Biomedical subjects
Publications and source records attributed to H Schöttle.
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Ectopic ossifications occassionally occur after stable osteosyntheses. The literature and our own observations indicate that osseous bore-chips probably favour these ossifications, especially after intermedullary nailing. Experiments determined the weight of osseous bore-chips which occur in intermedullary nailing of femur and in plate osteosynthesis of radius and ulna. Conclusions drawn from these findings should be considered when performing osteosynthesis.
In a comparative experimental study stability of different extra- and intramedullar methods of osteosynthesis for stable and unstable pertrochanteric fractures has been examined under dynamical stress. For the treatment of stable pertrochanteric fractures in old patients the intramedullar methods of osteosynthesis (nailing by Ender of Küntscher) were shown to be biomechanically superior. Extramedullar osteosyntheses (130 degrees and 95 degrees angled plate) also guaranteed very high stability; under permanent stress however angled plates showed metal fatigue. In case of unstable pertrochanteric fractures the osteosyntheses with additional application of bone cement produced sufficient stability under permanent stress. The importance of reconstructing a stable medial support for the biomechanics of osteosynthetic materials was emphasized. According to our results especially the combination of 95 degrees angle-plates with bone cement permits immediate mobilisation of old patients in case of unstable pertrochanteric fractures.
Bending burdening of stable and unstable per- and subtrochanteral fractures after osteosynthesis with Y-nails (Küntscher), Ender-nails, 130 degrees and 95 degrees angled plates of the AO were tested in a comparative experimental study. The unstable fractures were also tested after treatment with osteosynthesis and additional application of bone cement in the artificial defect. The essential results were as follows: in the group of stable pertrochanteral fractures the Ender-nails bear in the mean 147 kp, the 130 degrees angle plate 200 kp. In the fracture-group with lacking medial support a highly burdening osteosynthesis could only be achieved by filling up the defects with bone cement. The 95 degrees-angled plate-osteosynthesis combined with bone cement bearing more than 300 kp was superior to the other procedures in the unstable per- and subtrochanteral fractures. In our investigation the stabilizing forces of muscles and fascia have not been taken into consideration.
For chest X-ray in the ward and for intraoperative cholangiography the registered doses were low. A limitation of the exposures or the operations was not necessary. For osteosynthesis operations the doses for the patient and the staff could be kept low by preparing the operation adequately, by using modern image-intensifer units with grid and automatic regulation in fluoroscopy, and with discipline in using fluoroscopy. During one week a surgeon could do eight osteosynthesis operations without reaching legally imposed dose limit. The control area could be restricted to a space around the patient with a radius of two meters.
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33 CT-investigations of 23 patients with malignancies of the shoulder girdle were analyzed. In 80% of the surgically treated bone tumours of 17 patients the presence and extend of soft tissue infiltration and of osseous destruction could be delineated. The size of the 6 soft tissue tumours was better demonstrated by CT than by any other radiologic procedure. As CT is the most reliable noninvasive method to visualize the extend of a tumour of the shoulder girdle it is a valuable aid in treatment planning. Diagnostic pitfalls and results of follow-up studies are discussed.
PROBLEM: The major problem of reconstructing the anterior cruciate ligament (ACL) with the semitendinosus tendon (STT) is the low primary stability of the STT graft fixation techniques. METHODS: On 10 cadaver knees a surgical procedure for arthroscopic reconstruction of the ACL with the double looped STT was performed. The femoral attachment was achieved with an "U-formed" tendon wrapped around a bone-plug, which then was blocked in a single-staged femoral bone tunnel. The tibial fixation was attained using a bone-plug and an interference-screw. Anatomic studies were performed on the STT of the cadaver knees. Isometrical determinations were performed intraoperatively for precise anatomical placement of the tendon. We compared these measurements with the postoperative position of the STT-transplant. The tibial and the femoral attachment was tested separately for primary stability and stiffness. The mode of failure of the fixation methods was determined. RESULTS: The average length of the STT was 29.4 cm (SD +/- 3.6 cm, 24-33). With comparing the measured intraoperative and postoperative isometrical values we found a high correlation. The primary stability of the attaching methods in the pullout-testing amounted for the femoral attachment to 448.2 N (SD +/- 76.5 N, 322-560 N) and for the tibial attachment to 440.0 N (SD +/- 72.5 N, 316-538 N). The average stiffness of the femoral fixation was 29.23 N/mm (SD +/- 1.64 N/mm; 26.6-32.1 N/mm). The average stiffness of the tibial fixation measured 28.31 N/mm (SD +/- 1.55 N/mm, 25.1-30.4 N/mm). CONCLUSION: The presented method provides an economical and easy to perform autologous STT-fixation technique with a high level of primary stability.