Biomedical subjects

L Rudig

Publications and source records attributed to L Rudig.

At least 19 recordsLinked to original sources

PubMed1998

[Efficacy of ultrasound controlled direct reposition of fragments of the posterior vertebral body facet].

To calculate canal compromise and decrease of midsagittal diameter caused by retropulsion of fragments into the spinal canal we analyzed the pre- and postoperative computed tomographies of 32 patients with unstable thoracolumbar burst fractures treated by USS (universal spine system). Our intention was to examine the efficiency of ultrasound guided repositioning of the dispaced fragments which was performed in all 32 cases. We found a clear postoperative enlargement of canal area (ASP preoperatively 55%, postop. 80%) and midsagittal diameter (MSD preop. 58%, postop. 78%). 10 of 13 patients presented a postoperative improvement of neurological deficit, no neurological deterioration occurred. Fractures with neurological deficit showed more canal compromise (52%) and less midsagittal diameter (MSD compromise 51%) than those without (40% or 39%). There was no correlation between the percentage of spinal canal stenosis and the severity of neurological deficit. Below L 1 the spinal canal is greater than between Th 11 and L 1, so a more important spinal stenosis is tolerated. In case of unstable burst fractures with neurological deficit the ultrasound guided spinal fracture reposition is an effective procedure concerning the necessary improvement of spinal stenosis: an additional ventral approach for the revision of the spinal canal is unneeded. In fractures without neurologic deficit the repositioning of the displaced fragments promises an avoidance of long-term damages such as myelopathia and claudicatio spinalis.

Adolescent↗

PubMed1998

[3D CT of fractures: comparison of volume and surface reconstruction].

PURPOSE: The comparison of volume rendering (VR) and surface rendering (SSD) for demonstrating fractures from spiral-CT data. MATERIALS AND METHODS: Standardized VR and SSD projections were produced from 50 spiral CT scans of 50 consecutive patients with fractures. Appropriate multiplanar reformattings (MPR) were used as the standard. RESULTS: SSD provided sufficient information in 31/50 cases. Results of VR were not significantly different (33/50). VR was superior in demonstrating 6/7 craniofacial fractures and 3/3 calcaneal fractures. SSD was superior for visualizing 2/3 shoulder fractures and 2/2 elbow fractures. CONCLUSION: VR is a flexible technique for the depiction of fractures and the assessment of spongiosa and articular surfaces at one setting. SSD is superior in the delineation of small dislocated fragments.

Calcaneus↗

PubMed1997

[Magnetic resonance tomography examination of thoracolumbar spinal fractures after fixateur interne stabilization].

To analyse the possible injuries of vertebral segments, especially the disc, after unstable thoracolumbar fractures stabilised with AO internal fixator, we performed magnetic resonance imaging (MRI) of the traumatised region after implant removal. There were two aspects of disc degeneration (DD):(1) biochemical changes and (2) structural damage. MRI detects biochemical processes as one aspect of DD that is often small even in the presence of greater structural damage of the nucleus pulposus caused by fracture. None of the patients presented with structural failure of the anulus fibrosus, which is the essential structural component of the vertebral segments with regard to stability. We observed biochemical changes more often in the lower of the two fracture-adjacent discs and alterations of discal shape more often in the upper of the two, whereas loss of height concerned both discs to approximately the same degree. The supporters of upper-disc resection in thoracolumbar fractures justify their procedure among other things with the structural disc damage, such as alteration of shape and loss of height (altogether more frequent in the upper disc). Our observations that a disc with a structurally altered nucleus pulposus can be biochemically intact and can show an intact anulus fibrosus are arguments in favour of disc preservation. With regard to the upper disc, the widespread opinion that complete and regular disc damage requires a resection has to be revised. The question of whether the lower disc should be resected more often because of its greater biochemical changes cannot be answered by the present study alone. Besides the excellent static information in all anatomical structures of the vertebral column available by MRI, a repeat examination in a prone position yields dynamic information on the spinal cord in the case of suspected dorsal adhesions.

