Biomedical subjects

F Kutscha-Lissberg

Publications and source records attributed to F Kutscha-Lissberg.

At least 19 recordsLinked to original sources

PubMed2006

Fusion of the septic knee with external hybrid fixator.

Arthrodesis is a well-recognized salvage procedure in patients with septic destruction of knee joints. It offers the opportunity for restoring weight bearing capability and significant pain relief as well as eradication of infection, but at the expense of joint motion. However, arthrodesis in order to joint sepsis may be difficult to achieve because of poor bone stock, persistent infection and soft tissue compromise. From 2000 to June 2004, in 70 consecutive patients arthrodesis of the knee was indicated. Nineteen patients were considered to have external hybrid fixator (EHF) and were therefore included to the prospective study protocol. Forty-three stabilisations of destructed knee joints were done by a modular titanium rod. In these cases bony fusion was very unlikely to be achieved because of devastating defects due to infected total knee arthroplasties. Eight patients were treated by compression nailing. In these situations EHF was not indicated. In three patients minor complication occurred. In two out of 17 patients fusion failed because of primary underestimated bony defects (11.8%). The use of EHF for arthrodeses after septic destruction of knee joints can be recommended according to our results. However, EHF will not be successful or applicable in each case. Therefore, physicians and institutions that offer this special method should have not only experiences with EHF but also with arthrodeses and alternative procedures.

Adult↗

PubMed2004

[Periprosthetic supracondylar femoral fractures: LISS or retrograde intramedullary nailing? Problems with the use of minimally invasive technique].

Retrograde intramedullary locking nailing as well as the LIS system are propagated as minimally invasive treatment options for distal femoral fractures following total knee arthroplasty. In a retrospective study, we reviewed the clinical results after operative treatment of 18 periprosthetic supracondylar femoral fractures. The fracture was stabilized with the less invasive stabilization system (LISS) in nine patients (average age: 80.3 years) and with a retrograde intramedullary locking nail in the remaining nine patients (average age: 76.8 years). The mean follow-up was 18.2 months (6-35 months). We did not find significant differences concerning the operation time (nailing 99.8 min vs 102.3 min with the LISS) or the length of stay in the hospital (nailing 10.6 days vs 12.7 days with the LISS). In one patient of the nailing group we found a valgus malalignment of 18 degrees. Seven patients in each group were satisfied with the clinical results. In one patient of the LISS group a revision due to an infection was necessary. In one patient of the nailing group a reosteosynthesis had to be performed. To sum up, both systems are useful tools in the treatment of dislocated periprosthetic fractures and both systems are not without any problems. However, under special consideration of the complications we found in our study, the LISS seems to be a better alternative in osteoporotic bone with a small distal fragment. The choice of the optimal implant should therefore depend on the type of fracture and knee arthroplasty, the type of bone, and the experience of the surgeon.

Activities of Daily Living↗

PubMed2004

[Open pelvic fracture. Treatment strategy and results for 12 patients].

This article presents treatment priorities for open pelvic fracture and the results of 12 patients. In a retrospective study we analyzed 12 patients treated at a level 1 trauma center between 1994 and 1998 of whom eight were male and four female with an average age of 29.6 years. Six type C (6 x III degrees open) and six type B (4 x II degrees and 2 x III degrees open) were identified. On average, 15 EKs were necessary within the first 12 h of treatment (type C=17, type B=13). All type C fractures underwent emergency stabilization with the pelvic C-clamp. Early laparotomy was performed in 60%. Perineal laceration was identified in 58%, followed by nerve and plexus lesions in 42%, injuries of the genitourinary tract in 33%, and lesions of the fecal stream in 25%. Altogether, there were more peripelvic injuries associated with type C fracture than with type B (12 vs 8). On average, there were 27 second-look operations necessary with 3-.2 operations per patient. The average stay in the ICU was 82 days (80-360); 25% died. Control of hemorrhage is fundamental; therefore, emergency stabilization of the pelvis is essential followed by surgical procedures. Early surgical definitive stabilization of the fracture decreases septic complications. Such complex injuries should be treated at specialized trauma centers.

Adult↗

PubMed2004

[Influence of local application of basic fibroblast growth factor on resistance to local infection after standardized closed soft tissue trauma. An experimental study in rats].

