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Biomedical subjects

S Winckler

Publications and source records attributed to S Winckler.

At least 37 records · Page 2Linked to original sources
PubMed1994

[Fracture and dislocation fracture of the os capitatum. Review of the literature and case report].

Capitate fractures are serious and rare carpal injuries. A case of a closed, isolated capitate fracture is presented. The largest fragment of the capitate, which was fractured at its waist, was dislocated with the wrist twisted in an ulnodorsal orientation. The supposed traumatic cause of the capitate fracture was a fall onto the outstretched and ulnar-deviated hand. After open reduction, osteosynthesis with K-wires was performed. Immobilization for 6 weeks in a plaster-of-Paris cast followed. The excellent functional result (according to the modified evaluation scale of Pechlaner/Beck) obtained after 15 months is demonstrated. Diagnosis and subsequent therapy should be as aggressive as in the case of scaphoid fractures. Different modalities and possible complications of an operative treatment are discussed.

Adult↗
PubMed1994

[Distal diaphyseal fracture of the humerus].

Fractures of the distal humeral diaphysis are rare and have not been reported very often in the literature, although therapeutic management is more difficult than that of midshaft humeral fractures. As they are so near to the elbow, these fractures are not suitable for bracing, because pro/supination movements cannot be eliminated. Muscular forces, especially of the pronator teres muscle, force the fracture into a varus position with every supination movement. From 1974 to 1990 we treated 174 fractures of the humeral diaphysis by operative means; 31 of these were located in the distal third. According to the AO classification, 8 were graded as less difficult type A fractures, 15 as type B and 7 as type C fractures. In 22.6% of the patients primary radial palsy was present. In all, 15 fractures were treated by plating, 9 with Hackethal's bundle nails and 6 with monolateral fixators. These last patients had sustained either multiple trauma or severe soft tissue injury or both. The plated cases included 1 with non-union and with superficial infection, both in type C comminuted fractures. In 1 case the fracture was not suitable for plating, and in the other case technical errors led to failure. In the 9 cases treated with Hackethal nails there were no complications. The advantage of the method is that the nails are inserted far distant from the fracture site. Anatomical reduction is not necessary, which means there is no danger of devitalizing fragments; the technique is also quick. In the "fixator" group, we saw 1 case of non-union and 1 of refracture, both following compound fractures.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Plates↗
PubMed1993

[Long-term results of surgical management of patellar fractures].

Between 1973 and 1989, 129 patients with 135 fractures of the patella were treated operatively. More than two-thirds of these patients were younger than 40 years at the time of the accident. The main cause of trauma was a traffic accident in 65.9%. Sixty patients had polytraumata. There were 74 comminuted, 28 transverse, 17 starlike, 10 longitudinal and 6 fractures with one large fragment. Eighty-two patients with 85 fractures were followed up after 8.4 years on average (1.2-16.3 years). The overall results were excellent or good in 64.7%, fair in 18.8% and poor in 16.5%. The best results were seen in transverse fractures after modified tension-band wiring using two longitudinal K wires, and in longitudinal fractures applying screws. Sixty-three percent of the fair and poor results were seen after osteosynthesis of comminuted fractures. In these cases primarily partial or complete patellectomy seems to be indicated instead of just insufficient reconstruction of the retropatellar face. Early functional physiotherapy is very important for all kinds of patellar fractures to gain full range of motion.

Adolescent↗
PubMed1993

[Results of dorsal pelvic ring stabilization].

