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Biomedical subjects

H H Wetz

Publications and source records attributed to H H Wetz.

At least 37 records · Page 2Linked to original sources
PubMed2003

[The MRSA patient in technical orthopaedics and rehabilitation].

Colonisation and infection of humans by methicillin-resistant Staphylococcus aureus (MRSA) was examined retrospectively at the Clinic of Technical Orthopedics and Rehabilitation of the University Clinic at Münster (Germany). The cohort consisted of 28 patients who over the period were microbiologically shown to harbour MRSA from January 1997 to June 2000. Out of these, only 16 patients were colonised and only 12 patients developed MRSA infection. The inpatient stay was longer for MRSA subjects than for non-MRSA subjects. All patients had chronic wound healing disorders of the lower extremities which were due to peripheral neuropathies, diabetes mellitus and/or obstructive disease of the arteries. All patients were at risk for colonisation with MRSA.

Adult↗
PubMed2003

[The MRSA patient in technical orthopaedics and rehabilitation. Part 2: Hygiene management].

One of the multiresistant pathogens is methicillin-resistant Staphylococcus aureus (MRSA),which was increasingly found in the 1980's. In the USA, the ratio of MRSA rose from 2% in 1975 to 29% in 1991. A similarly steep rise was seen in Germany, with the Paul Ehrlich Society for Chemotherapy reporting a rise from 1.7% in 1990 to 15.7% in 1998. In order to control MRSA, the Clinic and Polyclinic of Technical Orthopaedics and Rehabilitation at the University Clinic Münster, Germany,has set up a comprehensive hygiene management programme for early detection and treatment of nosocomial infections. In addition to addressing the usual problems of MRSA carriers (e.g., higher mortality, longer hospital stays, stigmatisation), these preventive measures are also aimed at combating MRSA-caused cost increases.

Anti-Bacterial Agents↗
PubMed2001

[Functional anatomy and kinematics of the femorotibial joint. Results of research 1836-1950].

Ever since the investigations of the Weber brothers in 1836, on the mechanics of the walking implements of humans, several others, like von Meyer (1853), Langer (1858), Robert (1855), Albert (1878), Bougnion (1892), Fischer (1907), Zuppinger (1904), A.E. Fick (1877), R. Fick (1911), Strasser (1917), Tretter (1944), and Knese (1959), have presented a vast amount of literature on the kinematics and functional anatomy of the knee joint which continue to be a source of inspiration even for contemporary international research work. This literature has been reviewed and is now presented in short form, not only because of its historical value, but to stimulate further research activity in this field. Furthermore, possible application of the kinematics of the physiological knee joint in orthotics and prosthetics is indicated.

Biomechanical Phenomena↗
PubMed2001

[Syme amputation in heel defects].

The main advantage of Syme's amputation is the end-bearing stump. A defective heel pad often leads to below-knee amputation. The question of interest is whether an atypical cutaneous flap also provides a covering for the stump adaptable to weight-bearing. Thirteen patients with heel pad ulcers or tumors who could not be attended to with a classic Syme's amputation were operated on in a modified fashion. Skin from the dorsum of the foot or a medial flap was used for covering the stump. Two patients underwent transtibial amputation. The remaining 11 patients received a covering for the end of the stump composed of tissue thick and bulky enough for weight-bearing in a prosthesis typical for a Syme stump. The results show that a transtibial amputation can be prevented by atypical soft-tissue coverage of a Syme stump with satisfactory results regarding function and cosmetics.

Amputation, Surgical↗
PubMed2001

[Effect of walking speed on pressure distribution of orthopedic shoe technology].

