Biomedical subjects

P A Ostermann

Publications and source records attributed to P A Ostermann.

At least 19 recordsLinked to original sources

PubMed2001

[Value of magnetic resonance tomography (MRI) in diagnosis of triplane fractures of the distal tibia].

The rare transitional fractures occur in adolescents at a time of incomplete dosis of the epiphysis. The anatomy of this fracture type is complex with the fracture line running in multiple planes. Conventional plain film radiographs often underestimate the extent and geometry of the fracture due to its transverse components. This study was performed to asses the benefit of MR-imaging compared to plain film radiographs in diagnosis and analysis regarding fracture-type, anatomy and dislocation of fracture. During a time period of 18 months we treated 15 patients with a fracture of the distal tibial epiphysis. In addition to plain film radiographs they got MRI of the distal tibia. Plain film radiographs and MRI were anonymized and diagnosed by 2 surgeons and 2 radiologists. 12 transitional fractures were diagnosed in plain radiographs as well as MRI, but regarding our criteria as above, we found two wrong classifications of fracture-type, an underestimation of fracture dislocation of an average of 0.5 mm in plain film radiographs and two rotational dislocations were missed. The MRI was found to provide anatomical detail and information superior to plain film radiographs.

Adolescent↗

PubMed2001

[Early death of the severly injured patient--A retrospective analysis].

With 44.9 % trauma is the main cause of death in men under 40 years. From September 3(rd) 1997 to June 30(th) 1998 174 patients with severe injuries or polytrauma were treated in our hospital. The mean ISS was 29 (18-75). 15 (8.75 %) patients died within the first 24 hours. The mean age was 34.5 (2-85) years. The mean ISS of these patients was 48 (25-75). In a retrospective study we analyzed the pattern of injury as well as the preclinical and clinical management. The fact that orthopedic surgery still has got a poor position within the patient's satisfaction-scale and that 15 of 174 analyzed patients had to die within the first 24 hours points out the importance of internal and external quality improvement measurements.

Adolescent↗

PubMed2001

The stabilizing effects of different orthoses in the intact and unstable upper cervical spine: a cadaver study.

BACKGROUND: Although cervical orthoses are frequently used in prehospital stabilization and in the definitive treatment for lesions of the cervical spine, there is little information about the control of extension-flexion, lateral bending, and rotation given to individual segments by different designs. METHODS: In an experimental in vitro study with four fresh frozen cadavers, the halo vest was compared with the soft collar, prefabricated Minerva brace, and Miami J collar. The controlling effects for the segments C1-2 and C2-3 were tested for all four devices in the intact and the unstable spine with an Anderson type II fracture of the odontoid. RESULTS: All four orthoses reduced the range of motion at both C1-2 and C2-3 of the intact spine significantly, although none of the three semirigid devices provided a halo-like immobilization in the intact spine. The osteotomy of the odontoid increased the range of motion in the segment C1-2. The soft collar did not give any clinically relevant stability to the unstable spine. Miami J and Minerva brace provided a similar moderate control in the sagittal plane but a much better control of "torque" in the upper cervical spine. The halo vest did not allow any measurable motion in any plane with our experimental external loading. CONCLUSION: The halo vest seems to be the first choice for conservative treatment of unstable injuries of the upper cervical spine, although pin track problems, accurate fitting of the vest, and a lack of patient compliance lead to clinical failures.

Biomechanical Phenomena↗

PubMed2001

[Computer-assisted, robot-assisted hip prosthesis--standard procedure or specialty indication?].

Approximately 150,000 total hip replacements annually are performed in Germany, with an increasing incidence of implants carried out on young subjects. Due to aseptic loosening, this group will undergo some revision arthroplasty after 15 years. Therefore, a permanent fixation appears mandatory. In case of posttraumatic or postoperative anatomical changes, exact preoperative planning by x-rays is extremely difficult. This might result in a higher rate of complications (e.g., displacement of the implanted prosthesis, fractures of the proximal femur), as documented by the available literature. The preoperative planning with CT images obtained at the 3D workstation shows the exact cortical situation, while the robot-assisted surgery allows the precise execution of the preoperative plan during surgery. By this point of time, long-term results of computer-guided, robot-assisted implantation of endoprosthesic devices are still lacking. However, the preliminary data indicate good results by means of anatomical position of the endoprosthesis and perioperative complications.

Arthroplasty, Replacement, Hip↗

PubMed2001

[Knee joint endoprosthesis].

