126
|
Nüchtern JV, Hartel MJ, Henes FO, Groth M, Jauch SY, Haegele J, Briem D, Hoffmann M, Lehmann W, Rueger JM, Großterlinden LG. Significance of clinical examination, CT and MRI scan in the diagnosis of posterior pelvic ring fractures. Injury 2015; 46:315-9. [PMID: 25527459 DOI: 10.1016/j.injury.2014.10.050] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 05/29/2014] [Accepted: 10/14/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Patients with a fracture in the anterior pelvic ring often simultaneously demonstrate pain in the posterior pelvic ring. The aim of the present prospective study was to assess the sensitivity of CT, MRI and clinical examination in the detection of fractures in the posterior pelvic ring in patients with fractures of the anterior pelvic ring diagnosed in conventional radiographs. METHODS Sixty patients with radiographic signs of an anterior pelvic ring injury were included in this prospective analysis. Following a focused clinical examination of the posterior pelvis, all patients underwent both a CT and then a MRI scan of their pelvis. Two board certified radiologists evaluated the CT and MRI scans independently. To estimate the presence of osteoporosis the Hounsfield units of the vertebral body of L5 were measured in each case. RESULTS Fifty-three women and seven men, with a mean age of 74.7+/-15.6 years were included into the study. A fracture of the posterior pelvic ring was found in fourty-eight patients (80%) patients using MRI. Fractures of the posterior pelvic ring would have been missed in eight cases (17%), if only CT had been used. Eighty-five percent of the patients with a posterior fracture had an osteoporosis. The majority of the cases suffered from a low energy trauma. Thirty-eight patients (83%) with positive clinical signs at the posterior pelvic ring actually had a fracture of the posterior pelvic ring in the MRI. The clinical examination proved to be equally effective to CT in detecting posterior pelvic ring fractures. CONCLUSION The significance of both, clinical examination and CT was confirmed in the detection of fractures in the posterior pelvic ring. MRI examination of the pelvis however, was found to be superior in detecting undislocated fractures in a cohort of patients with a high incidence of osteoporosis. Using MRI may be beneficial in select cases, especially when reduced bone density is suspected.
Collapse
|
127
|
Behzadi C, Karul M, Henes FO, Laqmani A, Catala-Lehnen P, Lehmann W, Nagel HD, Adam G, Regier M. Comparison of conventional radiography and MDCT in suspected scaphoid fractures. World J Radiol 2015; 7:22-27. [PMID: 25628802 PMCID: PMC4295175 DOI: 10.4329/wjr.v7.i1.22] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/28/2014] [Accepted: 12/31/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the diagnostic accuracy and radiation dose of conventional radiography and multidetector computed tomography (MDCT) in suspected scaphoid fractures.
METHODS: One hundred twenty-four consecutive patients were enrolled in our study who had suffered from a wrist trauma and showed typical clinical symptoms suspicious of an acute scaphoid fracture. All patients had initially undergone conventional radiography. Subsequent MDCT was performed within 10 d because of persisting clinical symptoms. Using the MDCT data as the reference standard, a fourfold table was used to classify the test results. The effective dose and impaired energy were assessed in order to compare the radiation burden of the two techniques. The Wilcoxon test was performed to compare the two diagnostic modalities.
RESULTS: Conventional radiography showed 34 acute fractures of the scaphoid in 124 patients (42.2%). Subsequent MDCT revealed a total of 42 scaphoid fractures. The sensitivity of conventional radiography for scaphoid fracture detection was 42.8% and its specificity was 80% resulting in an overall accuracy of 59.6%. Conventional radiography was significantly inferior to MDCT (P < 0.01) concerning scaphoid fracture detection. The mean effective dose of MDCT was 0.1 mSv compared to 0.002 mSv of conventional radiography.
CONCLUSION: Conventional radiography is insufficient for accurate scaphoid fracture detection. Regarding the almost negligible effective dose, MDCT should serve as the first imaging modality in wrist trauma.
