Biomedical subjects

L Gotzen

Publications and source records attributed to L Gotzen.

At least 73 records · Page 4Linked to original sources

PubMed1996

[Bone bank management using a thermal disinfection system (Lobator SD-1). A critical analysis].

In the study presented on 380 allogenic bone donations from living and organ donors, we analyzed the safety of allograft handling bone-band documentation, logistics and costs. For transplant treatment we routinely used a thermal disinfection system (Lobator SD-1). From 380 allograft donors, 400 bone transplants were gained. The rejection rate was 12.2%. After thermal disinfection for 1 h at 80 degrees C, the grafts were cryopreserved at -80 degrees C and released from the bone bank for potential transplantation after 14-16 days. Five of 730 microbiological specimens showed bacterial contamination after thermal graft decontamination. The bacterial species found on the allografts normally have an inactivation temperature under 80 degrees C. Therefore, only secondary contamination can explain the positive bacteriological test results. With reform of the health care system the economical aspects of bone banking have triggered more interest. The cost for one bone transplant released from the bone bank was 424.75 DM: the overall cost for the bone bank in one year was 75,076 DM. Laboratory (58.2%) and material costs (22.5%) were the major factors. Personnel costs and apparatus costs were relatively low (< 20%). With introduction of the thermal disinfection system (Lobator SD-1) into the bone bank, the safety of allogenic bone transplants was greatly improved. Clinical and serological donor screening must be performed according to international bone bank directives. Considering the low rejection rate and the short turnover rate, the economical costs could be reduced. Using an appropriate disinfection system (thermal disinfection at 80 degrees C), laboratory tests covering venereal diseases, malaria and cytomegalia are no longer required. Also, secondary HIV testing of living donors can be omitted without reducing the safety of the transplant.

Bone Banks↗

PubMed1996

[Proximal humerus fracture in advanced age].

Functional results after plate osteosynthesis of unstable and displaced proximal humeral fractures, occurring in elderly patients, are good to excellent in 70% of patients, when surgery is performed according to the no-touch-technique. The incidence of aseptic necrosis of the humeral head and non-union are, in comparison with other internal fixation techniques, low. In four-part fractures and fracture-dislocations, primary arthroplasty remains the treatment of choice.

Aged↗

PubMed1995

Influence of ceruletid on gallbladder contraction: a possible prophylaxis of acute acalculous cholecystitis in intensive care patients?

The purpose of this study was to investigate the utility of repeated applications of ceruletid to reduce gallbladder volume and its feasibility as a means of prophylaxis of acute acalculous cholecystitis in intensive care patients. First, a dose-response curve of ceruletid was obtained in 20 mechanically ventilated patients of a surgical intensive care unit (SICU) not receiving enteral nutrition. An effective dose of ceruletid, defined by a 50% reduction of gallbladder volume was established and subsequently studied in 40 mechanically ventilated SICU patients on total parenteral nutrition in a prospective, randomized, controlled, triple-blind trial. Gallbladder volume, sludge formation and side effects were evaluated. A dose of 1.5 micrograms/kg body weight ceruletid was established as the effective dose, causing 50% reduction of gallbladder volume in all patients studied and reduction of gallbladder sludge in 95%. In 67.5% of patients side effects were observed, requiring therapeutic intervention in 68%. It is concluded that ceruletid is effective in stimulating gallbladder contraction and reducing sludge formation in severely ill patients on intensive care units. Its routine use as prophylaxis of acute acalculous cholecystitis, however, may be limited by the nature, severity and frequency of side effects.

Acute Disease↗

PubMed1995

[Progress in internal fixator stabilization of thoracolumbar spinal fractures].

At present, several different fixators are in clinical use in the full range of thoracic and lumbar spine disorders. Nevertheless, an effort must be made to continue to improve pedicle fixation devices so that more safety, strength, adaptability and user-friendliness can be obtained. Fixation systems are subject to high loads, especially in major spinal injuries with marked loss of stability. Implant failure, producing poor clinical results, is a series problem. For safer and easier instrumentation a new fixator called the modular spine fixator (MSF) has been designed. The MSF consists of only a few basic components. Its main advantages are the smooth construction and small size, the modularity and easy handling, the high mechanical stability and optimal fatigue properties. In contrast to other fixators, the pedicle screws of the MSF act as compression screws. In high-load static and fatigue testing the MSF revealed no component loosening, material yielding or breaking. More than other systems, the MSF is suitable for short one-level instrumentation, thus avoiding overbridging uninjured motion segments. Between 1991 and 1993 60 instrumentations in the treatment of unstable thoracic and lumbar injuries were performed with the MSF. Single-level instrumentations were done in 34, two-level instrumentations in 24, three- and four-level instrumentations in 2 cases, all combined with posterior allogenic bone grafting. Since the beginning of 1993 transpedicular anterior bone grafting has been performed in addition, using autogenic bone material. In this series no implant fatigue failure has been noted. There were three infections requiring removal of the posterior bone graft in two and graft in fixator removal in one.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

[Treatment and outcome of supracondylar humeral fractures in childhood].

