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Biomedical subjects

M Hessmann

Publications and source records attributed to M Hessmann.

At least 19 recordsLinked to original sources
PubMed2006

[The cloverleaf plate for osteosythesis of humeral head fractures. Definition of the current position].

In this prospective study we evaluated the functional and radiological results obtained in 62 patients who had been treated for fracture of the humeral head by internal fixation with a cloverleaf plate. They were examined postoperatively, after 14 weeks and after an average follow-up of 75 weeks. Nine patients (14.5%) had dislocated 2-part fractures, 36 had 3-part fractures (58%; additional dislocations of the greater or lesser tubercle), 13 patients (21%) had 4-part fractures and 4 (5.6%) had luxation fractures of the humeral head. Early functional physiotherapy was started on the third day after surgery. The complications observed were: subcutaneous infection (2 cases; 3.2%), haematoma (2 cases; 3.2%), temporal paraesthesia of the axillary nerve (1 case; 1.6%). Only 4 (6.5%) patients suffered from necrosis of the humeral head (partial in 3, total in 1); in 2 cases (3.2%) we switched to a different procedure; in both these patients a humeral head prosthesis was implanted; in both these cases the clinical result was poor because of progressive varus dislocation. To improve mobility we performed arthrolysis in 8 cases (12.9%) and acromioplasty in 10 (16.1%), in addition to removing the plates after fracture consolidation confirmed by X-ray examination. In the present study those of our patients who had been treated with open reduction and internal fixation with a cloverleaf plate achieved average Neer scores of 77+/-13 and average Constant scores of 72.4+/-18, and the rates of complications or revisions were low. "Good" or "very good" results were obtained according to the Constant score in 59% of the treated patients. Even patients with complex 4-part fractures had average Constant scores of 72.7 points ("good"). The accuracy of the refixation of the greater tubercle, sufficiently low fixation of the cloverleaf plate and avoidance of varus position when the humeral head was repositioned were significant parameters influencing the functional outcome in our patients.

Adult↗
PubMed2004

[Monteggia injuries in adults: Critical analysis of injury pattern, management, and results].

BACKGROUND: Complications, revision surgery, and unsatisfactory functional results after operative management of Monteggia fractures are frequent. Moreover, hardly any studies exist that deal exclusively with the therapeutic concept for adults. PATIENTS AND METHODS: Between January 1988 and December 2001, 68 patients with Monteggia fractures or equivalent injury were surgically treated. A total of 49 patients could be followed up after 83 months (25-176). Fracture type was assessed according to Bado's classification, functional results according to the Mayo elbow performance score, and the extent of osteoarthritis based on the criteria of Baird and Johnson. RESULTS: The median age of the follow-up patients was 38 years (18-89, 31 men, 18 women). Corresponding to Bado's classification the following injuries were observed: 18 cases of type 1, 22 of type 2, 5 of type 3, and 4 cases of type 4. After surgical intervention, 14 patients achieved "very good", 21 "good", 9 "satisfactory", and 5 "poor" results. Of the 14 patients with either "satisfactory" or "poor" results, 9 manifested a type 2 injury. Complications requiring revision surgery occurred in 14 patients and complications not requiring revision in another 14. Severe osteoarthritic changes in the humeral or radioulnar joint were observed in 4 cases. CONCLUSIONS: Monteggia fractures in adults are fraught with complications despite good functional results in the majority of cases. The patient should be made aware early on of the risk of residual functional deficits and the need for further surgical intervention.

Adolescent↗
PubMed1999

Plate fixation of proximal humeral fractures with indirect reduction: surgical technique and results utilizing three shoulder scores.

