Biomedical subjects

G Sennwald

Publications and source records attributed to G Sennwald.

At least 19 recordsLinked to original sources

PubMed1995

[Use of the Ilisarow device for correction of extensive Madelung's deformity].

After a historical review of the Madelung's deformity, an operative technique is presented, using the Ilisarow distractor to correct severe deformities in adolescence. The goal of surgery at this age is the prevention of complications in a later period. These complications include arthrosis, pain, progressive limitation of motion in the wrist, and ruptures of extensor tendons. Our method is useful to do an operative correction - also of big angles - without using an autologous bone graft. Furthermore, the use of Ilisarow techniques allows gradual non-invasive corrections in the first postoperative period, and we can avoid surgery of the distal ulna to maintain the distal radio-ulnar joint. In 1991, three patients were treated in this manner and the results are encouraging.

Adolescent↗

PubMed1994

[The value of silastic prostheses in Kienböck's disease].

Eight patients underwent silicon replacement arthroplasty for treatment of Kienböck's disease between 1980 and 1984. Seven patients were available for a clinical and radiological ten-year follow-up control. A three-stemmed arthrodesis by arthrosis was done on one patient. Subjective results were good, although a reduction of one third of the mobility and strength of the wrist was noticed. Erosive osteolysis, carpal instability, radiocarpal arthrosis and a 36% reduction of the initial height of the implants was seen on the X-rays. The lytic lesion represents a progressive silicone particle-wear synovitis which threatens the future of the carpus. Nowadays, this kind of arthroplasty no longer has its place in the treatment of Kienböck's disease.

Adolescent↗

PubMed1994

Measurement of ulnar translation and carpal height.

Ulnar translation, carpal height and carpal collapse are methods of measurement described by Youm, by Chamay and by DiBenedetto. The accuracy of these methods has been statistically examined using 65 normal X-rays. The lines of measurement were correlated with each other and more lines were sought to demonstrate better correlation. The validity of these methods was tested on 40 X-ray films from rheumatoid patients. The greater accuracy of the recommended lines of measurement was confirmed.

Adolescent↗

PubMed1994

[Long-term outcome of a silastic semilunar bone prosthesis].

Eight silastic implants of the lunate bone were inserted between 1980 and 1984 on 8 patients. Seven patients were seen, at a ten year follow-up visit and were satisfied with the results. However, STT osteoarthritis secondary to the carpal collapse had to be stabilized by a triscaph arthrodesis. The clinical course showed a clear improvement of force and mobility in a first phase, followed by progressive deterioration ending in a return to preoperative values. Multiple intracarpal cysts were found radiologically in all wrists as well as in the distal radius in two cases and in the metacarpal bones in 3 cases. The height of the prosthesis was decreased by about 36%. Carpal collapse and ulnar translation showed a statistically significant progression. According to these findings, silastic prostheses should no longer be recommended.

Adolescent↗

PubMed1993

[Correction of distal radial malunion by forward-sliding osteotomy. 3 case reports].

The "forward-sliding autograft" osteotomy is designed for the correction of malposition of the distal radius following distal radius fracture of which more than 70% (of 122 fractures) appear to unite with a dorsal tilt. The osteotomy technique described seems to be effective, maintaining identical length of both arms, and only needs local anesthesia. A local autologous graft is used instead of the iliac graft. Only minimal internal fixation material is required and removal of metal is not necessary. The dorsal approach is safe and free of nerve endings. The procedure is ideal for outpatient surgery and can be performed in a one day surgery center, ie on an outpatient basis. Osteopororis appears to have no effect on the results. However the technique is demanding and preoperative planning is mandatory. The surgeon should be familiar with the use of the external fixator in the case of secondary instability.

Adult↗

PubMed1993

[Radio-carpal and medio-carpal arthroscopy in instability of the wrist].

Forty-one arthroscopies were performed on previously asymptomatic wrists following trauma. In about 25% of the wrists there was only one specific ligamentous lesion. In 75% however a combination of 2 or several distinct lesions was observed. These lesions, localised on the ulnar aspect of the mid-carpal joint, are more complex than those on the radio-carpal joint on the radial aspect of the carpus. These observations would tend to confirm our present day knowledge of wrist biomechanics but disagree with the currently proposed concepts of instability by several American authors. "Instability" seems to be inadequate to define complex lesions, more adequate would be the simple description of a "dysfunctional state" of the wrist complex. This statement must be related to the position of the carpal bones, which do not show any significant change despite the tears shown. The arthroscopy appears to range first in a series of diagnostic tools. However it concerns mainly the ligamentous layers facing the interior of the joint while lacking information about time elapsed since the actual trauma. We therefore state that arthroscopy may decrease but not exclude diagnostic failures. Type and risk of therapeutic decisions are also appreciated with increased accuracy. No doubt there still remain discrepancies when clinical, arthrographic and arthroscopic examination are compared, which indicates the complementary nature of the technics of investigation, especially in the light of the current state of the biomechanic sciences of the wrist.

