Biomedical subjects
D Heim
Publications and source records attributed to D Heim.
[Can humerus shaft fractures be treated with osteosynthesis?].
The treatment of fractures of the humerus shaft is still controversial. The results of functional treatment (brace) are good, consolidation occurs in most cases within 8-10 weeks, slight malalignment can be accepted, and there is no risk of postoperative complications like osteitis, neurological iatrogenic disorders and technical errors. On the other hand a correct osteosynthesis allows painless functional postoperative treatment, the patient comfort is excellent and a selected group of patients might return to work faster. We present the results of plate fixation of humerus shaft fractures in 127 patients, operated from 1980 to 1988. 102 patients were clinically and radiologically controlled after 1 year: 85 patients (83.4%) presented an excellent or good result with complete functional recovery. 17 patients (16.6%) showed a limited range of motion in shoulder and/or elbow mostly due to other fractures of the same arm or to persistent neurological disorders (plexus or radial lesions). Postoperative complications included 2 postoperative radial palsies recovering completely within months, 5 failures of internal fixation due to technical errors, 2 pseudarthrosis and 4 postoperative infections, healed by reoperation and early removal of the implant with one exception (osteitis). We therefore conclude, that a correct plate fixation of humerus shaft fractures is an alternative to conservative treatment. The main advantage is better patient comfort and shorter disability for a selected group of patients.
[External fixator as primary and definitive treatment of tibial fracture with severe soft tissue damage].
The initial treatment of choice of fractures with severe soft tissue damage of the leg is the stabilization with an external fixator. After successful healing the question arises whether to continue the initial treatment with the external fixator to bone union or to change the initial concept by an internal fixation. Our experience with 62 fractures of the tibia (follow-up of 59 fractures) from 1985 to 1989 shows that 72% of the fractures were healed by the external fixator alone. Delayed union or pseudoarthrosis occurred in 17% and were mostly treated by late internal fixation. An analysis of the fracture types (new AO classification) did not show certain fracture types, that did not respond to the external fixator treatment alone. We conclude that the reason for a delayed union or pseudoarthrosis is less a morphological than a biological one. We recommend the first and final external fixator as treatment for fractures with severe soft tissue damage of the leg.
[4 fragment fractures of the proximal femur: is the dynamic hip screw a suitable implant?].
The DHS-implant system is widely used in the operative treatment of pertrochanteric fractures of the femur. The telescoping effect of the implant in the unstable 4-fragment fracture leads to lateralisation of the greater trochanter and shortening of the leg. The quality of reposition influences this secondary dislocation. In our series of 65 patients treated with this device 17 repositions were in a varus position, followed by leg shortening of more than 10 mm in 9 patients. Independent of the quality of reposition in the long-term follow-up only one patient of 25 complained of persistent pain.
[Vascular reconstruction following trauma. Experience in Basel 1980-1988].
From 1980-1988 twenty patients with vascular trauma were treated at the Kantonsspital Basel, Switzerland. The incidence of 1% in open fractures is low. Nerve lesions in combination with vascular trauma are very frequent, specially at the upper extremity. Nearly all patients were treated with the interposition of a venous graft from the vena saphena magna. We deplore 3 amputations after successful vascular reconstruction, mainly due to extensive bone and soft tissue damage. Our long-term control shows very satisfying vascular results, but poor neurological results. We therefore conclude that the functional outcome is--apart from a short ischemia time--highly related to the neurological situation at the time of the trauma.
[How have recent results concerning transfusion-induced immunosuppression and danger of transmission of AIDS changed indications for the transfusion of blood and blood components?].
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[Base fracture of the 5th metatarsal. Classification and therapy using a strapping bandage].
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Common pediatric i.v. meds at a glance.
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