Collapse
|
128
|
Aubin H, Kühn C, Ellenrieder M, Junge K, Larena-Avellaneda A, Lehmann W, Mittelmeier W, Pakos P, Radtke C, Schmitz-Rixen T, Schwarz M, Steiner T, Walles T, Wünsch L, Wilhelmi M. Arbeitsgemeinschaft „Implantatforschung“ der Deutschen Gesellschaft für Chirurgie. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2014. [DOI: 10.1007/s00398-014-1113-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
129
|
Lehmann W, Hoffmann M, Fensky F, Nüchtern J, Großterlinden L, Aghayev E, Lehmann H, Stuby F, Rueger JM. What is the frequency of nerve injuries associated with acetabular fractures? Clin Orthop Relat Res 2014; 472:3395-403. [PMID: 25141842 PMCID: PMC4182421 DOI: 10.1007/s11999-014-3838-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acetabular fractures and surgical interventions used to treat them can result in nerve injuries. To date, only small case studies have tried to explore the frequency of nerve injuries and their association with patient and treatment characteristics. High-quality data on the risk of traumatic and iatrogenic nerve lesions and their epidemiology in relation to different fracture types and surgical approaches are lacking. QUESTIONS/PURPOSES The purpose of this study was to determine (1) the proportion of patients who develop nerve injuries after acetabular fracture; (2) which fracture type(s) are associated with increased nerve injury risk; and (3) which surgical approach was associated with the highest proportion of patients developing nerve injuries using data from the German Pelvic Trauma Registry. Two secondary aims were (4) to assess hospital volume-nerve-injury relationship; and (5) internal data validity. METHODS Between March 2001 and June 2012, 2236 patients with acetabular fractures were entered into a prospectively maintained registry from 29 hospitals; of those, 2073 (92.7%) had complete records on the endpoints of interest in this retrospective study and were analyzed. The neurological status in these patients was captured at their admission and at the discharge. A total of 1395 of 2073 (67%) patients underwent surgery, and the proportions of intervention-related and other hospital-acquired nerve injuries were obtained. Overall proportions of patients developing nerve injuries, risk based on fracture type, and risk of surgical approach type were analyzed. RESULTS The proportion of patients being diagnosed with nerve injuries at hospital admission was 4% (76 of 2073) and at discharge 7% (134 or 2073). Patients with fractures of the "posterior wall" (relative risk [RR], 2.0; 95% confidence interval [CI], 1.4-2.8; p=0.001), "posterior column and posterior wall" (RR, 2.9; CI, 1.6-5.0; p=0.002), and "transverse+posterior wall" fracture (RR, 2.1; CI, 1.3-3.5; p=0.010) were more likely to have nerve injuries at hospital discharge. The proportion of patients with intervention-related nerve injuries and that of patients with other hospital-acquired nerve injuries was 2% (24 of 1395 and 46 of 2073, respectively). They both were associated with the Kocher-Langenbeck approach (RR, 3.0; CI, 1.4-6.2; p=0.006; and RR, 2.4; CI, 1.4-4.3; p=0.004, respectively). CONCLUSIONS Acetabular fractures with the involvement of posterior wall were most commonly accompanied with nerve injuries. The data suggest also that Kocher-Langenbeck approach to the pelvic ring is associated with a higher risk of perioperative nerve injuries. Trauma surgeons should be aware of common nerve injuries, particularly in posterior wall fractures. The results of the study should help provide patients with more exact information on the risk of perioperative nerve injuries in acetabular fractures. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Collapse
|
130
|
Lehmann W, Fensky F, Hoffmann M, Rueger J. Der Stoppa-Zugang zur Versorgung von Azetabulumfrakturen. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2014; 152:435-7. [DOI: 10.1055/s-0034-1368601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
131
|
Weiser L, Korecki MA, Sellenschloh K, Fensky F, Püschel K, Morlock MM, Rueger JM, Lehmann W. The role of inter-prosthetic distance, cortical thickness and bone mineral density in the development of inter-prosthetic fractures of the femur. Bone Joint J 2014; 96-B:1378-84. [DOI: 10.1302/0301-620x.96b10.33461] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
It is becoming increasingly common for a patient to have ipsilateral hip and knee replacements. The inter-prosthetic (IP) distance, the distance between the tips of hip and knee prostheses, has been thought to be associated with an increased risk of IP fracture. Small gap distances are generally assumed to act as stress risers, although there is no real biomechanical evidence to support this. The purpose of this study was to evaluate the influence of IP distance, cortical thickness and bone mineral density on the likelihood of an IP femoral fracture. A total of 18 human femur specimens were randomised into three groups by bone density and cortical thickness. For each group, a defined IP distance of 35 mm, 80 mm or 160 mm was created by choosing the appropriate lengths of component. The maximum fracture strength was determined using a four-point bending test. The fracture force of all three groups was similar (p = 0.498). There was a highly significant correlation between the cortical area and the fracture strength (r = 0.804, p < 0.001), whereas bone density showed no influence. This study suggests that the IP distance has little influence on fracture strength in IP femoral fractures: the thickness of the cortex seems to be the decisive factor. Cite this article: Bone Joint J 2014;96-B:1378–84.
