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  • 1
    Electronic Resource
    Electronic Resource
    Grenzen der arthroskopischen Arthrolyse des Kniegelenks (1999)
    Springer
    Arthroskopie 12 (1999), S. 268-273 
    Details
    ISSN: 1434-3924
    Keywords: Schlüsselwörter Knie ; Arthroskopie ; Arthrolyse ; Judet-Operation ; Key words Knee ; Arthroscopy ; Arthrolysis ; Judet operation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: The development of minimally invasive and arthroscopic techniques as well as early rehabilitation has brought a significant increase in the functional outcome of joint mobility following knee surgery. Despite this fact, surgeons are still being confronted with an increasing number of knee operations in patients suffering from limited knee motion or arthrofibrosis. Several surgical techniques to improve knee mobility can be performed, depending on the amount and characteristics of immobility. Indications for arthoscopic or open surgery should be based on an algorhithm. The goal of this paper is to present this algorhithm and discuss the limitations of arthroscopic procedures. In seven patients with an average range of motion of 42.8° preoperatively, an open procedure had to be performed. The average range of motion intraoperatively was 115° and 97.8° at follow-up after 22.4 months.
    Notes: Obwohl verfeinerte, minimalinvasive Operationstechniken sowie neue Implantate in der Kniegelenkchirurgie zumeist eine frühfunktionelle Nachbehandlung ermöglichen und eine langfristige Ruhigstellung vermeiden, ist man auch sicher aufgrund der steigenden Zahl an Eingriffen in der täglichen Praxis immer wieder mit Patienten mit störenden Bewegungseinschränkungen des Kniegelenks konfrontiert. Dauer und Art der Gelenksteife, Ausmaß und Sitz des Bewegungshindernisses sowie Umfang der Funktionseinschränkung indizieren zwar die jeweilige Vorgangsweise, die Indikationsstellung gestaltet sich jedoch aufgrund der Komplexität des pathomorphologischen Substrats der Arthrofibrose problematisch. Diese Arbeit versucht anhand der Empfehlungen anderer Autoren sowie eigener Erfahrungen nach 7 offenen Arthrolysen die Grenzen der arthroskopischen Arthrolyse bzw. die Indikation zum offenen Eingriff aufzuzeichnen. Bei den 7 Patienten wurde die Beweglichkeitsamplitude von präoperativ durchschnittlich 42,8° intraoperativ auf einen Wert von durchschnittlich 115° angehoben, fiel jedoch bei der Nachuntersuchung (im Schnitt nach 22,4 Monaten) auf durchschnittlich 97,8° zurück.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001420050136
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  • 2
    Electronic Resource
    Electronic Resource
    Die chirurgische Therapie des stenosierenden Ulcus duodeni —Ergebnis einer unkontrollierten Vergleichsstudie (1986)
    Springer
    Langenbeck's archives of surgery 368 (1986), S. 233-239 
    Details
    ISSN: 1435-2451
    Keywords: Duodenal ulcer ; Stenosis ; Highly selective vagotomy ; Resection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung In einer unkontrollierten Vergleichsstudie an 77 Patienten wurden die Ergebnisse verschiedener Operationsverfahren beim stenosierenden Ulcus duodeni untersucht. Die Zuordnung zu den Verfahren erfolgte nach Präferenz des Operateurs. Die Nachuntersuchung erfolgte ohne Kenntnis des Operationsverfahrens im Median 40–42 Monate nach dem Eingriff. Die postoperative Letalität betrug nach Resektion 6,6%, nach Vagotomie + Drainage 0%. Hinsichtlich der postoperativen Folgeerscheinungen schnitt die selektiv proximale Vagotomie + Gastroduodenostomie mit 15 von 17 Visick I am besten ab. Bei der Resektion hatten nur 15 von 33 Visick 1. Am schlechtesten was das Ergebnis nach selektiv proximaler Vagotomie mit Pylorusbougierung, wo 4 von 9 Visick IV hatten. Dieses Verfahren wurde aufgegeben.
