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W Mutschler

Publications and source records attributed to W Mutschler.

At least 37 records · Page 2Linked to original sources
PubMed2005

[Complete rupture of the proximal semimembranosus tendon. Minimally invasive surgical repair by use of a suture anchor in a rare but often underestimated injury].

Complete rupture of the proximal semimembranosus tendon is a rare injury associated with significant functional loss. Conservative treatment has proven inadequate in returning patients to their previous activity level. However, diagnosis is often delayed because of underestimation of the severity of this injury. Satisfactory results can be achieved with both early and late surgical tendon repair in the majority of cases. However, repair delayed by more than 4 weeks post trauma usually requires extended mobilisation of the injured muscle and neurolysis of the sciatic nerve. Therefore, we recommend surgical repair as early as possible. We report on the successful minimally invasive surgical repair of a complete rupture of the proximal semimembranosus tendon by use of a suture anchor 18 days after injury.

Bone Screws↗
PubMed2005

[Central bone transport system optimizes reconstruction of bone defects. Results of 40 treatments].

BACKGROUND: This article describes the results, experiences, and advantages of a bone transport system with one single rope or a fully implantable distraction nail for the treatment of bone defects that totally avoids soft tissue cross traction. METHODS: 40 patients with bone defects were treated by central bone transport systems. 30 post-traumatic defects (12 aseptic, 18 post-septic) and 10 defects after resection of bone tumors (2 benign, 8 malignant). Thirty defects were located at the tibia and ten at the femur; the mean defect size was 10.1 cm; 36 central rope systems and 4 motorized distraction nails were used. The follow-up examination took place after an average of 2.4 years. RESULTS: All defects were totally bridged. The mean distraction time was 131 (57-208) days and the mean time of external fixation 283 (126-326) days. The time of partial load bearing was 466 (302-594) days and the healing index was 47 (33.1-60.4) d/cm. In 34 patients autologous bone grafting at the docking site was performed, and in 30 patients the external fixator was replaced by internal stabilization. The mean leg length discrepancy compared to the contralateral side was 4+/-3 mm, and the leg axis deviation from the center of the knee joint was 1.5+/-7.0 degrees . There were 1.8 complications per patient on average (15 pin tract infections with replacement, 2 premature consolidations). CONCLUSIONS: In contrast to conventional methods reduced pin tract infections offer better conditions for internal fixation. Control of length and axis can be optimized, immobilization of the patients is reduced, and the comfort of treatment is significantly improved.

Adolescent↗
PubMed2005

[Evidence based diagnostic procedures for the determination of suspected blunt cervical spine injuries. Development of an algorithm].

BACKGROUND: The aim of this study was to present existing publications, describing various diagnostic procedures as well as considering the evidence supporting them, to develop a recommendation for diagnosis. MATERIAL AND METHODS: We reviewed relevant publications between 1966 and 2004 by a systemic literature search in MEDLINE, EMBASE, National Guideline Clearinghouse, Cochrane Library as well as a manual reference search. Keywords were cervical spine, cervical vertebrae, spinal, spinal cord, injury, trauma, fracture, dislocation, imaging, radiography, flexion, extension, fluoroscopy, computed tomography, computed scanning, and magnetic resonance imaging. The selected search results were then classified into levels of evidence. RESULTS: From among a total of 10,000 publications, 137 relevant publications were stringently reviewed. The level of evidence is on the whole limited due to deficit data; therefore, only class II-III recommendations are possible. We developed an algorithm for the diagnostic approach to suspected trauma of the cervical spine. This clinical algorithm displays the complex diagnosis of cervical spine injury in a clear and logically structured process. CONCLUSIONS: The diagnostic algorithm for cervical spine injury meets the presently required standards and maximizes care for the newly injured. The development, which can be followed using evidence-based medicine, is transparent and therefore aids the decision process when choosing an adequate diagnostic procedure.

Algorithms↗
PubMed2005

[New-bone formation by osteogenic protein-1 and autogenic bone marrow in a critical tibial defect model in sheep].

