Publications by authors named "H H Wetz"

59 Publications

Clinical benefit and improvement of activity level after reconstruction surgery of Charcot feet using external fixation: 24-months results of 292 feet.

BMC Musculoskelet Disord 2014 Nov 22;15:392. Epub 2014 Nov 22.

Clinic for Technical Orthopedic Surgery, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Muenster, Germany.

Background: Reconstruction of Charcot feet remains a surgical challenge. The goal of this study was to investigate safety and clinical benefit from reconstruction of Charcot feet using an external fixator. There is limited valid data regarding long-term outcomes for Charcot foot procedures.

Methods: In a retrospective study, 292 Charcot feet (282 patients) undergoing reconstructive procedures in our clinic from 1996-2010 were included (93 female, 189 male, mean age 57.9 years). Average follow-up was 24.1 months. Exclusion criteria were previous major amputation on the same side. All patients underwent surgery using a Hoffmann II external fixator for six to eight weeks with offloading. The fixator was then removed, and a customized AFO with full weight bearing was applied for another 11 months. After one year, patients received customized orthopedic shoes.

Results: Initial amputations were avoided. Patient activity improved significantly by more than 1 level (SD 0.67, p < .001) according to the Hoffer activity score for lower limb amputees. The most common minor complication was persistent or recurrent ulceration in 67 feet (23%). Secondary amputation (after failure of external fixation) was required in only 12 patients (6.2%). Orthopedic shoes were used by approximately 34% of patients 18 months after surgery.

Conclusions: Reconstructive surgery of Charcot feet using external fixation is a safe and economically feasible procedure. Activity levels improved significantly by more than 1 level (p < 0.01), severe complications were rare, and secondary amputation was required in only 12 patients (6.2%) of a high-risk patient population. Use of an external fixator offers the advantage that all extraneous material is removed after six weeks; thus, there is no risk of broken screws or plates and the associated potential complications.
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November 2014

Diabetic charcot neuroarthropathy of the knee: conservative treatment options as alternatives to surgery: case reports of three patients.

Diabetes Care 2014 Jun;37(6):e129-30

Clinic for Technical Orthopedic Surgery and Rehabilitation, University Hospital of Münster, Münster, Germany.

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June 2014

Clinical acceptance, reasons for rejection, and reduction of in-shoe peak pressure with interdigital silicone orthoses.

J Am Podiatr Med Assoc 2014 Jan-Feb;104(1):30-3

Clinic for Technical Orthopedic Surgery, University Hospital of Muenster, Muenster, Germany.

Background: For several years, confectioned or customized interdigital silicone orthoses have been used to treat toe malformations; however, long-term clinical and biomechanical studies are missing. The aim of this study was to evaluate the biomechanical effects of these orthoses and their clinical acceptance.

Methods: In 2008, 46 patients (30 women and 16 men; average age, 56.8 years) received interdigital silicone orthoses. All of the patients were included in the biomechanical and clinical study. Compliance and acceptance were measured by the Muenster shoe and foot questionnaire, which includes 13 items on pain, activities of daily living, satisfaction, and activity. Mean follow-up was 18 months. Ten feet (eight patients) were chosen by random and underwent pedobarography. One forefoot sensor and two single sensors were attached between the skin and the orthosis. Measurements were performed in-shoe three times with and without the orthosis without removal of the sensors.

Results: Forty-four of the 46 patients (95.7%) were included. At the 18-month investigation, 19 patients no longer used their orthoses, most commonly because of pain and failure of the material. Twenty-two patients regularly used their orthoses (8 h/d on average). In-shoe peak pressure lowered significantly with orthosis use (P < .04). Patients who used the orthoses were mostly satisfied.

Conclusions: Interdigital silicone orthoses reduce in-shoe peak pressure. Patient satisfaction was good. The durability of the material has to be optimized, and manufacturing remains difficult. The effect on ulcer reduction must be evaluated in a large prospective study.
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November 2016

[Criteria for socket type prescription: indications and contraindications of a liner system].

Z Orthop Unfall 2013 Feb 19;151(1):66-73. Epub 2013 Feb 19.

Abteilung für Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster.

Background: The prescription of socket type for above-knee-amputees is based on clinical experience. There are no official guidelines. On the basis of treatment statistics and a patient survey, this study shows the indications and contraindications of a liner system.

Patients And Methods: Treatment statistics including data from the medical reports of 183 above-knee-amputees, who were treated in our clinic from 2003 to 2007 were analysed. 32 patients had a system change between liner- and contact-shaft accommodation and were contacted by telephone. The aim was to evaluate satisfaction with the current socket type and thus be able to compare types.

Results: A statistically significant relation in the treatment statistics between the quality of the stump and the socket type can be shown. A mesh graft to cover the stump, extreme volume fluctuation, low activity class and co-morbidities are the main reasons for the use of a liner system. Main reasons for a change to a liner system were the preservation of individual independence, better adhesion and skin problems.

Conclusion: The developed clinical criteria can help physicians decide which socket type is most beneficial for each individual patient.
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February 2013