Biomedical subjects

M Hessmann

Publications and source records attributed to M Hessmann.

26 records · Page 2Linked to original sources

PubMedDate not supplied

Acromioclavicular reconstruction augmented with polydioxanonsulphate bands. Surgical technique and results.

During a 5.5-year period, we treated 64 patients with acute acromioclavicular separations by surgical reconstruction. According to the classification of Rockwood and Matsen, 54 patients had type III lesions, 1 patient had a type IV lesion, and 9 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 polydioxanonsulphate bands. Forty-five patients (70%) were re-examined at 2 to 7.5 years after surgery (mean, 32 months). The results were good or excellent in 40 cases (89%). Forty-one patients (92%) achieved a range of motion with an abduction deficit of less than 20 degrees. Calcifications in the area of the coracoclavicular or acromioclavicular ligaments did not affect the final range of motion. Complications consisted of one subcutaneous infection, one deep infection, and one failure of the reconstruction. Augmenting the reconstruction with polydioxanonsulphate bands allowed an early functional postoperative treatment. With this procedure, patients do not require removal of an implant, and complications from breakage or migration of metal implants are avoided.

Acromioclavicular Joint↗

PubMedDate not supplied

Posterior wall fractures of the acetabulum: characteristics, management, prognosis.

A consecutive series of 60 fractures of the posterior wall of the acetabulum, treated operatively in a Level I Trauma center, is reviewed retrospectively. Characteristics of the lesion, type of treatment, early and late postoperative complications and two-year functional results were recorded. In 27 patients (45%), additional damage to the cartilage of the acetabular cavity such as subchondral impaction, free articular fragments or separation of the posterior wall into several pieces was present. Seven patients (11.6%) showed preoperative neurological deficit. All fractures were treated with open reduction and internal fixation through a Kocher-Langenbeck approach. Secondary nerve damage was present in 8.3%. Early secondary surgery was necessary in 8.3%. During the first two years, additional surgery was performed in 7 patients (15.2%). The rate of periarticular ossifications was 26.1%. The rate of excellent and good results was 69.5%. The posterior wall fracture of the acetabulum is a more complex injury than generally is accepted. A large variety of articular lesions with varying degree of complexity is collected in this fracture type. Even in experienced hands, excellent and good long-term results will not exceed 75%. Poor results are due to suboptimal reconstruction of the posterior wall, partial osteonecrosis and/or complications of the Kocher-Langenbeck approach.

Acetabulum↗

PubMedDate not supplied

Traumatic false aneurysm of the superficial temporal artery.

Traumatic false aneurysms of the superficial temporal artery are very infrequent. They usually do not reveal themselves clinically until 1 to 6 weeks after the initial trauma. Diagnostic techniques are echo-doppler, CT-scan and arteriography; treatment is surgical.

Aged↗

PubMedDate not supplied

The use of the stomach in repairing tracheal leaks after resection of the oesophagus for carcinoma.

A 44-year old male with carcinoma of the upper third of the oesophagus and invasion of the trachea recently underwent surgical treatment at our institution. After oesophageal resection tracheal and main bronchial leaks were unsuccessfully closed with pleural patches. The stomach was subsequently used to seal the remaining leaks. The post-operative recovery was uneventful and the patient was discharged after a hospital stay of 41 days.

Adult↗

PubMedDate not supplied

Reconstruction of complete acromioclavicular separations (Tossy III) using PDS-banding as augmentation: experience in 64 cases.

Sixty-four patients with an acute type Tossy III acromioclavicular separation were treated surgically. Both the coracoclavicular ligaments and the ligaments of the acromioclavicular joint were reconstructed. An additional ligamenteous augmentation was performed, using completely resorbable 5 and 10 mm PDS bands. Thirty-nine patients (61%) were reexamined (follow-up time 2-45 months, mean 26 months). Results were good to excellent in 77% of cases. In 91% of patients, a range of motion with an abduction deficit of less than 20 degrees was obtained. Calcifications in the area of the coracoclavicular or acromioclavicular ligaments did not affect the final range of motion. Complications consisted of a subcutaneous infection in one case, a deep infection in another patient and one reluxation. PDS banding enables an early functional postoperative treatment. Implant removal is not required. Complications as breakage or migration of metal implants are avoided.

