Biomedical subjects

L Gotzen

Publications and source records attributed to L Gotzen.

At least 37 records · Page 2Linked to original sources

PubMed2001

[Arthroscopic and clinical evaluation after isolated, augmented anterior cruciate ligament replacement. A prospective study].

80 patients were examined in to perform a prospective essay on the isolated substitute of the anterior crucial ligament being done by Miniarthrotomie and two channel technique. All patients received a substitute of the anterior cruciate ligament by using an autogenous, TETRA-L3 augmentated bone tendon bone graft from the middle third of the patellar ligament of the injured knee. Clinical and arthroscopical examination was carried out in the average 28 months (24-36) after crucial ligament reconstruction, by the routinely removal of the augmentation and fixation material. Clinical examination was carried out using the strict and objective IKDC-Score. The arthroscopical evaluation of the ACL-graft was performed with our recently developed Score for ACL-graft evaluation (Marburger Arthroscopy Score for graft evaluation). The Score distinguishes between four stages: type I: tight, crucial ligament like structured graft, type II: a firm, more bundle like structured graft, type III: a lax, untidy structured graft and type IV: the rudimentary graft. A statistical analysis was performed on the question whether there is a correlation between the clinical and the arthroscopical results. Furthermore, with the Marbuger Arthroscopy Score for graft Evaluation we introduced a standardised, simple-to-use new score for the arthroscopical ACL-graft evaluation. We find a high correlation (r = 0.77) between the clinical results and the arthroscopical findings, so that from clinical evaluation there might be draw conclusion to the arthroscopical expective results with high probability. Due to our previous experience we assume the Marburger Arthroscopy Score For Graft Evaluation to be a standardised and simple assessment method for the evaluation of the ACL-graft, considering pathobiomechanical influences on the ACL-substitute.

Adolescent↗

PubMed2001

[Continuous stroke volume monitoring as "hemodynamic online monitoring" in polytrauma intensive care patients: technically possible--clinically necessary?].

PURPOSE: Is the measurement of continuous cardiac output useful for the management of polytrauma patients? METHODS: In a prospective non randomized study (ethic commission file 43/96) we evaluated the diagnostic and therapeutic impact of the CCO (continuous cardiac output measurement) for polytrauma patients on the ICU. The Baxter Vigilance System was used for measuring the continuous cardiac output. The CCO values were controlled once a day by the conventional "cold" thermodilution technique. RESULTS: All values are given as mean +/- standard deviation. The Patients were scored on the first day for ISS (injury severity score) (47 +/- 17) and APACHE II (15 +/- 5). The CCO was used no later than 12 hours after the initial treatment in 20 polytrauma patients. As clinical outcome parameters were chosen: days on ventilation (23 +/- 23 days), days on the ICU (31 +/- 26 days) and mortality (20%). The treating ICU physicians were asked in a standardized questionnaire, whether or not there was an impact of the CCO measurement on their therapy. Seven different surgeons were working with the system. CONCLUSION: The unique opinion was that the CCO device had an impact on their decision making in the fluid and drug management of the study patients. Our first experience, however, suggests that this device may become an important improvement in the management of haemodynamics in the early trauma phases. Before a wide-spread application of this method on the ICU an evidence based prospective randomized trial should be performed.

Adult↗

PubMed2001

[Selection of subjects: a problem of clinical trials in traumatology. Selection effects and the problem of representation as exemplified by a prospective randomized trial on whiplash injuries].

INTRODUCTION: The internal and external validity of studies is endangered by many factors, such as selection of subjects for inclusion. Selection bias itself is a major problem, but remains unmentioned and probably unexamined in the majority of published clinical trials in traumatology. AIM OF THE STUDY: The aim of this investigation was to detect effects of subject selection which occurred during our own prospective intervention study. The clinical trial compared subjects with whiplash injury who were either treated by early mobilization or immobilization (soft collar). MATERIAL AND METHODS: Source population, eligible subjects, study participants and final study participants were compared for differences on various items like age, gender and further sociodemographic as well as crash related factors and clinical findings. RESULTS: Between 21.08.1997 and 30.04.1999 a total of 732 patients was examined and treated after whiplash in our trauma department. The options for inclusion were met by 453 patients. While 346 escaped from the study, 107 agreed to participate. Of these another 39 patients dropped out of the study. Selection effects were detected on two different levels, leading to distinct statistical procedures from those proposed in the study protocol. CONCLUSIONS: Uncontrolled selection effects could undermine the interpretability of the results of clinical trials. Awareness of selection effects is mandatory regarding the applicability of these results to subjects, other than those in the group of the final study participants.

