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Biomedical subjects

R Kreusch-Brinker

Publications and source records attributed to R Kreusch-Brinker.

18 recordsLinked to original sources
PubMed2002

Biomechanical comparison of effects of supraspinatus tendon detachments, tendon defects, and muscle retractions.

BACKGROUND: Rotator cuff ruptures are frequently associated with loss of strength of the shoulder. However, the characteristics of the rotator cuff tear that are responsible for the loss of force generation and transmission have not yet been identified. The purpose of this study was to compare the effects of supraspinatus tendon detachments, tendon defects, and muscle retractions on in vitro force transmission by the rotator cuff to the humerus. METHODS: The rotator cuff tendons from ten cadaver shoulders were loaded proportionally to the respective cross-sectional areas of their muscles. A fiberglass rod was cemented into the medullary canal of the humerus and connected to a three-component load cell for the measurement of the forces transmitted by the rotator cuff to the humerus. This study was performed with the humerus in a hanging arm position and with various sizes of supraspinatus tendon detachments, tendon defects, and muscle retractions. RESULTS: Detachment or creation of a defect involving one-third or two-thirds of the supraspinatus tendon resulted in a minor reduction in the force transmitted by the rotator cuff (< or =5%), while detachment or creation of a defect involving the whole tendon resulted in a moderate reduction (11% and 17%, respectively). Simulated muscle retraction involving one-third, two-thirds, and the whole tendon resulted in losses of torque measuring 19%, 36%, and 58%, respectively. Side-to-side repair of the one-third and two-thirds defects nearly restored the force transmission capability, whereas a deficit remained after side-to-side repair following complete resection. CONCLUSIONS: Our results support the rotator cable concept and correspond to the clinical observation that patients with a small rupture of the rotator cuff may present without a loss of shoulder strength. Muscle retraction is potentially an important factor responsible for loss of shoulder strength following large rotator cuff ruptures. CLINICAL RELEVANCE: Supraspinatus muscle retraction diminishes glenohumeral abduction torque significantly more than either a defect in the tendon or a simple detachment of the tendon from the tuberosity. In cases of irreparable defects, side-to-side repair may be worthwhile to restore muscle tension and the integrity of the rotator cable.

Biomechanical Phenomena↗
PubMed1990

[Corrective osteotomy of the femoral and tibial shafts using the interlocking nail].

The indication for nailing a femur or tibia fracture has been extended by the method of interlocking up to the meta/diaphyseal zone. For the stabilisation of osteotomies in these regions, the nail was used in 19 cases of femur and 23 of tibia corrections between 1983 and 1988 in the Orthopedic University Clinic Berlin. The osteotomies were done with a small skin incision in open way. Although there were three infections, bone consolidation was succeeded in all but one patient with the planned axis. The first achieved gain in length could not be hold in five cases after removing the interlocking screws in order to give full weight bearing to the leg for callus formation. In situations of non-unions with wrong position or refracture of biologically troubled bones after plating the method of interlocking nail is stable and enables bone recovery after grafting by drilling. The possibility of early full weight bearing is a great advantage for the rehabilitation of patients, who had been suffering from delayed fracture healing before. The nail itself preserves the right position of the bone in two dimensions, even if there are not exact fitting osteotomy fragments, and the interlocking screws secure the shorter part of diaphysis against malrotation.

Adolescent↗
PubMed1988

[Fatigue fracture of the femoral neck following femoral intramedullary nailing].

The course of a fracture of the femur shaft treated in an unstable manner by medullary nailing was full of complications. This handicapped patient can be taken as an example to show the risks involved in the extended intramedullary stabilization using a locking nail on the one hand and, on the other hand, to demonstrate that subsequent fractures induced by therapy can immediately be controlled by simple methods such as additional bolting. Furthermore, the fracture of the femur neck feared as technically or biologically induced consequence of femur nailing in a previously weakened bone can quickly be treated by the relatively simple with osteosynthesis traction screw. This method does not only meet all biomechanical requirements with respect to stability and load-capacity, but has also proved its value in clinical practice when it was applied alone in cervical femur fractures as well as combined with the locking nail in layered fractures of the femur.

Bone Screws↗
PubMed1987

The forearm flap as a free neurovascular flap for treatment of an extensive bone/soft-tissue defect in the calcaneal part of the foot.

