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Biomedical subjects

L Kinzl

Publications and source records attributed to L Kinzl.

At least 91 records · Page 5Linked to original sources
PubMed2001

Trauma severity-dependent changes in AT III activity.

Trauma may cause a relevant reduction in antithrombin (AT) III activity, which is associated with adverse events. The very early changes in AT III activity after accident trauma are still unclear and possible relations with Interleukin (IL)-6, which is known to interact with AT III, have not been investigated so far. Upon approval of the IRB/IEC, 30 patients were enrolled with multiple injuries (ISS 9-75). Groups were performed according to injury severity, IL-6 concentration, and survivors versus non-survivors. Blood samples were collected at the scene of accident then at 2, 4, 6, 12, and 24 h and at day 3, 5, 10 and 15. No patient received AT III concentrates. In all groups a reduction in AT III activity occurred, which was most pronounced in very severe injuries. The activity re-increased spontaneously and steadily in all groups regardless of the IL-6 concentration. There was no clear impact of the AT III activity on survival.

Adolescent↗
PubMed2001

The effect of partial and full weight-bearing on venous return in the lower limb.

We studied the effect of full and partial weight-bearing on venous peak velocity in the legs of 73 subjects. We used colourflow Duplex ultrasound to determine the minimal amount of weight-bearing required to produce the same venous peak velocity as full weight-bearing. We found that the venous peak velocity remains the same in the femoral vein during partial weight-bearing (196 N and above). This is important for postoperative physiotherapy and thromboprophylaxis. The median peak velocity was 30 cm/s. This corresponds to an amplification factor of four in relation to the individual resting level (peak velocity). In addition, we found that partial weight-bearing at 196 N can reliably be reproduced. The median value of partial weight-bearing after a three-day training programme was 206 N.

Blood Flow Velocity↗
PubMed2001

Computer assisted treatment of pelvis fractures.

The presented approach is the realization of a minimal invasive treatment of pelvis fractures using the computer aided surgery (CAS). Main problem of tracking of major bone fragments after reposition is solved by implementing of 3D ultrasound to obtain intraoperative bone surfaces. Preoperative and intraoperative data sets are matched. Major fragments are tracked. The real time navigation is possible.

Feasibility Studies↗
PubMed2001

Computer simulation of osteotomy correction.

This paper describes a novel approach to correct osteotomy deformities of long bones using virtual reality and image processing techniques on personal computers. The discussed method allows to simulate osteotomy corrections by implementing a single cut and a rearrangement of the dissected bone parts. It allows the surgeon to directly control the pre-operative situation and the post-operative result of the simulation by comparing bone-length, angles, and torsion of the bone. In addition, he or she obtains the coordinates and angles of the planned cut relative to anatomical landmarks.

Bone Malalignment↗
PubMed2000

Is interleukin 6 an early marker of injury severity following major trauma in humans?

HYPOTHESIS: Interleukin 6 (IL-6), a multifunctional cytokine, is expressed by various cells after many stimuli and underlies complex regulatory control mechanisms. Following major trauma, IL-6 release correlates with injury severity, complications, and mortality. The IL-6 response to injury is supposed to be uniquely consistent and related to injury severity. Therefore, we designed a prospective study starting as early as at the scene of the unintentional injury, to determine the trauma-related release of plasma IL-6 in multiple injured patients. PATIENTS AND METHODS: On approval of the local ethics committee, 94 patients were enrolled with different injuries following trauma (Injury Severity Score [ISS] median, 19; range, 3-75). The patients were rescued by a medical helicopter. Subsets were performed according to the severity of trauma--4 groups (ISS, <9, 9-17, 18-30, and >32)-and survival vs nonsurvival. The first blood sample was collected at the scene of the unintentional injury before cardiopulmonary resuscitation, when appropriate. Then, blood samples were collected in hourly to daily intervals. Interleukin 6 plasma levels were determined using a commercial enzyme-linked immunosorbent assay test. The short-term phase protein, C-reactive protein, was measured to characterize the extent of trauma and to relate these results to IL-6 release. RESULTS: As early as immediately after trauma, elevated IL-6 plasma levels occurred. This phenomenon was pronounced in patients with major trauma (ISS, >32). Patients with minor injury had elevated concentrations as well but to a far lesser extent. In surviving patients, IL-6 release correlated with the ISS values best during the first 6 hours after hospital admission. All patients revealed increased C-reactive protein levels within 12 hours following trauma, reflecting the individual injury severity. This was most pronounced in patients with the most severe (ISS, >32) trauma. CONCLUSIONS: To our knowledge, this is the first study that elucidates the changes in the IL-6 concentrations following major trauma in humans as early as at the scene of the unintentional injury. The results reveal an early increase of IL-6 immediately after trauma. Moreover, patients with the most severe injuries had the highest IL-6 plasma levels. There is strong evidence that systemic IL-6 plasma concentrations correlate with ISS values at hospital admission. Therefore, IL-6 release can be used to evaluate the impact of injury early regardless of the injury pattern.

