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Biomedical subjects

W Schlickewei

Publications and source records attributed to W Schlickewei.

At least 19 recordsLinked to original sources
PubMed2001

[Effectiveness of an improved antiseptic in treatment of contaminated soft tissue wounds].

A novel antiseptic biguanide has been shown to be more bactericidal and tissue compatible in vitro than other antiseptics. In our controlled, prospective and randomized double-blind study on patients with bacteria-contaminated wound types 2-4, one group (n = 45) was treated with humid cotton swab dressings of 0.2% Lavasept solution compared with Ringer solution (n = 35). No deterioration of wound healing was observed in either group. Lavasept treatment resulted in faster and significant reduction of gram-positive germs. The tissue compatibility of Lavasept was evaluated as significantly better than Ringer solution.

Adult↗
PubMed2001

[Indications for intramedullary stabilization of shaft fractures in childhood. What is reliable, what is assumption?].

For some 15 years the elastically stable medullary nailing (ESIN) has been used in fracture treatment in children. The group of Nancy (Prevot and colleagues) first described the procedure for shaft fractures in children. Now the method is the standard procedure for stabilisation of long bone diaphyseal and metaphyseal fractures. During recent years a number of papers have described good and excellent results with this method, especially for shaft fractures of femur and forearm. In some papers there are also methods for articular fractures in more demanding techniques presented. Also when we have no evidence-based studies, we can say from the experience out of the last years that the ESIN is a biological, minimally invasive fracture treatment to achieve a high level of reduction and stabilisation in fractures in children. The use of titanium nails leeds to a higher rate of flexural elasticity and so the titanium nails are more recommended for this method.

Bone Nails↗
PubMed1999

The concept of "sense of coherence" and the development of posttraumatic stress disorder in traffic accident victims.

According to the "sense of coherence" concept, those subjects who can give meaning to a traumatic event can comprehend what has happened and have a sense of manageability of the sequelae, are able to cope better with the traumatic event itself. In the present study, this concept was applied to traffic accident victims. Severely injured traffic accident victims were assessed a few days after the accident and at 6-month follow-up. At follow-up, patients filled in the 29-item version of the Sense of Coherence (SOC) self-rating scale. The results show that the SOC total score correlated negatively with the development of: (i) posttraumatic psychopathology; (ii) psychological disorders (i.e., posttraumatic stress disorder after the accident); and (iii) anxious cognitions. The personality trait of neuroticism correlated negatively and extraversion and frustration tolerance correlated positively with SOC total score. Previous hypotheses are supported by our findings.

Accidents, Traffic↗
PubMed1998

[Using autoclaved spongiosa].

Since transmission of HIV through allogenic bone grafts has been established, the concept of cryopreservation of allogenic bone had to be reconsidered. The strict guidelines of the scientific board of the Bundesärztekammer of 1990 are very labour-, time- and money-intensive. We have therefore moved to autoclaving allogenic cancellous bone. This is harvested from femoral heads during THR in slices of 2 to 3 mm, then cleaned under non-sterile conditions with a hard water jet followed by an ultrasonic bath for approx. 20 minutes. The slices are then double sealed individually and autoclaved at a temperature of 134 degrees C and a pressure of 2.5 atmospheres. Storage is in sealable containers at room temperature, so the material available at any time. Since the bone tissue has been freed of most organic matter and therefore lost its bone-specific antigenic structure, all that is left is the anorganic component with its inimitable architecture. This treatment results in a cancellous bone graft which is sterile, biocompatible and osteoconductive. Biologically it is inferior to autogenic and cryopreserved bone. Experimental and clinical studies show, however, that autoclaved cancellous bone can be a suitable substitute in well-selected indications. To elucidate the ultrastructural changes of the spongiosa and proteins induced by autoclaving further investigations are necessary. For example, the specific proteins involved need to be determined.

Bone Transplantation↗
PubMed1998

Prediction of posttraumatic stress disorder by immediate reactions to trauma: a prospective study in road traffic accident victims.

Road traffic accidents often cause serious physical and psychological sequelae. Specialists of various medical faculties are involved in the treatment of accident victims. Little is known about the factors which might predict psychiatric disorders, e.g. Posttraumatic Stress Disorder (PTSD) after accidents and how psychological problems influence physical treatment. In a prospective study 179 unselected, consecutively admitted road traffic accident victims were assessed a few days after the accident for psychiatric diagnoses, severity of injury and psychopathology. All were inpatients and had to be treated for bone fractures. At 6-months follow-up assessment 152 (85%) of the patients were interviewed again. Of the patients, 18.4% fulfilled the criteria for Posttraumatic Stress Disorder (DSM-III-R) within 6 months after the accident. Patients who developed PTSD were injured more severely and showed more symptoms of anxiety, depression and PTSD a few days after the accident than patients with no psychiatric diagnosis. Patients with PTSD stayed significantly longer in the hospital than the other patients. Multiple regression analysis revealed that the length of hospitalization was due mainly to a diversity of factors such as severity of injury, severity of accident, premorbid personality and psychopathology. Posttraumatic stress disorder is common after road traffic accidents. Patients with PTSD at follow-up can be identified by findings from early assessment. Untreated psychological sequelae such as PTSD cause longer hospitalization and therefore more costs than in non-PTSD patients.