Lesions to the diabetic foot have various causes. However, there is broad consensus that excessive plantar pressure plays a major role in the chain of events leading to ulcerations and gangrenes. During walking, on the other hand, peak values of plantar pressure are likely to increase with velocity even in therapeutic shoes. Therefore, the question arises whether a moderate velocity should be recommended to diabetic patients to reduce the risk of foot lesions. In this study, two velocities were compared for different types of therapeutic footwear. The velocities selected were considered moderate (0.7 m/s) and normal (1.3 m/s) for diabetic patients. A specially designed mathematical algorithm (velocity normalization) provided the pressure distributions from a common set of measurements: seven trials at different velocities for each subject and each type of footwear. Ten test subjects with healthy feet were studied. The shoes were ready-made and all had a midfoot rocker. The following four conditions were tested: flexible or rigid outsole respectively in combination with a flat insole or molded foot bed respectively. Pressure distribution measurements were performed with the Pedar in-shoe system, and the Pedar software package was used for analysis. The foot was divided into six regions: first toe, second to fifth toes, metatarsal region, medial midfoot, lateral midfoot, and heel. Only peak pressures were taken into account. Gait velocity was found to have an effect on plantar pressure distribution, mainly in the toes and heel region. Peak pressure in the heels increased significantly by about 20%. In the toe region, the increase was about the same, but was not statistically significant. At a higher velocity, pressure even slightly decreased in the midfoot region. The percentage variation was similar for all four conditions. Thus, walking slowly prevented the foot from high peak pressures, and the combination of rigid outsole and molded foot bed was best suited for both slow and higher velocities.

Acceleration↗
PubMed2001

[Incidence and detection of nosocomial infections in technical orthopedics].

The significance of nosocomial infections is increasing. The reasons for this are a higher concentration of problematic patients in hospitals due to the increasing number of outpatient surgeries, the increase of invasive therapeutic and diagnostic procedures, the growing share of immunodeficient patients as well as the increase in antibiotic-resistant and multiresistant pathogenic organisms. Basic changes in the medical system call for a systematic discussion about directed quality management. Surveillance, i.e., the systematic registration and evaluation of occurred diseases as well as the feedback to the personnel in charge is very important in this context, particularly when complemented by comprehensive hygienic measures. The growing significance of hospital infections increasingly triggered by multiresistant pathogenic organisms emphasizes the importance of general prevention. Each hospital has to determine which surveillance methods for the registration of nosocomial infections and multiresistant pathogenic organisms are the most appropriate under their respective conditions. To get a first idea of possible problem areas, prevalence studies are very suitable for the start before moving on to well-directed incidence studies in certain wards and for certain kinds of infection.

Adult↗
PubMed2001

[Significance of 3 dimensional motion of the femurotibial joint for design of knee support orthoses].

Stimulated by investigations on the kinematics of the human knee joint conducted during the nineteenth and early twentieth centuries, we have determined the spatial motion of this articulation, describing it by means of the helical axis concept, as obtained with the assistance of modern tools. As expected, there are similarities with the results of other recent investigators. Some details of the photogrammetrical method employed are unique. We have now related our findings to unsolved problems in orthotics and prosthetics. The presentation also describes a technique to align the movement of a brace with that of the knee joint. This work serves as a basis on which criteria for the fitting of braces could be determined.

Adult↗
PubMed2001

[Clubfoot orthosis with integrated dynamic cuff for retention and redressing].

Conservative treatment of clubfoot deformities with braces and bandages is traditionally several hundred years old. The clubfoot braces of Venel, Scarpa, and Schulthess, as well as the redressing bandage of Cheselden, are reviewed as typical examples. The treatment of clubfoot deformities was initiated in the Balgrist Hospital for Orthopedic Surgery by W. Schulthess. Recently, in Balgrist, we developed a brace that retains and redresses the foot. This brace is described, and early clinical results are reported.

Bandages↗
PubMed2001

[External fixator for reconstruction of foot statics in neurogenic osteoarthropathies].

The localization of neurogenic osteopathy in the hindfoot often results in deformities which cannot be corrected by conservative methods. Indications for operation are recurring ulcers, deep infection, and reduced stability with progressive deformity. The aim of this study was to ascertain whether external fixation enables reestablishment of foot stability even when the osteoarthropathic processes have not entirely ceased. A bilaterally mounted Hoffman 2 fixator was used for open repositioning and restabilization on 14 patients with osteoarthropathy of the hindfoot: 12 had diabetes mellitus and 13 had florid processes. Revision with axial correction was necessary in 2 patients. One underwent amputation according to Syme and received a prosthesis. Thirteen were completely remobilized: ten were fitted with an orthosis and three with a rigid orthopedic shoe. Complicated deformities of the hindfoot from neurogenic arthropathy can be satisfactorily restabilized in the edematous and demineralizing stages by surgery and the application of external fixation.

Adult↗
PubMed2001

[Holt-Oram syndrome. 3 case reports and their physical therapy, occupational therapy and technical orthopedic treatment].

