PubMed Health⌕ Search

Biomedical subjects

G Möllenhoff

Publications and source records attributed to G Möllenhoff.

At least 19 recordsLinked to original sources
PubMed2006

[Fracture of the distal ulna accompanying fracture of the distal radius. Minimally invasive treatment with elastic stable intramedullary nailing (ESIN)].

The distal radius is one of the commonest sites of fracture, and this injury is sometimes associated with fracture of the distal ulna. In recent years, surgical treatment of distal radius fractures has consisted increasingly in internal fixation with locking plates followed by early functional postoperative treatment. The associated injury to the distal ulna has so far not received much attention in the literature. Various techniques have veen described for its treatment: Kirscher wire fixation, tension band wiring, and internal fixation with screws and plates. Following positive results with elastic stable intramedullary nailing (ESIN) in the treatment of shaft fractures in children this technique was also applied in in fractures in adults (forearm, clavicle). Use of this technique for stabilisation of distal ulnar fractures has not previously been reported. In the course of a prospective longitudinal study (EBM level II), in 26 patients with an average age of 73.6 (42-88 years), bone healing in anatomical position was achieved in all cases within 6-12 weeks after closed reduction and anterograde ESIN with subsequent treatment that did not involve immobilization. No length differences of more than 2 mm and no functionally relevant deviations of the ulnar axis were observed. Apart from 3 cases of nail perforation at the distal end of the ulna, which had no clinical manifestations, there were no complications. ESIN offers a minimally invasive option for the treatment of unstable fractures of the distal ulna associated with distal radius fractures; it allows functional aftertreatment and can be regarded at least as an alternative to open reduction with internal fixation.

Adult↗
PubMed2006

[Long-term results after acetabular fractures with respect to heterotopic ossifications].

BACKGROUND: Arthrosis, necrosis of the femoral head and heterotopic ossification (HO) tend to decline the outcome of acetabular fractures despite of good fracture reduction. In this study functional outcome and degree of HO were analyzed due to fracture type and surgical approach. The aim of this study is to delineate wether minimization of soft tissue damage increases the functional outcome. PATIENTS AND METHODS: 55 patients with surgically treated acetabular fractures (mean age: 40.4 (20-81) years, male 43, female 12) where retrospectively evaluated with a mean follow-up of 7.7 (4.4-12.3) years. Fractures were classified according to the Orthopaedic Trauma Association (OTA), functional outcome was scored by D'Aubigné-Postel and the degree of HO was defined by Brooker's classification. RESULTS: Following the OTA the distribution of fractures was: A-24 (44 %), B-23 (42 %) and C-8 (15 %). Mean D'Aubigné Index (max. 18 points) was 15.2, distributed to fracture type: A-15.9, B-15.0 and C-13.6. 32 % of all heterotopic ossifications were classified as Brooker 0, 10 % as Brooker 1, 29 % as Brooker 2 and Brooker 3 each, whereas Brooker 4 ossifications were not observed. 2/3 of the severe ossifications were observed using extended approaches or in case of type C fractures. The iliofemoral approach showed the tendency of fewer ossifications compared to extended approaches. CONCLUSION: Decrease of soft tissue damage during acetabular surgery plays an important role to improve outcome. Due to the higher risk of wrong implant position and insufficient reduction using a soft tissue sparing approach, we recommend a CT scan postoperatively to evaluate reduction and osteosynthesis.

Acetabulum↗
PubMed2004

Population pharmacokinetics of methylprednisolone in accident victims with spinal cord injury.

OBJECTIVE: High-dose methylprednisolone (MP) is used to treat acute spinal cord injury (ASCI). The objective of the present study was to determine the pharmacokinetics of the pro-drug methylprednisolone hemisuccinate (MPHS) and MP in accident victims with ASCI. METHODS: The patients (n = 26) were treated with a bolus intravenous loading dose of 30 mg/kg MPHS within 2 h after injury and this was followed by a maintenance infusion of 5.4 mg/kg/h up to 24 h. Blood, CSF and saliva samples were collected up to 48 h after the initial dose and the samples were analyzed by HPLC. Concentration-time data of MPHS and MP were analyzed using population pharmacokinetic analysis with NONMEM software. RESULTS: MPHS and MP could be monitored in plasma and CSF. MP but not MPHS was present in saliva. High variability was seen in the MPHS levels in CSF. The pharmacokinetics of the pro-drug and the metabolite were adequately described by a 2-compartment model with exponential distribution models assigned to the interindividual and the residual variability. At steady state, the average measured MP concentration in plasma was 12.3+/-7.0 microg/ml and 1.74+/-0.85 microg/ml in CSF. The CSF levels of MP could be modeled as a part of the peripheral compartment. CONCLUSION: This study demonstrated that CSF concentrations of MP were sufficiently high after i.v. administration and reflected the concentrations of unbound drug in plasma. Salivary levels of MP were about 32% of the plasma level and may serve as an easily accessible body fluid for drug level monitoring.