AIM: Osteogenic Protein-1 (OP-1) is known to be a very potent osteoinductive growth factor. However, experimental studies using critical-size defect models in the weight-bearing lower extremity show non-uniform results. Therefore, we studied the osteoinductivity of OP-1 in a tibial worst-case defect model in sheep. Potential improvement of OP-1 induced new bone formation using a composite graft with autogenous bone marrow was to be investigated. METHOD: In 19 sheep a 5 cm segmental defect of the tibial diaphysis was treated by intramedullary nailing and filled with the following implants: 5 mg OP-1 + inactivated demineralized bone matrix (group 1; n = 6); 5 mg OP-1 + inactivated demineralized bone matrix + 5 ml autogenous bone marrow (group 2; n = 5); autogenous cancellous bone (group 3; n = 4), or inactivated demineralized bone matrix + 5 ml autogenous bone marrow (group 4; n = 4). RESULTS: In total, 3 out of 10 defect sites treated with OP-1 were completely bridged radiographically by 12 weeks. Initially, x-rays showed accelerated new bone formation by use of the composite grafts containing OP-1 and autogenous bone marrow. However, 12 weeks post surgery 3D-CT-volumetry could not detect significant differences of new bone formation within the defect sites treated by OP-1 with or without bone marrow, while new bone formation by autogenous cancellous bone was better than by OP-1. CONCLUSION: In our worst case defect model, the osteoinductive potential of OP-1 is initially accelerated but 12 weeks post surgery not increased when combined with autogenous bone marrow transplantation. So far, critical segmental bone defects of the weight-bearing lower extremity can not be bridged regularly in our model by use of OP-1. Therefore, for the treatment of such critical defects with rotational instability the examined application device of OP-1 can not yet be recommended.

Animals↗
PubMed2005

[Role of osteoporosis in trauma diagnostics].

PURPOSE: To evaluate the current bone mineral density (BMD) distribution in elderly patients hospitalized due to traumatic hip fracture and to assess the necessity of concomitant pharmacotherapy of underlying osteoporosis. MATERIALS AND METHODS: 58 female patients > or = 50 years (mean 81 years) with proven hip fracture were included. The diagnosis of fracture was established either by conventional radiography (CR) or by computed tomography (CT). BMD was assessed prospectively by means of dual energy X-ray absorption (DXA) measurement of the lumbar spine and/or femoral neck. DXA data was routinely achieved by analysis of T- and Z-values of the BMD. Distribution of BMD was assessed. Results for both measurement sites were compared using T-test and Pearson correlation analysis. RESULTS: 56/58 patients with proven hip fracture received DXA of the lumbar spine, 51 DXA of the femoral neck. The mean BMD was 0.829 +/- 0.137 g/cm (2) (lumbar spine) and 0.451 +/- 0.126 g/cm (2) (femur). T-values were - 2.8 +/- 1.14 (lumbar spine) and - 3.53 +/- 0.97 (femur). Compared to the normal distribution (lumbar spine), 53 patients (94.6 %) had diminished BMD (T < or = - 1). Of these 15 (26.8 %) had osteopenia (T > - 2.5) and 38 (67.9 %) had osteoporosis (T < or = - 2.5) according to WHO definition. With respect to femoral bone measurement, all patients (100 %) had diminished BMD (T < or = - 1), 9 patients (17.6 %) had osteopenia (T > - 2.5) and 42 patients (82.4 %) had osteoporosis (T < or = - 2.5). Results for different measurement sites differed significantly and were weakly correlated. CONCLUSION: This data indicate that diminished BMD in terms of osteopenia or osteoporosis is a frequent finding in hip fractures of elderly females. A large majority of these elderly patients therefore should be treated according to recent guidelines for treatment of osteoporosis. Our data indicate that this entity is potentially underdiagnosed and should be considered by radiologists as well as traumatologists.

Absorptiometry, Photon↗
PubMed2005

Reduction of high dislocation of the hip using a distraction nail before arthroplasty.

We report the case of a 22-year-old woman who underwent plate and screw fixation for a traumatic left acetabular fracture and fixation with cancellous screws for an associated femoral neck fracture. Two months later, the internal fixation became infected and was removed. This resulted in a painful high dislocation of the hip. We solved the problem with continuous soft-tissue distraction using a fully implantable motorised distraction nail in order to reduce the proximal femur prior to total hip arthroplasty. To our knowledge, this is the first time that reduction of a high dislocation of the hip has been performed using such a system.

Acetabulum↗
PubMed2005

The management of leg-length discrepancy in Ollier's disease with a fully implantable lengthening nail.