    Notes: Summary In an uncontrolled trial on 77 patients we investigated the results of different surgical procedures in stenosis secondary to duodenal ulcer. The assignment to a procedure was dependent on the preference of the surgeon. The follow-up investigation after a mean observation time of 40–42 months was performed without knowledge of the surgical procedure. The postoperative mortality was 6.6% after resection, 0% after vagotomy and drainage. Postoperative sequelae were lowest in highly selective vagotomy + gastroduodenostomy (Visick I in 15 out of 17). After resection only 15 out of 33 had Visick 1. The worst result was obtained after selective vagotomy and pyloric dilatation (4 out of 9 Visick IV). This procedure has been given up.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01263212
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  • 3
    Electronic Resource
    Electronic Resource
    204. Thromboembolieprophylaxe bei hüftgelenksnahen Oberschenkelfrakturen. Ergebnisse einer prospektiven randomisierten Studie zwischen Heparin 5000 DHE und Acetylsalicylsäure (ASS) 0,5 G + 2,5 mg DHE (1986)
    Springer
    Langenbeck's archives of surgery 369 (1986), S. 754-754 
    Details
    ISSN: 1435-2451
    Keywords: Thromboembolism ; Heparin-DHE ; Acetylsalicylic acid ; Femur ; Thromboembolie ; Heparin DHE ; Acetylsalicylsäure ; Oberschenkel
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung In diese Studie wurden 404 Patienten aufgenommen. Die Wirksamkeit der Prophylaxe wurde mittels Perfusionsszintigraphien (mind. 3 x), täglichen klinischen Kontrollen und durch Autopsie der Verstorbenen überprüft. Die Prophylaxeabbruchrate war in der ASS-DHE Gruppe, insbesondere wegen gastrointestinaler Komplikationen und Phlebothrombosen deutlich höher; die allgemeine Mortalität, Mortalität an embolischen Komplikationen war hingegen ebenso wie die Rate positiver Scans in beiden Gruppen vergleichbar und ohne statistische Signifikanz. ASS-DHE ist zur Prophylaxe von Embolien gleich wirksam wie Heparin DHE. Es wird oral verabreicht, die Prophylaxe kann auch nach der Entlassung des Patienten fortgesetzt werden. Die Beurteilung der Wirksamkeit einer Thrombembolieprophylaxe nur an Hand der Häufigkeit von Phlebothrombosen ist unsicher und abzulehnen.
    Notes: Summary A prospective randomised study of 404 patients with fractures of the proximal end of the femur compared the effectiveness of prophylaxis of thromboembolism from heparin (H) 5000 dihydroergotamine (DHE) and acetylsalicylic acid (ASS) at dosages of 0.5 g ASS with 2.5 mg DHE. The effectiveness of the prophylaxis was proved by perfusion scans, of the lung at least three times, by autopsy and by clinical monitoring. The prophylaxis had to be stopped in the ASS-DHE group more often than in the heparin group, especially because of gastrointestinal complications and phlebothrombosis, but the frequency of positive scans the general mortality and mortality due to embolism were absolutely comparable, there being no significant statistical difference. For prophylaxis of embolism, ASS-DHE is comparable to heparin with DHE. The possibility of continuing prophylaxis with oral ASS-DHE after discharge is a great advantage. Judgement of the effectiveness of prophylaxis of thromboembolism simply by the rate of phlebothrombosis is unreliable and not acceptable.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01274522
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  • 4
    Electronic Resource
    Electronic Resource
    199. Vorteile der zementierten Hemiprothese bei Schenkelhalsfraktur im hohen Alter (1987)
    Springer
    Langenbeck's archives of surgery 372 (1987), S. 849-850 
    Details
    ISSN: 1435-2451
    Keywords: Femoral neck fracture ; Femoral head prosthesis ; Complication rate ; Schenkelhalsfraktur ; Hüftkopfprothese ; Komplikationsrate
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Von 1975–1986 wurde bei 420 Patienten (Ø Alter 81,7 a) eine zementierte Hüftkopfprothese implantiert. Indikation: Schenkelhalsfraktur Typ Garden III und IV bei über 75jährigen und bei Patienten im reduzierten AZ. Die Operation erfolgte nach Ø 4 Tagen (Operationsdauer Ø 45 min, Blutverlust (Ø 1,9 Konserven). Nach 5 Tagen wurde mit der Mobilisation unter Vollbelastung begonnen. Innerhalb der ersten zwei Monate verstarben 53 (12,6%) der Patienten. Nach 8–193 Monaten (Ø 41 Monate) leben 151 Patienten (35,9%); 120 (80%) sind selbständig gehfähig, 133 (88%) schmerzfrei. Reoperationen waren 5mal (1,2%) nötig (2mal Protrusion, 1mal Lockerung, 2mal chronischer Infekt). Protrusionen fanden wir 13 (3% der Operierten, 8,6% der Lebenden). Nur 3 (2mal OP, 1 mal Schmerzen) führten zu Problemen.