Total knee replacement is increasing in number due to increased life expectancy and improved implants. [figure: see text] Degenerative changes (arthritis) and joint destruction based on polyarthritis and posttraumatic deformities are the common indications. There are basically four modes for knee replacement: Unicompartimental prosthesis, non-constrained, semi-constrained (posterior stabilized) and constrained total knee arthroplasty. Of major importance in knee alloarthoplasty are restitution of the correct limb axis, sufficient lateral ligaments and the restoration of the patellofemoral joint. Therefore particularly in cases with deformities an extensive soft tissue release is mandatory. A meticulous operative technique and versatile implants lead to good clinical outcome. Possible complications are still septic and aseptic implant loosening as well as wound infections.

Arthroplasty, Replacement, Knee↗

PubMed2001

[The infected endoprosthesis with the example of the hip joint endoprosthesis. An increasing danger to patient and society].

Because of demographic factors there is an increase in the numbers of total joint replacement operations each year. Deep infection after joint replacement remains one of the major complications in orthopedic surgery. The economic consequences for society are enormous. The treatment of such infections usually means a long and difficult course for the patient. In most cases multiple operations, including removal or exchange of the prosthesis are required. Concepts of treatment are very different and vary from debridement and keeping the prosthesis, resection arthroplasty to one- and second-stage exchange procedures. It is essential to know the special advantages and disadvantages of each concept to be able to choose the right strategy of treatment. Even getting the right diagnosis may be difficult since only about 2/3 of all cases go along with a positive microbiology. By the example of the infected hip prosthesis, the aim of the article is to give recommendations on the bases of current literature and our own experience. The strategy of treatment of infections used in our hospital is reported.

Arthroplasty, Replacement, Hip↗

PubMed2001

[Techniques of extramedullary osteosynthesis in proximal femoral fractures].

Plate osteosynthesis at the proximal femur is possible for intertrochanteric and subtrochanteric femoral fractures. Common implants are the dynamic hip screw (DHS), the dynamic condylar screw (DCS) and the condylar blade plate. The dynamic hip screw is mainly used in introchanteric femoral fractures, whereas the other two devices are suitable for stabilizing subtrochanteric fractures. Those extramedullary implants compete with several intramedullary nailing systems. Because of less soft tissue compromise the nailing systems have been favored by many surgeons during the last decade. This is particularly true for the subtrochanteric area where intramedullary devices offer higher primary stability, allowing initial full weight bearing. A good indication for the extramedullary technique with a two-hole dynamic hip screw is the stable intertrochanteric fracture with an intact lesser trochanter. The other fracture types of the proximal femur in the intertrochanteric and subtrochanteric area are better treated with intramedullary devices. The remaining indications for the dynamic condylar screw and the condylar blade plate are correction osteotomies and some salvage procedures.

Bone Plates↗

PubMed2000

[Benign tenosynovial giant cell tumor in the region of the upper ankle joint. A rare differential diagnosis of a soft tissue tumor of the foot].

The giant cell synovioma is a benign neoplasia classically located in the fingers. It mostly rises from tendon sheaths, sometimes from the synovia. Other locations than the fingers are rare. Making a differential diagnosis to lipomas, gangliomas or even malignant soft tissue tumors can be very difficult especially in rare locations. We report the case of a 21 years old man suffering from a giant cell synovioma in the area of the right ankle joint. The clinical, radiological and patho-morphological findings are documented. The tumor was excised totally, other foci were not found. The problems of making the right diagnosis are described.

Adult↗

PubMed2000

[Rotational dislocation of the cervical spine].

Unilateral cervical dislocations are less common and have fewer accompanying neurological complications than bilateral. A case of unilateral rotational dislocated facet has been described. Postoperatively, all deficts were improved. According to the literature, the diagnosis of this entity is often missed and the treatment is controversial.

Cervical Vertebrae↗

PubMed1999

[Pediatric forearm fractures: indications, technique, and limits of conservative management].

