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Biomedical subjects

L Kinzl

Publications and source records attributed to L Kinzl.

At least 163 records · Page 9Linked to original sources
PubMed1997

[Occupational disease 2108. Degeneration pattern in magnetic resonance tomography of the lumbar spine in patient with differential weight-bearing activity].

The addition of vertebral disc degeneration to the job-related disease register raises the question of vertebral disc degeneration patterns according to loading strain. The readings of the lumbar vertebra of construction workers and nurses were compared with those of a group without workload. In the groups examined, aged 35 to 50, monosegmental damage was found in only 17% of the patients with high workload, as opposed to 29% of those with no workload, mostly with monosegmental damage at level L5/S1. Damage to the upper segments of the lumbar spine with intact discs in between was found exclusively in patients with high workload. Multiple segment damage in the age range examined was found in subjects with activities that add to the load of the spinal column. The value of MRI in assessing and evaluating illness originating from the vertebral discs is currently being discussed.

Adult↗
PubMed1997

Chest trauma and its impact on the release of vasoactive mediators.

Every year, major chest injury is involved in 56% of deaths in trauma victims. Blunt chest trauma apparently plays a crucial role in trauma-induced death of multiply injured patients. Therefore, the aim of this study was to evaluate the impact of different types of injuries, including lung tissue damage, on the release of various prostanoids. In a prospective study, the release of arachidonic acid (AA) metabolites was estimated in patients suffering blunt chest trauma alone, i.e., single thoracic injury, and in multiple injured patients including blunt chest trauma. The results were compared with those of patients suffering from single long bone fractures of the leg without additional injury. The plasma concentrations of the AA metabolites, prostacyclin, thromboxane, prostaglandin F2 alpha, and prostaglandin M were determined immediately after admission and in hourly and daily intervals thereafter. Despite clearly different injury scores, elevated levels of circulating AA metabolites were found in the plasma in all patients. This study reveals that any trauma increases significantly the release of prostanoids into the peripheral blood without regard to the impact of tissue damage. This phenomenon is, however, most pronounced following lung injury. On the basis of these results we suggest that there is a specific impact of those mediators in blunt chest trauma. The prostanoids apparently are suitable to describe and even to monitor the extent of thoracic trauma, thus giving additional information in some respect to the individual outcome.

Adolescent↗
PubMed1997

Length and torsion of the lower limb.

Corrective osteotomies are often planned and performed on the basis of normal anatomical proportions. We have evaluated the length and torsion of the segments of the lower limb in normal individuals, to analyse the differences between left and right sides, and to provide tolerance figures for both length and torsion. We used CT on 355 adult patients and measured length and torsion by the Ulm method. We excluded all patients with evidence of trauma, infection, tumour or any congenital disorder. The mean length of 511 femora was 46.3 +/- 6.4 cm (+/-2SD) and of 513 tibiae 36.9 +/- 5.6 cm; the mean total length of 378 lower limbs was 83.2 +/- 11.4 cm with a tibiofemoral ratio of 1 to 1.26 +/- 0.1. The 99th percentile level for length difference in 178 paired femora was 1.2 cm, in 171 paired tibiae 1.0 cm and in 60 paired lower limbs 1.4 cm. In 505 femora the mean internal torsion was 24.1 +/- 17.4 degrees, and in 504 tibiae the mean external torsion was 34.9 +/- 15.9 degrees. For 352 lower limbs the mean external torsion was 9.8 +/- 11.4 degrees. The mean torsion angle of right and left femora in individuals did not differ significantly, but mean tibial torsion showed a significant difference between right (36.46 degrees of external torsion) and left sides (33.07 degrees of external torsion). For the whole legs torsion on the left was 7.5 +/- 18.2 degrees and 11.8 +/- 18.8 degrees, respectively (p < 0.001). There was a trend to greater internal torsion in femora in association with an increased external torsion in tibiae, but we found no correlation. The 99th percentile value for the difference in 172 paired femora was 13 degrees; in 176 pairs of tibiae it was 14.3 degrees and for 60 paired lower limbs 15.6 degrees. These results will help to plan corrective osteotomies in the lower limbs, and we have re-evaluated the mathematical limits of differences in length and torsion.

Adolescent↗
PubMed1997

[Acetabular fractures in elderly persons. Primary endoprosthetic treatment].

