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Biomedical subjects

J Raunest

Publications and source records attributed to J Raunest.

35 records · Page 2Linked to original sources
PubMed1991

Application of a new positioning device for isometric replacement in anterior cruciate ligament repair and reconstruction.

The functional effects of displacing the cruciate ligament attachments were studied in ten adult cadaver knees. On a systematic variation of the femoral and tibial attachment sites according to a three-dimensional raster scheme, a quantitative analysis of the absolute length and of motion-dependent changes in ligament isometry was performed. All insertion points deviating from the original anatomic landmarks did not accomplish biomechanical requirements. A femoral displacement had an increased effect on disturbing isometry compared to a tibial malposition. Although recommended by several authors, the "over-the-top" position gave the most unsatisfactory results with a maximum isometry failure of 10 mm. In cruciate ligament replacement a positioning guide with isometry testing capacity should be mandatory to ensure correct placement of bone tunnels. For this purpose a new positioning device which allows for isometry measurements before a bone channel is drilled is introduced and applied in an experimental setup.

Aged↗
PubMed1990

[Incidence of complications and early mortality in surgical management of coxal femoral fractures].

In a retrospective study the clinical course of 393 patients treated for proximal femur fractures is evaluated. Intraoperative complications occurred in 2% whereas early complications related to the operative procedure were seen in 19.8% and unspecific complications in 36.8%. Factor analysis proved the following items to be associated with a high risk of complication: age (p less than 0.01), preexistent diseases, kind of operative procedure (p less than 0.05) and the lapse of time between trauma and operation. The extraordinary high incidence of unspecific complications is explained by the prevailing proportion of elderly patients with a corresponding multimorbidity. A decrease in complications and lethality can be achieved by early operative treatment. With regard to the necessity of early mobilization we prefer a hemiarthroplasty in fractures of the femoral neck for elderly patients. Stable pertrochanteric fractures are treated by a dynamic hip screw whereas instable pertrochanteric fractures are an indication for Ender nailing.

Aged↗
PubMed1990

Arthroscopic cartilage debridement by excimer laser in chondromalacia of the knee joint. A prospective randomized clinical study.

A new operative technique in arthroscopic treatment of chondromalacia using ultraviolet laser systems is introduced. The postoperative results are evaluated in a prospective and randomized clinical trial. One hundred and forty patients stage II or III chondromalacia according to Outerbridge were randomly assigned to arthroscopic operation using either laser or mechanical instruments. After a 6-month follow-up period the clinical results were compared, guided by a specially designed modification of the Lysholm scoring scale. In the short-term follow-up laser surgery gave superior results in regard to reducing pain (P less than 0.05) and leading to a lower incidence of reactive synovitis (P less than 0.01). No difference was found in respect of disability and functional impairment. Our results lead to the conclusion that arthroscopic laser application seems to be a successful procedure in the treatment of degenerative cartilage disorders, providing precise ablation of tissue without significant thermal damage to the remaining cartilage.

Aged↗
PubMed1990

[External synovial fistula of the infrapatellar bursa following arthroscopic meniscus resection. A clinical case report and topographic-anatomic study].

Following arthroscopic meniscectomy a 41-year old patient developed an external synovial fistula in the area of the central joint approach with a communication to the deep intrapatellar bursa. Anatomical preparations performed on 20 knee joints revealed extraordinary variations in the dimension of the infrapatellar bursa with a mean longitudinal diameter of 24 mm and a transversal diameter of 38 mm. The distance between bursa and the distal margin of the patella measured 15 to 39 mm. These topographic conditions lead to the assumption that the bursa is exposed to iatrogenic lesion by placing a central joint approach. Therefore a proximal incision is recommended for the central portal to avoid a lesion of the bursa with the potential risk of a postoperative fistula formation.

Adult↗
PubMed1990

[Clostridium perfringens infection following intramedullary nailing of an open femur shaft fracture].

In a 47-year old patient, clostridial bacteraemia and local gas gangrene developed following osteosynthesis of a penetrating femoral fracture by a medullary nail. The operation had been performed in a post-injury interval of 14 days. The first clinical symptoms did not appear until 6 days after surgery. Operative treatment by large local incisions, debridement and drainage with the medullary nail left in situ accompanied by administration of penicillin G resulted in recovery. In the case presented here, local haematoma and debris due to the osteosynthesis procedure had probably induced a proliferation of clostridia leading to gas gangrene. The delay in development of signs and symptoms and the benign appearance of the wound resulted in delay in early diagnosis and appropriate treatment of this potentially life-threatening entity. Ultrasound proved to be a valuable tool in the evaluation of local changes. Even in performed in an appropriate postinjury interval, medullary nailing bears a potential risk of inducing a clostridial infection, so that the indication must be very strict.