Although several "minimal invasive" techniques for the operative management of pediatric forearm fractures have been developed recently, conservative treatment still remains the option with the lowest risk for small patients. We present the results of our clinical and radiological follow-up after an average of 52.4 months (4-112) in 102 pediatric patients. All fractures were treated conservatively. There were 68 fractures (66.7 %) of the distal third of the forearm, 30 fractures (29.4 %) of the midshaft area, and four fractures (3.9 %) in the proximal third of the shaft. Greenstick fractures were seen in 58 cases (56.8 %), complete fractures with displacement of both corticalices in 26 patients (25.5 %), and folding fractures in 18 cases (17.7 %). With the exception of one fracture with the necessity of remanipulation after redisplacement in the cast, all fractures healed uneventfully without any further intervention. Functional results were excellent with a free range of motion of the wrist and elbow and without any signs of muscular atrophy in 96 children (94.1 %) at the time of follow-up. Six patients, however, showed a significant loss of forearm rotation of an average of 25 degrees (15 degrees -50 degrees ). In four of these six patients, the fracture had been situated in the proximal and midshaft area. Thus, two out of four fractures of the proximal forearm (50.0 %) showed a poor functional outcome. On the basis of our data we recommend conservative management for (closed) pediatric fractures of the distal and midshaft area. Operative treatment is indicated in forearm fractures close to the elbow.

Adolescent↗

PubMed1999

Arthrodesis of the infected ankle and subtalar joint: technique, indications, and results of 45 consecutive cases.

OBJECTIVE: To analyze the results of 45 patients after ankle arthrodesis in the presence of joint infection. METHODS: Arthrodesis was performed with two compression screws and an anterior plate in 29 patients and with two compression screws only in 16 patients. In all patients, additional stabilization with external fixation was used. In 29 patients, isolated fusion of the ankle joint was performed; in 13 patients, the ankle and subtalar joints were fused, and in 3 patients, isolated arthrodesis of the subtalar joint was performed. RESULTS: In 39 of 45 patients (86.6%), solid fusion was obtained. Nonunions occurred in 6 patients (13.4%). A below-knee amputation was necessary for one patient. Full weight-bearing was achieved after 21.6 weeks on average. Thirty-two patients returned to work after 35.5 weeks on average. Five of the six patients with failed ankle fusion needed special shoes; in one patient, a below-knee amputation was performed. A total of 33.3% of failed ankle fusions were associated with systemic disorders such as diabetes mellitus, and other concomitant diseases compromising local arterial blood supply and proprioception. CONCLUSION: Our results prove that limb salvage is possible even in complex ankle and subtalar pathology by thorough fusion by using a number of different techniques.

Adult↗

PubMed1999

[Minimally invasive therapeutic concepts in fracture surgery].

Recent publications show a clear tendency towards minimally invasive procedures for fracture care in trauma patients. Intramedullary stabilization has become the first choice in reconstructing axis and length of the diaphyseal fractures of the long bones. Indications for intramedullary nailing have become wider with the development of unreamed or retrograde nailing. Essential modifications of plate osteosynthesis from limited contact implants to percutaneous plating and the development of an internal fixator have made this procedure minimally-invasive as well. Techniques of closed reduction and percutaneous osteosynthesis or arthroscopically-assisted procedures have become more important in the stabilization of metaphyseal fractures. Although long term results of some of the mentioned procedures are unknown by now, minimally-invasive techniques appear to have positive influence on functional outcome in most patients. However problems of intraoperative control of axis and rotation in long-bone fractures as well as the surgeon's high exposure to radiation remain unsolved problems in minimally-invasive traumatology.

Bone Nails↗

PubMed1998

[Ankle para-articular tibial fracture. Is osteosynthesis with the unreamed intramedullary nail adequate?].

In a prospective study, 53 fractures of the distal fifth of the tibia were stabilized by unreamed nailing. Additional involvement of the ankle joint occurred in 18 patients. 50 patients returned for follow-up. In 30 patients tibia and fibula were fractured at the same (distal) level; in 20 patients the fracture of the fibula was located more proximally. In 12 patients the fractures extended into the tibial pilon. Severe soft tissue damage was seen in 24 fractures (18 open, 6 closed). Ninety percent of all fractures healed uneventfully without further surgical intervention after unreamed nailing. In two patients the unreamed nail had to be exchanged for a reamed tibial nail. Bone grafting and secondary dynamization of the nail by removal of a proximal interlocking bolt were performed in one case each. Thirty-one fractures healed in anatomical position. Valgus or varsus angulation of less than 5 degrees occurred in 18 patients. One fracture healed with rotatory angulation of 15 degrees. The highest rate of complications (22%) was seen in patients with distal fractures of the fibula without additional plating (of the fibula). There was no deep infection. Tibial fractures close to the ankle joint can be managed by unreamed nailing. Distal fractures of the fibula should be stabilized by additional plating. Because of the unreamed technique of implantation this procedure can also be used in grade II or III open fractures.

