[Results after surgical treatment of distal intra-articular humeral fractures].
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Adult↗
Biomedical subjects
L Kinzl
Publications and source records attributed to L Kinzl.
[Do organizational structures and factors influence the outcome of physiotherapy--a questionnaire survey related to whiplash-associated disorders].
BACKGROUND: The effectiveness of physiotherapy in patients with whiplash injuries of the cervical spine is a subject of critical discussion. Besides the inadequate situation with regard to the medical data available and the financial cuts in drug prescription, organizational factors and structures are assumed to be factors that have an influence on the effectiveness of physiotherapy. AIM: The aim of this study was to evaluate data on training, patient population, communication, prescription activity and therapies of physiotherapists. METHODS: In a survey of 213 physiotherapists in the City of Ulm, data were collected with the aid of questionnaires related to "therapy of whiplash-associated disorders". RESULTS: The results show deficits in the theoretical knowledge of physiotherapists, in the exchange of information and in therapy management. The survey further revealed that 22% of the patients decide themselves which therapy they will undergo. One can assume that these factors have a detrimental effect on the effectiveness of conservative therapy. CONCLUSION: An optimization of the organizational structures is thus urgently required and constitutes the only possibility, in the short to medium term, of improving the effectiveness of physiotherapy in patients with whiplash injuries of the cervical spine.
Adult↗
[Incidence of joint-specific risk factors in patients with advanced cox- and gonarthroses in the Ulm Osteoarthrosis Study].
AIM OF STUDY: To determine the prevalence of joint specific risk factors in patients with different patterns of advanced hip and knee osteoarthritis (OA). METHODS: We performed a cross-sectional multicenter study in four orthopaedic hospitals in the southwest of Germany. A detailed medical history (date and nature of trauma, conservative and surgical treatment of congenital or acquired joint disorders known as secondary causes of OA) and radiographic evaluation (sequelae of hip dysplasia, slipped capital femoral epiphysis or other malformations) was obtained in 809 patients with advanced hip (n = 420) or knee (n = 389) osteoarthritis, which required unilateral total joint replacement. According to the presence or absence of joint specific risk factors, patients were classified as having secondary or primary (idiopathic) OA. RESULTS: In 41.7% (25.5%) of patients with hip OA and 33.4% (11.1%) of patients with knee OA some predisposing abnormality of the operated (or contralateral) joint could be observed. In hip OA the underlying pathological conditions were mainly hip dysplasia (25.0% in the operated joint and 14.8% in the non-operated joint) and slipped capital femoral epiphysis (7.1% and 14.8%), while knee OA was most often associated with a history of severe trauma (28.6% and 8.3%) CONCLUSION: While there is a lack of comparable investigations in patients with advanced knee OA, the presented data is somewhat contradictory to earlier reports of the prevalence of identified underlying risk factors in patients with hip OA. The reported differences, however, might be attributed to different methodological approaches and could also resemble recent changes in the multifactorial ethiopathologic concept of OA.
Aged↗
[Fractures of the upper extremity in the elderly].
PROBLEM: The primary goal in treating fractures in elderly persons is safe and rapid restoration of their functional capabilities to secure independence in everyday activities. The intention of this paper is to present an overview of treatment principles useful in this age group. METHODS: We analysed a series of 404 patients above the age of 70 years who underwent surgery for fractures of the arm between 1981 and 1997. RESULTS: Diaphyseal fractures are less frequent in this age group and their treatment does not differ significantly from principles established for younger patients. The majority of fractures of the proximal humerus and the distal radius can be treated by conservative means. Unstable fractures are frequent in the distal humerus and the olecranon requiring operative reduction and osteosynthesis. CONCLUSIONS: Preferred operative techniques in aged persons inflict minimal surgical trauma and have a low rate of complications and secondary interventions. In contrast, anatomical reconstruction has the highest priority in younger individuals.
Aged↗
[Therapy of para-articular hip fractures in the elderly].
