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Biomedical subjects

L Gotzen

Publications and source records attributed to L Gotzen.

At least 55 records · Page 3Linked to original sources
PubMed1999

Plate fixation of proximal humeral fractures with indirect reduction: surgical technique and results utilizing three shoulder scores.

To determine the outcome after indirect reduction and buttress plate fixation of displaced and unstable proximal humeral fractures, we retrospectively evaluated 98 patients, an average of 34 months (range 24-72 months) after fracture fixation. The patients were reviewed and results were evaluated clinically according to the Neer, UCLA and Constant score. A radiographic evaluation of fracture healing, avascular necrosis and degenerative changes of the shoulder joint was performed in all patients. Any complications of treatment were assessed. Results were, according to the UCLA-rating system, good to excellent in 76% of fractures. According to the Constant-score and the Neer score, good to excellent results were obtained in 69 and 59% of fractures, respectively. Poor results were mainly due to secondary malunion. The avascular necrosis rate was 4%. Non-union was seen in one case. Secondary varus deformity and retroversion of the humeral head as a result of lack of rotational and angular stability of the plate developed in twelve (12%) and eight (8%) cases, respectively. Plate fixation is an adequate procedure for treating unstable and displaced two- to four-part fractures of the proximal humerus, enabling early functional after-treatment. The incidence of avascular necrosis and nonunion are low, when fracture reduction is performed indirectly. Poor rotational and angular instability can lead to a loss of reduction.

Adult↗
PubMed1998

[Prospective randomized pilot study of ambulatory prevention of thromboembolism. 2 times 500 mg aspirin (ASS) vs. clivarin 1750 (NMH)].

From March 1994 to March 1996, 287 patients, presenting with lower extremity injuries, who required immobilizing bandages or casts, where included in a prospective, randomized study. These patients received either low-molecular heparin or acetylsalicylic acid for thrombosis prophylaxis. In all patients a clinical examination and a colour-coded duplex sonography were performed after removal of the cast for detection of lower extremity venous thrombosis. A plebography was performed when thrombosis was suspected. A subcutaneous injection of divarin 1750 was given once daily in 143 patients. Thrombosis prophylaxis with Aspirin 2 x 500 mg administered orally was performed in 144 patients. Deep vein thrombosis occurred in 9 patients (6.3%) with clivarin prophylaxis and in 7 patients (4.8%) treated with Aspirin. In both groups, no clinically significant side effects of the medications were observed.

Adult↗
PubMed1998

[Calcaneus cyst--an indication for surgery? Case report and review of the literature].

Simple bone cysts are asymptomatic, benign lesions which are usually an incidental finding on a radiograph. Etiology and treatment are controversially discussed. The weight-bearing status of the calcaneus and possible pathologic fracturing lead many authors to recommend therapeutic measures after diagnosis has been made. We present a case report of an intact unicameral bone cyst of the calcaneus concomitant with tibial and talar fractures following crush trauma. Several types of treatment for simple bone cysts of the calcaneus have been suggested. The question whether treatment is unconditionally necessary is controversially discussed. It is the author's opinion, that asymptomatic bone cysts of the calcaneus require no further treatment.

Adult↗
PubMed1998

[Morbidity after contralateral transplantation of the patellar ligament for cruciate ligament replacement].

After cruciate ligament reconstruction using an autogenous central bone-patellar tendon-bone graft persistent complaints are described in the literature. There is the difficulty to distinguish the morbidity associated with the graft harvest and the morbidity caused by the injury and the reconstruction procedure. In order to clarify the morbidity resulting from the graft harvest alone, we evaluated those patients who had transplantat harvest from the opposite knee. Between 1990 and 1995 a central bone-tendon-bone graft has been taken from the contralateral uninjured knee in 37 patients, in 22 cases for anterior and in 15 cases for posterior cruciate ligament reconstruction. 27 patients were clinically (IKDC Score), isokinetically and radiologically followed up in an average of 25.3 months after the operation (range: 9-73 months). 21 patients were classified into IKDC group A. Except of one patient with an extension deficit of 5 degrees all others showed normal range of motion. Only 5 of 27 patients expressed minimal knee pain during vigorous activities. Three of them reported about weather sensitivity in addition. These 6 patients were ranked in group B. No patient was classified into IKDC group C or D. The isokinetic examination showed a normal level of quadriceps strength. At final followup, the technique of Blackburne and Peel was used to assess patellar height. There was no radiographic evidence of patella contracture or baja. According to our results taking the autogenous CBTB graft used for cruciate ligament reconstruction leads to no serious morbidity.