A discussion is presented on the case of a 28-year-old motorcyclist who had an accident and got caught in the spoked wheel of her vehicle. The result was an extensive soft-tissue injury of the metatarsus and calcaneal part of the foot, a defect fracture of the calcaneus, an osseous disinsertion of the Achilles tendon, a lateral malleolus Weber type-A fracture, and a fracture of the second metatarsal bone. The primary treatment consisted in extensive débridement of the strongly contaminated soft parts and refixation of the Achilles tendon on the calcaneus with two osteosynthesis screws. The bruised skin flaps remaining were adapted in a tension-free manner. However, this was possible only in a considerable talipes equinus position. In the further course, the patient developed an extensive skin and soft-tissue necrosis over the calcaneal part of the foot. A neurovascularly pedicled forearm flap was freely grafted in order to maintain the load capacity of the calcaneal part of the foot, to prevent osteitis of the calcaneus, to correct the talipes eqinus position, and to achieve a resensibilization in the load zone of the sole. The healing result was good, and it was possible to achieve extensive correction of the talipes equinus position as well as prevention of calcaneus osteitis; the function of the Achilles tendon was also maintained. Moreover, there was satisfactory resensibilization of the calcaneal part of the foot, so that the patient can now walk in ready-made shoes with a fully molded arch support.

Achilles Tendon↗
PubMed1987

[Indications, technic and dangers of intra-articular injection treatment of the knee].

The indication for knee injection depends on the drugs to be used and the illness to be treated. These are lot of degenerative and inflammatory joint pains which demand for monarticular treatment by corticosteroid crystal suspension, local anaesthetica, non-steroidal antiinflammatory substances or drugs for chemical synovectomy in PCP. The technique is quite easy as for the big volume and the broad entrance of the articular space when the knee is flexed. The demand of hygienic circumstances must content a handling which prevents infection by quite simple methods by local antiseptics for the skin and one-way instruments. With the seldom exception of haemarthros and osteochondral necrosis infection is the utmost danger of knee injection. The putride arthritis should be managed by early synovectomia and movement trauma in order to limit infection and prevent ankylosis. Nevertheless, in case of empyema half of the joints will not regain their pre-existent movement and nearly a quarter loses their natural function.

Adolescent↗
PubMed1987

[Apophyseal rupture of the pelvis and lower extremity caused by sports].

Apophyses are secondary ossification centers and serve as the insertion or origin of tendons. They are under a dynamic but not static load. During sexual maturity, they represent a weak point in the locomotor system. Apophyseal injuries can apparently be attributed to an incongruity between load tolerance and increased strain on the seam of the apophysis. The majority of these injuries occur during sports and involve men more frequently than women. The injury is often primarily misinterpreted as a pulled-muscle. The treatment method is dependent on the localization of the injury and the extent of the fragment dislocation.

Adolescent↗
PubMed1987

[Thermography as an additional study method in the follow-up of reconstructive operations of the hand].

The hand is very accessible to thermography. Disturbed circulation, vascular disease, tissue damage, or other causes of change in thermoproduction lead to deviation from a normal temperature chart. We found a high correlation between thermographic readings and prognosis after replantation. Thermography is, therefore, a method of examination that can be recommended.

Amputation, Traumatic↗
PubMed1986

[Injuries of the distal epiphysis of the humerus in the period of growth].

From 1978 to 1983 in the Orthopedic University Clinic (Oskar-Helene-Heim, Berlin) 75 children with fractures of the distal humerus received medical treatment. The results of 25 intra-articular fractures of the distal humerus in children (ten fractures of the radial condyles, eight fractures of the ulnar epicondyles, three Y-fractures of the condyles, two luxations with additional flake fractures, one fracture of the ulnar condyle) will be reported. The frequency of remaining complications like valgus and varus deformities, pseudarthroses, posttraumatic osteochondroses and "fish tail" deformities are described. The possible mechanism of such developing deformities is discussed. The resulting consequences for the surgical treatment in the future are also discussed.

Adolescent↗
PubMed1986

[Intramedullary nailing as an alternate method in the management of slow-healing or pseudarthrotic upper and lower leg fractures].

Intramedullary nailing of delayed healing fractures and non-unions in the lower extremity is the method of choice in biological and biomechanical aspects. With the technic of interlocking screws the indication is extended to the metaphyseal areas of tibia and femur. By nailing as alternative method an ossification of fractures and non-unions can be reached at a rate of about 90 per cent. This result is rather unique in the literature. In the treatment of shaft non-unions after cast fixation or rigid stabilisation by plates or external fixation nailing must succeed throughout its weight-bearing system and only fails in the case of infection and wrong indication.

