Biomedical subjects
P Holzach
Publications and source records attributed to P Holzach.
[Injury pattern of the fibular ligaments. Radiological diagnosis and clinical study].
Injuries to the lateral ligaments of the ankle require accurate diagnosis, especially because most injuries to a single ligament are not treated surgically any more. Various stress devices are in use for objective and standardized assessment of the instability of the ankle joint. In a group of 76 patients with injuries to the lateral ligaments of the ankle, we compared post-traumatic instability by a radiological stress test as done by hand or by using a Telos stress device. In 25 patients treated by surgery an additional intraoperative stress X-ray (talar tilt) was performed. The results of the instability tests done by hand versus those obtained with the Telos stress device correlated poorly (r = 0.786). A similar result was obtained by comparing the Telos stress device views to the intraoperative stress controls done by hand (r = 0.771). Only the pre- and intraoperative measurements by hand were in good correlation (r = 0.958). These results are discussed with reference to a biomechanical model and recommendations for routine diagnosis are proposed.
[Ultrasonography of meniscus lesions].
Controversy exists about the value of ultrasonography of meniscal tears. We therefore examined 101 knee joints of 99 patients in a prospective study. Prior to the arthroscopy the menisci were scanned from an independent team by using 7.5 and 10.0 MHz ultrasound waves. 81 meniscal tears were seen at arthroscopy; 36% of these tears could not be detected with the scanner (false negative results) while 20% of intact menisci showed positive echogenic structures, which were analysed as meniscal tears. It seems that ultrasonography of the menisci is still of experimental use without any clinical importance.
[The radiological functional testing in fibular ligament lesions--a critical analysis and clinical study].
Injuries to the lateral ligaments of the ankle require an accurate diagnosis, especially because most injuries to one ligament are not treated surgically any more. Different stress devices are in use for an objective and standardised assessment of the instability of the ankle joint. In a group of 76 patients with injuries to their lateral ligaments of the ankle we compared posttraumatic instability by radiological stress test as done by hand or by a Telos stress device. In 25 patients treated by surgery an additional intraoperative stress X-ray (talar tilt) was performed. The results of the instability tests done by hand versus those obtained with a Telos stress device showed a poor correlation (r = 0.786). An analogous result was obtained by comparing the Telos device stress views to the intraoperative stress controls done by hand (r = 0.771). Only the pre- and intraoperative measurements by hand showed a good correlation (r = 0.958). The results are discussed with reference to a biomechanical model and recommendations for routine diagnosis are proposed.
[The treatment of fibular ligament lesions using the Ortho-Rehab shoe].
In a prospective study we examined 46 patients (14-49 years of age) with fresh ruptures of the lateral ligaments of the ankle (talar tilt greater than or equal to 10 degrees). Treatment consisted in six weeks of taping combined with wearing of a special rehabilitation shoe (Ortho Rehab). 28 patients were treated conservatively and 18 had an operative repair of their ruptured ligaments. After 8 weeks every patient was clinically controlled. Until now 35 patients were reevaluated more than one year after injury. Treatment was judged as very comfortable and positive. Working capacity was achieved after an average of 14.8 days and all patients returned to their former sports activity 3 to 8 weeks after the event. Mechanical and functional stability after more than one year are excellent with the exception of 3 cases. The results are discussed and compared with other studies.
[Ultrasonic diagnosis of meniscus lesions].
Controversy exists about the value of ultrasonography of meniscal tears. We therefore examined 101 knee joints of 99 patients in a prospective study. Prior to the arthroscopy the menisci were scanned from an independent team by using 7.5 and 10.0 MHz ultrasound waves. 81 meniscal tears were seen at arthroscopy; 36% of these tears could not be detected with the scanner (? false negative results) while 20% of intact menisci showed positive echogenic structures, which were analysed as meniscal tears. It seems that ultrasonography of the menisci is still of experimental use without any clinical importance.
[Position on "Results of diagnostic sonography in injuries of the knee joint"].
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[Accident risk in winter sports].
Ski accidents are quite frequent but not alarming if we consider the benefit of the outdoor sporting. In the countryside around Davos-Klosters more than 5 Mio kilometers of vertical drop are performed in down hill skiing. They result in approximately 1300 accidents per year. Since 1972 more than 20,000 ski accidents were analysed. The injuries of the lower extremity have decreased slightly (44%), on the other hand we observed more injuries of the upper extremity (32%). There are only a few polytrauma patients registered, mainly on the basis of too high speed on the ski slopes. Fractures have become rather uncommon at least in relation to the complex knee injuries which today amount to 50% of all the injuries of the lower extremities. For the prevention of ski accidents a detailed control of the equipment, especially the safety bindings at the beginning of each winter season is of utmost importance.
