Biomedical subjects
F W Thielemann
Publications and source records attributed to F W Thielemann.
Locked posterior dislocation of the shoulder: treatment using rotational osteotomy of the humerus.
This study reports the use of rotational osteotomy in 10 patients with locked posterior dislocation of the shoulder. The average interval between injury and diagnosis was 155 days (range, 21-400 days). Patients were aged 40-78 years old, with an average age of 53 years. Articular impaction fracture of the humeral head involved 20-40% of the articular surface as determined by CT analysis. There were no postoperative complications except a transient axillary nerve palsy. Patients were started on immediate passive motion followed by an active program at 2-3 weeks. Using the Rowe/Zarins scale, six patients had good-excellent results, two fair results, and two poor results. The poor results were seen in cases where articular cartilage damage was advanced. Rotational osteotomy is an effective procedure at restoring glenohumeral congruity and early functional activity in the patient with locked posterior shoulder dislocation given the following criteria: (a) healthy articular cartilage, (b) a humeral head defect involving less than 40% of the articular surface, and (c) a patient who is able to participate in an active rehabilitation program.
[Isolated injury of the subscapular muscle tendon].
Avulsion of the subscapularis tendon is caused by a combined abduction and external rotation trauma of the upper limb. Weakness of internal rotation and a positive apprehension test are clinical signs of the injury. A fracture of the lesser tuberosity in the x-ray film or a disruption of the subscapularis tendon documented in dynamic sonography of the shoulder clarify the diagnosis. Operative treatment is indicated of prevent weakness of internal rotation as well as anterior instability. This recommendation is supported by four cases with full range of motion and good anterior stability after surgery.
Bone morphogenetic protein: a review.
The osteogenic potential of bone and bone matrix has been characterised only by its biological effects and the parameters influencing it. Recently, the osteoinductive ability of bone matrix had been defined chemically by the description of a bone morphogenetic protein (BMP), and the parameters of osteogenic factors from different species have now been recognised. The current state of isolation, purification and characterisation of these factors is summarised in this review. General aspects of the isolation and testing of BMP preparations, and the results of orthotopic application of BMP implants, including clinical cases, are reported.
[Primary valgisation osteotomy in femoral neck fractures].
Technique and results after primary valgisation osteotomy in 41 patients with femoral neck fractures are described. 2 non unions and 9 avascular femoral head necroses were observed. The primary valgisation most probably does not influence the rate of necrosis. When performed by accurate technique it lowers the incidence of non union of the femoral neck. Postoperative leg lengthening is always evident. The most current avoidable mistake is an external rotational deformity. The procedure requires proper preoperative planning.
[Modified transpeduncular spongiosa-plasty with osteotomy of the transverse process].
Bone grafting of the vertebral body is an essential part in stabilisation of the spine. A modified transpeduncular approach to the vertebral body is described. Using this approach a bone graft can be placed more exactly in a shorter time.
[Differential diagnosis of shoulder dislocation with special reference to posterior dislocation].
Evaluation of a dislocated shoulder must classify the direction of dislocation and describe additional injuries as well as the recurrence rate. This is required in all types of dislocations by recording the case history in detail, and by examining the shoulder clinically as well as radiographically in two planes. Ultrasound and arthro-computer tomography are valid methods to demonstrate injuries of bony and ligamentous structures. They may therefore influence surgical treatment. In posterior dislocation of the shoulder quite often early diagnosis is missed. If this injury is suspected, careful clinical and radiographical evaluation is most important.
[Plate osteosynthesis of femoral shaft fracture with reference to biological aspects].
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[Surgical treatment of distinct gynecomastia in juveniles].
The article reports on operative plastic and reconstructive surgery in the management of gynaecomastia in adolescents. The disadvantages of an unsatisfactory early result after circumareolar approach and the uncertainty with regard to the possible late result are avoided by the approach presented here. The surgical management is described in detail.
[New aspects of the treatment of larger bone defects].
A characterisation of mainly used implant materials into bone defects is performed. The materials are classified in two groups; their biological effects are described in detail. Using OCG as a typical osteoinductive implant histological and radiological findings are described which take place in animals after heterotopic and orthotopic implantation.
Osteoinduction. Part I: Test model and comparative long term observation of allogenic and xenogenic matrix implants.
In order to demonstrate osteoinductive activity of transplants and implants an experimental approach is presented in this study. Matrix induced osteogenesis following allogenic and xenogenic implantation is demonstrated morphologically, by induction of alkaline phosphatase, and by mineralisation of the newly formed matrix. Beginning on day 20 new bone formation can be found lasting up to 6 months in allogenic implants, whereas in xenogenic implants only inflammatory infiltrations are detectable. Osteoinduction is a matrix conducted phenomenon, as was confirmed by control experiments. Orthotopic allogenic implantation in diaphyseal defects of dogs demonstrates the ability of such implants to bridge a great defect by induced new bone formation and the property of the newly formed bone to adapt to physiologic stress.
Osteoinduction. Part II: Purification of the osteoinductive activities of bone matrix.
Using a previously described experimental model for demonstration of osteoinduction biological activity of variably prepared fractions of demineralized bone matrix was studied. Sequential extraction of matrix using CaCl2, EDTA, LiCl and water results in an acceleration of the induction process and a reduction of immunological host reaction in the case of xenogenic implants. Application of chaotropic reagents such as guanidinium chloride and sodium thiocyanate has the consequency of lowering the inductive signal. From these results it is likely that noncollagenous constituents of bone matrix play a significant role in osteoinduction.
[Defect replacement with osteogenin containing gelatin].
In order to demonstrate an alternative way to correct diaphyseal defects allogenic cortical bone prepared as "osteogenin containing gelatine (OCG)" was used in sheep. Animals without any implants served as controls. Healing was assessed by radiological examination after 3, 6, 9 and 12 weeks and histological examination after 12 weeks. In the control group there was no bridging of the defect in all of the four animals. Out of the six animals of the OCG-group one animal suffered from a postoperative infection and one animal failed because of a breakdown of the osteosynthesis. The other four animals exhibited a complete reconstruction of the former defect roentgenologically after 9 weeks. Histologically a new formed spongious bone could be demonstrated in the former defective site. The OCG-implants were completely resorbed after 12 weeks.