Biomedical subjects

J Heineck

Publications and source records attributed to J Heineck.

3 recordsLinked to original sources

PubMed2006

[Percutaneous dorsal versus open instrumentation for fractures of the thoracolumbar border. A comparative, prospective study].

STUDY DESIGN: A prospective clinical study. OBJECTIVE: To evaluate whether a percutaneous dorsal instrumentation of thoracolumbar fractures prevents irreversible damage to the spinal muscles. METHODS: A total of 57 patients with thoracolumbar fractures (Th12-L4) were divided into two groups, comparable in terms of gender, fracture level, classification and surgical concept. In the first, 24/57 patients were treated using an open procedure (OP-G); in the second, 33/57 were treated via percutaneous dorsal instrumentation (PER-G). Fracture localisation and classification, accuracy of pedicle screw placement, perioperative blood loss, OR- and image converter time as well as muscle damage (needle-EMG) were evaluated. RESULTS: OR- and image converter time as well as the accuracy of pedicle screw placement were not statistically different between groups. The difference in perioperative blood loss [43 (10-90) ml (PER-G) vs [870 (570-1,200 ml (OP-G)] was statistically significant (P <0.005). Needle EMG revealed no muscle damage, and the physiological activity and muscle potentials were normal (PER-G). In the OP-G, polyphasic EMG signals were most common (80%), a sign of the drop-out of numerous motor units. CONCLUSIONS: The open procedure caused permanent and significant damage to the strongest extensors of the autochthonus back musculature, the m. multifidus, which results from multisegment combined damage to the r. posterior nervi spinalis and muscle fibres. In contrast, percutaneous placement of an internal fixative reduces perioperative access morbidity causing little iatrogenic damage to back muscles and only a minor perioperative blood loss.

Adult↗

PubMed2006

[Traumatic hemipelvectomy].

With an incidence of only 0.6% of all pelvic injuries, traumatic hemipelvectomy is a rare event. It is defined as open or closed avulsion of one hemipelvis with occlusion or disruption of the main vessels and lengthening or disruption of the nerves, often complicated by urogenital or anorectal injuries. The mechanism of injury in this case is a typical one with extreme abduction and external rotation of the leg, causing sacroiliac joint disruption and symphysis separation. Two other mechanisms described are avulsion when the leg becomes entangled in a piece of machinery or a massive crushing at the groin. After a fast treatment in the field, the patient described was treated with immediate open revision, tamponade and stabilization of the pelvis. Upper leg preservation by reconstruction of the femoral vessels with vascular prostheses was attempted. Because of a broad necrosis of soft tissues, early completion of the hemipelvectomy was performed. The patient recovered well. Miction and bowel evacuation as well as sexual function could be preserved. The resulting quality of life is high and the patient is socially reintegrated without problems.

Adolescent↗

PubMed2005

[Hindfoot arthrodesis resulting from retrograde medullary pinning].

BACKGROUND: Simultaneous arthrodesis of the ankle and subtalar joints and correction of axial malalignment of the hindfoot in cases of bony defects and/or circulatory disturbances of the talus after multiple previous interventions. Internal stabilization with a short distal femur nail. Restoration of pain-free weight bearing. Failure of arthrodesis of the ankle and subtalar joint in patients with severely altered bone structure particularly at the level of the talar dome. Malalignment of hind- and/or forefoot after previous arthrodesis of the ankle and subtalar joint. Poor skin or soft-tissue condition. Acute osteitis/osteomyelitis. METHODS: Posterolateral approach. Resection of the articular cartilage and the areas of sclerosis of the ankle and posterior facet of the subtalar joint. Interposition of bone grafts harvested from the posterior iliac crest. Correction of malalignment of the hind- and forefoot. Locked nailing with a short distal femur nail. RESULTS: All 21 prospectively enrolled patients were followed-up clinically and radiographically at an average of 1.2 years (0.6-2.1 years) postoperatively. The average age of the 4 women and 17 men at the time of surgery was 53.4 years (38.9-73.7 years). The goal of the surgery was achieved in all patients. Subjective assessment was good in 14 patients and satisfactory in 3 patients. Complications occurred in 5 patients; these included loss of nail purchase (2), dislocation of locking screw (1), breakage of locking screw (1), and nonunion (1).

Ankle Joint↗