Humans↗

PubMed2001

External patellotibial transfixation: indications, operative technique and outcome.

Patellotibial transfixation with the MPT fixator is a new method of external stabilisation for lesions of the extensor mechanism of the knee joint. The biomechanical principle is the external transmission of tensile forces in the quadriceps muscle from the patella to the lower thigh and the translation of these forces into extension of the knee joint. The construction is an external patellotibial frame. In fitting method A, a Steinmann pin with central thread is inserted transversely through the patella and proximal tibia. Connection is made via laterally positioned rods with rotatable fixator jaws. In fitting method B, a Schanz screw is inserted sagittally into the proximal tibia and connected to the tibiocentral fixator jaw. In the frame construction a threaded pin is tightened into the fixator jaw. The MPT fixator is mostly used to secure suture repairs and transosseous refixations of the patellar ligament, or to reconstruct neglected patellar tendinous or osseous lesions of the distal extensor apparatus when functionally stable results cannot be obtained by osteosynthesis. The advantages of patellotibial transfixation are that: (1) a minimum of internal allogenic material is required to reconstruct the extensor apparatus and the repair is protected against excessive strain; (2) immediate functional post-operative therapy with an unlimited range of motion and early full weight-bearing is possible. Between 1990 and 1997 the MPT fixator was here used on 74 patients, 51 of whom had an acute lesion of the extensor mechanism, 19 lesions had either been neglected or subjected to an earlier operation. Among 20 of the acutely injured knee joints there were other serious associated injuries. Fitting method A was used in 48 patients and fitting method B in 26 patients. In four patients the operation was followed by severe infection, owing to the fixator in two cases. The remaining 70 patients wore the system for an average of 7.3 weeks. Eight patients with caudal comminuted fractures who had had segmental patellectomy and transosseous refixation of the patellar tendon and 15 patients who had had transosseous suture refixation of the patellar ligament after rupture at the lower pole or suture repair after intraligamentous rupture, were followed up isokinetically and radiologically with IKDC scoring for an average of 49.3 months after the operation. The outcome was classified as normal or close to normal in 19 patients and as abnormal in four. Isokinetically only five of the 23 had a 10-20% deficiency in the strength of the extensor muscles of the operated leg in comparison to the opposite side. External patellotibial transfixation with the MPT fixator produced good operative results in re-establishing the continuity of the distal extensor apparatus of the knee joint and is an effective alternative to patellotibial cerclage with wire or synthetic ligament.

Adolescent↗

PubMed2001

MRI versus arthroscopy in the diagnosis of scapholunate ligament injury.

In a prospective study 103 patients with clinically or radiologically suspected tears of the scapholunate interosseous ligament were investigated with magnetic resonance imaging (MRI) and wrist arthroscopy. MRI was performed with the conventional technique in 72 cases and after intravenous injection of contrast medium in the remaining 31 patients. The correct diagnosis was made by MRI in 75% of cases and its overall sensitivity and specificity were 63% and 86% respectively. There was no statistical difference in the accuracy of MRI for acute or chronic tears and the use of intravenous contrast medium did not improve its accuracy. In conclusion, MRI is not recommended for the diagnosis of scapholunate ligament injury.

Adolescent↗

PubMed2001

[MRI or arthroscopy in the diagnosis of scapholunate ligament tears in fractures of the distal radius?].

In a prospective study, 45 patients with fractures of the distal radius and radiologically suspected tears of the scapholunate interosseous ligament were examined. Magnetic resonance imaging was performed prior to wrist arthroscopy. The latter examination gave the definite diagnosis. MRI was performed in conventional technique (without contrast medium) in 25 cases and after additional intravenous injection of contrast medium in the remaining 20 patients. The images were obtained with a 1.0-T clinical imager using a T(2)-weighted turbo spin echo sequence (slice 3 mm, transversal) and a FLASH 2D sequence (slice 2 mm, oblique/coronal). Three independent observers assessed the MRI scans before arthroscopy was performed. The correct diagnosis was made by MRI in 76 %. Overall sensitivity and specificity came to 71 % and 86 %, respectively. The use of intravenously applied contrast medium did not improve MRI accuracy. In conclusion, MRI is not recommended for the diagnosis of scapholunate ligament tears. Presumably, the results of MRI could be improved by a more sophisticated technique.

Adolescent↗

PubMed2001

[Arthroscopic diagnosis of concomitant scapholunate ligament injuries in fractures of the distal radius].