Ollier's disease is characterised by severe deformity of the extremities and retarded growth because of multiple enchondromas. For correction of deformity, the Ilizarov method has been used although it has many complications. A 17-year-old boy with Ollier's disease had a limb-length discrepancy of 17.4 cm, with a valgus deformity of the right knee and recurvatum of the femur of 23 degrees . He had undergone three unsuccessful attempts to correct the deformities by using external fixators. We used a fully implantable, motorised, lengthening and correction nail (Fitbone) to achieve full correction of all the deformities without complications. We decided to carry out the procedure in three stages. First, we lengthened the femur by 3.6 cm and the tibia by 4 cm. We then exchanged the femoral nail for a longer implant and achieved a further 6 cm of length. This reduced the shortening to 3.8 cm. When the boy has finished secondary school we will adjust the remaining discrepancy.

Adolescent↗
PubMed2004

[Vascular injuries in extremities].

Vascular injuries of the extremities account for most instances of vascular trauma (ca. 70%), and they entail a risk of amputation about 10-20%. According to the kind of force that has acted, arterial trauma is classified as direct or indirect. The scale of hemorrhage and peripheral ischemia depend on the nature and severity of the arterial lesion. In patients with multiple injuries, routine use of Doppler sonography and duplex sonography can facilitate early diagnosis and treatment of vascular injuries. With great certainty, clinical examination and an AB or WB index of >1.0 can rule out the presence of vascular injury that requires treatment. After excluding further life-threatening injuries, surgery should be performed immediately when there is critical ischemia, squirting hemorrhage, or a rapidly expanding hematoma. Angiography or duplex sonography findings determine the further procedure in vascular injuries that do not require immediate treatment. Occlusion of a reconstructed artery, manifestation of a compartment syndrome, and insufficient anticoagulation are the main factors affecting the risk of amputation.

Amputation, Surgical↗
PubMed2004

[Identification of high-risk patients after minor craniocerebral trauma. Measurement of nerve tissue protein S 100].

The indication for an initial cranial computed tomography (CCT) in minor head trauma (MHT) patients remains the subject of discussion. The aim of this study was to investigate whether a newly developed, rapid test system (ELECSYS S100, Roche Diagnostics) might allow a diagnostically valid, reproducible measurement of S 100 in MHT patients. Blood samples were drawn from 75 MHT patients, a CCT scan was performed, and those with a post-traumatic intracranial lesion counted as CCT+. Results were compared to a healthy control group (n=17). Of the 75 patients included in the study, 14 were stratified as CCT+. The systemic concentration of S 100 in these CCT+ patients was significantly increased (0.31 microg/l) compared to the healthy control group (0.04 microg/l) as well as to the CCT-negative patients (0.08 microg/l). The ELECSYS S100 system allows a rapid, valid, and reproducible assessment of S 100B in patient serum and this concentration is significantly elevated in patients suffering from intracranial lesions as shown by initial CCT scan. Hence, this study is the basis for a multicenter trial currently underway to confirm the results of our pilot study.

Adult↗
PubMed2004

[Priority-oriented shock trauma room management with the integration of multiple-view spiral computed tomography].

In major trauma it is essential to immediately recognize and treat life-threatening problems and conditions. Most trauma protocols reserve the use of computed tomography for the secondary survey, as patients cannot be attended to during the examination and must be transferred from the emergency room to the CT suite. The relevant reduction in the scanning time of multidetector computed tomography (MDCT) or multislice computed tomography (MSCT) justifies its use as the major diagnostic adjunct for primary trauma survey and initial resuscitation. According to our ATLS((R))-based trauma algorithm, the multidetector scanner situated in the emergency department is utilized immediately after the correction of respiratory problems to detect causes of bleeding or intracranial hematomas. In a prospective series a total of 125 consecutive major trauma patients were evaluated. After focused sonography in trauma (FAST) and plain chest films in intubated patients, whole body MDCT was performed. By retrieving data from our trauma registry and a picture archiving and communication system (PACS), time from trauma room admission to the end of head CT scan for the entire MDCT study and calculation of multiplanar reconstruction (MPR) was analyzed. Additionally, relevant complications such as untreated tension pneumothorax or circulatory arrest during MDCT examination were recorded. The time from admission to the trauma room until completion of head CT scan without contrast was 21:12 min (median, IQR 18:13-27:52). The entire contrast-enhanced MDCT study, including pilot scan and contrast application, required 6:08 min (median, IQR 4:33-8:14) with a total scanning time of 0:59 min (median, IQR 0:55-1:03). MPR calculation of the spine and bony pelvis was performed in 11:37 min (median, IQR 8:03-16:41). A relevant life-threatening complication due to CT scanning during primary trauma survey was not observed in the 125 cases (0/125 CI 95% 0%-3%). Complete diagnostic imaging can be performed within 30 min after trauma room admission by using MDCT. During the primary survey, treatment of the patient is interrupted just for the few minutes of the CT scan and contrast application. An adequate survey of injuries can be achieved earlier and a targeted therapy can be initiated ahead of time. Integration of MDCT scanners in the primary trauma survey provides a high standard of imaging in a very short time without endangering the patient. When dealing with multiple casualties, MDCT could be used also as an accurate and time-efficient means of hospital triage to diagnose and prioritize patients and to plan further surgical interventions and intensive care.

