K. Dresing
University of Göttingen
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Featured researches published by K. Dresing.
Unfallchirurg | 2003
Karl-Heinz Frosch; W. Knopp; K. Dresing; C. Langer; K. M. Stürmer
ZusammenfassungBei Trümmerfrakturen des Radiusköpfchens mit ligamentären oder ossären Begleitverletzungen auf der ulnaren Seite lassen sich durch die Radiusköpfchenresektion meist keine befriedigenden Ergebnisse erzielen. Neben Instabilität des Ellbogengelenkes und Bewegungslimitierung werden Proximalisierung des Radius,Arthrose und Schmerzen im Ellbogengelenk beschrieben. Ziel dieser Arbeit ist es, Ergebnisse nach Implantation einer bipolaren Radiuskopfprothese bei nicht rekonstruierbaren Radiusköpfchentrümmerfrakturen zu untersuchen.Zwischen 1995 und 1997 wurden 11 Radiuskopfprothesen bei 10 Patienten mit Radiusköpfchentrümmerfraktur und ligamentären oder ossären Begleitverletzungen auf der ulnaren Seite implantiert.8 Patienten mit 9 Prothesen konnten nach durchschnittlich 5 Jahren nachuntersucht werden, eine Patientin war verstorben, ein Patient lehnte bei subjektiver Beschwerdefreiheit die Nachuntersuchung ab.Nach dem Morrey-Score fanden sich 2 sehr gute, 5 gute und 2 mäßige Ergebnisse. Bei allen Patienten bestanden stabile Gelenkverhältnisse. Radiologisch konnten bei keinem Patienten Lockerungszeichen nachgewiesen werden.Die bipolare Radiusköpfchenprothese ist eine empfehlenswerte Alternative zur Resektion bei osteosynthetisch nicht rekonstruierbarer Radiusköpfchentrümmerfraktur mit Begleitverletzung auf der ulnaren Seite und ist der Resektion vorzuziehen.AbstractThe treatment of comminuted fractures of the radial head with concomitant injuries of the ulnar complex by resection of the radial head usually does not provide satisfactory long-term results.Other than joint instability in the elbow and a limited range of motion, radius proximalisation in the sense of ulnocarpal impingement, osteoarthritis and pain in the elbow have been described.Between 1995 and 1997, 11 radial head prostheses were implanted in ten patients who had sustained a comminuted fracture of the radial head with concomitant injury to the ulnar complex. A follow-up survey was conducted with the patients on average 5 years after the injury. Eight patients with nine implants participated in the follow-up, one patient had died and another refused to participate but declared that he did not suffer from any impairment.According to the Morrey score, two of the results were found to be very good, five to be good, one to be fair and one to be poor.Despite the severe injuries sustained by the elbow, neither joint instability in the elbow nor proximalisation of the radius, cubitus valgus, ulnar nerve syndrome, nor loosening of the prosthesis were found in any of the patients.In the event of comminuted fractures of the radial head which are impossible to reconstruct by osteosynthesis and which occur with concomitant ulnar ligamentous or osseous injury, the implantation of a prosthesis is preferred over the resection of the head of the radius.
Journal of Orthopaedic Research | 2003
Karl-Heinz Frosch; I. Sondergeld; K. Dresing; T. Rudy; C. H. Lohmann; J. Rabba; D. Schild; J. Breme; K. M. Stuermer
The goal of this study was to assess the osseointegration of porous titanium implants by means of coating with autologous osteoblasts.
World Journal of Urology | 2007
Hossein Tezval; Mohammad Tezval; Christoph von Klot; Thomas R. W. Herrmann; K. Dresing; Udo Jonas; Martin Burchardt
This article mainly reviews urinary tract injuries in patients with multiple trauma. Approximately 10% of all traumatic injuries resulting from an external force will involve the genitourinary system. The article discusses mechanisms of injury, diagnosis, and therapeutical approaches for renal, ureteral, bladder, and urethral trauma. Due to the complexity of such injuries—despite several attempts to provide a standard strategy in trauma patients with urinary tract involvement—an individual and patient-specific-therapeutic approach is mandatory in most cases. However, the availability of classified guidelines may help the surgeon to reach the most accurate decision. Because of the similarity of American and European guidelines on urological trauma, this article adapts injury severity scales and classification from the American Association for the Surgery of Trauma.