The aim of the study was to obtain information on the importance/influence of local application of an angiogenic potent growth factor (bFGF) on local infection resistance after soft tissue trauma.A paired comparison of infection rates was carried out on Sprague-Dawley rats after standardized, closed soft tissue trauma and local, percutaneous bacterial inoculation of different concentrations (2 x 10(4)-2 x 10(7)), whereby the lower leg was treated with 1, 10, and 100 ng bFGF (n=16 each) and without bFGF (n=16). Statistical evaluation of the differences between the infection rates of both groups was performed using the two-sided Fisher's exact test ( p<0.05). For the group without bFGF application, the infection rate was 25%. In the groups with 1, 10, and 100 ng bFGF application, the infection rates were 50%, 69%, and 81%. The difference in the infection rates for the groups in which 10 and 100 ng bFGF were applied was highly significant ( p=0.032/ p=0.004) compared with the group without bFGF. If these initial results are confirmed for other angiogenic potent growth factors, then the local application of growth factors to stimulate wound and bone healing will need to be reconsidered and preceded by a very strict evaluation of the risks and benefits.

Animals↗

PubMed2004

[Autologous chondrocyte transplantation for the treatment of articular cartilage defects inf the knee joint. Techniques and results].

BACKGROUND: Currently the use of autologous chondrocytes as a cartilage-repair procedure for the repair of injured articular cartilage of the knee joint, is recommended. METHODS: This review presents the technique of autologous chondrocyte transplantation (ACT) and their modifications as matrix-associated autologous chondrocyte transplantation (MACT). Beside the surgical procedure the experimental and clinical results are discussed. Furthermore the major complications and the indication guidelines are presented. RESULTS: Articular cartilage in adults has a poor ability to self-repair after a substantial injury. Surgical therapeutic efforts in treating cartilage defects have focused on bringing new cells capable of chondrogenesis into the lesions. With ACT good to excellent clinical results are seen in isolated posttraumatic lesions of the knee joint in the younger patient with the formation of hyaline-like repair tissue. The major complications are periosteal hypertrophy, delamination of the transplant, arthrofibrosis and transplant failure. The current limitations include osteoarthritic defects and higher patient age. CONCLUSION: With the right indication and operative technique ACT is an effective and save option for the treatment of large full thickness cartilage defect of the knee joint.

Cartilage Diseases↗

PubMed2004

[Osteochondritis dissecans of the knee joint].

BACKGROUND: Osteochondritis dissecans (OD) is an affection of the subchondral bone involving progressive detachment of an osteochondral fragment. METHODS: This article describes the epidemiology, etiology, clinical appearance, possibilities for radiological diagnostics, and classification of OD and presents conservative and surgical therapeutic techniques. RESULTS: Treatment of OD depends on the size, location, stability of the fragment, and skeletal maturity. The majority of young patients can be treated conservatively. Surgical interventions include antegrade or retrograde drilling with optional refixation and osteochondral transplantation as well as autologous chondrocyte transplantation. CONCLUSION: The results of surgical intervention are quite promising; nevertheless, further prospective comparative studies are necessary to evaluate effectivity.

Cartilage, Articular↗

PubMed2004

[Pathophysiology of posttraumatic osteitis].

Over the last few decades, significant reduction of post-traumatic infections could be attained by establishing novel surgical techniques and tactics, by adapting surgical decisions to the risk of infection, by employing chemotherapeutic agents, and by developing new implants. Here a novel understanding of the pathophysiologic mechanisms of post-traumatic and postoperative osteomyelitis were directive. Nevertheless, post-traumatic infections later cause significant physical and economic sequelae. This article sums up the fundamental pathophysiological mechanisms of post-traumatic infection. New ideas about post-traumatic prevention and therapy of osteomyelitis are discussed.

Foreign-Body Reaction↗

PubMed2004

[Principles of surgical therapy concepts for postoperative and chronic osteomyelitis].

Infection of the bone is one of the most serious complications in the field of orthopedic and trauma orthopedic surgery. Sufficient treatment protocols not only contain complex surgical procedures but also sophisticated diagnostic tools, proper use of antibiotics, and intensive physical therapy right from the beginning. Even in light of these advanced treatment protocols, which have great impact on both patients and health care systems, persisting infection and residual functional deficits of the extremities are not rare. In cases of early (acute) infection, the main objective is to avoid chronification by diligent surgical interventions. The surgical principle is the meticulous debridement and lavage of the situs. Revision of only the epifascial layers is as inadequate as the simple reopening of the wound without excision of the whole wound including all tissue layers. In cases of chronic soft tissue and bone infection, radical debridement of all infected and scar tissue is also the basic requirement of treatment. Reconstruction of the soft tissue envelope is done by local or free flap surgery. Because of they are better resistant to infection, musculo(cutaneous)flaps are preferred. Bony reconstruction is done by autologous cancellous bone grafting (partial defects), segment transport (full thickness defects), or freely transplanted vascularized bone grafts (large partial defects). Both soft tissue and osseous reconstruction take a relatively long period of time requiring several operations and periods of hospitalization. These have to be discussed and explained to the patients extensively. If the required amount of resection and the capability of reconstruction do not coincide, the surgeon and the patient have to decide whether restoration of function without definitive infection care, symptomatic infection therapy, or amputation is the most proper treatment option according to the patient's everyday needs and lifestyle. Because each treatment protocol is a composition of orthopedic trauma surgeons, plastic surgeons, radiologists, microbiologists, and physical therapists, reliable cooperation and communication is essential.

