Biomedical subjects

M Gabl

Publications and source records attributed to M Gabl.

At least 55 records · Page 3Linked to original sources

PubMed1998

[Post-traumatic ischemia of the talus. Is talus necrosis unavoidable?].

50 patients following talar fractures type Marti 2, 3 and 4 during the years 1972-1993, could be analysed retrospectively. Evaluated factors effecting posttraumatic avascular necrosis of the body of the talus are: type of fracture, age of the patient, additional fracture of the medial malleolus and time of non weight bearing. The Hawkins sign is reliable to show vitality in the body of the talus. We could see vascular impairment in 51% of all Marti 3 fractures and in 100% of all Marti 4 fractures. Patients with a concomitant fracture of the inner malleolus showed positive influence on the blood supply of the talus. In this case the ligamentum deltoideum and the ramus deltoideus of the arteria tibialis posterior remained intact. In addition to this the prognosis was better in young patients. A long period of non weight bearing could not preserve vitality of the talus. Necrosis of the talus did only appear in 34% of the Marti 3 and in 51% of the Marti 4 fractures. This means that early anatomic reconstruction of the talus is necessary. Primary arthrodesis of the ankle joint and talectomie are not up to date.

Adolescent↗

PubMed1998

[Distal, metaphyseal compression fractures of the radius. Results of open reposition, stable defect replacement with cortico-cancellous iliac crest bone and plate osteosynthesis].

Conservative treated distal radius fractures with extended metaphyseal void and missing cortical support resulted in loss of reduction. From 1988 till 1994 117 fractures of the distal radius were treated by open reduction, filling the metaphyseal void with a corticocancellous iliac bone graft and plate fixation. In this retrospective study results after surgical reconstruction were evaluated radiologically and clinically and were discussed to conservative treatment. 30 patients suffering from extraarticular metaphyseal distal radius fracture were evaluated after a mean of 42 months (minimum 20, maximum 68 months) after surgery. Ulnar variance was restored in 70% to the uninvolved side. Ulnar minus variance up to 2 mm persisted in 30%. Radial joint angles were restored to normal in 53%. In 40% of the patients a loss of reduction up to 10 degrees and in 7% up to 25 degrees occured. Active range of motion in the sagittal and frontal plane was equivalent to the non involved side in 30%. 70% of the patients showed reduced range of motion up to 20%. Rotation was unlimited in 77%, reduced up to 10% in 23%. Subjective results were excellent in 90%, good in 10%. Compared to conservative therapie, surgery showed superior results.

Adolescent↗

PubMed1998

The interosseous membrane and its influence on the distal radioulnar joint. An anatomical investigation of the distal tract.

From the interosseous membrane of the forearm a tract extends to the dorsal capsule of the distal radioulnar joint. The structure and function of this tract have been investigated. The tract originates from the radius 22 mm proximal to the distal dorsal corner of the sigmoid notch. Central fibres are attached there with fibrous cartilage and superficial bundles mix with the periosteum. The tract is 8 mm wide, 31 mm long and 1 mm thick. Distally it inserts at the capsule of the distal radioulnar joint between the tendon sheaths of extensor digiti minimi and extensor carpi ulnaris. Deep fibres insert directly at the triangular fibrocartilage. The tract of the interosseous membrane is taut in pronation and loose in supination. It strengthens the dorsal capsule of the distal radioulnar joint. During pronation the tract protects the ulnar head in a sling. Its attachment at the triangular fibrocartilage influences the distal radioulnar joint. Its insertion at the triangular fibrocartilage and the support of the weakest part of the dorsal capsule are of interest.

Aged↗

PubMed1997

[Wound margin necroses after open calcaneal reconstruction. Anatomical considerations of surgical approach].

Skin and soft tissue necrosis of the heel are the main problems following open reposition and fixation of calcaneal fractures. In order to demonstrate how the classic approaches harm the supplying vessels, the classic medial, lateral, enlarged lateral and bilateral approaches have been simulated in ten lower limbs prepared by arterial latex injection. Bases on anatomic literature and on these findings, we have proposed two modified approaches that minimize damage to the vessels of the adjacent soft tissues yet allow exact reposition of the fractures.

Arteries↗

PubMed1997

Flexor tenosynovitis in the hand caused by Mycobacterium malmoense: a case report.

This report analyzes a rare case of flexor tenosynovitis caused by Mycobacterium malmoense. A synovectomy was carried out on the index finger (no other finger was afflicted) of a 66-year-old farmer, followed by antibiotic therapy with ethambutol, rifampin, and clarithromycin. Because of strong side effects, the treatment with ethambutol and rifampicin had to be discontinued after 4 months. There was no recurrence after 14 months, and the patient's finger had a full range of motion.

Aged↗

PubMed1996

[Perilunate dislocation and dislocation fractures--results of surgical management].

