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Biomedical subjects

K W Klemm

Publications and source records attributed to K W Klemm.

4 recordsLinked to original sources
PubMed1993

Antibiotic bead chains.

Gentamicin-PMMA chains are an effective drug delivery system for local antibiotic therapy in bone and soft-tissue infections. The gentamicin concentrations at the site of infection are far higher than after systemic application of the same antibiotic and far above the minimal inhibitory concentrations of most common pathogens. Because of the very low concentrations in the serum and urine after implantation of the antibiotic bead chains, toxic side effects are not to be feared. Radical debridement with removal of all sequestrated bone fragments and removal of all alloplastic implants is mandatory before implantation of gentamicin-PMMA chains into the infected bone cavity. Primary wound closure is necessary to achieve high local concentrations. The chains can be used for temporary or permanent filling of osteomyelitic cavities. Guidelines are given for the clinical application in sequestrating osteomyelitis, infected osteosynthesis, and infected pseudarthrosis. There are distinct advantages of this new form of antibiotic therapy in chronic osteomyelitis, such as increased patient comfort by primary wound closure, no need for prolonged systemic antibiotic therapy with toxic side effects, no irrigation-suction-drainage, early ambulation, shortening of hospitalization, and reduced cost.

Adult↗
PubMed1986

Treatment of infected pseudarthrosis of the femur and tibia with an interlocking nail.

Between 1970 and 1977, 64 patients with infected pseudarthrosis of the femur and tibia were treated with an interlocking nail. The type of primary treatment prior to the development of the infected pseudarthrosis was plate fixation in 21 femurs and seven tibias and conventional intramedullary nails in 16 femurs and 20 tibias. Fracture union was obtained in 34 of the 38 femoral infected pseudarthrosis (89.5%) and 19 of 27 tibial infected nonunions (62.5%) following interlocking nailing. Seven of the eight failures (87.5%) in the tibial group were the result of reoperation with interlocking nails following infected plate fixation. Following removal of the interlocking nail and treatment of residual infection, osteomyelitis was considered quiescent in 59 patients (35 femurs and 24 tibias) and active in five patients (two femurs and three tibias). Today, external fixation in combination with gentamicin-PMMA chains for local antibiotic treatment is used in the majority of such cases, because fracture instability and the chronic osteomyelitis can be treated simultaneously.

Adult↗
PubMed1986

Interlocking nailing of complex fractures of the femur and tibia.

The interlocking nail widens the range of indications for medullary osteosynthesis of femoral and tibial shaft fractures. Stability is achieved by transverse threaded bolts in prefabricated holes in the nail, which anchor the implant directly to cortical bone, thereby controlling length, alignment, and rotation of the limb. Two hundred eighty-three femoral and 401 tibial fractures were treated with an interlocking nail and followed for an average of 20 months. Overall, 97% of the femurs and 94.3% of the tibias were judged to have an excellent or good result, based on both clinical and radiographic parameters. Delayed union or nonunion requiring bone grafts occurred in 2% of the femurs and 0.7% of the tibias following interlocking nailing. Deep infection developed in 2.4% of the femurs and 2.2% of the tibias. All of these patients eventually healed their fractures without evidence of chronic osteomyelitis. The main advantage of interlocking nails is that surgery can be performed using closed nailing techniques, allowing early protected weight-bearing and joint motion. The rates of nonunion and infection are very low, and there is little risk of refracture after implant removal.

Bone Nails↗