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Biomedical subjects

H Kuderna

Publications and source records attributed to H Kuderna.

At least 19 recordsLinked to original sources
PubMed1988

[Thrombosis prevention with heparin/dihydroergotamine versus heparin/Sintrom in Ender nailing of pertrochanteric fractures].

The effect of either (randomized) Heparin/Dihydroergotamine (HDHE) or heparin-acenocoumarin (Hep/S) on the incidence of deep-vein thrombosis in the legs was studied in 212 women of more than 60 years of age with hip fractures. All patients were screened with the 125-I-fibrinogen uptake test (FUT) confirmed by a bilateral ascending venogram upon positive FUT. This revealed good sensitivity and specificity (85/84%) for the FUT. Deep vein thrombosis developed in 37.6% of the HDHE group and in 59.1% of the Hep/S group which was significantly different (p less than 0.005). The calculated thrombosis risk was significantly diminished (by 38% - p less than 0.005) in the HDHE group. Therefore we conclude that in traumatology Heparin/Dihydroergotamine seems to be the prophylaxis of choice.

Acenocoumarol↗
PubMed1988

[Development and forms of post-traumatic carpal instability].

Posttraumatic carpal instabilities may be caused either by fractures or by rupture of the ligaments and originate mostly from a sudden fall on the hand risen in defense. In this case forced dorsiflexion, supination and ulnarduction will be developed in the wrist joint and intracarpal region. The injury takes its course in four stages. According to the localisation we differ between radial carpal instabilities, which develop especially in the stages I and II, ulnar instabilities, which develop in the stages III and IV. Furthermore there exists a third kind of instability: the proximal carpal instability, which is localised in the radiocarpal joint. In addition to that we differ static and dynamic instabilities. For treatment in recent injuries the continuity of the ligaments and the shape and the size of the carpal bones are restored. In delayed cases it will be necessary to restore the ligaments by grafting, to perform intracarpal arthrodesis or osteotomy to correct the bony configuration.

Carpal Bones↗
PubMed1988

Inferior acromioclavicular separation. Report of an unusual case.

An inferior acromioclavicular separation occurred in a 33-year-old man. Diagnosis was based on plain roentgenograms and a computed axial tomographic scan. There were no fractures and no vascular or nerve damage. Open reduction was performed 48 hours after injury followed by tension wire fixation of the acromioclavicular joint and repair of torn ligaments. Clinical outcome four months after injury was perfect.

Acromioclavicular Joint↗
PubMed1986

Thromboembolic prophylaxis in hip fracture.

The effect of either heparin-dihydergot or heparin-acenocoumarin on the incidence of deep-vein thrombosis in the legs was studied in 181 women undergoing Ender nailing for intertrochanteric fracture of the femur. All the patients were screened with the 125-I-fibrinogen uptake test, confirmed by a bilateral ascending venogram. Deep-vein thrombosis developed in 40 per cent of the heparin-dihydergot group and in 61 per cent of the heparin-acenocoumarin group (p less than 0.015).

Acenocoumarol↗
PubMed1986

[Fractures and dislocation fractures of the wrist joint].

Most carpal fractures are based on the same injury mechanism. In most cases the injury is caused by a fall on the dorsiflexed hand, which is raised as a protective measure, and less frequently by a fall on the clenched fist. The latter leads to passive palmar flexion, pronation and radial inclination of the hand; in the former, the hand is passively superextended by the impact, supinated, and brought into ulnar inclination. The instability caused by injury to various articular structures has four developmental stages. The bones or syndesmoses that are involved depend on the stage and quantitative relationship between the three above-mentioned moments of force. If the lateral ligament of the wrist is slack, scaphoid fractures occur; in the last stage of superextension, fractures of the capitate bone occur. With increasing ulnar inclination, perilunar dislocations or fracture-dislocations and triquetrum fractures occur in the third stage and dislocations of the semilunar bone in the fourth stage. In addition, compression and avulsion of the 1st, 4th or 5th metacarpal bones cause fractures of the trapezium and the hamate bone. To avoid unpleasant late sequels, scaphoid fractures with diastasis due to soft tissue interposition or non-reducible dislocated scaphoid fractures must be treated surgically. Vertical oblique fractures and scaphoid fractures with small proximal fragments are relatively good indications for operation. Perilunar instability and dislocations, particularly De Quervain's fracture-dislocations, must be treated operatively because reduction of the scaphoid bone requires a different approach than correcting alignment in the carpus and because soft tissue interpositions are always present, even though they may not be evident in the X-ray pictures. Fracture-dislocations in the distal carpal row also require operation, preferably percutaneous internal fixation using K-wire and fluoroscopy. Immobilization is accomplished by a below-elbow cast with a dorsal plaster splint up to the interdigital webs and from the palmar to the proximal crease. The thumb is only embedded in trapezium fractures; fractures requiring fist or above-elbow casts are indications for operation.

