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Biomedical subjects

P C Strohm

Publications and source records attributed to P C Strohm.

At least 19 recordsLinked to original sources
PubMed2007

[Congenital radial head dislocation on both sides].

Both traumatic and congenital dislocation of the radial head are very rare in childhood. It can sometimes be difficult to tell them apart in practice. In this paper therefore, we present one case and discuss the various aspects of both conditions with reference to the available literature. Traumatic dislocation of the radial head is generally easily reduced without open surgery, and an open procedure is virtually never indicated in a patient who is still growing. In contrast, specific treatment of congenital radial head dislocation is not necessary because most patients are free of pain.

Bone Wires↗
PubMed2007

[The AO/ASIF Flexnail : A flexible intramedullary nail for the treatment of humeral shaft fractures].

BACKGROUND: The use of conventional implants for intramedullary nailing of humeral shaft fractures is associated with specific difficulties. During antegrade implantation structures of the rotator cuff can be affected leading to a reduced functional result of the shoulder. If the nail is implanted in a retrograde manner problems arise due to a relatively large hole close to or within the olecranon fossa, which is necessary for insertion of the nail. Supracondylar fractures as well as persistent elbow pain and loss of function are reported in the literature. To overcome these disadvantages a flexible nail has been developed that can be stiffened and locked after implantation. METHOD: Between October 2000 and February 2002, 34 patients were treated with the flexible nail at our institution; 29 were available for follow-up. Fracture healing was documented on radiographs and clinical outcome was evaluated with use of the Constant as well as the Kwasny score. RESULTS: Median duration until fracture consolidation was 10 weeks. In two patients fracture union was not achieved within the follow-up period. The median outcome measured with the Constant score was 93 points and 2.5 with the Kwasny score. Both values correspond to a very good functional outcome. CONCLUSION: We conclude that the flexible humeral nail is an excellent treatment option for humeral shaft fractures. Damage to the rotator cuff and the distal humerus can be avoided due to its unique flexible construction, improving the functional outcome of intramedullary nailing for the treatment of humeral shaft fractures.

Adolescent↗
PubMed2006

[Rupture of the arteria subscapularis following reduction of an anterior shoulder dislocation].

Anterior shoulder dislocations are one of the most common problems seen in an emergency department. Doubtless, immediate reduction is necessary for treatment, a procedure that is extremely rarely accompanied by complications. In these cases early diagnosis and treatment may be limb saving. We report a case with rupture of the arteria subscapularis following reduction of an anterior shoulder dislocation with formation of an axillary hematoma and consecutive paresis of the plexus brachialis. Interdisciplinary operative revision was necessary to remove the hematoma, stop the hemorrhage and for neurolysis of the plexus brachialis. Treatment resulted in a speedy recovery of the patient. Gentle reduction of a dislocated shoulder is a prerequisite for a low complication rate. Contrast-enhanced computed tomography facilitated diagnosis of the hematoma and identification of the bleeding vessel.

Aged, 80 and over↗
PubMed2006

[Intertrochanteric femoral fractures in children].

Based on two cases and a review of the literature, we describe a rare injury in childhood, intertrochanteric femoral fracture. Because of the insertion and traction of muscles at the proximal femur, conservative treatment is difficult. The hip muscles pull the proximal fragment into flexion, abduction and external rotation. In our opinion, surgical stabilization is the therapy of choice. We use an angular stable, locking compression plate for the stabilization of these fractures. Postoperatively, mobilization with full weight bearing is possible.

Adolescent↗
PubMed2006

[Diagnosis and treatment of the Essex-Lopresti lesion. Literature review and four case reports].

BACKGROUND: A fracture of the radial head in combination with a rupture of the interosseous membrane and lesion of the distal radioulnar joint known as Essex-Lopresti lesion is a rare injury. Usually it is caused by a high-energy trauma. Initially unrecognized distal radioulnar dislocations often show poor results. MATERIAL AND METHOD: Four case reports are presented to discuss the trauma mechanism together with diagnostic and treatment options. Especially the accuracy of ultrasound to diagnose an interosseous membrane disruption was evaluated. RESULTS: After an average of 35 months all patients were examined using the Morrey score and the modified score of Green and O'Brien. Initially the extent of the injury was not diagnosed in three cases. According to the score values the average results have been fair. CONCLUSIONS: An early diagnosis is the key for the correct treatment of an Essex-Lopresti lesion based on the classification of Edwards and Jupiter. In addition to the clinical and radiological assessment ultrasound should be used to diminish the rate of unrecognized interosseous membrane disruptions.