In the Department of Traumatology at the University of Ulm, 26 elderly patients with displaced acetabular fractures were treated with primary implantation of a hip joint endoprosthesis between 1986 and 1996. The principles of operative therapy are stabilization of the acetabular ring, grafting of acetabular defects with autogenous corticocancellous bone and cranial buttressing with a reinforcing ring. This concept permits immediate mobilization of elderly patients and full weight-bearing and thus results in favorable early postoperative results. Secondary complications typically caused by immobilization can therefore be avoided.

Acetabulum↗
PubMed1996

[The "low contact plate" for stabilizing the dislocated intra-articular calcaneus fractures].

Open reduction and internal fixation of intraarticular calcaneus fractures have been increasingly emphasized in recent years. Operation of most of these fractures is via an extended lateral approach. Different implants are used to stabilize the often complex fractures. We have developed a low contact plate that is specially designed for calcaneal fractures. Because the design is based on the anatomy of the calcaneus, all types of fractures can be treated. The plate has a large number of holes to accommodate screw fixation. Our results in 36 cases were comparable to those of other series using open reduction and internal fixation with plates and the demands on the plate were fulfilled.

Adolescent↗
PubMed1996

[Covering soft tissue defects].

In the past, the main emphasis in the treatment of complex limb injuries was placed upon the reconstruction of bony defects. Recently, however, reconstructive soft-tissue procedures have gained the attention they deserve. The salvage of a severely injured extremity depends rather on the feasibility of reconstructive surgical tissue procedures than on restoration of the bony defect. Sufficient vascularity is an essential condition for fracture healing and the prevention of post-traumatic complications like osteomyelitis and pseudarthrosis. If primary closure of a soft-tissue defect is not possible, preliminary covering has to be obtained with artificial skin replacement (vacuum sealing) until definitive covering with muscle or musculocutaneous flaps can be achieved. With the microvascular restorative techniques available today even complex soft-tissue problems can be solved. Nevertheless, an appropriate infrastructure and a trained and skilled surgeon are essential.

Amputation Stumps↗
PubMed1996

[Infected pseudarthrosis].

In open fractures the rate of infected non-union defects has in recent years decreased due to the increased primary application of external fixation. In spite of this positive state of affairs the condition is still encountered often enough to warrant specific treatment strategies and techniques. In the treatment of infected pseudarthroses the general principles of osteitis treatment are applied. This includes radical excision of infected pseudarthrotic bone and of the diseased surrounding soft tissue, provides mechanical stability in the non-union area and requires effective local treatment of the infection in combination with systemic, target-specific and temporary well-defined antibiotic therapy as well as procedures to improve local circulation. The incorporation of autogenous bone transplants in defects appears to depend on close contact between the transplant and the vascularized receiving site and on the quantity of the transplanted osseous material. A promising alternative method of dealing with extensive bone defects is osteogenesis produced by callus distraction; therefore special attention is given to Ilizarov's ring fixation system. Unstable scar formation demands local muscular flaps or microvascularized free flap transfer, which seems to be superior to other methods.

Anti-Bacterial Agents↗
PubMed1996

[Vacuum assisted wound closure after dermatofasciotomy of the lower extremity].

Between 1 January 1992 and 15 March 1994 25 patients with compartment syndromes of the lower limb were treated by the vacuum-sealing technique (VS). Ten out of 25 patients had multiple injuries. Eight compartment syndromes were located in the thigh, 14 in the lower leg and 3 in the foot. The average time of VS was 12.7 (4-31) days with 2.1 (1-8) changes per patient. The wounds were either closed by secondary suturing (n = 20) or by skin grafts after partial closure of the wounds by suturing (n = 5). One patient developed a superficial wound necrosis, which healed spontaneously without invasive surgical treatment. In 52 intraoperative swabs of the wound surface there was bacterial growth in five bacteriologic specimens, but there were no clinical signs of infection.

Compartment Syndromes↗
PubMed1996

[Arthrodesis of the ankle joint].

