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Biomedical subjects

G Suger

Publications and source records attributed to G Suger.

15 recordsLinked to original sources
PubMed1998

Chronic osteomyelitis: detection with FDG PET and correlation with histopathologic findings.

PURPOSE: To evaluate use of positron emission tomography (PET) with 2-(fluorine-18) fluoro-2-deoxy-D-glucose (FDG) in detection of chronic osteomyelitis. MATERIALS AND METHODS: Thirty-one patients suspected to have chronic osteomyelitis in the peripheral (n = 21) or central (n = 10) skeleton were evaluated prospectively with FDG PET. Analysis of the receiver operating characteristic curve was performed. The final diagnosis was made by means of bacteriologic culture of surgical specimens and histopathologic analysis. RESULTS: FDG PET allowed identification of 17 of 18 patients with osteomyelitis and 12 of 13 without osteomyelitis. There was one false-positive and one equivocal result. The area under the ROC curve was 0.96 for all patients, 1.00 for patients suspected to have osteomyelitis in the peripheral skeleton, and 0.88 for patients suspected to have osteomyelitis in the central skeleton. The overall accuracy of FDG PET was 97% with a high degree of interobserver concordance (kappa = 0.93). The overall sensitivity and specificity were 100% and 92%, respectively. CONCLUSION: FDG PET enables noninvasive detection and demonstration of the extent of chronic osteomyelitis with a high degree of accuracy. Especially in the central skeleton within active bone marrow, FDG PET is highly accurate and shows great promise in diagnosis of chronic osteomyelitis.

Bone and Bones↗
PubMed1997

Influence of size and stability of the osteotomy gap on the success of fracture healing.

Flexible fixation of fractures with minimally invasive surgical techniques has become increasingly popular. Such techniques can lead to relatively large fracture gaps (larger than 5 mm) and considerable interfragmentary movements (0.2-5 mm). We investigated the influence of the size of the fracture gap, interfragmentary movement, and interfragmentary strain on the quality of fracture healing. A simple diaphyseal long-bone fracture was modeled by means of a transverse osteotomy of the right metatarsus in sheep. In 42 sheep, the metatarsus was stabilized with a custom-made external ring fixator that was adjustable for gap size and axial interfragmentary movement. The sheep were randomly divided into six groups with three different gap sizes (1, 2, or 6 mm) and small or large interfragmentary strain (approximately 7 or 31%). The movement of the fracture gap was monitored telemetrically by a displacement transducer attached to the fixator. After 9 weeks of healing, the explanted metatarsus was evaluated mechanically in a three-point bending test to determine bending stiffness and was radiographed to measure the amount of periosteal callus formation. Increased size of the gap (from 1 to 6 mm) resulted in a significant reduction in the bending stiffness of the healed bones. Larger interfragmentary movements and strains (31 compared with 7%) stimulated larger callus formation for small gaps (1-2 mm) but not for larger gaps (approximately 6 mm). The treatment of simple diaphyseal fractures with flexible fixation can be improved by careful reduction of the fracture; this prevents large interfragmentary gaps. The experimental fracture model for the metatarsus showed that the healing process was inferior when the gap was larger than 2 mm.

Animals↗
PubMed1997

[Correcting torsion after intramedullary nailing osteosynthesis of the lower extremity].

Intraoperative control of torsion is delicate in intramedullary nailing of femur and tibia fractures. Post-traumatic torsional deformities cause clinical problems if the rotational 0-position, according to the neutral-0-method, cannot be attained or exceeded. The necessary precondition for every indication and planning of corrective osteotomies is conscientious analysis of the geometry of the lower extremities by clinical means, radiography and computed tomography. Operative procedures and techniques of corrective osteotomies in case of torsional deformities after intramedullary nailing are presented. Preoperatively, the intraindividual torsional differences in 15 patients with maltorsions of the femur were 33 degrees (-37/+50) and in 7 patients with maltorsions of the tibia 23 degrees (-21/+29). Positive signs indicate external and negative signs of internal maltorsions. Postoperatively, the intraindividual torsional differences were 6 degrees (-3/+14) in the femora and 7 degrees (+3/+12) in the tibiae. Therefore, the physiological torsional tolerance of 15 degrees was respected in all 22 patients. Additionally, limb lengthening was realized in 4 patients with shortening after intramedullary nailing of the femur. In 3 patients a one-step procedures with interposition of allogeneic cancellous bone in the osteotomy gap was performed and in one patient continuous callus distraction by external fixation.