Anti-Bacterial Agents↗
PubMed1990

[Experimental results of biomechanical strength of the meniscus suture in the area of zone II].

The biomechanics of the sutured meniscus were studied in an experimental in vitro assembly. The characteristics of load transmission and changes in radial tensile strength were analyzed under static load conditions. With the knee joint in extension the longitudinally ruptured meniscus presents only slight changes with regard to load transmission and radial stretch. Increased gaping of the anterior horn accompanied by a compensatory radial compression in the posterior segment occurs with flexion and contralateral tibial rotation. Repair of the meniscus results in partial compensation of these phenomena, although both changes are still reproducible to a lesser extent. A vertically applied suture provides more mechanical stability than horizontal fixation. Static weight bearing is of lesser significance in producing separation of the reconstructed meniscus. Postoperative care following meniscus reconstruction must include immobilization, although early weight bearing can be permitted.

Biomechanical Phenomena↗
PubMed1990

[Intra- and postoperative complications of arthroscopic surgery of the knee joint].

In a review of the literature, intra- and postoperative complications in arthroscopic surgery of the knee joint are analyzed on the basis of 167,210 reported cases. Depending on the variable criteria and definitions, the respective studies are based upon the individual complication rates differ greatly between 0.8 and 17.7%. The incidence of serious complications was less than 1%. Factor analysis proved the following variables to be correlated with the incidence of complications: age and sex, kind and etiology of joint lesion, kind of operative procedure performed, duration of operation, and experience of the surgeon. Compared to arthrotomy, arthroscopic surgery is associated with reduced morbidity and a low complication rate.

Arthroscopes↗
PubMed1990

[Pathogenesis of Achilles tendon rupture].

The etiology underlying ruptures of the Achilles tendon is analyzed in 65 patients in a retrospective clinical study. A typical mechanism leading to a rupture of the tendon consists in an extraordinary tension force applied on a tendon in a state of active preload. A spontaneous rupture was observed in merely 3 cases. In 21 out of 65 patients risk factors such as hypercholesterolemia, hyperuricemia and arteriosclerosis were present. A systematic application of corticosteroids proved to be a decisive factor in the etiology of a tendon rupture. There was no correlation between the presence of associated risk factors and the degree of histological degeneration. During follow-up 3 re-ruptures and 6 ruptures of the contralateral tendon were registered. Our results lead to the conclusion that the etiology of the rupture of the Achilles tendon is based on a multifactorial disposition which includes the mechanism of injury, preexistent risk-factors as well as degenerative changes in the tendon structure.

Achilles Tendon↗
PubMed1989

Follow-up results of 3,500 arthroscopic operations on the knee joint.

In a clinical study the postoperative results of 3,500 arthroscopic operations on the knee joint were analyzed with a follow-up period of 1 year. At the time of examination 55.3% of patients were symptom-free, 33.8% had definite relief of symptoms and in 10.9% the symptoms were unchanged or progressive. The results of the different procedures performed varied widely, with the best results being obtained after meniscectomy. The average postoperative hospitalization was 3.5 days. Arthroscopy is a procedure with a low morbidity. Rehabilitation in the immediate postoperative period is accelerated due to reduced pain and functional impairment.

Arthroscopy↗
PubMed1989

[Arthroscopic synovectomy using the Neodymium-YAG laser].

Arthroscopic laser synovectomy consists of a mechanical abrasion of the superficial layers followed by a laser devitalization of the basal synovium. The Neodymium-YAG-laser is suitable for this purpose because of its depth of penetration in tissue and the transmission through quartz flexible fibers. In histological in-vivo-studies laser induced changes in the deep synovial layers could be verified. After a total of 50 arthroscopic laser procedures the clinical results of the first 15 laser synovectomies are analyzed in a follow-up period of 6 months. Compared to the preoperative condition the arthroscopic operation resulted in a significant improvement. A reduced hemorrhage is a specific advantage of this technique. Arthroscopic laser synovectomy is as effective as conventional open capsulosynovectomy preserving the advantages of arthroscopic surgery, a reduced morbidity, a low functional impairment and short rehabilitation periods.

Arthroscopy↗
PubMed1986

[Arthroscopic meniscus resection and open meniscectomy--a comparative study].