To determine the outcome after indirect reduction and buttress plate fixation of displaced and unstable proximal humeral fractures, we retrospectively evaluated 98 patients, an average of 34 months (range 24-72 months) after fracture fixation. The patients were reviewed and results were evaluated clinically according to the Neer, UCLA and Constant score. A radiographic evaluation of fracture healing, avascular necrosis and degenerative changes of the shoulder joint was performed in all patients. Any complications of treatment were assessed. Results were, according to the UCLA-rating system, good to excellent in 76% of fractures. According to the Constant-score and the Neer score, good to excellent results were obtained in 69 and 59% of fractures, respectively. Poor results were mainly due to secondary malunion. The avascular necrosis rate was 4%. Non-union was seen in one case. Secondary varus deformity and retroversion of the humeral head as a result of lack of rotational and angular stability of the plate developed in twelve (12%) and eight (8%) cases, respectively. Plate fixation is an adequate procedure for treating unstable and displaced two- to four-part fractures of the proximal humerus, enabling early functional after-treatment. The incidence of avascular necrosis and nonunion are low, when fracture reduction is performed indirectly. Poor rotational and angular instability can lead to a loss of reduction.

Adult↗
PubMed1998

[Prospective randomized pilot study of ambulatory prevention of thromboembolism. 2 times 500 mg aspirin (ASS) vs. clivarin 1750 (NMH)].

From March 1994 to March 1996, 287 patients, presenting with lower extremity injuries, who required immobilizing bandages or casts, where included in a prospective, randomized study. These patients received either low-molecular heparin or acetylsalicylic acid for thrombosis prophylaxis. In all patients a clinical examination and a colour-coded duplex sonography were performed after removal of the cast for detection of lower extremity venous thrombosis. A plebography was performed when thrombosis was suspected. A subcutaneous injection of divarin 1750 was given once daily in 143 patients. Thrombosis prophylaxis with Aspirin 2 x 500 mg administered orally was performed in 144 patients. Deep vein thrombosis occurred in 9 patients (6.3%) with clivarin prophylaxis and in 7 patients (4.8%) treated with Aspirin. In both groups, no clinically significant side effects of the medications were observed.

Adult↗
PubMed1998

[Callus distraction of femur and tibia. Experiences with the mono-fixateur--indications for procedural changes].

In a 4-year period, 18 patients underwent callus distraction of the femur or tibia with the use of a unilateral external fixator. Twelve patients had post-traumatic bone loss resulting from complex lower-limb fractures. The bony defect was located in the tibia in 11 cases and in the femur in one case. All patients had major associated soft-tissue lesions. The length of the bony defect averaged 6.25 cm. Eight fractures were infected at the beginning of treatment. Six other patients underwent callus distraction for reasons of limb shortening. Five femora and one tibia were lengthened. The average increase in length was 6.5 cm. There were no fixator-related complications during distraction. The rate for the lengthening and consolidation phase was 49 days for 1 cm of length. Complications consisted of angulatory deformities in 6 cases, infections in four cases, fractures at the docking site in four cases and a fracture of the callotasis in one case. Nine patients underwent reosteosynthesis: planned secondary nailing after callus distraction was carried out in six patients. Three patients underwent plating at the docking site. The follow-up examination after bone transport showed a good-to-excellent outcome in 7 out of 11 patients. The outcome was satisfactory in 4 cases. Results after limb lengthening were good to excellent in all cases. The unilateral external fixator is, in our opinion, a convenient stabilization device and permits appropriate bone transportation for distraction osteogenesis. Alignment control during distraction, however, was difficult to manage in some cases. At the time of docking, reosteosynthesis by intramedullary nailing represents a viable alternative for further external fixation if the limb is free of infection.

Adolescent↗
PubMed1998

Operative treatment of displaced proximal humeral fractures: two-year results in 99 cases.

