Biomedical subjects

S Winckler

Publications and source records attributed to S Winckler.

At least 19 recordsLinked to original sources

PubMed2006

[Value of a combined ossification prophylaxis with indomethacin and radiotherapy for acetabular fractures].

BACKGROUND: Heterotopic ossification is a complication in patients with surgically treated acetabular fractures. The incidence is related to the surgical approach (extended iliofemoral, posterior or a combined approach). The objective of this study was to evaluate the incidence of heterotopic ossification in patients with acetabular fractures who received a combined prophylaxis with both a single dose of radiation and indomethacin compared to those who received only a prophylaxis with radiation or indomethacin. PATIENTS AND METHODS: A total of 24 patients with a combined prophylaxis after surgery were examined retrospectively 24 months after trauma. A systematic literature review was performed and our own results were compared with different methods for prophylaxis of heterotopic ossification from the literature. RESULTS: Only one patient developed a heterotopic ossification. In accordance with the literature, combined prophylaxis showed the least incidence of ossification compared to the other methods. Differences in incidence frequencies were significant between the different prophylaxis methods. CONCLUSION: A combined prophylaxis for heterotopic ossification in surgically treated acetabular fractures seems to be a better alternative than a prophylaxis with radiation or indomethacin alone.

Acetabulum↗

PubMed2004

Expression of cell surface antigens in diabetic patients and healthy controls after injury.

AIMS: Due to the systemic character of Type 2 diabetes, cellular disturbances paralleled by an altered expression of various growth factors constitute the basis for impaired wound healing. Cell-surface antigens are altered in chronic wounds and may also have an effect on the persistance of diabetic foot lesions. METHODS: We investigated blood samples of diabetic patients with diabetic foot ulcers (n=21) in comparison with those from healthy control patients subsequent to an injury (n=9). A blood sample (EDTA) was taken from each participant (in the trauma control group on the third day after injury) and examined by flow cytometry [fluorescence-activated cell sorter (FACS)]. Typical cell surface antigens involved in wound healing were studied [cluster of differentiation (CD)2, CD3, CD4, CD25 and human leukocyte antigen (HLA)-diabetic retinopathy (DR)]. RESULTS: known to adversely affect wound healing were elevated in diabetic patients (CD2 p<0.001; CD3 p=0.016, CD4 p=0.22, CD25 p<0.001). HLA-DR expression was also decreased in diabetic foot patients (p=0.023). CONCLUSIONS: Cell-surface antigens appear to be altered in diabetic patients when compared to healthy controls. Thus, due to the systemic character of Type 2 diabetes, cellular disturbances may well constitute the basis for impaired wound healing in diabetes.

Adult↗

PubMed2003

[Quality of life after calcaneal fractures. A matched-pairs trial with a standardised German control group].

The purpose of the study was the assessment of the limitations of health related quality of life after open reduction and internal fixation (ORIF) of calcaneal fractures and the comparison of these results with those of normal foot-scores. The quality of life of 55 patients with calcaneal fractures treated by ORIF was compared 2.9 years after injury with that of 55 people from the standardised German population of the German-Health-Survey 1998 using the Short Form 36 (SF-36) (Wilcoxon test). The results of SF-36 of patients were correlated with results of the calcaneus score according to Zwipp and AOFAS Ankle Hindfoot Scale (Spearman's correlation coefficient). Health related quality of life showed significant limitations in patients with calcaneal fractures in 9 of 10 scales of the SF-36. Correlations between SF-36 and foot-scores were strong in the function and pain scale and moderate in all other scales. The quality of life of shows significant limitations after calcaneal fractures. Usual foot-scores measure only the function and pain dimension of the outcome. To measure all dimensions, application of the SF-36 can be recommended. International comparisons of results and comparison with a standardised German population is possible.

Activities of Daily Living↗

PubMed2003

[Intramedullary stabilisation of metastatic fractures of long bones].