Acromioclavicular Joint↗

PubMedDate not supplied

Abdominal aortic aneurysm, an absolute surgical indication?

In a retrospective study, 155 patients operated for infrarenal abdominal aortic aneurysm during a 5.5-year period (jan. 1986-->oct. 1991) were reviewed. In our series, 111 patients underwent elective (EL) surgery, 44 patients had an emergency (EM) operation. Male/female ratio was 10/1. Mean age in the EL group and EM was 68.1 years and 71.82 years respectively (p < 0.05). In the EL group, 68 (= 61%) patients were asymptomatic. All patients in the EM group had symptoms: shock + syncope in 28 patients, acute back pain in 4 patients, acute abdominal pain in 12 patients. Aneurysm diameter > or = 8 cm was present in 33% of the EL group, but in 57% of the EM group. Early mortality for the EL and EM group was 3.6% and 23% respectively (p < 0.001). Major postoperative complications were present in 13% in the EL group, in 55% in the EM group (p < 0.001). During a 5-year follow-up of 135 patients (= 96%), 22 patients died. Cardiac problems (7/22) and cancer (5/22) were most prominent. 5-year survival for the entire group was 83%; EL (85%) and EM (76%) were not significant. None of the patients subsequently underwent an operation related to the abdominal aortic intervention.

Acute Disease↗

PubMedDate not supplied

The unilateral external fixator (Monofixator) in acute fracture treatment: experience in 50 fractures.

From 1988 to 1992, 50 fractures with associated soft tissue lesions were treated with an unilateral fixator (Monofixator). The location of the fracture was the tibia in 39 cases, the pelvis in 5 cases, the femur in 4 cases, the ankle and the humerus in one patient respectively. Twenty-two tibial fractures (56%) were open. Unproblematic healing with the monofixator was achieved in 71.8% 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 7 tibial fractures (18%). After secondary internal osteosynthesis, no late problems were seen. Complications with the monofixator in acute tibial fracture treatment consisted of refracture in 3 patients, pin track infection in 2 patients and hypertrophic pseudarthrosis in one patient. The monofixator provides a safe and stable fixation in tibial fractures with important associated soft tissue damage. In haemodynamically unstable patients with severe associated lesions, pelvic ring and femoral fractures can be reduced and stabilized satisfactorily with a monofixator, mostly until better condition permits definitive osteosynthesis.

Adolescent↗

PubMedDate not supplied

Does the intrapelvic compartment syndrome exist?

Pelvic compartment syndrome is a rare condition. As in other musculoskeletal localizations, the intra-compartmental pressure raises above a critical level. In the pelvic compartment syndromes, the gluteal compartments are mainly concerned. We report on three patients with bilateral ureteral obstruction, due to compression by a massive retroperitoneal haematoma as a complication of an unstable pelvic ring or acetabular fracture. Anuria with renal organ failure, due to compression of the ureters in the small true pelvis represents an intrapelvic compartment syndrome. Anuria, due to ureteral compression, mostly developing 24 to 48 hours after injury, has to be differentiated from anuria due to hypovolaemic shock or lesions of the lower urine tract. Bilateral tube nephrostomy represents a temporary and suboptimal therapy. Treatment of the intrapelvic compartment syndrome consists in fracture stabilization and surgical revision of the retroperitoneal space, including evacuation of the haematoma and decompression of the ureters, as it was performed in our patients. Persistent isolated bleeding points can be ligated. If the patient is haemodynamically stable, internal fracture fixation can be performed during the same operative session. A second look procedure may be required for prevention of septic complications.

Adult↗