The combination of organ and skeletal malformation as well as the fact that Holt-Oram syndrome appears in many forms with related functional disturbances and makes it mandatory that the therapy for these patients be determined on an individual basis. Supportive statomotoric therapy of young patients plays a particularly central role, as do development-synchronized treatment aids. Physiotherapy, ergotherapy, and technical orthopedic support oriented toward functionality are all part of the therapeutic concept.

Adult↗
PubMed2001

[Methicillin-resistant Staphylococcus aureus (MRSA). Current status and significance of preventing infection in technical orthopedics].

Many patients of the Clinic for Technical Orthopedics and Rehabilitation of the Munster University are facing several risk factors at the same time, which have to be considered for infection registration and therapy accordingly. The interaction of the known late consequences of diabetes mellitus creates the prerequisites which give way for infections of the soft parts and bones. Very often, patients are only being transferred to special university clinics after long-lasting pre-treatments as day-patients or inpatients. The integrity of patients physiological barriers is often broken through by the already existing morphological damages, and the function of the immune systems defence possibly is affected by already existing basic diseases. Parallel to the increasing importance of Staphylococcus aureus (S. aureus) being the pathogen for nosocomial infections, the resistance situation towards a lot of antibiotics has significantly and increasingly deteriorated. The methicillin resistance of S. aureus, i.e. the resistance of the pathogen towards so-called staphylococcus-effective penicillinase-resistant penicillins (isoxazolylpenicillins), is presently creating the especially for the clinical practice problematic resistance mechanisms. The methicillin (oxacillin)-resistant S. aureus (MRSA, ORSA) stems usually present the phenomenon of multiresistance, i.e. the resistance towards substances of several classes of antibiotics, and, therefore, are not only resistant to all beta-lactamantibiotics (penicillins, cephalosporins, carbapenems). Thus, MRSA infections become a significant risk factor for the respective patients. In many cases there are only a very few options left for an antibiotic therapy. The increasing and often unquestioned use of "reserve substances" is leading to a selection of pathogens creating resistances to the corresponding substances. This results in a resistance spiral which makes an antibiotic therapy more and more difficult.

Cross Infection↗
PubMed2001

[Diagnostic control. Psychiatric comorbidity in patients of technical orthopedic units].

Because of the new hospital finance law a DRG (Diagnosis Related Groups) controlled discount liquidation under consideration of the medical impairment becomes necessary. In this paper the importance of a correct and complete description of the psychic comorbidity for the development of German-Refined-DRGs (GR-DRGs) in the orthopedic field is described. Therefore we analysed data of orthopedic in-patients, who are diagnosed by consultation of the clinic for psychosomatics and psychotherapy. A psychic comorbidity (ICD-10 Chapter F (V)) was diagnosed by 95% of the consulted patient. 30% of the patients showed difficulties in coping with their disease. 40% suffered from chronical psychoneurotic patterns and conflicts, which can be explained (a) as consequence of a difficult psychosocial adaptation by chronic disease or after an amputation (b) as basic mental disorders (c) as cause of the orthopaedic complications. Therefore the number of indications for a psychotherapeutic or psychiatric treatment is very high. The knowledge about a psychic comorbidity can--beside financial aspects--help the team on the orthopaedic station in the treatment of difficult patient.

Adaptation, Psychological↗
PubMed2000

[History of artificial limbs for the leg].

Following the development of prosthetics for the lower limb since the middle of the 18th century one will find very interesting similarities to modern prostheses. This becomes evident when looking at former knee and ankle joint mechanisms or socket designs. Also, the materials used for the prostheses underwent very interesting variations. In our paper we will describe the development of socket designs and several materials from the beginning of the 19th century. Several still obtainable books dealing with 200 years of prosthetics development, were reviewed. Charles White describes in the year 1761 a supramalleolar amputation using the flap technique and the specially built BK prostheses the socket. V. Brünninghausen describes in 1809 a socket made of tin sheet. It was built oval, as the normal transverse section of the thigh is. Stump adhesion was obtained when a shortly trimmed dog fur--panelling the socket and covering the stump--was attached like brushes end on end. A similar fitting was described by Heine in 1811, v. Dornblüth in 1831, and Mrs. Eichler in 1836. Hermann first mentioned the need of a perpendicular construction of prostheses. Parmelee developed in 1868 the first suction socket. The first tuber-enclosing socketdesign was made by Riedel in 1911. We will show documents from this time and will also show, that muscle-physiological aspects had a very important influence on socket designs.

Amputation, Surgical↗