UNLABELLED: Surgical treatment of metastatic fractures of long bones is mostly a palliative one. Intramedullary stabilisation without resection of metastases follows the aim of the palliative therapy concept. PATIENTS AND METHODS: From 01.01.1995 to 30.08.2001 36 manifest and 4 impending long bone fractures were registered in 22 female and 16 male patients, with a mean age of 63 years. In addition, one revision was necessary due to persisting instability after humeral intramedullary bundle nailing. Pathological fractures were found in the humerus (n=11), femoral neck (n=6), per- and subtrochanteric region (n=12), femoral shaft (n=10) and tibia (n=2). Most of them were malignancies of the kidneys (n=13), bronchi (n=7) and breast (n=6). One patient with a solitary metastasis in the humerus received curative treatment by resection, open reduction and internal fixation. All other cases underwent palliative stabilisation. Metastatic lesions of the femoral neck were treated by resection and prosthetic replacement. The remaining fractures were stabilized intramedullarily without resection of metastases or use of bone cement. In 9 cases, a locking nail was implanted in the humerus, and one patient received humeral bundle nailing. In the lower extremities, we used a classic-nail or gamma-nail in 15 and a locking nail in 8 cases. Two moribund patients did not undergo surgery. RESULTS: No intraoperative complications occurred. 63 % of the patients with stabilisation of the leg were able to walk at the time of discharge. The mean survival time (Kaplan-Meier) of patients after palliative operation amounted to 161.5 days (95 % CI 92.7; 230.3). We found 6 postoperative complications: temporary palsy of the radial nerve (n=1), soft tissue infection (n=1), dislocation of the nail (n=2), loosening of the distal locking screw (n=1), proceeding osteolysis with high fracture risk (n=1). CONCLUSION: Intramedullary stabilisation without resection of metastases using locking nails meets the requirements of palliative therapy. This procedure is less invasive and allows early weight bearing.

Adult↗

PubMed2002

[Comminuted radial head fractures. Initial experiences with a Judet radial head prosthesis].

PURPOSE OF THE STUDY: Comminuted fractures of the radial head represent a particular therapeutic problem. Due to characteristic complications the resection as well as the implantation of the Swanson-prothesis could not convince. MATERIAL AND METHODS: We applied the radial head prothesis of Judet in 16 cases (14 type IV and 4 type III by Mason). RESULTS: At the moment we survey the follow up of 15 patients after 12 to 45 months (average 18.2), the evaluation was performed using the score of Radin and Riseborough and the score of Morrey. With the score of Radin and Riseborough we found in 7 cases good, in 6 case fair and in 2 case poor results. With the score of Morrey we found 2 excellent, 11 good and 1 fair and poor results. The radiological examination did not show an increase of the carrying angle of the elbow, an osteoporosis, a proximal migration of the radius and a distal radio-ulnar dissociation. CONCLUSION: Compared with resection or Swanson-prothesis the bipolar prothesis of Judet has definite advantages.

Adult↗

PubMed2002

[Retrograde intramedullary nailing of femoral shaft fractures. A prospective study].

PURPOSE OF THE STUDY: Antegrade intramedullary nailing is seen as a most effective method in the management of femoral fractures. However, complications may arise due to the surgical approach.Can these disadvantages be avoided by using a retrograde approach? MATERIAL AND METHODS: In a prospective study 70 femoral fractures in 62 patients were stabilised using a long intramedullary nail by a retrograde approach. RESULTS: We were able to re-examine 50 patients (57 fractures) 13,3 (3-36) months after the operation. Apart from one non-union by infection, all fractures healed in time. Flexion of the knee joint was within a normal ROM in 81% of shaft fractures 12 months or more after the operation, as was the case in 44% of distal fractures. A inhibition of extension was not found in any patient. Two patients had a femoral shortening of up to one centimeter. We observed no rotational malalignment of more than 5 degrees. The clinical results were excellent in 89% of shaft fractures, and in 50% of supra-/diacondylar fractures. In 18 cases a nail removal was already performed, thereby allowing an arthroscopic follow-up inspection of the knee joint. No knee pathology due to nailing was found in either case. CONCLUSION: Our results show the advantages of retrograde intramedullary nailing in comparison to the antegrade method.

Adolescent↗

PubMed2002

[Quality of life after foot injuries].

OBJECTIVE: Assessment of quality of life after foot injuries. METHODS: All patients with foot injuries treated operatively from July 1995 to December 1999 were asked to complete the SF-36 health survey. Values of four subgroups (male with foot injuries without any other injury, multiple injured male with foot injuries, male without any other injury and both calcaneus fractures or other injuries) were compared with the standardized German population (Mann-Whitney-U-Test, alpha = 0.05). RESULTS: 110 of 201 patients completed the questionnaire (follow-up 54.7 %). Values of most of the subscales showed significant differences in comparison with the standardized population for three of four groups. Men with calcaneus fractures revealed the highest disabilities especially for the pain subscale. Quality of life in multiple injured patients is dominantly influenced by foot injuries. CONCLUSIONS: Foot injuries cause a strong limitation of quality of life. The SF-36 health survey provides a very suitable outcome measurement for foot injuries.