Adolescent↗

PubMed1997

[Complications of endoscopic retinaculum dissection].

Reviewing the literature on endoscopic carpal tunnel release (biportal Chow-technique and uniportal Agee-technique), we found 31 different intra- and postoperative complications. Of these, 14 affected nerve structures, four vessel structures, two tendon structures, two bony structures, and nine surrounding tissues. The most common complications were analyzed taking anatomical and pathological variations of the carpal tunnel into consideration. In our own prospective series of 88 endoscopic releases of the carpal tunnel using the Agee technique, we had eleven complications: one patient suffered residual symptoms, five patients experienced transient ulnar neurapraxia, and one patient complained of intense pain in the middle- and ringfinger after the operation. In four cases, intraoperative change of technique from endoscopic to open became necessary, due to poor visualization.

Carpal Tunnel Syndrome↗

PubMed1996

Hypothenar hammer syndrome in sports.

Repetitive blunt trauma or single severe trauma to the hypothenar region may lead to traumatic thrombosis of the distal ulnar artery (hypothenar hammer syndrome, HHS). In the sports-related literature we found and analysed isolated cases attributed to injuries sustained during sporting activities such as baseball, badminton, handball, football, frisbee, softball, karate, weight-lifting and hockey. Further, we report the case of an amateur golf player with ischaemic symptoms of his left hand, where angiography revealed filling defects in the digital arteries associated with a corkscrew-like configuration of the distal ulnar artery. Magnetic resonance imaging (MRI) scan demonstrated, at the level of the hamulus ossis hamati, accessory fibres of m. palmaris brevis forming a sling around the ulnar artery. Treatment by resection of the thrombosed a. ulnaris segment and replacement with an autologous vein graft resulted in complete relief of symptoms. Histological sections revealed partially organized thrombi adherent to the intimal surface with fragmentation of the internal elastic membrane, indicating a traumatic genesis. As the mechanism of injury, we suspected intensive golf playing with the grip style and subsequent motions leading to pressure injury of the hypothenar area and the underlying ulnar artery. Contraction of the anomalous muscle belly may have additionally compressed the artery, slowing down the arterial flow and promoting thrombosis. In most reported cases including our own, it took a relatively long time until the cause of the disease as traumatic was found and accepted. The initial repetitive blunt or single severe trauma initiating the HHS can easily be overlooked or ignored. After intimal damage of a. ulnaris, the beginning of symptoms may be prolonged and mislead one into thinking the cause is a collagen or vasospastic disease.

Adult↗

PubMed1996

[Radiation burden to the hands of surgeons in intramedullary nailing].

During 41 procedures of intramedullary nailing of femoral and tibial fractures the primary surgeon and the first assistant wore ring dosimeters on their dominant index fingers. While the average fluoroscopy time per procedure was 4.6 min the average dose of radiation to the dominant hand of the primary surgeon was 1.27 mSv and 1.19 mSv to the first assistant. The dose limit for the extremities is 500 mSv per year recommended by the International Commission on Radiological Protection. Extrapolation of the average dose of the primary surgeon and first assistant per procedure of 1.23 mSv leads to the result, that the recommended dose limit of 500 mSv would only be exceeded if more than 407 intramedullary nailing procedures are carried out per year. The duration of fluoroscopy-time correlated with the radiation dose of the hands of the surgeons, though it was determined by phantom measurements that the majority of radiation exposure occurred during brief exposures of the hands in the direct X-ray beam on the X-ray tube near side of the patient.

Body Burden↗

PubMed1995

[The "inserted" condylar plate].

