Biomedical subjects

O Gonschorek

Publications and source records attributed to O Gonschorek.

14 recordsLinked to original sources

PubMed2003

[Thoracolumbar spine fractures after conservative and surgical treatment. Dependence of correction loss on fracture level].

QUESTION: This retrospective study presents results after conservative and operative treatment of thoracolumbar fractures as function of its localization. METHODOLOGY: In 2 years 70 patients with A1/A2 fracture were conservatively treated, 38 patients with A3/B/C injury were treated by internal fixtor. For evaluation 3 vertebral sections(Th5-10,Th11-L2,L3-5)were defined. Follow-up took place 1 year after implant removal or end of conservative treatment. RESULTS: The correction-loss was highest in thoracic, lowest in lumbar region. After conservative therapy,correction-loss was located to 3/4 in vertebra itself, after operative treatment especially in adjacent disc spaces. There was no general correlation to complaints. CONCLUSION: In consequence of these results A1/A2-fractures in the upper thoracic spine ( 15 degrees will be stabilized anteriorly, in other regions functional treated. A3-fractures of thoracic spine and thoracolumbar junction will be operated from anterior, in lower lumbar spine (>L3) from dorsal. B- and C-injuries should be instrumented with a combined dorsoventral procedure.

Adolescent↗

PubMed2002

[Endoscopically assisted minimally invasive reconstruction of the anterior thoracolumbar spine in prone position].

Irrespective of an anterior open or endoscopic approach, the combined postero-anterior instrumentation of thoracolumbar fractures requires time consuming intraoperative maneuvers changing the patients position from prone to lateral.A standardised anterior endoscopically assisted approach for the segments Th4 to L4 is described, allowing the patient to remain in prone position, using a 4-5cm incision combined with a retractor system. The approach to the anterior spine in prone position is feasible by using a self holding retractor system for the region from Th4 to L4. Time of anaesthesia for the one stage combined procedure can be reduced by about 40 min, when changing the position of the patient is no longer necessary. The minimal incision in combination with the retractor system allows mainly the use of conventional instruments and implants, which provides reasonable lower costs. The advantages of the open and the endoscopical technique are combined. The main advantage of the prone position is the opportunity to access the anterior and posterior spine simultaneously, which is extremely helpful in reduction maneuvers.

Adult↗

PubMed2000

Vascularised knee joint transplantation in man: the first two years experience.

OBJECTIVE: To describe our early experience with a new technique for restoring destroyed knee joints to give reasonable functional results. DESIGN: Observational clinical trial. SETTING: Level-1-Trauma centre, Germany. SUBJECTS: 5 patients with large bone defects of the knee and loss of the extensor apparatus caused either by serious injury alone, or infection after serious injury. INTERVENTIONS: Transplantation of fresh and perfused knee joints with a vascular pedicle from multiorgan donors under immunosuppression. MAIN OUTCOME AND MEASURES: Ability to walk, need to remove one transplanted joint. RESULTS: Four patients are able to walk, the range of movement being from 50 degrees-120 degrees. The first patient additionally had to be provided with a total knee joint arthroplasty. In the third patient the graft became infected and had to be removed. She finally had an arthrodesis and bone lengthening by the Ilizarov technique. CONCLUSIONS: Transplantation of the knee joint may be an alternative to bone lengthening or amputation for patients with total loss of the extensor apparatus.

Adult↗

PubMed1999

[Allogeneic vascularized transplantation in cases of bone and joint defects].

This paper presents preliminary results of allogeneic vascularized transplantations of three femoral diaphyses and four total human knee joints. Grafts were harvested from multi-organ-donors and immediately transplanted. Osteosyntheses were performed employing intramedullary nails. Vascular pedicles of the grafts were anastomosed in end-to-side technique. Immunosuppression mainly based on Cyclosporine and Azathioprine. Grafts' perfusion was demonstrated by DSA and Duplex-sonograms, bone metabolism by SPECT-scintigraphy. Five months following transplantation osteotomies demonstrated consolidation in conventional X-rays. Biopsies of the grafted bone revealed intact osteocytes and arthroscopy demonstrated intact synovial, chondral and ligamentous structures. From the technical aspect vascularized transplantation of the femoral diaphyses and total knee joints is feasible. The main problems are of immunologic nature. Transplantations were performed respecting the ABO-compatibility but with a large HLA-mismatch. Acute and chronic rejection crises may damage the grafts. At least in synovial joints live-long immunosuppression of the recipients seems to be unavoidable.

Adult↗

PubMed1998

Allogeneic vascularized grafting of human knee joints under postoperative immunosuppression of the recipient.

