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Biomedical subjects

L Kinzl

Publications and source records attributed to L Kinzl.

At least 109 records · Page 6Linked to original sources
PubMed2000

Spinal cord injury without radiographic abnormalities in children and adolescents: case report of a severe cervical spine lesion and review of literature.

The biomechanics of the child's and juvenile's spine is responsible for the commonly encountered closed spinal trauma with significant neurological injury but without bony or ligament injury (particularly of the cervical spine). The ligamentous laxity and hypermobility of the young bony cervical and thoracic spine predispose to spinal cord injury without radiographic abnormalities. We report a 16-year-old girl with typical features of this type of injury after a "flic-flac" sports injury. We conclude that children and adolescents who have neurological deficits without positive radiographic findings require appropriate diagnostic screening, monitoring, and often a prolonged therapy. The sometimes changing neurological deficits should never be ignored or dismissed as psychogenic affection.

Adolescent↗
PubMed2000

Volume replacement in trauma patients within the first 24 h and its impact on the interpretation of biochemical data.

BACKGROUND AND AIMS: Patients of the same and particularly of different trauma studies are primarily incomparable due to different volume replacements. The aim of this prospective study was to analyze the amount of initially administered fluids in trauma patients during the first 24 h and to estimate the impact of dilution on plasma protein concentrations (PPCs) of prostanoids. These substances are vascular endothelium-derived and are thus influenced by blood pressure. PATIENTS/METHODS: Sixty-nine casualties suffering from multiple injuries were enrolled in the study. The amount of any fluid administered was scrutinized during the first 24 h. Patients were divided into subsets according to trauma severity by Injury Severity Score (ISS) (group=G-I: < or = 9; G-II: 10-18; G-III: 19-32; G-IV: >32) and between survivors and non-survivors. At corresponding time points, hemoglobin, hematocrit (Hct) and PPC as well as prostaglandins (PGI, TxA, PGF2a) were evaluated at the site of accident, at hospital admission, and every hour thereafter for the first 24 h. RESULTS: During this period, the total amount of infused fluids ranged between 0.51 (G-I) and >481 (G-IV). The higher the trauma severity, the greater the volume infused (G-III/IV P=0.0003 vs G-I/II). Simultaneously, PPC dropped markedly (P<0.01). Patients who died within 36 h required higher volumes (P<0.003) than survivors. PPC was linearly related (r2=.6685, P<0.001) to Hct. During the first 24 h, the time course of prostanoid concentration was altered when dilution is not taken into account. CONCLUSION: PPC proved a suitable parameter to estimate dilution effects and to adjust plasma concentrations of prostanoids. We recommend that consideration be given to possible dilution effects during the first 24 h when interpreting biochemical data in trauma patients.

Adult↗
PubMed2000

Vertebral body replacement with a bioglass-polyurethane composite in spine metastases--clinical, radiological and biomechanical results.

Metastatic spine lesions frequently require corpectomy in order to achieve decompression of the spinal cord and restoration of spinal stability. A variety of systems have been developed for vertebral body replacement. In patients with prolonged life expectancy due to an improvement of both systemic and local therapy, treatment results can be impaired by a loosening at the implant-bone interface or mechanical failure. Furthermore, early detection of a metastatic recurrence using sensitive imaging modalities like computed tomography (CT) and magnetic resonance imaging (MRI) is possible in these patients without artefact interference. The aim of our pilot study was to evaluate the clinical applicability and results of a new radiolucent system for vertebral body replacement in the lumbar spine. The system consists of bone-integrating biocompatible materials - a polyetherurethane/bioglass composite (PU-C) replacement body and an integrated plate of carbon-fibre reinforced polyetheretherketone (CF-PEEK) - and provides high primary stability with anterior instrumentation alone. In a current prospective study, five patients with metastatic lesions of the lumbar spine were treated by corpectomy and reconstruction using this new system. Good primary stability was achieved in all cases. Follow-up (median 15 months) using CT and MRI revealed progressive osseous integration of the PU-C spacer in four patients surviving more than 6 months. Results obtained from imaging methods were confirmed following autopsy by biomechanical investigation of an explanted device. From these data, it can be concluded that implantation of the new radiolucent system provides sufficient long-term stability for the requirements of selected tumour patients with improved prognosis.

