A. Schmelz

Universität Ulm, Ulm, Baden-Württemberg, Germany

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Publications (28)13.45 Total impact

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    M Schofer · A Schmelz · M Schultz

    Preview · Article · May 2009 · Value in Health
  • T Einsiedel · J Dieterich · L Kinzl · F Gebhard · A Schmelz
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    ABSTRACT: Irreversible destruction of the forefoot and midfoot generally leads to amputation. So-called limited surgical procedures such as transmetatarsal or Chopart/Syme amputations often result in poor clinical outcomes. Prostheses for these stumps are difficult to fit, a fact that reduces mobility for these patients, so reamputations are not rare. The very old method of tibiocalcaneal arthrodesis introduced by Pirogoff in 1854 can be an interesting surgical alternative in these cases, and the use of an Ilizarov external ring fixator may solve the stabilisation problem. From 1 January 1990 to 1 January 2007, six patients underwent surgery for tibiocalcaneal Pirogoff arthrodesis with an external Ilizarov ring fixator. All patients could be evaluated postoperatively, with a medium follow-up time of 45.8 months. Outcome was measured with a modified ankle disarticulation score. In four cases, the outcome was good or excellent. Two cases (33%) with initially successful arthrodeses required transtibial reamputations because of secondary infection. All other cases healed very well. There was no delayed union or nonunion of the arthrodeses in our series. Tibiocalcaneal Pirogoff arthrodesis can be a surgical alternative in forefoot and midfoot destructions to achieve a well-covered, comfortable stump with a minimum of leg-length shortening that is easy to fit with a prosthesis and even allows some limited barefoot mobility. Bony fixation and healing of the arthrodesis are the challenges, but these difficulties can be avoided by using an external ring fixator system. Despite a failure rate of up to one-third, this method can be an effective solution due to the good functional outcome.
    No preview · Article · Mar 2008 · Der Orthopäde
  • T. Einsiedel · J. Dieterich · L. Kinzl · F. Gebhard · A. Schmelz
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    ABSTRACT: Background Irreversible destruction of the forefoot and midfoot generally leads to amputation. So-called limited surgical procedures such as transmetatarsal or Chopart/Syme amputations often result in poor clinical outcomes. Prostheses for these stumps are difficult to fit, a fact that reduces mobility for these patients, so reamputations are not rare. The very old method of tibiocalcaneal arthrodesis introduced by Pirogoff in 1854 can be an interesting surgical alternative in these cases, and the use of an Ilizarov external ring fixator may solve the stabilisation problem. Material and methods From 1 January 1990 to 1 January 2007, six patients underwent surgery for tibiocalcaneal Pirogoff arthrodesis with an external Ilizarov ring fixator. Results All patients could be evaluated postoperatively, with a medium follow-up time of 45.8 months. Outcome was measured with a modified ankle disarticulation score. In four cases, the outcome was good or excellent. Two cases (33%) with initially successful arthrodeses required transtibial reamputations because of secondary infection. All other cases healed very well. There was no delayed union or nonunion of the arthrodeses in our series. Conclusions Tibiocalcaneal Pirogoff arthrodesis can be a surgical alternative in forefoot and midfoot destructions to achieve a well-covered, comfortable stump with a minimum of leg-length shortening that is easy to fit with a prosthesis and even allows some limited barefoot mobility. Bony fixation and healing of the arthrodesis are the challenges, but these difficulties can be avoided by using an external ring fixator system. Despite a failure rate of up to one-third, this method can be an effective solution due to the good functional outcome.
    No preview · Article · Feb 2008 · Der Orthopäde
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    ABSTRACT: In a prospective study 104 patients >or=65 years with distal radius fractures (DRF; n=52) and proximal forearm fractures (PHF; n=52) were followed up for a period of 4 months after injury. As an inception- cohort study, influence on treatment pattern was not part of the examination. A total of 53% of the DRF and 74% of the PHF patients underwent surgery. There were no significant changes in the ability of daily living management (IADL) with either fracture form. Functional outcome was better in PHF than DRF patients. PHF patients showed a high incidence in "fear of falling" throughout the whole study, whereas fear of falling rose significantly in DRF patients. 4% of DRF and 9.6% of PHF patients died during the observation period, while 6% of DRF and even 17% of PHF patients had to give up their own housekeeping. One third of both patient groups did not receive physiotherapy. In only 12% of DRF and 6% of PHF patients was osteoporosis treated. In both groups of patients there was a significant worsening in the ability of walking after injury, leading to two or more new falls in 24% of DRF and 28% of PHF patients.
