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Biomedical subjects

C Krettek

Publications and source records attributed to C Krettek.

At least 19 recordsLinked to original sources
PubMed2005

[Operative management of cervical spine injuries in patients with Bechterew's disease].

Cervical spinal injuries in patients with ankylosing spondylitis are complex in their nature and management. This condition is associated with a high risk of dislocation and neurological impairment related to osseous instability due to almost absent compensatory mechanisms of the adjacent vertebral segments. Multilevel stabilization and dorsoventral instrumentation is usually required. We report on two patients suffering from ankylosing spondylitis who presented at our institute with cervical spine injuries in whom primary treatment had consisted of single-site stabilization which resulted in secondary fracture dislocation and implant failure. Secondary management by combined dorsoventral stabilization resulted in more rigid fixation and uneventful healing in both cases. We recommend careful assessment and well-planned management in these cases.

Aged↗
PubMed2005

[Compound osteosynthesis as treatment for an osteoporotic LWK-1 burst fracture in a 76 year old female patient].

The surgical treatment of osteoporotic vertebral compression fractures is rarely necessary and is mostly done in fractures with neurological deficit. We present a case of compound osteosynthesis in an osteoporotic fracture of the first lumbar vertebra as a "salvage procedure" after a dislocation of a dorsal internal fixator in a 76 year old female sustaining incomplete paraplegia. In this case, an additional ventral stabilization using a vertebral body replacement was not practicable because of old age and previous pneumonia. We performed an additional compound osteosynthesis using bone cement because of insufficient stability when only using cement for augmentation of the pedicle screws.

Aged↗
PubMed2004

Effects of cyclic longitudinal mechanical strain and dexamethasone on osteogenic differentiation of human bone marrow stromal cells.

The aim of the study was to investigate the effect of cyclic mechanical strain on differentiation markers in the presence or absence of dexamethasone. Human bone marrow stromal cells (BMSC) from seven donors (32.5+/-6.2 years) were cultivated with (D+) or without (D-) dexamethasone. A cyclic mechanical strain with an elongation of 2% (D+2; D-2) or 8% (D+8; D-8) was applied for three days with a stimulation time of three times two hours each day. Levels of alkaline phosphatase (ALP) and osteocalcin (OC) were compared after time intervals of four and seven days. mRNA expression of Collagen I, III and Cbfa1 was investigated after one, four, and seven days. ALP levels were significantly increased in the D+8 group after four and seven days (147.1+/-6.3%; p<0.05 and 168.6+/-6,5%; p<0.03) and in the D-8 group after 7 days (197.4+/-10.4; p<0.04). Cyclic strain had a significant influence on ALP-secretion (F=7.5; p<0.01). In the D-8 group there was a significant increase in OC secretion after 4 days (140.9+/-12.5%; p<0.05).; p<0.01). The effect of stretching was significantly stronger than that of dexamethasone (F=17.2 vs. 1.8). Collagen I (Col I) expression was upregulated in D+8 cultures after 4 days (215.0+/-53.3 p<0.04) and after seven days (166.7+/-55.7; p<0.04). Collagen III (Col III) expression was upregulated in D+2 and D+8 cultures after 4 days (200.7+/-16.3 and 185.9+/-12.7; p<0.04) and after seven days (154.4+/-10.1 and 118.8+/-16.4; p<0.04). There was a significant increase of Cbfa1 expression in D+8 cultures at all investigated time intervals (day 1: 105.5+/-3.7%; day 4: 104.7+/-3.0%; day 7: 104.4+/-2.1%; p<0.03). Stretching (F=20.0; p<0.01) was a stronger contributor to Cbfa-1 expression than dexamethasone (F=12.1; p<0.01). Cyclical mechanical stimulation with 8% elongation increases ALP and OC levels and upregulates Col I and III synthesis and Cbfa1 expression. In the short term, cyclical stretching is a stronger differentiation factor than dexamethasone. Cyclical stretching and dexamethasone both enhance the osteogenic commitment of hBMSC.

Adult↗
PubMed2004

[Restoration of the ability to walk through bilateral triple arthrodesis in marked spastic pes equinovarus].

