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Biomedical subjects

P Knöringer

Publications and source records attributed to P Knöringer.

15 recordsLinked to original sources
PubMed1992

Osteosynthesis of injuries and rheumatic or congenital instabilities of the upper cervical spine using double-threaded screws.

The surgical treatment of instabilities of the upper cervical spine, independent of their cause, requires the use of differentiated procedures if functional anatomy is to be largely restored. Successful procedures have been the diagonal screw fixation of the axis from the anterolateral aspect in case of acute fractures of the odontoid process, transpedicular screw osteosynthesis of C2 in hangman's fractures with bony instability, and the transarticular screw fixation of C 1/2 with interarcual fusion for atlantoaxial instabilities. Compared with conventional screws, the use of double-threaded screws which are almost totally imbedded in the vertebral body has the advantage of eliminating local irritation, reducing the risk of surgery, and simplifying the operative procedure itself.

Bone Screws↗
PubMed1992

[Surgical treatment of injuries of the upper cervical spine].

The surgical treatment of instabilities of the upper cervical spine requires the use of differentiated procedures if physiological anatomy is to be largely restored. Successful procedures are diagonal screw fixation of the axis from the anterolateral aspect in the case of odontoid fractures Anderson type II and III (high type), transpedicular screw osteosynthesis of C2 in hangman's fractures, and transarticular screw fixation of C1/2 with posterior fusion for atlantoaxial instabilities. In occipito-atlantal trauma occipitoatlantoaxial fusion is required.

Atlanto-Axial Joint↗
PubMed1989

Late brain abscess years after severe cerebrocranial trauma with fronto-orbitobasal fracture.

An 8-year-old boy suffered severe craniocerebral trauma with left-sided fronto-orbitobasal fracture. The CT scan showed minor subdural air inclusions. The child recovered well and had no clinical signs of aftereffects. Eight years after the accident, symptoms of intracranial pressure developed progressively with nuchal rigidity and elevated temperature. The CT showed an extensive left fronto-orbitobasal abscess. The intraoperative finding was a brain prolapse both into the frontal sinus and into the ethmoidal cavity with a large dura-bone defect at the site of the former fracture line, which was closed with refobacin-bone-meal fibrin sealant plasty and glued periostal patch. The postoperative course was unremarkable. Evidently, the accident had caused a brain prolapse into the bone defect, which prevented liquorrhea. Due to the lack of bone and dura barrier, a late brain abscess developed in the course of sinusitis. In such cases, primary surgical revision seems to be indicated.

Brain Abscess↗
PubMed1989

Frontobasal and orbital reconstruction following trauma and tumor removal using a compound of bone meal, antibiotic, and fibrin sealant.

In the treatment of fronto-basal cerebrocranial trauma and primary or secondary orbital tumors, definitive surgical intervention in one sitting has proven very successful. The orbital roof, the lateral orbital walls, and the frontal base are reconstructed with a bone meal/fibrin sealant plastic, whereas the orbital rims are revised using available bone fragments refitted using osteosynthetic procedures. Remaining calotte defects are covered alloplastically with Refobacin-Palacos. Bones can be easily remodeled with the bone meal/fibrin sealant plastic. The fibrin sealant holds the shape in regions not subject to mechanical stress, and contributes to an immediate, watertight closure. The addition of an antibiotic achieves effective prophylaxis against infections in the initial phase. The result is an autologous bone which provides a maximum of protection against late infections such as occur in alloplasties and against ascending infections with meningitis, as observed in unreconstructed bone defects. Since the bone meal is usually obtained during trepanation, bone biopsies of other body regions are unnecessary.

Anti-Bacterial Agents↗
PubMed1986

[Treatment of bone infection in the area of the skull].

Osteomyelitis in the skull region is encountered preferably as a postoperative, but also as a posttraumatic lesion, furthermore it occurs in case of infection of the paranasal sinuses or, rarely, as hematogenic metastasis. The routine treatment comprises a careful wound cleaning with excision of fistula, resection of the osteomyelitic bone and ablation of all purulent and devital tissues, eventually sanitation of an infected paranasal sinus. Between six and twelve months after the healing of the infection, the bone defect is closed by plastic surgery. In 1976, we have introduced Refobacin-Palacos R for the local treatment of the infection with simultaneous definitive closing of the bone defect in case of osteomyelitis of the skull. 44 patients have been treated since with this method. The rate of reinfection was 3% in osteomyelitis of the calotte without involvement of the sinuses and 25% in case of involvement of the frontal sinuses. A twofold method has been developed in order to reduce the relatively high frequency of reinfection in case of involvement of the frontal sinuses. The wound cleaning with revision of the frontal sinuses and parenteral administration of antibiotic drugs was performed as usual. An additional local treatment of the infected frontal sinuses was performed by implantation of Septopal chains which were removed ten to fourteen days later. During the same session the nasal excretory ducts were closed and the frontal sinuses largely filled up with muscle pieces together with a compound of spongiosa, fibrin, and antibiotic. The remaining bone gap was closed with Refobacin-Palacos R. A significantly decreased reinfection rate is anticipated with this twofold procedure, however, a clear statement is not yet possible due to the small number of cases and the relatively short follow-up period.