Methods of Information in Medicine | 2008
Oliver J. Bott; Michael Teistler; Christopher Duwenkamp; Markus Wagner; Michael Marschollek; Maik Plischke; B. W. Raab; Klaus Michael Stürmer; Dietrich Peter Pretschner; K. Dresing
OBJECTIVES Operating room personnel (ORP) operating mobile image intensifier systems (C-arms) need training to produce high quality radiographs with a minimum of time and X-ray exposure. Our study aims at evaluating acceptance, usability and learning effect of the CBT system virtX that simulates C-arm based X-ray imaging in the context of surgical case scenarios. METHODS Prospective, interventional study conducted during an ORP course with three groups: intervention group 1 (training on a PC using virtX), and 2 (virtX with a C-arm as input device), and a control group (training without virtX) - IV1, IV2 and CG. All participants finished training with the same exercise. Time needed to produce an image of sufficient quality was recorded and analyzed using One-Way-ANOVA and Dunnett post hoc test (alpha = .05). Acceptance and usability of virtX have been evaluated using a questionnaire. RESULTS CG members (n = 21) needed more time for the exercise than those of IV2 (n = 20): 133 +/- 55 vs. 101 +/- 37 sec. (p = .03). IV1 (n = 12) also performed better than CG (128 +/- 48 sec.), but this was not statistically significant. Seventy-nine participants returned a questionnaire (81% female, age 34 +/- 9 years, professional experience 8.3 +/- 7.6 years; 77% regularly used a C-arm). 83% considered virtX a useful addition to conventional C-arm training. 91% assessed virtual radiography as helpful for understanding C-arm operation. CONCLUSIONS Trainees experienced virtX as substantial enhancement of C-arm training. Training with virtX can reduce the time needed to perform an imaging task.
Operative Orthopadie Und Traumatologie | 2013
S. Sehmisch; J. Rieckenberg; K. Dresing
OBJECTIVE Restoration of function and anatomy of the proximal femur. Possibility of full weightbearing after surgery. Less invasive intramedullary osteosynthesis. INDICATIONS Unstable trochanteric fracture (AO classification 31-A2, 31-A3), subtrochanteric fracture (AO classification 32-A1), fracture of the femoral shaft in the proximal region. CONTRAINDICATIONS Ipsilateral coxarthrosis, open growth plate, hip fracture. SURGICAL TECHNIQUE Closed or open reduction on the extension table. Intramedullary reaming of the proximal femur, insertion of PFNA and blade as proximal locking screw, static or dynamic distal locking screw. Implantion of bone cement via blade, if necessary. POSTOPERATIVE MANAGEMENT Weightbearing as limited by pain. Osteoporosis diagnostics and initiation of treatment, if necessary. RESULTS The stabilization of trochanteric fractures is usually done with PFNA. Compared to other methods, e.g., DHS, fewer complications were observed with the PFNA. Subtrochanteric fractures were associated with higher complication rates compared to intertrochanteric fractures.ZusammenfassungOperationszielWiederherstellung der Funktion und Anatomie des proximalen Femur. Primär belastungsstabile Osteosynthese. Wenig invasive intramedulläre Osteosynthese.IndikationenInstabile pertrochantäre Frakturen (AO-Klassifikation 31-A2, 31-A3), subtrochantäre Femurfrakturen (AO-Klassifikation 32-A1), Schaftfrakturen im proximalen Femurdrittel.KontraindikationenGleichseitige ausgeprägte Coxarthrose, Frakturen im Wachstumsalter mit offenen Wachstumsfugen und mediale Schenkelhalsfraktur.OperationstechnikGeschlossene oder offene Reposition auf dem Extensionstisch. Intramedulläre Aufbohrung des proximalen Femur, Einbringen des proximalen Femurnagels (PFNA) und proximale Verriegelung mittels Klinge und statischer oder dynamischer distaler Verriegelung. Zementaugmentation der proximalen Verriegelung möglich.WeiterbehandlungBelastung bis zur Schmerzgrenze. Osteoporosediagnostik und ggf. Therapie einleiten.ErgebnisseIm eigenen Patientenkollektiv wird die Stabilisierung der per- und subtrochantären Frakturen überwiegend mit dem PFNA durchgeführt. Dabei zeigte sich eine geringere Komplikationsrate als bei alternativen Verfahren wie der dynamischen Hüftschraube (DHS). Subtrochantäre Frakturen waren mit einer höheren Komplikationsrate verbunden als pertrochantäre Frakturen.AbstractObjectiveRestoration of function and anatomy of the proximal femur. Possibility of full weightbearing after surgery. Less invasive intramedullary osteosynthesis.IndicationsUnstable trochanteric fracture (AO classification 31-A2, 31-A3), subtrochanteric fracture (AO classification 32-A1), fracture of the femoral shaft in the proximal region.ContraindicationsIpsilateral coxarthrosis, open growth plate, hip fracture.Surgical techniqueClosed or open reduction on the extension table. Intramedullary reaming of the proximal femur, insertion of PFNA and blade as proximal locking screw, static or dynamic distal locking screw. Implantion of bone cement via blade, if necessary.Postoperative managementWeightbearing as limited by pain. Osteoporosis diagnostics and initiation of treatment, if necessary.ResultsThe stabilization of trochanteric fractures is usually done with PFNA. Compared to other methods, e.g., DHS, fewer complications were observed with the PFNA. Subtrochanteric fractures were associated with higher complication rates compared to intertrochanteric fractures.
Unfallchirurg | 2007
Karl-Heinz Frosch; Hingelbaum S; K. Dresing; Roessler M; K. M. Stürmer
Background. The anatomic region on the lateral cortex of the ileum, where a palpable “groove” is formed by angulations of the lateral cortex of the iliac wing, is recommended as the insertion point for the pelvic emergency clamp by many authors. In our opinion this technique often leads to an incomplete closure of the anterior pelvic ring as well as to bacterial contamination of the access for the sacroiliac joint screw fixation and is accompanied by a risk for nerve and vessel injuries. To reduce these risks the pelvic clamp was placed at a supra-acetabular location. The goal of our study was to report on our experiences with the supra-acetabular position of the pelvic emergency clamp and to compare our results with the current literature. Material and method. From September 1998 to February 2006 the pelvic emergency clamp was applied in 15 polytraumatized patients (9 male, 6 female), with a mean age of 46 years (19–93) and a mean injury severity score (ISS) of 40 points (25–66) with mechanically and hemodynamically unstable pelvic ring fractures. According to the AO classification the injury pattern was type B2 in four cases, type B3 in one case, type C1 in seven cases, type C2 in two cases and type C3 in one case. The pelvic clamp was percutaneously applied 2–3 cm cranial to the acetabular roof. The duration from hospital admission until the pelvic emergency clamp was applied amounted to an average of 54 min (15– 150); the procedure itself was performed in all cases in less than 15 min. The mean Hb at arrival in the emergency department was 7.4 (2.4–13.8) mg/dl and the mean systolic blood pressure 69 (0–130) mmHg. Results. In 14 patients a complete closure of the anterior and posterior pelvic ring could be achieved; in 1 patient an overcompression of the anterior pelvic ring was observed. Four patients died due to massive bleeding. Three patients with isolated pelvic ring fractures became hemodynamically stable within 20 min after treatment with the supra-acetabular pelvic clamp. Nine patients needed additional emergency surgery because of intracerebral, intrathoracic or intra-abdominal injuries. On average in the first 6 h, 36.7 (9–175) units of erythrocyte concentrates and 34.5 (4–200) units of fresh frozen plasma were transfused. Conclusions. The supra-acetabular pelvic clamp leads to a homogeneous force distribution to the pelvic ring and enables complete closure of the anterior and posterior pelvic ring in unstable pelvic fractures. Reduction of the intrapelvic volume and compression of the posterior pelvic ring can thus be achieved. Risks for intrapelvic perforation or injuries of vessels and nerves are low. No bacterial contamination of the access for the sacroiliac screw fixation occurs. To avoid overcompression of the unstable pelvic ring, manual or radiological control of the closure of the ventral pelvic ring is necessary.