Adolescent↗

PubMed1992

[Toxic necrosis following a bite by Naja nigricollis, a therapeutic challenge].

The surgical approach to snake bite lesions remains controversial. As a rule surgery is not recommended. However, the attitude towards severe local effects of envenoming should be revised and treatment made more aggressive, as our case report illustrates: following envenoming by Naja nigricollis, progressive necrosis jeopardized not only the function but also the survival of the hand. In view of this observation, we believe that a restrictive attitude is debatable. At first, immediately after the bite, splinting of the upper extremity is necessary, the hand being in intrinsic-plus position. Close clinical observation is necessary to detect early necrosis or a compartmental pressure-rise. As soon as pressure rises or local necrosis is suspected, extensive debridement with fasciotomy is recommended, especially in the presence of a venom with well known local toxic effects. Soft tissue coverage necessitates extensive flap surgery, such as the pedicled radialis flap, which appears not only to guarantee skin coverage but, by its excellent blood supply, prevents necrosis and allows for regeneration of underlying tissue. Our case confirms the local cytotoxicity of the venom of Naja nigricollis. Local and general effects of the snake bite must be clearly defined. The local development deserves immediate surgical attention, while the systemic effects need intensive medical care.

Adult↗

PubMed1992

[The medical record at the center of medical informatics].

Several areas in medical institutions, particularly the technical and administrative ones have been governed by computers for a long time. The proper medical work field (diagnosis, treatment, follow-up, correspondence and billing) however has hitherto mostly been ignored by data processing. We describe an electronic medical record introduced 4 years ago. All aspects of medical practise and all the specialists involved in patient care are integrated in the electronic document. In the center is a medical base of knowledge adaptable to all specialties as well as an expert system for direct control of the data entered by all concerned persons.

Ambulatory Surgical Procedures↗

PubMed1992

[Malunion of the distal radius and its treatment. Apropos of 122 radii].

We have reviewed 109 out of 122 operations performed for malunion of the distal radius. An excellent or good result was achieved in 80%, with 3% poor and 7% mediocre. Complications occurred in 12.6%. Accurate assessment of the frontal and sagittal angles of the articular surface of the distal radius was necessary in planning the operation, and correct realignment was required to achieve a proper result. Some cases in which an excellent correction was achieved did not produce a satisfactory outcome because of residual problems with soft tissue or ligaments. No patient with carpal instability had a good result. The morphology of the fracture and the sex or activity level of the patient did not influence the result.

Adolescent↗

PubMed1992

[Surgical indications for partial inpatient and ambulatory surgery of the lower extremities].

Outpatient (ambulatory) surgery has become widely accepted in free-standing outpatient surgery centres and in hospitals covering the field of hand surgery as well as, increasingly, the field of lower-extremity surgery. Three factors are decisive for secure ambulatory surgery: adequate material and personal resources guaranteeing a round-the-clock medical service, outpatient anesthesia which focuses mainly on the perioperative care of outpatient surgery, and a well-informed patient. Under these prerogatives the majority of surgical procedures of the lower extremities are performed on an outpatient basis without any undue risk. This includes also the diagnostic and operative arthroscopy of different joints.

Adult↗

PubMed1992

[Biomechanics of the carpus--functional anatomy and movement analysis of the carpal bones].

The often unsatisfactory outcome of attempts to reconstruct ligaments and perform partial arthrodeses of the wrist bones has prompted us to investigate the kinematic behavior of the proximal row of carpal bones in their immediate environment. The movements of the individual bones were observed on fresh autopsy specimens before they were dissected to study the exact location of the interconnecting ligaments. Finally, a special model of epoxy resin was made in which the exact form of the joint surfaces (cartilage surfaces) was maintained. The ligaments were simulated by means of stout threads and, according to the observations recorded in the previous study, attached to the model bones. In this manner a working model resulted that not only proved the correct positioning of the ligaments, but also enabled their function in controlling the movements of the bones during dorsal-palmar flexion and radial-ulnar abduction of the wrist to be established. It was seen that movement of the proximal row of carpal bones is caused primarily by the orientation of the adjoining articular surfaces and limited by the ligaments. Therefore, it is of paramount importance that the friction at the joint surfaces remains as low as possible. If the friction increases, the "floating" bones can no longer slide under load and movement of the hand becomes limited.

Biomechanical Phenomena↗

PubMed1990

[Decompression of the carpal tunnel. Apropos of 16 reoperated cases].