A tendon transfer is the method of choice in easily reducible pes equinovarus. However, in long-time persisting deformities with spasms, a plantigrade position can not be maintained with these procedures. Therefore, we perform an additional bilateral triple arthrodesis in a patients with such bilateral deformities. A 55-year-old woman developed, within the scope of several surgical procedures on the cervical spine, marked bilateral pes equinovarus and flexion contractures of the knees. The patient's ambulation was limited to a wheelchair for 3 years. Then, in an interval of 1 year, we performed an unilateral soft tissue release, z-tenotomy of the Achilles tendon, triple arthrodesis with correction of the deformity, and posterior tibial tenden transfer. At follow-up 5 years after the second procedure, the 61-year-old patient was able to walk alone with two walking sticks. In the case described, the correction of a marked pes equinovarus with spasms, which was achieved by an extensive soft tissue release, could be stabilized through a triple arthrodesis in such way that the plantigrade position of the foot could be controlled through a posterior tibial tendon transfer.

Arthrodesis↗
PubMed2004

[Osteotomy of the iliac fossa in the treatment of a hip dislocation associated with a two-column acetabular fracture. Modification of the ilioinguinal approach to avoid an extended surgical approach].

Open reduction and internal fixation is the treatment of choice for displaced acetabular fractures. The surgical approach depends on the fracture type, concomitant injuries, and general condition of the patient. The ilioinguinal approach provides a good exposure to the medial wall and is associated with an acceptable degree of surgical trauma. Exposure of the joint surface, however, is difficult when using the ilioinguinal approach. We report a case of a polytraumatized 39-year-old patient who sustained a posterior hip displacement and a two-column acetabular fracture. An osteotomy of the iliac ala was performed via an ilioinguinal approach to fragments of the acetabular surface that were displaced distally. Thereby, reposition of a craniolateral fragment was achieved without the need to extend the surgical approach or to perform a second incision.

Acetabulum↗
PubMed2004

[Reosteosynthesis in dens pseudarthrosis. Case report and review of the literature].

According to general recommendations, unstable nonunions of the odontoid are treated by posterior fusion of the segments C1/C2 and transarticular screwosteosynthesis. The aim of the surgical procedure is to obtain secure reduction stabilization, and fusion of the nonunion. We present a case of secondary atlanto-axial instability treatment following of an odontoid nonunion. In this situation stability of C1/C2 was achieved by atlanto-axial fusion by transarticular screw fixation. The ventral parts of the broken implants were left in place. Diagnosis, treatment and complications of pseudarthrosis of the dens axis are discussed in the context of this case and of literature.

Bone Screws↗
PubMed2004

[Extensive reconstruction of the acetabular dome after redisplacement of an acetabular fracture. Case report].

Anatomical reconstruction and stable internal fixation is the treatment of choice in displaced acetabular fractures. Marginal impaction zones are of negative prognostic value. They are normally treated with a cancellous bone graft from the greater trochanter. In the presented case, a secondarily failed acetabular reconstruction with redisplacement of the acetabular dome was treated with several corticocancellous blocks filled in the dome defect. In this case, a comminuted area and secondary displacement could be successfully treated with anatomical reconstruction. This resulted in joint congruency and an acceptable long-term result after 16 years.

Acetabulum↗
PubMed2004

[DRG reimbursement for multiple trauma patients -- a comparison with the comprehensive hospital costs using the German trauma registry].

UNLABELLED: The introduction of diagnosis related groups (DRG) will radically change the payment system for German hospitals. In 2002 the values for most DRG's were published for the german system (G-DRG). The polytrauma working group of the German Trauma Society developed a calculating algorithm to estimate the comprehensive hospital costs for every patient in the German trauma registry. The aim of this study was to compare these costs with the reimbursement according the the G-DRG's for a standardized population of polytrauma patients. MATERIAL AND METHODS: For polytrauma patients treated at Hannover Medical School in 2000 and 2001 the reimbursement according to the G-DRG's was calculated using a base value of 2900 euro. In the same patients the total cost of inpatient treatment was calculated according to the algorithm developed by the polytrauma working group of the German Trauma Society. The difference between these values represents the economic result. This was calculated as an overall result, but also for specific subgroups of patients (injury severity, mortality, G-DRG grouping). RESULTS: Datasets of 103 polytrauma patients were included. The following G-DRG's were most frequently occuring: A06Z (n=41), A07Z (n=16), W01Z (n=13). All other G-DRG's were documented less than 3 times. The mean reimbursement according to the G-DRG was 21.380+/-12.300 euro for a polytrauma patient. However, the mean hospital cost accounted to 34.274+/-22.501 euro, which resulted in a mean deficit of 12.893+/-15.534 euro. Analysis of subgroups revealed, that an ISS of more than 35 points, patients with a prolonged hospital stay and patients of the G-DRG group A06Z show a particularly negative result. CONCLUSION: The comprehensive hospital costs for treating polytrauma patients are on average 12.893 euro higher than the reimbursement according the G-DRG's. For hospitals to be fully reimbursed G-DRG values have to be reconfigured according to the German health care system. Thus, inclusion criteria to specific G-DRG have to be changed and a specific G-DRG group for very severely injured patients needs to be established.