Complete disruptions of the posterior pelvic ring are rotationally and vertically unstable [type C according to the Tile/AO (ASIF) classification (1991)]. Usually operative treatment is required. The data on 24 patients over a 5-year period were analyzed. Thirteen patients were female (54.2%) and 11 male (45.8%); the average age was 32.8 years. Multiple trauma was present in 20 patients (83.3%). In most cases operative stabilization of the posterior pelvic ring was performed by lag screws from the ilium into the body of the sacrum. The mortality in this series was 16.7% (4 patients). One patient had a thrombosis of the femoral and pelvic veins. In 2 patients we had to perform a second operative procedure because of lag screws that had not been precisely placed or had dislocated. Two incisions healed secondarily. On the postoperative radiographs in 3 patients a slight deformity of the pelvic ring was visible; in another patient the reduction of the injured hemipelvis was not sufficient. The 20 survivors had a clinical and radiological examination on average 27.5 months after their injury. Eleven patients were without pain, while 9 complained of low back pain. Gait disturbances were found in 8 patients; in 2 of them this was due to associated injuries. Five patients were unable to work. Eight patients had neurological deficits, some of them minor. Additional complications were impotence (3 patients), urinary (2 patients) or fecal incontinence (1 patient), and dystocia requiring a cesarean section (1 woman) [multiple entries].(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Resorbable antibiotic delivery systems in local treatment of chronic osteitis--polyglycolic acid/poly-L-lactide as drug carrier. Experimental studies in vitro].

Resorbable polyglycolic acid (PGA)- and poly-L-lactic acid (PLLA) cylinders were investigated in vitro to explore their properties as an antibiotic deposit (Ciprobay, Bayer Leverkusen) with prolonged release. PGA cylinders sized 3.2 x 5 mm, 4.5 x 5 mm and 4.5 x 7 mm respectively were shaped in monofil and polyfil technique. The Ciprofloxacin concentration varied from 0.5 mg to 5.0 mg of each cylinder. The cylinders were eluated in phosphate buffer, pH-value of 7.4, at 37 degrees C. The daily antibiotic release was measured by high performance liquid chromatography. Best combinations we could find demonstrated an initial delivery of Ciprofloxacin in vitro of 67 mg/l. The average daily release was about 16 mg/l during the first 36 days. After complete hydrolysis of the PGA carriers the recovery of Ciprofloxacin reached up to 6.5% and 11.6% respectively. For 40 bioactive cylinders (size phi 3.5 mm x 5 mm, containing 4 mg Ciprofloxacin) were eluated with phosphate buffer (pH 7.4 at 37 degrees C) respectively fresh human blood plasma and tested under various conditions. A gentamicin-polymethylmetacrylate (PMMA) chain (Septopal, E. Merck, Darmstadt) was exposed to equal test conditions for comparison. The quantities of released Ciprofloxacin and Gentamicin were analysed by a microbiological method (bioassay). Initially released rates of Ciprofloxacin were measured very high (up to 180 mg/l) but decreased rapidly within the first 5 days (4.2-22.5 mg/l). The release of Gentamicin produces an initial sharp decrease in concentration during the first 3 days (from 227.5 mg/l to 77.5 mg/l); this is then followed by an almost constant release over a long period of time (about 20 mg/l).(ABSTRACT TRUNCATED AT 250 WORDS)

Ciprofloxacin↗
PubMed1992

Ciprofloxacin-impregnated poly-L-lactic acid drug carrier. New aspects of a resorbable drug delivery system in local antimicrobial treatment of bone infections.

Resorbable poly-L-lactic acid (PLLA) cylinders (3.5 mm diameter, 5 mm in length) carrying 6% of weight ciprofloxacin (Ciprobay, Bayer AG, Leverkusen, FRG) were investigated in vitro to explore their properties as a slow-release antibiotic deposit. Forty bioactive cylinders stored in test tubes were covered with phosphate buffer (pH 7.4 at 37 degrees C) and 40 with fresh human blood plasma and tested under various conditions. For comparison a gentamicin-polymethylmethacrylate (PMMA) chain (Septopal, E. Merck, Darmstadt, FRG) was exposed to similar test conditions. The quantities of ciprofloxacin and gentamicin released were analysed by a microbiological method (bioassay). The concentrations of ciprofloxacin released were analysed by a microbiological method (bioassay). The concentrations of ciprofloxacin released from 40 cylinder were initially very high (up to 180 mg/l) but they decreased rapidly within the first 5 days (4.2-22.5 mg/l). Early release of gentamicin reached up to 227.5 mg/l but dropped to of 22 mg/l on the 14th day. Complete degradation of the PLLA-cylinders was not seen in the observed period of 92 days. The mean loss of mass was 8.4%. The recovery of incorporated ciprofloxacin was 6.5% on average.

