| 1. |
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| 2. |
- Gohritz, A, et al.
(författare)
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Ersatzoperationen bei Ausfall motorisher Funktionen an der Hand : Tendon transposition to restore muscle function in the hand
- 2007
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Ingår i: Der Unfallchirurg. - : Springer Science and Business Media LLC. - 0177-5537 .- 1433-044X. ; 110:9, s. 759-76
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Tidskriftsartikel (refereegranskat)abstract
- Nerve injuries in the upper extremity can result in severe disability. In the last three decades, progress in microsurgical techniques has improved the outcome for nerve injuries and if the prognosis is reasonably good, nerve repair should usually be performed prior to tendon transfer procedures. However, above all proximal lesions of peripheral nerves such as high radial nerve palsy still often yield unsatisfactory results, despite a technically well-executed nerve repair. Prognosis further depends on the time interval since the injury and also on the age of the patient, as the regenerative process is delayed in older patients. The indication for tendon transfers strongly depends on the personal and professional profiles of the individual patient. Tendon transfer procedures alleviate the suffering from functional hand impairment providing a superior alternative to permanent external splints. Tendon transfers are usually secondary procedures for replacing function after evaluation of the functional motor loss. Numerous transfer procedures have been described for every nerve trunk of the upper extremity, their prognosis depending mainly on the extent and pattern of nerve loss, local effects of the trauma (e.g. involvement of soft tissues, joints), and the physiological characteristics of the transferred muscle. Even if the results of the tendon transfers may finally be less satisfactory in cases of complex nerve damage than in isolated motor nerve lesions, they offer a valuable functional benefit, often being the only possibility to restore hand function. Although regrettably underused, tendon transfer improve upper extremity function in more than 70% of patients with cervical spinal cord injury. Reconstruction of key elements such as wrist extension, key grip between the thumb and the index finger, or digital flexion and extension leads to highly improved use of the tetraplegic hand and thus provides new mobility and independence from the help of others. This article presents an overview of the most common procedures to restore hand function in peripheral nerve injuries and tetraplegia in order to provide a systematic approach for decision making.
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| 3. |
- Gohritz, A., et al.
(författare)
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[Nerve and muscle transfer surgery to restore paralyzed elbow function]
- 2008
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Ingår i: Unfallchirurg. - : Springer Science and Business Media LLC. - 0177-5537. ; 111:2, s. 85-101
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Tidskriftsartikel (refereegranskat)abstract
- Paralysis of elbow flexion or extension leads to major impairment of upper extremity function. Surgical reconstruction can be achieved using several procedures.If the time interval since the nerve injury is short, anatomic reconstruction by means of nerve suture or nerve transplantation should be attempted. Alternatively, nerve transposition is possible. If more than 12-18 months have elapsed, reinnervation of arm muscles can no longer be expected. In this case, muscle transposition is helpful. Restoring flexion is predominantly required following brachial plexus injury, when the function of the biceps, brachioradialis and brachialis muscles are lost. As donor muscles the latissimus dorsi, pectoralis major and triceps brachii can be used, alternatively a transfer of the flexor-pronator muscles of the forearm is possible. Latissimus dorsi transfer to reconstruct elbow flexion is also indicated in defects of the anterior upper arm muscle compartiment due to trauma, ischemia, or tumor. Patients with proximal radial nerve lesions may benefit from latissimus transfer to reachieve elbow flexion extension.In tetraplegic patients, elbow extension is restored mainly by transfer of the posterior deltoid muscle extended with a tendon graft, or by means of a biceps-to-triceps transfer.
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| 4. |
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| 5. |
- Hinz, P, et al.
(författare)
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[Current recommendations for diagnosis and therapy of heparin-induced thrombocytopenia].
- 2002
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Ingår i: Der Unfallchirurg (Berlin. Print). - : Springer Science and Business Media LLC. - 0177-5537 .- 1433-044X. ; 105:9, s. 845-50
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Tidskriftsartikel (refereegranskat)abstract
- Thrombosis prophylaxis using heparins is mandatory in most trauma patients. However, heparins can induce heparin-induced thrombocytopenia (HIT), the most common and clinically important immune-mediated drug-dependent thrombocytopenia. Affected patients are at risk of developing new thromboembolic complications. HIT has to be considered if platelet counts decrease >50% between day 5-10 of heparin therapy that cannot be explained alternatively or if new thromboses occur in a sufficiently heparinised patient. Immediately changing the anticoagulant to danaparoid or lepirudin is most important. Proof of anti-platelet-factor-4/heparin antibodies secures the diagnosis, usually retrospectively. Diagnosis and therapy are demonstrated in a typical HIT patient. HIT usually occurs in the second week of heparin administration. Heparin-reexposure within 100 days can lead to HIT before day 5. For early recognition of HIT, platelet counts should be monitored regularly. Because of earlier discharge of patients to rehabilitation or outpatient care, the problem of HIT-diagnosis and therapy gains increasing relevance in these sectors.