Adult↗
PubMed1998

On the possible role of positive end-expiratory pressure ventilation in the treatment of chylothorax caused by blunt chest trauma.

Recent reports on the treatment of chylothorax postulate a benefit to ventilator therapy, especially using positive end-expiratory pressure (PEEP). This report describes the use of mechanical ventilation with PEEP in the management of a 24-year-old male motorcyclist who sustained a ligamentous Chance fracture of the thoracic spine at the T6-7 level with bilateral traumatic chylothorax. Treatment of the chylothorax consisted of high PEEP ventilation, bilateral chest tube thoracostomies, and total parenteral nutrition. The chylothoraces resolved within 4 days of treatment and mechanical ventilation was stopped. Ventilator therapy of traumatic chylothorax and the physiologic grounds for its use are discussed. A review of the literature and experimental evidence seem to suggest that ventilator treatment of traumatic chylothoraces is effective.

Accidents, Traffic↗
PubMed1998

Detection of differential gene expression in human osteoblastic cells by non-radioactive RNA arbitrarily primed PCR.

The aim of the present study was to detect differentially expressed genes in the human osteoblast-like osteosarcoma cell line SaOS-2 using non-radioactive RNA fingerprinting (RNA arbitrarily primed polymerase chain reaction, RAP-PCR). RNA was isolated at different time points from SaOS-2 cells grown with and without dexamethasone (DEX). By RAP-PCR we detected changes in band patterns of cells treated with DEX compared with untreated cells. PCR fragments further characterized and sequences from three of these gave perfect matches to the coding sequences of the human nucleophosmin gene B23, cDNA clone 4_c6 from P1 H25 and the human TRA1 gene, respectively. differential regulation of these genes in DEX-stimulated SaOS-2 cells could be demonstrated by RT-PCR.

Antineoplastic Agents, Hormonal↗
PubMed1998

Operative treatment of displaced proximal humeral fractures: two-year results in 99 cases.

The operative treatment of comminuted and displaced fractures of the proximal humerus has been evolving in recent years. Classical open reduction and internal fixation techniques have an increased risk of avascular necrosis. Minimal osteosynthesis procedures often result in a suboptimal fracture reduction and require postoperative immobilization of the arm in some cases. This study reviewed ninety-nine out of 142 patients (70%), an average of 30 months (range 12 to 72 months) after indirect reduction and internal fixation of two-, three- or four-part fractures of the proximal humerus. The surgical procedure includes indirect fracture reduction with no manipulation of the different fracture fragments and subsequent buttress-plate fixation, using a limited deltopectoral approach. Mean age of patients was 63 years (range 17 to 85 years). Twenty percent of patients had associated lesions. Five patients presented with fracture-dislocations. Results were, according to the UCLA- and the Constant-rating system good to excellent in 76 and 69% of cases. Twelve patients had a poor functional outcome. The indirect reduction technique reduces the opening of the fracture site to minimum and thereby limits the risk of iatrogenic damage to local vascularity and the rotator cuff. Complete and partial humeral head necrosis developed in 3% and 1% of cases respectively. Non-union occurred in one case. Plate fixation is an adequate procedure for treating unstable and displaced two- to four-part fractures of the proximal humerus. The incidence of avascular necrosis and non-union are low, when fracture reduction is performed indirectly. Plate fixation enables an early functional treatment, with no need for postoperative immobilization.

Adolescent↗
PubMed1997

[Therapy and outcome of lateral clavicular fractures].

Fractures of the distal third of the clavicle tend to develop delayed union or nonunion when treated conservatively. Correct diagnosis of fracture instability and/or associated lesions of the ligamentous structures of the acromioclavicular joint is mandatory for adequate fracture treatment. When classical radiographs fail to demonstrate instability, stress roentgenographs of both shoulders are indicated. From 1985 to 1994, 66 adult patients with a fracture of the distal clavicle were treated at our institution. Fracture classification was performed according to Jäger/Breitner. Fractures were unstable in 36 cases (54.5%). An associated lesion of the acromioclavicular joint was present in 8 patients presenting with an unstable fracture. Fracture instability was due to an associated fracture of the coracoid process in two cases. Stable fractures were treated conservatively. Thirty-three unstable fractures were treated surgically. Plate fixation was performed when at least three screws could be placed in the distal fragment. When the distal fragment was small or associated with acromioclavicular joint involvement, it was stabilized by PDS banding of the clavicle to the coracoid process and reconstruction of the ligaments. Results were evaluated retrospectively by questionnaire, clinically and by radiological examination. Fifty patients (76%) were reexamined. The outcome was good or excellent in 96% of unstable fractures that had been treated surgically. Results after conservative treatment of unstable fractures (n = 3) were poor. Conservative treatment of stable fractures resulted in all cases in a good-to-excellent result. For fractures of the distal clavicle, good results can be achieved when the instability is recognized and adequately treated. The association of a distal clavicular fracture and an acromioclavicular ligament disruption should be added as a separate subtype in the existing classification of distal clavicular fractures. PDS banding is a valuable alternative for fractures with small peripheral fragment or associated acromioclavicular disruption.