Twelve extensive segmental and comminuted fractures of the femur affecting the metaphyseal areas (7 times proximal, 5 times distal) and the diaphysis were treated with extremely long condylar plates (16 to 20 holes). The condylar plates were inserted via a proximal and a distal incision leaving the Musculus vastus lateralis intact at the fracture site in all cases. Following standard preparation of the blade position using the seating chisel, the condylar plate was inserted behind the musculus vastus lateralis with the blade pointing towards the surgeon. The condyles or the trochanteric area were tilted slightly and the plate was turned 180 degrees and driven home. No screws were inserted in the area of the fracture, in particular, lag screws were not used. Ten out of 12 fractures healed without problems, in 2 cases bone grafting was necessary. Three main observations resulted from analysis of the operations and subsequent clinical and radiographical assessments. In the presence of relatively intact soft tissue covering, an astonishingly good reduction of the fragments was achieved after restoration of leg length and extension. In the healing process, callus formed rapidly and provided medial support. The bone structure was found to be more homogeneous than in the case for plate fixation involving several screws at the fracture site around which considerable fluctuations in bone density frequently occur. The application of condylar plates behind the musculus vastus lateralis by only proximal and distal incision for osteosyntheses of extensive multifragmental fractures is a further development of bridge-plating and can be recommended for long fractures.

Bone Plates↗

PubMed1995

[Color-coded duplex ultrasound as a screening method in trauma surgery].

Deep vein thrombosis with consecutive pulmonary embolism is one of the most important complications for trauma patients. At the University Hospital of Mainz, Department of Traumatology, colour duplex ultrasound is used as screening method in trauma patients. Fractures of thoracic and lumbal spinal bones, pelvis, hip and lower extremities, endoprosthesis of hip and knee joints and longer immobilisation are considered as special risk for the genesis of deep vein thrombosis. Out of 326 patients investigated with colour duplex ultrasound, 24 patients suffered from unknown deep vein thrombosis, 8 developing pulmonary embolism. We recommend colour duplex sonography on day 10, after the third week, and after longer immobilisation. Colour duplex sonography provides an easy performable and noninvasive method for screening evaluation of deep vein thrombosis in trauma patients.

Adolescent↗

PubMed1995

[The effect of bone marrow embolization on the choice of procedure in the stabilization of femoral fractures].

Because of an extended venous drainage system, especially in the supracondylar area, a pressure increase in the femoral cavity results in embolization of the contents of the bone marrow cavity. Bone marrow embolization alone is mostly not apparent clinically but together with cofactors it may result in severe pulmonary damage and occasionally even in death. Cofactors are volume deficit, shock, thoracic and polytrauma and preexisting pulmonary disease. In the field of traumatology a pressure increase in the femoral cavity regularly occurs during unavoidable movement of femoral fragments in traction, during reduction, intraoperatively during intramedullary nailing, and in hip replacement. A hematoma acts as a hydraulic transmitter. Early osteosynthesis within 24 h avoids permanent intravasation of moderate amounts of the contents of the bone marrow cavity. Concerning intramedullary nailing, there are considerable differences between reamed and unreamed nailing. Reaming always leads to high-pressure increases in the femoral cavity, resulting in embolization. Therefore, reaming should not be performed if cofactors of manifestation of pulmonary impairment are present. Unreamed nailing results in less intravasation, but is not entirely harmless, as considerable pressure increases occur in unreamed nailing as well. The gap between the nail and the entrance of the distal fragment is the decisive parameter. Not just the smaller intravasation of bone marrow during unreamed nailing is important. After each reaming process, the bone marrow cavity rapidly refills with blood, which is activated concerning coagulation and pressed into the circulation during the following reaming process. Because of superior bone healing, interlocking nailing is the treatment of choice in diaphysial femoral fractures. As far as the differential indications of reaming are concerned, the discussion is not yet closed. However, reaming should undoubtedly be restricted to a few reaming processes. Before unreamed femoral nailing, the width of the bone marrow cavity must be examined exactly. If the width of the bone marrow cavity, the patient's condition and experience of the surgeon allow unreamed nailing, this procedure can be recommended. As the venous drainage system of the tibia is not important compared to the femur, the question of reaming or not in tibial fractures is not influenced by the danger of embolization, but by soft tissue damage and the stability of interlocking bolts. In patients with femoral fractures and co-factors for the manifestation of pulmonary impairment, the choice of osteosynthesis type should take plating in its improved form into consideration, as this preserves the vascularity of the fragments.(ABSTRACT TRUNCATED AT 400 WORDS)

Bone Marrow↗

PubMed1994

[Results of implantation of uncemented porous metal hip prostheses].