We report 22 patients who sustained a perilunate dislocation (PD) with or without a fracture of the scaphoid. The carpal ligaments were explored and reattached in all cases. The fractured scaphoid in perilunate fracture dislocations (PFD) was stabilised by a Herbert screw in 13 cases and in one case with a Matti-Russe bone graft. After an average of 5 years the clinical score of Green and O'Brien showed good results for both PD and PFD. Patients with PFD had less pain and better grip than the patients with PD. The sagittal range of motion (average between 70 degrees and 99 degrees) and the subjective limitation in sports and work were equal for PD and PFD. The only open injury (PD) had the worst clinical result. All patients with PD showed a carpal instability dissociative of the proximal row (CID) and an arthrosis of the radiocarpal joint. In the patients with PFD a CID could be seen in 78% and an arthrosis in 93%. A carpal collapse occurred in 75% of cases after PD and in 29% after PFD. In 57% of cases the PFD was accompanied by a disruption of the SL ligament. The anatomical reconstruction of the scaphoid is essential for good carpal alignment. The stable fixation of bony avulsions showed good results. A CID could not be avoided in any of our patients with PD.

Adolescent↗

PubMed1996

[Long-term outcome of conservative or surgical therapy of anterior cruciate ligament rupture].

The treatment of anterior cruciate ligament (ACL) rupture continues to be a controversial subject. This study was undertaken to compare long-term results of different therapy regimens A total of 52 patients (mean age: 34.7 +/- 3.2 years) who underwent ACL reconstruction using the central one third of the patellar tendon and 32 patients (mean age: 38.3 +/- 5.2 years) treated conservatively were evaluated 5-7 years clinically, radiologically and with respect to their sports activities. In all, 25% of the patients operated on subjectively rated their knees as "excellent", 40.4% as "very good", 22.2% "good", 12.5% "fair" and 0% as "poor". The ratings for the conservatively treated group were: 12.9%, 19.4%, 29%, 25.8% and 12.5%, respectively. The results of the OAK score were significantly better for the surgically treated group (87.5 +/- 7.1 points compared with 77.1 +/- 13.4). An increasing number of degenerative changes were found on radiographs in both groups at follow-up as compared with their pre-injury status.

Adult↗

PubMed1996

The role of dynamic magnetic resonance imaging in the detection of lesions of the ulnocarpal complex.

A prospective study of 32 patients was carried out to investigate the significance of dynamic magnetic resonance imaging (MRI) in diagnosis of triangular fibrocartilage (TFC) lesions. Tears of the TFC can be diagnosed well by means of static MRI and arthroscopy. Dynamic MRI examination has an advantage in evaluating the stability of the TFC and ulnocarpal impingement. By means of dynamic MRI it was possible to make a preoperative diagnosis of an ulnocarpal impingement in five patients, a diagnosis which was confirmed through arthroscopy in all cases. In three further patients, dynamic MRI showed ulnocarpal impingement caused by instability of the ulnar attachment of the TFC. This kind of impingement could not be ascertained arthroscopically. Dynamic MRI extends the possibilities of evaluating obscure ulnar wrist pain. Its significance lies in the non-invasive examination of ulnocarpal impingement as well as the evaluation of TFC stability.

Adolescent↗

PubMed1996

[Functional treatment of the interphalangeal joints in palmar ligament rupture].

Palmar plate injuries of the interphalangeal joints are very common, yet they require careful treatment until full functional recovery is attained. This paper presents the results of follow-up examinations of 76 patients who underwent early functional treatment with a special dynamic splint. All had sustained an injury of the palmar plate of the PIP-joint (Type 1 or 2 according to Hintringer and Leixnering). After a velcro strip is released, the splint enables daily active exercise of the PIP joint with the joint being protected laterally and protected against hyperextension. This splint was worn for four weeks. After removal of the splint, 71% of all patients indicated that they did not have any problems, while 26% achieved the same mobility as the unaffected joint of the other hand after two more weeks of dynamic splinting. In only one case motion was inhibited for several further weeks.

Exercise Therapy↗

PubMed1996

[Rupture or stress injury of the flexor tendon pulleys? Early diagnosis with MRI].

Eighteen extreme rock climbers underwent primary clinical and MRI examination because of recent closed injuries to the flexor tendon pulleys. Follow-ups were after approximately 36 months on the average. The recent injuries, which are difficult to diagnose clinically, could be ascertained by means of MRI: This type of injury seems to occur more frequently than is currently diagnosed. Eight patients with overuse syndrome and eight patients with a short pulley rupture were treated conservatively. In two patients with long pulley rupture, the pulleys were reconstructed by means of a tendon graft using Kleinert's technique. Clinically manifest bowstringing or flexion contracture after treatment could not be ascertained on any one of the patients. All except for one showed an almost normal range of motion. By means of control MRI it was, however, possible to ascertain minor bowstringing and scars in most patients. Clinically, this partial instability manifested by lasting swelling. What was most disturbing, however, was reduced strength and the subjective feeling of insecurity during climbing.

Adolescent↗

PubMed1994

[Pediatric pelvic fractures].

From 1977 through 1992 a total of 25 children (age 4 months to 14 years) were hospitalized for pelvic fractures. Clinical outcome and X-ray evaluation had been recorded and were retrieved for 21 children. In 3 patients pelvic fractures required surgery. All pelvic fractures healed uneventfully whether treated by surgery or conservatively. Concomitant injuries, treatment, and types of pelvic fracture are discussed.