Adult↗
PubMed1996

[Covering soft tissue defects].

In the past, the main emphasis in the treatment of complex limb injuries was placed upon the reconstruction of bony defects. Recently, however, reconstructive soft-tissue procedures have gained the attention they deserve. The salvage of a severely injured extremity depends rather on the feasibility of reconstructive surgical tissue procedures than on restoration of the bony defect. Sufficient vascularity is an essential condition for fracture healing and the prevention of post-traumatic complications like osteomyelitis and pseudarthrosis. If primary closure of a soft-tissue defect is not possible, preliminary covering has to be obtained with artificial skin replacement (vacuum sealing) until definitive covering with muscle or musculocutaneous flaps can be achieved. With the microvascular restorative techniques available today even complex soft-tissue problems can be solved. Nevertheless, an appropriate infrastructure and a trained and skilled surgeon are essential.

Amputation Stumps↗
PubMed1996

[Infected pseudarthrosis].

In open fractures the rate of infected non-union defects has in recent years decreased due to the increased primary application of external fixation. In spite of this positive state of affairs the condition is still encountered often enough to warrant specific treatment strategies and techniques. In the treatment of infected pseudarthroses the general principles of osteitis treatment are applied. This includes radical excision of infected pseudarthrotic bone and of the diseased surrounding soft tissue, provides mechanical stability in the non-union area and requires effective local treatment of the infection in combination with systemic, target-specific and temporary well-defined antibiotic therapy as well as procedures to improve local circulation. The incorporation of autogenous bone transplants in defects appears to depend on close contact between the transplant and the vascularized receiving site and on the quantity of the transplanted osseous material. A promising alternative method of dealing with extensive bone defects is osteogenesis produced by callus distraction; therefore special attention is given to Ilizarov's ring fixation system. Unstable scar formation demands local muscular flaps or microvascularized free flap transfer, which seems to be superior to other methods.

Anti-Bacterial Agents↗
PubMed1996

[Local complications of intramedullary nailing].

In the period from January 1990 to the end of December 1995 intramedullary nailing was performed in 294 patients with 156 fractures of the femur and 162 fractures of the tibia. Early nailing within the first 24 h after trauma was realized in 70% of the femur and in 64% of the tibia fractures. A synopsis focusing on local complications after intramedullary nailing is given on the basis of our results and a thorough analysis of the literature. Iatrogenic fractures of the femoral neck (0-5%), of the proximal femur (0.8-11.2%) and of the tibial head (0-8.3%) represent important intraoperative complications. Less frequent, but even more serious, are intraoperative lesions of nerves and arteries, as well as the development of compartmental syndromes of the lower leg (0-8.6%). Lengthy procedures and the use of traction tables seem to foster those complications. After primary intramedullary nailing, non-unions of the femur can be expected in 1-2% and of the tibia in 2-4%. The corresponding rates of osteomyelitis are 1-1.5% and 2-3%, respectively. After secondary nailing, particularly when changing from external fixation, and in cases of open fractures, the risk of deep infection is essentially elevated. Intramedullary nailing of the femur presents an important tendency to external torsional malalignment. In our investigation the torsional tolerance of 15 degrees was exceeded in 26%. A corresponding postoperative shortening of more than 2 cm length difference can be expected in 1.7-9.8%. Spiral fractures of the distal tibia offer a critical tendency to secondary varus and torsional malalignment, particularly after unreamed nailing and consecutive shortening due to breakage of locking bolts. The therapeutic indications of fracture stabilization in cases of unstable metaphyseal fractures should be reviewed.