Adult↗
PubMed2006

[Injuries of the cervical spine with Forestier's disease. Problems in the diagnostic and surgical management].

The incidence of diffuse idiopathic sceletal hyperostosis (DISH) is described in men more than 50 years old up to 25% and in women up to 15%. Even little trauma in patients with DISH often leads to injuries of the spine, especially the cervical spine. In many cases MRI is necessary to find the injury in this anatomically modified spine. It is often difficult to detect the injury by plane radiographs or even CT. Based on two cases of cervical spine fractures in patients with DISH we will describe the difficulties and specialities in the diagnostics and surgical treatment of injuries of the cervical spine in patients with DISH. In the one case we stabilized a patient with an odontoid fracture type Andersson II, the other case was a traumatic spondylolisthesis C4/C5. Both cases were treated operatively, the odontoid fracture was stabilized by a single screw, the spodylolisthesis by a ventral plate. If there are modifications in the spinal anatomy by degenerative diseases like DISH or spondylitis ankylosans, it is important to perform an intense search for injuries of the spine. In many cases MRI is indicated to detect the injury because plane radiographs and CT are not sensitive enough. For the planning of the operation it is important to meet concerns to the thick anterior longitudinal ligament and to use screws, that are long enough because the use of standard instruments is often not successful.

Aged, 80 and over↗
PubMed2006

[Injuries of the midfoot in children].

Midfoot injuries of children are rare entities and often caused by high energy trauma mechanisms. Foot fractures in children may pose a diagnostic challenge but they usually have a good prognosis. In special cases computed tomography is necessary to find the right diagnosis in addition to plain X-rays. Based on two cases of midfoot injuries, a type II open Lisfranc fracture dislocation and a dislocation of a Chopart's joint, we describe the causes, diagnosis, and possibilities for treatment of juvenile midfoot injuries.

Athletic Injuries↗
PubMed2006

[Clinical, radiological and arthroscopical aspects in nail patella syndrome. Literature review based on an affected family].

Nail patella syndrome (NPS) is an autosomal dominant hereditary disorder affecting the nails, skeletal system, kidneys, and eyes. Skeletal features include absent or hypoplastic patellae, patella dislocations, elbow abnormalities, talipes and iliac horns on plain films. The existing literature focuses on clinical and radiographic findings in patients with NPS. We also report the case of a 40-year-old male patient and his family affected by NPS and includes clinical, radiographic as well as arthroscopic findings. Arthroscopic findings in this case are characterized by multiple synovial plicae in the knee joint leading to cartilage defects on the corresponding cartilage surfaces. A review of the recent literature suggests that the occurrence of synovial plicae might be related to NPS and might account for at least part of the characteristic symptoms of these patients. Therefore, in cases of unspecific knee pain associated with NPS arthroscopy of the knee joints and plicae resection seems to be recommendable.

Adult↗
PubMed2006

Clinical and radiological findings after different treatment of odontoid fractures type Anderson II and III.

PURPOSE OF THE STUDY: In the period from 06/00 to 08/02, 31 patients with odontoid fractures type Anderson II and III were treated and stastically recorded. 25 patients were followed up; the progess of 24, documented in detail radiographically, were evaluated independently by a traumatologist and by a radiologist. The usual time of immobilization when treating odontoid fractures type Anderson type II and III with the halo-fixator is 12 weeks. For this 12 weeks that it is worn, objective assessment of bone healing is performed radiographically and the results critically considered in terms of the length of time that the halo-fixator should be worn and whether this duration should be altered on the basis of the clinical and radiological results obtained. MATERIALS AND METHODS: 16 patients with an odontoid fracture type Anderson type II were treated partly with a halo-fixator and partly by additional operative stabilization. 15 patients with a type III fracture were treated in a halo over 12 weeks. At the time of the accident the patients to be treated had to have conventional radiographic examination and a CT scan as well as a position check following reduction. After 4, 8 and 12 weeks radiographic and CT investigation was repeated. These findings were evaluated independently by a surgeon and a radiologist. The clinical follow-up was carried out using the VAS Score and, in addition, the general activity level before and after the accident was recorded in a similar way on the Tegner/Lysholm subjective activity score. RESULTS: In most cases, according to the CT scan, the osseous bridging decreased again between the 8th and 12th weeks, as defined by resorption zones seen during the fracture healing period. Radiological evidence of complete osseous bridging was only seen after 12 weeks in three cases. CONCLUSION: Conventional radiography does not seem to us to be the most suitable technical means to evaluate osseous healing in odontoid fractures. The CT is more reliable for this. According to our radiological results, osseous healing of different types of odontoid fractures takes more than 12 weeks. Despite of its known complications, the halo fixator is still a good instrument for the treatment of odontoid fractures.