Arthrodesis of the ankle joint is still an important operation in the treatment of painful arthrosis, chronic infection, and malalignment instability when these cases have been treated unsuccessfully with other therapeutic procedures. To date, prosthetic replacement of the ankle joint has been an alternative only in rheumatoid patients. Concerning the long-term results, ankle arthrodesis is much better than alloarthroplasty. Because of the good functional results achievable by arthrodesis when done in the right position, there is less often a need for prosthetic replacement than in the hip or knee joint. A patient with a fused ankle joint is only limited when running. Compression arthrodesis is possible at present with various operative techniques utilizing external fixators, ring fixators and open reduction internal fixation with plates and screws. The last procedure can be carried out arthroscopically. With these techniques, fusion of the ankle joint in the correct position is possible in nearly all situations, e.g., infection, malalignment, osteoporosis, soft tissue damage. The main complication of ankle arthrodesis is pseudarthrosis (up to 35%) and postoperative infection (3%-25%). An important late sequela is arthrosis in the joints adjacent to the fused ankle joint (10-60%).

Ankle Joint↗
PubMed1996

[Local complications of intramedullary nailing].

In the period from January 1990 to the end of December 1995 intramedullary nailing was performed in 294 patients with 156 fractures of the femur and 162 fractures of the tibia. Early nailing within the first 24 h after trauma was realized in 70% of the femur and in 64% of the tibia fractures. A synopsis focusing on local complications after intramedullary nailing is given on the basis of our results and a thorough analysis of the literature. Iatrogenic fractures of the femoral neck (0-5%), of the proximal femur (0.8-11.2%) and of the tibial head (0-8.3%) represent important intraoperative complications. Less frequent, but even more serious, are intraoperative lesions of nerves and arteries, as well as the development of compartmental syndromes of the lower leg (0-8.6%). Lengthy procedures and the use of traction tables seem to foster those complications. After primary intramedullary nailing, non-unions of the femur can be expected in 1-2% and of the tibia in 2-4%. The corresponding rates of osteomyelitis are 1-1.5% and 2-3%, respectively. After secondary nailing, particularly when changing from external fixation, and in cases of open fractures, the risk of deep infection is essentially elevated. Intramedullary nailing of the femur presents an important tendency to external torsional malalignment. In our investigation the torsional tolerance of 15 degrees was exceeded in 26%. A corresponding postoperative shortening of more than 2 cm length difference can be expected in 1.7-9.8%. Spiral fractures of the distal tibia offer a critical tendency to secondary varus and torsional malalignment, particularly after unreamed nailing and consecutive shortening due to breakage of locking bolts. The therapeutic indications of fracture stabilization in cases of unstable metaphyseal fractures should be reviewed.

Adolescent↗
PubMed1996

[Quality control after pelvic injuries with a scoring system].

Quality control after treatment of pelvic injuries is often poor because many criteria of assessment lack objectivity. In order to attain improved comparability of results, we present a scoring system including subjective as well as functional and radiological criteria. The assessment is based on a calculation according to the importance of the criteria. The total score supplies the final result with a breakdown into excellent, good, fair and poor. 33 patients with type B and C injuries (Tile) underwent evaluation with this scoring system. We found 15 excellent, 10 good, 2 fair and 6 poor results. The score showed that patients' most frequent handicap was pain (median 60% of maximum score). Hip mobility was hardly affected, and from the radiological point of view it appeared that alterations of pelvic symmetry and symphysis were most common. Our proposal is to apply this scoring system on a wide basis, because only with a great number of patients can the effectiveness of the score be tested and different ways of treatment assessed with regard to early and late results. Our system could be a useful contribution to sufficient quality control, particularly after such complex and severe injuries.

Activities of Daily Living↗
PubMed1996

[Polytrauma and economics].

Treatment of polytrauma patients requires a large number of well trained staff and expensive medical equipment. The high medical standard in polytrauma care resulted in a reduction of a 40% lethality in the 70's to 10 to 15% today. The changes in german health systems (GSG) cut down the financial resources and call for careful evaluation of costs in trauma centers. Our analysis of the costs of 1 multiple injured patient in 1996 showed, that the reimbursements of hospital charges ended in a deficit of DM 30,000,-. Our department treats approximately 100 polytraumas a year which implies a budget deficit of 3 million DM per year. Today the aim of trauma centers is the maintenance of a high surgical standard in trauma care together with adequate reimbursement of hospital expenses. Trauma care and life saving interventions must not be shortened by financial restrictions. The trauma surgeon has to take care for his multiple injured patients and balanced financial reimbursements as well.

