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Biomedical subjects

K E Rehm

Publications and source records attributed to K E Rehm.

At least 19 recordsLinked to original sources
PubMed1997

[Local foreign body reactions to biodegradable implants. A classification].

Biodegradable implants are increasingly used in orthopedic and trauma surgery. Many different implants consisting of different biodegradable polymers are currently available. Different factors contribute to the biocompatibility of these implants, and local foreign-body reactions remain a matter of concern. Therefore, it is mandatory to document and compare the tissue reactions caused by various biodegradable implants in experimental or clinical studies. We have developed a standardized system of classification based on our previous experimental and clinical observations. Foreign-body reactions are differentiated into osteolysis (0-0 to 0-4), extra-articular (EA-0 to EA-4) and intraarticular (IA-0 to A-4) soft-tissue reactions.

Animals↗
PubMed1997

Post-traumatic costochondritis caused by Candida albicans. Aetiology, diagnosis and treatment.

Candida costochondritis is a rare disease of complex aetiology. Pathogenetic factors range from postoperative and posttraumatic complications to haematogenous dissemination in intravenous drug addicts. In addition to clinical examination, possible diagnostic procedures include scintiscan and magnetic resonance imaging. The treatment of choice is extensive debridement and resection of the structures affected by the inflammatory process. The long-term prognosis is good.

Abdominal Injuries↗
PubMed1997

[New developments in the application of resorbable implants].

The application of biodegradable implants is combined with advantages and disadvantages. They offer a great deal of innovative ideas. Best evaluation has been done with pins for the fixation of low loaded osteochondral fractures. When using 2.7 mm Polypin primary mechanical stability of distal radius fractures is comparable with the fixation by 1.8 mm K-wires. A prospective and randomised study with two years follow up, including 183 radial head fractures, showed no significant difference in results and complications in metal and polyactide implants. For this localisation and other comparable indications the implant can be recommended. Despite the more extensive degradable device overall costs can be reduced with the polymer implant. Orientruded polyactide screws showed good clinical results, newetheless resorption was extremely late within 5 to 7 years.

Adolescent↗
PubMed1996

Hip fracture.

Explore the source record for details and available documents.

Femur Head Necrosis↗
PubMed1996

[Segmental displacement by callus distraction in extended tibial defects].

In open tibial fractures with defects over 4 cm, spongiosaplasty is considered to be insufficient. Since 1988 we have tried to apply Ilisarov's ideas of callus distraction in combination with modern external fixation devices and AO/ASIF implants. By August 1995, 15 patients with severe tibial fractures had been treated. The bone defect averaged 7 cm. Thus, more than 1 m of tubular bone was produced. Eleven male and 4 female patients, averaging 21.3 years in age, were given this treatment. The defect was caused by resection of a malignancy in 3 cases and a second- or third-degree open fracture in 12 cases, accompanied by osteomyelitis in 6 cases. Reconstruction required an average of 5.3 operations. The complication rate was 53%, and the median duration of treatment was about 1 year. The final results were excellent or good. Amputation could be avoided in all instances. This treatment is contra indicated if the patient exhibits a lack of compliance. There is a realistic chance of salvaging the limb in cases of severe soft tissue and bone defects. In terms of economical considerations, this treatment is cost effective. Physical integrity and mobility without aid is the important motivation for these patients.

Adolescent↗
PubMed1996

[Partial median sternotomy in resection of metastases of the upper thoracic spine].

A modified method of access to the upper thoracic spine is presented based on a case report. The third and fourth thoracic vertebral bodies can be reached by partial upper sternotomy. This approach takes the local anatomic situation into account, thus avoiding the typical complications of complete sternotomy and reducing the postoperative pain. Closure was done using biodegradable sutures, achieving satisfactory stabilisation and a low rate of complications. In only 4 of 130 cases (3%) did a superficial wound infection occur. There was no case of deep infection, osteomyelitis or dehiscence of the sternum.

Aged↗
PubMed1996

[Roentgen image presentation in the patient's room. Simple equipment for demonstration and storage of roentgen images].

Immediate presentation of the more significant X-ray pictures facilitates planning and supervision of therapy in trauma surgery and orthopedics. If a wire rope is stretched in front of the window X-ray pictures can be clipped onto it, which avoids time-consuming searches. Suspended filing boxes placed in each sickroom make appropriate storage of each patient's X-ray pictures possible. The expenditure for all this amounted to 100 DM for each two-bedded room. Wire ropes and boxes were technically easy to install with a minimum investment of time. The presentation of X-ray pictures considerably increased the patients' understanding of their illness. It was also very rare for X-ray pictures to get mixed up once this system had been instituted.

Equipment Design↗
PubMed1996

New bioresorbable pin for the reduction of small bony fragments: design, mechanical properties and in vitro degradation.