Chronic Disease↗

PubMed2004

[The comeback of osteitis?].

Explore the source record for details and available documents.

Adult↗

PubMed2004

[Efficiency of low-intensity pulsed ultrasound on distraction osteogenesis in case of delayed callotasis -- clinical results].

AIM: Low-intensity pulsed ultrasound has been proven to accelerate fracture healing both clinically and experimentally. In this study the influence of low-intensity pulsed ultrasound during distraction-osteogenesis in case of delayed callotasis was investigated. METHOD: 20 patients could be included in this study. 16 patients initially were treated because of fractures of the lower leg, 2 because of fractures of the femur with resulting shortening of the afflicted limb. One patient suffered from chronic osteitis at the thigh and one from chronic osteitis at the upper arm without previous trauma. Because of delayed callotasis an adjunctive ultrasound treatment device was transcutaneously applied (frequency 1.5 MHz, signal burst width 200 microseconds, signal repetition frequency 1.0 kHz, intensity 30 mW/cm (2)) with the transducer placed at the distraction zone for 20 minutes daily. In all cases in-home treatment was performed. Evaluation was done by radiographic and sonographic controls of the distraction zone during examination of all patients at the outpatients' department every 3-4 weeks. RESULTS: Progress of callotasis was achieved in 15 out of 20 patients. Patients who were smokers during ultrasound therapy showed lower healing rates than those who never smoked. 2 patients suffering from osteitis of the tibia and missing callotasis had to be amputated. 3 other patients needed additional operative treatment including cancellous bone grafts because of missing new bone formation. Negative effects of low-intensity pulsed ultrasound during therapy could not be detected. CONCLUSION: We conclude that ultrasound treatment can accelerate bone maturation and formation in distraction osteogenesis, sometimes even in states of poor callotasis. It may provide a method of great promise in cases where delayed bone formation during distraction osteogenesis occurs.

Adult↗

PubMed2003

[Why do osteosyntheses fail? The problem with biomechanics and biology].

Avoidance of complications in the course of fracture treatment is of essential importance not only for patients but increasingly from an economic point of view. In the past 15 years emphasis has been placed on the development and fine-tuning of minimally invasive reduction techniques with suitable implants. The main objectives were avoidance of surgical site infection and uneventful fracture healing. This facilitated the solving of long-standing problems but created new sources of error. Minimally invasive, dynamic forms of osteosynthesis were found to fail with extensive open reduction or neglect of biomechanics. Additionally, it appeared that some traditional techniques and basic rules of operative fracture treatment fell into oblivion. The majority of complications are determined already preoperatively by the choice of treatment or implant. After exact analysis of the biomechanics and biological etiology, nonunion is dealt with by an imperative increase in mechanical stability. Additional procedures, i.e., bone graft or debridement, are incorporated into the therapeutic regime. Increasing mechanical stability should be attempted with a minimum of added trauma to avoid local biological impairment. Further improvement of outcome depends on innovative and adapted teaching concepts. Training exclusively with one implant, even under the guidance of the producing company, is insufficient to grasp the various fundamentals of operative fracture treatment indispensable for a successful day-to-day routine.

Biomechanical Phenomena↗

PubMed2003

[Complex fractures of the humeral head: which long-term results can be expected?].