Adult↗
PubMed1996

[Are ISS and PTS unsuitable trauma scores for prediction of (possible) post-traumatic lung failure?].

Prostanoids are inflammatory mediators which originate from endothelial cells following local tissue damage. That is why plasma levels of prostanoids are possible markers of inflammatory response and severity of trauma. We were able to demonstrate that the systemic release of prostanoids does not depend on the score values (ISS, PTS) but rather on different trauma patterns (chest trauma, head injury). Influencing vascular permeability and resistance elevated plasma levels of prostanoids may explain the impairment of pulmonary function in traumatized patients. It seems to be useful to re-evaluate the scoring systems with respect to chest trauma and head injury.

Adolescent↗
PubMed1995

Ilizarov callus distraction produces systemic bone cell mitogens.

We tested the hypothesis that the application of strain during callus distraction induces systemic osteoblast stimulating factors that enhance osteoblast activity both locally and systemically. To study the systemic occurence of strain-induced osteoblast stimulating factor during callus distraction, we investigated the mitogenic capacity of sera from 12 patients who had undergone callus distraction on the osteoblastic cell line SaOS-2 (part I). Serum samples from six patients who had undergone rigidly fixed high tibial osteotomy (i.e., without distraction) served as controls. The sera were assayed for platelet-derived growth factor and transforming growth factor-beta. In part II of the study, the in vitro effects of mechanical strain were investigated in a simplified model by cyclic stimulation of osteoblast cultures isolated from cortical bone explants from the same patients; a specially developed apparatus was used for cell-stretching. Sera taken during the third to fourth week of callus distraction demonstrated a significant increase in proliferation of SaOS-2 cells (p < 0.005). In contrast, sera from patients who had had an osteotomy failed to induce or decreased the mitogenic capacity of SaOS-2 cells. The concentration of platelet-derived growth factor increased significantly (p < 0.01) in sera from both the patients who had undergone callus distraction and the controls who had had osteotomy. However, the level of transforming growth factor-beta was increased (p < 0.05) in the sera from the patients who had distraction (sera that stimulated proliferation of SaOS-2 cells), but the level was not increased in the sera from patients who had osteotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Human osteoblasts from younger normal and osteoporotic donors show differences in proliferation and TGF beta-release in response to cyclic strain.

Mechanical stimulation of bone tissue by physical activity stimulates bone formation in normal bone and may attenuate bone loss of osteoporotic patients. However, altered responsiveness of osteoblasts in osteoporotic bone to mechanical stimuli may contribute to osteoporotic bone involution. The purpose of the present study was to investigate whether osteoblasts from osteoporotic patients and normal donors show differences in proliferation and TGF beta production in responses to cyclic strain. Human osteoblasts isolated from collagenase-treated bone explants of 10 osteoporotic patients (average age 70 +/- 6 yr) and 8 normal donors (average age 54 +/- 10 yr) were plated into elastic rectangular silicone dishes. Subconfluent cultures were stimulated by cyclic strain (1%, 1 Hz) in electromechanical cell stretching apparatus at three consecutive days for each 30 min. The cultures were assayed for proliferation, alkaline phosphatase activity and TGF beta release in each three parallel cultures. In all experiments, osteoblasts grown in the same elastic dishes but without mechanical stimulation served as controls. Significant differences between stimulated cultures and unstimulated controls were determined by a paired two-tailed Wilcoxon test. In comparison to the unstimulated controls, osteoblasts from normal donors significantly increased proliferation (p = 0.025) and TGF beta secretion (p = 0.009) into the conditioned culture medium. In contrast, osteoblasts from osteoporotic donors failed to increase both proliferation (p > 0.05) and TGF beta release (p > 0.05) in response to cyclic strain. Alkaline phosphatase activity was not significantly affected (p > 0.05) in normal as well as osteoporotic bone derived osteoblasts. These findings suggest a different responsiveness to 1% cyclic strain of osteoblasts isolated from normal and osteoporotic bone that could be influenced by both the disease of osteoporosis and the higher average age of the osteoporotic patient group. While osteoblasts from osteoporotic donors failed to increase proliferation and TGF beta release under the chosen mechanical strain regimen that stimulated both parameters in normal osteoblasts, it is possible that some other strain regimen would provide more effective stimulation of osteoporotic cells.

Age Factors↗