Adolescent↗
PubMed2000

[Compartment syndrome of the thigh with sciatic nerve paralysis].

UNLABELLED: Acute compartment syndrome of the thigh has been infrequently reported in the literature. Closed femoral fractures and blunt soft tissue trauma are the main causes of this injury. The multiple injured patient in this case report developed a compartment syndrome of the thigh after intramedullary nailing of a comminuted fracture of the femur. Fasciotomy was performed two days after surgery because of extense swelling of the thigh in the ventilated and sedated patient. Sciatic and femoral nerve palsy was recognized after extubation of the patient nine days after the injury. During the following weeks the paresis of the femoral nerve recovered but neither motor nor sensory function of the sciatic nerve could be demonstrated. Therefore an operative revision of the sciatic nerve was performed eighteen weeks after trauma. No direct nerve injury could be detected but there were adhesions around the nerve as a sign of compression neuropathy caused by the compartment syndrome. The tibial component of the sciatic nerve showed a complete recovery within the next months but there was a persisting peroneal nerve palsy. CONCLUSION: Early clinical symptoms of a compartment syndrome like pain, paresthesia and paresis can not be ascertained in a ventilated and sedated patient. Tense swelling of the muscles is often the only detectable sign. Frequent measurements of compartment pressure should be done in these patients. We suggest early decompressive fasciotomy because the morbidity caused by fasciotomy in a borderline compartment syndrome is far outweighed by the morbidity that accompanies an undiagnosed untreated compartment syndrome with possible nerve palsy.

Adult↗
PubMed2000

[Tuberculous spondylitis of the cervical spine].

WHO estimates that worldwide more than 4 million people are infected with tuberculosis (TB), 95% of them living in third world countries. TB is once again the most frequent infectious disease [1, 2, 7]. Extrapulmonary forms (EPTB) frequently appear with HIV-associated TB [3, 4, 6]. We present the case of a 23-year old patient with abscess forming TB of the right apical lung with infiltration and partial osteolytical destruction of the 7th cervical- and the first thoracal vertebral body. Progressive spinal compression lead to partial sensomotorical deficits. Surgical revision of the abscess, an atypical resection of the right apical lung and right wing hemilaminectomy of Th1/2 for spinal decompression became necessary. The spinal stabilisation was achieved by conservative treatment for 6 weeks only by a Minerva cast and for another 8 weeks by a cervical stiffneck. Following mobilisation was without problems and the neurological deficits subsided within 3 months. Clinical examination and functional X-rays analysis proved vertebral stability and good function. The treatment of TB is basically conservative. Surgery is only recommended in case of functional and infectious complications.

Abscess↗
PubMed2000

[Computer-assisted surgery].

The term "computer-assisted surgery" (CAS) contains a variety of different applications. Priorities in trauma surgery have navigation systems. In fact, two basically different developments can be distinguished: on one hand, the possibility of navigation, based on preoperative CT data sets; and on the other hand navigation in intraoperative C-arm images. With the present available navigation technology, it can be assumed that intraoperative CT-based tracking in the field of spinal surgery can be performed accurately, regardless of whether active or passive markers are used. Another navigation option is C-arm-based osteosynthesis of the proximal femur. An application of navigation assistance in the field of pelvic surgery is osteotomy and placement of iliosacral screws. Future developments will have to concentrate on the technical characteristics of each navigation system. Advantageous concepts of visualization may generate required information to the surgeon in a way that unconstrained interaction at the operation table is combined with simultaneous integration of virtual and computer-aided visual information. New tracking systems will allow the reconstruction of data sets after reposition of segmented bone fragments, so that also in complex pelvic fractures the implantation of screws after reposition will be possible. Computer-aided surgery is able to improve the precision of operations in trauma surgery. In future, further developments of navigation systems can be expected. This fact is supported by the establishment of faster and cheaper hardware, as well as more intelligent and user-friendly software.

Bone Screws↗
PubMed2000

[Cost analysis of the treatment of patients with multiple trauma].