    No preview · Article · Dec 2006 · Zeitschrift für Gerontologie + Geriatrie
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    ABSTRACT: In a prospective study 104 patients ≥65 years with distal radius fractures (DRF; n=52) and proximal forearm fractures (PHF; n=52) were followed up for a period of 4 months after injury. As an inception- cohort study, influence on treatment pattern was not part of the examination. A total of 53% of the DRF and 74% of the PHF patients underwent surgery. There were no significant changes in the ability of daily living management (IADL) with either fracture form. Functional outcome was better in PHF than DRF patients. PHF patients showed a high incidence in “fear of falling” throughout the whole study, whereas fear of falling rose significantly in DRF patients. 4% of DRF and 9.6% of PHF patients died during the observation period, while 6% of DRF and even 17% of PHF patients had to give up their own housekeeping. One third of both patient groups did not receive physiotherapy. In only 12% of DRF and 6% of PHF patients was osteoporosis treated. In both groups of patients there was a significant worsening in the ability of walking after injury, leading to two or more new falls in 24% of DRF and 28% of PHF patients.
    No preview · Article · Nov 2006 · Zeitschrift für Gerontologie + Geriatrie
  • A Schmelz · L Kinzl · T Einsiedel
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    ABSTRACT: Infections of the locomotive system appear in many different forms such as acute inflammation of joints or bone following injury or surgical or chronic processes, often lasting for years. They demand an exact treatment plan not only to remove necrotic tissue but also for reconstruction of defects. A special problem is infection following alloplastic reconstruction of joints or spine. Multiple surgical procedures are required to hinder reinfection, restore function, and assure acceptable patient quality of life.
    No preview · Article · Nov 2006 · Der Chirurg
  • Article: Osteitis
    A. Schmelz · L. Kinzl · T. Einsiedel
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    ABSTRACT: Infektionen des Bewegungsapparates kommen in vielen Erscheinungsformen vor. Sie reichen von akuten Infekten an Gelenken und knchernen Strukturen der Extremitten nach Frakturen oder chirurgischen Manahmen bis hin zu chronischen Verlufen. Neben dem radikalen Debridement des nekrotischen Gewebes ist ein genauer Behandlungsplan zur Defektrekonstruktion und Wiedererlangung der Funktion erforderlich. Eine Sonderstellung nehmen Infektion nach alloplastischem Gelenkersatz oder der Wirbelsule ein. Ein abgestuftes, oft mehrzeitiges operatives Vorgehen vermag dem Patienten Infektrezidivfreiheit, Funktion sowie eine angemessene Lebensqualitt wiedergeben.Infections of the locomotive system appear in many different forms such as acute inflammation of joints or bone following injury or surgical or chronic processes, often lasting for years. They demand an exact treatment plan not only to remove necrotic tissue but also for reconstruction of defects. A special problem is infection following alloplastic reconstruction of joints or spine. Multiple surgical procedures are required to hinder reinfection, restore function, and assure acceptable patient quality of life.
    No preview · Article · Sep 2006 · Der Chirurg
  • A. Schmelz · L. Kinzl · T. Einsiedel
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    ABSTRACT: Infektionen des Bewegungsapparates kommen in vielen Erscheinungsformen vor. Sie reichen von akuten Infekten an Gelenken und knöchernen Strukturen der Extremitäten nach Frakturen oder chirurgischen Maßnahmen bis hin zu chronischen Verläufen. Neben dem radikalen Debridement des nekrotischen Gewebes ist ein genauer Behandlungsplan zur Defektrekonstruktion und Wiedererlangung der Funktion erforderlich. Eine Sonderstellung nehmen Infektion nach alloplastischem Gelenkersatz oder der Wirbelsäule ein. Ein abgestuftes, oft mehrzeitiges operatives Vorgehen vermag dem Patienten Infektrezidivfreiheit, Funktion sowie eine angemessene Lebensqualität wiedergeben.
    No preview · Article · Sep 2006 · Der Chirurg
  • A. Schmelz · A. Friedrich · L. Kinzl · T. Einsiedel