Adolescent↗

PubMed2002

[Fresh fractures of the radial head: results with the Judet prosthesis].

PURPOSE OF THE STUDY: Communitive fractures of the radial head are a therapeutic challenge when fixation is not possible. Secondary sequelae including ulnar valgus, ascension of the radius, osteoporosis of the humeral condyle and biomechanical impairment of the elbow cannot be avoided with resection or the Swanson prosthesis. The Judet prosthesis, with its floating cup, is a technically attractive solution, but the question is whether it can avoid the secondary effects observed with resection or the Swanson prosthesis. MATERIAL AND METHODS: We have used the Judet prosthesis since August 1995 in 16 patients. These patients had Mason type IV (Johnston modification) lesions of the radial head in 14 cases and type III lesions in 2. Associated injuries included: Monteggia fracture in 2, open fracture-dislocation in 1, fracture of the radial neck associated with fracture of the lower radius in 1, and dislocation of the elbow in 2. Preoperatively, 7 of the 16 patients had an osteocartilaginous injury of the humeral condyle. The Judet prosthesis was implanted after resection in 3 patients, after osteosynthesis of the radial head in 3 others, and as the first line treatment in 10. Postoperatively, 13 of the 16 patients were given a unique 7 Gy radiation to prevent ossification as well as nonsteroidal antiinflammatory drugs (indometazin 50 mg b.i.d.) for 3 weeks. None of the patients were immobilized. RESULTS: Mean follow-up for the 16 patients was 19 months (12-45). Deficient extension persisted in 5 patients (mean 5 degrees ). Average flexion was 128 degrees; two patients were limited to 100 degrees. Average pronation was 77 degrees, and average supination 79 degrees. Muscle force was 10% weaker than the healthy side. Sagittal and frontal stability in valgus was preserved in 14 patients. Two patients had a frontal instability with minimal valgus related to a minor insufficiency of the medial collateral ligament. According to the Radin and Riseborough classification, outcome was good in 7, fair in 6 and poor in 3. According to the Morrey classification, outcome was excellent in 2, good in 12, fair in 1 and poor in 1. Radiologically, there were no cases with ulnar valgus, humeral condyle osteoporosis, ascension of the radius, or subluxation of the distal radioulnar joint. The prosthesis loosened in one case without clinical expression. DISCUSSION: Our results with the Judet prosthesis were much better than those reported in the literature for resection and Swanson prosthesis.

Adult↗

PubMed2001

[Arterial vascular injuries in fractures and dislocations].

We analyzed reasons, numbers and results of arterial lesions accompanying fractures (n = 21) and luxations (n = 6) in a 6-year-period (1993-1998) retrospectively. Traffic accidents were in nearly 50% responsible for the injuries. 8 patients had suffered multiple injuries. In 17 patients the lower, and in 10 patients the upper extremities were affected. The vascular wall was completely disrupted or severed in 74%. In 7 cases (26%), patients had suffered blunt or indirect arterial trauma with intima- and media-lacerations due to subcapital fracture of the humerus (n = 2), fractured femoral bone (n = 1), luxation of the knee joint (n = 3) or the elbow (n = 1). The mean preoperative time period was 6 hours and 20 minutes (2 to 16 hours) in patients with complete ischaemia. Vascular reconstruction was performed by interposition of an autologous vein graft or an autologous venous bypass (n = 20), by direct reconstruction and primary suturing (n = 2), by use of a venous patch plasty (n = 2) and, in a single case, by autologous bypass procedure. In one case, a crural artery was ligated, in another case with a Mangled Extremity Severity Score (MESS) of 7 points a primary amputation of the lower leg was necessary. In 5 patients (19%) secondary amputations were performed. No patient died. The final outcome is mostly influenced by the preoperative period of ischaemia.

Adolescent↗

PubMed2000

Bactericidal effect of extracorporeal shock waves on Staphylococcus aureus.

Despite considerable knowledge about the effects of shock waves on eukaryotic soft tissues, no data are available concerning their effect on prokaryotic micro-organisms. In vitro studies on the bactericidal effect of extracorporeal shock waves on staphylococci were performed with energy levels that are standard for the disintegration of calculi. Suspensions containing 10(4)-10(5) cfu of Staphylococcus aureus/ml were sealed in plastic tubes and exposed to shock waves, resulting in a mean decrease of 3.1 log(10). Whereas impulse rates of > or =350 resulted in a decrease of cfu/ml equalling the detection limit, lower numbers of impulses did not result in an appreciable bactericidal effect. The bactericidal effect of extracorporeal shock waves might provide the basis for the development of novel therapeutic strategies for bacterial infections.