Adult↗
PubMed2006

[Complex injuries of the shoulder - floating shoulder].

Complex injuries of the shoulder are comparatively rare. Within the field of complex shoulder injuries this article particularly deals with the diagnosis and therapy of the "floating shoulder injury" as a review article. This term describes a discontinuation of the osseus and soft tissue suspension of the upper extremity from the axial skeleton. By literature review and involvement of recent biomechanical studies this article will show the injury patterns that lead to instability of the shoulder girdle and the therapeutic to be employed in respective cases. Key words: shoulder, floating shoulder, clavicle fracture, scapula fracture.

Acromioclavicular Joint↗
PubMed2005

[Polytrauma in cyclists. Incidence, etiology, and injury patterns].

BACKGROUND: In our region we have noticed an increasing number of cyclists and consequently a rise in bicycle-related accidents in recent years. A large number of our polytraumatized patients are victims of bicycle-related accidents. MATERIAL AND METHODS: Retrospectively we analyzed the data of our polytraumatized patients recorded between May 2003 and June 2004 for bicycle-related injuries. Of 153 polytraumatized patients treated in our emergency room 32 were cyclists (21%). The average age of our polytraumatized cyclist was 42 years, and the male-to-female ratio was 1:1. RESULTS: The median score on the Glasgow Coma Scale (GCS) after the accident was 8 (min. 3, max. 15), the median Injury Severity Score (ISS) was 24 (min. 18, max. 41), and the median Polytrauma Score (PTS) was 23 (min. 14, max. 51). A total of 30 patients (94%) suffered a head injury; in 28 patients (88%) the head injury was the leading diagnosis. The median score on the Abbreviated Injury Scale (AIS) Head was 4 (min. 1, max. 5), the AIS Thorax 3 (min. 2, max. 4), and the AIS Extremities 3 (min, 2, max. 5). Our data were also compared with the official injury statistics of the region and the current literature. CONCLUSION: The most frequent and most severe injury was the head injury (94%). Of the 32 polytraumatized cyclists 30 did not wear a helmet. Successful prevention could possibly be practiced if all cyclists wear helmets.

Abdominal Injuries↗
PubMed2005

[Rupture of the pectoralis major muscle -- causes, diagnosis, treatment].

PURPOSE OF THE STUDY: Between 01/02 and 01/03 four cases of ruptures of the pectoralis major muscle were treated in our hospital by suture. The data were retrospectively analysed, all patients underwent a follow up examination. We compared our results with the literature found by internet search. PATIENTS AND METHODS: Between 01/02 and 01/03 four male patients with a rupture of the pectoralis major muscle (PM) were treated surgically by suture. Three of them had an acute rupture (75%), in one case the injury was older (25%). In three cases patients underwent MRI examination. All patients were examined for a follow up by the Constant score and the score of McEntire. RESULTS: The median age of the patients was 36.5 (min: 27; max: 51) years; in three cases the left side was injured, in one case the right. All cases of the acute injury happened during weight bearing. The older rupture (1.5 years ago) was caused by a motorcycle accident. The follow up examination was performed after 8.5 (min: 7; max: 13) months. According to the score of McEntire the functional and clinical result was in all cases good to very good. The median value of the Constant score on the injured side was 90 (min: 63; max: 96) compared to 99 (min: 95; max: 100) on the other side. CONCLUSION: The rupture of the pectoralis major muscle is a rare entity and appears in young male patients. The most common reason for this injury is weight bearing or physical exercises, often in combination with anabolic steroids. Clinical and functional results after suture are good; patients normally reach the former level of activity and are able to practice their sports in the same way like they did before the trauma. According to our experiences, we recommend the surgical therapy.