72 patients having cementless spongy-metal hip prosthesis were reexamined by clinical and radiological check up two to seven years after implantation (average 43 months). In case of five patients hip prosthesis had to be changed due to loosening (no bony ingrowth n = 2, loosening of acetabular component due to technical faults n = 3). In correlation to clinical results 88% could be considered as excellent or good, 9% acceptable and 3% as inadequate. 10% of the patients complained about thigh pain. The typical radiological bony reactions of the surrounding bone are described. An evaluation of the radiological results can only be done under consideration of the clinical problems involved. In view of the positive results obtained in the recent time the use of spongy-metal hip prosthesis can be recommended for cementless hip joint replacement in case of younger patients. Especially in case of cemented hip joints which have become loose it will be an advantage to use spongy-metal hip prosthesis.

Adult↗

PubMed1994

[2- to 7-year results of cement-free and cemented joint replacement in femoral neck fractures and coxarthrosis].

In 43 patients with cementless and 43 patients with cemented hip prosthesis (S+G hip system) a clinical and radiological follow up was performed 2-7 years after total hip replacement. In average the follow up period was 43 or 48 months. We found good or excellent results in 88% after cementless and 95% after cemented fixation. The results after cementless hip replacement were caused by loosening in the early postoperative period in 3 cases and more frequently thigh pain. In conclusion of our results and the expected later results after 10 years follow up we prefer the cementless fixation in patients under 60 years and cemented fixation in the group over 70 years. Patients between 60 and 70 years seems to benefit from a fixation with an cementless acetabular component and an cemented stem (hybrid prosthesis).

Adult↗

PubMed1993

[Treatment and results of ruptures of the patellar tendon].

Ruptures of the patellar ligament are rather uncommon. In younger individuals they are due to adequate trauma, in older individuals spontaneous ruptures occur after inadequate trauma. We observed eight traumatic (mean = 26.5 years) and eleven spontaneous ruptures (mean = 57.5 years) between 1980 and 1990. There is no alternative to surgical repair of the ruptured or torn-out patellar ligament. Tendon-repair with supportive wire-looping and early functional physiotherapy produces a good functional result. The outcome of patients treated in this manner shows persisting slightly muscular atrophy of minor degree and limited knee mobility with only a little all-day handicap.

Adult↗

PubMed1993

[Therapy of burst ceramic head of a hip prosthesis].

The therapeutical possibilities in case of fracture of a ceramic head ball of a hip prosthesis system are discussed. A seventy year old patient suffered a fracture of a ceramic ball of a cemented hip prosthesis with polyethylene cup, ceramic ball and metal stem without trauma after one year after implantation. During operative revision a marked destruction of the gliding plane of the polyethylene cup by craters and an extreme metallose because of wear of the metal conus far into the bone bed of the acetabulum was found. The reason for the very seldom occurring fracture of the ceramic ball are minimal differences in the ascent grade of the metal conus of the stem and the corresponding connection of the ceramic ball. The broken ceramic ball should be substituted by a metal ball.

Aged↗

PubMed1993

[Detection of primarily unrecognized fractures in severely injured patients by skeletal scintigraphy].

Even in despite of diligent investigation clinical and radiological diagnostics can leave fractures unrecognized in seriously injured patients. Bone-scans of 53 patients revealed 68 additional fractures. In 45% of all cases the initial diagnosis was altered, 19% resulted in therapeutical consequences. Routine diagnostics should be supplemented by a bone-scan if clinical and radiological findings are not in line. A bone-scan can exclude any osseous lesion and can survey the full extent of injuries especially in the disoriented or unconscious patient.