Adult↗
PubMed2000

The effectiveness of ADCON-T/N, a new anti-adhesion barrier gel, in fresh divisions of the flexor tendons in Zone II.

In a prospective randomized clinical trial, ADCON-T/N was investigated with regard to its effectiveness in fresh traumatic injuries of the flexor tendons in Zone II of the hand. Thirty patients participated in the trial. Following a standardized technique of tendon repair, the total active motion (TAM) and total extension lag (TEL) were determined after 12 weeks and evaluated according to the Buck-Gramcko score. Excellent results were achieved in 15 out of 16 patients in the ADCON-T/N group and 12 out of 14 in the control group. However, no statistically significant difference was found between the mean TAM and TEL in the two groups.

Administration, Topical↗
PubMed2000

[DIGITOS-prosthesis for the proximal interphalangeal joint. A 2-year follow-up].

The treatment of osteoarthrosis of the proximal interphalangeal joint by prosthesis bears several specific problems. With the DIGITOS-prosthesis a new implant is now available. It is a cemented modular hinged prosthesis. We report our experiences with this implant from a prospective clinical trial. Seven patients with osteoarthrosis of the proximal interphalangeal joint had ten prosthetic middle joint replacements performed with DIGITOS-prostheses. Over an observation period of two years, the functional results were found to be good. The mean preoperative range of motion in the affected joints was 51.5 degrees. Three months after surgery, this had improved to 60.5 degrees, but then decreased to 53.0 degrees after one year and to 49.5 degrees, i.e. the original range of motion, by the end of the second postoperative year. No implant became loose. Nearly all patients were free from pain. The only serious complication was an iatrogenic lesion of the middle slip of the extensor aponeurosis resulting in a buttonhole deformity. In spite of these encouraging two-year results, the further follow-up has to be observed carefully.

Aged↗
PubMed2000

Translocation of endotoxin and acute-phase proteins in malleolar fractures.

BACKGROUND AND OBJECTIVE: Translocation of endotoxins was demonstrated for multiple injury but not for minor trauma such as isolated malleolar fractures. Major trauma leads to substantial changes in the plasma concentration of acute-phase proteins. However, isolated malleolar fractures are minor trauma. The objective of this study was to elucidate the kinetics of endotoxemia and the ability of plasma to inactivate endotoxin of patients operated on malleolar fractures and to demonstrate the early time course of the acute-phase proteins C-reactive protein, transferrin, alpha1-acid glycoprotein, haptoglobin, and interleukin-6 and to correlate them with the amount of endotoxemia. METHODS: Thirty patients with malleolar fractures were operated on within 6 hours after injury. Blood was collected immediately after admission and regularly up to 96 hours after surgery. RESULTS: Preoperative endotoxin plasma levels were increased compared with that of healthy individuals (0.05 +/- 0.017 vs. 0.02 EU/mL). Endotoxemia peaked 0.5 hours after the surgical procedure at 0.096 +/- 0.03 (p < 0.05 vs. healthy) and decreased to almost normal values after 24 hours. The ability of the plasma to inactivate endotoxin was significantly reduced after the surgical procedure compared with normal subjects (recovery, 0.17 +/- 0.028 EU/mL vs. 0.04 +/- 0.01 EU/mL; p < 0.05). Plasma interleukin-6 peaked 0.5 hours postoperatively (114 +/- 11 pg/mL, p < 0.05 vs. healthy), decreasing thereafter. C-Reactive protein peaked at 45 +/- 5 mg/mL (p < 0.05) 48 hours after injury. Transferrin decreased significantly postoperatively (2.41 +/- 0.12 mg/mL vs. pre-OP 2.65 +/- 0.1 mg/mL) and remained on this level for 96 hours. Both, alpha1-acid glycoprotein and haptoglobin increased postoperatively until day 4 (0.78 +/- 0.06 mg/mL to 1.15 +/- 0.08 mg/mL and 1.51 +/- 0.12 mg/mL to 3.24 +/- 0.22 mg/mL). There was no correlation between endotoxemia and the concentrations of the acute-phase proteins and interleukin-6. CONCLUSION: Surgery for malleolar fractures is associated with temporary endotoxemia and temporary reduced endotoxin inactivation capacity of the plasma. The injury and the surgical procedure leads to substantial changes in the plasma concentrations of acute-phase proteins. The relation between endotoxemia and acute-phase response is not dose dependent.