Biological Assay↗
PubMed1992

[The treatment concept and results of peri-/sub-prosthetic fractures].

The treatment of choice in ipsilateral femoral shaft fractures in patients with hip prosthesis depends on the location of the fracture lines and the observation of loosening of the prosthesis. Either a change of prosthesis, if necessary in combination with refixation of the greater trochanter or simple open reduction with internal fixation (ASIF) along with autologous and/or homologus spongiosa are the used techniques. The rate of complications in peri- or subprothetic fractures is high. Lack of motion in hip and knee joint occurs frequently.

Adult↗
PubMed1991

[Long-term results after operation of Achilles tendon rupture].

From 1973 to 1986 90 patients with rupture of Achilles' tendon were operated on (4 of these had open ruptures). Different surgical approaches were employed during the period under report. The assessment schemas after Arner/Lindholm and after Trillat formed the basis of both clinical follow-up and a questionnaire operation (participants were 81 patients 10 months to 14 years after the operation). 92.6% good and very good results confirmed the authors' concept of surgical treatment around the 4th or 5th day.

Achilles Tendon↗
PubMed1991

[The most frequent tendon injury: the "mallet finger". Review, therapeutic concept and results].

This study covers treatment and after-treatment of 126 extensor tendon injuries of the DIP-joint in 125 patients over a period of 4 years. Tendon injuries were classified into 4 types and the final results were evaluated using a modified Riedeberger and Zeumer scale. In recent subcutaneous tendon injuries conservative therapy is indicated, depending on the primary extension deficit (less than 20 degrees modified Stack splint, greater than 20 degrees Mommsen plaster of Paris or special dressing). Chip fractures should be stabilized by pull-out suture.

Athletic Injuries↗
PubMed1991

[Therapeutic concept and results of treatment of subcutaneous extensor tendon rupture of the finger end joint].

This study covers treatment and after-treatment of 95 extensor tendon injuries of the DIP-joint in 94 patients over a period of 3 years. Tendon injuries were classified into 4 types according to Suckert et al. and the final results were evaluated using a modified Riedeberger and Zeumer scale. In recent subcutaneous tendon injuries conservative therapy is indicated, depending on the primary extension deficit (less than 20 degrees = modified Stack splint, greater than 20 degrees = Mommsen plaster of Paris or special dressing). Chip fractures should be stabilized by pull-out suture.

Adolescent↗
PubMed1991

[Bundle nailing of forearm fractures. Indications and results].

Hackethal developed the nailing procedure named after him in 1959. The rationale of Hackethal nailing is an elastic jamming, which can only be achieved by obeying four rules: jamming of the nails in the cortical window, jamming then 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. We confined Hackethal nailing to closed and first-degree open fractures of the 2nd-5th sixth of the shaft of the forearm. If closed reduction and nailing were impossible, we performed a plate fixation (AO), in second- or third-degree open fractures we treated with fixators (Orthofix). In a 13-year period we performed Hackethal bundle nailing in 65 patients with 115 fractures. In 54% 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 we needed a plaster of Paris, we achieved rational stability. On average, the nails were removed after 11.5 months. The healing and complication rates were assessed by follow-up examination of 49 patients. The results were excellent and good in 71.5% patients, satisfactory 11.4% and poor in 17.1%. Complications consisted of a 2.1% infection rate (osteitis), 3.1% non-union, 2.1% with a synostosis, 1% refracture (during removal of the nails) and 3.1% migration of nails, combined with tendon rupture. We have seen 1 case with metallosis. In conclusion with our confined spectrum of indications Hackethal nailing is a low-risk method, which leads to a rational stability and early bone healing.