Adolescent↗
PubMed1995

Increase of stability in external fracture fixation by hydroxyapatite-coated bone screws.

A major problem in fracture treatment by external fixation is screw loosening, which often results in reduced stability and can lead to prolonged treatment. A load-carrying experiment was conducted to determine whether coating implants with bioactive hydroxyapatite (HA) increases screw stability. Twelve HA-coated ASIF screws with 3 different macroporosities were inserted in 12 sheep that had already been fitted with a 6-pin external fixator for the treatment of a tibial osteotomy. The same number of uncoated polished steel screws served as controls. Although initial stability was not different for HA-coated screws, average removal torque after a 9-week implantation period increased with increasing macroporosity of the HA coating (p < .002). Instability of some screws was accompanied by histologic findings of cartilagenous tissue and proliferation of periosteal callus. Near the threads in the tibial cortex and in the shaft area of the screw were seen large numbers of HA particles that had been sheared off during implantation as well as during screw removal because of high contact forces between the HA coating and bone. Particulate debris of HA particles as well as the release of small bone fragments during explanation is likely to be unavoidable since HA adherence to bone is greater than adherence to steel after several weeks of implantation.

Animals↗
PubMed1995

Ilizarov callus distraction produces systemic bone cell mitogens.

We tested the hypothesis that the application of strain during callus distraction induces systemic osteoblast stimulating factors that enhance osteoblast activity both locally and systemically. To study the systemic occurence of strain-induced osteoblast stimulating factor during callus distraction, we investigated the mitogenic capacity of sera from 12 patients who had undergone callus distraction on the osteoblastic cell line SaOS-2 (part I). Serum samples from six patients who had undergone rigidly fixed high tibial osteotomy (i.e., without distraction) served as controls. The sera were assayed for platelet-derived growth factor and transforming growth factor-beta. In part II of the study, the in vitro effects of mechanical strain were investigated in a simplified model by cyclic stimulation of osteoblast cultures isolated from cortical bone explants from the same patients; a specially developed apparatus was used for cell-stretching. Sera taken during the third to fourth week of callus distraction demonstrated a significant increase in proliferation of SaOS-2 cells (p < 0.005). In contrast, sera from patients who had had an osteotomy failed to induce or decreased the mitogenic capacity of SaOS-2 cells. The concentration of platelet-derived growth factor increased significantly (p < 0.01) in sera from both the patients who had undergone callus distraction and the controls who had had osteotomy. However, the level of transforming growth factor-beta was increased (p < 0.05) in the sera from the patients who had distraction (sera that stimulated proliferation of SaOS-2 cells), but the level was not increased in the sera from patients who had osteotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Open segmental bone transport. A therapeutic alternative in post-traumatic and osteitis soft tissue and bone defects].

Between 1990 und 1992, 22 patients with bone and soft tissue defects were treated by open segmental bone transport according to Ilizarov, and 20 of these were followed up over a period of 18 months after removal of the external fixator. In 19 cases the bone defect could be filled by callus distraction only, while 1 patient needed additional spongeous bone transplantation because of delayed ossification. In 1 case amputation was necessary because of extensive fistula carcinoma of the resected bone and soft tissue. Closure of soft tissue defect was achieved in 14 patients simultaneously with docking of the bone segments. In 5 patients additional skin transplantation was needed, and in 1 case a latissimus dorsi flap had to be transferred because of unstable scar formation. Transporting vital bone simultaneously with the overlying tissue into a defect allows for limb salvage even in poor biological conditions and in patients with vascular problems. Open bone transfer has extended the range of methods available for the treatment of bone and soft tissue defects.

Adolescent↗
PubMed1994

[Treatment of problem fractures with the Ilisarow procedure. Minimally invasive fixation technique and callus distraction].