Acute-Phase Proteins↗
PubMed2000

Influence of etiology in heterotopic bone formation of the hip.

OBJECTIVE: Heterotopic ossification (HO) in periarticular tissue can appear after brain or local joint trauma. The aim of this study was to investigate differences of manifestation and outcome after surgical therapy of patients suffering from HO of the hip after isolated brain injury (n = 18), local hip trauma (n = 21), or the combination of both (n = 25). HO can cause progressive lost of joint movement; once mature, the only therapy to improve joint mobility is the excision. METHODS: All patients underwent surgical removal of HO and postoperative irradiation therapy. On the basis of plain radiographic findings, we evaluated the recurrent ossification after 1-year and 5-year follow-up periods. Within this prospective study, clinical performance status was scored according to the classification of d'Aubigne and a planimeter was used to evaluate the area of heterotopic bone formation in standard x-rays films. RESULTS: The severity of brain trauma observed by Glasgow Coma Scale correlated with the ossification size (square centimeters). Correlation was noticed as well between severity of brain injury and functional outcome. The evaluation of an average 1-year and 5-year follow-up period showed relief of pain and clear improvement of range of motion in all patients. There was mild recurrence of heterotopic bone growth within the first postoperative year without deterioration of the functional results. CONCLUSION: The severity of brain trauma has an influence on the extent of HO near the hip joint and also on the rehabilitation process. The histologic findings and recurrence of HO after excision were not affected by the localization of initial trauma. There was only mild recurrence of heterotopic bone growth between the first and fifth postoperative year. For objective evaluation of heterotopic bone formation in standard x- ray films, planimetric measurement is a useful method.

Brain Injuries↗
PubMed2000

Comparative stability of the "Internal Fixator" and the "Universal Spine System" and the effect of crosslinking transfixating systems. A biomechanical in vitro study.

In this study, the three-dimensional stabilizing capabilities of the AO-Internal Fixator (IF) and the new Universal Spine System (USS) were investigated. Both devices were tested without and with the cross-link system (IF, IFC, USS, USSC). To determine biomechanical characteristics, a human thoracolumbar spine instability model with resection of the vertebral body Th12 was created. The vertebral body was replaced by a spacer and transpedicular posterior stabilization was performed from Th11 to L1. All devices reduced the range of motion (ROM) significantly compared to the values of the intact specimen. In flexion the IFC showed the highest reduction of ROM (85% of intact), followed by the USSC, USS and IF (79% of intact). In extension the ROM was restored again most by the IFC (52% of intact), followed by the USSC, IF and USS (44% of intact). In lateral bending stability was provided by the USSC (right 78% and left 81% of intact), followed in right lateral bending by the IF, IFC and USS and in left lateral bending by the USS, IF and IFC. In axial rotation the ROM was reduced primary by the IFC (right 51% and left 46% of intact), followed in right axial rotation by the USS, USSC and IF, in left axial rotation by the USSC, USS and IF. Additional stability by crosslinking has been provided in the IF and the USS in flexion and extension, in the USS in lateral bending and in the IF in axial rotation nonsignificantly. The neutral zone (NZ) was reduced by posterior instrumentation in flexion/extension and right/left lateral bending significantly. In axial rotation only the USSC decreased the NZ below intact levels. The study showed no statistical significant differences in the stabilizing capabilities of the USS compared to the IF. For both implants the cross-link system increased stability in the chosen instability model insignificantly only.

Aged↗
PubMed2000

The influence of stiffness of the fixator on maturation of callus after segmental transport.

The treatment of large bony defects by callus distraction is well accepted, but the duration of treatment is long and the rate of complications increases accordingly. We have examined the effect of the stiffness of the axial fixator on reducing the time for maturation of callus. We created a mid-diaphyseal defect of 15 mm in the metatarsal bone in sheep and stabilised it with a ring fixator. After four days a bony segment was transported for 16 days at 1 mm per day. After 64 days the animals were divided into four groups, three with axial interfragmentary movement (IFM) of 0.5, 1.2 and 3.0 mm, respectively, and a control group. The 3.0 mm IFM group had the smallest bone density (p = 0.001) and area of callus and the largest IFM after 12 weeks; it also had typical clinical signs of hypertrophic nonunion. The most rapid stiffening of the callus was in the 0.5 mm group which had the smallest IFM (p = 0.04) after 12 weeks and radiological signs of bridging of the defect. These results indicate that suitable dynamic axial stimulation can enhance maturation of distraction callus when the initial amplitude is small, but that a large IFM can lead to delayed union.

