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Biomedical subjects

R Grass

Publications and source records attributed to R Grass.

At least 19 recordsLinked to original sources
PubMed2006

[Percutaneous dorsal versus open instrumentation for fractures of the thoracolumbar border. A comparative, prospective study].

STUDY DESIGN: A prospective clinical study. OBJECTIVE: To evaluate whether a percutaneous dorsal instrumentation of thoracolumbar fractures prevents irreversible damage to the spinal muscles. METHODS: A total of 57 patients with thoracolumbar fractures (Th12-L4) were divided into two groups, comparable in terms of gender, fracture level, classification and surgical concept. In the first, 24/57 patients were treated using an open procedure (OP-G); in the second, 33/57 were treated via percutaneous dorsal instrumentation (PER-G). Fracture localisation and classification, accuracy of pedicle screw placement, perioperative blood loss, OR- and image converter time as well as muscle damage (needle-EMG) were evaluated. RESULTS: OR- and image converter time as well as the accuracy of pedicle screw placement were not statistically different between groups. The difference in perioperative blood loss [43 (10-90) ml (PER-G) vs [870 (570-1,200 ml (OP-G)] was statistically significant (P <0.005). Needle EMG revealed no muscle damage, and the physiological activity and muscle potentials were normal (PER-G). In the OP-G, polyphasic EMG signals were most common (80%), a sign of the drop-out of numerous motor units. CONCLUSIONS: The open procedure caused permanent and significant damage to the strongest extensors of the autochthonus back musculature, the m. multifidus, which results from multisegment combined damage to the r. posterior nervi spinalis and muscle fibres. In contrast, percutaneous placement of an internal fixative reduces perioperative access morbidity causing little iatrogenic damage to back muscles and only a minor perioperative blood loss.

Adult↗
PubMed2006

[Traumatic hemipelvectomy].

With an incidence of only 0.6% of all pelvic injuries, traumatic hemipelvectomy is a rare event. It is defined as open or closed avulsion of one hemipelvis with occlusion or disruption of the main vessels and lengthening or disruption of the nerves, often complicated by urogenital or anorectal injuries. The mechanism of injury in this case is a typical one with extreme abduction and external rotation of the leg, causing sacroiliac joint disruption and symphysis separation. Two other mechanisms described are avulsion when the leg becomes entangled in a piece of machinery or a massive crushing at the groin. After a fast treatment in the field, the patient described was treated with immediate open revision, tamponade and stabilization of the pelvis. Upper leg preservation by reconstruction of the femoral vessels with vascular prostheses was attempted. Because of a broad necrosis of soft tissues, early completion of the hemipelvectomy was performed. The patient recovered well. Miction and bowel evacuation as well as sexual function could be preserved. The resulting quality of life is high and the patient is socially reintegrated without problems.

Adolescent↗
PubMed2005

[Teaching methods in anesthesia and intensive care medicine. The new legislation and its possibilities for the specialty].

BACKGROUND: As of October 1, 2003, a new government-initiated legislative basis for undergraduate medical education was initiated in Germany which resulted in substantial changes to the structure of the medical curriculum and in a heightened teaching load. METHODS: The Medical Faculty of the University of Dresden established an interdisciplinary reform curriculum in 1998. Since then a hybrid model of traditional lectures, seminars, practical and problem-based learning courses has been implemented for all courses in undergraduate medical training (Dresdener Integrated Problem-based Learning: DIPOL). RESULTS: Examplarly for all other DIPOL courses, the 2003 evaluation results of the "Emergency medicine-Injuries-Intensive care medicine" are presented and show that the course was very well received by students and tutors, and that 95% of the students passed the exams. CONCLUSIONS: The DIPOL anesthesiology course conforms with the new German federal law. A continuous further evaluation is an essential part of quality control and is necessary for the further development of a new curriculum.

Anesthesiology↗
PubMed2005

[Foot injuries in the polytraumatized patient].

Foot injuries in polytraumatized patients are not critical for survival but for the later quality of life. Closed fractures or dislocations of the foot are frequently overlooked or misinterpreted in association with polytrauma, which leads to severe functional impairment in those patients who survive. Repeated clinical examinations and early radiographic examinations are essential in the unconscious patient after resuscitation. Emergent indications for surgery even in the presence of multiple injuries are open injuries, incarcerated soft tissues, manifest compartment syndrome of the foot, and neurovascular injury. The decision on limb salvage or amputation has to be individualized with respect to the patient's overall condition and the severity of local trauma to the foot. The "life before limb" principle has to be respected. Emergent reduction of fracture dislocations of the talus, calcaneus, Chopart's and Lisfranc's joints via direct approaches and temporary transfixation with K-wires should be attempted in a first step whenever possible. Additional external fixation facilitates wound care and prevents soft tissue contractions until definite internal fixation becomes feasible. Early soft tissue coverage is always sought in order to avoid infection.