Adult↗
PubMed1991

[Direct radiographic magnification in bone infections].

An experimental model of bacterial osteomyelitis was used to investigate the correlation of direct radiographic magnification and histopathologic changes in the femora of rabbits. The histopathologic changes demonstrated a severe chronic state of osteomyelitis. The extent of radiographic changes was more clearly recognizable with direct radiological enlargement (up to 15-fold) than on normal radiographs: this applied to destruction of marrow and cortical bone, formation of sequestra, and (frequently) extraosseous extension. Histopathologic findings were in agreement with the changes revealed by direct radiographic enlargement.

Animals↗
PubMed1991

[Mechanical impedance: a new, noninvasive method for measuring tissue pressure in tibial compartment syndrome. I. Physical principles and results of an animal experiment].

The basic factor involved in the development of compartmental syndrome is increased tissue pressure, which leads to impairment of microcirculation, the ultimate cause of muscle cell necrosis, In practice, however, the technical side of pressure measurement has its problems since the current invasive methods using intracompartmental catheters are always at risk of infection. It would be preferable to do the assessment in a noninvasive way from the exterior the pressure that prevails inside. An apparatus was developed to measure the mechanical impedance in the soft tissue layer above the anterior tibial compartment: an impedance head is applied to the overlying tissue with a defined initial pressure. The impedance head contains a driving probe that touches the skin, a receptor measuring force, and acceleration. The ratio of force and acceleration describe and record the mechanical impedance [Z = kg/s]. The accuracy of the appliance was tested in a test using the hindlegs of 21 rabbits with compartmental syndrome, which was induced experimentally by gel instillation. The mechanical impedance was measured under increasing tissue pressures in the anterolateral muscle. We performed a total of 100 gel instillations and 121 times the mechanical impedance was measured at a frequency of 20 Hz. The graphs of all 21 measuring series showed an average rise of 0.0243 kg/s per cm H2O. In general, all graphs showed a linear rise in the mechanical impedance that was proportional to the intracompartmentally measured tissue pressures.

Animals↗
PubMed1991

[Mechanical impedance: a new noninvasive method for measuring tissue pressure in anterior compartment syndrome. II. Results of clinical measurements in patients with tibial trauma].

In acute compartmental syndrome, it is difficult to decide on the basis of clinical criteria alone whether fasciotomy is indicated or not. Reliable and objective parameters are required before a treatment schedule can be devised. We tested mechanical impedance as a parameter for the pressure inside the tissue. The technique and associated apparatus for measuring mechanical impedance of the skin overlying the anterolateral compartment of the lower leg are described in detail. We performed the non-invasive measurement in 25 patients with leg injuries. There were 2 patients with acute compartmental syndrome and 5 with imminent compartmental syndrome. In normal legs, the mechanical impedance was between 2 and 6.5 kg/s, with an average of 3.83 kg/s. After the impedance is increased to 10 kg/s or higher, there is acute or imminent compartmental syndrome. Once the compartment has been decompressed by unilateral parafibular fasciotomy, the mechanical impedance decreases to normal values. Clinically relevant results were obtained by this method and they correlated well with the other clinical findings.

Adolescent↗
PubMed1991

[A return to callus healing using dynamic osteosynthesis procedures. Principles, indications, complications, x-ray diagnosis of interlocking nailing and dynamic monofixators in comparison with conventional bone plates].

A disproportionately high rate of complications such as osteomyelitis, nonunion and refracture after plating have brought about a change in our understanding of the process of fracture healing. Locked nailing and dynamic external Monofixators, however, avoid fracture exposure obviate the necessity of arranging fragments and aim at callus healing of fractures. Fracture hematoma and axial micromovements of these dynamic stabilizing devices are two of the yet known elements to promote callus production.

Bone Nails↗