Current clinical management after multiple trauma is expensive. The aim of the present study was to quantify the actual costs of inpatient treatment after multiple trauma in a German university hospital, to compare the actual costs with the reimbursement rates, and to identify important determinants of costs. Routine documentation of hospital costs at a patient level was not available. Therefore a method for calculating the costs of resource utilization during clinical treatment of patients was developed. The concept was based on financial and utilization data provided by the hospital administration and patient-specific data. The average costs per case in the study group (mean ISS = 37) were 73.613 DM, maximal costs were up to 292.490 DM. The most costly components were intensive care, accounting for 60%, followed by procedures in the operating room (24%). A comparison with the reimbursement rates resulted in an average loss of 23.211 DM per case. Factors significantly associated with the costs of acute care hospitalization were outcome, injury severity, pattern of injury, blood volume replacement, length of mechanical ventilation, and number of operations. Whereas patient age, CNS state, mechanism of injury, pre-hospital care, and time between accident and hospital admission revealed no effect. Given the current reimbursement rates, multiple trauma care clearly belongs to those categories of care which have to be subsidized within the hospital. Any challenge to the optimal level of care resulting from this should be avoided.

Acute Disease↗
PubMed2000

[Limits of CT-based computer navigation in spinal surgery].

Computer-assisted and navigation-based therapeutic tools have found their first application in the field of spinal surgery. Meanwhile, the basic principles have been extended to other procedures, such as screw osteosynthesis of the pelvis and navigation of long bones. Commonly, all procedures except C-arm navigation are based on three-dimensional data sets. Data acquisition and processing as well as planning require specific steps, which should guarantee adequate accuracy and successful navigation. All steps up to intraoperative navigation and potential pitfalls in every part of the interaction are demonstrated, with reasons of undesired results presented.

Bone Screws↗
PubMed2000

[Conservative management of articular metacarpophalangeal joint fractures].

We present a splint system for a protected mobilization program after closed reduction of articular proximal phalangeal base fractures. This therapy consists of the periarticular soft tissue and functional anatomy. The soft-tissue around the base of the proximal phalanx leads to a circular stabilization effect. This so called Zancolli Complex (Metacarpophalangeal Retention Apparatus) can be used with the effect of a brace treatment. Treating 31 patients with articular fractures of the proximal phalanx way we found good functional results within a mean follow up period of 2 years after the accident.

Adult↗
PubMed2000

[Soft tissue reconstruction after scalping injury caused by a dog bite].

The reconstruction of soft-tissue damage on the part of the head which is covered with hair is aimed not only at repairing the damage in such a way that it will withstand mechanical strain but also at the restoring the hair on the scalp. In a 5-year-old boy with a scalping injury involving second- and third-degree soft-tissue damage over an area of 20 x 12 cm after a dog bite, surgery was initially performed to transform the damage into purely second-degree damage, which was then repaired with a split skin graft. One year later, the scalp containing the hair was stretched with the aid of two skin expanders over a period of 3 months, so that the split skin graft area could be removed and the hair on the scalp restored.

Animals↗
PubMed2000

[Temporary instrumentation in dixlocations, subluxations and fractures of the lower cervical spine].

The anterior interbody fusion with instrumentation seems to be the standard procedure in unstable traumatic lesions of the lower cervical spine. The goal of this study was to objective the outcome of patients, treated by only temporary stabilisation of the injured motion segment (without bone-graft fusion). Between 1990 and 1998 155 patients with traumatic lesions of the cervical spine were treated operatively, in 22 cases transfixation of the injured level without bone-graft application was performed, an implant-removal was carried out in 12 patients so long. Only patients were included into the study, who were less then 45 years old at trauma and who had no trauma related osseous or disc encrouchment of the spinal canal. Not included were patients with degenerative formations of the cervical spine at time of trauma. Until follow up all patients with implantat removal returned back to work in their former profession, 11 of 12 patients classified their result as excellent or good. No secondary instabilities or postraumatic disc prolapse were observed. Restmobility in flexion/extension of the injured level was demonstrated in 8 patients. The preservation of traumatized motion segments may reduce the incidence of degenerative alterations and hypermobilities in adjacent levels. The transfixation technique in anterior procedures leads to a reduced time of spinal exposure, complications as a result of spinal graft manipulation, pseudarthrosis or donor graft site problems are no more relevant.

Adult↗
PubMed2000

[Surgical treatment of injuries of the thoracolumbar transition. 2: Operation and roentgenologic findings].