To investigate the occurrence of carpal ligamentous injuries in patients with fractures of the distal radius, the results of 122 wrist arthroscopies were analysed within a retrospective study. Indications for arthroscopy included suspected carpal instability according to radiographic findings and/or the necessity for internal fixation of the radius fracture. Arthroscopy revealed acute scapholunate ligament tears in 84 patients. Scapholunate separation was found to be of prognostic value for ligament tears. There was no association between ligamentous lesions and carpal angles or fracture dislocation. Scapholunate ligament tears were most frequent in sagittal articular fractures. In these cases, wrist arthroscopy should be performed during operative treatment of the radius fracture to allow direct visualization and subsequent repair of ligamentous tears.

Adolescent↗

PubMed2001

[Primary arthroscopic treatment of TFCC tears in fractures of the distal radius].

The primary simultaneous diagnosis and therapy of TFCC tears in distal radius fractures is still the exception. We present our results of arthroscopic treatment of these injuries. From January 1998 until September 1999, we treated 21 patients with a type C fracture (AO classification) of the distal radius and one patient with a scaphoid fracture and TFCC tears. The Palmer 1A (n = 5) and 1 C (n = 4) tears have been arthroscopically shaved as well as the meniscal tear (n = 1). The Palmer 1B tears were refixed either in an outside-inside technique (n = 6) or in a new all-inside technique (n = 6). Palmer 1D tears were refixed in the Fellinger technique (n = 5). In the clinical follow-up examination six to fifteen months later, we saw symptoms of ulnar-sided wrist pain only in one case of a Palmer 1B tear treated in an outside-inside technique. Especially the patients treated by the new all-inside technique were free from symptoms of TFCC instability. We conclude, that arthroscopic treatment of TFCC tears in acute radius fractures is possible with good results. The new technique of all-inside repair is minimally invasive and shows good results.

Adolescent↗

PubMed2001

Procalcitonin versus interleukin-6 levels in bronchoalveolar lavage fluids of trauma victims with severe lung contusion.

OBJECTIVE: To examine whether measurement of procalcitonin (PCT) in comparison with interleukin-6 is a reliable marker to score the extent of lung contusion in bronchoalveolar lavage (BAL) fluids in polytrauma patients. DESIGN: Prospective, nonrandomized, observational study. SETTING: Twelve-bed intensive care unit in a 1,100-bed primary care university hospital. PATIENTS: Fourteen trauma victims presenting with severe lung contusion and acute lung injury or acute respiratory distress syndrome were enrolled in the study. INTERVENTIONS: Bronchoscopy with collection of lavage fluid and serum blood samples. Samples were obtained on days 1 and 2 after severe chest trauma, and lung contusion was assessed by computed tomography scan. MEASUREMENTS AND MAIN RESULTS: PCT was detectable in BAL fluids of all 14 patients. A significant correlation for PCT serum and BAL levels was found on day 2 (p =.0063). For PCT, no significant correlations (Spearman rank) were found to the lung injury score (p =.93), the abbreviated injury scale-lung (p =.33), or the sepsis-related organ failure assessment score-lung (p =.38). Also, for interleukin-6 there was no significant correlation to the lung injury score (p =.62), abbreviated injury scale-lung (p =.45), or the sepsis-related organ failure assessment score-lung (p =.54). CONCLUSIONS: PCT and interleukin-6 BAL levels cannot be considered as reliable parameters to assess the extent of lung contusion.

Adult↗

PubMed2000

[Effect of various bone disinfection and sterilization methods on osteoblast function. A comparative in vitro study].

All sterilization and disinfection procedures for bone grafts are different in regard to influence of bone graft features, which may influence the function of different cell types. We used an in-vitro approach to assess the influence of bone matrix, which was sterilized or disinfected, on osteoblastic activities in-vitro by simulating a cell-transplant-interface. Primary bovine osteoblast cell cultures were established from periosteum. Bone graft specimens made of bovine cortical bone (O 15 mm, 300 microns thickness) were treated in 5 different ways: autoclaved, ethylene-oxide-sterilized, demineralized and low-temperature-plasma-sterilized (DEM-LTP), chemically sterilized (modified Tutoplast method), and 80 degrees C-temperature disinfected. The following cell function parameters were assayed: plating efficiency proliferation by measuring the DNA-content, and MTT-activity, soluble protein and extracellular matrix synthesis, alkaline phosphatase, and osteocalcin expression. All disinfected bone grafts were biocompatible with primary periosteal osteoblasts. Measured cell activities upon bone specimens showed better results than cells of the plastic surface control. The DEM-LTP-bone showed better results in comparison to other groups, and stimulated the proliferation and differentiation.

Animals↗

PubMed2000

[Is a general pharmacologic thromboembolism prophylaxis necessary in ambulatory treatment by plaster cast immobilization in lower limb injuries?].

