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Biomedical subjects

H R Siebert

Publications and source records attributed to H R Siebert.

16 recordsLinked to original sources
PubMed2006

[Fracture of the distal radius].

Distal fracture of the radius is an injury to a complex joint that is comprised functionally of four partial joints and makes it possible for the hand to move in all directions. The injuries to bone and cartilage and to the stabilizing ligamentous structures and the surrounding soft tissue vary as functions of the impact responsible the mechanism of injury, and any previous illnesses. The objectives of treatment are restoration of pain-free, unrestricted and lasting function of the wrist and lower arm and avoidance of the typical complications. Stable fractures are treated by conservative means, while unstable fractures with fragmentation are realigned in a closed procedure and then stabilized by internal or external fixation. In the case of fractures in bones affected by osteoporosis it is usually not necessary to make good a metaphyseal defect when specially adapted fixed-angel plates are used. Complex intraarticular AO type C3 fractures with multiple fragments frequently require a two-step procedure with primary closed realignment, an external fixator spanning the joint, and subsequent extensive diagnostic examinations to ascertain any concomitant injuries and allow a decision on the definitive treatment that is most suitable for the type of injury present.

Adolescent↗
PubMed2005

[Trauma surgery in the elderly].

The indications for the surgical treatment of fractures in elderly patients should consider the individual's general health status, the specific pattern of injury, and the ability of the patient to actively participate in the rehabilitation process. Intramedullary systems are the gold standard for shaft and metaphyseal fractures due to the decreased operative trauma and the possibility of early weight bearing and functional treatment. Minimally invasive locking plate systems can frequently be applied, offer decreased risk of secondary fracture displacement, and have great advantages in the treatment of periprosthetic fractures with firm implants. The possible reasons for falls should be diagnosed in order to allow their prevention. An exact assessment of the severity of osteoporosis in important in allowing adequate treatment for associated pain and for decreasing the risk of future osteoporosis related fractures.

Accidental Falls↗
PubMed2005

[Fracture of the distal radius].

Distal fracture of the radius is an injury to a complex joint that is comprised functionally of four partial joints and makes it possible for the hand to move in all directions. The injuries to bone and cartilage and to the stabilizing ligamentous structures and the surrounding soft tissue vary as functions of the impact responsible, the mechanism of injury, and any previous illnesses. The objectives of treatment are restoration of pain-free, unrestricted and lasting function of the wrist and lower arm and avoidance of the typical complications. Stable fractures are treated by conservative means, while unstable fractures with fragmentation are realigned in a closed procedure and then stabilized by internal or external fixation. In the case of fractures in bones affected by osteoporosis it is usually not necessary to make good a metaphyseal defect when specially adapted fixed-angle plates are used. Complex intraarticular AO type C3 fractures with multiple fragments frequently require a two-step procedure with primary closed realignment, an external fixator spanning the joint, and subsequent extensive diagnostic examinations to ascertain any concomitant injuries and allow a decision on the definitive treatment that is most suitable for the type of injury present.

Fracture Fixation↗
PubMed2003

[Metacarpal fractures: treatment indications and options. Results of a multicenter study].

This multicenter study analyzes data on metacarpal fractures in 1260 patients to determine optimal treatment concepts. Of the 740 patients followed up, 487 (66%) presented with fractures of a single metacarpal in one of the three most frequently observed locations (distal fractures of the 4th and 5th metacarpal, shaft fractures of the 2nd to 5th metacarpal, and fractures of the base of the first metacarpal). The overall clinical and radiological results were good to excellent. The "path" analysis used to identify baseline parameters and treatment options influencing outcome led to recommendations for metacarpal fracture treatment. Functional protocols are predominantly applied for postoperative/post-traumatic treatment. Pain and regional pain syndromes should be prevented whenever possible and early adequate treatment should be initiated due to their significant impact on outcome.

Bone Plates↗
PubMed2003

[Distal radius fractures. 2.4 mm locking compression plates. Are they worth the effort?].