Accidents↗
PubMed2000

[Chronic venous insufficiency after open tibial fracture. An underestimated problem].

There is a wide range of alternatives for primary bone reconstruction in the treatment of open lower leg fractures with soft tissue damage of the type Gustillo II and III. The primary objective should always be the protection of soft tissue damage whether one uses the fixateur externe, or an unreamed nail or primary bone shortening with secondary callus distraction. In recent years, this approach has produced better results and a reduction in the rate of major amputations. The overall effects of the initial treatment can only be analysed after a number of years. Research results indicate long-term soft tissue complications of the lower leg, varying from harmless swelling to venous ulcer. We conducted a clinical investigation which compared 80 patients, who were treated between 1985 and 1994 using the venous-occlusion plethysmography, to 50 healthy individuals. Clinically significant damage of the deep venous system was found in over 50% of cases. There was a direct correlation between the number of years since the initial treatment and the degree of damage found. Based on these findings, we recommend that the initial treatment of this condition and the preventative treatment of the secondary trauma diseases should follow regulated surgical guidelines and be recognised for insurance purposes.

Adult↗
PubMed2000

[Femoral neck fracture. Osteosynthesis or which endoprosthesis is indicated?].

Femoral neck fractures are frequent fractures of the elderly. They can be treated by the use of dynamic hip screws, lag screws, bipolar hemi-protheses or total hip replacement. The results are markedly influenced by the timing of the operation and the choice of the implant. Using the Garden classification of femoral neck fracture we demonstrate a different therapeutic approach according to Garden stadium I-IV.

Aged↗
PubMed2000

Effects of single-dose versus fractionated irradiation on the suppression of heterotopic bone formation--an animal model-based follow-up study in rats.

The histological and enzymatic effects of single-dose irradiation of 7 Gray (Gy) versus fractionated irradiation of 5 x 2 Gy on the suppression of heterotopic ossification were examined over a period of 60 days in adult male Wistar rats (n = 57). The standardized osteogenesis model system in rats 19, 10, 11, 16, 19] was used for this purpose. The course of developing ossifications was documented quantitatively and qualitatively by means of quantitative computed tomography/osteodensitometry and digital luminescence radiography. Assessment of the activities of the enzymes alkaline and acid phosphatase throughout the experiment as well as characterization of the isoenzyme of alkaline phosphatase (AP) in connection with histological observations displayed a metaplasia of the ingrowing connective tissue into bone-typical cells during osteoinduction. Thus, the increase of AP is the first sign of a functional transformation of mesenchymal stem cells into chondroid bone cells. The increase in the acid phosphatase level with a maximum of activity between the 15th and 30th day (according to the respective treatment group) is highly suggestive of a remodeling process paralleling incipient chondroclast and osteoclast activity. In the animal groups undergoing irradiation, the above-mentioned increase of enzymes occurred after a delay. Furthermore, the maximum values observed were lower than those in the group not undergoing irradiation. Both findings were more manifest in the animal group which underwent 5 x 2 Gy of radiation than in the group which underwent single-dose irradiation of 7 Gy. Radiation suppresses matrix-induced osteogenesis. The histological and enzymatic course of this process was unchanged in the animals which did not undergo irradiation. However, it was quantitatively reduced and accompanied by a retardation of osteogenesis. Both effects were again reduced with fractionated irradiation of 5 x 2 Gy, which is theoretically dose-equivalent to a 1 x 7 Gy application. Histological examinations revealed damage to the migratory, proliferating mesenchymal stem cell population by irradiation doses which had relatively small effects on preosteoblasts, osteoblasts, chondroblasts and other specialized cell forms. Therefore, it may be concluded that the smaller degree of heterotopic ossification in the irradiated groups was due to damage of and a decrease in the number of mesenchymal stem cells at the implant site. Our results stress the necessity of instituting postoperative irradiation therapy as early as possible to prevent heterotopic ossification. In view of experimentally proven better effects, fractionated irradiation has to be preferred to a dose-equivalent single-dose radiation, especially considering the fewer side-effects noted with fractionated irradiation.