Lithotripsy↗

PubMed1999

[Pseudarthrosis of an occult fracture in zone III of the sacrum].

Fractures in the midline of the sacrum are rare, a pseudarthrosis has not been described previously. We report about a 53-year-old woman with a midline fracture of the sacrum which has not been recognized, although there were indirect fracture signs on the native x-rays and a CT was performed. The surgical treatment with sacral compression bars was successful and pseudarthrosis healing resulted but the patient continued to have mild low back pain. The case reported here confirms that low back pain may caused by pathologic changes of the posterior part of the pelvis. The unusual fracture location could be caused by a bifid spinous process.

Female↗

PubMed1997

[Paraproctic fistula in acetabulum loosening after implantation of a total hip endoprosthesis. A rare complication].

In this paper we present the unusual case of a fistula after implantation of a total hip prosthesis. In a 75-year old woman with a fracture of the thigh bone, we observed a paraproctic fistula 42 months after implantation of a total hip prosthesis. To our knowledge there have been no such cases reported with this complication. Thus, we wound like to demonstrate the progress of the illness, the first symptoms, and the kind and success of the treatment.

Acetabulum↗

PubMed1997

[Intramedullary nailing in forearm shaft fractures--an 18 year retrospective study of a patient sample].

Between 1976 and 1993 we have operated 253 patients with 350 fractures of the radius-and/or ulna. 180 fractures were stabilized with a plate (ASIF) or external fixation. In 100 patients with 170 fractures Hackethal's bundle nailing was performed, including 23 times nailing of one bone and external fixation or plating of the other bone. Our indications for Hackethal's bundle nailing of forearm fractures are closed and 1 degree open A and B-fractures of the 2. to 5. sixth of the radius and/or the ulna. 83 of 100 patients, stabilized with bundle nailing, were followed up clinically and radiologically after a mean of 6.8 years. For evaluating follow-up results, the score by Oestern and Tscherne was employed. Very good and good results were found in 74.7%, satisfying and poor results in 25.2% of the cases. Injuries of the same extremity, e.g. fractures of the humerus, arterial- or nerve lesions interfered with the results. We found a low complication rate after bundle nailing: 1 osteomyelitis (0.59%), 3 non-unions (1.76%), 1 refracture (0.59%), 5 synostoses (4.12%, incl. 2 patients (1.18%) with a combination of bundle nailing and plate osteosynthesis or external fixation). In the mentioned indications the stabilization of forearm fractures by Hackethal's bundle nailing is a low-risk method with fast bone healing and short operation time.

Adult↗

PubMed1996

Clinical and biomechanical aspects of external fixation of the pelvis.

OBJECTIVE: The aim was to evaluate the mechanical stability of several traditional and modern external fixators in unstable pelvic ring disruption. DESIGN: In a laboratory study external and internal fixation techniques were tested in seven fresh and five embalmed human pelves with a disruption of the pubic symphysis and one sacroiliac joint (type C1.2 injury according to the Tile-AO classification). BACKGROUND: Stability provided by external fixation depends upon many factors, with the residual pelvic stability being the most important. METHODS: Simulating a single-leg stance, the load was applied quasi-statically to the acetabulum of the unstable hemipelvis. Device failure was defined as displacement >10 mm either at the symphysis pubis or the sacroiliac joint. RESULTS: The frame with the highest failure load (fresh versus embalmed specimens) was the Egbers configuration with the AO fixator (analysis of variance; P < 0.05). Failure was noted at 114.9 N versus 129.5 N. Augmentation of the Mono-Tube by additional internal posterior osteosynthesis gave the following results: sacral bars 325.4 N versus 217.8 N, plate fixation 294.3 N versus 215.8 N, lag screws 338.4 N versus 215.8 N. Failure loads of hybrid fixation of the Orthofix were as follows: sacral bars 257.9 N versus 213.9 N, plate fixation 333.5 N versus 245.3 N, lag screws 397.3 N versus 280.6 N. The differences between the two fixators were not statistically significant. CONCLUSIONS: No single external frame provided sufficient stability. The addition of a posterior internal fixation significantly increased failure loads and controlled the weight-bearing pelvic elements.