Adolescent↗

PubMed1993

[Fiberoptic intubation in the prone position. Anesthesia in a thoraco-abdominal knife stab wound].

An ambulance was dispatched to a 40-year-old man with a stab wound. On arrival, the emergency physician found the patient lying face down with a large knife protruding from his back between the scapula and spinal column (Fig. 1). The vital signs were stable (blood pressure 120/70 mmHg, heart rate 90 min, respiratory rate 25-30 min, oxygen saturation 94%); the estimated blood loss was 500 ml. Oxygen was administered and two i.v. lines were inserted. After light sedation (diazepam), the patient was transported to the clinic in the face-down position. X-ray films and physical examination showed that the knife, with a length of about 30 cm, had penetrated 15 cm into the thorax; the tip was located at the diaphragm (Fig. 2). Endotracheal intubation for the surgical revision was performed with the patient in the face-down position: after topical anaesthesia of the nasal mucosa (cocaine), a fiberoptic device was introduced. Additional topical anaesthetic (lignocaine) was applied through the biopsy channel onto the mucosa of the larynx and pharynx. After a sufficient waiting period, the endotracheal tube was pushed over the fiberoptic device into the trachea without problems (Fig. 3). During the entire period the patient was awake and breathing spontaneously; no coughing or change of body position occurred. After correct placement of the tube, general anaesthesia was induced. During positioning of the patient in the operating theatre, the knife was unintentionally dislodged and critical bleeding occurred. The situation could be controlled by immediate transfusions and rapid surgical revision, which revealed injuries to the lung, diaphragm, and stomach. The patient recovered without severe complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗

PubMed1993

[Nuclear magnetic tomography in shoulder dislocation].

Sixty-two patients with anterior shoulder dislocations were examined by magnetic resonance imaging (MRI). After a primary dislocation, 30 patients showed 23 (77%) tears of the glenoid labrum, 13 (45%) anterior-inferior separation of the capsula, 24 (83%) Hill-Sachs lesions, 6 fractures of the greater tuberosity and 4 glenoid rim fractures. Thirty-two patients with recurrent shoulder dislocation had 14 (44%) tears and 15 (47%) defects of the glenoid labrum, 16 (50%) anterior-inferior separation of the capsula, 28 (88%) Hill-Sachs lesions and 3 glenoid rim fractures. MRI permits complete non-invasive documentation of glenohumeral instability if joint effusion is present. In the absence of joint effusion, diagnostic accuracy can be improved by application of a contrast medium.

Adolescent↗

PubMed1991

[Significance of shape differences between medial and lateral knee joint menisci for functional change of position].

The attachments of the anterior and posterior horn of the menisci to the tibial plateau are of a most important functional value. At the medial meniscus the circumference is more widely configurated, because of the greater distance between anterior and posterior horns. The areas of sagittal cuts through the menisci slightly differ regarding medial and lateral side. A higher area momentum of inertia of the medial meniscus, related to a vertical axis within the examinated sagittal plane, is found. It derives from a geometrical distribution of partial areas more distant from the axis. The medial meniscus therefore has a higher stiffness against sagittal bending stress. Experiments and theoretical stress simulation prove these results. According to them, the medial meniscus is less mobile in comparison to the lateral. These findings are discussed as a basic geometrical cause for the higher incidence of injuries of the medial meniscus.

Biomechanical Phenomena↗

PubMed1990

[Treatment and results following rupture of the quadriceps tendon].

Ruptures of the quadriceps tendon are rather uncommon and are usually due to minor trauma. From 1971 to 1986 we observed 13 spontaneous ruptures in contrast to a single case due to adequate trauma. The average age of the patients was 64.0 years. There is no alternative to surgical reconstruction of the ruptured or torn out quadriceps tendon. Tendon-repair with supportive wire-looping produces a good functional result. After immobilisation of the knee for five to six weeks intensive physiotherapy is required. The outcome of patients treated in this manner shows persisting slightly muscular atrophy of minor degree and limited knee-mobility with only a little all-day handicap.

Adult↗