Critical Care↗
PubMed2004

[The importance of Advanced Trauma Life Support (ATLS) in the emergency room].

INTRODUCTION: There is clinical evidence, that a standardized management of trauma patients in the emergency room improves outcome. METHODS: The ATLS training course teaches a systematic approach to the trauma patient in the emergency room. The aim is a rapid and accurate assessment of the patient's physiologic status, the treatment according to priorities and the decision making if transfer to a trauma center is necessary. The German Trauma Society has taken over the course concept from the American College of Surgeons (ACS) and is authorized to organize ATLS courses in Germany. RESULTS: A standardized management in the emergency room helps to prevent secondary injury, to realize timing as a relevant factor in the initial treatment and to assure a high standard of care. The ATLS course provides the participant with knowledge, skills and attitudes and is open to doctors of all specialties involved in the initial management of severely injured patients. CONCLUSION: ATLS teaches a standardized and established approach to the trauma patient in the emergency room. It has been transferred to 46 countries and the content is reviewed regularly to consider new scientific evidence. Germany has the chance to participate in this international standard of care and to introduce own experiences into the review process.

Critical Care↗
PubMed2004

[Telomerase activity and telomere length of human mesenchymal stem cells. Changes during osteogenic differentiation].

Human mesenchymal stem cells (hMSC) exhibit properties of self-renewal and differentiation. Assuming that telomerase activity is associated with self-renewal, it might be useful to identify and define hMSC on the basis of their telomerase status. However, telomerase activity in hMSC remains a controversial issue. Therefore, the aim of our study was to investigate telomerase activity in proliferating and highly proliferating hMSC and to measure telomerase activity and changes in telomere restriction fragment (TRF) length of confluent hMSC and of osteogenically differentiated hMSC. For tissue engineering applications scaffolds should be seeded with cells that have not lost their ability to self-replicate and differentiate during in vitro cell culture. Telomerase activity could be used to characterise and isolate these cells.

Cell Differentiation↗
PubMed2004

[Tissue engineering of bone. Integration and migration of human mesenchymal stem cells in colonized contructs in a murine model].

Tissue engineering opens up new ways for therapy of bone defects. Therefore, the aim of this study was to establish a mouse model to investigate local cell growth of human mesenchymal stem cells (hMSC) on the scaffold in vivo. Moreover, migration of cells to other organs should be excluded.hMSC (Cambrex, USA) were cultivated according to supplier's recommendations. After inoculation on cylindric scaffolds, one matrix cell construct and one scaffold without hMSC were implanted subcutaneously left and right paravertebrally in athymic nude mice. After 2, 4, 8, and 12 weeks constructs and organs were harvested for immunohistological evaluation and PCR. In conclusion, we found integration of scaffolds loaded with hMSC implanted ectopically. HMSC seeded on 3D scaffolds survived for a period of up to 12 weeks. In addition, we could not detect hMSC in any other organ of the host.

Animals↗
PubMed2004

[Central cable system--fully automatic, continuous distraction osteogenesis for the lengthening treatment of large bone defects].

Distraction osteogenesis involving bone transport enables the reconstruction of large bone defects. The main bone fragments are usually stablilised externally, an intermediate bone segment is separated and moved through the defect at a rate of about 1 mm/day. New high-quality bone is built up in the constantly enlarging osteotomy gap. A major problem associated with the method is the fact that the fixation pins are also moved over the same distance, and cut through the soft tissue, often resulting in painful pin tract infections and ugly scars. An automatic motorized bone transport system employing a single central cable now eliminates this problem. The system can be combined with any external fixateur, since the relevant implanted parts for bone transport are independent of the external stabilizer. The surgical procedure, which is easy on the patient, consists of bone segment separation, central cable fixation, and stabilisation of the main fragments, and requires the use of numerous special tools. The distraction itself results in significantly less soft tissue irritation and pain. Pin tract infections are rare, so that changeover to internal fixation after completion of bone transport carries little risk of infection. This article details the technical features of the stabilizing system and the transport and the control systems, and describes the clinical application in a patient.