Fracture of the distal radius has a second peak of incidence in the second half of life. Because complex injuries are seen frequently, there is a need for differentiated treatment to achieve good results. The aim of our study was to evaluate the treatment of distal radius fractures with 2.4-mm locking compression (LC) plates in patients older than 65 years suffering from osteoporosis to determine the complications and compare costs of treatment with different interventions. Thirty-seven patients were included in this prospective study. The distribution of fractures according to AO classification was: nine type A, one type B, and 27 type C. The mean age was 76 years. Twenty-six volar plates, seven dorsal and four "sandwich" procedures were applied. The mean follow-up for 33 patients was 11.1 months. Using the functional Lidström score, we found 13 very good results, 15 good, four fair, and one poor, the radiologic Lidström scores were: 15 very good, 13 good, four fair, and one poor results. With the application of 2.4-mm LC plates, findings were good or very good in over 80%of osteoporotic distal radial fractures. Compared to other treatments, the real costs of intervention for LC plates is much higher.

Age Factors↗
PubMed1997

[Guidelines: treatment of distal radius fracture].

The treatment aim is restoration of adequate length of the radius, adjustment of the distal radioulnar joint, alignment of the distal radius joint surface, and prevention of reflex dystrophy syndrome. Stable fractures are treated by close reduction and a cast for 3-4 weeks, depending on bone stock quality. Instable extra-articular fractures are treated by K-wiring using various methods. In case of a comminuted dorsal or palmar area, K-wiring is unstable, so additional fixation is necessary (autogeneous bone graft + external fixator + plate or cast). The external fixator alone or in combination with K-wires is the appropriate fixation method all intra- or extra-articular comminuted fractures. Palmar or dorsal plate osteosynthesis is highly recommended in palmar or dorsal rim fractures (B 3, B 2 type), whereas in C 2 to C 3 fractures additional autogeneous graft and/or K-wires or screws are necessary should be used in combination with autogeneous graft, according to the fracture pattern. Ligament injuries or luxation in the carpal row must be looked for precisely and treated according to the injury pattern.

Bone Transplantation↗
PubMed1993

[Indications, technique and results of treatment of fractures of the base of the first metacarpal bone with movement stable osteosynthesis].

We report about the indication, technique and results of 27 fractures of the base of the metacarpus I. All those fractures were treated by open reduction and screw-/plate osteosynthesis according to the AOSIF-technique. Using these implants and the technique of open reduction with an additional autologous bone graft it offers the possibility to start active motion therapy immediately after operation. Perioperative complications can be bypassed with the use of external mini-fixateur as well as in those cases of open fractures with various types of damage patterns. Total active mobility (TAM) of the thumb joints showed in our series of 27 treated fractures an active total mobility of 80% or more in 25 patients. There where three patients with wound healing disturbances. No fracture healed delayed or resulted in non union, no patient showed signs of reflex dystrophy, yet in two cases insufficient joint reconstruction had to be noted. Neither our own short followed-up results or those few cases published so far allow us a final critical judgement of the best technique in treating the fractures of the base of metacarpus I.

Adult↗
PubMed1986

[Conservative functional treatment of fractures of the thoracic and lumbar vertebrae].

The treatment of fractures of the thoracic and lumbar vertebraes is determined by the (primary) stability or instability of the injury. "Stable" vertebral injuries are defined to affect the firmness of the vertebral column only slightly or not at all. Thus an early mobilization is generally possible without essential losses in shape and function. The dynamic functional treatment of vertebral fractures developed by Magnus and repeatedly modified later on has, together with a physiotherapeutical program containing 13 points, proved successful in the treatment of "stable" fractures of the thoracic and lumbar vertebraes.

Bed Rest↗
PubMed1986

[Biological value of various bone substitutes in the treatment of bone defects. Animal experiment studies].

In clinical practice, biologic and synthetic substances have been used more and more as bone substitutes during the last few years. Different properties of the implant material are required according to the various fields of application. This implies a precise investigation of the biologic value by adequate experimentations on animals. It has been demonstrated in a bioassay with several synthetic implant materials, especially ceramics made of calcium phosphate, powders and granulated materials of tricalcium phosphate, and hydroxylapatite with different pore sizes and numbers, that there is only poor or even not any biologic activity in these substances which would produce an orthotopic stimulation of osseous formation. The application of these substances as bone substitutes can only be recommended in an adequate transplantation bed. However, all implant materials tested by different experimentations on animals showed an incomplete absorption in the histomorphological investigation even after twelve months. The various biologic bone substitutes (autologous and homologous spongiosa, demineralized homologous spongiosa, different forms of bone gelatin) show different degrees of biologic activity. Hitherto an inducing heterotopic effect could be demonstrated for bone gelatin in rats, dogs, and sheep. The inducing effect of bone gelatin combined with soluble calcium phosphate ceramics in rats was increased as compared with autologous spongiosa. Regarding our own results as well as various communications in literature, we consider it absolutely necessary to give more attention to the objectifying criteria when describing the biologic activity of "biologic and synthetic bone substitutes".