UNLABELLED: Fractures of the hip in old patients are life-threatening events. A steady increase of that fracture type is likely in the near future. Surgical therapies and strategies have to consider the special requirements and problems of geriatric patients to achieve better results. They have to be designed together with new concepts of geriatric rehabilitation programmes. MATERIAL AND METHODS: In 1992 148 patients with hip fractures were treated at the department of traumatology, University Ulm. Follow-up parameters were daily activities in life pre- and postoperatively as well as mortality, type of fracture and surgical treatment. RESULTS: There were 79 femur fractures of the collum and 69 fractures of the trochanteric region. Mean age was at 81.2 and 81.9 years respectively (68 f/11 m versus 52 f/13 m). At the time point of accident 84 patients lived at home whereas the remaining stayed at a nursing home. The highest mortality was found in patients living in a nursing home (93%). The overall mortality one year following the trauma was 26%. 50% of the patients had hip prosthetic replacement, the remaining received a gliding screw, 9 patients a proximal femoral nail or lag screws (n = 6). CONCLUSION: Our results demonstrate that hip fractures in geriatric patients have a high mortality, especially in those living in a nursing home. The surgical concepts should aim to reduce that number and to allow the same daily activity of life as preoperatively. The main part in these concepts is an early start of geriatric rehabilitation. There are at least two groups. On the one hand, the active old patient who acquires his fracture during an activity. In this cases the aim must be the full rehabilitation and afterwards returning to normal environment. On the other hand there are the patients living in a nursing home who have the highest risk of injury related death. In these patients the first aim must be prevention of the accident.
Aged↗
Primary repair for posterior cruciate ligament injuries. An eight-year followup of fifty-three patients.
We reviewed 53 of 58 patients who had primary repairs of posterior cruciate ligament injuries between 1981 and 1988. Sixteen patients had isolated posterior cruciate ligament ruptures, 16 had complex injuries with capsular and collateral ligament involvement, and 21 had additional anterior cruciate ligament ruptures. Forty-six patients were treated by transosseous multiple-loop sutures and seven with bony avulsions by screw osteosynthesis. The mean follow-up time was 7.5 years (range, 3 to 12). All patients were examined subjectively (questionnaire) and objectively (clinical examination, KT-1000 arthrometer, functional testing, radiographs, and Cybex II isokinetic strength analysis). The results were graded according to the International Knee Documentation Committee evaluation form and the Lysholm score. The average Lysholm score was 82.4 (range, 40 to 100). Thirty-eight patients returned to their preinjury activities at the same intensity level. The patients' subjective assessments were normal or nearly normal in 35 patients. The posterior drawer test was negative or 1+ in 46 patients. Cybex isokinetic strength analysis revealed a decrease in quadriceps muscle strength of the involved limb by 10.5% (P < 0.01). Our data suggest that primary repair of posterior cruciate ligament ruptures provides good results after 8 years in approximately two thirds of the patients. Distal ligamentous ruptures, lack of athletic activity, and temporary olecranization correlated with poor results. Bony avulsions, midsubstance or proximal ruptures, and athletic activity correlated with good results.
Adolescent↗
Suitability of external fixators for use in the tropics.
External fixation systems proved to decrease the osteomyelitis rate in patients in the tropics compared with internal stabilization. This study was designed to show how external fixators being used for treatment of patients in industrial countries compare with cheap alternatives regarding their suitability for the application in tropical countries. Eleven external fixation systems were compared for stability, cost, weight, variability, handling, and capability of being produced locally. Stiffness, slipping moment, and irreversible deformation were determined in material testing machines. The technically best fixators are expensive and cannot be manufactured locally. The inexpensive constructs lack variability and stability. When cost is not a problem, the Synthes model is recommended. With some restrictions in mechanical stability and variability, the Pfeifer Fixator II and a wooden model offer inexpensive and locally producible alternatives. These results may help to select an external fixation device to meet local needs and possibilities in tropical countries.
Biomechanical Phenomena↗
Fracture of the cuboid in children: case report and review of the literature.
Although fractures of the cuboid are rare, they can be very disabling. The diagnosis is often missed, and overlooked cuboid fractures can lead to severe alterations in foot mechanics and function. We report the case of a displaced compression fracture of the cuboid in an 8-year-old girl after a fall from a height, which we treated by open reduction, bone grafting, and internal fixation. Follow-up examination 2 years after the injury revealed a very good result. Cuboid fractures should be considered in the differential diagnosis of limping toddlers. Children seen with pain, swelling, and inability to bear weight on the lateral aspect of the foot require proper evaluation and treatment.
Accidental Falls↗