Accidents, Traffic↗
PubMed1998

[Method for measuring the comparative stability of osteosynthesis in the dorsal pelvic ring].

In the past, biomechanical investigations on the dorsal pelvic ring have generally been performed on a small number of cadaveric pelves in various non-standardized procedures. Significant differences in stability between different internal fixation methods of unstable pelvic ring fractures were not found. The experimental design presented here was based as closely as possible on the physiological loading of the pelvis in one-leg stance. This method made it possible to carry out standardized, reproducible tests on different osteosytheses of the sacroiliac joint. Furthermore, the suitability of artificial bones for such investigations can be assessed on the basis of a larger number of similar experiments on artificial and human pelves and the number of human pelves required for such studies could be reduced.

Biomechanical Phenomena↗
PubMed1998

[Fracture management during bone growth].

In treating fractures in children, there have been more and more demands for the primary treatment to be definitively planned, i.e., for a conclusive order of events to be laid down so as to exclude the necessity for re-reductions or a change of therapy. Long-term conservative methods of treatment are becoming less and acceptable to parents and children. From the psychosocial point of view, the aim must be to avoid extensive periods of hospitalization or bedrest in traction and to dispense with repeated anesthesia for re-reduction and changes in procedure. The child should be able to leave the hospital as soon as possible after a definitive and circumscribed primary course of treatment. Since complication-free surgical interventions are now available, many more operative procedures for dealing with fractures during the years of growth have become routine in this field.

Child↗
PubMed1997

Restoration of the spinal canal by the internal fixator and remodeling.

It has been observed that after reduction of an unstable vertebral fracture, treated either conservatively or operatively, the encroachment of the spinal canal remaining after reduction can decrease considerably with time. A series of 31 cases, each with a set of CT scans taken preoperatively, immediately after surgery and after implant removal respectively, was assessed using computer-aided planimetry. The mean initial narrowing of the spinal canal was 44.6%. Through surgery this was decreased by 20.4%, leaving a remaining deficit of 24.2%. After implant removal, 15 months after trauma and surgery, the area of the spinal canal increased a further 17.4%, leaving a remaining deficit of only 6.8%. Comparing the values of the spinal canal for T12-L5 directly after surgery and after implant removal, an almost identical degree of restoration for each level can be seen. This additional and gradual restoration of the spinal canal is termed remodeling. This study demonstrates that a residual postoperative narrowing of the spinal canal of up to 25% can be ignored, provided there is no initial neurologic damage.

Adolescent↗
PubMed1997

[Long-term results and late complications following acetabular fractures].

The long-term functional results of acetabular fractures are assessed in terms of the corresponding criteria of Merle-D'Aubigné and Postel (pain, mobility, walking). Other essential criteria include the quality of reduction and the radiological appearance. The age of the patient, the type of fracture and above all, the interval between the accident and the surgical treatment or reduction of the fracture must be counted among the decisive factors which influence the late effects of this injury. Whether or not reduction can correctly center the femoral head in the socket is of paramount importance, but postoperative infection or the development of a hematoma may also critically affect outcome. In addition to a report on the long-term results achieved at the Trauma Department of the University Hospital of Freiburg, Germany, the literature on the late complications of acetabular fracture is also reviewed.

Acetabulum↗
PubMed1996

Injury reduction by the airbag in accidents.

Today an increasing number of automobiles are being equipped with additional passive safety devices: driver and passenger airbags. To examine the efficiency of the airbag in real road traffic accidents, a collective study was conducted from 181 traumatology centres throughout Germany. The inquiry was answered by 81 per cent of the medical centres contacted. From the evaluation of 122 accident victims in 1993 who were protected with an airbag the following was concluded. The patients treated in surgical and in traumatological departments suffered predominantly superficial injuries of the head, cervical vertebra and thorax. Some of these chiefly superficial wounds, such as abrasions and bruises, were initiated by contact with the airbag. It is remarkable that 72.1 per cent of the airbag-protected patients suffered a maximum of MAIS 2. What is also notable is the continuing high number of patients suffering from severe injuries (AIS 3+) of the lower extremities.

Abbreviated Injury Scale↗
PubMed1996

[Pelvic fractures: epidemiology, therapy and long-term outcome. Overview of the multicenter study of the Pelvis Study Group].

