Biomedical subjects
Publications and source records attributed to L Kinzl.
By utilizing all its specialist facilities, the specialized trauma centre can optimize the chances of survival of the severely injured patient. However, this is possible only when the specialties involved have the ability to cooperate and when a "team leader" applying treatment guidelines worked out and accepted on an interdisciplinary basis is available to coordinate activities.
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In the treatment of infected pseudarthroses the general principles of osteitis treatment are applied. This includes radical excision of pseudarthrotic and infected bone tissue, and of diseased surrounding soft tissue. External fixation devices are the preferred method of stabilization of the bone. Based on the data of a retrospective study of 31 Papineau procedures, 65 local flap transfers, and 46 free flap transfers we found that the Papineau procedure works in minor bone and soft tissue defects. Unstable scar formation is a major disadvantage of this method. Local muscular flaps are indicated in the treatment of soft tissue defects in the proximal and medial portions of the lower leg. A prerequisite for free flap transfers is the availability of trained personnel and suitable technical equipment. The option is limited by the patient's vascular situation. This kind of tissue transfer seems to be superior to other methods. For the substitution of bone defects corticocancellous bone transplantation may be used. A promising alternative method to deal with extensive bone defects is osteogenesis produced by callus distraction.
An isolated ventral approach to the thoracal or lumbar spine seems sufficient in special burst fractures (type A2/3) or older compression fractures. The most effective ventral decompression of the spinal cord is followed by the fusion of the ventral body. Ventral plate instrumentation avoid dislocations of the interposed bone transplants. Our own clinical results are demonstrated.
More understanding of the biomechanics of injured segments, standardized dorsal and ventral accesses to all spinal column levels, and developments in fixation systems specifically conceived for the stabilization of vertebral column lesions have all greatly expanded the operative indications for spinal column injuries. Modern fixation systems should have the following features: short-term application, angular stability, universal suitability for all types of fractures, ability to bear axial loads, thus dispensing with the need for additional external stabilization.
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The treatment of fractures of the distal humerus is very well standardized. The classification according to Müller allows for easy differentiation between the many types of fractures, helps in the determination of therapeutic guidelines and contributes to an objective comparison of results of treatment. Fractures in group A/B are treated either conservatively or with comparatively simple instrumentation using K-wires, screws, and plates. Injuries falling in group C demand a high standard of operative skill. The underlying principle of internal fixation aims primarily at reconstruction of the articular surface. The next operative step consists in the realignment of the reconstructed articular block with the proximal humeral fragment by osteosynthesis. Autologous cancellous bone is used to give a solid counterbalance for screw fixation and to re-establish osseous continuity. Sound assessment of concomitant injury to the soft tissue demands wide clinical experience. This is necessary for essential decision as to whether primary osteosynthesis, delayed, secondary reconstruction of the joint following recovery of the soft tissue or conservative treatment is indicated.
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The result of the experimental studies encouraged us to treat our patients with chondro-malacia patellae not only by superficially rasping the damaged cartilage, but also by drilling several holes down to the subchondral layer. This allows a type of tissue repair by connective tissue. In addition we prefer a section of the retinacula and an anteposition of the patella ligament.
The change of physical properties of plastics (polyoxymethylene-copolymer, polyethyleneterephthalate, polyethylene, polytetrafluorethylene) and the bio-compatibility of these materials were examined by implantation in the backmuscle of 6-month-old male rabbits for 4 and 12 weeks and after autoclavation. We have found out, that after implantation and autoclavation polyethylene-terephthalate demonstrates a strong diminution of the visco-elastic qualities. Polyethylene and polytetrafluorethylene were not changed by these treatments. After an implantation of 12 weeks and an autoclavation of four times the visco-elastic properties of polyoxymethylene-copolymer were only slightly diminished by 10 to 15%. The histological investigation of the surrounding tissue demonstrated a very good bio-compatibility of polyethylene. After an implantation of 4 weeks polyoxymethylene-copolymer, polyethyleneterephthalate and polytetrafluorethylene produced a comparable foreign body reaction, which, however, was evidently diminished after an implantation of 12 weeks.
The bio-compatibility of different plastic materials were examined after their implantation in the back-muscle of 6-months-old male rabbits. Twelve weeks after the implantation chemical measurements (DNS-concentration of the tissue) and histological investigations of the surrounding tissue demonstrated for polyethylene the best bio-compatibility.
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Mathematical and experimental results demonstrate that the customary Redon drain as well as the improved Neo-Redovac drain develop suction only over a short initial distance. The above mentioned innovation of three additional oval holes does not increase efficiency. The disadvantage of rapidly diminished suction is overcome in the "Ulmer Drain", in which equidistant openings of continually increasing aperture are aligned towards the drain end.
"Osteosynthesis" or internal fixation is the term used for operative reduction of bone fragments. The aim of the procedure is to effect such stable fixation that the affected extremity may be moved freely. The paper gives a survey of the technical basis of and indications for modern methods of internal fixation.
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2,5 gr. of bone wax (Knochenwachs) were implanted in the iliac crest of 10 sheep. The induction of a foreign body reaction and chronic inflammation was proven demonstrable until the 12th week after implantation of the bone wax. In this period only partial resorption of the wax occurred simultaneously with significantly retarded osseous regeneration. From a clinical point of view it therefore seems necessary when using bone wax to pay particular attention to inflammatory reactions, reduced new bone formation and eventual occurrence of pseudo-arthrosis.