Between march 1990 and december 1992, 19 patients with compound fractures were treated with Ilisarow's external fixator at the Department of Traumatology of the University of Ulm. The device was applied as a primary implant in 7 patients, most of whom showed fractures of infectious cavities or refractures in a latent state of infection. 12 patients were stabilized with a change to the ringfixator in secondary fracture treatment during 4 weeks after trauma. 5 of these patients suffered of acute osteomyelitis after internal fracture fixation, 3 patients had metaphyseal fractures and in four cases extensive bone defects were filled by callotasis. Treatment could be completed with the ring device in 16 patients whereas in 3 patients a change to internal fixation had to be performed due to delayed union or atrophic pseudarthrosis. The main disadvantages of this system consisted in the comparatively time consuming operative procedure and limited comfort for the patient. Nevertheless, Ilisarow's device has proved to be an useful tool in the treatment of compound fractures or fracture treatment under poor biological conditions due to its minimal invasive fixation technique.

Accidents, Traffic↗
PubMed1994

[A UNIX-based electronic data processing system for routine use in a trauma surgery department].

A computer program for a UNIX workstation has been developed to support routine activities in a surgical department. A relational database contains reports on operations, medical letters and further data imported from independent computer subsystems outside the department. Data are accessible at 15 terminals and PCs through a simple and intuitive user interface with a mouse. The patient record is organized in a hypertext fashion and permits direct access to the various types of documents in a consistent manner. The implementation is currently used to manage information on 40,000 patients and has proved valuable in daily routine over a 2-year period.

Computer Systems↗
PubMed1993

[Primary treatment of gunshot and explosion injuries of the extremities with the Ilisarov ring fixator].

High-energy missile and explosion injuries of the upper and lower extremities are complex and require treatment over a long time. Following classic strategies of surgical therapy, bone defects can be reconstructed only after the injured soft tissue has healed. The callus distraction technique now permits the beginning of bony reconstruction at the same time as the initial surgical debridement. During the period 1 July 1987 to 30 June 1990, 25 grade III open fractures in 24 patients were primarily treated with the Ilisarov technique at Wazir Akbar Khan Hospital, Kabul, Afghanistan. Twelve months after the removal of the fixation devices the patients were examined and the following results were demonstrated: no amputations; bony, aseptic healing in 22 cases (88%); 3 non-unions, including 2 infected non-unions; 2 axial deviations > 10 degrees. The primary initiation of bony reconstruction by callus distraction offers numerous advantages in the treatment of gunshot and explosion injuries.

Adult↗
PubMed1992

Treatment of bone and soft tissue defects in infected nonunion.

In the treatment of infected pseudarthroses the general principles of osteitis treatment are applied. This includes radical excision of pseudarthrotic and infected bone tissue, and of diseased surrounding soft tissue. External fixation devices are the preferred method of stabilization of the bone. Based on the data of a retrospective study of 31 Papineau procedures, 65 local flap transfers, and 46 free flap transfers we found that the Papineau procedure works in minor bone and soft tissue defects. Unstable scar formation is a major disadvantage of this method. Local muscular flaps are indicated in the treatment of soft tissue defects in the proximal and medial portions of the lower leg. A prerequisite for free flap transfers is the availability of trained personnel and suitable technical equipment. The option is limited by the patient's vascular situation. This kind of tissue transfer seems to be superior to other methods. For the substitution of bone defects corticocancellous bone transplantation may be used. A promising alternative method to deal with extensive bone defects is osteogenesis produced by callus distraction.

Bone Transplantation↗
PubMed1983

Lesions of the basal ganglia, thalamus, and deep white matter: differential effects on language functions.

Forty-five patients with unilateral demarcated vascular lesions in the basal ganglia, the thalamus and the deep white matter were investigated with an "aphasia battery." Patients with basal ganglia lesions performed worse than both other groups in tests of articulation, syntax, and lexical functions. The deficit of patients with basal ganglia lesions on all expressive language modalities was lateralized to the left hemisphere. Patients with left thalamic lesions showed impairments of speech fluency and in the Token Test. Patients with white matter lesions alone showed no effect of laterality in tests of language functions. The results are discussed on the basis of a recent theory of the participation of the deep nuclei in language processing.

Adult↗