Acid Phosphatase↗
PubMed1999

[Supination trauma. A classic case].

Sprains in the lateral ligaments of the ankle produce the most common ligamentous injuries of the human body. The mechanism of injury is complex, while supination represents the main component of foot movement. Classifying lateral ankle ligament injuries, many authors use a system of three degrees, which includes mild, moderate and severe sprains. Despite this scientific categories, in our opinion is the differentiation between elongation and complete ruptures of practical relevance. Under a biomechanical point of view, ligamentous trauma of the lateral ligaments lead to acute antero-lateral rotational instability (ALRI). Following the retrospective clinical study of Zwipp with 1,235 patients, in 70% of complete disruptions, the anterior talo-naviculare and fibulocalcanear ligaments are involved together. Syndesmotic injuries have been reported at a rate up to 10% of ankle sprains with deltoid ligaments at 2.5%. Rarely, the classic ankle sprain leads to injuries which affect the foot on a so called "supination fracture line". A rate of 7.4% is reported for these accompanying injuries. Therefore, clinical examination of ankle sprains should not only address on the distal tip of the fibula. Critical bony and ligamentous structures like the fifth metatarsal base, the calcaneo-cuboideal ligament, the ligaments of the anterior calcaneal process, the talus and syndesmotic ligaments have to be screened for pain and swelling. In our opinion, careful clinical examination and plain radiographs in two plains are sufficient for diagnosing ankle sprains and functional therapy.

Acute Disease↗
PubMed1999

[Transport-fixator for reconstructive surgery of the extensor apparatus of the knee joint].

Operative repair in ruptures of the extensor mechanism of the knee joint mostly requires additional external or internal fixation by plaster, transfer of tendons or encircling wires. Reconstruction of initially undiagnosed ruptures has to solve the problems of fixed proximal or distal migration of the patella and tendenous shortening. This can be performed with a tibiopatellar external fixator which allows gradually reduction of the patella in an anatomical position before operative reconstruction by suturing or reinsertion. During this period as well as a post-operative protection this fixator enables patients to maintain motion of the knee joint and full weightbearing. This technique can avoid poor functional results caused by long periods of immobilisation and is helpful in patients with marked displacement of the patella and inability to manually reduce the patella distally when delayed repair is necessitated.

Adult↗
PubMed1998

[Nonbacterial osteomyelitis of the clavicle].

Osteomyelitis can be subdivided into a bacterial exogenic (post-traumatic/postoperative), bacterial endogenic (hematogenous) and an abacterial type, including the rare group containing primary chronic sclerosing osteomyelitis, which is typically localized in the clavicle. In a review of the literature, the criteria for the various types of chronic sclerosing osteomyelitis are analyzed. Out of a group of 17 patients with osteomyelitis of the clavicle treated between 1978 and 1996, three cases of primary chronic sclerosing osteomyelitis are demonstrated. In the differential diagnosis, primary chronic sclerosing osteomyelitis of the clavicle has to be taken into consideration despite its rareness. After establishing a diagnosis by biopsy, in contrast to the other forms, drug therapy will be the treatment of choice and not an operation.

Adolescent↗
PubMed1998

[CPAP-augmented spontaneous respiration in thoracic trauma. An alternative to intubation].

Intubation and Positive End Expiratory Pressure Ventilation (PEEP) is a well established therapeutic strategy for impaired lung function, particularly following blunt chest trauma. Complications of this regime are however also well known and pose the question why non-invasive forms of respiratory assistance such as Continuous Positive Airway Pressure (CPAP) have only gained minor popularity. In a prospective study, 30 patients who had suffered blunt chest trauma were treated with CPAP administered by mask. The regime consisted of continuous administration of CPAP by a face-mask, with gradually increasing periods of spontaneous breathing. Initially a FiO2 of 0.33 (range 0, 28-0, 33) proved necessary. The initial CPAP level was 7 mbar (range 5-8) with an (Assisted Spontaneous Breathing) ASB of 15 mbar (range 13-8). FiO2 and CPAP/ASB levels were subsequently gradually reduced until no longer necessary. In all patients intubation and ventilation was avoided by this regimen. The treatment was well accepted by all patients and common ventilation associated complications such as pneumonia did not occur. In comparison with the former standard method of treatment the average ICU stay was dramatically reduced, principally due to not having to gradually wean patients from ventilation and sedation. Other positive benefits include normal communication and feeding with active early mobilisation leading to faster recovery, both physical and psychological. We conclude that non-invasive respiratory techniques should be used more frequently and recommend further studies are undertaken to define the indications.