The operative treatment of comminuted and displaced fractures of the proximal humerus has been evolving in recent years. Classical open reduction and internal fixation techniques have an increased risk of avascular necrosis. Minimal osteosynthesis procedures often result in a suboptimal fracture reduction and require postoperative immobilization of the arm in some cases. This study reviewed ninety-nine out of 142 patients (70%), an average of 30 months (range 12 to 72 months) after indirect reduction and internal fixation of two-, three- or four-part fractures of the proximal humerus. The surgical procedure includes indirect fracture reduction with no manipulation of the different fracture fragments and subsequent buttress-plate fixation, using a limited deltopectoral approach. Mean age of patients was 63 years (range 17 to 85 years). Twenty percent of patients had associated lesions. Five patients presented with fracture-dislocations. Results were, according to the UCLA- and the Constant-rating system good to excellent in 76 and 69% of cases. Twelve patients had a poor functional outcome. The indirect reduction technique reduces the opening of the fracture site to minimum and thereby limits the risk of iatrogenic damage to local vascularity and the rotator cuff. Complete and partial humeral head necrosis developed in 3% and 1% of cases respectively. Non-union occurred in one case. Plate fixation is an adequate procedure for treating unstable and displaced two- to four-part fractures of the proximal humerus. The incidence of avascular necrosis and non-union are low, when fracture reduction is performed indirectly. Plate fixation enables an early functional treatment, with no need for postoperative immobilization.

Adolescent↗
PubMed1997

[Therapy and outcome of lateral clavicular fractures].

Fractures of the distal third of the clavicle tend to develop delayed union or nonunion when treated conservatively. Correct diagnosis of fracture instability and/or associated lesions of the ligamentous structures of the acromioclavicular joint is mandatory for adequate fracture treatment. When classical radiographs fail to demonstrate instability, stress roentgenographs of both shoulders are indicated. From 1985 to 1994, 66 adult patients with a fracture of the distal clavicle were treated at our institution. Fracture classification was performed according to Jäger/Breitner. Fractures were unstable in 36 cases (54.5%). An associated lesion of the acromioclavicular joint was present in 8 patients presenting with an unstable fracture. Fracture instability was due to an associated fracture of the coracoid process in two cases. Stable fractures were treated conservatively. Thirty-three unstable fractures were treated surgically. Plate fixation was performed when at least three screws could be placed in the distal fragment. When the distal fragment was small or associated with acromioclavicular joint involvement, it was stabilized by PDS banding of the clavicle to the coracoid process and reconstruction of the ligaments. Results were evaluated retrospectively by questionnaire, clinically and by radiological examination. Fifty patients (76%) were reexamined. The outcome was good or excellent in 96% of unstable fractures that had been treated surgically. Results after conservative treatment of unstable fractures (n = 3) were poor. Conservative treatment of stable fractures resulted in all cases in a good-to-excellent result. For fractures of the distal clavicle, good results can be achieved when the instability is recognized and adequately treated. The association of a distal clavicular fracture and an acromioclavicular ligament disruption should be added as a separate subtype in the existing classification of distal clavicular fractures. PDS banding is a valuable alternative for fractures with small peripheral fragment or associated acromioclavicular disruption.

Acromioclavicular Joint↗
PubMed1997

[Results of reconstruction of acromioclavicular joint rupture with PDS implants].

From 1986 to 1994, we treated 79 patients with acute acromioclavicular separations by surgical reconstruction. According to the classification of Rockwood and Matsen. 65 patients had type III lesions, 1 patients had a type IV lesion and 13 patients had type V lesions. Both the coracoclavicular ligaments and the ligaments of the acromioclavicular joint were reconstructed. An additional ligamentous augmentation was performed using completely resorbable 5- and 10-mm polydioxanone-sulphate bands. Fifty-five patients (70%) were reexamined 1-7.5 years after surgery (mean 28 months). The results were good to excellent in 50 cases (90%). Fifty-two patients (93%) achieved a range of motion with an abduction deficit of less than 20 degrees. Calcifications in the area of the coracoclavicular ligaments did not affect the final range of motion. Early complications consisted of a subcutaneous infection, one deep infection, and one reconstruction failure. Late complications consisted of a redislocation in 2 patients and symptomatic post-traumatic arthritis of the joint in 3 cases. Augmenting the reconstruction with polydioxyanone-sulphate bands allowed early functional post-operative treatment. With this procedure, patients do not require removal of the implant, and complications from breakage or migration of metal implants are avoided.