    No preview · Article · Aug 2006 · Aktuelle Traumatologie
  • T. Einsiedel · D. Seitz · M. Schultheiss · L. Kinzl · A. Schmelz

    No preview · Article · Apr 2006 · Aktuelle Traumatologie

  • No preview · Article · Aug 2005 · Aktuelle Traumatologie
  • A Beck · M Bischoff · F Gebhard · M Huber-Lang · L Kinzl · A Schmelz
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    ABSTRACT: Opinions vary with regard to the equipment and structural furnishings required for adequate management of the trauma patient in the dedicated shock suite. In order to assess the current situation in Germany, we conducted a survey of the 76 centers participating in the Polytrauma Registry of the DGU. Fifty-one questionnaires were returned by centers representing all levels of care. Responses revealed, for example, that not all centers possess capabilities for conventional radiography in the shock suite (7/51). Only 20 centers had a fixed table; the remaining 24 hospitals used either an image converter or a mobile X-ray unit. A dedicated ultrasound scanner was provided for the shock suite in 39 of 51 centers responding. Dedicated computed tomography scanners were provided for the shock suite in only eight centers (one dedicated trauma center, three level 3 centers, four university hospitals). All eight scanners use helical CT technology; at least three of the units are 8- or 16-slice. Of 51 shock suites, 12 are air-conditioned in compliance with sterile criteria (and are officially designated as surgical suites), while the remaining 39 are not. In acute cases, emergency surgeries can be performed in the shock suite in 37 centers, but not in the remaining 14 shock suites. According to the survey, slightly less than half of the hospitals responding are un-satisfied with the shock suite infrastructure ( n=24) and, of these, 13 centers are actively planning changes (the necessary financial resources have been guaranteed in 10 centers). Fourteen centers desire changes but do not currently have the required money. Information provided by Philips and Siemens suggests that the cost of furnishing a new shock suite ranges between 1.4 and 1.7 million euros. Responses to our survey show that a large gap remains between wishes and reality in the technical infrastructure in many shock suites in Germany.
    No preview · Article · Nov 2004 · Der Unfallchirurg
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    ABSTRACT: Zusammenfassung Zur strukturellen Voraussetzung für eine adäquate Versorgung eines schwerverletzten Patienten im Schockraum gibt es viele Überlegungen in Bezug auf die apparative Ausstattung. Um einen Überblick zu bekommen wurde hierzu eine Umfrage unter den am Polytraumaregister der DGU teilnehmenden 76 Kliniken durchgeführt. Zur Auswertung kamen 51 Bögen aus Krankenhäusern aller Versorgungsstufen. Hier zeigte sich, dass nicht in allen Kliniken bisher die Möglichkeit des konventionellen Röntgens im Schockraum zu Verfügung steht (7/51). Nur 20 Kliniken verfügen über ein Deckenstativ, in den restlichen 24 Kliniken werden entweder Bildwandler oder mobile Röntgengeräte eingesetzt. Ein eigenes Sonographiegerät steht in 39 von 51 Kliniken im Schockraum zu Verfügung. Nur 8 Kliniken verfügen über einen Computertomographen (CT) im Schockraum. Hierbei handelt es sich um Spiral-CT, wobei mindestens 3 Geräte 8- bzw. 16-Zeiler sind. 12 von 51 Schockräumen sind nach Reinraumkriterien klimatisiert (und somit offiziell als Operationssaal zugelassen), die übrigen nicht. Im Notfall können in 37 Kliniken Notoperationen im Schockraum durchgeführt werden. Entsprechend der Erhebung sind knapp die Hälfte der Kliniken mit ihrer Infrastruktur im Schockraum unzufrieden ( n=24), wobei 13 Häuser Änderungen planen. Eine gesicherte Finanzierung hierfür gibt es nur in 10 Kliniken. Eine Anfrage bei den Marktführern Medizintechnik (Philips und Siemens) ergab, dass für die diagnostisch-apparative Ausstattung eines neu einzurichtenden Schockraums zwischen 1,4 und 1,7 Mio. Euro zu investieren sind. Die Datenlage zeigt, dass zwischen Anspruch und Realität in Bezug auf die apparative Ausstattung in den Schockräumen deutscher Krankenhäuser noch z. T. große Unterschiede oder gar Defizite vorliegen.
    No preview · Article · Oct 2004 · Der Unfallchirurg