Adolescent↗

PubMed1994

[Diagnosis of the ulnocarpal complex in MRI cineradiography].

73 patients with persistent ulnar wrist pain of undetermined origin were examined by Magnetic Resonance Imaging (MRI). A series of 15 coronal slices was acquired using a T2* weighted gradient echo sequence. With repetitive measurement of those three slices that showed the triangular fibrocartilage complex (TFCC) best, the carpus was imaged 12 times during radial-ulnar deviation in increments of five degrees. The single images were combined according to their slice positions and continuously displayed on an image workstation, allowing for kinematic evaluation. Three different types of impingement of the TFCC were identified.

Adolescent↗

PubMed1993

[Destabilization of the discus articularis with rupture of the ulnar styloid apex in distal radius fracture. Diagnosis with dynamic MR].

An avulsion of the ulnar styloid apex led--because of a simultaneous rupture of the ulnar collateral ligament and a rupture of the disc's insertion in the fovea ulnaris--to a displacement of the triangular fibrocartilage. During movements in the frontal plane, the latter underwent a deformation, was displaced, compressed and blocked ulnar abduction. This pathology and the ulnar impingement could be observed in a "MRI-movie".

Adult↗

PubMed1992

[Isolated injuries of the pulley of the finger flexor tendon sheath--injuries in extreme climbing sports].

Injuries of pulleys are quite common in mountain climbing. The clinically diagnosed rupture of a pulley can now be verified by MRI. Partial ruptures, which in MRI always showed as scars, can frequently lead to intrinsic bow-stringing. The injuries were primarily treated non-surgically. With regard to chronic, recurring cases or large ruptures, however, annular ligament plastics have to be considered. As a prophylaxis we recommend special training exercises for climbers on wide ledges with changing exertion patterns and a tape-bandage for the fingers. During climbing, the PIP-joint should best not be strained in an obtuse angle. Warming-up and stretching exercises before climbing are absolutely necessary.

Athletic Injuries↗

PubMed1992

[Dorsal compression fractures of the distal radius metaphysis. Long-term follow-up with conservative therapy].

Conservatively treated compressed fractures of the distal radius dorsal metaphysis healed despite primarily good reduction and consequent treatment with a decrease in dorsal length. The amount of this decline depends on the primary loss of dorsal length. If the fracture showed a loss of dorsal length at the time of the accident of up to 2 mm, the long-term results were almost anatomical. If there was primarily a larger loss of dorsal length, a decline of the distal fragment into the dorsal cave resulted. Most of the dorsal length regained after reduction was lost when the cast was removed. The long-term follow-up examinations were made after about 9 years.

Adolescent↗

PubMed1992

[Plate osteosynthesis of the radius. Own implant and technique].

In 1989 and 1990, 46 acute distal radius fractures with die-punch compression cavities underwent open reduction and internal fixation using a new compression plate and surgical technique. In 34 of these patients, functional and radiological results after plate removal were studied. Surgical exposure was palmar or dorsal, or combined palmar with a supplementary dorsal incision, depending on the location of the compression cavity and the extent of fracture dislocation. A cortico-cancellous graft from the iliac crest was fitted into the compression cavity, thus supporting the reduced joint surface against the radius shaft. Superior maintenance of the reduction was achieved using cortico-cancellous instead of simple cancellous graft. A new titanius radius reconstruction plate was used for internal fixation. This two-fold support of the fracture allowed for earlier wrist mobilization.

Adolescent↗

PubMed1991

[Snowboarding injuries].

This retrospective study includes 59 people treated at our trauma centre for snowboard accidents that happened in the 1989 winter season. 22 People were severely injured. 2 people died due to a polytrauma. One fracture of the cervical vertebrate column was followed by complete hemiplegia. Reasons for these accidents were a lack of knowledge how to behave outside the marked alpine regions, as well as lack of technical equipment and theoretical education.

Adolescent↗

PubMed1990

[Closed tendon injuries of the hand].

Cases of subcutaneous tendon ruptures of the hand were compiled over a period of 10 years; the lesions were all traumatic rather than due to degenerative illness. The 914 injuries fall into two categories: 867 extensor and 47 flexor tendon ruptures. The localisation of the lesions is most often distal. The extensor tendon lesion is accompanied more often by a ruptured bony fragment; the distal flexor tendon is mostly torn-off bony fragment. The extensor tendon ruptures can be subdivided as follows: distal injuries of the extensor aponeurosis in the DIP joint (751 cases), IP joint (31), tractus intermedius (27), ext. carpi radialis longus (5) and brevis (1), ext. carpi ulnaris (6); proximal ruptures of the ext. pollicis longus (42), ext. digitorum communis II and indicis (1 each) and ext. carpi radialis longus and brevis (1 each). The flexor tendon lesions are as follows: distal injuries to flex. digitorum profundus (32 cases), flex. pollicis longus (9), and the opponens pollicis, which is classified under this heading (2). Proximal lesions to flex. pollicis longus (2) and flex. digitorum profundus and superficialis (1 each).

Hand Injuries↗