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Biomedical subjects

G Muhr

Publications and source records attributed to G Muhr.

At least 19 recordsLinked to original sources
PubMed1997

[Monocondylar fractures of the femur. Therapeutic strategy and clinical outcome].

Twenty-nine unicondylar fractures of the distal femur were treated at the Trauma Center "Bergmannsheil", University of Bochum, Germany, between 1981 and 1994. All patients sustained their injuries from severe direct trauma. There were 16 lateral condylar fractures, 7 medial condylar fractures and 6 tangential posterior ("Hoffa-type") fractures. Twenty-eight closed injuries and 1 grade IIIB open fracture injuries to the skeleton. All fractures were treated with open reduction and internal fixation with screws within 8 h of admission. Postoperative management consisted of early continuous passive motion and minimal weight-bearing for 6-8 weeks, progressing to full weight-bearing. The mean follow-up was 68 months (18-120). The therapeutic outcome (clinical result, radiographs) was rated by the Neer score. Twenty-seven patients were available for follow-up examination. Of these, 23 were rated as excellent. 3 achieved satisfactory results, and 1 had an unsatisfactory result. All patients who did not achieve an excellent outcome had had accompanying injuries. Open reduction and internal screw fixation of unicondylar femur fractures provided overall excellent long-term results. The therapeutic outcome was significantly affected by associated injuries of the skeleton.

Adolescent↗
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↗
PubMed1996

[Retrograde interlocking nailing of distal femoral fractures with the intramedullary supracondylar nail].

Between June 1993 and September 1995, 18 distal femoral fractures were treated using the supracondylar intramedullary nail. There were 8 type A fractures and 10 type C fractures (AO classification). The operative technique involved retrograde insertion of an unreamed supracondylar nail through the intercondylar notch. Follow-up was available on all patients and averaged 18.3 months (range 6-32 months). All fractures healed with an average time to union of 12.4 weeks (range 8-16 weeks). Bone grafting was not necessary in any case. Sixteen patients achieved almost the same ROM as they had had before the injury. One patient developed a varus malignant and underwent correction with a supracondylar osteotomy 20 months post trauma. There were no infections or nonunions. The retrograde supracondylar nail is an excellent alternative to plate osteosynthesis in the management of dia- and supracondylar femoral fractures.

Adult↗
PubMed1996

[Ultrasound follow-up of callus distraction of the tibia. Technique, possibilities and limits].

In a prospective study 20 patients were monitored with serial sonograms and radiographs during distraction osteogenesis at the lower limb. All sonograms were obtained in four planes using a 7.5 MHz transducer. The distraction gap was seen as a sonolucent area in all patients after corticotomy. At an average of 20.7 (14-28) days after the beginning of the distraction, echogenic foci occurred and showed increasing longitudinal alignment with further distraction. Radiographical signs of beginning mineralization were seen an average of 48.3 days after the start of the distraction. Exact measurement of the distraction gap was possible in all patients during lengthening. Bone healing complications and hematoma could be detected by ultrasound. A rapid increase of bone mineralization was seen after the distraction was stopped. With increasing cortication of the regenerate bone, sonograms showed a hyper-reflecting solid line so that further mineralization and the time of removal of the fixator could not be assessed by ultrasound. Ultrasound is more sensitive than radiography in identifying new bone formation during distraction, measuring the length of the distraction gap, and detecting early bone-healing complications and can therefore reduce the need for radiographs.

Adult↗
PubMed1996

[The dynamic hip screw with support plate--a reliable osteosynthesis for highly unstable "reverse" trochanteric fractures?].

ORIF management of unstable trochanteric fractures of type A3 of the A0 classification is difficult because of lateral dislocation of the proximal fractured segments, particularly when only the sliding hip-screw is used for fixation. A connectable butt-press plate was recently developed in order to prevent this type of dislocation. We review the results with this fixation technique in 22 elderly patients with an average age of 76 years who presented with highly unstable trochanteric fracture of the A3 type. Three patients died of diseases unrelated to the trauma or operation before the fractures had healed. The other 19 were followed prospectively until fracture healing had occurred. Complaints, leg shortening and changes in the CCD angle were recorded. Furthermore, the mobility score was determined. Although the patients were able to bear full weight after the operation, no lateral dislocation of fragments was observed. Only 1 patient had a varus dislocation of 5 degrees until the fracture had consolidated. This was due to severe osteopenia and subsequent dislocation of the screw within the femoral head. No pseudarthrosis, osteitis or rotational malalignment was noted. Five of the surviving patients had a lower mobility score after fracture healing as compared to the status before the fracture was sustained. On the basis of this review, we recommend the use of this new connectable buttress plate with sliding hip screws because it provides sufficient fixation of highly unstable fractures of type A3.