Adult↗
PubMedDate not supplied

[Corrective osteotomy of the shaft of the femur and tibia with an interlocking nail].

The indication for nailing a femur or tibia fracture has been extended by the method of interlocking up to the meta/diaphyseal zone. For the stabilization of osteotomies in these regions, the nail was used in 16 cases of femur and 21 of tibia corrections between 1982 and 1986 in orthopedic university clinic Berlin. The osteotomies were done with a small skin incision in open way. Although there were three infections bone consolidation was succeeded in all but one patient with the planned axis. The first achieved gain in length could not be hold in five cases after removing the interlocking screws in order to give full weight bearing to the leg for callus formation. In situations of non-unions with wrong position of refracture of biologically troubled bones after plating the method of interlocking nail is stable and enables bone recovery after grafting by drilling. The possibility of early full weight bearing is a great advantage for the rehabilitation of patients, who had been suffering of the delayed healing of their leg. The nail itself preserves the right position of the bone in two dimensions, even if there are not exact fitting osteotomy fragments, and the interlocking screws secure the bone against malrotation.

Adolescent↗
PubMedDate not supplied

[Arthroscopic diagnosis of disk injury of the wrist joint].

Arthrography of the wrist joint is a possibility to show a disc lesion by demonstrating a communication between the radioulnar and -carpal space in cases of persistent wrist pain after an accident without any bone disorders in x-ray. For differentiation between a pre-existent disc variety with a central whole and a real traumatic tear or degenerative alterations arthroscopy is the method of choice. Furthermore other changes of the wrist as free bodies and chondropathy can be seen. The indication for an arthrotomy and a causal treatment are more exact and were proved by a follow-up of 10 patient between 1985-1987 at the orthopedic university clinic Berlin.

Arthrography↗
PubMedDate not supplied

[Indications and results of the surgical treatment of distal intra-articular humeral fractures in the elderly].

In this paper we review 16 patients with closed intercondylar fractures of the distal end of the humerus that had open reduction and internal fixation. All patients were older than 60 years of age. Using the classification system of Müller et al. 6 fractures were classified as type C2 and 10 fractures as type C3. The surgical procedures and the types of internal fixation of the fractures allowed early postoperative mobilisation (3rd postoperative day). A rating scale modified according to Cassebaum was used for the results. At a mean follow-up of 4.2 years 3 patients were rated as excellent 9 as good and 2 as fair. No severe complications were registered.

Aged↗
PubMedDate not supplied

[Macroreplantation of the upper extremity. Report of experiences based on 4 cases].

Amputation of an extremity frequently represents a life-threatening injury and is accompanied by volume deficiency shock through loss of blood. The loss of an arm leads to diability and thus impairs the physical and psychic integrity of the person concerned. This contribution presents 4 cases with macroamputation at the upper extremity, 3 of them involving successfully performed reimplantations. After a historic survey, these cases are used as a basis for discussing the establishment of the indication, the procedure, the complications and the results of the reimplantation.

Adult↗
PubMedDate not supplied

[Stress fractures of the femur and tibia 8 years after corrective osteotomy with a plate].

Stress fractures of the low extremities 8 years after correcting osteotomy with plate fixation are described and critically valued in 2 cases. As both legs were operated bilaterally, technical faults could be demonstrated in comparison. The alternative treatment with the dynamic system of osteosyntheses by interlocking nailing is the solution of the biological and biomechanical problems and leeds to a physiological bone consolidation.

Adolescent↗
PubMedDate not supplied

[Ventral intercorporal spondylodesis in lumbar instabilities].

Ventral spondylodesis is said to be a useful method for the treatment of lumbar illness in combination with instability and pain. Between 1969 and 1983 62 patients of the Orthopedic University Hospital Berlin were operated for a ventral fusion of the lumbar column, excluded the Dwyer spondylodesis indicated in lumbar scoliosis. 50 of them could be re-examined. The result was good and fair in seventy per cent; the consolidation rate 62 per cent in no relation to the clinical result. Best satisfaction was got by those patient who suffered from spondylolisthesis without any compressions of sciatic nerve. Any previous operation of the nerve root with persistent symptoms lowers the aim of spondylodesis as a salvage procedure. With the experience of the surgeon the method itself is without a higher rate of complication than any other way of spondylodesis.

Adolescent↗