Adult↗
PubMed2004

Acute compartment syndrome of the limb.

In this review the aetiology, clinical signs, diagnosis and therapy of the acute compartment syndrome of the limb is discussed. It is a limb- and untreated life threatening emergency. For good results, early detection is necessary. It is important to educate those taking care of patients of risk, especially in the early symptoms and signs. In uncooperative, unconscious and sedated patients pressure monitoring is recommended. The critical level of the absolute intracompartmental pressure is unclear. It is recommended to use a delta p pressure of 30 mm Hg. Below this pressure in the presence of clinical signs a fasciotomy of all compartments is the treatment of choice.

Acute Disease↗
PubMed2004

Two procedures for Kirschner wire osteosynthesis of distal radial fractures. A randomized trial.

BACKGROUND: The treatment of displaced Colles-type fractures of the distal part of the radius remains a challenge. Two procedures for closed reduction and Kirschner wire osteosynthesis of these fractures were compared in a prospective randomized study. METHODS: One hundred consecutive patients with a Colles fracture of the distal part of the radius (AO classification 23-A2, 23-A3, or 23-C1) were treated over an eighteen-month period. One group was managed with the conventional method, described by Willenegger and Guggenbuhl in 1959, in which two Kirschner wires are introduced into the styloid process of the radius. The other group was treated with the Kapandji method, as modified by Fritz et al., in which two Kirschner wires are inserted into the fracture gap and a third is placed through the styloid process. Postoperative care was standardized for both groups and carried out according to a strict procedure. Forty patients who had been operated on according to the modified Kapandji method and forty-one treated with the Willenegger technique were available for follow-up, for a follow-up rate of 81%. The follow-up assessment was performed with a modified version of the Martini score. RESULTS: The median time to follow-up was ten months (range, six to twenty months). The results as assessed with the Martini score were, on the average, good to very good for the patients treated with the Kapandji method and satisfactory to good for the patients treated with the conventional Kirschner wire fixation. The duration of radiographic exposure was significantly shorter with the Kapandji method than with the Willenegger technique. CONCLUSIONS: Conventional Kirschner wire fixation remains a good method of osteosynthesis for the treatment of displaced fractures of the distal part of the radius. We found both the functional and radiographic outcomes of the Kapandji method to be significantly better than those of the Willenegger technique. LEVEL OF EVIDENCE: Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.

Adult↗
PubMed2004

Fracture treatment in the elderly.

With an ever increasing percentage of elderly people among the population fracture management in the aged is of increasing importance in the field of traumatology, since people between the ages of 60 and 80 will constitute the largest subpopulation by 2030. Due to relevant interindividual differences concerning physical constitution and comorbidity this group resembles an extremely inhomogenic population of patients. Discrepancies between biologic and chronologic age make a careful selection of suitable therapeutic strategies individually adapted to a single patient's situation necessary. For the biologically younger patient with good compliance conservative treatment or minimal osteosynthetic procedures requiring partial weight bearing might constitute a reasonable and appropriate therapeutic option whereas for biologically older patients with relevant co-morbidity early mobilisation with short hospitalisation periods is of the highest priority. This is why in these cases osteosynthetic procedures with implants that allow full weight bearing initially after surgery should be preferred. Even though in advanced age there is an increasing risk of fractures in general -- due to increasing incidence of falls and decreasing bone mineral density -- the majority of fractures in elderly is located in the proximal femur, the proximal humerus and the distal radius. Therefore, therapy of fractures in these typical locations shall in recognition of the particular characteristics of the advanced age be displayed in this article.

Aged↗
PubMed2003

[SCIWORA-syndrome. Case report and review of the literature].

The SCIWORA-syndrome was firstly described by Pang and Wilberger in 1982 [11]. It is characterized by a neurological injury without radiological appearance. Since the standardized use of MRI in spinal cord diagnosis, the number of the "real" SCIWORA-syndromes decreases. By the case report of a 14 years old boy falling down from a wall of 2 meters height with a complete paraplegia from Th12 without radiographic abnormality (even in MRI) we will give a short review of the literature.

Adolescent↗