Vascularized knee joint transplantations have been performed in various animal systems. Up to now no allogeneic vascularized transplantation of a fresh and perfused human knee joint has been realized. This paper reports on the first four grafted human knee joints, performed between April 1996 and July 1997 at the Trauma Center Murnau. The indication for transplantation of a human knee joint is total loss of the joint, including the extensor apparatus, following severe trauma. Management of this defect is first to effect closure of the soft tissue defect combined with external transfixation and bone cement spacers. For the second phase the external stabilization is switched to internal stabilization using femoral tibial nails and a temporary knee joint prosthesis manufactured of polyethylene. The transplantations are performed with respect to ABO compatibility, ignoring the HLA system after a negative crossmatch. Osteosyntheses are employed by femoral and tibial nails. The vascular anastomoses are established in an end-to-side technique between the recipient's superficial femoral vessels and the graft vascular pedicles. Immunosuppression starts as quadruple induction therapy for 3 days. Subsequently it is reduced to a two-drug maintenance protocol with cyclosporin A and azathioprine. We utilize radiography, digital subtraction angiography, duplex sonography, scintigraphy, and arthroscopy for graft monitoring. Six months after transplantation the osteotomies were bridged with callus, and the patients were completely mobilized. The motion in the transplanted knee joint ranges from complete extension to 110 degree flexion.

Adolescent↗

PubMed1998

Interlocking compression nailing: a report on 402 applications.

Nailing techniques have changed tremendously in recent years. One significant development has been the interlocking compression nail (ICN) which provides active interfragmentary compression. Apart from its beneficial effect in the treatment of acute fractures, allowing early weight-bearing and mobilization of the patient the ICN is useful in many types of revision operations: resection and stabilization of pseudarthroses without cancellous bone grafts, corrective operations of malalignments through a minimally invasive technique, as well as the readaptation of the resection sites in arthrodeses. Between April 1993 and September 1996, 402 consecutive applications of an ICN were followed prospectively to evaluate the practibility and reliability of the system. A special focus was placed on the active compression device. Along with 153 acute fractures, 112 non-unions and 41 cases of malalignment were treated; 96 arthrodeses were performed. Even for difficult courses of healing only a low complication rate was observed, and a remarkably high percentage was managed successfully.

Adult↗

PubMed1998

Allogeneic vascularized transplantation of human femoral diaphyses and total knee joints--first clinical experiences.

This article has presented the preliminary results of three patients who received vascularized allogeneic femoral diaphyses and three patients having undergone vascularized transplantation of fresh and perfused total human knee joints. The large osseous defects in the femora followed osteomyelitis and chondrosarcoma. The three knee joints were lost due to various trauma mechanisms. All grafts were harvested within 25 hours from multiorgan donors perfused with 4 L of UW solution. All osteosyntheses were performed employing intramedullary nails. Vascular pedicles of the grafts were anastomosed end-to-side to the superficial femoral artery and vein in the adductorial canal of the recipient thigh. Immunosuppression was based mainly on two drugs: CyA and AZA. Perfusion of the grafts was demonstrated by DSA, and bone metabolism in the graft by SPECT scintigraphy. Six months after the operation all osteotomies demonstrated callus formation and osseous consolidation in conventional radiographs. Biopsies of the grafted bone revealed intact osteocytes, and arthroscopy of the transplanted knee joints demonstrated intact synovial, chondral, and ligamentous structures. From the surgical aspect, the vascularized transplantation of the femoral diaphyses and total knee joints is technically feasible. The main problems are immunologic. All transplantations were performed with respect to ABO compatibility, but with a large HLA mismatch. Therefore, acute and chronic rejection crises were observed. In total synovial joints, lifelong immunosuppression of graft recipients seems to be currently unavoidable.

Adult↗

PubMed1998

[Bridging long bone and joint defects with allogeneic vascularized transplants].

Three patients with large osseous defects following trauma and infection received vascularized allogeneic femoral diaphyses and five patients vascularized allogeneic total knee joints. From the surgical aspect these transplantations are technically feasible. The remaining problems are of immunological nature; at least in patients with allogeneic synovial joints, lifelong immunosuppression seems to be currently unavoidable.

Bone Transplantation↗

PubMed1993

Thromboxane--co-factor of pulmonary disturbances in intramedullary nailing.

UNLABELLED: Pulmonary complications during and after intramedullary nailing particularly in trauma patients have directed clinical interest to thromboembolic events and metabolic alterations, as found in different methods of fracture stabilisation. In 30 patients (mean age 34 years) isolated, closed or 1 degree open fractures of the tibia were operated on in three groups with reamed nailing (RN; n = 11), unreamed nailing (UN; n = 11) and external fixation (EF; n = 8) respectively. In blood samples of the femoral vein of the fractured limb, a 5-7 fold increase of the thromboxane (TXB2) concentration was found in all patients. However, differences of TXB2 concentrations in the arterial blood after passage of the lungs were conspicuous. The highest arterial TXB2 concentrations were found in connection with RN, followed by UN and finally EF. The transpulmonary TXB2-clearance displayed the following relationship: EF > UN > RN (5.7:4,4:2.2). A similar correlation was found for PGF2 alpha while other arachidonic acid metabolites showed no significant behaviour. TXB2 and PGF2 alpha cause bronchoconstriction, pulmonary vasoconstriction and aggregation of thrombocytes. These pulmonary disturbances may results in ARDS, a feared complication after intramedullary nailing. CONCLUSION: Early fracture stabilisation particularly in severely injured patients is an established procedure. To prevent pulmonary disturbances the external fixator is preferrable to the UN and finally the RN. Our data suggest that for the prevention of pulmonary disturbances EF is superior to UN and RN.