Collapse
|
132
|
Fensky F, Kueny RA, Sellenschloh K, Püschel K, Morlock MM, Rueger JM, Lehmann W, Huber G, Hansen-Algenstaedt N. Biomechanical advantage of C1 pedicle screws over C1 lateral mass screws: a cadaveric study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:724-31. [PMID: 24378628 PMCID: PMC3960438 DOI: 10.1007/s00586-013-3143-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 12/14/2013] [Accepted: 12/15/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE The established technique for posterior C1 screw placement is via the lateral mass. Use of C1 monocortical pedicle screws is an emerging technique which utilizes the bone of the posterior arch while avoiding the paravertebral venous plexus and the C2 nerve root. This study compared the relative biomechanical fixation strengths of C1 pedicle screws with C1 lateral mass screws. METHODS Nine human C1 vertebrae were instrumented with one lateral mass screw and one pedicle screw. The specimens were subjected to sinusoidal, cyclic (0.5 Hz) fatigue loading. Peak compressive and tensile forces started from ±25 N and constantly increased by 0.05 N every cycle. Testing was stopped at 5 mm displacement. Cycles to failure, displacement, and initial and end stiffness were measured. Finally, CT scans were taken and the removal torque measured. RESULTS The pedicle screw technique consistently and significantly outperformed the lateral mass technique in cycles to failure (1,083 ± 166 vs. 689 ± 240 cycles), initial stiffness (24.6 ± 3.9 vs. 19.9 ± 3.2 N/mm), end stiffness (16.6 ± 2.7 vs. 11.6 ± 3.6 N/mm) and removal torque (0.70 ± 0.78 vs. 0.13 ± 0.09 N m). Only 33 % of pedicle screws were loose after testing compared to 100 % of lateral mass screws. CONCLUSIONS C1 pedicle screws were able to withstand higher toggle forces than lateral mass screws while maintaining a higher stiffness throughout and after testing. From a biomechanical point of view, the clinical use of pedicle screws in C1 is a promising alternative to lateral mass screws.
Collapse
|
133
|
Rehfeld K, Hökelmann A, Lehmann W, Blaser P. Auswirkungen einer Tanz- und Kraft-Ausdauer-Intervention auf kognitive Fähigkeiten älterer Menschen. ZEITSCHRIFT FÜR NEUROPSYCHOLOGIE 2014. [DOI: 10.1024/1016-264x/a000124] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Mentale und körperliche Gesundheit sind eng verbunden mit einem erfolgreichen Altern. Diese Studie untersucht die Auswirkungen eines Tanztrainings im Vergleich zu einem Kraft-/Ausdauertraining sowie der Kombination beider auf die fluide Intelligenz, die allgemeine Intelligenz und das Arbeitsgedächtnis älterer Menschen (M=68 ± 4.16 Jahre). 95 Senioren wurden in folgenden Gruppen randomisiert: 1. Tanz, 2. Sport, 3. Tanz und Sport. Die Gruppe Tanz und die Gruppe Sport trainierten 90 Minuten, die Gruppe Tanz und Sport 180 Minuten für 15 Monate. Die Ergebnisse zeigen signifikante Leistungssteigerungen in allen gemessenen Merkmalen in den drei Gruppen. Post Hoc Vergleiche verdeutlichen, dass sich die Leistungssteigerungen zwischen den Gruppen signifikant nicht unterscheiden. Körperliche Bewegung jeglicher Art trägt zum erfolgreichen Altern bei.
Collapse
|
134
|
Kolb JP, Kueny RA, Püschel K, Boger A, Rueger JM, Morlock MM, Huber G, Lehmann W. Does the cement stiffness affect fatigue fracture strength of vertebrae after cement augmentation in osteoporotic patients? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:1650-6. [PMID: 23677522 PMCID: PMC3698342 DOI: 10.1007/s00586-013-2809-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 02/23/2013] [Accepted: 04/28/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Normal progression of osteoporosis or the rigid reinforcement of the fractured vertebral body with polymethyl methacrylate (PMMA) cement is being discussed as a cause for adjacent-level fractures after vertebroplasty. The purpose of this study was to investigate whether augmentation with low stiffness cement can decrease the risk of adjacent-level fractures in low-quality bone. METHODS Eighteen female osteoporotic lumbar specimens (L1-L5) were harvested and divided into three groups according to bone mineral density: (I) native; (II) PMMA; (III) modified PMMA (lower stiffness). For the PMMA and modified PMMA groups, a compression fracture was first mechanically induced in L3, and then the fracture received vertebroplasty treatment. The cement stiffness reduction of the modified PMMA group was achieved via an addition of 8 mL of serum to the typical PMMA base. All specimens were exposed to cyclic loading (4 Hz) and a stepwise increasing applied peak force. Cement stiffness was tested according to ISO 5833. RESULTS A 51% decrease in cement stiffness was achieved in the modified PMMA group (954 ± 141 vs. 1,937 ± 478 MPa, p < 0.001). Fatigue fracture force (the force level during cyclic loading at which the deformation experienced a sudden increase; FFF) was significantly affected by bone quality (r (2) = 0.39, p = 0.006) and by the initial fracture force (the force necessary to create the initial fracture in L3 prior to augmentation; r (2) = 0.82, p < 0.001). Using initial fracture force as a covariate, the FFF of the modified PMMA group (1,764 ± 49 N) was significantly higher than in the PMMA group (1,544 ± 55 N; p = 0.03). CONCLUSIONS A possible method to reduce adjacent-level fractures after vertebroplasty in patients with reduced bone quality could be the use of a lower modulus cement. Therefore, mixing cement with biocompatible fluids could prove useful to tailor cement properties in the operating theater.