Journal Article↗

PubMed1996

[Efficacy of intramedullary stabilization of pathologic femoral shaft fractures].

We report here on the treatment with intramedullary nailing or gamma nailing of 23 pathological femoral shaft fractures, 14 patients having tumors or metastases. Thirteen (13/14) tumor patients were treated palliatively and one patient radically. The results were that 10 patients were able to walk after the operation, all patients gained considerable relief from pain and nursing was facilitated. Intramedullary nailing or gamma nailing offers, in the given indications, a good alternative to the other osteosynthesis procedures.

Activities of Daily Living↗

PubMed1995

[Multifascicular intramedullary nailing of the forearm].

PURPOSE OF THE STUDY: Purpose of the study was to present the advantages of intramedullary nailing of long bones for treatment of fractures of the forearm. These advantages are 1) preserving the fracture-hematoma and 2) non exposure of bone. This technique is based on the technique of bundle nailing developed by Hackethal (1959). MATERIAL AND METHODS: In a 16-year period we performed Hackethal bundle nailing in 94 patients with 159 fractures. Hackethal developed the nailing procedure named after him in 1959. The rationale of Hackethal nailing is based on elastic jamming, which can only be achieved by following four rules: jamming of the nails in the cortical window, jamming then in the waist of the medullary cavity, spreading the bundle of nails in the metaphysis and filling up the conus of the medullary cavity with short nails. We confined Hackethal nailing to closed and first-degree open fractures of the midshaft of the forearm. If closed reduction and nailing were impossible, we performed a plate fixation (AO). Second- or third-degree open fractures were treated with external fixators. RESULTS: In 62.8 per cent patients surgery was performed within the first 8 hours following admission. We used two or three nails passing the fracture and one short nail. Except for 1 case, in which a cast was necessary, we achieved rotational stability. On average, the nails were removed after 11.5 months. The healing and complication rates were assessed by follow-up examination of 77 patients. The results were excellent and good in 75.3 per cent patients, satisfactory 14.3 per cent and poor in 10.4 per cent. Complications consisted of a 0.74 per cent infection rate (osteitis), 2.2 per cent non-union, 1.5 per cent with a synostosis, 0 per cent refracture and 2.2 per cent migration of nails, combined with tendon rupture. We have seen 1 case with metallosis. DISCUSSION: There are four important benefits of this treatment. First with this principle bone healing is achieved after 2.6 month, but with the plate fixation it lasts 7.5 month. Second, the rate of non-union goes down from almost 6 per cent to 1.5 per cent. Third, the postoperative infection rate is reduced (0.74 per cent) and fourth joint motion is preserved. Our bad results are mainly caused by the polytraumatic conditions of some patients. CONCLUSION: In conclusion with our confined spectrum of indications Hackenthal nailing is a low-risk method, which leads to rotational stability and early bone healing.

Adult↗

PubMed1995

[Transposition of the extensor indicis tendon in reconstruction of thumb extension after rupture of the extensor pollicis longus tendon].

During a period of 13 years we performed 56 extensor indicis proprius (EIP) transpositions for reconstruction of the ruptured or severed extensor pollicis longus tendon. The open injuries (n = 9) involved failed primary repair or untreated tendon injuries. The subcutaneous ruptures occurred after distal radius fractures (n = 17) or other closed injuries of the wrist (n = 10), without trauma in 14 patients and in 6 patients by rheumatoid synovialitis or collagenosis. 35 patients returned for follow-up examination 8 months to 10.5 years after operation. According to the evaluation scheme suggested by Geldmacher et al. we report 13 excellent, 19 good and 3 satisfactory results. Although several authors prefer EPL reconstruction with an intercalated tendon graft, we recommend the EIP transposition as a simple procedure with predictable satisfactory results.

Adolescent↗

PubMed1995

Bundle nailing of diaphyseal fractures of the humerus.

The principles of bundle nailing--jamming of the nails in the cortical window, jamming in the waist of the medullary cavity, spreading the bunch of nails in the metaphysis and filling up the conus of the medullary cavity with short nails-should be observed. Then this method of intramedullary osteosynthesis is of diaphyseal fractures with slight damage to the soft tissues is indicated ideally in the second to fifth sixth of the humerus. The complication rate is low. If there is a primary traumatic lesion of the radial nerve or if there are open fractures and/or multiple fractures in case of polytraumatized patients, operative stabilization is mandatory using plate osteosynthesis or external fixation.

Adolescent↗