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K Dresing

Publications and source records attributed to K Dresing.

At least 19 recordsLinked to original sources
PubMed2006

Pre-operative dynamic interactive exploration of complex articular fractures using a novel 3D navigation tool.

OBJECTIVES: Trauma surgeons possess specific anticipative pathoanatomical and procedural domain knowledge that can be used for information extraction from original CT image data. This knowledge so far remains unused in clinical workflow and surgeons do not take an active part in the process of image generation and processing. The objectives of our work are to propose and employ a strategy to directly involve surgeons in a dynamic image exploration process and to exemplarily assess the clinical use of this approach for pre-operative diagnosis of complex articular fractures. METHODS: We used an interactive 3D navigation tool with a novel human-computer interface for the exploration of articular fractures of two selected anatomical structures. The system offers dynamic interaction with a virtual 3D reconstruction model and the possibility to create on-the-fly oblique multiplanar reformations by tracking hand movements. Three expert surgeons performed exemplary explorations and rated the use of the method for preoperative diagnosis in informal interviews. RESULTS: The approach and the system were well received by the three surgeons. The dynamic interaction was rated to be helpful in understanding fracture morphology. Two examples--a radius and a calcaneal fracture--are presented. CONCLUSIONS: Surgeons with their specific domain knowledge should be involved in the process of image processing. The benefit of using oblique multiplanar reformations for pre-operative planning in articular fractures appears to be substantial and they should therefore be included in radiological and surgical textbooks. Further evaluation is necessary to assess the use of interactive exploration systems in routine diagnosis.

Feasibility Studies↗
PubMed2003

[HCV, HBV and HIV infections: risk for surgeon and staff. Results and consequences of routine screening in emergency patients].

BACKGROUND: Trauma and emergency surgeons (S) are in contact with high-risk patients (P) infected with HBV, HCV, and HIV without knowing which P is and which is not infected. The aim of this paper was to analyze routine screening (SCR) in trauma care. METHOD: Microparticle enzyme immunoassays (MEIA) (Abbott Axym system) were analyzed from routine blood samples: HBsAg (V2), HCV version 3.0, HIV 1/2gO. All positive or uncertain samples were confirmed with ELISA/PCR. RESULTS: From January 2002 to October 2002 a total of 1074 emergency P were examined. The results were available within 50 min after admittance to the emergency room. In 53 of 1074 (4.9%) the MEIA was positive or in threshold margins (LV): HBV 15 P plus 3 LV (9 secured by ELISA/PCR), prevalence (PV) 0.84%. HCV 34 P plus 1 LV (31 secured with ELISA/PCR), PV 2.9%. HIV 2 P, PV 1.86 per thousand, 1 in co-infection with HCV, 1 with HBV. Of 42 infections, 21 were unknown before screening, and in 5 P the S suspected an infection. After screening, nine surgical procedures were changed to safer procedures. CONCLUSION: MEIA is a good tool for quick SCR of HCV, HBV, and HIV in emergency surgery (ES). When the infection is known the S is more aware to perform only safe procedures during surgery (no touch technique) or to use more protective devices (e.g., fluid shield, double gloves). Our results indicate that surgeons and nurses in ES are exposed four to six times more often to infection with HCV, HBV, and HIV than represented by officially published data. We recommend routine SCR of HBV, HCV, and HIV for all P in ES. Prevention procedures are discussed.

Adolescent↗
PubMed2003

[A bipolar radial head prosthesis after comminuted radial head fractures: indications, treatment and outcome after 5 years].

The treatment of comminuted fractures of the radial head with concomitant injuries of the ulnar complex by resection of the radial head usually does not provide satisfactory long-term results. Other than joint instability in the elbow and a limited range of motion, radius proximalisation in the sense of ulnocarpal impingement, osteoarthritis and pain in the elbow have been described. Between 1995 and 1997, 11 radial head prostheses were implanted in ten patients who had sustained a comminuted fracture of the radial head with concomitant injury to the ulnar complex. A follow-up survey was conducted with the patients on average 5 years after the injury. Eight patients with nine implants participated in the follow-up, one patient had died and another refused to participate but declared that he did not suffer from any impairment. According to the Morrey score, two of the results were found to be very good, five to be good, one to be fair and one to be poor. Despite the severe injuries sustained by the elbow, neither joint instability in the elbow nor proximalisation of the radius, cubitus valgus, ulnar nerve syndrome, nor loosening of the prosthesis were found in any of the patients. In the event of comminuted fractures of the radial head which are impossible to reconstruct by osteosynthesis and which occur with concomitant ulnar ligamentous or osseous injury, the implantation of a prosthesis is preferred over the resection of the head of the radius.

