Biomedical subjects
Publications and source records attributed to H Reilmann.
The choice of surgical approach to fractures of the acetabulum is determined by the type of fracture. The most popular approaches are the Kocher-Langenbeck, the ilio-inguinal and the extended iliofemoral. The techniques of reduction and internal fixation using special instruments and implants are demonstrated.
On the occasion of the 1990 Conference of the German Society for Accident Surgery (DGU) in Berlin, a working group "Pelvis" of the DGU and the AO International was established on the initiative of H. Tscherne. It is the objective of this working group to formulate guidelines for the diagnosis and treatment of pelvic girdle fractures, within the framework of a prospective multicentre study based on comparable results. In the annual report for 1991, a total of 460 pelvic fractures were documented. Classification shows that 9.5% belong to group A, 46.3% to group B, and 44.2% to group C. One hundred and eighty-two patients (39.6%) had an isolated pelvic injury, while 278 (60.4%) sustained multiple injuries. The average polytrauma score for all 460 subjects was 23.2 points. The surgical management was shown to depend on the severity of the fracture.
From 1982 to 1986, a total of 106 children with supracondylar fractures of the humerus were treated at the trauma surgery clinic in Braunschweig. Undisplaced or slightly displaced fractures were treated with plaster casts. More severely displaced fractures were initially treated by closed reduction under general anesthesia and percutaneous Kirschner wiring. In 72 cases (= 85.7%) a follow-up examination revealed a very good or good result. In 9 cases (= 10.7%) satisfactory results were found and in 3 cases (= 3.6%) unsatisfactory results. The most common complication prejudicing the result was cubitus varus. It was found in 27 cases (= 32.1%), most often with a varus under 10 degrees (19 of the 27 cases). A retrospective study of the 12 cases in which the results were classified as satisfactory or unsatisfactory showed 8 insufficient reductions in fractures with severe instability.
A correlation could be demonstrated between four pathological femoral neck fractures in patients who regularly underwent hemodialysis; cystic bone deposits of beta-2-microglobulin amyloid were also found. The characteristic symptom complex includes painful arthralgia of the shoulder, carpal tunnel syndrome, pain in the hip and recurrent knee effusions. The first step in the diagnostic procedure is to demonstrate cystic defects in skeletal radiographs. Then a biopsy of the cystic bone lesion is needed for histological verification of beta-2-microglobulin. The surgical treatment is total joint replacement or augmented composite osteosynthesis due to poor regeneration capacity in the amyloid bone lesion.
The risk of thrombo-embolic complications in multiple injured patients is increased due to several pathophysiological factors. The purpose of this study was to analyse the effect of a continuous IV heparin prophylaxis (10000IE/24h) in polytraumatized patients. A post-mortem evaluation of 72 decreased patients out of 373 multiple trauma patients treated during 1984-1985 was performed. In one patient multiple major pulmonary emboli were found to contribute to his death. No deep vein thrombosis as well as no fulminant pulmonary embolism were found in any case.
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Thromboembolic complications are one of the most common complications in patients undergoing major surgery or conservative treatment in cast. The incidence of thromboembolic complications is the highest in orthopedic and trauma surgery. Stasis in the deep veins of the lower extremity, intimal damage and disorders in blood coagulation are important factors in the pathogenesis of deep vein thrombosis. The most important predisposing risk factors are age, previous thrombosis, varices and the combination of oral contraceptives and smoking. 50% of thrombosis begins intraoperatively and 80-90% in the first 3-4 days after operation. The incidence of thromboembolic complications was significantly reduced after introduction of low-dose heparin and heparin with dihydroergotamine in the perioperative regimen. Recently various investigations demonstrated that low-molecular-weight heparin (LMWH) is equally as effective as a low-dose heparin regimen in preventing postoperative thromboembolic complications. Our own management of prophylaxis of thromboembolic complications is presented. In a prospective pilot study 100 trauma patients were evaluated. 84 patients received LMWH plus dihydroergotamine (DHE), 12 patients heparin alone because of contraindications for DHE and 4 patients received a low dose continuous intravenous heparin prophylaxis because of high risk. Two deep vein thrombosis occurred, one in a patient with high risk prophylaxis and one in a patient with a subcutaneously heparin prophylaxis. No thromboembolic complications occurred in patients with LMWH + DHE prophylaxis.
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The growth kinetics, perfusion and immune response of autotransplanted splenic tissue were studied in pigs. Splenic fragments were transplanted subfascially or in the greater omentum and regenerated to small splenules with a normal histologic structure 6 months later. The grafts showed a normal function of the white pulp after antigenic stimulation, and of the red pulp as demonstrated scintigraphically. The blood flow was reduced. The growth kinetic was less rapid than in rodents and resulted in a relatively lower mass of splenic tissue, but these results are closer to findings in human splenosis.
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