In an 8-year period, from 1985 to 1992, 89 children presenting with a supracondylar humeral fracture were treated at the Department for Traumatology, Philipps-University, Marburg. All dislocated fractures (n = 48) were treated surgically. The majority (n = 34) of dislocated fractures were reduced open by a radial and an ulnar approach and subsequently stabilized using crosswise introduced K-wires. All fractures were differentiated retrospectively according to the degree of dislocation, the presence of associated injuries, the type of treatment chosen, and the function outcome. Fifty-two patients were reexamined. Clinically relevant varus deformities (4% of cases) and impaired elbow function were observed only in cases where anatomic fracture reduction or fracture fixation was not obtained. Critical analysis of our results and the literature led us to the development of a new, treatment-oriented classification of supracondylar humeral fractures in children. We consider fractures that are dislocated less than 20 degrees, and where dislocation exists only in a saggital plane to be type A fractures. These fractures can be treated conservatively. Type B fractures are fractures that are dislocated more than 20 degrees only in the saggital plane, but with remaining ventral or dorsal cortical bony contact between the fragments. In these fractures, we perform closed fracture reduction and K-wire stabilization. Type C fractures are fractures with rotational deformity, fractures dislocated in a frontal plane and fractures dislocated in a saggital plane with loss of cortical bony contact between proximal and distal fragments. Type C fractures should be reduced open by both a radial and an ulnar approach and subsequently stabilized using K-wires, introduced crosswise.

Adolescent↗

PubMed1995

[Overview, analysis and evaluation of the 1995 public health structural law and the federal social care law from the viewpoint of the trauma surgery department of a university clinic. Measures for preparation of a new reimbursement system and documentation requirements].

All doctors in Germany are required to cooperate in the implementation of the health system reform and the new system for reimbursement of the hospitals to limit the negative consequences to the patients. It would be absolutely wrong to leave the medical services of the insurance companies to define the diagnosis-related groups and determine the charges. The revision of the health system is beneficial in that it supports the economical independence of hospital departments. It is a good idea for them to be paid by results; however, there are no established methods of measuring results or efficacy in medicine. Germany is about 10 years behind the USA in this, so that our country is not yet ready for this reform. Hospital departments do have the freedom to make economic decisions, being heavily dependent on the insurances and the government, because most people who work in hospital are paid from these sources. Departments of trauma or orthopaedic surgery are disadvantaged by the reform, because of the number and kind of diagnosis related groups and the method of reimbursement. This leads to a profit-oriented system of medical documentation, with possible upcoding of diagnoses in future. The present health reform most probably will not increase the efficiency of hospitals; it will not be possible to attain cost reductions with the same level of medical care. The reduced reimbursement will force doctors to cut down their expenses and restrict diagnostic and therapeutic procedures. On the other hand the administration sector in hospitals and insurances will expand dramatically in future.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost Control↗

PubMed1994

Posterior cruciate ligament (PCL) reconstruction--an in vitro study of isometry. Part I. Tests using a string linkage model.

In six intact cadaver knees, we measured how the distance between six selected points in and around the femoral and tibial attachment area of the posterior cruciate ligament (PCL) changed with knee flexion. After complete removal of the PCL, 2-mm drill holes were made at the selected points. Each femoral point was measured against each tibial point using a heavy string that was passed through the drill holes. The distal end of the string was attached to a measuring unit. The changes in femorotibial distance were noted during flexion from 0 degrees to 110 degrees in 10 degree steps. The tibial drill hole locations had only a minor effect on the changes in femorotibial distance. The most isometric point was located in the centre of the posterior intercondylar area. The femoral locations of the drill holes were the primary determinant of whether the distance increased, decreased or remained nearly constant. According to our results, the most isometric femoral point is located at the posterosuperior margin of the anatomical PCL attachment. Using the tibial isometric point as a reference, the femoral points positioned anterior or posterior to the isometric point produced considerable changes in the femorotibial distance upon knee flexion. The anterior point led to an increase of about 7-8 mm at 110 degrees of flexion, the posterior point to a decrease of the same extent. Much smaller changes in femorotibial distance resulted from the points located superior or inferior to the femoral isometric point.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1994

Posterior cruciate ligament (PCL) reconstruction--an in vitro study of isometry. Part II. Tests using an experimental PCL graft model.