Adult↗
PubMed2003

Autologous osteoblasts enhance osseointegration of porous titanium implants.

The goal of this study was to assess the osseointegration of porous titanium implants by means of coating with autologous osteoblasts. Titanium implants (8 x 5 x 4 mm) having drill channels with diameters of 400, 500, and 600 microm were coated with autologous osteoblasts obtained from spongiosa chips. The implants were inserted into the distal femora of 17 adult Chinchilla Bastard rabbits (group I). Uncoated implants were inserted as controls in the contralateral femur (group II). The animals were sacrificed after 5, 11, and 42 days. Intravital fluorochrome labeling and microradiography were used for the assessment of bone ingrowth into the titanium channels. In both groups, no bone tissue was formed in the channels up to day 5. On day 11, group I exhibited significantly more (p<0.05) bone tissue (19.8+/-14.0% vs. 5.8+/-9.1%) with greater bone-implant contact (13.3+/-15.1% vs. 5.7+/-5.3%, p<0.05) at the channel mouths than group II. Bone tissue was formed mainly between day 15 and 30 in group I, in group II between day 25 and 40. Six weeks after implantation, bone tissue filled on an average 68.8+/-15.1% of the mouths of the drill channels in implants in group I, the filling for group II was 49.8+/-18.1% (p<0.05). The average bone-implant contact at the channel mouths after six weeks was 56.5+/-13.5% in group I, 40.2+/-21.9% in group II (p<0.05). 600-microm channels showed at this time point the best osseous integration (p<0.05). Coating with autologous osteoblasts accelerates and enhances the osseointegration of titanium implants and could be a successful biotechnology for future clinical applications.

Animals↗
PubMed2002

[Functional results of dynamic gait analysis after 1 year of hobby-athletes with a surgically treated ankle fracture].

Retrospectively 20 patients with a surgically treated ankle fracture caused by hobby-accidents were examined clinically and radiologically by a score modified to Phillips after 12 months postoperatively. Further they have taken part in a dynamical gait analysis at the same time. A group of 20 healthy adults was used as a control group comparable to age, sex, height and weight. Although 19 patients out of 20 have achieved a good result at the score evaluation and none of them was clinically noticed with any pathological gait, gait analysis has shown a significant slowed gait speed and a decreased stride length. The reduction of the plantarflexor moment at the injured ankle joint immediately following heel contact was yet the most remarkable result of the gait analysis. The changes of gait pattern are interpreted as an adapted and internalized motion pattern caused by pain and behaviour of rest at any time while the mobilisation-phase was going on. It could not document any significant correlation between subjective and clinical parameters and parameters registered by gait analysis. However, a significant correlation of gait-analysed parameters was found between the injured and uninjured side. By dynamical gait analysis it is possible to quantify remarkable gait changes, to obtain objective data, but also to demonstrate asymmetrical loading and motion that were not clinically detectable previously. It follows that it can be relevant to patients with complaints by leading them to specific physiotherapeutical treatment and gait training so that they would be able to carry on their sports-activities again.

Adult↗
PubMed2002

Migration, matrix production and lamellar bone formation of human osteoblast-like cells in porous titanium implants.