Animals↗
PubMed1999

A new radiolucent system for vertebral body replacement: its stability in comparison to other systems.

Anterior intervention of metastatic lesions of the spine can accomplish relief of pain, spinal decompression, and restoration of spinal stability. Ventral vertebral body replacements have been developed to provide these conditions but there have been problems with loosening at the implant-bone interface, mechanical failure, and X-ray artifacts from the metal. Intraoperative stability of the vertebral body replacement is especially critical to avoid loosening of the implant and to achieve long-term bony incorporation. This study compared the biomechanical performance in vitro of a new radiolucent system for vertebral body replacement to three currently marketed systems. The new system features a composite bioglass-polyurethane body and a new configuration of polymeric fastening hardware. Range of motion, neutral zone, and several interfacial motion parameters were measured under pure moments of 3.75 Nm in the three anatomical directions. The new system provided the significantly highest restraint of motion for all parameters. Mechanically, the new system is preferable at least initially to a sampling of systems representative of those currently used.

Artifacts↗
PubMed1999

[Not Available].

Explore the source record for details and available documents.

Journal Article↗
PubMed1999

[Trauma surgery 2020. Developments in the past--challenges and perspectives for the future. I: Trauma surgery management].

In germany over 5 million individuals are involved in an accident annually. The economical consequences are huge with direct treatment cost amounting to approx. 72 billion marks. The available data indicates an increase in the incidence of overall trauma and trauma cases treated in specialised trauma departments. An identical development can be documented for severe trauma, especially for for fractures of the spinal column, whereas the incidence of automobile and occupational accidents has declined in recent years. The current system of reimbursement in the treatment of severely traumatized patients is deficitary for trauma departments. Therefore, to avoid a reduction in the standard of care, new methods of reimbursement have to be devised. In a limited financial environment the benefit of high level trauma care for the individual and the society has to be demonstrated with adequate public relations.

Cost-Benefit Analysis↗
PubMed1999

[Trauma surgery 2020. Development in the past, definition of future topics and programs. II. Research in trauma surgery 1998].

The field surgery has been structured into four specialties of equal importance that are Thoracic Surgery, Vascular Surgery, Visceral Surgery and last but not least Trauma Surgery. Each specialty defines its research tasks. Therefore it is necessary to evaluate the situation of research in trauma surgery and define future topics and programs. The aim of this survey was to cover the present research situation in Germany. Out of the 200 questionnaires 112 were available for evaluation. The major deficiencies were stated to be a lack of personnel, budget and coordination of topics and resources. Of general interest was to initiate activities of the German Society for Trauma Surgery (DGU) in view of coordination of research activities, setting up of new funds and integration of teaching hospitals into university research programs. The data, shown in this article, may serve to start a discussion aiming on the improvement of the financial and scientific environment.

Forecasting↗
PubMed1999

[Arthroscopic therapy of patellar dislocation. Surgical technique and clinical results].

Between January 1986 and August 1995, we treated 86 patients suffering from lateral displacement of the patella with arthroscopic medial tightening and lateral release after a conservative functional treatment remained unsuccessful. 49 patients were available for follow-up studies. 29 patients were treated after primary dislocation of the patella, and 20 patients after recurrent dislocations (2-20). The lateral release was performed by arthroscopy in 28 patients and in 21 patients in an open procedure. The mean follow-up time was 47.3 months. The rate of reluxation was 8%. In the opinion of the patients, 44 (90% of the follow-up) operations were evaluated as good/very good, the average Lysholm score was 87.3 +/- 13.9. The clinical results were influenced by the point of time of the operation. Patients with monoluxation showed a lower rate of reluxation (3% vs. 15%) and superior functional and subjective results than those with recurrent dislocation. However, there were no significant differences between the open and closed performed lateral release. We recommend the technique presented here as a minimal-invasive method especially for patients with monoluxation of the patella.