Isometric positioning of the posterior cruciate ligament (PCL) graft is important for successful reconstruction of the PCL-deficient knee. This study documents the relationship between graft placement and changes in intra-articular graft length during a passive range of motion of the knee. In eight cadaveric knees the PCL was identified and cut. The specimens were mounted in a stabilising rig. PCL reconstruction was performed using a 9-mm-thick synthetic cord passed through tunnels 10 mm in diameter. Three different femoral graft placement sites were evaluated: (1) in four specimens the tunnel was located around the femoral isometric point, (2) in two specimens the tunnel was positioned over the guide wire 5 mm anterior to the femoral isometric point, (3) in two specimens the tunnel was positioned over the guide wire 5 mm posterior to the isometric femoral point. In all knees only one tibial tunnel was created around the isometric tibial point. The location of the isometric points is described in part I of this study. The proximal end of the cord was fixed to the lateral aspect of the femur. Distally, the cord was attached to a measuring unit. The knees were flexed from 0 degrees to 110 degrees, and the changes in the graft distance between the femoral attachment sites were measured in 10 degrees steps. Over the entire range of motion measured, the femoral tunnels positioned around the isometric point produced femorotibial distance changes of within 2 mm. The anteriorly and posteriorly placed tunnels produced considerable changes in femorotibial distance with knee flexion, e.g. about 8 mm at 110 degrees of flexion.

Aged↗

PubMed1994

Anterior cruciate and medial collateral ligament injury. ACL reconstruction and functional treatment of the MCL.

Since August 1989 we have treated acute anteromedial instabilities with medial instability of 1+ and 2+ by augmented anterior cruciate ligament (ACL) reconstruction alone. Subsequently, functional therapy for the lesion of the medial collateral ligament (MCL) was carried out. In a follow-up examination, we evaluated Lysholm, Marshall, OAK and IKDC scores, measured stability with the KT 1000, and tested isokinetic muscle function in 28 patients. The majority demonstrated stable healing of the MCL and ACL and good or excellent knee functions and muscle strength.

Adolescent↗

PubMed1994

Technique of using the AO-femoral distractor for femoral intramedullary nailing.

Immediate closed interlocking intramedullary (IM) nailing of femoral shaft fractures in polytraumatized patients using the fracture table may be difficult due to concomitant adjacent injury. We report on the technique of using the AO-femoral distractor for femoral IM nailing and our experience with 56 consecutive cases of IM nailing of the femur. The AO distractor is an alternative to the traction table. Unlike the latter, it does not rely on intact adjacent structures to distract the main fragments. Schanz screws are placed into the femur condyle and into the lesser trochanter. The fracture is distracted and reduced by manipulating the mobile elements of the device. The femur is aligned and stabilized while reaming and nailing commence. Between April 1988 and June 1992, 56 IM nailings were performed using the AO distractor for reduction: 41 for acute unstable fractures and 15 for corrective procedures. In 11 of 15 polytraumatized patients, the fractured femurs were nailed immediately. Intraoperatively, the distractor greatly facilitated fracture reduction and presented no problems for proximal or distal interlocking. Intraoperative complications included two fracture extensions during nailing and three rotational malalignments over 15 degrees. One nonunion occurred; otherwise, all fractures were considered healed within 16 weeks. No postoperative nerve palsies were recorded, and no infection occurred. Based on our experience, we believe that the AO distractor is a suitable alternative to the traction table as a distraction and reduction device and can be implemented in all nailing cases. We particularly recommend its use in polytrauma cases in which concomitant injury precludes the initial use of the fracture table.

Adolescent↗

PubMed1994

[Pathomorphology, stability and classification of wedge compression fractures of the thoracolumbar spine].