Operative Orthopadie Und Traumatologie | 2013
S. Sehmisch; J. Rieckenberg; K. Dresing
OBJECTIVE Restoration of function and anatomy of the proximal femur. Possibility of full weightbearing after surgery. Less invasive intramedullary osteosynthesis. INDICATIONS Unstable trochanteric fracture (AO classification 31-A2, 31-A3), subtrochanteric fracture (AO classification 32-A1), fracture of the femoral shaft in the proximal region. CONTRAINDICATIONS Ipsilateral coxarthrosis, open growth plate, hip fracture. SURGICAL TECHNIQUE Closed or open reduction on the extension table. Intramedullary reaming of the proximal femur, insertion of PFNA and blade as proximal locking screw, static or dynamic distal locking screw. Implantion of bone cement via blade, if necessary. POSTOPERATIVE MANAGEMENT Weightbearing as limited by pain. Osteoporosis diagnostics and initiation of treatment, if necessary. RESULTS The stabilization of trochanteric fractures is usually done with PFNA. Compared to other methods, e.g., DHS, fewer complications were observed with the PFNA. Subtrochanteric fractures were associated with higher complication rates compared to intertrochanteric fractures.ZusammenfassungOperationszielWiederherstellung der Funktion und Anatomie des proximalen Femur. Primär belastungsstabile Osteosynthese. Wenig invasive intramedulläre Osteosynthese.IndikationenInstabile pertrochantäre Frakturen (AO-Klassifikation 31-A2, 31-A3), subtrochantäre Femurfrakturen (AO-Klassifikation 32-A1), Schaftfrakturen im proximalen Femurdrittel.KontraindikationenGleichseitige ausgeprägte Coxarthrose, Frakturen im Wachstumsalter mit offenen Wachstumsfugen und mediale Schenkelhalsfraktur.OperationstechnikGeschlossene oder offene Reposition auf dem Extensionstisch. Intramedulläre Aufbohrung des proximalen Femur, Einbringen des proximalen Femurnagels (PFNA) und proximale Verriegelung mittels Klinge und statischer oder dynamischer distaler Verriegelung. Zementaugmentation der proximalen Verriegelung möglich.WeiterbehandlungBelastung bis zur Schmerzgrenze. Osteoporosediagnostik und ggf. Therapie einleiten.ErgebnisseIm eigenen Patientenkollektiv wird die Stabilisierung der per- und subtrochantären Frakturen überwiegend mit dem PFNA durchgeführt. Dabei zeigte sich eine geringere Komplikationsrate als bei alternativen Verfahren wie der dynamischen Hüftschraube (DHS). Subtrochantäre Frakturen waren mit einer höheren Komplikationsrate verbunden als pertrochantäre Frakturen.AbstractObjectiveRestoration of function and anatomy of the proximal femur. Possibility of full weightbearing after surgery. Less invasive intramedullary osteosynthesis.IndicationsUnstable trochanteric fracture (AO classification 31-A2, 31-A3), subtrochanteric fracture (AO classification 32-A1), fracture of the femoral shaft in the proximal region.ContraindicationsIpsilateral coxarthrosis, open growth plate, hip fracture.Surgical techniqueClosed or open reduction on the extension table. Intramedullary reaming of the proximal femur, insertion of PFNA and blade as proximal locking screw, static or dynamic distal locking screw. Implantion of bone cement via blade, if necessary.Postoperative managementWeightbearing as limited by pain. Osteoporosis diagnostics and initiation of treatment, if necessary.ResultsThe stabilization of trochanteric fractures is usually done with PFNA. Compared to other methods, e.g., DHS, fewer complications were observed with the PFNA. Subtrochanteric fractures were associated with higher complication rates compared to intertrochanteric fractures.
