Biomedical subjects

Reinhard Schnettler

Publications and source records attributed to Reinhard Schnettler.

18 recordsLinked to original sources

PubMed2007

Intraoperative radiation exposure in displaced supracondylar humeral fractures: a comparison of surgical methods.

Crossed K-wires, descending elastic stable intramedullary nailing and radial external fixator are alternatives in the operative treatment of displaced supracondylar humeral fractures. Only little knowledge of intraoperative radiation exposure exists in those procedures. We found average image intensifier times of 30.7 s for K-wires, 41.4 s for the external fixator and 80.0 s for elastic stable intramedullary nailing. Extensively increased fluoroscopy times was seen in cases switched from closed to open reduction intraoperatively. To avoid unnecessary intraoperative radiation exposure for patient, surgeon and staff, limits of radiation time are recommended as an additional indicator to change the surgical procedure to another fixation method or open reduction.

Adolescent↗

PubMed2006

The effects of combined gentamicin-hydroxyapatite coating for cementless joint prostheses on the reduction of infection rates in a rabbit infection prophylaxis model.

Infections remain a critical issue in total joint arthroplasty. Addition of antibiotics to bone cement was shown to significantly improve antimicrobial prophylaxis in cemented joint arthroplasty. In cementless joint arthroplasty a comparable prophylaxis by local antibiotics has not been possible yet. The aim of the current study was to investigate the antimicrobial effect of two different gentamicin-hydroxyapatite (HA) coatings for cementless prostheses in a rabbit infection model. Staphylococcus aureus with a dose of 10(7) CFUs was inoculated into the intramedullary canal of the tibia of 30 rabbits followed by the implantation of standard steel HA K-wires (n=10), steel K-wires coated with a gentamicin-HA combination (n=10), and steel K-wires coated with a gentamicin-RGD-HA combination (n=10), respectively. The animals were sacrificed after 28 days and clinical, histological and microbiological assessment on the bone and on the removed K-wire itself by agar plating and DNA-pulsed field gel electrophoresis were carried out to detect infection. There was a statistically significant reduction of infection rates by both gentamicin-coating types (0 infections in both groups) compared to standard HA coating (7 infections in 8 animals; 2 animals were lost due to acute diarrhea) (p<0.001). An excellent correlation between agar plating testing results of the K-wires and of the bone samples was found. Detailed histology showed cortical lysis, abscess and sequester formation in the infected animals. Both gentamicin-coating types showed significant improvement of infection prophylaxis compared to standard HA coating and, therefore, this coating technology could help to improve infection prophylaxis in cementless total joint arthroplasty. In further studies biocompatibility of the coatings has to be assessed.

Animals↗

PubMed2006

Immunochemical, ultrastructural and electrophysiological investigations of bone-derived stem cells in the course of neuronal differentiation.

Numerous reports have highlighted the use of mesenchymal stem cells (MSC) for tissue engineering because of the capacity of the cells to differentiate along the osteogenic, chondrogenic or adipogenic pathway. As MSC also display neuronal morphologies under appropriate culture conditions, the differentiation capacity of stem cells seems to be more complex than initially thought, but it requires careful characterization of the cells. This is especially the case because recently it has been suggested that neuronal differentiation of stem cells is only an artifact. Here, we investigate the sequence of ultrastructural changes of bone-derived stem cells during neuronal induction and compare these data with immunocytochemical and electrophysiological properties of the cells. For further comparative analyses, stem cells were incubated with non-neurologically inducing stressors. The stem cells were harvested from human osseous debris and were characterized morphologically, immunocytochemically and by using FACS. After 6 h of neuronal induction, the cells had assumed neuronal morphologies and expressed neuron-specific enolase, beta-III-tubulin, neurofilament-H and HNK-1, while only a subpopulation expressed CD15 and synaptophysin. However, electrical signaling could not be detected, neither spontaneously nor after electrical stimulation. Nevertheless, transmission electron microscopy revealed cellular features of neuritogenesis and synaptogenesis in the course of neuronal induction and suggested that the cells have features similar to those observed in immature neurons. Based upon the results, it can be concluded that neuronal induction had initiated the early steps of neuronal differentiation, while exposure of the cells to non-neurological stressors had caused necrotic alterations.