In a clinical follow-up study the postoperative results after arthroscopic meniscectomies are compared to conventional arthrotomies. 200 selected patients, half treated arthroscopically and half by open meniscectomy are reviewed after a postoperative period of 1.5-4 years. Each patient in the arthrotomy-group is matched with a patient in the endoscopic collective by age, sex and type of meniscus lesion. Ligamentous instability was an excluding criteria. The mean hospital stay in the arthroscopic group is 4.9 days compared to 12.3 days in the arthrotomy-group. At follow-up 46% of the arthroscopically treated patients are free of symptoms, in 49% the operation resulted in a significant relief of symptoms, whereas 5% have unsatisfactory results. In the arthrotomy-group 38% have excellent, 54% good and 8% unsatisfactory results. The total amounts of remission with 95% and 91.5% in both collectives are comparable. Using a modified Larson-scoring-scale to record the symptomatic results in the longer term we found a mean score of 91.3 points in the arthroscopic and of 89.4 points in the arthrotomy-group. Apart from the operative technique a partial meniscectomy results in a mean score of 91.9 points compared to 88.5 points at total meniscectomies. The presence of degenerative changes seems to influence the postoperative result negatively. The advantages of endoscopic surgery include a decreased hospitalisation and a shorter sick leave, whereas the long-term results do not differ significantly from conventional menisectomy. Referring to the progress of degenerative changes a partial meniscectomy should be preferred to a total meniscectomy to prevent the cartilage from degeneration and arthrosis.

Adolescent↗
PubMed1984

[Topography of the posterior horn of the lateral meniscus--arthroscopico-anatomic study].

The topographic relation of the popliteus bursa to the peripheral rim of the lateral meniscus is described with particular attention to the arthroscopic appearance. The arthroscopic findings are compared to sections of knee joints obtained after amputation. As a constant result we found a peripheral separation of the lateral meniscus in the posterior part which extends for 2-3 cm. In consequence of these physiological defects in the superior and inferior attachments to the joint capsule the popliteus bursa communicates with the central part of the joint cavity on the femoral and in the majority of cases on the tibial level of the lateral meniscus. These anatomical conditions which appear arthroscopically as a peripheral longitudinal tear might be confounded with a traumatic or degenerative lesion of the lateral meniscus.

Arthroscopy↗
PubMed1984

[Partial arthroscopic meniscus resection. Results of 234 arthroscopic operations].

In a clinical follow-up study the postoperative results of 234 meniscus lesions treated by partial arthroscopic meniscectomy are analysed. After a period of 3-12 months 43% of cases were completely free of symptoms, in 50% the operation resulted in a significant relief of symptoms whereas 7% of the patients had unsatisfactory results. Serious intra- and postoperative complications did not occur. Compared to open meniscectomies the hospital stay is considerably shorter with an average duration of 4.7 days. The postoperative short-term result seems not to be related to the presence of degenerative changes. In 89% of cases with a severe chondromalacia an isolated arthroscopic meniscectomy gave an excellent or good result.

Adolescent↗
PubMedDate not supplied

Acute acalculous cholecystitis complicating trauma: a prospective sonographic study.

Acute acalculous cholecystitis (AAC) is a well known complication in severely traumatized patients. Existing data of AAC originate from retrospective analyses and episodic case reports. In a prospective study 45 polytraumatized patients admitted to our intensive care unit from January 1989 to June 1990 were clinically and sonographically screened for this condition at defined time intervals. Trauma scoring was performed according to the injury severity score and polytrauma score. AAC was defined as a combination of hydrops of the gallbladder, an increased wall thickness (> 3.5 mm), and the demonstration of sludge. We were able to document this diagnostic triad in 8 (18%) of 45 patients. As a consequence early elective cholecystectomy was performed in 1 of the 8 patients. The remaining patients were treated conservatively. The incidence of AAC in severely traumatized patients is higher than figures so far published suggest. Ultrasound is a reliable method of early detection and follow-up of this complication.

Acute Disease↗
PubMedDate not supplied

Acute acalculous cholecystitis in severely traumatized patients: a prospective sonographic study.

Acute acalculous cholecystitis is a well known complication in severely traumatized patients. Existing data originate from retrospective analyses and episodic case reports. In a prospective ultrasonographic study 25 polytraumatized patients admitted to our intensive care unit between January 1, 1989, and December 31, 1989, were examined in daily intervals for this condition. Trauma scoring was performed according to the injury severity score (ISS) and polytrauma score (PTS). "Stress cholecystitis" was defined as a combination of hydrops of the gallbladder, an increased mural thickness (> 3.5 mm), and the demonstration of "sludge." We were able to demonstrate this diagnostic triad in four out of 25 patients (= 16%). As a consequence early elective cholecystectomy was done in one patient. The remaining patients were treated conservatively. The incidence of stress cholecystitis in severely traumatized patients is probably higher than figures so far published suggest. Ultrasonography is a reliable method of early detection and follow-up for this complication.

Acute Disease↗