Amputation, Surgical↗
PubMed2005

[Reorientational arthrodesis of the ankle joint using four screws].

BACKGROUND: Arthrodesis of the ankle has gained wide acceptance as a first-line treatment option for painful posttraumatic osteoarthritis. The technique using four to five lag screws for internal osteosynthesis is a safe and biomechanically stable method to obtain a sound ankle fusion with good to excellent long-term results in the majority of patients. Malalignment hazards are minimized by preservation of the ankle mortise. METHODS: The meticulous resection of all cartilage and sclerotic bone as well as an atraumatic surgical technique are essential for preventing major complications. The need for revision surgery is minimized by correction of talar malalignment, fusion with the foot in a 90 degrees position and preoperative evaluation of the subtalar joint. In a series of 40 ankle fusions fixed with the lag screw technique, 82.5% good to excellent results were obtained after 5.6 (4.8-7.6) years. No infection, stress fracture or non-union was seen. RESULTS: In cases of osteitis, osteonecrosis, osteoporosis, and poor soft-tissue condition, external fixation techniques are preferred. In the presence of severe loss of bone stock at the distal tibia, stability can be achieved by using a compression nail for tibiotalar fusion without additional subtalar arthrodesis.

Adult↗
PubMed2005

[The reorientational rearthrodesis of the upper ankle joint following failed arthrodesis].

There are three important principles for the correction of nonunion and/or malunion of the ankle joint: (1) reorientation back to anatomic shape and to the normal biomechanical axis of the ankle and foot; (2) respect for the biology of bone by resecting all sclerotic bone and/or transplantation of autogenous bone graft; and (3) achievement of optimal biomechanical stability by using the four-screw technique, a limited-contact dynamic-compression plate or a blade plate. CT scanning is the most reliable method for detecting nonunion of the ankle joint after arthrodesis. According to Saltzman, in order to understand the pathology of malunions and nonunions and to plan their correction, weight-bearing anteroposterior radiographs with a 20 degrees internal rotation of the feet, precise lateral views, and rear views of both sides are highly recommended.

Adult↗
PubMed2005

[Hindfoot arthrodesis resulting from retrograde medullary pinning].

BACKGROUND: Simultaneous arthrodesis of the ankle and subtalar joints and correction of axial malalignment of the hindfoot in cases of bony defects and/or circulatory disturbances of the talus after multiple previous interventions. Internal stabilization with a short distal femur nail. Restoration of pain-free weight bearing. Failure of arthrodesis of the ankle and subtalar joint in patients with severely altered bone structure particularly at the level of the talar dome. Malalignment of hind- and/or forefoot after previous arthrodesis of the ankle and subtalar joint. Poor skin or soft-tissue condition. Acute osteitis/osteomyelitis. METHODS: Posterolateral approach. Resection of the articular cartilage and the areas of sclerosis of the ankle and posterior facet of the subtalar joint. Interposition of bone grafts harvested from the posterior iliac crest. Correction of malalignment of the hind- and forefoot. Locked nailing with a short distal femur nail. RESULTS: All 21 prospectively enrolled patients were followed-up clinically and radiographically at an average of 1.2 years (0.6-2.1 years) postoperatively. The average age of the 4 women and 17 men at the time of surgery was 53.4 years (38.9-73.7 years). The goal of the surgery was achieved in all patients. Subjective assessment was good in 14 patients and satisfactory in 3 patients. Complications occurred in 5 patients; these included loss of nail purchase (2), dislocation of locking screw (1), breakage of locking screw (1), and nonunion (1).

Ankle Joint↗
PubMed2004

[Advantages of minimally-invasive reposition, retention, and Ilizarov-(hybrid)fixation for pilon-tibial-fractures fractures with particular emphasis on C2/C3 fractures].