Brain Abscess↗
PubMed1986

X-ray-translucent retractors in spine surgery. Technical note.

With surgery of the vertebral column under image intensification, surgical instruments and conventional metal retractors often obscure important x-ray landmarks. Surgery is more difficult, operating time is longer, and exposure to x-rays is increased. The author has developed x-ray-translucent retractors for ventral and dorsal operations. Although for reasons of strength these retractors have somewhat more bulk than equivalent metal retractors, they are sufficiently stable and are compatible with spacial requirements. They can be sterilized and reused.

Humans↗
PubMed1985

[Operative treatment of injuries of the lower cervical spine. Indications and technic for single ventral, dorsal and combined dorsoventral procedures, clinical results].

Since the introduction of osteosynthetic surgery of the vertebral column in our clinic in 1978 we have treated surgically 51 injuries of the lower cervical spine (C3-D1) (1978-end of January 1985). In this article we describe the operative technique with dorsoventral approach and ventral approach alone. We also indicate to the possibility of using the dorsal approach alone. The criterion governing the choice of approach is not the resulting stability, but the pathological anatomy of the vertebral column ventrally and dorsally, and the reducibility of the dislocation, especially in the case of old injuries. The results are reported. In our sample, patients presenting with incomplete radicular and medullary lesions generally recovered, whereas in the group of 12 patients with transverse lesion of the spinal cord with paraplegia only two could be mobilised again. We demonstrated that in transverse lesions of the cord with paraplegia a lowering of the level by one or more segments and an improvement of the radicular neurological deficit can considerably increase the chance that the patient may be able to use his upper extremities again.

Bone Plates↗
PubMed1985

[Percutaneous fibrin gluing in subcutaneous cerebrospinal fluid fistulas following operations on the brain and spinal cord].

In spite of a careful operation technique subcutaneous CSF fistulae may occur after operations to the central nervous system, which will then require repeated puncture treatment in combination with compression bandages and draining of the cerebrospinal fluid or a surgical treatment. The originally obtained result of the operation may in this way become doubtful. The percutaneous fibrin sealing of the fistulous opening and the tissue layers of the fistulous cavity after complete puncturing of its content is a safe and riskless procedure with which the therapy of this complication can be decisively improved. The indications and the technique are described. Contraindications are pointed out. The chances to obtain good results are shown on the basis of various cases.

Adolescent↗
PubMed1984

[Treatment of fresh fractures of the dens axis by compression screw osteosynthesis].

Today most fractures of the odontoid process are treated conservatively. In 32% a bony stabilization is not achieved. Therefore each third has to have a secondary operation, because the only life-threatening psuedoarthrosis is one in the odontoid process of the axis. For this reason the question is repeatedly raised, whether better results will be achieved by on early primary operation. The advantages of the compression-screw osteosynthesis are compared with the well-known operative procedures. The operative management is described. An illustrative case in regard to diagnostic operation and follow up study is described.

Axis, Cervical Vertebra↗
PubMed1979

[Long-term results of plastic skull repairs with acrylic resins].

In the period from the beginning of 1956 until June 1978, we closed 312 skull gaps with acrylic resin. We used Palacos G (group I) 205 times and Refobacin Palacos R (group II) 107 times. Owing to the antibiotic action of Palacos, the infection rate, which was 6.8 per cent in the first group, could be lowered to 1.07 per cent even with a larger range of indications. The cosmetic results were very satisfactory. Owing to only slight changes in consistency and elasticity, a good protection of the brain was ensured. With the exception of one patient who temporarily showed psychic alterations, the acrylic resin was not felt as a foreign body. Disagreeable sensations, especially in case of the action of heat and cold such as are occasionally mentioned by wearers of metal plates, did not occur in our patients. Formation of neoplasms caused by polymethyl methacrylate has been found in none of the patients during the observation period of 20 years. The plastic repair with acrylic resin can be carried out quickly and in a simple manner. It may be used in all regions of the cranium. Even larger defects can be closed in this way.

Acrylic Resins↗