Compression fractures with anterior wedging of the vertebral body are the most frequent fractures of the thoraco-lumbal spine. As yet, there is no fracture classification that has achieved general clinical acceptance. A classification is presented that defines fractures as A, B, and C types, according to their pathomorphology and mechanical stability. The main types are subdivided into A1-A2, B1-B2 and C1-C2. The A fractures incorporated a compression lesion of the anterior column with minimal or moderate loss of anterior height of the vertebral body. An intact intervertebral disc defines the A1 lesion. With loss of disc function through disc rupture into the fractured body, the vertebral segment is biomechanically destabilized and the lesion is classified as A2. The B-type wedge compression fracture defines a disc and bone lesion of the anterior column with severe wedging combined with a distraction lesion of the posterior column involving mostly ligaments. Not infrequently, the middle column presents with a dorso-cranial wall fragment, which may be dislocated into the spinal but without endangering the cord. Isolated lesions of the anterior and posterior columns are considered B1 lesions. B2 lesions incorporate an additional stable osseous lesion of the middle column. Wedge compression fractures of the C type are mechanically and neurologically unstable three-column lesions producing cord compression by way of dislocated fragments of the dorso-cranial vertebral body, which compromises the spinal canal. C1 fractures are like B fractures in the degree of severity of the anterior and posterior column lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanical Phenomena↗

PubMed1994

[Rupture of the anterior cruciate ligament in the athlete].

Athletic trauma is the main cause for rupture of the anterior cruciate ligament (ACL). In order to regain joint stability and return to unrestricted sports activities operative management is indicated. The patella tendon autograft with bone plugs on each end is presently the most commonly used graft to reconstruct the ACL. The concept of synthetic augmentation was developed for protection of the biological tissue during revascularization and remodeling. We use as augmentation device the TETRA-L3, which is a 3-mm-wide and 1-mm-thick Trevira braid. The function of the composite graft, which is sufficiently strong to allow early stress, is based on the principle of load-sharing. Isometric placement of the graft without impingement is achieved by using the miniarthrotomy technique and specially designed drill guides. Graft fixation is performed with ligament staples. An accelerated rehabilitation program emphasizing full extension and weight bearing follows. The total rehabilitation program we recommend--preoperative rehabilitation, a reliable surgical procedure, postoperative rehabilitation, and the patient's return to activity--is a team effort. A detailed follow-up evaluation of 41 athletes with ACL reconstruction using a central patellar BTB graft and synthetic augmentation with the TETRA-L3 showed that restoration of stability (KT 1000 testing, maximum manual excursion, < 3 mm difference) and full ROM, muscle strength and power (> 85% of the uninvolved knee) and functional capacity (Hop index > 90%) are the main prerequisites for sports activities at the desired level.

Anterior Cruciate Ligament↗

PubMed1994

[Is prevention of thromboembolism in ambulatory and conservative therapy of rupture of the fibular ligament of the upper ankle joint necessary?].

In a prospective clinical study, 111 outpatients with tears of the lateral ankle ligaments were investigated for the occurrence of deep venous thrombosis (DVT). All patients had been treated by a plaster cast for 1 week and had not received any form of DVT prophylaxis. After removal of the plaster cast (mean 7.1 days), colour flow imaging of the veins of the injured leg was performed. A phlebography was undertaken whenever there was any suspicion of DVT. Risk factors for thrombosis [3, 10] were documented in all patients. Besides injury and immobilisation, a median of 1.2 (0-4) risk factors for DVT was involved. Only 31 patients had no additional risk factors at all. Median age of the patients was 26.1 years (16-53 median range). Only 1 patient over 40 years of age was diagnosed as having DVT, and none under 40. Therefore, medicamentous prophylaxis of DVT is not considered necessary in outpatients younger than 40 years with ankle ligament tears treated by bi-valved casts in cases when there are no additional risk factors (Table 4) for DVT.

Adolescent↗

PubMed1994

[Surgical management of a dens fracture in a 3-year-old child. Clinical case report and discussion with reference to the literature].

Because of the special features of subdental synchondrosis, fracture of the odontoid process in childhood can be seen as a separate entity. Among the rare fractures of the cervical spine in children this type is the most common. Ontogenetically, the subdental synchondrosis must be regarded as an intervertebral disc and not as a growth plate. Usually conservative treatment with a halo fixateur or minerva jacket leads to consolidation. We report on the case of a 3-year-old boy with a fracture of the odontoid process who was treated operatively with anterior log screw fixation because of extensive anterior dislocation and tetraplegia. Five months after the operation bony consolidation was achieved and the screws could be removed. Full neurological recovery had occurred by this time.

Bone Screws↗

PubMed1994

[The "biological" plate osteosynthesis in multi-fragment fractures of the para-articular femur. A prospective study].