Between October 1993 and September 1999 a total of 62 tibial pilon fractures in 59 patients were treated at the Clinic for Trauma and Reconstructive Surgery, University Hospital Carl-Gustav-Carus, Technical University Dresden. In a retrospective study 49 patients with 50 tibial pilon fractures (81%) could be examined an average of 28 months after injury. The purpose of this study was to compare clinically and radiographically the healing results obtained after using the Ilizarov technique in combination with minimally invasive internal fixation (group I) with those after a conventional surgical procedure (internal fixation with a plate, external fixation with or without minimally invasive internal fixation, and screw fixation exclusively, group II) and to evaluate the efficacy of the Ilizarov technique. Data analysis showed a significantly higher incidence of 43 C2/C3 fractures in Ilizarov group I (73%) than in group II (33.3%). Severe soft tissue injuries and particularly open injuries had a significantly higher incidence in Ilizarov group I (100%) than in group II (38%). Despite the high incidence of C2/C3 fractures and severe soft tissue injuries in group I, there was no incidence of pseudarthrosis or osteitis in the further course and there was no need for arthrodesis during the long-term course. After therapy with a conventional surgical technique, the incidence of osteitis was 5% and of delayed union of a fracture 2.5% and arthrodesis was necessary in 8%. A disadvantage of the Ilizarov system was the relatively frequent incidence of pin infection (45%) necessitating surgical debridement in 18%. The efficacy of the treatment of 43 C2/C3 fractures with the Ilizarov technique was obvious by a statistically significantly better Maryland Foot Score in comparison with group II. More than 87% of the patients treated with the Ilizarov technique and only 38% of the patients treated with a conventional surgical procedure obtained a very good or good score. According to these findings, the Ilizarov technique in combination with minimally invasive internal fixation is an effective method to treat complicated tibial pilon fractures with severe soft tissue trauma.

Adult↗
PubMed2004

[Nutcracker fractures of the navicular and cuboid].

Nutcracker fractures of the tarsal navicular and cuboid usually result from dislocations of the midtarsal (Chopart's) joint. The classic pathomechanism consists of forced adduction or abduction (medial or lateral stress) mostly in combination with axial force. The resulting injuries are frequently misjudged or underestimated with respect to their potential consequences for global foot function. Radiographic imaging includes plain radiographs in exact standard projections and computed tomographic scanning. Classification of Chopart fracture-dislocations is based on the proposed pathomechanics and the direction of the dislocating force. The goals of open reduction and stable internal fixation of Chopart fracture-dislocations are realignment of the medial and lateral columns of the foot, restoration of joint congruity and temporal transfixation in case of ligamentous instability to ensure proper ligament healing.

Fracture Fixation, Internal↗
PubMed2004

Foot function after subtalar distraction bone-block arthrodesis. A prospective study.

Subtalar distraction bone-block arthrodesis for malunited calcaneal fractures was performed in 31 patients (26 men, five women), with a mean age of 38.5 years. The mean time from injury to arthrodesis was 36 months. There were no cases of nonunion. One patient had an early dislocation of the bone block requiring a repeat arthrodesis, and one had a soft-tissue infection. The mean AOFAS hindfoot score improved significantly from 23.5 before operation to 73.2 at a mean follow-up of 33 months (p > 0.001). Compared with the unaffected side, the talocalcaneal height was corrected by 61.8%, the talus-first metatarsal axis by 46.5%, the talar declination angle by 38.5% and the talocalcaneal angle by 35.4%. Dynamic pedobarography revealed a return to normal of the pressure distribution during roll-over and a more energetic gait. The distribution of local transfer of load correlated well with the AOFAS score. The amount of correction of the heel height correlated with a normal pattern of pressure transfer on the heel (p < 0.05).

Adult↗
PubMed2003

[Treatment of ingrown toenails. What is an "Emmert plasty"?].

In Germany,"Emmert plasty" is one of the terms most frequently used in daily surgical practice. It describes the wedge excision of nail fold, nail edge, and corresponding matrix for advanced stages of ingrown toenail in most standard textbooks of surgery but without direct reference to Emmert. The method, however,was apparently first described by the French military surgeon Baudens in 1850 and was strongly opposed by Emmert himself who propagated a pure soft tissue resection. This text gives a short historical review of the various treatment methods of ingrown toenails.

France↗
PubMed2002

Monitoring and healing analysis of 100 tibial shaft fractures.

BACKGROUND: We assessed the value of measuring biomechanical stiffness by assessing the fixator's external deformation as an objective means for monitoring fracture healing and determining the postoperative treatment regime, as compared to clinical and radiographic means of evaluation. PATIENTS AND METHODS: One hundred patients with tibial shaft fractures managed by unilateral external fixation had their fracture stiffness monitored. Stiffness was measured and clinical and radiological examinations were performed every 3-4 weeks. RESULTS: The time required for healing as indicated by stiffness measurement was an average of 2.5 weeks earlier than by radiological assessment. Eighty-two patients healed within 19 weeks (12.1+/-3.3 weeks) and ten patients in the following 6 weeks (24+/-4.3 weeks). Eight patients did not show an increase in fracture stiffness and received intramedullary nailing at a second operation. The average healing time was 11.3+/-4 weeks for type A, 13.1+/-3.6 weeks for type B fractures, and 15.1+/-5.9 weeks for type C fractures. The healing time for closed fractures was 11.3+/-3.2 weeks and for open fractures 14+/-4.9 weeks. CONCLUSIONS: The measurement of fracture stiffness allows the detection of patients at risk for nonunions. The healing time increased with increasing fracture gap size and was less in patients with younger age, less complex fractures, and lesser degrees of soft tissue damage.