Selected patients with minor lower limb injuries and low risk for deep vein thrombosis (DVT), who required cast immobilizing and did not receive medical thrombosis prophylaxis, were included in a prospective study. The decision to give not medical thrombosis prophylaxis depended on an concept of individualised prophylaxis for patients at risk for thromboembolism. From March 1994 to March 1996 in 178 outpatients (118 men, 60 women, mean age 25.8 [16-39] years) a clinical examination and a colour-coded duplex sonography were performed after removal of the cast for detection of DVT of the lower limb. A phlebography was performed when thrombosis was suspected. Two patients developed a one bundle thrombosis of the calf. Clinical appearance of lung embolism was not observed. These results suggest, that low risk patients with minor injuries of the lower limb and plaster cast immobilisation do not need a medical thrombosis prophylaxis.

Adolescent↗

PubMed2000

[Kinetic therapy for therapy and prevention of post-traumatic lung failure. Results of a prospective study of 111 polytrauma patients].

The effects of kinetic therapy on the oxygenation in the injured lung of 111 polytrauma patients were analysed in an open prospective study. The patient collective comprised 82 men and 29 women. For the total group, the average age was 38.3 years (+/- 16.1). The initial ISS was 39.3 points (+/- 18.9), and the APACHE II evaluated 24 h after including the patient into the study was 13.1 (+/- 5.2). The data of 3 treatment groups were evaluated: 1, acute respiratory disease (ARDS, n = 42); 2, acute lung injury (ALI, n = 36); and 3, prophylaxis (n = 33, a group of prophylactically treated patients with a PaO2/FiO2 ratio > or = 300 and an ISS > or = 15). Positioning therapy was administered in group 3 in order to prevent atelectases, and respirator-induced lung injuries during a foreseeable, relatively long period in the intensive care unit in view of the severity of the trauma. The mean treatment time in the kinetic bed was 6.3 days (+/- 3.9), the time on respirator 18.5 days (+/- 15.4). The patients stayed in the ICU 22.4 days (+/- 15.4) and left the hospital after 35.1 days (+/- 27.7). For scoring the severity of respiratory failure, the lung injury score (LIS) according to Murray and the SOFA score lung (sepsis-related organ failure assessment) according to Vincent were evaluated. The LIS at time of recruitment into the study was 2.2 (+/- 1.0), the SOFA score lung 3.0 (+/- 0.9). In the ALI and ARDS groups a significant improvement in oxygenation was observed (p < 0.0001). No patient of the prophylaxis group developed an ALI or ARDS. The mortality rate in the total group of 10.8% was relatively low in comparison with other published data. Consistent kinetic therapy integrated in a standardised treatment regimen contributes towards improving the negative outcome to date of patients with severe respiratory failure after major trauma.

APACHE↗

PubMed2000

[Arthroscopically controlled minimal invasive screw fixation of scaphoid fractures. A pilot study].

We could not find any systematic studies about the value of arthroscopy in scaphoid fractures in the literature, and therefore undertook a pilot study of 20 scaphoid fractures which were treated arthroscopically by the Herbert-Whipple screw and were minimally invasive. We found very good radiological and clinical results in 17 patients and good results in 3 patients evaluated by the Wozasek and Moser score. For reduction of dislocated fractures we used distraction with 5 kg in the wine waiters position. In four cases we used additional K wires as joysticks. Arthroscopy is less valuable in reduction, however, it is important in verification of the compression force of the Herbert-Whipple screw and for diagnosis and therapy of lesions of the scapholunate ligament and TFC complex. We found seven SL instabilities, two lesions of the meniscus, and one Palmer 1B lesion of the TFC complex. From these results we conclude that arthroscopy should necessarily be done by minimally invasive osteosynthesis of scaphoid fractures to detect and treat discoligamentous injuries of the wrist.

Adult↗

PubMed2000

[Percutaneous osteosynthesis of scaphoid fracture with the Herbert-Whipple screw--technique and results].

In order to diminish the surgical trauma a percutaneous osteosynthesis of acute fractures of the scaphoid was performed in 22 cases using the cannulated Herbert-Whipple screw. Displaced fractures were reduced under fluoroscopy in a position of extension and supination while pulling the thumb with a weight of 5 kg by means of a Japanese finger trap. Additional correction could be achieved by using Kirschner wires as joysticks. The guide wire allowed a correct positioning of the cannulated screw. We have found that radiocarpal and midcarpal arthroscopy was of little benefit for fracture reduction. However, arthroscopy was important for the detection of concomitant carpal injuries. Due to minor projection over the distal scaphoid pole, three screws had to be removed underlining the difficulty of exact length determination. Sound bony union was achieved in all 22 cases even in those treated without plaster immobilisation. Limitations in wrist motion and grip strength have been found after concomitant injuries such as fractures of the distal radius and scapholunate ligament injury. On the other hand, there was no impairment of wrist function after percutaneous osteosynthesis of isolated scaphoid fractures. In conclusion, percutaneous osteosynthesis of the fractured scaphoid with the cannulated Herbert-Whipple screw permits a reliable treatment with minimal operative trauma.