Collapse
|
135
|
Fensky F, Nüchtern JV, Kolb JP, Huber S, Rupprecht M, Jauch SY, Sellenschloh K, Püschel K, Morlock MM, Rueger JM, Lehmann W. Cement augmentation of the proximal femoral nail antirotation for the treatment of osteoporotic pertrochanteric fractures--a biomechanical cadaver study. Injury 2013; 44:802-7. [PMID: 23545113 DOI: 10.1016/j.injury.2013.03.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/19/2013] [Accepted: 03/03/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Proximal femoral fractures will gain increasing importance in the future due to the epidemiological development. Osteoporosis is often a limiting factor in the achievement of implant stability. New nailing systems offer the possibility of augmentation of the femoral neck component with cement. The aim of this study was to perform a biomechanical comparison of implant stability in osteoporotic pertrochanteric fractures using the proximal femoral nail antirotation (PFNA, Synthes GmbH, Umkirch, Germany) with cement augmented and non-augmented blades. MATERIALS AND METHODS Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DEXA) in six pairs of fresh-frozen human femurs. Standardised pertrochanteric fractures (AO31-A2.3) were treated with a PFNA. Cement augmentation was performed in six constructs. Axial loading was applied according to a single-leg-stance model using a hydraulic testing machine increasing to 1400N over 10,000 cycles. Biomechanical comparisons between the two groups that were comparable concerning BMD, tip-apex-distance and native stiffness were made with regard to postoperative stiffness, survived cycles, load to failure, failure mechanism and axial displacement. RESULTS The stiffness of all stabilised femurs was significantly lower than for native specimens (native 702.5±159.6N/mm vs. postoperative 275.4±53.8N/mm, p<0.001). Stiffness after instrumentation was significantly greater for the cement augmented group than for the non-augmented group (300.6±46.7N/mm vs. 250.3±51.6N/mm, respectively, p=0.001). Five of the twelve constructs survived cyclic testing. Statistically significant differences of the BMD were detected between survived and failed constructs (0.79±0.17g/cm(2) vs. 0.45±0.12g/cm(2), respectively, p=0.028). The failure loads for specimens surviving 10,000 cycles were 4611.9±2078.9N in the cement augmented group (n=3) and 4516.3N and 3253.5N in the non-augmented group (n=2). Postoperative stiffness was found to be a positive predictor of maximum force to failure (R(2)=0.83, p=0.02). CONCLUSIONS The results of this biomechanical study show that cement augmentation of the PFNA increases the implant stability in osteoporotic pertrochanteric fractures. Further studies are necessary to evaluate this procedure in providing long term clinical results.