The goal of this study was to characterize growth, mineralization and bone formation of osteoblast-like cells in titanium pore channels of defined diameter. Titanium implants with continuous drill channels of diameters of 300, 400, 500, 600 and 1,000 microm were inserted into human osteoblast-like cell cultures. The ingrowth of the cells into the drill channels was investigated by transmitted-light microscopy and scanning electron microscopy. Immunofluorescence and histological analysis of 15-channel sections of each diameter were used to investigate the growth behavior and the matrix protein patterns. Mineralization was evidenced by Alizarin red staining and high-resolution microradiography. The ingrowth of human osteoblast-like cells in the drill channels occurred in a sequence of four characteristic stages. In stage 1, osteoblast precursor cells adhered to the wall of the channel and migrated three-dimensionally into the channel by forming foot-like protoplasmic processes. For all 15 sample drill channels that were investigated, the cell ingrowth over 20 days amounted on average to 793 microm (+/- 179) into 600-microm-diameter channels, where they migrated significantly faster than in all the other channels. In stage 2, approximately on day 5-7, the osteoblast-like cells began to anchor on the substrate wall by matrix proteins and to build up a dense network of matrix proteins in the drill channel. The mineralization of the extracellular matrix, while depending on cell stimulation, was initiated in stage 3, on average after 4 weeks. In drill channels of a diameter of 1,000 microm the cell growth was incomplete and no mineralization was found by radiological assessment. Starting in week 6, in the drill channels of diameters ranging from 300 to 600 microm, the network of extracellular matrix proteins and osteoblast-like cells began to form an osteon-like structure. Neither the highly developed migration behavior of osteoblastic cells nor the reorganization from a fiber-like matrix to a lamellar structure have so far been described for cell cultures.

Bone Matrix↗
PubMed2000

[Resection of the calcaneus as a treatment option in osteitis following an open calcaneus fracture].

Surgical treatment of calcaneal fractures is demanding due to the poor musculocutaneous coverage. Infection with osteitis is a severe complication with open fractures. The appearance of osteitis requires aggressive surgical treatment including amputation in case of persistence, leading to considerable invalidism. We report the case of an 37-year-old mason with an grade III open calcaneal fracture caused by a fall. Osteitis appeared after primary osteosynthesis with open reduction and eventually--after several revisions--required a calcanectomy. By preservation of the forefoot and midfoot and thanks to sufficient orthosis treatment the patient was able to return to his profession after eight months.

Accidental Falls↗
PubMed2000

[Press-fit bone dowel arthrodesis of the ankle or the subtalar joint using a diamond bone cutting system. Surgical technique and initial results in 10 patients].

Arthrodesis of the ankle (AA) or the subtalar joint (AST) is still a necessary treatment in case of painful posttraumatic arthrosis or paresis of the muscles after compartment syndrome. Today the alloplastic ankle joint replacement does not satisfy. Many treatments of arthrodesis with minimal or extended resection of the joint surface with or without bone transplantation are described in literature. We present in detail a new developed technique of press-fit dowel arthrodesis (KDA) for the ankle and subtalar joint. After adjustment of the joint position and retention with Kirschner wires the surface of both sides of the joint surface and underlying bone is removed by a cannulated diamond bone cutting device. Dowels from the anterior iliac crest are impacted in the cutted joint defect. The dowels are 1/10 mm bigger in dimension than the primary defect in the joint surface. The surgery will be completed with a compression screw osteosynthesis, at the ankle joint transarticular through the lateral and medial malleolus, at the subtalar joint from plantar. Ten patients have treated by press-fit-KDA (female 2, male 8; AA 7, 33.6 +/- 9 y; AST 3.38 +/- 10.9 y). The indication for KDA was in nine cases a severe posttraumatic arthrosis, in one case the paretic malfunction after compartment syndrome. The arthrodesis were clinically and radiologically consolidated after 8.2 +/- 1.9 weeks. At this time the patients showed no symptoms and were fully mobilised with complete weight-bearing. The advantages of KDA: preservation of the outline of joint and hindfoot, preservation of length of the leg and outline of iliac crest, no risk for the soft tissue, quick consolidation of the arthrodesis, no need of external fixation. The technique is also suitable for other indications as presented.

Adult↗
PubMed1999

[Instability of spinal fractures--therapeutic relevance of different classifications].

PURPOSE: To investigate if the assessment of spinal fracture stability according to the Magerl classification permits a better therapy decision than using the Denis 3-column model. MATERIAL AND METHODS: The X-ray and CT images of 99 consecutive patients treated for thoracolumbar spine fractures were analysed and the fractures were classified according to the above mentioned classifications. Using the 3-column model, the involvement of two or more columns was considered as unstable, whereas the fracture types A3.2, A3.3, B and C of the Magerl classification were defined as unstable. The stability evaluation was compared with the therapy decision and outcome. RESULTS: According to the 3-column model, 23 of 53 fractures which were classified as unstable were operated. Only five of the 30 conservatively treated unstable fractures showed a reduced healing process. The 46 stable fractures were treated conservatively with good results. Using the Magerl classification, 21 of the 28 unstable fractures were operated and 4 of the remaining 7 cases showed a reduced healing process. Of the 71 stable fractures only 2 were operated and in one patient minimal neurological symptoms occurred. CONCLUSION: The Magerl classification enables a more exact definition of stable and unstable spinal fractures.