Bone and Bones↗

PubMed2005

Derotation of post-traumatic femoral deformities by closed intramedullary sawing.

Different techniques and devices have been used for correction osteotomies of bones in patients with malalignments. The most frequently used technique for rotational deformities of the femur and tibia is open osteotomy with an oscillating saw and pre-drilled holes with all well-known drawbacks of open surgery. An intramedullary device with an adapted minimal-invasive surgical technique allows intramedullary osteotomy of the bone preserving the surrounding soft tissue. We performed femoral osteotomies with an intramedullary saw followed by static interlocking nailing in 14 patients with post-traumatic rotational deformity in the femur. Twelve patients had an external rotational deformity of the femur ranging between 26 and 63 degrees , one had an additional leg-shortening of about 4 cm. Two patients had internal rotational deformities. In two patients with delayed fracture healing union was achieved within one year without secondary surgery. Post-operative clinical assessment and CT-scans revealed good derotation results with deformities of less than 4 degrees in all cases. No device-related complications were observed. Therefore, we conclude that "closed" osteotomy with an intramedullary saw is a minimal-invasive, safe and reliable option for derotation procedures in the femur.

Adolescent↗

PubMed2005

Glycerol-l-lactide coating polymer leads to delay in bone ingrowth in hydroxyapatite implants.

Glycerol-l-lactide as coating polymer for the delivery of basic fibroblast growth factor (bFGF) from hydroxyapatite (HA) ceramic implants was shown to lead to significant delay in bone ingrowth into the implants compared to implants without the coating polymer. The purpose of this work was to study bone ingrowth in HA ceramic implants with and without the coating polymer but without growth factors to enable differentiation between a locking effect of the pores by the polymer and the fact of inactivation of the growth factors by the polymer, which could both be possible for the delay. A defect was created in the subchondral region of both femurs in 24 miniature-pigs and was either filled by the HA implants with or without the coating polymer. Histomorphometry showed a significant delay in bone ingrowth in the polymer coated implants both after 6 and 12 weeks. Detailed histology revealed that the HA pores were completely "locked" by the polymer leading to complete loss of the osteoconductive properties of the HA. Also electron microscopy showed filling of the HA pores by the polymer. Therefore, it can be concluded that glycerol-l-lactide should not be used to coat HA ceramic implants due to significant delay in bone ingrowth.

Animals↗

PubMed2005

The tissue response to an alkylene bis(dilactoyl)-methacrylate bone adhesive.

Gluing is an attractive technique to fix small bone fragments. However, to date no bone adhesive could be established successfully for all day clinical use. The purpose of this experimental study was to investigate the biocompatibility of a new bone glue based on alkylene bis(dilactoyl)-methacrylate in 36 rabbits. Monocondylar osteotomy of the distal femur was performed and bone glue was applied into the osteotomy gap in 24 rabbits. The remaining 12 animals served as controls. In all rabbits the osteotomy was subsequently stabilized by K-wire osteosynthesis. Six animals of the glue group and 3 controls were euthanized after 7, 21, 42, and 84 days, respectively. Fracture healing and degradation pattern of the glue was studied using histological, histomorphometrical, scanning electron microscopical, and radiological methods. Good resorption of the glue by mononuclear and multinucleated giant cells without prolonged inflammatory processes was observed in the glue group. Histomorphometrical analysis did not reveal any significant differences in fracture healing between the glue and control group at any time. Complete remodelling of the former osteotomy gap was found in all rabbits after 84 days. This bioresorbable bone adhesive exhibited good biocompatibility and its degradation did not interfere with physiological fracture healing.

Animals↗

PubMed2005

Nanocrystalline hydroxyapatite and calcium sulphate as biodegradable composite carrier material for local delivery of antibiotics in bone infections.