Collapse
|
136
|
Nüchtern JV, Sellenschloh K, Bishop N, Jauch S, Briem D, Hoffmann M, Lehmann W, Pueschel K, Morlock MM, Rueger JM, Großterlinden LG. Biomechanical evaluation of 3 stabilization methods on acromioclavicular joint dislocations. Am J Sports Med 2013; 41:1387-94. [PMID: 23618701 DOI: 10.1177/0363546513484892] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Traumatic acromioclavicular (AC) joint dislocations can be addressed with several surgical stabilization techniques. The aim of this in vitro study was to evaluate biomechanical features of the native joint compared with 3 different stabilization methods: locking hook plate (HP), TightRope (TR), and bone anchor system (AS). HYPOTHESIS The HP provides higher stiffness than the anatomic reconstruction techniques. STUDY DESIGN Controlled laboratory study. METHODS A new biomechanical in vitro model of the AC joint was used to analyze joint stability after surgical repair (HP, TR, and AS). Eighteen cadaveric specimens were randomized for bone density and diameter in the midclavicle section. Joint stiffness was measured by applying an axial load and a defined physiological range of motion for internal and external rotations and upward and downward rotations. Data were recorded at 3 stages: for the native joint after dissecting the AC ligaments, directly after repair, and after axial cyclic loading (1000 cycles with 20 and 70 N at 1 Hz). To evaluate which implant mimics physiological joint properties best, axial stiffness of vertical stability was assessed in combination with rotation. Finally, static loading in the superior direction was applied until failure of the joints occurred. RESULTS Axial stiffness of the TR and AS groups was 2-fold higher than for the HP group and the native joint (67.1, 66.1, and 22.5 N/mm, respectively; P < .004). Decreased load-to-failure rates were recorded in the HP group compared with the TR and AS groups (248.9 ± 72.7, 832.0 ± 401.4, and 538.0 ± 166.1 N, respectively). The stiffness of the rotations was not significantly different between the treatment methods but was lower in horizontal and downward rotations compared with the native state. Thus, native AC ligaments contributed a significant share to joint stiffness. CONCLUSION The TR and AS groups demonstrated higher vertical load capacity. Compared with the TR and AS, the HP demonstrated an axial stiffness closest to the native joint. For restoring physiological properties, reconstruction of the AC ligaments may be necessary. CLINICAL RELEVANCE The results show different biomechanical properties of the HP and anatomic reconstructions.
Collapse
|
137
|
Lehmann W, Großterlinden L, Rueger JM. [Posterior approaches to the pelvic ring]. Unfallchirurg 2013; 116:205-12. [PMID: 23478897 DOI: 10.1007/s00113-012-2330-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The posterior pelvic ring is critical for the mechanical stability of the pelvis. There is considerable variability in the degree of traumatic injury to the posterior pelvis which results in damage to the ligaments, the bones or a combination of these two functional structures. For management of combined posterior and anterior pelvic ring injuries it is crucial to decide which side has to be treated with priority. Surgical approaches for the posterior pelvic ring include transiliacal plate osteosynthesis, local plate osteosynthesis, iliosacral screw ostheosynthesis and spinopelvic stabilization. The degree of soft tissue damage represents an important criterion that should be considered when determining the surgical approach because extensive soft tissue damage often prevents enlarged explorative surgical access. Especially in posterior pelvic ring injuries, soft tissues should be preserved as much as possible because long periods of immobilization in severely injured patients can compromise wound healing. The aim of this paper is to provide an overview of the most commonly used posterior surgical approaches for pelvic ring injuries.
Collapse
|
138
|
Spiro AS, Regier M, Novo de Oliveira A, Vettorazzi E, Hoffmann M, Petersen JP, Henes FO, Demuth T, Rueger JM, Lehmann W. The degree of articular depression as a predictor of soft-tissue injuries in tibial plateau fracture. Knee Surg Sports Traumatol Arthrosc 2013; 21:564-70. [PMID: 22965381 DOI: 10.1007/s00167-012-2201-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 08/30/2012] [Indexed: 02/08/2023]
Abstract
PURPOSE Magnetic resonance imaging (MRI) provides sufficient information with regard to specific soft-tissue injuries in the knee, but it is not generally used to evaluate acute tibial plateau fractures. The aim of the present study was to determine whether the amount of tibial plateau fracture depression on multi-detector computed tomography (MDCT) scans correlates with the incidence of associated soft-tissue injuries on MRI. METHODS A total of 54 consecutive patients with a mean age of 51.2 years (SD = 18.3) were included in this retrospective study. All patients were admitted to the emergency department of a university clinic with acute tibial plateau fracture. The amount of articular depression was assessed from MDCT scans. Magnetic resonance images were evaluated for crucial and collateral ligament injury, meniscal tears, and patellar retinaculum lesions. RESULTS Logistic regression revealed a significant impact of increasing tibial plateau fracture depression on the incidence of meniscus lateralis tears (P = 0.025) and anterior cruciate ligament lesions (P = 0.018). Analysis of covariance demonstrated a significant correlation between the amount of articular depression and absolute number of soft-tissue injuries (P = 0.001). CONCLUSIONS Articular depression is a potential predictor of specific meniscal and ligamentous injuries in acute tibial plateau fracture. Magnetic resonance imaging is generally recommended with respect to associated soft-tissue injuries, especially in cases with distinct tibial plateau fracture depression on multi-detector computed tomography scans. LEVEL OF EVIDENCE Case series, Level IV.