BACKGROUND: Although improved techniques of internal fixation and prosthetic replacement were introduced successfully in the field of operative fracture care, treatment of complex fractures of the proximal humerus also involving the humeral head remains to be a challenge to the trauma surgeon. We therefore investigated clinical and radiological long-term results after humeral head preserving procedures. METHODS: 41 patients with a three or four part fracture of the humeral head were evaluated on average 6.6 years (min. 4.4 y; max. 9.0 y) after the trauma. The evaluation was based on the Constant- and HSS score clinically and on the Neer score radiologically. Nine patients were treated conservatively (group A), 13 patients had primarily an operative treatment (group B) and another 19 were operated upon after failure of conservative means. 24 of the patients were female and 17 male, with an average age of 52 years (min. 14.4 y; max. 71.2 y). According to Neers 's fracture classification of humeral head fractures we saw 14 type IV, 25 times a combination of type IV and V and in another 2 cases a type VI fracture. RESULTS: In group A (conservative) the Constant score showed on average 82.0 points for the injured and 95.3 points for the contralateral shoulder, the HSS score revealed 73.6 points and Neer's x-ray score 5.6 points. Group B (operated) showed also good results on average according to a Constant score of 72.1 points (fractured humerus) compared with 98.1 points of the contralateral shoulder. HSS score was 64.7 points. The radiological results reached 4.0 points. Group C (conservatively failed, secondary operation) achieved 68.2 points for the injured side and 95.8 points for the contralateral side according to Constant and 59.5 points according to HSS score. The x-ray evaluation showed 5.3 points. Fracture type did not influence the outcome in any of the groups. There was no humeral head necrosis in group A, one in group B (2.4 %) and four in group C (9.8 %). CONCLUSION: These data show that regarding to clinical and radiological long-term results also complex fractures of the humeral head should be treated by head preserving procedures.

Adolescent↗

PubMed2003

[Primary hemiarthroplasty after complex fracture of the humeral head--functional late results].

UNLABELLED: Treatment of complex fractures of the humeral head remains an obviously unsolved problem. Under consideration of the problems of head preserving methods, the development of the last years tended towards the hemiprosthetic replacement. As the discussion about the methods and implants continues to be controversial, long-term results of Neer-II-replacement of humeral head in own trauma cases are presented here. PATIENTS AND METHODS: 46 patients were investigated, in whom a cemented Neer II hemiprosthesis was implanted between 1983 and 1996 due to complex fracture patterns. Median age was 60.2 years, 74 % of patients were female. 59 % had a luxation fracture type Neer VI, 22 % presented a concomitant nerval lesion. Follow up was performed 5 years on average after the operation. 38 patients were investigated clinically according the score of Constant and Murley, 36 had a x- ray control. Additionally an individual questionnaire was completed by 46 patients. RESULTS: Average Constant-score was 66.2 points, whereas in 76.3 % a satisfactory or better result was achieved. In 23.9 % the outcome was poor. In one patient (2.2 %) explantation of the hemiprosthesis and shoulder fusion due to pain was necessary. Conditions for a good result were a patient aged 50 years and younger (75.9 pts. versus 64.2 pts.), an early hemiprosthetic replacement within 4 weeks after the trauma (71.7 pts. versus 55.3 pts.) and a patient without an earlier operation and nerval lesion (76.8 pts. versus 53.9 pts.). No correlation was found between the date of the follow-up and the interval of time since the operation. CONCLUSION: After complex fractures of the humeral head satisfactory long-term results can be obtained by the cemented Neer II hemiprosthesis. Thus, implants of the newer generation can not yet whitness their superiority under consideration of functional aspects. Refixation and reintegration of both the tubercula after trauma still seems to be an unsolved problem and requires further development.

Adult↗

PubMed2003

Arthrodesis of the shoulder after septic arthritis. Long-term results.

We analysed the long-term results of arthrodesis of the shoulder after infection in 15 patients. At the time of operation, 14 cultures were positive for Staphylococcus aureus. The mean follow-up was 8.3 years (3 to 14) and 90% of the patients were satisfied with the outcome. There were complications in five patients (33%); in three there was nonunion with loosening of the implant. One patient had a sound bony union but with a persistent sinus six years after arthrodesis and another had a sinus which healed after the metal was removed. Four of these five patients (80%) were heavy smokers (> 20 cigarettes/day). Cancellous bone grafting did not affect the incidence of complications. The mean age of the patients with complications was 58.6 v 48.6 years for those without (p = 0.2808; not significant). Those with complications had had more previous operations (6.4 v 2.5, p < 0.05). Antibiotics, as determined by the bacteriological cultures, were administered for six weeks. The complication rate was higher in patients with active sepsis but the younger the patient and the fewer number of previous operations (< 50 years, < four previous operations), the better was the outcome. Considering the rate of complications, we recommend early surgery in these patients.

Activities of Daily Living↗

PubMed2002

[Outcome quality in trauma surgery].