The use of polymethylmetacrylate beads for local delivery of antibiotics requires a second surgical procedure for their removal and resorbable calcium sulphate exhibits cytotoxic effects. In this work, a bioresorbable composite of calcium sulphate and nanoparticulate hydroxyapatite (PerOssal was studied regarding its antibiotic release properties and biocompatibility. Material characteristics of plain PerOssal and pure calcium sulphate pellets were studied using scanning and electron microscopy and X-ray methods. Pellets were soaked with gentamicin and vancomycin, respectively. Release properties of both antibiotics from both materials were investigated over 10 days. Quantitative and qualitative cytotoxic assays were performed for biocompatibility testing. Specific surface was 106 m(2)/g for PerOssal and 2.2 m(2)/g for pure calcium sulphate. Almost complete elution of gentamicin was found for both carrier materials (94.7% for PerOssal vs. 95.8% for calcium sulphate) within 10 days, whereas vancomycin release was higher for PerOssal (96.3% vs. 74.8%). PerOssal showed higher initial and lower release after approximately 5 days compared to calcium sulphate. No significant in vitro cytotoxic differences were found between PerOssal and nontoxic cell culture medium. Calcium sulphate showed cytotoxic effects in two out of four tests. PerOssal exhibits excellent properties regarding resorption, biocompatibility, and antibiotic release.

Absorbable Implants↗

PubMed2005

New blood vessel formation and expression of VEGF receptors after implantation of platelet growth factor-enriched biodegradable nanocrystalline hydroxyapatite.

Vascular endothelial growth factor (VEGF) plays a key role for the interaction of osteoblasts and endothelial cells and, therefore, is an important factor for the osteointegration of bone substitutes. The aim of the current work was to study the effects of platelet growth factors (PLF) on new blood vessel formation and VEGF-receptors expression pattern in bone defects filled with nanocrystalline hydroxyapatite (HA) paste in miniature-pigs. Conventional histology, RT-PCR for VEGF and receptors mRNA, Western blot analysis, immunohistochemical staining and quantitative assessment of newly formed vessels was performed. HA enriched with platelet growth factor (HA/PLF+) led to an up-regulation of VEGF-R1 synthesis, a slightly enhanced number of newly formed vessels with higher sprouting activity compared with HA without PLF (HA/PLF-) filling defects. These observation are most likely attributable to a stimulating effect of TGF-ss from the platelet factor on VEGF expression in osteoblasts.

Animals↗

PubMed2004

Human reaming debris: a source of multipotent stem cells.

The biological characteristics of human reaming debris (HRD) generated in the course of surgical treatment of long bone diaphyseal fractures and nonunions are still a matter of dispute. Therefore, the objective of the present investigation has been to characterize the intrinsic properties of human reaming debris in vitro. Samples of reaming debris harvested from 12 patients with closed diaphyseal fractures were examined ultrastucturally and were cultured under standard conditions. After a lag phase of 4-7 days, cells started to grow out from small bone fragments and established a confluent monolayer within 20-22 days. The cells were characterized according to morphology, proliferation capacity, cell surface antigen profile, and differentiation repertoire. The results reveal that human reaming debris is a source of multipotent stem cells which are able to grow and proliferate in vitro. The cells differentiate along the osteogenic pathway after induction and can be directed toward a neuronal phenotype, as has been shown morphologically and by the expression of neuronal markers after DMSO induction. These findings have prompted interest in the use of reaming debris-derived stem cells in cell and bone replacement therapies.

Adult↗

PubMed2004

Effect of glycerol-L-lactide coating polymer on bone ingrowth of bFGF-coated hydroxyapatite implants.