Adult↗
PubMed2004

[Fracture of the medial femoral condyle as a complication of retrograde femoral nail removal].

A 26-year-old female patient with a femoral shaft fracture underwent retrograde femoral nailing. Nail removal was performed 2 years later, after fracture healing. An intraoperative fracture of the medial condyle of the femur occurred. This complication has not been previously described in the literature. Screw osteosynthesis of the fracture was performed and articular congruence reestablished. After 6 weeks of fractional weight bearing, the patient proceeded up to full weight bearing without complication. The case demonstrates that the removal of retrograde femoral nails is not without complications. The decision to undertake implant removal should be made carefully.

Adult↗
PubMed2004

[Evaluation of costs incurred for patients with multiple trauma particularly from the perspective of the hospital].

The aim of this study was to evaluate the costs involved in treating severely injured patients at the clinic differentiated by several characteristics (injury, age), sectors (emergency room, surgery, intensive and normal care), and kinds of costs (fixed costs, variable costs) and to determine influencing factors regarding costs based on the register of the DGU (Deutsche Gesellschaft für Unfallchirurgie). All patients were taken into account who had an injury severity score (ISS) of at least 16. On this basis costs of 3702 patients were analyzed. They were compared by using analysis of variance for different groups of patients classified according to kind of injury, severity of injury, and age. Moreover, multiple regression was performed to control the common influence of demographic factors and the type of injury on costs. The average ISS of the analyzed patients was 30.6 (+/-11.6) points. The average costs of the clinic were 32,166 (+/-25,404) EUR per patient. More than half of the costs was incurred by intensive care and about one-fourth by surgery. On average 30.6% were variable costs and 69.4% were fixed costs. The analysis of variance revealed that costs increased with advancing age and severity of injury (ISS). Multiple regression confirmed these interrelations indicating that extremities are very cost intensive. Due to the high portion of fixed costs, the overall costs strongly depend on the capacity utilization and less on hospital stay. That is why it may be necessary in the future to create centers for trauma care to maintain economic efficiency for treatment of these patients. Besides large differences of costs within closely defined groups of patients, hospitals carry a high economic risk so that a more complex reimbursement system should be discussed than implemented by the German DRGs.

Adult↗
PubMed2004

[Percutaneous cementing techniques of the spine -- chances and limits].

Vertebroplasty and Kyphoplasty represent minimal-invasive techniques for cement augmentation of vertebral bodies. Both procedures are successfully used for pain-relieving stabilizations of osteoporotic fractures or malignant processes. Advantages of kyphoplasty over vertebroplasty are to be seen in the possibility of deformity correction as well as in a decreased risk of cement extrusions which represent the most important potential for clinical complications. Long-term experiences with the effect of cementing are sparse. Thus it seems even more important, to judge indications and possibilities realistically. The decision whether and when to perform an augmentation is influenced by multiple factors. These include age of the patient, age of the fracture, degree of deformation and further degenerative changes of the spine. This article summarizes the present research and literature und is thought to provide guidelines for the aforementioned decision making processes.

Age Factors↗
PubMed2004

[Knee para-articular focal dome osteotomy].

Focal dome osteotomy (FDO) is a cylindrically shaped osteotomy, with corresponding bone cuts rotating around the central axis of the deformity. Thus, complete correction can be achieved without secondary translation. FDO provides high adjustability of the bone ends, optimal bone contact, and high primary stability. As with straight cut closing, neutral, and opening-wedge osteotomies, FDO allows closing, neutral, and opening corrections. Opening FDO allows preservation of bone contact, whereas closing FDO does not require removal of bone stock. The osteotomy can be modified to tighten the medial collateral ligament. A FDO below the tuberosity does not compromise patellofemoral function and reduces the risk of intra-articular fractures. Sufficient bone stock of the proximal tibial or distal femoral fragment allows intramedullary stabilization. FDO is of high value in the treatment of sagittal plane and frontal plane corrections of the knee even in severe deformities.

Bone Malalignment↗
PubMed2004

[The V.A.C. system (vacuum assisted closure) as bridging between primary osteosynthesis in conjunction with functional reconstructed of soft tissue--open fractures type 2 and type 3].