Acromioclavicular Joint↗
PubMed1997

[External patello-tibial transfixation. I: Indications and technique].

Patello-tibial transfixation using the MPT-fixator is a new kind of external fixation. The device works biomechanically transferring the quadriceps tension forces from the patella to the lower leg and converting them into extension of the knee. The fixator can be applied in two different configurations. When performing configuration A, a Steinmann pin with a central thread is transversely placed through the patella and proximal tibia. Both pins are joined to connecting rods. Configuration B differs from type A in that a Schanz screw is inserted from anterior to posterior through the proximal tibia. The frame construction is achieved by fastening the tibial-sided Steinmann pin with a special clamp at the Schanz screw. Patello-tibial transfixation is indicated in the repair of fresh extensor mechanism disruption and reconstruction of neglected rupture of the patellar tendon. The technique provides a secure protection of the repair and reconstruction against mechanical overloading during the healing period. It enables immediate functional after-treatment and mobilization with early full weight bearing.

Biomechanical Phenomena↗
PubMed1997

[Results of reconstruction of acromioclavicular joint rupture with PDS implants].

From 1986 to 1994, we treated 79 patients with acute acromioclavicular separations by surgical reconstruction. According to the classification of Rockwood and Matsen. 65 patients had type III lesions, 1 patients had a type IV lesion and 13 patients had type V lesions. Both the coracoclavicular ligaments and the ligaments of the acromioclavicular joint were reconstructed. An additional ligamentous augmentation was performed using completely resorbable 5- and 10-mm polydioxanone-sulphate bands. Fifty-five patients (70%) were reexamined 1-7.5 years after surgery (mean 28 months). The results were good to excellent in 50 cases (90%). Fifty-two patients (93%) achieved a range of motion with an abduction deficit of less than 20 degrees. Calcifications in the area of the coracoclavicular ligaments did not affect the final range of motion. Early complications consisted of a subcutaneous infection, one deep infection, and one reconstruction failure. Late complications consisted of a redislocation in 2 patients and symptomatic post-traumatic arthritis of the joint in 3 cases. Augmenting the reconstruction with polydioxyanone-sulphate bands allowed early functional post-operative treatment. With this procedure, patients do not require removal of the implant, and complications from breakage or migration of metal implants are avoided.

Acromioclavicular Joint↗
PubMed1997

[Monosegmental internal fixator instrumentation and fusion in treatment of fractures of the thoracolumbar spine. Indications, technique and results].

Dorsal fusion with the internal fixator has become the standard treatment of instabilities and deformities of the thoracolumbar spine. With our new device, the modular spine fixator (MSF), which has been specially designed for short-distance instrumentations, we have increasingly been treating unstable injuries of the thoracolumbar spine by one-level stabilization. Prerequisite is an accurate evaluation of the indication, including CT and MRI to assess the involvement of the intervertebral disc and the ligamental structures. The operative technique differs in some details from the procedure in more-multi-level instrumentations, especially concerning the application of the pedicle screws. The instrumentation is always combined with posterior allogenic bone grafting. Since the beginning of 1993 we also perform anterior autogenic transpedicular bone grafting. Between January 1991 and July 1995, 57 one-level stabilizations with the MSF were performed. Of the 57 patients operated on 39, 27 men and 12 women, with an average age of 41 years, have had a clinical and radiographic follow-up examination so far, on average, 27 months after the accident. Seventeen patients were completely free of pain and 17 patients (were only) sensitive to weather changes or had minor pain during great physical stress. Five patients had pain even during slight physical stress or at rest. The preoperatively measured Cobb angle was 15.1 degrees on average, after the operation 5.2 degrees, and at the time of the follow-up examination amounted to 8.1 degrees. The patients' range of motion was normal. Only five minor complications have been seen. No implant fatigue failure has been noted in this series. We derive from these results that, for correct indications, one-level stabilization can be performed successfully and should be firmly established in the operative treatment of unstable fractures of the thoracolumbar spine.