In a prospective study, 24 fractures of the femur were treated by indirect reduction and internal fixation with a condylar plate or a condylar buttress plate. The inclusion criterion was that each patients's fracture(s) should be amenable to indirect reduction. The goal of the study was to determine the value of biological plating techniques incorporating the use of the distractor and the articulating tension device for indirect reduction, bridging of the fracture zone without dissection of the medial cortex, and calculated instability through undetermined axial compression. Most fractures were comminuted (5 type A, 10 type B and 9 type C according to the AO classification); 14 fractures were subtrochanteric, 8 fractures were supra-/intracondylar and 2 were diaphyseal in nature. The average age of the 14 mean and 10 women was 46 years (16-96). In 4 cases the fracture was open; 8 patients had multiple trauma and 6 had further ipsilateral fractures. The fractures were sustained in motor vehicle accidents in 14 cases. In 16 fractures operative treatment was performed within 36 h. All fractures were reduced indirectly, and 21 fractures were put under axial compression. There was no medial cortex dissection and no primary bone grafting. Secondary bone grafting was necessary in 2 patients, while 1 (diaphyseal fracture) had delayed bone union and required interlocking nailing. In 2 patients varus deformities under 10 degrees were present after completion of bone healing. There were no refractures and no implant failures. Full weight-bearing commenced at 14.7 weeks. Bone healing time was 18.7 weeks in the 19 patients followed up.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1993

Non-operative treatment of acute medial collateral ligament lesions of the knee joint.

From 1985 to 1990 102 patients with isolated lesions of the medial collateral ligament of the knee were managed non-operatively with early protected motion and physical therapy. Eighty-six returned to a follow-up examination. The mean follow-up time was 44.2 months. The knees were stable in all but two cases and showed good or excellent results. Ninety-seven percent of the patients returned to their earlier activity level.

Adult↗

PubMed1993

Two-stage operative treatment of comminuted os calcis fractures. Primary indirect reduction with medial external fixation and delayed lateral plate fixation.

The indication for otherwise established lateral plate fixation in fractures of the calcaneus becomes relative when severe comminution (Sander's Type III and IV) of the bone involves concomitant massive soft-tissue swelling. The calcaneus is shortened, Böhler's angle flattened, and lateral bulging and varus deformity persist throughout the six or more days needed for soft-tissue compromise to recede. Intraoperatively, problems with anatomic reduction are encountered primarily because of soft-tissue shrinkage and muscle contraction, underscoring the rationale for conservative treatment modalities. A two-stage approach--primary medial external fixation and delayed lateral plate fixation--stabilizes the calcaneus in a nearly anatomic position by calculated distraction through medial external fixation, leaving joint congruency to be restored in a secondary procedure, when soft tissues pose no problem for a lateral approach. The two-stage procedure was used in 13 of 49 cases, in which soft-tissue compromise was severe. Anatomic primary reduction greatly facilitated delayed lateral plate fixation. Infection rates were not traced to the external fixation. Massive bone grafting was associated with a high occurrence of complications.

Ankle Injuries↗

PubMed1993

[Pediatric femoral shaft fracture in the 6-14 year age group. A retrospective therapy comparison between conservative treatment, plate osteosynthesis and external stabilization].

The optimal choice between operative and conservative therapy in the treatment of femur shaft fractures in school age children remains controversial. Between 1985 and 1991, 34 children aged 6-14 years were treated in our institution for fractures of the femoral shaft: 8 were treated conservatively with traction, while 10 underwent plate fixation and 15 external fixation. The 34 cases were analyzed retrospectively. In the conservatively treated group a plate osteosynthesis become necessary in 2 patients because of delayed union and fracture malalignment. Hospitalization was the longest in these children, although their concomitant injuries were the least extensive. In the group with plating there were no serious complications but open surgery is needed for two major operations for insertion and removal. The average time on crutches after plate fixation was 56 days. In the group treated by external fixation four secondary plate osteosyntheses were performed, two at an early stage because of unacceptable fracture malalignment and two others because of fracture instability after removal of the fixateur. The stay in hospital was the shortest in this group. The 11 children who had been completely managed by external fixation achieved walking without crutches in the shortest time, viz. 15 days after the operation on average. The average time to removal of the fixateur was 67 days. Review was possible in 27 of the 28 children who had been completely managed by the initial treatment method. All had unlimited hip and knee motion. Two children in the conservative treatment group were seen on radiographical examination to have a varus angulation of more than 10 degrees. In the plate and fixator group no malalignment was present.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