Adult↗

PubMed2000

[Results after minimally invasive therapy of acute scapholunate dissociation].

In 27 cases with acute scapholunate ligament injury, minimal invasive treatment was performed. After closed reduction scapholunate transfixation was achieved by Kirschner wires. Postoperatively, a short-arm cast was applied for six weeks. All patients have been reexamined on average 26 months after operation. Follow-up results have been good concerning clinical examination and patients' satisfaction. Radiological examination has shown recurrence of scapholunate instability in 15 cases. In fact, 11% of the patients had dynamic and 44% static instability at follow-up. Recurrence has been most frequent in cases involving primary static instability. Consequently, these cases should be treated by open reduction. Minimal invasive treatment of acute scapholunate dissociation is not recommended. The therapeutic procedure must be adapted to the different stages of scapholunate ligament injury.

Acute Disease↗

PubMed2000

Comminuted pelvic ring disruption in toddlers: management of a rare injury.

Pediatric pelvic fractures are rare injuries. The clinical management, classification, and operative treatment of this type of injury was presented in two toddlers ranging in age from 1 to 3 years. The CT examination proved to be the most reliable diagnostic tool for the assessment of the fracture morphology. The findings of the CT examination provide the possibility for an exact classification and operative planning. The surgical treatment was performed with the AO instrumentation for small fragments by using the approved standard approaches of adult surgery. The postoperative management has to be adapted to the physiology of the children. It is important to remove the osteosynthesis material in due time to avoid the risk of epiphysiodesis at the pelvis. To detect late sequelae of the trauma, follow-up should be performed regularly until growth is completed.

Accidents, Traffic↗

PubMed1999

[The external patello-tibial transfixation (EPTT). Part II: Clinical application and results].

In part I of the paper the biomechanical and technical background of the EPTT using the MPT fixator and the indications for this procedure have been described. In part II we report about the clinical application of the EPTT in 67 patients with a wide spectrum of repairs and reconstructions of the extensor mechanism. 48 patients had fresh injuries, 18 of them with severe concomitant knee lesions and 19 patients had neglected rsp. unsuccessfully operated injuries. There were 4 deep infections, two of them related to the MPT fixator. In the patients with uneventful healing the fixator remained in place for 7.3 weeks in average. The clinical, isokinetic and radiological results were reviewed in 17 patients with an average follow-up time of 37.3 months. There were 5 patients with partial patellectomy and tendon reattachment because of lower patella pole comminution and 12 patients with tendon reattachment ruptured at the inferior patella pole or suture repair in midsubstance rupture. The clinical results according to the IKDC score were rated in 3 patients as normal, in 10 patients as nearly normal and in 4 patients as abnormal. This rating was highly dependend on the subjective judgement by the patients who considered their operated knees not as normal as the contralateral knees. From our clinical experiences and results we can derive that the EPTT enables the surgical management of extensor mechanism disruptions with a minimum of internal fixation material and provides a safe protection of the repairs and reconstructions during the healing period. The EPTT allows immediate unrestricted functional rehabilitation and early walking without crutches. Thus the EPTT represents an effective alternative to the patello-tibial cerclage with a wire or synthetic ligaments.

Adolescent↗

PubMed1999

[Epiphyseal injuries of the distal tibia. Does MRI provide useful additional information?].

Plain film radiography often underestimates the extent of injury in children with epiphyseal fracture. Especially Salter-Harris V fractures (crush fracture of the epiphyseal plate) are often primarily not detected. MRI of the ankle was performed in 10 children aged 9-17 (mean 14) years with suspected epiphyseal injury using 1.0-T Magnetom Expert. The fractures were classified according to the Salter-Harris-Rang-Odgen classification and compared with the results of plain radiography. In one case MRI could exclude epiphyseal injury; in four cases the MRI findings changed the therapeutic management. The visualisation of the fracture in three orthogonal planes and the possibility of detection of cartilage and ligamentous injury in MR imaging makes this method superior to conventional radiography and CT. With respect to radiation exposure MRI instead of CT should be used for the diagnosis of epiphyseal injuries in children.

Adolescent↗