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| 6. |
- Hinz, P, et al.
(författare)
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[Thrombosis prophylaxis in trauma surgery units in Germany : a survey].
- 2009
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Ingår i: Der Unfallchirurg. - : Springer Science and Business Media LLC. - 1433-044X .- 0177-5537. ; 112:12, s. 1029-33
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A questionnaire study was conducted to ask trauma surgery centers about thrombosis prophylaxis methods and strategies for the diagnosis and therapy of heparin-induced thrombocytopenia (HIT). METHODS: Questionnaires were sent by post to German hospitals with trauma surgery units inquiring about the use of unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH), the duration of medication, and the HIT diagnosis. Questionnaires were evaluated descriptively. RESULTS: 314 of 685 questionnaires sent out were evaluable (46%): half were from general hospitals, 96 (31%) from specialized hospitals, and 53 (17%) from tertiary care hospitals (others: 8). In more than 90%, only LMWH was used. The mean duration of pharmacological thrombosis prophylaxis was 16.6+/-10.4 days (inpatient/outpatient). Only 10% adhered to the recommended platelet count controls every 2 days (days 5-14) for early detection of HIT. CONCLUSIONS: While pharmacological thrombosis prophylaxis following trauma surgery seems to be generally performed according to guidelines, diagnosis and treatment of HIT need to be systematized.
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| 7. |
- Li, Yan, et al.
(författare)
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Osseointegrated prostheses for rehabilitation following amputation : The pioneering Swedish model
- 2017
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Ingår i: Unfallchirurg. - : Springer Science and Business Media LLC. - 0177-5537 .- 1433-044X. ; 120:4, s. 285-292
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Tidskriftsartikel (refereegranskat)abstract
- The direct attachment of osseointegrated (OI) prostheses to the skeleton avoids the inherent problems of socket suspension. It also provides physiological weight bearing, improved range of motion in the proximal joint, as well as osseoperceptive sensory feedback, enabling better control of the artificial limbs by amputees. The present article briefly reviews the pioneering efforts on extremity osseointegration surgeries in Sweden and the development of the OPRA (Osseointegrated Prostheses for the Rehabilitation of Amputees) program. The standard implant design of the OPRA system and surgical techniques are described as well as the special rehabilitation protocols based on surgical sites. The results of long-term follow-up for transradial, transhumeral, and thumb amputee operations are briefly reported including the prospective study of transfemoral amputees according to OPRA protocol. The importance of refinement on implant designs and surgical techniques based on the biomechanical analysis and early clinical trials is emphasized. Future aspects on osseointegration surgery are briefly described, including novel treatment options using implanted electrodes.
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| 8. |
- Waldén, Markus, 1975-, et al.
(författare)
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Perspectives in football medicine
- 2018
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Ingår i: Der Unfallchirurg (Berlin. Print). - : Springer. - 0177-5537 .- 1433-044X. ; 121:6, s. 470-474
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Tidskriftsartikel (refereegranskat)abstract
- The high injury rate among mens professional football players is well-known. Therefore, the Union of European Football Associations (UEFA) launched an injury study already in 2001. This study, the UEFA Elite Club Injury Study (ECIS), currently includes data from a total of 51 clubs from 18 European countries with more than 14,000 registered injuries. With the 21(st) World Cup (WC) in Russia just around the corner, we have from our study identified a higher match injury rate and a higher proportion of severe injuries in the European Championships compared to the preceding club competitive seasons. Moreover, we have also recently showed that the muscle injury rate is higher when players are given a recovery window of five days or less between two matches. Considering the congested match schedule of the upcoming WC, it is therefore likely that injuries and fatigue once again will be a topic of discussion this summer.
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| 9. |
- Wennergren, David, et al.
(författare)
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Implementation of the Swedish Fracture Register
- 2018
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Ingår i: Unfallchirurg. - 0177-5537. ; 121:12, s. 949-955
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- © 2018, The Author(s). Large financial resources are needed to treat fractures. Surprisingly little is, however, known about actual numbers, treatment methods or outcomes. A large population-based observational study can add valuable knowledge, especially if patient-reported results are included. There is no previous national fracture register with prospectively collected data on fractures of all types, treated surgically as well as non-surgically. With the implementation of the Swedish Fracture Register (SFR), we have shown that this is possible. More than 285,000 fractures have been registered. The database is increasing at a rate of 70,000 fractures a year, i. e. one fracture every 7 min. The aim of this article is to describe the first seven years in the history of the SFR, with opportunities for the future as well as limitations.
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