Adolescent↗
PubMed1998

[Diagnosis and therapy of pediatric and juvenile hematogenous osteomyelitis].

Haematogen osteomyelitis is mostly found in children and adolescents. In western Europe acute haematogen osteomyelitis (AHOM) is a rare disease. This is the cause why AHOM is often diagnosed with delay. The treatment usually is an antibiotic medication and/or surgical interventions. Uncharacteristic pain of extremities in children should always consider the diagnosis of acute osteomyelitis. Investigation should include conventional X-rays, ultrasounds or MRI to prevent the spreading of infection. In cases of multifocal infection radionuclide imaging should be undergone. Differential diagnosis should always include malignant tumor. If under treatment of antibiotics the clinical signs of illness do not decrease within 24 h surgery with fenestration of the involved bone, debridement and local application of antibiotics is indicated. In unusual cases or in cases with clinical signs of AHOM but no bacteria specification a malignant tumor has to be excluded.

Adolescent↗
PubMed1998

Intraindividual comparison of 99mTc-labelled anti-SSEA-1 antigranulocyte antibody and 99mTc-HMPAO labelled white blood cells for the imaging of infection.

Technetium-99m labelled antigranulocyte antibodies are ready to use and are sensitive and specific in the diagnosis of infectious diseases. 99mTc-SSEA antigranulocyte antibodies have a very high affinity constant (Kd 10(-12) M) for human neutrophils (PMNs), and excellent imaging qualities with high target/background ratios. The aim of this study was to compare the diagnostic accuracy of the 99mTc-anti-SSEA-1 monoclonal antibody (Mab) with that of 99mTc-hexamethylpropylene amine oxime (HMPAO)-labelled white blood cells (WBCs). To this end, 17 patients with 23 proven infectious foci were examined with 555 MBq 99mTc-anti-SSEA-1 MAb and with 370 MBq 99mTc-HMPAO labelled autologous leucocytes within a period of 7 days. All the infections were confirmed by culture, biopsy, surgery and follow-up. Whole-body images and planar spot views with the antibody were performed at 1-h, 4-h and 24-h post injection; the biodistribution of the antibody was quantified, absorbed radiation doses were calculated and the diagnostic results were compared with the 99mTc-HMPAO WBC images. Human anti-mouse antibody (HAMA) evaluation was performed in all patients before and 3 months after antibody injection. Blood was drawn at different times after 99mTc-anti-SSEA-1 MAb injection to determine the amount of granulocyte-associated radioactivity and to calculate recovery. 99mTc-anti-SSEA-1 MAb scintigraphy detected all 23 lesions, while 21 were detected with 99mTc-HMPAO WBC scan. In this small group of patients, the sensitivity and specificity of 99mTc-anti-SSEA-1 MAb scintigraphy were 95% and 96% respectively, as compared with 91% and 82% respectively for 99mTc-HMPAO WBC scan. An increasing uptake of the injected activity in the lesion at different time points was indicative of high affinity and of specific PMN binding. There was no HAMA formation. In four of five patients investigated, a transient mild leukopenia was found at 15 min p.i.. There was increased uptake of the antibody in liver and spleen and normal uptake in kidneys and bone marrow. The estimated radiation doses for the whole body and the red bone marrow were 1.1x10(-2) cGy/37 MBq and 5.3x10(-2) cGy/37 MBq, respectively. The activity associated to the PMNs in vivo was 33.5%, 30.6%, 21.3% and 9% at 5, 15, 30 and 45 min. post-injection, respectively. It is councluded that use of 99mTc-anti-SSEA-1 antigranulocyte antibodies demonstrates promising results comparable to those obtained with 99mTc-labelled autologous WBCs. The 99mTc-labelled MAb is ready to use, has excellent image qualities and a high target/background ratio.

Adult↗
PubMed1997

[Rationalizing the organization and structure of a trauma surgery clinic based on rationing of personal and financial resources--analysis, simulation and conversion using modern data processing techniques].