Operative Orthopadie Und Traumatologie | 2011
K. Dresing
ZusammenfassungUnfallchirurgen und Orthopäden setzen intraoperativ Röntgenstrahlen in hohem Maße ein. Trotz des häufigen und teilweise langwierigen Einsatzes der Röntgenbildverstärker werden die Erkenntnisse über Strahlenschutz nicht angewendet und Strahlenvermeidung wird nicht selten negiert. Diese Arbeit soll einen kompakten Überblick über physikalische, biologische Effekte der Röntgenstrahlung und die Möglichkeiten der Strahlenreduzierung im Operationssaal geben. Das Operationsteam ist hauptsächlich Streustrahlung ausgesetzt. Die Strahlenbelastung ist auf der Röhrenseite 10-mal höher als auf der Bildverstärkerseite. Die Distanz zwischen Röhre und Chirurg sollte möglichst weit sein. Es wird empfohlen, die Röhre immer unterhalb des Operationstischs zu positionieren und den Abstand zwischen Röhre und Patient möglichst kurz zu halten. Die Positionierung des C-Bogens sollte immer ohne Strahlung erfolgen. Hierzu werden die Landmarken des Patienten benutzt. Durch präoperatives Training mit virtuellen Lernsystemen, wie virtX, lässt sich die Strahlenbelastung reduzieren.AbstractOrthopedic and especially trauma surgeons’ use of x-rays during operations vary extensively, especially in minimally invasive osteosynthesis procedures. Radiation hazards often are neglected. In this paper, a short overview of physical and biological effects of radiation are given. In addition, practical information about how to lower radiation exposure in the daily work in the operating room (OR) is given. The operating team is exposed mainly to scattered radiation. The radiation exposure is 10 times higher on the tube side than on the amplifier side. The distance between tube and surgeon must be as great as possible. The tube should be positioned under the OR table, and the distance between tube and patient should be as short as possible. The positioning of the C-arm device without radiation is important. The use of patient landmarks is used to position the C-arm over the region of interest, but the preoperative training of surgeons and team with virtual learning tools, e.g., virtX, is very effective in reducing radiation hazards.
Unfallchirurg | 2000
M. Fuchs; H. Burchhardt; K. Dresing; T. Radebold; K. M. Stürmer
ZusammenfassungDie operative Behandlung von Fersenbeinfrakturen ist anspruchsvoll, nicht zuletzt aufgrund des dünnen Weichteilmantels. Bei offenen Frakturen mit unfallbedingten Knochennekrosen stellt die Infektion eine schwere Komplikation dar. Das Auftreten einer Osteitis ist gefürchtet und macht ein konsequentes operatives Regime erforderlich. Persistiert die Infektion, wird nicht selten die Amputation der Gliedmaß mit konsekutiver erheblicher Invalidisierung erforderlich.Wir stellen den Fall eines 37-jährigen Maurers nach Absturztrauma mit einer drittgradig offenen Fersenbeintrümmerfraktur vor, bei dem eine Infektion nach primärer offener Osteosynthese zahlreiche Revisionen und schließlich die Fersenbeinresektion erforderlich machte. Unter Erhalt des Vor- und Mittelfußes und Dank einer suffizienten orthopädischen Schuhversorgung konnte der Patient nach 8 Monaten in seinen Beruf als Maurer zurückkehren.AbstractSurgical treatment of calcaneal fractures is demanding due to the poor musculocutaneous coverage. Infection with osteitis is a severe complication with open fractures. The appearance of osteitis requires aggressive surgical treatmentincluding amputation in case of persistence, leading to considerable invalidism.We report the case of an 37-year-old mason with an grade III open calcaneal fracture caused by a fall. Osteitis appeared after primary osteosynthesis with open reduction and eventually – after several revisions – required a calcanectomy. By preservation of the forefoot and midfoot and thanks to sufficient orthesis treatment the patient was able to return to his profession after eigth months.
Journal of Arthroplasty | 2009
Peter Balcarek; K. Dresing; Tim Alexander Walde; Mohammad Tezval; Klaus Michael Stürmer
An uncommon case of myoclonus-induced bilateral central acetabular fracture-dislocation is presented. Although different fracture types due to forceful muscular contractions have been reported, this is an exceedingly uncommon injury pattern. Bilateral total hip arthroplasty, in combination with a reinforcement ring and autologous bone grafting, was performed after open reduction and internal fixation.