Adolescent↗
PubMed1980

[Connection between deviated axis and impaired function after fractures of the forearm (author's transl)].

Based on follow-up studies of forearm fractures in children the connection between malunion and limitation of forearm rotation has been examined. This limitation of forearm rotation is often caused by deviations of the ulnar and radial shaft in the same direction which have not been corrected by growth. With the aid of geometric drawings it is demonstrated that palmar deviations of bones lead to limited supination whereas dorsal deviations must cause reduced pronation. This limitation increases in proportion to the angle of deviation and proximity to shaft middle.

Biomechanical Phenomena↗
PubMed1980

Combined cranio-facial fractures.

Clinically, fronto-maxillary injuries may constitute a diagnostic problem, as their severity need not correlate with the patient's general condition. To establish a definitive radiological diagnosis, both normal standard films and tomographs are required. These will help to identify fracture lines involving the base of the skull. Most serious among the complications which may be associated with fronto-maxillary injuries is the occurrence of cerebrospinal rhinorrhoea with potential ascending infection. Other complications include oculomotor dysfunction, obstruction of lacrimal drainage and nasal airways as well as dental malocclusion. Primary surgical management is indicated in compound fractures, suspected intracranial haemorrhage and compression of the optic nerve, while fractures with associated dural injuries and involvement of orbital roofs as well as all other combined maxillo-facial fractures with functional impairment require early secondary management. Open exposure of the fracture site is best obtained through a coronal hair-line incision. Dural injuries are preferentially approached through craniotomies.

Adult↗
PubMed1977

[Results of the Ender-nailing method in Austria. With special reference to the cases of the Lorenz-Böhler-Hospital (author's transl)].

The problems of the method are briefly analyzed by the early results of together 2137 patients, who were operated in 10 different traumatological departments or accident-hospitals and by the late results of 109 patients, who were followed up in the Lorenz-Böhler-Hospital. The advantages of the Ender-method are: 1. relatively minimal operative stress to the patients (there are nearly no contraindications); 2. the low infection rate of 1.9%; 3. the favorable mechanical principle of these osteosynthesis, so that in 2137 there was no case with broken nails and no case with nonunion. 4. Rotational stability is better, than by Küntscher's trochanteric nail, because of the diverging tips of the nails in the head of the femur. Furthermore the insertion of the Ender nails does not injure the medial collateral ligament of the knee. 5. External rotation failures of the femur can be avoided by bending the nails in a second plane corresponding to the antetorsion angle of the collum femoris.

Aged↗
PubMed1977

Management of upper midfacial injuries.

Midfacial fractures may extend into orbital roofs, frontal sinus walls, and ethmoidal and sphenoidal bones if the traumatic impact is of sufficient force. The cranium and facial skull are affected and there is the risk of intracranial complications. Management thus requires a teamwork approach. Isolated compound fractures of the anterior frontal sinus may be reconstructed by direct access through the wound. We prefer a coronal hairline incision in most cases. In isolated (compound) fractures of the orbital roof, combined frontomaxillary fractures without dural involvement, and frontobasal fractures that necessitate an intracranial approach for dural closure, primary upper midfacial reconstruction is attempted. In frontal comminution, preservation of the frontal bone or orbital roof is impossible. Secondary management is indicated after an interval of at least six months for fronto-orbital reconstruction with autologous or alloplastic material.

Adult↗