Basic fibroblast growth factor (bFGF)-coated hydroxyapatite (HA) cylinders showed good bony incorporation in a previously conducted animal study. However, some cylinders exhibited focal inhomogeneous bone ingrowth. The purpose of the current study was to test whether glycerol-L-lactide polymer coating could improve release properties and bone incorporation of bFGF-coated HA implants. bFGF-coated HA cylinders with or without coating polymer were investigated for in vitro release of bFGF by an immuno-ligand-assay and also for bone ingrowth in miniature pigs after 42 and 84 days. Release from bFGF polymer composites was lower for the first 3 days compared to the other group but was more homogenous and detectable amounts were still found after 20 days. There was significant delay in bone ingrowth of the polymer implants in which even after 84 days bone ingrowth was not completed, whereas in the other group incorporation after 42 days occurred. Detailed histology revealed filling of the HA pores with the polymer, making ingrowth of the surrounding host bone impossible. Only after 84 days starting resorption of the polymer accompanied by bone ingrowth was found. The current study showed that glycerol-L-lactide is not suitable for coating of HA implants due to polymer induced "locking" of HA pores.

Animals↗

PubMed2004

An in vitro assessment of the antibacterial properties and cytotoxicity of nanoparticulate silver bone cement.

Infections with multiresistant bacteria have become a serious problem in joint arthroplasty. This study reports about in vitro antibacterial activity against multiresistant bacteria and in vitro cytotoxicity of polymethylmetacrylate bone cement loaded with metallic silver particles with a size of 5-50 nm called NanoSilver. In vitro antibacterial activity against S. epidermidis, methicillin-resistant S. epidermidis (MRSE), and methicillin-resistant S. aureus (MRSA) was studied by microplate proliferation tests. Quantitative elution testing and qualitative ongrowth of human osteoblasts was done to study in vitro cytotoxicity. Only NanoSilver cement showed high-antibacterial activity against all strains, including MRSE and MRSA. Gentamicin cement was not effective against MRSA and MRSE due to the high-level gentamicin resistance of the tested strains. Plain cement did not inhibit proliferation of any strains. There was no significant difference regarding in vitro cytotoxicity between NanoSilver and the non-toxic control. Cytotoxicity of cement loaded with silver salts made this kind of silver unsuitable for all day clinical use in the past. This new form of silver called NanoSilver was free of in vitro cytotoxicity and showed high effectiveness against multiresistant bacteria. If the results can be confirmed in vivo NanoSilver may have a high interest in joint arthroplasty.

Animals↗

PubMed2004

In vitro testing of antimicrobial activity of bone cement.

The purpose of this study was to establish a reliable and cost-effective microplate proliferation assay for in vitro antimicrobial testing of bone cement samples. Cement samples devoid of antimicrobial agents, loaded with 2% gentamicin or with different concentrations of high-porosity silver, were incubated in a 96-well microplate with several staphylococcal, Pseudomonas aeruginosa, and Enterococcus faecium isolates exhibiting different susceptibilities to gentamicin. After being rinsed, the samples were brought into a soy medium in which adherent cells on the cement surface either were killed by the antimicrobial surface or started to release clonal counterparts. The medium was monitored in real time by recording a time proliferation curve for each well. Microplate testing revealed no antibacterial effect of plain bone cement. The antibacterial activity of gentamicin-loaded bone cement was shown by the microplate test to depend on the gentamicin susceptibilities of the strains. The effect of high-porosity silver was dose dependent. Bactericidal activity against all tested strains was found for bone cement loaded with 1% high-porosity silver. The accuracy of this new proliferation assay was shown by the high correlation between the types of proliferation curves and antibiotic susceptibility. In contrast to routine agar diffusion testing, it assesses the dynamic response of microorganisms to antimicrobial agents in biomaterials and allows high-throughput screening and detection of antimicrobial properties of poorly water-soluble compounds like silver.

Anti-Bacterial Agents↗

PubMed2004

Frequency and effects of intratendinous and peritendinous calcifications after open Achilles tendon repair.