Acromioclavicular Joint↗
PubMed1996

[Impalement injury of the colon, iliac vein and sacrum--a rare combination in penetrating abdominal trauma. A case report].

We report on the treatment of a patient who sustained a penetrating abdominal wound with injury of the left common iliac vein, the sigmoid colon and the sacrum in a motorbike accident. The left iliac vein injury was treated using a Gore-Tex vein patch and an A-V fistula. The colon was restored after an intraoperative washout. The punched fragment of the sacrum was removed. An additional fracture of the proximal left humerus was managed with an osteosynthesis in a second operation. The principles of management of combined colon and vascular injuries are discussed and a short review of the literature is given.

Abdominal Injuries↗
PubMed1996

Treatment of unstable distal clavicular fractures with and without lesions of the acromioclavicular joint.

A series of 39 unstable fractures of the distal one-third of the clavicle is presented. As results after non-operative treatment of these fractures are poor, surgical therapy is indicated. In fractures with a small peripheral fragment or with an associated separation of the acromioclavicular joint, PDS-banding is a valuable technique for stabilization. According to the classification of Neer and Jäger/Breitner, a clear therapeutic strategy for lateral clavicular fractures can be defined. Unstable clavicular fractures with associated acromioclavicular ligament disruption should however be considered as a separate subtype in the existing classifications.

Acromioclavicular Joint↗
PubMed1996

Knee arthrodesis with a unilateral external fixator.

The operative fusion of the knee joint remains a valuable technique in posttraumatic and infectious destruction of the knee. External fixation is the technique of choice. Due to the benefits of the monofixator in regard to stability, limited damage of soft tissues and high patient comfort, arthrodesis of the knee joint using an anteriorly placed unilateral external fixator is the procedure routinely used at our institution. From 1985 to 1994, 19 knee arthrodesis procedures were performed with a monofixator. Indications for operative fusion of the knee were an infectious destruction of the joint following osteosynthesis (tibial plateau) in 12 cases, posttraumatic arthrosis of the knee joint with chronic infection in 4 cases, flexion ankylosis of the knee in 1 patient, and destructive osteoarthritis of the knee complicated by an empyema in one case. In one patient, a rearthrodesis was performed for a non-union, following an arthrodesis attempt for infected knee arthroplasty. In all cases, stable fusion of the knee joint in a correct position with complete eradication of infection was obtained. Mean fixation time was 22 weeks. The fixator did not need to be removed prematurely.

Adult↗
PubMed1996

[Proximal humerus fracture in advanced age].

Functional results after plate osteosynthesis of unstable and displaced proximal humeral fractures, occurring in elderly patients, are good to excellent in 70% of patients, when surgery is performed according to the no-touch-technique. The incidence of aseptic necrosis of the humeral head and non-union are, in comparison with other internal fixation techniques, low. In four-part fractures and fracture-dislocations, primary arthroplasty remains the treatment of choice.

Aged↗
PubMed1995

Surgical treatment of thoracic aneurysm: a 5-year experience.

The surgical results of 77 patients with an aneurysm of the thoracic or thoracoabdominal aorta who were surgically treated during a 5-year period were retrospectively evaluated. Eighty-four operations were performed. The aneurysm was located on the ascending aorta in 20 patients, on the arch in nine, and on the arch and ascending aorta in eight. Sixteen aneurysms involved the descending thoracic aorta and 27 were thoracoabdominal. Associated surgery was performed in 12 patients. Deep hypothermia and circulatory arrest were employed in 30 patients. Partial cardiopulmonary bypass was used in 15 patients. Mortality was significantly higher if operation was performed under emergency conditions: the early mortality rate was 11.7%. Aggressive surgical management of untreated aneurysm is justified, as rupture of such lesions is the most common cause of death and associated mortality is high, with a 5-year survival rate of less than 20%.