Aged↗
PubMed1996

[Is functional conservative treatment of stable lateral ankle fractures justified?].

For Weber type B ankle fractures, operative treatment is generally recommended. Yet, there is no general agreement about the role of functional treatment. In a prospective follow-up study from December 1990 to May 1994, 146 patients were reviewed. The mean follow-up time was 17.3 months for clinical examinations and 19.6 months for X-rays. There were no failures. In all, 85 patients (58%) were treated conservatively (group K). A below-the-knee plaster was applied to 23 patients for 6 weeks, and 62 patients had functional treatment with an ankle brace. According to the Olerud Score, the first subgroup (K-plaster) achieved 89.4 points and the last (K-func.) reached 95.7 points. There were no signs of post-traumatic arthritis. 61 patients (42%) had open reduction and internal osteosynthesis (group OP). In 19 patients a plaster immobilization was necessary, and in 42 patients early mobilization was possible. The first subgroup (OP-plaster) achieved 85.0 points in the Olerud Score; the last (OP-func.) achieved 92.4 points. According to the degree of instability following ankle injuries, a new algorithm for treatment of type B ankle fractures is described, emphasizing early mobilization and functional after treatment.

Adult↗
PubMed1996

[Infected pseudarthrosis].

Sequestrectomy, fragment fixation, wound treatment and bone grafting are the old principles of infected non union surgery. Today these principles are the frame, which contents a more aggressive treatment. Sequestrectomy is a radical excision of the complete infected bone-soft-tissue-scar, the resulting defects are covered by one of the various techniques (skin-traction, flap surgery, bone shifting, etc.). Out of 71 infected non unions, treated by radical resection and bone segment transport, healing rate without recurrence of infection was 94%, in 3 additional patients (4%) amputation was performed. For bone fragment fixation, a non devastating implant, like external fixateur, is preferred. To close the wound, the law of avoiding a dead space is used. Defects are closed by muscle flaps, by fragment shortening or by a antibiotic spacer temporarily. The skin is closed by skin-traction techniques or with flap surgery. After soft tissue healing, small bone defects are filled by autografts, defects of more than 3-4 cm with transported segments. Previous limb shortening to close bone defects, with a lengthening later in a "healthy" region, is also possible. Local antibiotic wound treatment cases a significant reduction of the contamination rate, improved dressing techniques support wound healing free of infection. This therapeutic techniques are comparable to open fracture treatment, where by similar surgery a very low infection rate can be achieved.

Amputation, Surgical↗
PubMed1996

[Ilizarov procedure in pseudarthrosis].

The treatment of nonunions has made an important development through the work of Ilizarov describing the principles of compression and distraction by using the ring-fixator. While local compression is sufficient in hypertrophic nonunions, the treatment of choice for atrophic infected nonunions with bony defects is a corticotomy followed by a segmental transport, especially in case of an osseous defect larger than 3 cm. Primary shortening poses a better starting point both for soft-tissue reconstruction and for early docking. External fixation systems are the ring-fixator, the unilateral fixator and hybrid systems combining both fixation methods. The use of a ring-fixator makes a shorter time of osseous consolidation possible when compared to a unilateral system (25,8 d/cm - 35,8 d/cm). Soft-tissue reconstruction before initiation of transport also shortens the time of osseous consolidation compared to later soft-tissue coverage. A docking-region in the metaphyseal area is supported by minimal internal fixation and cancellous bone graft. Segmental transport is complicated by local infection, regenerate failure (4.3% and regenerate fracture (2.9%).

Adult↗
PubMed1996

[Pseudarthroses in childhood].