Collapse
|
139
|
Kolb JP, Schilling AF, Bischoff J, Novo de Oliveira A, Spiro A, Hoffmann M, Amling M, Rueger JM, Lehmann W. Calcium homeostasis influences radiological fracture healing in postmenopausal women. Arch Orthop Trauma Surg 2013. [PMID: 23179475 DOI: 10.1007/s00402-012-1650-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Recent studies suggest that calcium and 25-[OH]-cholecalciferol represent substantial co-factors in fracture healing. However, there still seems to be no sustainable consensus regarding the influence on fracture healing patterns. In this study, the influence of calcium and vitamin D levels on fracture callus formation was prospectively analysed using pQCT scan. METHODS 94 postmenopausal females with distal radius fractures and consecutive surgery were included. Calcium, 25-[OH]-cholecalciferol, parathyroid hormone and bone-specific alkaline phosphatase levels were obtained prior surgical treatment and after 6 weeks. A pQCT scan was performed on both sites. Bone mineral density and fracture callus area were determined after detecting the outer border contour at a threshold of 280 mg/ccm. Patients received daily supplements of 1000 mg calcium and 880 IU 25-[OH]-cholecalciferol. RESULTS Mean 25-[OH]-cholecalciferol level was 19.61 ± 21.87 ng/ml, mean parathyroid hormone level was 52.6 ± 58.9 ng/l and mean Ca level was 2.23 ± 0.35 mmol/l. After 6 weeks of supplementation a significant increase of calcium (p < 0.001) and 25-[OH]-cholecalciferol (p < 0.001), and a significant decrease of parathyroid hormone (p < 0.001) levels were observed. Sixth week follow-up fracture callus area correlated significantly with postoperative normal range calcium levels on the fractured site (p = 0.006). Bone mineral density correlated with age (p < 0.001), but not with calcium and 25-[OH]-cholecalciferol levels after 6 weeks. All fractures presented timely adequate callus formation. CONCLUSION Calcium and parathyroid hormone serum levels influence fracture callus area interpreted as fracture callus formation patterns. Calcium levels within physiological range accounted for highest fracture callus area. Therefore, a balanced calcium homeostasis is required for appropriate callus formation.
Collapse
|
140
|
Horton P, Lillicrap S, Lamm IL, Lehmann W. Introduction to suspension levels: radiotherapy. RADIATION PROTECTION DOSIMETRY 2013; 153:174-178. [PMID: 23175641 DOI: 10.1093/rpd/ncs290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In 2007, the European Commission (EC) commissioned a group of experts to undertake the revision of Report Radiation Protection (RP 91) 'Criteria for acceptability of radiological (including radiotherapy) and nuclear medicine installations' written in 1997. The revised draft report was submitted to the EC in 2010, who issued it for public consultation. The EC has commissioned the same group of experts to consider the comments of the public consultation for further improvement of the revised report. The EC intends to publish the final report under its Radiation Report Series as RP 162. This paper describes the background to the selection of the key performance parameters for radiotherapy equipment and sets out the sources of their criteria of acceptability including suspension levels for a wide range of radiotherapy equipment.
Collapse
|
141
|
Lamm IL, Horton P, Lehmann W, Lillicrap S. Practical application of suspension criteria scenarios: radiotherapy. RADIATION PROTECTION DOSIMETRY 2013; 153:179-184. [PMID: 23169812 DOI: 10.1093/rpd/ncs292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In 2007, the European Commission (EC) commissioned a group of experts to undertake the revision of Report RP91 'Criteria for Acceptability of Radiological (including Radiotherapy) and Nuclear Medicine Installations' written in 1997. The revised draft report was submitted to the EC in 2010, which issued it for public consultation. The EC commissioned the same group of experts to consider the comments of the public consultation for further improvement of the revised report. The EC intends to publish the final report under its Radiation Report Series as RP162. This paper presents a selection of practical applications of suspension criteria scenarios in radiotherapy, mostly in brachytherapy, with special emphasis on the critical roles and responsibilities of qualified radiotherapy staff (radiation oncologists, medical physicists and radiotherapy technicians).