The design, material properties, and in vivo degradation characteristics of a new resorbable pin for the reductions of small bony fragments are described. The Polypin, made of 70:30 poly (L, DL-lactide), had an initial bending strength of 155-163 MPa, as measured by a three-point bending test. Ethylene oxide (EO)- and gamma-sterilization did not substantially affect its initial mechanical properties. The initial molecular weight (Mw) of 523,000 to 600,000, however, decreased 60-75% after gamma-sterilization. Incubation of the EO-sterilized pins in 37 degrees C saline solution produced a complete loss of bending strength at 18 months. An accelerated test at 70 degrees C led to a complete loss of strength after only 96 h. Degradation of the gamma-sterilized pin at 70 degrees C was about 30% faster than that of the EO-sterilized pin. Bending strength and molecular weight were unaffected by storage at room temperature for 46 months. The relatively slow strength loss rate of the Polypin potentially extends the application of resorbable devices to slow-healing fractures. The new pin design allows application of light interfragmentary compression, thus reducing the risk of pin loosening, and an X-ray marker is provided.

Biocompatible Materials↗
PubMed1996

Foreign-body reaction and the course of osteolysis after polyglycolide implants for fracture fixation: experimental study in sheep.

Foreign-body reaction to polyglycolide (PGA) implants has been described in man. Many animal experiments have verified the mechanical properties of fixation devices made from PGA, but a significant foreign-body reaction has not been described. We studied the effect of PGA rods in 12 sheep with standardised osteochondral fractures of the medial femoral condyle fixed with uncoloured, self-reinforced PGA rods (Biofix). Radiographs were taken at intervals ranging from two weeks to two years, and the sheep were killed at intervals ranging from six to 24 months. All knees were examined histologically. Eleven of the 12 fractures healed radiologically and histologically. Moderate to severe osteolysis was seen at four to six weeks with maximum changes at 12 weeks in ten animals. Six knees showed fistula-like connections between the implant site and the joint space. Three developed synovitis, one with inflammatory changes involving the whole cartilage and one with destruction of the medial condyle. Although in our study osteochondral fractures fixed with PGA rods healed reliably, there were frequent, significant foreign-body reactions. Caution is needed when considering the use of PGA fixation devices in vulnerable regions such as the knee.

Animals↗
PubMed1996

[Trauma in the last trimester of pregnancy].

Although accidents during pregnancy are fairly rare, besides endangering the mother, they nearly always mean a vital threat to the fetus: lethality rates are up to 8% for the mother and up to 34% for the fetus. Besides depression of the circulatory system in the mother, coupled with fetal hypoxy, injury to the placenta and uterus is also possible. Moreover, the unborn child may be injured by direct trauma. If the fetus sustains a direct injury, the head of the child is affected in the majority of instances. In addition, the risk of an intrauterine death is very high. If the injured baby survives after a section, permanent damage must be taken into account. Pregnant women who are injured in an accident should quickly be checked by sonography and cardiotocography. If no danger is expected for the child, the usual therapeutic rules that apply for traumatology should be followed. If the mother and child are endangered, a cesarean section must be undertaken along with simultaneous accident-related surgery on the mother. Case reports are presented on three cases in our clinic last year, and the current literature is discussed. All three mothers and newborns survived because of the cooperation between surgeons, gynecologists and pediatricians.

Adult↗
PubMed1996

[Treatment methods for geriatric patients at the Traumatology Clinic at the University of Cologne --retrospective studies].

From 1st January 1988 until 31st December 1994, a total of 123 patients, aged over 80 years (2% of all patients) were treated in our clinic. Forty of the admitted patients showed degenerative alterations whereas 93 patients had had an accident. 77% of the falls at home constituted the most frequent cause resulting in a total of 81 fractures in 64 patients. Most of the fractures were located in the distal radius, the subcapital humerus by femoral shaft and the neck of the femur. Thirty-three patients received conservative treatment whereas ninety patients had to undergo surgery. 40% of the patients were operated on the first day of admittance. Median preoperative time amounted to one day. The perioperative mortality rate was 0.8%. Average time spent in the clinic amounted to 21 days. 74% of the patients could be discharged to their customary habitat. After discharge from the hospital, 25 cases required additional help and care. After more than 3 months following discharge 58% of all patients felt that reintegration into their former social environment had been achieved. In particular, the fractures of the lower extremities ought to be operated early for rapid mobilization. Long time of immobilization due to conservative methods of treatment increases the rate of complications. Reintegration into the normal environment at home and securing the necessary support for the patient after release are significant aspects of treatment in order to make the dusk their life as active, enjoyable and social as possible.

Aged↗
PubMed1995

Internal fixation of the distal radius. A comparative, experimental study.