Adolescent↗
PubMed2002

[Clinical trial with the distal femoral nail].

METHODS: The clinical results after DFN-osteosynthesis of n = 56 AO-classification 33A-fractures (32%), 33C-fractures (43%), 32X-fractures (21%) and treatment of non-union (4%) are presented. RESULTS: Follow-up was available for 54 fractures (96%) after a mean of 1.2 years (range 0.2-2.8 years). 95% of patients showed full-weight-bearing with a knee flexion of 120 (60-140) degrees. Extension-deficit > 10 degrees was observed in 5.4%. All fractures were consolidated. One soft-tissue infection, one partial loss of reduction and one implant failure were observed. A significant axial malalignment was found radiologically in 17%, a loosened spiralblade or locking screw in 7.4%. In 91% of cases the result was judged as good to excellent by patients. CONCLUSION: The mechanical stability of the implant allows a save osteosynthesis of unstable supracondylar and complete articular femoral fractures without additional bone grafting. Mechanical stability and minimal invasive operative technique permit a safe bone healing without major complications.

Adolescent↗
PubMed2002

[Clinical evaluation of the distal femoral nail].

METHOD: The clinical results after DFN-osteosynthesis of n=56 AO-classification 33A-fractures (32%), 33C-fractures (43%), 32X-fractures (21%) and pseudarthrosis treatment (4%) are presented. RESULTS: Follow up was available for 54 fractures (96%) after a mean of 1.2 years (range 0.2-2.8 years). 95% of patients showed full-weight-bearing with a knee flexion of 120 (60-140) degrees. Extension-deficit >10 degrees was observed in 5.4%. All fractures were consolidated. One soft-tissue infection, one partial loss of reduction and one implant failure were observed. A significant axial malalignment was found radiologically in 17%, a loosened spiralblade or locking screw in 7.4%. In 91% of cases the result was judged as good to excellent by patients and surgeons. CONCLUSION: The mechanical stability of the implant allows a save osteosynthesis of unstable supracondylar and complete articular femoral fractures without additional bone grafting. Mechanical stability and minimal invasive operative technique permit a safe bone healing without major complications.

Adolescent↗
PubMed2002

[Retrograde locking nail osteosynthesis of distal femoral fractures with the distal femoral nail (DFN)].

Non-operative treatment with immobilization or isometric traction has been abandoned as treatment for fractures of the distal femur at the end of the 1960ies. The technique of open reduction and internal fixation with a condylar plate as suggested by the AO has been the golden standard since the 1970ies. However, anatomic reconstruction of the condylar region with interfragmentary screw fixation and axial realignment of the femur shaft with a plate are challenging procedures especially in the presence of severely compromised soft tissues and put periosteal blood supply at risk. Soft tissue complications, axial malalignment and delayed fracture healing times led to the consideration of alternative techniques, such as intramedullary nailing which has been practiced with success since the 1940ies by Gerhard Küntscher and colleagues for femoral shaft fractures with minimal complication rates and improved results after closed reduction. The era of retrograde femoral nailing began with the systematic approach through the intercondylar notch by Green. This paper reviews the biomechanical properties, indication, technique as well as potential hazards and pitfalls of fracture management with the AO "distal femoral nail" (DFN). With appropriate application this technique is suitable for all fractures of the distal third of the femoral shaft including highly instable bicondylar fractures without damage to the soft tissues and the knee joint.

Biomechanical Phenomena↗
PubMed2002

[Intramedullary nail placement with percutaneous Kirschner wires. Illustration of method and clinical examples].

Unreamed nailing is an established method for internal fixation of femoral und tibial shaft fractures. The interlocking technique allows the stabilization of metaphyseal fractures, too, but the risk of malalignment increases. The "palisade method" presented here allows the precise positioning of the nail in the marrow cavity and works as a tool for successful minimally invasive nailing in the meta/epiphyseal region. The method is easy to use and suited particularly in combination with the UFN and UTN, but is in principal applicable to other nails, too. In contrast to the "Poller Screw" method developed by Krettek et al., no biomechanical augmentation of the osteosynthesis remains.

Adult↗