Nonunion of fractures in children is rare. It occurs after pathological fractures, post-infection and after incorrect osteosynthesis. Sometimes, delayed union of one bone in the forearm or the lower leg can be observed. Typical cases of nonunion are those of the radial condyle of the humerus and the femoral neck. A different problem is presented by congenital pseudoarthroses. The treatments of choice for nonunion are autogenous bone grafting and external or internal skeletal stabilization. In the radial part of the elbow joint the only indication for operative correction is an irritation of the ulnar nerve (ventralization of the nerve and supracondylar osteotomy). Nonunion of the femoral neck can be avoided by internal screw fixation.

Adolescent↗
PubMed1996

Vertical deceleration injuries: a comparative study of the injury patterns of 101 patients after accidental and intentional high falls.

We analysed the pattern of injury of 101 adult patients who were treated in our Trauma Center after a fall from an average height of 7.2 m between 1987 and 1990. In 62 patients the fall was accidental, and 39 jumped with suicidal intent. The most common injuries were fractures of the thoracic and lumbar spine (83.0 per cent) especially of the thoracolumbar junction. The pattern of limb injuries is towards a significant preference of the metaphyseal and epiphyseal parts of the bones of the distal joints (wrist, elbow, ankle, subtalar). Fractures of the diaphyseal areas and the proximal joints (shoulder, humerus, hip, femur) were rare. The incidence of thoracic (20.8 per cent) and pelvic injuries (30.0 per cent) was relatively lower. Blunt abdominal injury (5.9 per cent) was rare after a fall from a great height. Head injuries occurred in only 27 per cent of our patients who all survived their transport to hospital. There is no significant difference in injury patterns between deliberate and accidental falls, but there is a higher number of isolated injuries in all patients after unsuccessful suicidal jumps.

Accidental Falls↗
PubMed1996

Surgical correction of talipes equinovarus following foot and leg compartment syndrome.

Between 1984 and 1994, 40 patients with a posttraumatic compartment syndrome of the lower leg and foot were treated for talipes equinovarus adductus foot deformity, which subsequently developed. Twenty patients had a wedge osteotomy followed by arthrodesis of the midtarsal joint (Chopart joint). Another 17 patients had an arthrodesis of the midtarasal and subtalar joints. In the remaining three patients, in addition to arthrodesis, lengthening of the tendons of the long flexors and the Achilles tendon was performed. Complications included wound infections (six cases), drill hole infections (three cases), chronic osteomyelitis (one case), and an ankle joint infection (one case). The clinical result was assessed as good in 37.5%, fair in 52.5%, and poor in 10% of the patients. Before the operation, 37 patients required modified footwear. After the operation, only eight patients needed them. Wedge osteotomy of the midtarsal and subtalar joints followed by an arthrodesis is an advantageous treatment modality for the correction of severe postischemic equinovarus adductus foot deformities. In our study, patient satisfaction was high. While complications frequently occur, it is not extraordinary considering the salvage nature of the procedure.

Achilles Tendon↗
PubMed1996

[Elastic intramedullary nailing--a concept for treatment of unstable forearm fractures in childhood].

The standard treatment for forearm fractures in children is usually conservative. Unstable fractures of the proximal parts of the forearm often show poor results after nonoperative management, so that these fractures require surgical intervention. We report about 20 children ranging in age from 6 to 14 years who were treated by elastic intramedullary nailing. Ten patients were treated by intramedullary pinning immediately after their accident; 10 required intramedullary nailing after failure of the conservative treatment and redislocations of their fractures. At the time of follow-up 6 months later, functional results were "excellent" in 16 children, "good" in 3 children and "fair" in one child. There were no serious complications apart from the occurrence of one delayed union. According to these results intramedullary nailing can be recommended for the treatment of unstable fractures of the proximal and middle parts of the forearm in children.

Adolescent↗
PubMed1996

[Surgical treatment of ankle joint fractures with biodegradable screws and plates of poly-l-lactide].

In a first clinical protocol 19 ankle fractures have been fixed by plates and screws made of biodegradable polylactic acid. Fracture confirmation was achieved within 6 weeks. 52% of our patients demonstrated an aseptic soft tissue problem caused by delayed clearance of the degrading polylactide particles. In a 2nd protocol with 7 patients volume reduced plates and screws with flat heads were applied. None of these patients had any soft tissue reaction. These results emphasize that the application of plates and screws of polylactic acid is acceptable for fixation of ankle fractures. Soft tissue inflammatory reactions can be avoided by using volume reduced implants.