With a system of modeling, simulation, animation of information, communication in medicine (mosaic-m) the structures of organisation and information in a level 1 trauma center were analysed and animated as a virtual environment on screen in a first step. One result: in existing paper orientated documentation 50% of documentation was redundant. In a second step the requirements of the future information system were described systematically, user- and organisation-oriented. All components (hard- and software) were simulated an screen that the user could work virtually in the future working place. With mosaic-m the user is fully integrated in analysing and developing a new information system in the clinic.

Computer Simulation↗
PubMed1996

[Comparison of the quality of life before and after surgical management of pertrochanteric femoral fractures in elderly patients].

A reduction in perioperative mortality can be observed when the operative treatment of intertrochanteric femur fractures in the elderly is performed within a 6-h time limit, or after stabilisation of the patient within a 24-h frame. To insure optimal progress, a stable open reduction and internal fixation (ORIF) with a DHS or other implant, or a prosthetic replacement is needed to achieve early ambulation. The ability to walk and early ambulation are essential for a quick hospital discharge and reintegration into social life. The quality of life decreases due to the injury [Mayo Hip Score (2 M), and Traumatic Hip Rating Scale [4], 84.4% of pretrauma function, Functional Status Score [1], 68.2%]. About half of the injured (65% of the patients examined in our study) were able to return to their homes. This depends on the patient's age, independence before the accident and concomitant diseases.

Aged↗
PubMed1995

[Swelling of the sternoclavicular joint].

From 1990 through 1993 nine patients presented with unexplained swelling of the sternoclavicular joint. In some cases a tumor was suspected. The clinical histories included trauma with injury of forearm and wrist or strain on the shoulder girdle without acute onset of any symptoms in the sternoclavicular joint. In trauma cases the time from injury to onset of symptoms was between 1 day and 1 year (median 5 weeks). CT studies demonstrated widening of the joint space in two cases, thickening of the pectoral muscle in six cases and thickening of capsule and ligaments in five cases. In one case arthroplasty of the sternoclavicular joint was performed and in a second we performed a biopsy. The remaining cases were not treated. Other differential diagnoses to be considered in the case of a swelling of the sternoclavicular joint are listed.

Adolescent↗
PubMed1995

[The traumatized shoulder in computerized and magnetic resonance tomography].

Diagnosis of traumatic changes of the shoulder can be achieved by several invasive and nonivasive radiological procedures allowing visualization of bony and/or soft tissue structures. With reference to 74 shoulder examinations CT, CT-arthrography, and MRI were reviewed and their value for further treatment assessed. Since joint effusions occurred in nearly all cases of glenoid and rotator cuff lesions, a cost-effective strategy for diagnosing traumatic changes of the shoulder is presented.

Arthrography↗
PubMed1995

[Pertrochanteric fractures].

Pertrochanteric fractures ordinary appear to women 10 to 15 years later than to men. Only 49 per cent of the women and 63 per cent of the men have a good bone structure at that time according to the Singh-index. The classification of pertrochanteric fractures follows the proposal of the AO-ASIF Group. The force which works at the hip joint depends on the function of the limb and is mainly caused by the musculature. This force exceeds up to 4.5 times the body weight. The first 6-24 hours after trauma are the optimal moment for operation. Anaesthesia methods near by the spinal cord should be preferred. The mainly used implant in Germany is the Dynamic Hip Screw (DHS) in more than 60 per cent of cases. Intramedullary implants only reach 15.5 per cent. A fracture table is dispensable for the implantation of a DHS, but the additional fixation of the greater trochanter and in some cases also the lesser trochanter is important. The Gamma Nail is prone to complications caused by the operation. A total hip arthroplasty is performed in about 10 per cent of all pertrochanteric fractures. The AO-document-center can show, that arthroplasty gives very good long-term results. The 130 degrees blade-plate and the Ender-Nail are only used in individual cases. 20 per cent of the patients must have an intensive care follow-up treatment during a medium hospital stay of 29 days, 21 per cent have general non-surgical complications and 8 per cent of the patients die. Nevertheless 78 per cent of all patients can be discharged under partial or full weight-bearing. Scores which allow a comparison of the pre- and postoperative functional status must be applied in order to compare different methods of hip fracture treatment. In a follow-up study 2.7 years after the accident 54 of our own patients had a medium reduction in their functional status of 10 to 15 per cent compared pre- and postoperatively.

Activities of Daily Living↗