel. The microbiological results of tissue samples and results of animal infectious experiments were correlated to the clinical outcome. It could be shown, that gas gangrene due to C.perfringens alone had a higher mortality than gas gangrene due to polymicrobial infection. In trauma patients, however, the rate of amputations was lower in cases of clostridial monoinfections (25%), than in patients with mixed infections (48%). The results of animal experiments with guinea pigs which were infected by patients' infectious material showed a correlation to the clinical outcome. This correlation could not bee shown using isolated and cultured clostridia. Therefore and because of the quantity of mixed infections it is necessary to use broad spectrum antibiotics for treatment in cases of gas gangrene and for perioperative antibiotic prophylaxis. Penicillin-G alone can not more be recommended for this purpose.

Adult↗
PubMed1992

[Stabilizing the pelvic ring with the external fixator. Biomechanical studies and clinical experiences].

Experimental studies were performed on anatomic pelvis specimens. In different series of experiments the positioning of the screws and the assembly of the external fixator were changed. We tried fixing the external fixator to the screws at varying distances from the body surface. For stabilisation of the fractured pelvic girdle a self-constructed "bow fixator", fixed to supra-acetabular screws with proximal compression and distal traction showed the best results. Homogeneous distribution of the pressure could be achieved on the unstable dorsal pelvic ring structures. In clinical routine we used the triangular external fixator, which in the experimental situation yielded results close to those of the bow fixator. External fixation of the pelvic girdle has been performed 128 times since 1977, in January 1991 a prospective study was started. For Tile type B injuries the external fixator itself represents an effective, minimally invasive system, but type C fractures often require an additional internal fixation of the dorsal lesion.

Acetabulum↗
PubMed1991

[Early functional treatment of the injured shoulder supported by an active shoulder bandage].

The following study shows the results of treatment of 29 patients suffering from rotatory cuff lesion and of 20 patients with tendinosis. The results of functional physiotherapy of the patients with rotatory cuff lesion correspond to the results of post-operative treatment described in other studies. As a result of early functional physiotherapy backed up by an active shoulder support, the treatment was both improved and shortened considerably. The accompanying pain relief achieved an earlier usability of the shoulder joint in both groups of patients. Four patients with rotatory cuff lesions were resistant to physiotherapy and finally had to undergo surgery.

Bandages↗
PubMed1991

[Experimental in vitro studies of the stability of tendon sutures].

In early mobilization tendon sutures must perform a sufficient stability. For the examination of a suture under tension tendons of cows with 4 to 6 mm diameter were taken as specimen. They were divided and then sutured with the techniques of Kirchmayr, of Lange and of Dychno-Bunnell. We used the resorbable Polydioxanon-Suture (PDS) and the non-resorbable Polypropylene-Suture (PPS) in 3-0, 4-0 and 5-0 of cross diameter (USP). Breaking-strength, elongation of the suture, the absorbed strength until a gap is developing and the extent of the gaps at their maximum were measured. The results recommend the suture techniques of Dychno-Bunnell and of Lange with 4-0 and 5-0 PDS as sufficient stable for early mobilization.

Animals↗