Adult↗
PubMed1996

[Elbow arthrodesis and its alternative].

Significant functional impairment, increasing pain or joint infection are the indications for arthrodesis of the elbow joint. Six patients underwent a compression arthrodesis with internal and external fixation and an additional bone graft in our institution between 1987 and 1993. Out of this series only one patient developed a non-union due to a fall on the extremity. In a series of nine patients treated with external fixation alone between 1978 and 1987, four patients developed a non-union. Unlike other joints, there is no optimal position for arthrodesis of the elbow and the functional deficit cannot be compensated by the other joints of the upper extremity. Therefore, it should be useful to know if an interposition arthroplasty is possible. With this technique a joint infection can be healed. Ten patients treated with this technique between 1987 and 1993 had no recurrent infection. Two patients had instability. The best results were achieved in post-traumatic joint stiffness. Permanent instability and post-traumatic arthritis are indications for an allo-arthroplasty. Contraindications are a previous joint infection and intensive bone loss, as well as ipsilateral shoulder ankylosis and neuropathic joint disorders. In younger patients, resection arthroplasty is better due to a high loosening rate of the prostheses.

Adolescent↗
PubMed1996

Classification of articular cartilage lesions of the knee at arthroscopy.

Classification systems for articular cartilage lesions in the knee have been based primarily on the appearance and severity of damage to the articular cartilage. Each of these systems has deficiencies in the documentation of articular cartilage abnormalities. This article proposes a new classification system for articular cartilage lesions in the knee. This system incorporates multiple parameters such as appearance, depth of involvement, area, clinical stage, and location of the lesion. A four-sector-mapping system allowing precise documentation of the location of articular cartilage lesions in the femorotibial joint is proposed. One numerical category is used to assess severity of a chondral defect. The use of these categories allows the surgeon to accurately grade and locate damage to the articular cartilage and its relationship to other concomitant intra-articular abnormalities. The proposed classification system has proven advantageous in communicating complex findings.

Arthroscopy↗
PubMed1996

[Perineal injuries in complicated pelvic trauma].

Severe comminuted pelvic ring fractures are often associated by genitourinary and rectal injuries. Because of severe retroperitoneal bleeding, shock management has to be initiated before further diagnosis of the perineal lesions. If normotonic conditions cannot be achieved by volume replacement, a pelvic clamp is indicated providing immediate reduction of the posterior pelvic ring. A subsequent emergency laparotomy has to be considered if stable circulatory conditions cannot be achieved by these emergency procedures. After the initial management of the hypovolemic shock further examination of the rectum by endoscopy and endosonography is performed. Urethral lesions have to be excluded by ultrasound of the bladder, retrograde urethrography and intravenous urography. Urethral and bladder injuries can be initially treated by suprapubic fistula, whereas rectal and pararectal wounds have to be managed by immediate debridement, jet-lavage and wound drainage. Rectal wall and sphincter lacerations are initially restored by suture because delayed reconstructions have poor results. A deviation colostomy is mandatory in cases of colonic and rectal injuries about the internal sphincter.

Colon↗
PubMed1996

[Diagnosis of acute rupture of the anterior cruciate ligament. Value of ultrasonic in addition to clinical examination].

Post-traumatic knee injuries often deteriorate if reuptures of anterior cruciate ligaments (ACL) are not treated adequately. Further diagnostic procedures are required if pain-induced muscle contraction impairs clinical examination. The clinical relevance of sonography, however, for the diagnosis of ACL ruptures is controversial. Within 25 months, 74 patients were preoperatively evaluated clinically and by ultrasound. 58 ruptures of the ACL and 21 lesions of the collateral ligaments were confirmed by arthroscopy or arthrotomy. In 16 cases a menisceal tear was found, four patients had a luxation of the patella, and two had PCL ruptures. The sensitivity of the Lachman test was 93%, of the anterior drawer test 68% and of the pivot shift test 48%. Ultrasound diagnosis revealed 88% of all ACL ruptures (91% if patients with bony ruptures of the ACL were excluded). In 75% of ACL ruptures, a popping sensation was reported by the patients. In the case of uncertain diagnosis, examination with ultrasound could be easily performed before further operative diagnostic procedures are scheduled.

Acute Disease↗