Collapse
|
142
|
Lehmann W, Rupprecht M, Nuechtern J, Melzner D, Sellenschloh K, Kolb J, Fensky F, Hoffmann M, Püschel K, Morlock M, Rueger JM. What is the risk of stress risers for interprosthetic fractures of the femur? A biomechanical analysis. INTERNATIONAL ORTHOPAEDICS 2012; 36:2441-6. [PMID: 23132503 DOI: 10.1007/s00264-012-1697-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 10/17/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Due to increasing life expectancy we see a rising number of joint replacements. Along with the proximal prosthesis in the femur, more and more people have a second implant on the distal ipsilateral side. This might be a retrograde nail or a locking plate to treat distal femur fractures or a constrained knee prosthesis in the case of severe arthrosis. All these constructs can lead to fractures between the implants. The goal of this study was to evaluate the risk of stress risers for interprosthetic fractures of the femur. METHODS Thirty human cadaveric femurs were divided into five groups: (1) femurs with a prosthesis on the proximal side only, (2) hip prosthesis on the proximal end and a distal femur nail, (3) femurs with both a hip prosthesis and a constrained knee prosthesis, (4) femurs with a hip prosthesis on the proximal side and a 4.5-mm distal femur locking plate; the locking plate was 230 mm in length, with ten holes in the shaft, and (5) femurs with a proximal hip prosthesis and a 4.5-mm distal femur locking plate; the locking plate was 342 mm in length, with 16 holes in the shaft. RESULTS Femurs with a hip prosthesis and knee prosthesis showed significantly higher required fracture force compared to femurs with a hip prosthesis and a distal retrograde nail. Femurs with a distal locking plate of either length showed a higher required fracture force than those with the retrograde nail. CONCLUSIONS The highest risk for a fracture in the femur with an existing hip prosthesis comes with a retrograde nail. A distal locking plate for the treatment of supracondylar fractures leads to a higher required fracture force. The implantation of a constrained knee prosthesis that is not loosened on the ipsilateral side does not increase the risk for a fracture.
Collapse
|
143
|
Hoffmann M, Schröder M, Petersen JP, Spiro AS, Kammal M, Lehmann W, Rueger JM, Ruecker AH. Arthroscopically assisted retrograde drilling for osteochondritis dissecans (OCD) lesions of the knee. Knee Surg Sports Traumatol Arthrosc 2012; 20:2257-62. [PMID: 22258653 DOI: 10.1007/s00167-012-1886-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 01/10/2012] [Indexed: 10/14/2022]
Abstract
PURPOSE Accurate retrograde drilling for osteochondritis dissecans lesions remains technically challenging. A novel, radiation-free method using an electromagnetic guidance system was developed, and its feasibility and accuracy for retrograde drilling procedures evaluated in an experimental setting. METHODS Sixteen arthroscopically assisted, electromagnetically guided retrograde drilling procedures were performed in 4 human cadaveric knee joints. Therefore, two artificial cartilage lesions were set consecutively on each condyle. Final drill bit position was documented in two planes using fluoroscopy. Subsequently, drilling accuracy was measured in terms of distance from the final position of the drill bit to the articular cartilage surface (D1), and distance between the tip of the drill bit to the centre of the cartilage lesion on the articular cartilage surface (D2). All procedures were timed using a stopwatch. RESULTS Successful retrograde drilling was accomplished in all 16 cases. The overall mean time for the retrograde drilling procedures was 361.6 ± 34.7 s. Mean D1 was 2.2 ± 0.5 mm; mean D2 was 0.8 ± 0.7 mm. No complications occurred. CONCLUSIONS The novel electromagnetic guidance system used in this study showed accurate targeting results, required no radiation, was associated with no complications and demonstrated user-friendliness. LEVEL OF EVIDENCE II.
Collapse
|
144
|
Lehmann W. Pelvic and acetabular fractures. Eur J Trauma Emerg Surg 2012; 38:487-8. [PMID: 26816251 DOI: 10.1007/s00068-012-0226-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 09/02/2012] [Indexed: 10/27/2022]
|
145
|
Hoffmann M, Lefering R, Gruber-Rathmann M, Rueger JM, Lehmann W. The impact of BMI on polytrauma outcome. Injury 2012; 43:184-8. [PMID: 21696722 DOI: 10.1016/j.injury.2011.05.029] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 05/25/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND Varying results have been reported concerning the effect of body mass index (BMI) on polytrauma outcome. Although most studies focus on obesity and its associated preexisting medical diseases as a predictor for increased mortality rates, there is evidence that polytrauma patients with underweight also face an inferior outcome. METHODS Records of 5766 trauma patients (minimum 18 years of age, Injury Severity Score ≥ 16, treated from 2004 to 2008) documented in the Trauma Registry of the German Society for Trauma Surgery were subclassified into 4 BMI groups and analysed to assess the impact of BMI on polytrauma outcome. RESULTS Underweight (BMI Group I) as well as obesity (BMI Group IV) in polytraumatized patients are associated with significantly increased mortality by multivariate logistic regression analysis with hospital mortality as the target variable (adjusted odds ratio for BMI Group I, 2.1 (95% CI 1.2-3.8, p = 0.015); for BMI Group IV, 1.6 (95% CI 1.1-2.3, p = 0.009)). Simple overweight (BMI Group III) does not qualify as a predictor for increased mortality (odds ratio 1.0; 95% CI 0.8-1.3). CONCLUSIONS There is a significant correlation between obesity, underweight, and increased mortality in polytraumatized patients. Efforts to promote optimal body weight may reduce not only the risk of chronic diseases but also the risk of polytrauma mortality amongst obese and underweight individuals.