The authors report on a prospective multicenter study with regard to the operative treatment of acute fractures and dislocations of the thoracolumbar spine (T10-L2). The study should analyze the operative methods currently used and determine the results in a large representative collective. This investigation was realized by the working group "spine" of the German Trauma Society. Between September 1994 and December 1996, 682 patients treated in 18 different traumatology centers in Germany and Austria were included. Part 2 describes the details of the operative methods and measured data in standard radiographs and CT scans of the spine. Of the patients, 448 (65.7%) were treated with posterior, 197 (28.9%) with combined posterior-anterior, and 37 (5.4%) with anterior surgery alone. In 72% of the posterior operations, the instrumentation was combined with transpedicular bone grafting. The combined procedures were performed as one-stage operations in 38.1%. A significantly longer average operative time (4:14 h) was noted in combined cases compared to the posterior (P < 0.001) or anterior (P < 0.05) procedures. The average blood loss was comparable in both posterior and anterior groups. During combined surgery the blood loss was significantly higher (P < 0.001; P < 0.05). The longest intraoperative fluoroscopy time (average 4:08 min) was noticed in posterior surgery with a significant difference compared to the anterior group. In almost every case a "Fixateur interne" (eight different types of internal fixators) was used for posterior stabilization. For anterior instrumentation, fixed angle implants (plate or rod systems) were mainly preferred (n = 22) compared to non-fixed angle plate systems (n = 12). A decompression of the spinal canal (indirect by reduction or direct by surgical means) was performed in 70.8% of the neurologically intact patients (Frankel/ASIA E) and in 82.6% of those with neurologic deficit (Frankel/ASIA grade A-D). An intraoperative myelography was added in 22% of all patients. The authors found a significant correlation between the amount of canal compromise in preoperative CT scans and the neurologic deficit in Frankel/ASIA grades. The wedge angle and sagittal index measured on lateral radiographs improved from -17.0 degrees and 0.63 (preoperative) to -6.3 degrees and 0.86 (postoperative). A significantly (P < 0.01) stronger deformity was noted preoperatively in the combined group compared to the posterior one. The segmental kyphosis angle improved by 11.3 degrees (8.8 degrees with inclusion of the two adjacent intervertebral disc spaces). A significantly better operative correction of the kyphotic deformity was found in the combined group. In 101 (14.8%) patients, intra- or postoperative complications were noticed, 41 (6.0%) required reoperation. There was no significant difference between the three treatment groups. Of the 2264 pedicle screws, 139 (6.1%) were found to be misplaced. This number included all screws, which were judged to be not placed in an optimal direction or location. In seven (1.0%) patients the false placement of screws was judged as a complication, four (0.6%) of them required revision. The multicenter study determines the actual incidence of thoracolumbar fractures and dislocations with associated injuries and describes the current standard of operative treatment. The efforts and prospects of different surgical methods could be demonstrated considering certain related risks. The follow-up of the population is still in progress and the late results remain for future publication.

Adolescent↗
PubMed2000

[Minimal invasive implant removal after retrograde intramedullary nailing of the distal femur].

Recently, the retrograde femoral nailing has become a procedure with increasing acceptance. Indications for the retrograde femur nail are distal femoral fractures including dia- and transcondylar fractures, supracondylar osteotomies and distal periprosthetic femur fractures after total knee joint replacement. Controversial discussion is carried on about the implant removal, which is potentially afflicted with further damage to the knee joint. To minimize the operative damage due to the implant removal, an arthroscopic assisted procedure has been selected. The arthroscopic assisted implant removal was possible in all of our patients. Intraoperatively, 2/3 of the patients showed normal age-related findings of the chondral and meniscal structures. The arthroscopic assisted implant removal is a gentle procedure, which allows minimal invasive extraction of retrograde femur nails and prevents secondary damage to the knee joint due to the otherwise difficult localisation of the implant. The advantages of this procedure concerning gentleness and diagnostic capabilities are as convincing, that we indicate implant removal of retrograde femur nails in all younger patients (< 60 years), except in periprosthetic fractures.

Arthroscopy↗
PubMed2000

[Correction of complex deformities in infectious conditions].

Skeletal deformities do occur after conservative or operative fracture treatment, as a consequence of congenital growth disturbance and as sequlae after posttraumatic and haematogenous osteomyelitis. In postinfectious deformities the course of the bone and soft tissue infection plays a decisive role when choosing the appropriate operative technique. Even in non active situations with a closed soft tissues envelope and no draining sinus persistence of germs within the bone has to be anticipated. The biological quality of the bone and the soft tissue envelope is often reduced because of local changes and as a result of multiple local revisions. Consequently wide areas of scar tissue and sclerotic bone are often encountered. The apex of the deformity is in most cases identical with the focus of the active or non active infection. The correction of the deformity at the apex can therefore only be accomplished if the infectious bone is also resected. If a correction is not possible at the apex of the deformity, translation at the osteotomy site is necessary to achieve a correct mechanical axis. The later rather complex operative procedure necessitates intensive preoperative planning and an extensive experience with deformity corrections by external fixators.

Adolescent↗