Adult↗

PubMed1997

[Monocondylar fractures of the femur. Therapeutic strategy and clinical outcome].

Twenty-nine unicondylar fractures of the distal femur were treated at the Trauma Center "Bergmannsheil", University of Bochum, Germany, between 1981 and 1994. All patients sustained their injuries from severe direct trauma. There were 16 lateral condylar fractures, 7 medial condylar fractures and 6 tangential posterior ("Hoffa-type") fractures. Twenty-eight closed injuries and 1 grade IIIB open fracture injuries to the skeleton. All fractures were treated with open reduction and internal fixation with screws within 8 h of admission. Postoperative management consisted of early continuous passive motion and minimal weight-bearing for 6-8 weeks, progressing to full weight-bearing. The mean follow-up was 68 months (18-120). The therapeutic outcome (clinical result, radiographs) was rated by the Neer score. Twenty-seven patients were available for follow-up examination. Of these, 23 were rated as excellent. 3 achieved satisfactory results, and 1 had an unsatisfactory result. All patients who did not achieve an excellent outcome had had accompanying injuries. Open reduction and internal screw fixation of unicondylar femur fractures provided overall excellent long-term results. The therapeutic outcome was significantly affected by associated injuries of the skeleton.

Adolescent↗

PubMed1997

[Traumatic axial dislocation injury of the carpus and metacarpus with triquetrum fracture. Rare entity or typical injury].

Although there are only 39 reports of compression injuries with axial dislocation of the carpus and metacarpus, there are similar patterns of injury. In all cases the dislocation is located either between the first and second or the third and fourth metacarpals and the corresponding carpal bones so that weak points of the carpal arch can be assumed in these regions. Clinical and radiological findings in a 22-year-old patient with dislocation of the third and fourth metacarpals and a fracture of the os triquetrum of the right hand after compression injury of both forearms with severe soft tissue injuries are described. Wound débridement and subsequent skin grafting were performed. The osseous lesions were reduced and held by two Kirschner wires and an external fixator. Results at follow-up were satisfactory.

Accidents, Occupational↗

PubMed1997

[Pediatric forearm fractures. Diagnosis, therapy and possible complications].

Nonoperative management of forearm fractures in children has a good outcome in over 90% of all cases. In our own series (n = 102) there were only six children (6.1%) with significant limitation (> 25 degrees) of forearm rotation. In these cases two out of four (50%) were located in the proximal third but only two out of 68 in the distal third. Indications for operative stabilization are the following: compound fractures, fractures associated with vessel and nerve injuries, joint fractures, dislocated fractures of the middle and proximal third, and Monteggia/Galeazzi injuries. As implants intramedullary devices are preferred. Twenty children were managed with elastic IM rods between 1994 and 1995 at our institution. At final follow-up all had a free ROM and a maximal axial malalignment of less than 5 degrees. In the region of the distal forearm K-wires are useful. Plates play a dominant role for corrections and nonunions; external skeletal stabilization is indicated for temporary fixation in compound fractures.

Bone Plates↗

PubMed1997

[Changes in therapeutic principles in fractures of the extremities with severe soft tissue injuries exemplified by tibial fracture].

Functional results after open fractures have been improved during the last decades. Especially the rates of amputation and chronic osteitis after open tibial fractures have been reduced from 30% to less than 5%. The initial management of this type of fracture includes reconstruction of the perfusion of the involved vessels, subsequent debridement with resection of avascular tissues, decompression of compartments by fasciotomy and initial shortening of the tibia by osteotomy and followed by callus distraction in order to achieve the physiological length of the leg. Cortical bone with periostal stripping has to be covered by local muscle transfer or by free vascularized tissue transfer within 3-7 days. Bone defects are either reconstructed by cancellous bone graft or, if the defect is longer than 2 cm, by continuous segmental transfer, according to the technique described by Ilizarov.

Amputation, Surgical↗

PubMed1997

[Distal tibial fracture--an indication for osteosynthesis with the unreamed intramedullary nail?].

In a prospective study, 50 fractures of the distal fifth of the tibia with additional involvement of the ankle joint in 18 patients were stabilized by unreamed nailing. In all, 90% of all fractures healed uneventfully without further surgical intervention after unreamed nailing, the highest ratio of complications (22%) being seen in all patients with distal fractures of the fibula without additional plating (of the fibula). Tibial fractures close to the ankle joint can be managed by unreamed nailing; distal fractures of the fibula should be additionally stabilized by fibular plating.

Adult↗