Animals↗
PubMed1986

[Experiences with free and pedicled muscle tissue graft in the treatment of chronic post-traumatic osteomyelitis].

A relapse-free condition and/or healing of chronic posttraumatic osteomyelitis is obtained by 1. radical excision of the infected tissue, 2. absolute mechanical immobility in the area of the fracture, 3. optimized blood supply of soft tissues. The perfusion of soft tissues around the osteomyelitic focus is often disturbed due to large scar fields caused by injuries or repeated surgical interventions. It can be improved by means of plastic surgery with local muscle flaps or by transplantation of a free muscle flap with microsurgical connection of vessels. All muscles in which the axial vessels are predominant can be used for plastic surgery with local muscle flaps. In the leg, these are above all the musculi gastrocnemii and the musculus soleus. After having applied this method in six patients, we noticed that infection control could be achieved by this procedure after six to twelve months. When a free muscle flap (musculus latissimus dorsi) is used, the local soft tissue perfusion can be considerably ameliorated by these rather large muscle flaps, irrespective of the local blood flow after epicentric microsurgical connection of vessels. This is the precondition for the healing of the infection. Based on our own results, we discuss the difficulty to indicate exactly the duration and extent of the increased perfusion of transplanted muscles. As is shown by the clinical results available up to now, these two procedures make possible a considerably reduced recurrence rate in chronic posttraumatic osteomyelitis.

Adult↗
PubMed1985

[Experimental studies of ligament replacement].

In a mechanically stable situation (ligament transposition), the material allows capillary vessels to grow into the prosthesis, but it does neither induce the formation of a "neo-ligament" by dody-own tissue nor an interweaving of the nascent parallel collagenic fibres with one another. No direct contact between polyethylene and bone is built at the fixation points. Apparently this material is not suitable for being used as tendon substitute, and its applicability as a ligament substitute is limited because the mechanical properties which are acceptable until 500 days after the implantation are lost after this period and a good tolerance can only be achieved under certain, most restricted conditions.

Animals↗
PubMed1985

Time sequence of osteoinduction and osteostimulation elicited by biologic bone replacement materials.

The combinations of a biologic bone replacement material (BRM), bone gelatine (BG), a matrix extract, with one of the synthetic BRMs, either powderised beta-tricalcium-phosphate (TCP) or particulate hydroxyapatite (HA), as well as BG alone were implanted in muscle pouches and diaphyseal femoral drill-holes in rats. Implantation between one and 21 days. Evaluation by histomorphometry of PMMA embedded undecalcified specimen. In heterotopic implantation bone formation occurred earliest in the BG/TCP combination with highest values for volume density bone and osteoid after 21 days. In orthotopic implantation starting between days 9 and 13 the BG/HA combination stimulated intense woven bone formation with massive ingrowth of vital bone into the HA pores. The biodegradable TCP, by activating the monocyte-/macrophage-system for its degradation, obviously enhanced the already ongoing immunologic reaction to allogeneic BG, thus impeding bone formation and repair.

Animals↗
PubMed1984

[Criteria for the treatment of femoral shaft fractures in childhood. Do post-traumatic rotatory defects require treatment?].

Overgrowth and rotational deformity of the injured leg are sequelae of femoral shaft fractures in children. It is still questioned whether the posttraumatic rotational deformity is corrected spontaneously and whether this leads to arthrosis. An individual follow up of 25 children out of 94 with a malrotation after conservatively treated femoral shaft fracture - two to three times up to 4 years after the accident - showed a spontaneous correction of malrotation in 15 (60%). No prearthrotic sign could be found by physical and roentgenographical examination. In accordance with recent publications these results demonstrate again that in children up to the age often operative treatment of isolated femoral shaft fracture is not indicated, as posttraumatic malrotation is corrected at least to almost physiological values and no extensive study exist so far, which give evidence that malrotation after femoral fracture in children leads to arthrosis.

Adolescent↗