The aim of surgery is the healing of disease, and also the preservation or even the reconstruction of the function of an anatomical structure. In 12 out of 16 second look operations after carpal tunnel release we found luxation or subluxation of the intracarpal content. This suggests that the instability created by surgical release of the retinaculum flexorum is an important factor in postoperative symptoms. Therefore we suggest replacing the lengthwise incision of the retinaculum flexorum by widening of this structure. This serves to enlarge the carpal tunnel without forfeiting the function of the retinaculum flexorum. It acts as a pulley, serves as an anchor to the thenar muscles, and allows mechanical protection to the underlying nerve. The satisfactory results obtained after secondary functional reconstructive surgery suggest the same principle should be applied at the first operation.

Adult↗

PubMed1990

[Recurrent carpal tunnel syndrome--caused by an inadequate surgical technique?].

The carpal tunnel syndrome (CTS) is a common disease, and the decompression of the median nerve is one of the most often performed procedures in surgery. Within our patients from the 1. 12. 1987 to the 1. 12. 1988 we found 16 cases of recurrent CTS. Intraoperatively in more than 60% of the cases we could detect some sort of subluxation or even luxation of the median nerve and severe scarring involving the median nerve and the regenerated transverse carpal ligament in all cases. Considering the anatomy of the transverse carpal ligament, to guide the median nerve and the flexor tendon within the carpal tunnel, as well as serving as origin for the thenar musculature, especially for the opposition, one concludes that the simple dissection of the carpal ligament should be avoided. For the past 4 years we therefore have been performing a widening Z-plasty and reconstruction of the transverse carpal ligament, for the primary CTS as well as for revisions. The favorable postoperative results seem to confirm our theory. We discuss our operative technique as well as the results in CTS revision cases.

Carpal Tunnel Syndrome↗

PubMed1990

[Electronic organization of patient records as a component of integrated medical informatics].

Conventional patient records are not only inconvenient to store, their structure is often not consistent and faulty, research is difficult and quality control is not possible. One solution to this problem is the computerized patient record. It contains all necessary data beginning with the first medical statements and ending with the final results of treatment. At any time and from any with the system connected computer terminal it allows immediate access to all medical records. In addition to medical information also administrative data are stored. The here presented system of a computerized medical record has proven to be an effective tool in the daily work as well for clinical, administrative and research tasks.

Humans↗

PubMed1990

[Recurrent carpal tunnel syndrome. Problems and treatment].

Of 16 patients surgically treated for recurrent carpal tunnel syndrome, 60% demonstrated some degree of palmar subluxation or even luxation of the median nerve and flexor tendons intraoperatively, subsequent to previous simple division of the flexor retinaculum. During the past years, therefore, we have been performing a widening Z-plasty and reconstruction of the flexor retinaculum for surgical treatment of primary or recurrent carpal tunnel syndrome. In this paper, we present and discuss our operative technique and results.

Adult↗

PubMed1990

[Late results of operated scaphoid pseudarthroses].

Beyond elimination of pain, the objective of surgical treatment of scaphoid pseudarthrosis is the prevention of otherwise inevitable arthrosis of the wrist. In a follow-up of twenty-five patients over at least ten years post-operatively, the rate of union, but above all, the development of carpal instability and arthrosis was investigated. In the healed scaphoid, instability did not increase, although signs of arthrosis were found in almost all patients. As a rule, the degree of arthrosis was more pronounced in those cases with persisting subluxation of the lunate and DISI pattern of instability. Consequently, simultaneous correction of lunate subluxation via ligament reconstruction must be recommended when scaphoid pseudarthrosis is to be treated effectively. Late results of this modified procedure are not yet available though.

Adult↗

PubMed1989

[Silastic implant and synovitis].

The silastic implant based on siloxane polymere induces granulomatous synovitis in certain predisposed individuals, a reaction which may continue even after removal of the implant. This is also true of a prosthesis of the trapezium in two of our patients, though to a lesser degree. This is probably the reason why the problem has not yet been widely recognized. The hypothesis is put forward that an enzymatic predisposition may allow chemical degradation of the fragmented silastic implant into a toxic component responsible for the pathologic condition. The slow progression of the lesions is a challenge for the future and puts in question the further use of silastic implants.

Aged↗

PubMed1989

[Arthrodesis of the central support of the carpus. Indications, technic, results].

We have used this operation for the management of pain due to osteoarthritic changes at the radio-scaphoid and capitate-lunate joints. It allows correction of the carpal height by reposition of the flexed lunate, preserves the load bearing capitate-lunate axis, and decompresses the radio-scaphoid joint. We have carried out the procedure in 25 cases. Perilunate instability with osteoarthritic changes were present in 14 wrists; the remainder were consequent to non-union of fractures of the scaphoid with osteoarthrosis, or following complex fracture dislocations. At review 10 patients were free of pain, 12 had occasional pain and 3 were not improved. The mean residual range of movement in the wrist was 49 degrees, with a range from 20 degrees to 80 degrees. Bony union was not achieved in 5 wrists. At operation the lunate is reduced and carpal height restored with realignment of the weight bearing axis. Bone grafts and internal fixation are used.

Adult↗