Adolescent↗
PubMed1999

[Trauma surgery 2020. Past developments - future demands and perspectives. III: Ideas on future care].

A growing number of casualties and the increasing restrictions of funding will lead as a consequence to changes within the field of trauma surgery. Despite these developments trauma surgery must maintain its major responsibility towards the victims of accidents. Therefore the German Society for Trauma Surgery (DGU) has to face the future economic and social challenges to influence the coming changes. This role compromises the engagement in a continuous struggle for the high and global standard of injury care in Germany, for quality assessment, education and training, research and adequate public relations. This paper outlines the aspects and visions of future trauma surgery and the means which may continue to guarantee international acknowledged standard of trauma care in Germany.

Cost Control↗
PubMed1999

[Tibiocalcaneal fusion for the treatment of talar necrosis. An analysis of 21 cases].

Between 1986 and 1996, 21 patients had a tibiocalcanear arthrodesis. Indications for surgery were in all cases either osteomyelitis or avascular necrosis of the talus. External stabilisation was used in 17 patients due to severe soft tissue damage or extensive infection of the talus, internal screw fixation was used in four patients. There were eight complications in seven patients, one patient had a below the knee amputation. The leg length discrepancies after resection of the talus was equalized in four cases with callus distraction using an Ilisarov ring fixator. Follow up evaluation was available in 18 patients after an average of 38 months (12-86 mo.). There were no infectious recurrencies during the follow up period and a solid fusion was achieved in all patients that were followed. According to a modified Kitaoka score, results were excellent and good in 12 of the 18 patients. External stabilisation, especially the Ilisarov ring fixator is the primary method of treatment in cases with severe infection or soft tissue damage.

Adult↗
PubMed1999

[Surgical treatment of injuries of the thoracolumbar transition. 1: Epidemiology].

The authors report on a prospective multicenter study with regard to the operative treatment of fractures and dislocations of the thoracolumbar spine. 18 traumatologic centers in Germany and Austria, forming the working group "spine" of the German Society of Trauma Surgery, are participating in this continuing study. Between September 1994 and December 1996 682 patients (64% male) with an average age of 39 1/2 (7-83) years were entered. The entry criteria included all patients with acute and operatively treated (within 3 weeks after trauma) fractures and dislocations of the thoracolumbar spine (Th 10-L 2). Part 1 of this publication outlines the protocol and epidemiologic data. The incidence of fractures and dislocations of the thoracolumbar spine and associated injuries were recorded according to a standardized protocol, as well as the different operative methods and complications, duration of hospital stay, rehabilitation and incapacity. The analysis of the clinical social and radiological course was a second focus. The most frequent mechanism of injury was a fall (50%) or traffic accident (22%). Most of the fractures occurred at the L 1 level (49%). All injuries were classified according to the ASIF (AO) classification. 65% sustained an A-type fracture (compression fracture). Associated injuries were observed in 35% and 6% were polytraumatized. Extremities and thorax were most frequently affected. Younger age and traffic accidents lead more often to C-type fracture (fracture dislocation) and polytrauma. An increased number of multisegmental or multilevel lesions were observed in polytraumatized patients. There were 16% with incomplete paraplegia (Frankel/ASIA B-D) and 5% with complete paraplegia (Frankel/ASIA A). The rate of patients with initial neurologic deficits significantly increased with the severity of spinal injury according to the Magerl classification. Until discharge a neurologic improvement (at least 1 Frankel/ASIA grade) was observed in 32% of the partially paralyzed (Frankel/ASIA B-D) and in 12% of the patients with complete paraplegia (Frankel/ASIA A). A neurologic deterioration occurred in 3 patients (0.4%). As a base for further follow-up and late results the individual starting point was determined by collecting relevant data of the patients' history: 277 (40.6%) patients suffered from simultaneous diseases, one half was spine related. At the time of injury 559 (82.0%) patients were employed; 429 (62.9%) doing manual work. 369 (54.1%) patients stated sportive activities before the injury and 561 (82.3%) designated their "back function" as normal. For the time before injury the patients scored an average of 93.4 points in the Hannover Spine Score (0-100 points concerning complaints and function of the back/spine).

Adolescent↗