Adult↗
PubMed1997

[Changes in therapeutic principles in fractures of the extremities with severe soft tissue injuries exemplified by tibial fracture].

Functional results after open fractures have been improved during the last decades. Especially the rates of amputation and chronic osteitis after open tibial fractures have been reduced from 30% to less than 5%. The initial management of this type of fracture includes reconstruction of the perfusion of the involved vessels, subsequent debridement with resection of avascular tissues, decompression of compartments by fasciotomy and initial shortening of the tibia by osteotomy and followed by callus distraction in order to achieve the physiological length of the leg. Cortical bone with periostal stripping has to be covered by local muscle transfer or by free vascularized tissue transfer within 3-7 days. Bone defects are either reconstructed by cancellous bone graft or, if the defect is longer than 2 cm, by continuous segmental transfer, according to the technique described by Ilizarov.

Amputation, Surgical↗
PubMed1997

[Callotaxis--osteogenesis by stretching--a conservative possibility for restoring leg length after post-traumatic primary tibial shortening?].

From 1993 to the beginning of 1996 28 patients (20 male/8 female) with open fractures of the lower leg (classification of Gustilo Type II, Type III) were treated by a primary shortening with a maximum of 5.7 cm (+/- 0.6 cm) after first debridement. After this management 23 patients showed a good soft-tissue cover; 5 patients needed a supplementary musculus latissimus dorsi-transfer to cover the bone. After an average of 22 days (+/- 4.2 days) and the radiologic sign of new callus 8 patients were treated by callotaxis in the fracture gap; 20 patients underwent lengthening by callotaxis of a separate osteotomy after an average of 24 days (+/- 3.6 days). After the mean of 52 weeks (+/- 1 weeks) all patients demonstrated good healing of the fracture and osteotomy. No one showed clinical or radiological signs of osteitis.

Adult↗
PubMed1996

Arthroscopic diagnosis of posttraumatic disorders of the wrist.

Arthroscopy of the wrist is a helpful diagnostic procedure in cases of painful problems that cannot be diagnosed by clinical and radiological examination. Arthroscopy of the wrist was done in 32 patients, who could not be diagnosed by clinical and radiological examination. During arthroscopy, lesions of the fibrocartilaginous disc and of the cartilage, synovitis of the joint capsule, scaphoid-lunate dissociations and a loose body were detected. As a result of arthroscopic findings, 10 operative procedures were necessary. Resection of a torn disc, local synovectomy, reconstruction of the torn scaphoid-lunate ligament and removal of a loose body were done by open arthrotomy (8 patients). In 2 patients shaving of chondral ulcers on the radial joint surface was performed, which obviated the need for an explorative arthrotomy. Arthroscopy is a simple method that enables new diagnostic possibilities in rare but difficult cases of posttraumatic pain of the wrist.

Adult↗
PubMed1995

[Long-term results of cemented total endoprostheses of the hip joint].

211 Müller-Charnley resp. Müller-Straight-Stem prostheses have been implanted from 1974 to 1984 in our Department for Trauma-Surgery. They were evaluated 11.8 years after implantation by clinical and radiological examination. 24 (12.8%) prostheses have been replaced because of aseptic loosening. Patients have been further evaluated by means of a new score, which emphasizes the mobility of the patients after total hip replacement. Mobility decreases significantly in patients over 70 years.

Activities of Daily Living↗
PubMed1995

[Control of disordered wound healing using sonography based on postoperative follow-up after TEP implantation].

Clinical diagnosis of early postoperative complications remains a major issue in patients undergoing total hip replacement. Early diagnosis is essential because (clinical) signs of inflammations as fever or elevated white blood count already reflecting late complications. The goal of our study was to evaluate postoperative monitoring for early detection and treatment of hematoma and abscess following total hip replacement. 308 patients undergoing total hip replacement were postoperatively monitored for the development of hematoma and abscess, comparing routine ultrasound to on demand ultrasound in case of clinical signs of infection. The diagnostic puncture was 6.5% (10/154) in group A (on demand ultrasound) versus 11.7% (18/154) in group B (routine ultrasound). Infections were seen in 5.2% (8/154) of patients in group A compared to 0.6% (1/154) in group B, leading to surgical intervention in 3.3% (5/154) group A, respectively 0.6% (1/154) in group B.

Abscess↗