    Notes: Summary From 1975 to 1986, a cemented femoral head prosthesis was implanted in 420 patients (median age: 81.7 years). Indications were femoral neck fractures of type Garden III and W in patients over 75 years and in poor general condition. The operation was done after an average of 4 days (duration about 45 min, blood loss around 1.9 pints). Full weight-bearing started after 5 days. Fifty-three (12.6%) patients died within the first 2 months. Out of 151 (35.9%) patients who are alive after 8 to 193 months (average of 41 months), 120 (80%) are fully mobilized and 133 (88%) free of pain. Protrusions were found in 13 patients (3% of the cases operated on or 8.6% of the survivors). There was a problem in only 3 cases (surgery: 2, pain: 1).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01297983
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  • 5
    Electronic Resource
    Electronic Resource
    Rotational instability and integrity of the interosseous membrane in cadaveric ulnar shaft fractures (1998)
    Springer
    Archives of orthopaedic and trauma surgery 118 (1998), S. 53-56 
    Details
    ISSN: 1434-3916
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The stability of isolated ulnar shaft fractures required further investigation because no data were available for fractures in the middle third or on the effect on rotational stability. Ten intact cadaveric arms were used to study the pathomechanics of fractures of the middle ulna. In all of them a transverse osteotomy was performed (A), then in five of them, an additional osteotomy was done in order to create a third fragment (B). The interosseous membrane was subsequently divided for 2 cm on either side of the osteotomy (A→C, C→D). On radiographs the displacement was recorded in pronation and supination, and the rotational displacement was calculated. Rotational instability occurred in all fractures studied, even in the so-called stable ones. Also, dissection of the interosseous membrane was not followed by a displacement of more than 50%, and shortening of the ulna should also be considered in fractures with less than 50% displacement as a sign of instability.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004020050311
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  • 6
    Electronic Resource
    Electronic Resource
    Mechanical properties of a rat patellar tendon stress-shielded in situ (2000)
    Springer
    Archives of orthopaedic and trauma surgery 120 (2000), S. 70-74 
    Details
    ISSN: 1434-3916
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The effects of stress deprivation on the mechanical properties of the patellar tendon (PT) were studied using 14 albino rats. The PT was stress-shielded with cerclages on one side, while the contralateral patellar tendon served as a sham-operated control. After 10 weeks, paired load-strain as well as load-relaxation experiments were performed (11 and 3 specimen pairs, respectively). Mechanical tests showed, irrespective of the cerclage material used, that strain was increased significantly after stress-shielding (P 〈 0.02). The time constant significantly decreased in the stress-shielded specimens under ¶5 N loads, which may be considered ‘physiological’. Tissue remodeling might explain the observed changes in the viscoelastic behaviour of the stress-shielded tendons. Loading, even in the physiological range of normal daily activity, may lead to an elongation of previously stress-shielded tendons or ligaments and consequently alter the behaviour of a joint.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004020050014
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  • 7
    Electronic Resource
    Electronic Resource
    Cyclops and cyclopoid formation after anterior cruciate ligament reconstruction: clinical and histomorphological differences (1999)
    Springer
    Knee surgery, sports traumatology, arthroscopy 7 (1999), S. 284-289 
    Details
    ISSN: 1433-7347
    Keywords: Key words ACL reconstruction ; Cyclops syndrome ; Histomorphology ; Tibial tunnel placement
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract Prospectively, 119 patients were pursued clinically and by follow-up-arthroscopy for the occurrence of a “cyclops syndrome” after ACL reconstruction with a patellar tendon autograft, augmented by LAD. Twenty-one patients showed nodular formations. Ten of these (group 1) developed early clinical evidence of a “cyclops syndrome” with a mean extension deficit of 19° before follow-up-arthroscopy, on average 5.9 months after the index operation. The nodular formations found and excised during débridement had a hard consistency. Histomorphological undecalcified microtome section evaluation of six specimens revealed fibrocartilagineous tissue with active bone formation in the center. The other 11 patients showed no clinical symptoms (group 2). A similar but soft nodulous scar formation was detected at follow-up-arthroscopy, on average 9.5 months after the index operation. Histomorphologically these so-called “cyclopoid” formations were only built-up fibrocartilagineous islands surrounded by granulation tissue. Neither remnants of tendon graft fibers nor old bone particles were found in specimens of either group. It can be concluded that both the hard cyclops and the soft “cyclopoid” are de novo scar formations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001670050165
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