Pelvic fractures are rare injuries (3-8%) when compared to fractures in other body regions. They are accompanied by high mortality (5-20%), and the survivors suffer from severe pain and pelvic-related handicaps. The German Pelvic Group (German Chapter of the AO-International & German Trauma Society) started a prospective multicenter study, including ten major trauma centers for collecting a high number of data in a short period of time (1991-1993). All pelvic injuries were documented consecutively using a special set of evaluation sheets. The study closed with 1,722 patients. A 2-year follow-up was completed for 486 patients injured in 1991 and 1992 after type B and C injuries, complex pelvic trauma, acetabulum fractures and a random 25% of A-type injuries (overall follow-up rate 73%). The follow-up included special "out-come" criteria. Of the pelvic ring injuries without significant peripelvic soft tissue involvement, 63.6% were A-type fractures, 21.0% B-type injuries and 15.5% C-type injuries. The rate of operative stabilization was 3.9% after A-type injuries, 37.3% after B-type injuries and 54.3% after C-type injuries. In isolated acetabular fractures ORIF was performed in 38.6%. The total lethality was 7.9% with a significant difference between "complex" pelvic trauma (21.3%) and patients without concomitant peripelvic injuries (7.2%). In 0.9% the pelvic injury was reported as the main cause of death. Pain at follow-up was observed in every classification group, the rate of completely "pain-free" patients being 55% after A-type, 41% after B-type and 27% after C-type fractures. Malfunction of micturia was reported by 7.6% of all patients, sexual malfunction by 11.6% of the males ("erectile dysfunction") and 2.2% of the female ("dysparneuria"). Scaled by the recently developed "outcome score", the radiological result showed anatomical healing after 90.8% of the B-type and 74.6% of the C-type injuries. On the other hand, the clinical result was rated as good or excellent in only 70% of the B-type and 54% of the C-type injuries. Although progress in indications and treatment techniques has shown improved radiological results after unstable pelvic ring injuries when compared to earlier studies, the clinical result still remains unsatisfactory. Further analyses and studies must be conducted to identify the prognostic factors for the late sequelae. Whether it is possible influence these factors by additional surgical intervention cannot be answered at present.

Acetabulum↗
PubMed1996

[Reconstruction of open width of the spinal canal by internal fixator instrumentation and remodeling].

In 106 cases of unstable vertebral fractures treated with the ASIF internal fixator, the degree of restoration of the spinal canal could be studied in detail. Computer-aided planimetry was used to measure the area of the spinal canal. Three series could be studied, where the postoperative CT scans had been performed at different times. The first series of 58 cases had the CT scans taken immediately after surgery; the initial mean traumatic narrowing of the spinal canal had been 42.8%, but after surgery it was only 25.2%. The second series consisted of 74 CT scans performed after implant removal. At this time, a residual defect of only 3.7% was observed. In a third series 31 cases could be analysed where CT scans obtained both directly after surgery and after implant removal were available. This confirmed the first two series insofar as it demonstrated the existence of a further mechanism, i.e. remodeling, that served to increase the degree of restoration of the spinal canal. This biological-functional process operates to approximately the same degree at each fracture level, demonstrated by the almost parallel course of the graph showing reduction plus internal fixation and remodeling. In summary, the remaining deficit of 25% after surgery is restored almost to normal through remodeling and can be neglected, provided there is no neurologic damage.

Adolescent↗
PubMed1995

[Protective air bags in traffic accidents. Change in the injury pattern and reduction in the severity of injuries].

The effectiveness of air bags, drivers-side and passenger-side, as an additional passive safety system in motor vehicles was tested in a collective study in which 47 trauma centers in Germany participated. The inquiry was answered by 80% of 181 hospitals. The evaluation of a total of 119 air bag-protected patients involved in accidents, who were treated in German trauma centers in the year 1993 shows predominant minor injuries on the head-, cervical- and thorax-region. Some patients had superficial injuries caused by air bag in their face and chest area, such as abrasions and contusions. It is notable, that a large number of patients continue to suffer severe injuries (AIS 3+) in their lower extremities. The trend of the industry to equip more and more vehicles with air bags must be sustained. According to manufacturer statements, in 1994 already more than 60% of all mass produced vehicles in Germany will be provided with this modern passive safety system.

Abdominal Injuries↗
PubMed1994

Ligamentotaxis with an internal spinal fixator for thoracolumbar fractures.

We assessed narrowing of the spinal canal in 39 burst fractures and fracture-dislocations of thoracolumbar vertebrae treated by the AO Internal Spinal Fixator, using CT preoperatively and at various stages postoperatively. Computer-aided planimetry was used to measure the narrowing, and its restoration shortly after instrumentation, or at 15 months. The mean initial reduction of canal area was to 63.7% +/- 18.8% of normal; this was restored to a mean of 95.4% +/- 21.2% of normal when measured either soon after surgery or at 15 months (p < 0.001 for both groups). There was more improvement in cases assessed later. For fractures from D12 to L3, the mean canal area was restored to 99.4% of normal; but at L4 or L5 the mean restitution was to only 60.9% (p < 0.05). We found no correlation between preoperative loss of area and amount of restoration, or severity of neurological deficit. Nor was there any correlation between the delay before surgery and the improvement achieved. The mechanism of fracture reduction appears to be a combination of distraction ligamentotaxis and forced hyperextension.

Adolescent↗