In a comparative, experimental examination of 60 human cadaver radii, the stability of various, widely used internal fixation procedures of a distal radius fracture loco typico using a dorsal wedge was determined. The use of 2.5-mm Kirschner wires (K-wires) delivered a 10% greater stability than 1.8-mm K-wires. The 2.7-mm polylactide rods achieved a slightly greater stability than 1.8-mm K-wires under accurate pinning conditions. Polylactide rods (35 mm length, 2 mm diameter) and polyglycolide rods (60 mm length, 2 mm diameter) proved to be 20% less solid than 1.8-mm K-wires and almost 45% less than plate fixation. The short polylactide pins, however, did not have enough hold in the proximal cortical bone. The 2.7-mm polylactide rods (60 mm length) complied with the stability prerequisites necessary for comparable substitution for K-wires in distal radius fractures.

Bone Nails↗
PubMed1995

[Harvesting small amounts of autogenous spongiosa with a new set of instruments].

A new set of instruments with a special saw, a guide and a punch has been developed for harvesting of cancellous bone for small grafts. In a cadaver experiment use of the instruments was compared with the conventional open technique. Within half the operation time, nearly the same quantity of cancellous bone could be salvaged. In 29 clinical cases, bone defects resulting from 4 bone cysts, 6 enchondromas, 5 pseudarthroses and 5 fractures were closed with cancellous bone grafts harvested by means of the new instruments. In the case of 9 bone tumors the punches were used to obtain biopsy specimens, and sufficient tissue for the exclusion of malignancy was obtained in all 9. With the new instruments we are able to harvest cancellous bone for small grafts by a minimally invasive method.

Adolescent↗
PubMed1994

[Experience with surgical treatment of ruptures of the symphysis pubis].

Ten patients with symphyseal rupture and dehiscence of more than 10 mm who underwent different surgical procedures were reexamined between 8 and 59 months after surgery. In case of treatment within 3 weeks after the accident (n = 7) banding with completely absorbable Polydioxanon (PDS) cord (n = 4), PDS cord and crossing K-wires (n = 1), PDS-banding and plate-fixation for concomitant pubic fractures (n = 1), and wire banding (n = 1) were performed. In case of delayed operation (9 till 12 weeks after the injury n = 3) autologous bone grafts from the iliac crest were placed into the symphyseal split after removal of fibrous tissue, and double plate fixation (n = 2) respectively plate fixation and wirebanding (n = 1) were performed. There were no intraoperative and only 2 minor postoperative complications. The follow up revealed good and satisfactory results in 9 patients, and failure in one case. These results are better than to be expected from conservative management of this kind of injury. Banding with cord is a noteworthy alternative to wire banding and plate fixation.

Adult↗
PubMed1994

Intramedullary reduction and stabilisation of adult radial neck fractures.

We report the treatment of six adult patients with displaced fractures of the radial neck by intramedullary reduction and stabilisation. Nine months after operation all the patients had good joint function, little or no pain, complete healing and no significant periarticular calcification. This simple semi-closed procedure may help to avoid resection of the radial head in some cases.

Adolescent↗
PubMed1994

[Histologic studies of replacement of the anterior cruciate ligament with PDS-augmented patellar tendon transplants].

The bone-patellar tendon-bone graft is currently the best substitute for the anterior cruciate ligament (ACL). To improve the results we compared a modified Jones procedure with an additional PDS augmentation. In 25 sheep the ACL was reconstructed in the left knee after total resection. The only resection of the ACL was done in all right knees. One year postoperative 21 sheep remained in the experiment and came to evaluation. There were 10 modified Jones procedures and 11 PDS augmentations. In both groups, the central one-third of the patellar tendon was implanted through a femoral and tibial drill hole for reconstruction of the anterior cruciate ligament. The transplants were fixed on both ends with a 1-mm cord of polydioxanon (PDS), a soft preload of 50 N was given with a spring balance and the ends of the cords were fixed with a screw and a washer. In the second group we did an additional augmentation with a doubled cord of 2 mm PDS. Early mobilization and weight-bearing was allowed. Throughout the observation period all animals were labelled for fluorescence microscopy. One year after resection of the ACL without reconstruction there were totally destroyed joints. Histology showed damaged menisci and joint surfaces without any cartilage as a sign of severe arthrosis. The macroscopic aspect of the transplants showed strong ligaments coated totally by a synovial membrane with good vascularization. Only little signs of degeneration were to be seen.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

[Report of the Biodegradable Implants Study Group].

There is a group for the development and testing of biodegradable implants within the German Section of AO/ASIF-International. After in-vitro screening of various polylactide materials and copolymers a L/DL-polylactide 70/30 was selected. In animal experiments it showed long durability over a period of 9 months and expected degradation afterwards. In clinical experience over more than three years the biodegradable pins with x-ray opaque markers (Polypin) applied for fixation of osteochondral lesions yielded good results and no infections. A multicenter clinical study now includes 57 patients. Polypin is the first biodegradable implant of the AO/ASIF-group.

Animals↗