Adolescent↗
PubMed1996

[Impalement injury of the colon, iliac vein and sacrum--a rare combination in penetrating abdominal trauma. A case report].

We report on the treatment of a patient who sustained a penetrating abdominal wound with injury of the left common iliac vein, the sigmoid colon and the sacrum in a motorbike accident. The left iliac vein injury was treated using a Gore-Tex vein patch and an A-V fistula. The colon was restored after an intraoperative washout. The punched fragment of the sacrum was removed. An additional fracture of the proximal left humerus was managed with an osteosynthesis in a second operation. The principles of management of combined colon and vascular injuries are discussed and a short review of the literature is given.

Abdominal Injuries↗
PubMed1996

[Blunt thoracic trauma with aortic rupture and lung contusion caused by hoof kick in a 15-year-old girl. Diagnostic and therapeutic management].

The number of published cases of adolescents surviving thoracic aortic injuries with accompanying severe thoracic injuries is small. Only 20-30% of all these patients reach the trauma center alive. In the present case we demonstrate the diagnostic, operative and intensive care management in a 15-year-old girl. The exact interpretation of the AP thoracic X-ray in connection with a typical mechanism of injury led to the detection of a haemomediastinum. This is very important in the further development of diagnostics, because the conventional X-ray picture does not show significant signs in the case of an incomplete aortic rupture. Diagnostic hints have to be derived from the detection of the haemomediastinum. The girl was operated on under left heart bypass. Spinal ischaemia was absent after surgery, and renal failure also did not occur. The adjacent severe lung confusion healed under kinetic therapy with a kinetic treatment table without pulmonary complications.

Adolescent↗
PubMed1996

Treatment of unstable distal clavicular fractures with and without lesions of the acromioclavicular joint.

A series of 39 unstable fractures of the distal one-third of the clavicle is presented. As results after non-operative treatment of these fractures are poor, surgical therapy is indicated. In fractures with a small peripheral fragment or with an associated separation of the acromioclavicular joint, PDS-banding is a valuable technique for stabilization. According to the classification of Neer and Jäger/Breitner, a clear therapeutic strategy for lateral clavicular fractures can be defined. Unstable clavicular fractures with associated acromioclavicular ligament disruption should however be considered as a separate subtype in the existing classifications.

Acromioclavicular Joint↗
PubMed1996

[The pivot-shift test in relation to hip position and lower leg rotation. A clinical analysis].

In a prospective clinical study conducted on 50 patients with isolated insufficiency of the anterior cruciate ligament (ACL), we investigated the triggering of pivot shift as a function of the position of the hip joint and the rotational position of lower leg; the results were compared with those yielded by the Lachman test. The pivot shift phenomenon was found to be more readily triggered when the hip was abducted, and especially when the investigator had specified external rotation of the lower leg at the same time. Our results show that this modification of the classic pivot shift test can fill a diagnostic gap in the clinical investigation. The pivot shift test with hip abduction and external rotation of the lower leg is a valuable alternative test for the diagnosis of ACL insufficiency.

Adolescent↗
PubMed1996

Knee arthrodesis with a unilateral external fixator.

The operative fusion of the knee joint remains a valuable technique in posttraumatic and infectious destruction of the knee. External fixation is the technique of choice. Due to the benefits of the monofixator in regard to stability, limited damage of soft tissues and high patient comfort, arthrodesis of the knee joint using an anteriorly placed unilateral external fixator is the procedure routinely used at our institution. From 1985 to 1994, 19 knee arthrodesis procedures were performed with a monofixator. Indications for operative fusion of the knee were an infectious destruction of the joint following osteosynthesis (tibial plateau) in 12 cases, posttraumatic arthrosis of the knee joint with chronic infection in 4 cases, flexion ankylosis of the knee in 1 patient, and destructive osteoarthritis of the knee complicated by an empyema in one case. In one patient, a rearthrodesis was performed for a non-union, following an arthrodesis attempt for infected knee arthroplasty. In all cases, stable fusion of the knee joint in a correct position with complete eradication of infection was obtained. Mean fixation time was 22 weeks. The fixator did not need to be removed prematurely.

Adult↗