Open fractures are complex injuries affecting the integrity of bones and adjacent soft tissue. The therapeutic goals in dealing with open fractures should consist of primary osteosynthesis in conjunction with functional reconstruction of soft tissue. In a period over 2 years, 26 patients were treated with extensive trauma in an interdisciplinary approach. These patients suffered from open fractures type 2 and 3. All patients were treated by primary osteosynthesis, and temporary wound closure with V.A.C.-system. Definitive wound closure was achieved by day 31 after injury. In contrast to a review of the pertinent literature we report the successful free tissue transfer in 21 patients during the critical period between 72 hours and several months preceded by the use of V.A.C.-system for the temporary coverage of open wounds.

Adult↗
PubMed2004

Correlation of clinical findings, collision parameters, and psychological factors in the outcome of whiplash associated disorders.

OBJECTIVE: To determine prognostic factors for the duration and severity of acute symptoms in subjects with grade 1 or 2 whiplash injuries. METHODS: Collision victims presenting to a trauma centre with spinal pain or stiffness were assessed clinically (including a visual analogue scale (VAS)), radiologically, and psychologically (short form 36 (SF36), everyday life quality (EDLQ), pain control questionnaire (FSR)). Collision type and estimated DeltaV (change in velocity of the occupant's vehicle) were also assessed. Assessment at six months involved VAS symptom rating, SF36, EDLQ, depression scale (CES-D), and impact of event scale (IES). RESULTS: 43 consecutive collision victims (22 male, 21 female; mean age 29 years (range 19 to 72) with grade 1 or 2 whiplash associated disorders were assessed. Mean DeltaV, available for 36 of 43 collisions, was 13.9 (5 to 30) km/h. Thirty two (74%) of the subjects were available for follow up at six months. The mean duration of symptoms was 28 (1 to 180) days in this group. No correlation was found between severity and duration of symptoms and the DeltaV of collision or other collision parameters. Patients with initial pain VAS >5 or with duration of symptoms more than 28 days had significant changes in SF36, EDLQ, CES-D, and IES scores at six months, and had initial scores that were predictive of these outcomes. CONCLUSIONS: Psychological factors were found to be more relevant than collision severity in predicting the duration and severity of symptoms in collision victims with grade 1 or 2 whiplash associated disorders.

Accidents, Traffic↗
PubMed2003

Outcome assessment after arthrolysis of the elbow.

BACKGROUND: In the literature, the outcome after arthrolysis of the elbow is mainly assessed by range of motion (ROM). Our intention was to verify whether this parameter does sufficiently estimate the outcome after surgical arthrolysis. METHODS: We performed a retrospective study using the validated Disability of the Arm, Shoulder, and Hand Questionnaire (DASH) as our reference outcome parameter. This score was compared with other outcome parameters such as ROM, Mayo Performance Index (MPI) and SF-36. A total of 59 patients who underwent arthrolysis of the elbow was evaluated 53 months after surgery on average. RESULTS: The mean ROM was 101 degrees for flexion/extension with a relative gain of 60% and 134 degrees for pronation/supination with a relative gain of 58%. MPI was 84 points on average. The mean DASH was 17.6 and the mean SF-36 67.9. The correlation of these outcome parameters was calculated using Pearson's correlation (two-tailed, significance set at p<0.05). We found a high correlation between DASH and the physical function part of the SF-36 (Cov=-0.87, p<0.05). The correlation of DASH and MPI was moderate (Cov=0.71, p<0.05) and of DASH and ROM poor (Cov=-0.25, p<0.05). CONCLUSION: ROM as a single parameter does not sufficiently assess the outcome of arthrolysis of the elbow.

Adolescent↗
PubMed2003

[Drains in trauma surgery].

Closed suction drains are still commonly used following orthopedic procedures. While empirical recommendations predominated until the 1980s,many randomized controlled studies concerning the use of drains have been conducted within the last 20 years. This article compares studies that have been performed in a prospective randomized manner.Numerous investigations have shown that there is no positive effect of suction drains with regard to long-term results in aseptic orthopedic surgery. This even holds true in the fields of endoprosthetic surgery and procedures that are associated with a high incidence of complications, e.g., bone grafting from the iliac crest.Moreover, there is evidence from some studies that septic complications are significantly higher in the suction drain groups.Evidence-based surgery should call for a very critical indication to use suction drains;however, the acceptance of this evidence is very low among surgeons up to now.

Drainage↗