  • No preview · Article · Aug 2004 · Der Klinikarzt
  • A. Schmelz · Th. Einsiedel · L. Kinzl · A. Beck · P. Keppler · M. Kramer

    No preview · Article · Aug 2004 · Der Klinikarzt
  • A. Schmelz · M. Kramer · A. Beck · L. Kinzl · P. Keppler · Th. Einsiedel

    No preview · Article · Aug 2004 · Der Klinikarzt
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    ABSTRACT: The treatment of wounds, especially of chronic or complicated ones, is a long-lasting, expensive item that needs a lot of experience, knowledge and equipment. In these lesions, history taking, diagnostic procedures and apparative tests are obvious just like in the therapy of any other disease. The steps to solution in wound healing are avoiding of causative damage, revascularisation, control of infection and reconstruction of remaining tissue defects. All these methods, thus, can only support normal wound healing. A lot of temporary special dressings, such as hydrocolloids or alginates or procedures like vacuum treatment or biosurgery with maggots are available. As in the treatment plan of chronic wounds surgery has to be planned and performed, wound treatment was and will be a basic part of the surgeon's job.
    No preview · Article · Jan 2004

  • No preview · Article · Jan 2004
  • A Schmelz · D Ziegler · A Beck · L Kinzl · F Gebhard
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    ABSTRACT: Are the costs required for a polytraumatised patient sufficiently paid by the health care companies?The study population consisted of 71 polytrauma patients. The treatment-costs were calculated and compared with the reimbursements. The mean patient age was 38.0 years with a mean injury severity score (ISS) of 23.0 points. The mean duration of hospitalisation was 25.9 days and the mean calculated cost per patient was Euro 21,866.30. The reimbursement was only Euro 16,863.03/patient. This leads to a financial deficit of approximately Euro 5,000/patient (Euro 167/polytrauma patient/hospital day) and nearly Euro 355,000 for all patients during the period of 1 year. The introduction of the DRG system endangers the high standard of polytrauma treatment because of insufficient reimbursement.It is necessary to consider the implementation of an additional polytrauma-reimbursement based on the injury severity and duration of hospitalisation. The concentration of the patients in trauma centres, where the optimum of therapy is guarantied, leads in these hospitals to a continuously increasing deficit. The latter may be deleterious for the concept of "trauma centers" in the future.
    No preview · Article · Dec 2002 · Der Unfallchirurg
  • A. Schmelz · D. Ziegler · A. Beck · L. Kinzl · F. Gebhard
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    ABSTRACT: Are the costs required for a polytraumatised patient sufficiently paid by the health care companies? The study population consisted of 71 polytrauma patients. The treatment-costs were calculated and compared with the reimbursements. The mean patient age was 38.0 years with a mean injury severity score (ISS) of 23.0 points. The mean duration of hospitalisation was 25.9 days and the mean calculated cost per patient was Euro 21,866.30. The reimbursement was only Euro 16,863.03/patient. This leads to a financial deficit of approximately Euro 5,000/patient (Euro 167/polytrauma patient/hospital day) and nearly Euro 355,000 for all patients during the period of 1 year. The introduction of the DRG system endangers the high standard of polytrauma treatment because of insufficient reimbursement. It is necessary to consider the implementation of an additional polytrauma-reimbursement based on the injury severity and duration of hospitalisation. The concentration of the patients in trauma centres, where the optimum of therapy is guarantied, leads in these hospitals to a continuously increasing deficit. The latter may be deleterious for the concept of “trauma centers” in the future.
    No preview · Article · Nov 2002 · Der Unfallchirurg