[Incidence and treatment of fresh connective tissue injuries of the knee in winter sports].
For the last 18 years 21,808 alpine skiing injuries have been treated at the hospital of Davos. There is a great decline in the incidence of lower leg fractures with a contrary development of knee ligament injuries. Today half of the lower leg injuries are knee injuries. To ameliorate the documentation of all patients with acute injuries of the knee ligaments we are using a detailed questionnaire, including the mechanism of injury, release of the safety binding, skiing ability, pattern of instability and the techniques of treatment. We report of the evaluation of 145 patients with knee ligament injuries. It is the aim of that protocol to follow up all these cases up to 5 years.
Skiing accidents in the past 15 years.
For the last 15 years a statistical analysis of distances skied and of alpine skiing accidents has been performed in the Davos-Klosters skiing area, a 'closed' skiing area, where every skier has to return from the top to the bottom station. Distance skied is measured by vertical drop in 10(6) km determined by calculations from frequency surveys by lift-operators. About 2.5 million km per season have been skied during the past years, a number remaining constant for the last 15 years. In the same time the requirement for rescue-transports in this area has shown a decline of 46% to 288 transports per season due to a decrease of the number of injuries with initial immobilization. Therefore the so-called transport-quotient (one rescue-transport per 10(4) km of vertical drop skied) has decreased from its initial value of 4 to 1 per 10(4) km. During the same time all winter sport injuries were analysed at the hospital of Davos. About 90% are injuries caused by alpine skiing resulting in a total of 17,246 alpine skiing injuries for the last 15 years. There is a great decline in the incidence of lower leg fractures with a contrary development of knee injuries. Today half of the lower leg injuries are knee injuries (280 knee injuries out of a total of 1250 alpine skiing accidents per season). There is a gradual increase of upper extremity injuries from 17% of all skiing injuries in 1972 to 35% in 1976. A Swiss multicentre study on skiing safety shows comparable injury patterns in other skiing areas. The average injury-severity measured by several parameters is declining.(ABSTRACT TRUNCATED AT 250 WORDS)
[Rupture of the pectoralis major muscle].
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[Symmetrical bilateral injuries in skiing 1976-1985].
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[Base fracture of the 5th metatarsal. Classification and therapy using a strapping bandage].
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[Anterior cruciate ligament-plasty with a free transplant from the patellar ligament].
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Comparison of the effect of continuous positive airway pressure and blowing bottles on functional residual capacity after abdominal surgery.
In two groups of comparable patients undergoing elective abdominal surgery, functional residual capacity (FRC) was measured preoperatively and on the first 2 days after surgery. One group was treated by regular application of continuous positive airway pressure (CPAP), the other group by bottle blowing (BB). In both groups there was a significant reduction of FRC on the first postoperative day. BB and CPAP increased FRC preoperatively by approximately 50%. Postoperative CPAP or BB increased FRC towards the preoperative value. However, 10 min after the treatment was stopped, FRC was not different from the pretreatment level. In 4 healthy subjects the resistive work of breathing produced by CPAP or BB was measured. Both treatments increased mainly expiratory and total resistive work of breathing. BB resulted in especially high expiratory and total resistive work. It is concluded that CPAP and BB increase temporarily the reduced FRC after abdominal surgery. CPAP was much better tolerated by the patients due to the lower resistive work of breathing.
Intercondylar fractures of the humerus. An operative approach.
In this paper we review a series of thirty-four intercondylar fractures of the distal end of the humerus that were treated by open reduction over a ten-year period. The fracture patterns were classified according to the system of Müller et al. and a strict rating scale incorporating subjective data, objective motion, and the functional status of the involved elbow was used for the results. At a mean follow-up of 5.8 years, thirteen results were rated as excellent; fourteen, as good; four, as fair; and three, as poor. Complications included postoperative neuritis in five patients; three non-unions; and refracture, heterotopic bone, and deep sepsis in one patient each.
[Incidence, treatment and late results of fresh and old injuries of posterior cruciate ligaments].
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[Plastic surgery of the anterior cruciate ligament: late results after 5 different reconstruction procedures].
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