Adult↗
PubMed1995

[Treatment and outcome of supracondylar humeral fractures in childhood].

In an 8-year period, from 1985 to 1992, 89 children presenting with a supracondylar humeral fracture were treated at the Department for Traumatology, Philipps-University, Marburg. All dislocated fractures (n = 48) were treated surgically. The majority (n = 34) of dislocated fractures were reduced open by a radial and an ulnar approach and subsequently stabilized using crosswise introduced K-wires. All fractures were differentiated retrospectively according to the degree of dislocation, the presence of associated injuries, the type of treatment chosen, and the function outcome. Fifty-two patients were reexamined. Clinically relevant varus deformities (4% of cases) and impaired elbow function were observed only in cases where anatomic fracture reduction or fracture fixation was not obtained. Critical analysis of our results and the literature led us to the development of a new, treatment-oriented classification of supracondylar humeral fractures in children. We consider fractures that are dislocated less than 20 degrees, and where dislocation exists only in a saggital plane to be type A fractures. These fractures can be treated conservatively. Type B fractures are fractures that are dislocated more than 20 degrees only in the saggital plane, but with remaining ventral or dorsal cortical bony contact between the fragments. In these fractures, we perform closed fracture reduction and K-wire stabilization. Type C fractures are fractures with rotational deformity, fractures dislocated in a frontal plane and fractures dislocated in a saggital plane with loss of cortical bony contact between proximal and distal fragments. Type C fractures should be reduced open by both a radial and an ulnar approach and subsequently stabilized using K-wires, introduced crosswise.

Adolescent↗
PubMed1994

Use of the unilateral external fixator (monofixator) in fracture treatment: experience in 50 fractures.

From 1988 to 1992, a total of 50 fractures with associated soft tissue lesions were treated with a unilateral external fixator (monofixator). The location of the fracture was the tibia in 39 cases, the pelvis in 5 cases, the femur in 4 cases, and the ankle and the humerus in 1 patient each. There were 22 open fractures (56%). Unproblematic healing with the monofixator was achieved in 69.2% of tibial fractures after a mean healing time of 18.2 weeks. Axial dynamic compression was performed in 18 tibial fractures. Planned reosteosynthesis was performed in 8 tibial fractures (20%). No late problems were seen after secondary internal osteosynthesis. Complications with the monofixator in tibial fracture treatment were refracture in 3 patients, pin track infection in 3 patients and hypertrophic pseudarthrosis in 1 patient. The monofixator provides safe and stable fixation in lower limb fractures with severe associated soft tissue trauma. In unstable pelvic and femoral fractures, satisfactory reduction and stabilisation can be achieved, mostly lasting until definitive osteosynthesis is possible.

Adolescent↗
PubMedDate not supplied

Bilateral ureteral obstruction and renal failure caused by massive retroperitoneal hematoma: is there a pelvic compartment syndrome analogous to abdominal compartment syndrome?

OBJECTIVES: To describe an intrapelvic compartment syndrome analogous to abdominal compartment syndrome and to characterize its diagnosis and treatment. DESIGN: Retrospective analysis. SETTING: Level I trauma center. PATIENTS: Three patients with pelvic ring or acetabular fractures presented with bilateral ureteral obstruction, renal organ failure, and anuria due to direct compression of both ureters in the true pelvis by a massive retroperitoneal hematoma. INTERVENTION: Surgical therapy consisted of fracture stabilization, decompression of the retroperitoneal space, and evacuation of the hematoma. Persistent isolated bleeding points were either embolized preoperatively or ligated. RESULTS: After decompression, all three patients promptly recovered their renal organ function. CONCLUSION: An intrapelvic compartment syndrome can be defined as bilateral ureteral obstruction and renal failure caused by a massive intrapelvic hematoma with increased retroperitoneal pressure. Diagnostic differentiation of anuria in patients with pelvic ring or acetabular fractures must include intrapelvic compartment syndrome. Early diagnosis and treatment are mandatory.

Acetabulum↗