Adult↗
PubMed2004

[Tractive force measurement in bone transport--an in vivo investigation in humans].

Bone transport applying the principle of distraction osteogenesis makes it possible to reconstruct long bone defects caused by trauma or resection of bone tumors. The method employing a central cable, developed in Munich, is especially suitable for such applications. The main bone fragments are stabilized by an external fixateur, and bone transport is effected with a single central cable fixed to the tip of the segment, and driven by an external, programmable motor. In 15 patients the tractive forces during the entire bone transport were measured with a strain gauge incorporated within the cable. On the basis of the force profiles characteristics normal bone transport (forces between 150-250 N) can be distinguished from a critical transport (forces > 250 N) with the risk of premature consolidation. There is some evidence that at a very high level of force, just before premature consolidation a very effective form of bone transport with good bone neoformation can be achieved. Transport systems employing a central cable allow this special form of distraction osteogenesis, since there is continuous force monitoring, and there is the option of employing the traction force as a control factor in a loop.

Adolescent↗
PubMed2003

Initial RNA expression in human monocytes after multiple injury: a screening pilot study on potentially trauma-sensitive factors by using the microarray-technique.

BACKGROUND: Pathological affection of the immune system is one of the initiating mechanisms for the induction of multiple organ failure (MOF) in patients suffering from multiple injuries. Potential responsible intracellular mechanisms such as initial monocyte mRNA expression of specific mediators remain poorly studied, so far. Hence, we applied the microarray technique for screening of a wide variety of genes in circulating monocytes of multiple injured patients and compare the molecular results to the clinical course of the patients (MOF-score). METHODS: In our prospective pilot study 6 patients were enclosed presenting with blunt multiple injuries (Injury Severity Score 16 to 57 points). Monocytes were isolated out of sequentially drawn samples (6, 12, 24 and 48 hours after trauma) using magnetic cell sorting (CD14) and a human microarray system was used (Atlas stress 1.2, Clontech, 1176 genes). Alterations in the sequential samples were identified by calculating ratios to baseline levels on admission and cluster analysis was performed (Spotfire Decision). RESULTS: Only 86 (ca.5%) genes displayed an obvious signal. The house-keeping genes clustered well together in all patients in contrast to a substantial inter-individual variability of the other signal giving genes. No mediator burst of the classical pro- or anti-inflammatory cascade were detected. CONCLUSION: We demonstrate for the first time a screening analysis of mRNA expression patterns in circulating monocytes of multiple injured patients indicating that only very few genes appeared to be influenced by the traumatic event. So far, no correlation to the severity of trauma or MOF could be detected.

Adult↗
PubMed2003

Evaluation of minimally invasive percutaneous CT-controlled ventriculostomy in patients with severe head trauma.

Evaluation of percutaneous CT-controlled ventriculostomy (PCV) in patients with severe traumatic brain injury to measure intracranial pressure as a component of early clinical care. A consecutive series of 52 interventions with PCV was prospectively analyzed with regard to technical success, procedural time, time from the initial cranial computed tomography (CCT) until procedure and transfer to the intensive care unit (ICU). Additionally, the data was compared with a retrospective control group of 12 patients with 13 procedures of conventional burr-hole ventriculostomy (OP-ICP). The PCV was successful in all cases (52 of 52; 95% CI 94-100%). In 1 case a minor hemorrhage into the ipsilateral lateral ventricle was observed on CT scans due to an initially unsuccessful puncture (95% CI 0-6%). No infections occurred (95% CI 0-6%). In the control group with OP-ICP one catheter infection and one unsuccessful catheter placement occurred (each 8%, 95% CI 0-20%). The PCV led to a significant decrease of procedure time from 45 +/- 11 min (OP-ICP) to 20 +/- 12 min (PCV). The interval from the initial CCT until procedure (PCV 28 +/- 11 min, OP-ICP 78 +/- 33 min) and transfer to the ICU (PCV 69 +/- 34 min, OP-ICP 138 +/- 34 min) could also be significantly reduced (each with p<0.05, Mann-Whitney U-test). Percutaneous CT-controlled ventriculostomy is a safe and efficient method for ICP catheter placement during initial trauma room management. It significantly reduces the time of initial trauma room treatment.

Adult↗