Collapse
|
146
|
Hoffmann M, Lefering R, Rueger JM, Kolb JP, Izbicki JR, Ruecker AH, Rupprecht M, Lehmann W. Pupil evaluation in addition to Glasgow Coma Scale components in prediction of traumatic brain injury and mortality. Br J Surg 2011; 99 Suppl 1:122-30. [PMID: 22441866 DOI: 10.1002/bjs.7707] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Early diagnosis and prediction of traumatic brain injury (TBI) is essential for determining treatment strategies and allocating resources. This study evaluated the predictive accuracy of Glasgow Coma Scale (GCS) verbal, motor and eye components alone, or in addition to pupil size and reactivity, for TBI.
Methods
A retrospective cohort analysis of data from 51 425 severely injured patients registered in the Trauma Registry of the German Society for Trauma Surgery from 1993 to 2009 was undertaken. Only directly admitted patients alive on admission and with complete data on GCS, pupil size and pupil reactivity were included. The unadjusted predictive roles of GCS components and pupil parameters, alone or in combination, were modelled using area under the receiver operating characteristic (AUROC) curve analyses and multivariable logistic regression regarding presence of TBI and death.
Results
Some 24 115 patients fulfilled the study inclusion criteria. Best accuracy for outcome prediction was found for pupil reactivity (AUROC 0·770, 95 per cent confidence interval 0·761 to 0·779) and GCS motor component (AUROC 0·797, 0·788 to 0·805), with less accuracy for GCS eye and verbal components. The combination of pupil reactivity and GCS motor component (AUROC 0·822, 0·814 to 0·830) outmatched the predictive accuracy of GCS alone (AUROC 0·808, 0·800 to 0·815). Pupil reactivity and size were significantly correlated (rs = 0·56, P < 0·001). Patients displaying both unequal pupils and fixed pupils were most likely to have TBI (95·1 per cent of 283 patients). Good outcome (Glasgow Outcome Scale score 4 or more) was documented for only 1929 patients (8·0 per cent) showing fixed and bilateral dilated pupils.
Conclusion
The best predictive accuracy for presence of TBI was obtained using the GCS components. Pupil reactivity together with the GCS motor component performed best in predicting death.
Collapse
|
147
|
Catala-Lehnen P, Nüchtern JV, Briem D, Klink T, Rueger JM, Lehmann W. Comparison of 2D and 3D navigation techniques for percutaneous screw insertion into the scaphoid: Results of an experimental cadaver study. ACTA ACUST UNITED AC 2011; 16:280-7. [DOI: 10.3109/10929088.2011.621092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
148
|
Verheyden AP, Hölzl A, Ekkerlein H, Gercek E, Hauck S, Josten C, Kandziora F, Katscher S, Knop C, Lehmann W, Meffert R, Müller CW, Partenheimer A, Schinkel C, Schleicher P, Schnake KJ, Scholz M, Ulrich C. [Recommendations for the treatment of thoracolumbar and lumbar spine injuries]. Unfallchirurg 2011; 114:9-16. [PMID: 21246343 DOI: 10.1007/s00113-010-1934-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This paper gives recommendations for treatment of thoracolumbar and lumbar spine injuries. The recommendations are based on the experience of the involved spine surgeons, who are part of a study group of the "Deutsche Gesellschaft für Unfallchirurgie" and a review of the current literature. Basics of diagnostic, conservative, and operative therapy are demonstrated. Fractures are evaluated by using morphologic criteria like destruction of the vertebral body, fragment dislocation, narrowing of the spinal canal, and deviation from the individual physiologic profile. Deviations from the individual sagittal profile are described by using the monosegmental or bisegmental end plate angle. The recommendations are developed for acute traumatic fractures in patients without severe osteoporotic disease.
Collapse
|
149
|
Briem D, Ruecker AH, Neumann J, Gebauer M, Kendoff D, Gehrke T, Lehmann W, Schumacher U, Rueger JM, Grossterlinden LG. 3D fluoroscopic navigated reaming of the glenoid for total shoulder arthroplasty (TSA). ACTA ACUST UNITED AC 2011; 16:93-9. [DOI: 10.3109/10929088.2010.546076] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
150
|
Schilling M, Becker V, Raue A, Maiwald T, Winter D, Lehmann W, Kolch W, Timmer J, Klingmueller U. Design principles for information processing through signalling networks. J Biotechnol 2010. [DOI: 10.1016/j.jbiotec.2010.09.906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|