BACKGROUND: Although calcification of the Achilles tendon has been described by several authors, a detailed evaluation of its frequency and effects on clinical outcome has not been reported. The purposes of this work were to determine the frequency of calcifications in the Achilles tendon after open repair and their effects on clinical outcomes and to identify possible risk factors for postoperative calcification. METHODS: Thirty-six patients with open Achilles tendon repair were evaluated at an average followup of 19 months. Evaluation included a self-assessment questionnaire concerning treatment outcomes, clinical examination, and radiographic and ultrasonographic examinations. RESULTS: No patient had calcifications in the Achilles tendon area before surgery. Postoperatively, intratendinous or peritendinous calcifications, ranging in size from 3 mm to 37 mm, were found in 10 (28%) of the 36 patients. The development of calcifications was associated with chronic swelling, decreased range of motion of the ankle joint, and increase pain, especially with calcifications larger than 10 mm. No association was found between the development of calcifications and the surgical technique, suture materials, time from injury to surgery, or postoperative management, and no risk factors could be identified. CONCLUSIONS: Calcifications of the Achilles tendon appear to be frequent after open tendon repair and to have a negative effect on clinical outcome.

Achilles Tendon↗

PubMed2003

Bone ingrowth in bFGF-coated hydroxyapatite ceramic implants.

This experimental study was performed to evaluate angiogenesis, bone formation, and bone ingrowth in response to osteoinductive implants of bovine-derived hydroxyapatite (HA) ceramics either uncoated or coated with basic fibroblast growth factor (bFGF) in miniature pigs. A cylindrical bone defect was created in both femur condyles of 24 miniature pigs using a saline coated trephine. Sixteen of the 48 defects were filled with HA cylinders coated with 50 microg rhbFG, uncoated HA cylinders, and with autogenous transplants, respectively. Fluorochrome labelled histological analysis, histomorphometry, and scanning electron microscopy were performed to study angiogenesis, bone formation and bone ingrowth. Complete bone ingrowth into bFGF-coated HA implants and autografts was seen after 34 days compared to 80 days in the uncoated HA group. Active ring-shaped areas of fluorochrome labelled bone deposition with dynamic bone remodelling were found in all cylinders. New vessels could be found in all cylinders. Histomorphometric analysis showed no difference in bone ingrowth over time between autogenous transplants and bFGF-coated HA implants. The current experimental study revealed comparable results of bFGF-coated HA implants and autogenous grafts regarding angiogenesis, bone synthesis and bone ingrowth.

Animals↗

PubMed2003

Additional costs for preventing the spread of methicillin-resistant Staphylococcus aureus and a strategy for reducing these costs on a surgical ward.

OBJECTIVE: To determine the added costs of hygienic measures (barrier precautions, isolation, and decontamination) required for MRSA carriers in German hospitals and possible strategies for cost reduction. DESIGN: On a septic surgical ward caring for 35% of all MRSA cases in a university hospital (1,182 beds), additional costs for personnel time and materials were calculated and medical charts of all MRSA cases admitted to the ward during 1 year were analyzed retrospectively. Twelve of the ward's 13 beds were located in rooms with at least 2 beds. PATIENTS: Four hundred ninety-eight MRSA carrier hospital-days (of 20 MRSA cases) could be assessed. All patients (80% men, 50% older than 74.5 years) had broken skin. RESULTS: In 95% of the cases, microbiological findings suggested transmission of MRSA during the current or a previous stay on this ward. The study found total avoidable costs of approximately 142,794.01 euros in 1 year, averaging 371.95 euros for one MRSA patient hospital-day and 9,261.56 euros per MRSA case. The most expensive single measure was blocked beds in multibed rooms (305.75 euros/day), which accounted for 82% of the extra costs. Costs most likely were underestimated. CONCLUSIONS: Daily additional case costs amounted to 96% of social security payments. Blocked beds in multibed rooms accounted for more than 80% of these excess costs. Isolation has been scientifically validated and is required by law in Germany. Building an adequate number of single-bed rooms should help prevent spread and would greatly lower the added costs of infection.

Aged↗

PubMed2002

Reconstruction of the lower leg with the sural artery flap.