Adolescent↗

PubMed1993

[Endotoxin in blood plasma of patients after trauma].

Depending on the severity of the injury, high endotoxin levels may be found in patients with lung contusion but only slightly increased levels in patients with skull and brain trauma. This difference is highly significant. Patients with multiple injuries and fractures of the extremities as the main diagnosis and with a combination of injuries show a moderate increase in endoxin level on the day of admission. There is no relationship between the injury severity and endotoxemia.

Adolescent↗

PubMed1993

[Management of unstable forearm shaft fractures in children].

Complete dislocation fractures of the forearm are rare in children. Operative treatment is indicated if it is an open fracture and if neurovascular injury is present. There is no accepted standard treatment--operative or nonoperative--for fractures that cannot be accurately reduced and stabilized. In the last 10 years we have operated on 37 fractures of the forearm in children. In 22 cases the indication for operative treatment was that the fractures could either not be reduced or could not be stabilized. Our results show that most fractures were not recognized as unstable (17 out of 22 cases), and therefore several reduction maneuvers (2 to 4 times) were performed before definitive stabilization was obtained via an operation. It is therefore mandatory that unstable fractures of both bones or of one bone be operated on whereas semistable fractures (one bone completely fractured) should be reduced under general anesthesia and operative standby. For the surgical treatment of unstable forearm fractures we recommend intramedullary fixation by dynamic nailing or plate osteosynthesis in younger patients (5-10 years) and open reduction and plate osteosynthesis in older patients and in open fractures or fractures with primary neurovascular impairment.

Adolescent↗

PubMed1992

[Therapy of patients with multiple traumas: interdisciplinary organization at a specialized center].

By utilizing all its specialist facilities, the specialized trauma centre can optimize the chances of survival of the severely injured patient. However, this is possible only when the specialties involved have the ability to cooperate and when a "team leader" applying treatment guidelines worked out and accepted on an interdisciplinary basis is available to coordinate activities.

Humans↗

PubMed1989

Serum mediated depression of chemiluminescence response of granulocytes in hemorrhagic shock.

CL of PMNL was decreased in the early stage of hemorrhagic shock in the rat if evaluated from whole blood. When standardized PMNL were incubated with plasma of different shock states the same serum--mediated depression was observed. In all stages killing activity of PMNL per se from arterial blood (after passage of pulmonary endothelium) was nearly unchanged if measured in standardized pool plasma. Furthermore in the prefinal stage of uncompensated shock highly activated PMNL were obtained. These results support the hypothesis that plasmatic--cellular interactions play an important role in depression of killing activity of PMNL already in early hemorrhagic shock. Actual concepts mention protein cleavage products, fluid phase C3b and prostaglandins as potential mediators of this serum--mediated suppression.

Animals↗

PubMedDate not supplied

Segment transport employing intramedullary devices in tibial bone defects following trauma and infection.

OBJECTIVES: To compare two different methods of segment transport in posttraumatic and postseptic tibial defects by employing intramedullary tibial nails as the fixation system and to evaluate differences in the complication rate between external fixation and wire towropes as the transport system. DESIGN: Randomized, prospective, nonblinded study. SETTING: Level 1 trauma center. PATIENTS: Thirty patients with posttraumatic or postseptic defects of the tibial shaft were admitted at our center between January 1994 and December 1995. For study purposes, they were divided into two groups with fifteen patients in each. METHODS: All thirty patients underwent a standardized therapy protocol consisting of three phases: (a) eradication of infection, (b) restoration of soft tissue defects, and (c) bone segment transport. The first two phases were identical for both groups. The third phase was different: in Group A transport of the segment was performed with a combination of intramedullary nail and wire towrope; in Group B the intramedullary nail was combined with an external fixation device. We then evaluated both subjective data (patient comfort, restrictions in physiotherapy) and objective data (mobility of knee and ankle joint, transport time, reoperations, complications) to determine treatment success. RESULTS: Both methods are useful for segment transport in patients with tibial shaft defects following trauma and infection. The relative transport time was shorter in Group A than in Group B (12.2 versus 13.7 days/centimeter; p = 0.002). Group B also recorded a significantly higher complication rate than did Group A (septic complications, twenty-six versus six events; necessary recorticotomies, four versus zero events). CONCLUSIONS: An intramedullary nail and wire towrope proves to be a reliable combination for segment transport in tibial defects following trauma and infection and provides a relatively high patient comfort rate and a low complication rate.

Adolescent↗