Trauma surgery and orthopedic trauma surgery have been accompanied not only by internal quality assessment, but also by external quality assessment procedures right from the beginning. The reasons for these mechanisms were based on legal regulations of treatment of work-related accidents. In 1958, the Arbeitsgemeinschaft für Osteosynthese (Working Group on Osteosynthesis, AO group) was founded. The results of the AO's scientific activities built the basis of osteosyntheses. In 1988, legal regulations changed again in Germany. Since this reform of some important facets of public health care, each hospital or institution is committed to perform external and internal quality assessment. In addition, the introduction of a payment system based on diagnosis-related groups makes it necessary to install basic quality management systems within the next few years. This paper presents some well-established procedures, especially the diagnosis-related study in the whole district of Westphalia-Lippe. The aim of the study was a quality assessment of the treatment of intracapsular fractures of the collum of the femur. Problems in data analysis and interpretation are shown. Because of some grave problems, certain changes in the study design seem to be warranted. Despite these facts, however, we are convinced that we not only need this kind of quality assessment, but that we should try to expand these studies based on the experiences we gained.

Accidents, Occupational↗

PubMed2002

[Septic arthritis of the shoulder following intra-articular injection therapy. Lethal course due to delayed initiation of therapy].

Detection of a bacterial arthritis of the shoulder represents an absolute indication for intervention. Irrespective of the cause of the infection, the most decisive prognostic factors are early diagnosis and therapy. We report on two patients who suffered from generalized sepsis and resulting death after delayed treatment of iatrogenic joint infections of the shoulder caused by intra-articular injection therapy. Both patients suffering from septic shock syndrome had been transferred to our hospital for surgical and intensive care treatment. They died in spite of maximal intensive care and aggressive surgical treatment. On the basis of the cases presented, it can be concluded that an acute infection of the shoulder joint must be excluded early when painfully limited range of motion in combination with clinical and laboratory signs of inflammation become apparent. Successful therapy of joint infection also requires early surgical treatment, including resection of infected tissue. If surgical joint revision is not performed or is performed too late, there is the risk of irreversible damage to the afflicted joint, even septic spread endangering the patient's life.

Aged↗

PubMed2002

[The reality of preclinical treatment in thoracic trauma - a prospective study].

AIM OF THE STUDY: Because of the well proven fact of outcome improvement by early, preclinical intubation and ventilation of multiple injured and polytraumatized patients, the guidelines of different medical associations recommend this procedure especially in combination with blunt chest trauma. By the means of a prospective study protocol we analyzed whether these treatment standards were respected and whether the kind of preclinical treatment was influencing treatment outcome. PATIENTS AND METHODS: Using a prospective study protocol data were sampled and analyzed. From 1.12.2000 to 25.9.2001 48 consecutive patients were included into the protocol. 12 patients (25 %) had preclinical intubation (group A). 8 patients of group A were intubated by the helicopter emergency team. 36 patients had no tracheal tube (group B). In 34 cases mechanical ventilation has to be started during the emergency room procedures. Two patients were intubated after they were admitted to the intensive care unit (ICU). Insertion of a chest tube was done in 5 patients at the scene by the emergency team, in 15 cases after admission to the hospital and 21 at the ICU. Although the average age of years of patients was higher in group B (37,2 +/- 15,0 y vs. 46,9 +/- 21,1 y), p values calculated by ANOVA test revealed no significant difference. The two groups did not differ regarding to injury severity assessed by the "Injury severity score" (group A: 30,9 +/- 13,3; group B: 29,5 +/- 9,2). The mean duration of mechanical ventilation was 9,4 +/- 9,0d vs. 19,2 +/- 20,4 d in group A vs group B. Patients of group A required intensive care treatment for 12,6 +/- 8,7d vs 21,9 +/- 20,4 d of group B. One patient of group A died because of severe cranio cerebral trauma. 13 Patients of group B died (1 x pulmonal embolism, 12 x multiple organ failure). CONCLUSIONS: Assessment of injury severity by the emergency medical teams failed in a very high percentage. Especially the blunt trauma to the chest was not diagnosed and therefore not respected.

Adult↗

PubMed2002

[Pyogenic infection after joint replacement operations: incidence and economic effects].

Infection following arthroplasty is a rare but significant and threatening complication. The incidence is about 2%. Treatment of an infected joint replacement may be demanding, time consuming and expensive. For the treating institution there is a risk of substantial financial losses due to inadequate reimbursement. Calculated on the basis of approximately 150,000 implanted joint protheses/a, an infection rate of 2% and treatment costs of approximately 50,000 [symbol: see text]/infected case the economic burden is an estimated 150 million [symbol: see text]/a in Germany. This amount should justify a sound evaluation of costs related to infection in arthroplasty, which should be the effort of the health insurance organisations. Additionally specific research in the field of infection prevention must be sponsored. The system of reimbursement should be adequately adopted and corrected.

Arthritis, Infectious↗