BACKGROUND: Soft tissue covering on the lower leg is frequently a difficult challenge and causes increasing problems for treatment in smaller hospitals. We introduce a plastic surgery method for covering these soft tissue defects. METHOD: An island of skin, centered above the sural nerve, is cut out in the middle dorsal area of the lower leg. The subcutaneous vascular pedicle is prepared along the nerve. The gained skin flap is rotated into the defect site and fixed without tension. The wound of the donor-site defect is usually closed primarily, and the flap pedicle is covered with Meshcraft. RESULTS: In 18 of the 21 patients treated by this method the flap healed without functional impairment, one patient experienced a necrosis leading to the loss of the flap. And a partial loss of the skin island was recorded in two cases, complete healing was achieved by means of Meshcraft transplantation. CONCLUSIONS: The superficial sural artery flap usually results in a reliable and complete healing of soft tissue defects within the area of the lower legs with justifiable operational expenditures also for elderly patients and those with vascular ailments.

Adult↗

PubMed2002

Recombinant human bone morphogenetic protein-2 for treatment of open tibial fractures: a prospective, controlled, randomized study of four hundred and fifty patients.

BACKGROUND: The treatment of open fractures of the tibial shaft is often complicated by delayed union and nonunion. The objective of this study was to evaluate the safety and efficacy of the use of recombinant human bone morphogenetic protein-2 (rhBMP-2; dibotermin alfa) to accelerate healing of open tibial shaft fractures and to reduce the need for secondary intervention. METHODS: In a prospective, randomized, controlled, single-blind study, 450 patients with an open tibial fracture were randomized to receive either the standard of care (intramedullary nail fixation and routine soft-tissue management [the control group]), the standard of care and an implant containing 0.75 mg/mL of rhBMP-2 (total dose of 6 mg), or the standard of care and an implant containing 1.50 mg/mL of rhBMP-2 (total dose of 12 mg). The rhBMP-2 implant (rhBMP-2 applied to an absorbable collagen sponge) was placed over the fracture at the time of definitive wound closure. Randomization was stratified by the severity of the open wound. The primary outcome measure was the proportion of patients requiring secondary intervention because of delayed union or nonunion within twelve months postoperatively. RESULTS: Four hundred and twenty-one (94%) of the patients were available for the twelve-month follow-up. The 1.50-mg/mL rhBMP-2 group had a 44% reduction in the risk of failure (i.e., secondary intervention because of delayed union; relative risk = 0.56; 95% confidence interval = 0.40 to 0.78; pairwise p = 0.0005), significantly fewer invasive interventions (e.g., bone-grafting and nail exchange; p = 0.0264), and significantly faster fracture-healing (p = 0.0022) than did the control patients. Significantly more patients treated with 1.50 mg/mL of rhBMP-2 had healing of the fracture at the postoperative visits from ten weeks through twelve months (p = 0.0008). Compared with the control patients, those treated with 1.50 mg/mL of rhBMP-2 also had significantly fewer hardware failures (p = 0.0174), fewer infections (in association with Gustilo-Anderson type-III injuries; p = 0.0219), and faster wound-healing (83% compared with 65% had wound-healing at six weeks; p =0.0010). CONCLUSIONS: The rhBMP-2 implant was safe and, when 1.50 mg/mL was used, significantly superior to the standard of care in reducing the frequency of secondary interventions and the overall invasiveness of the procedures, accelerating fracture and wound-healing, and reducing the infection rate in patients with an open fracture of the tibia.

Adolescent↗

PubMedDate not supplied

Sonographic detection of an isolated cuboid bone fracture not visualized on plain radiographs.

We report the case of an isolated cuboid bone fracture in a child that was missed on radiography but was diagnosed on sonography. Plain radiographs of the patient's right foot showed no fracture, whereas sonograms demonstrated a fracture of the cuboid bone that appeared as a steplike discontinuity in the cortical bone. The diagnosis was confirmed on MRI. The fracture was treated with cast immobilization and no weight bearing for 4 weeks. In 8 weeks, the patient had no symptoms and good motor and sensory function of her right foot. Other imaging modalities are usually advocated for diagnosing fractures that are missed by radiography. Over the last decade, sonography has been increasingly used for diagnosing occult fractures. Although its use in such cases is not yet fully established, we believe that in the future, the sonographic detection of an injury that corresponds to the site of the reported pain will be adequate for initiating treatment of many types of fractures.

Child, Preschool↗