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Biomedical subjects

W Schlickewei

Publications and source records attributed to W Schlickewei.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1993

Influence of humate on calcium hydroxyapatite implants.

Implanted bovine apatite is highly osteoconductive, since it serves the host tissue as a "guide-line" for the deposition of newly developing bone tissue. It is well tolerated, but it showed no signs of being resorbed during the course of the experiment. Previous impregnation of the bovine hydroxyapatite with a low molecular humate substance obviously encourages its resorption. This is most easily explained by the known ability of humate to induce the activation of leucocytes. The occasional over-resorption of the apatite is dependent (1) upon the preparation of the implant (granulate) and (2) the local concentration of the humate. Future research is being directed towards the production of a satisfactorily usable form of humate and apatite and the investigation of its HIV blocking action on heterologous cancellous bone.

Animals↗
PubMed1993

Hip dislocation without fracture: traction or mobilization after reduction?

In all, 41 patients with traumatic dislocation of the hip, without associated acetabular or femoral fracture, were treated by two different methods after closed reduction, performed on average 2 h after injury. Patients in group A (N = 20) were subjected to skeletal traction for 2 weeks, followed by non-weight bearing for 3 months. Those in group B (N = 21) were mobilized a few days (average 9 days) after injury and allowed partial weight bearing. They were fully weight bearing at 3 months. The 31 patients were followed up for an average of 7.6 years and showed comparable long-term results in both groups. No early complications occurred in group B. There were no cases of avascular necrosis in either group. There were three cases of post-traumatic arthritis in group A and one in group B, and two cases each of heterotopic ossification. Early mobilization was concluded to be a safe and more comfortable method of after-treatment. Earlier return to work was a significant benefit in Group B.

Adolescent↗
PubMed1993

[Metal abrasion as an imaging artefact in nuclear spin tomography].

Eighteen patients with vertebral body fractures that had been stabilized by an internal spinal skeletal fixation system were prospectively examined by magnetic resonance (MR) imaging between February 1989 and November 1990 at the Department od Diagnostic Radiology of the University Hospital Freiburg 3-7 days after removal of the metallic implants. In most cases imaging artifacts in the paraspinal extensor muscles were evident on MR studies. These were found especially in the region of the previous site of the metal clip jaw bearing. In a few cases artifacts were also present within the vertebral body and/or vertebral arch, but only if the vertebral body had been surgically reconstructed by transpedicular spongiosa implantation. None or only minor artifacts by abrasion of metal were detected if the (modified Schanz's) screws appeared to be tight at surgical removal of the implants. Therefore, marked metal artifacts on MR imaging retrospectively indicate a chronic straining of the implants, which has been shown to be a risk factor for implant loosening. Additional in vitro studies with powdered metallic alloy showed that as little as 1 mg of metal could be detected as artifacts in routine spin-echo sequences. When the metallic pieces were large enough to be seen on conventional radiographs or computed tomograms, they caused severe, distorting artifacts on MR imaging. It is concluded that MR imaging is the method of choice for detection of small amounts of metal.

Adult↗
PubMed1992

[Improved interpretation of intra-operative myelography in dorsal spinal instrumentation].

Intraoperative assessment of the spinal canal during dorsal instrumentation for vertebral fractures which narrow the canal is facilitated by myelography. However, the flow of contrast medium around a displaced fragment may result in an erroneous interpretation of canal patency. By performing myelography prior to instrumentation and reduction of the fracture, a chance in myelography-findings after reduction can clearly be caused only by successful repositioning of the displaced fragment. The possibility of an incorrect interpretation of the investigation can thus be reduced.

Fracture Fixation, Internal↗
PubMed1992

Upper and lower limb fractures with concomitant arterial injury.

We describe a management strategy for upper- and lower-limb fractures with associated arterial injury and report the results in 113 cases treated over a period of 18 years. Primary amputation was performed in 23 patients and of those who underwent primary vascular repair, 27 needed secondary amputation, two-thirds of them within a week of the injury. Of those requiring secondary amputation, 51.8% had ischaemia exceeding six hours, 81.4% had severe soft-tissue injury and 85.2% had type III open fractures. The patients whose limbs had been salvaged were followed up for an average of 5.6 years. The eventual outcome depended on the severity of the fracture, the degree of soft-tissue damage, the length of the ischaemic period, the severity of neurological involvement, and the presence of associated major injuries. There was a 30% incidence of long-term disability in the salvaged limbs, largely due to poor recovery of neurological function. Prompt recognition of such combined injuries is vital and requires a high index of suspicion in patients with multiple injuries and with certain fracture patterns. We recommend a multidisciplinary approach, liberal use of pre-operative angiography in upper-limb injuries and selective use of intra-operative angiography in lower-limb injuries. Stable external or internal fixation of the fractures and re-establishment of limb perfusion are urgent surgical priorities to reduce the period of ischaemia which is critical for successful limb salvage.

Adolescent↗
PubMed1992

[Significance of ligamentotaxis for internal fixator osteosynthesis in fractures of thoracic and lumbar vertebrae].

Between 1985 and 1990 104 operations on the lower thoracic and lumbar spine using the AO-internal spinal fixation system were performed. The preoperative computed tomography (CT) scans as well as either the postoperative CT scans or the CT scans taken after implant removal of 41 cases were available for evaluation of the narrowing of the spinal canal and the subsequent fracture reduction by means of computer-aided planimetry. It is shown that a near normal reduction of the spinal canal through ligamentotaxis is achieved for a fracture between T 12 and L 2, whereas for fractures between L 3 and L 5 an incomplete reduction is observed. A correlation between the neurologic deficit and the degree of narrowing of the spinal canal could not be established. Obviously, the damage to the spinal cord is determined primarily through the dynamic forces of the impact. Also no statistical correlation could be demonstrated in our cases of the time interval between accident and operation to the degree of reduction of the fracture achieved.

Humans↗