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Baertl S, Rupp M, Kerschbaum M, Morgenstern M, Baumann F, Pfeifer C, Worlicek M, Popp D, Amanatullah DF, Alt V. The PJI-TNM classification for periprosthetic joint infections. Bone Joint Res 2024; 13:19-27. [PMID: 38176440 PMCID: PMC10766470 DOI: 10.1302/2046-3758.131.bjr-2023-0012.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Abstract
Aims This study aimed to evaluate the clinical application of the PJI-TNM classification for periprosthetic joint infection (PJI) by determining intraobserver and interobserver reliability. To facilitate its use in clinical practice, an educational app was subsequently developed and evaluated. Methods A total of ten orthopaedic surgeons classified 20 cases of PJI based on the PJI-TNM classification. Subsequently, the classification was re-evaluated using the PJI-TNM app. Classification accuracy was calculated separately for each subcategory (reinfection, tissue and implant condition, non-human cells, and morbidity of the patient). Fleiss' kappa and Cohen's kappa were calculated for interobserver and intraobserver reliability, respectively. Results Overall, interobserver and intraobserver agreements were substantial across the 20 classified cases. Analyses for the variable 'reinfection' revealed an almost perfect interobserver and intraobserver agreement with a classification accuracy of 94.8%. The category 'tissue and implant conditions' showed moderate interobserver and substantial intraobserver reliability, while the classification accuracy was 70.8%. For 'non-human cells,' accuracy was 81.0% and interobserver agreement was moderate with an almost perfect intraobserver reliability. The classification accuracy of the variable 'morbidity of the patient' reached 73.5% with a moderate interobserver agreement, whereas the intraobserver agreement was substantial. The application of the app yielded comparable results across all subgroups. Conclusion The PJI-TNM classification system captures the heterogeneity of PJI and can be applied with substantial inter- and intraobserver reliability. The PJI-TNM educational app aims to facilitate application in clinical practice. A major limitation was the correct assessment of the implant situation. To eliminate this, a re-evaluation according to intraoperative findings is strongly recommended.
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Affiliation(s)
- Susanne Baertl
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Maximilian Kerschbaum
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Mario Morgenstern
- Center for Musculoskeletal Infections, Department of Orthopaedic and Trauma Surgery, University Hospital of Basel, Basel, Switzerland
| | - Florian Baumann
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christian Pfeifer
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
- Department Trauma, Orthopaedics and Hand Surgery, Innklinikum Altötting, Altötting, Germany
| | - Michael Worlicek
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
- Department Knee Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Daniel Popp
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Derek F. Amanatullah
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Volker Alt
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
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Pagano S, Müller K, Alt V, Maderbacher G, Holzapfel DE, Baumann F, Freigang V. [Navigated or conventional acetabular surgery : Comparison of positional accuracy exemplified by the infra-acetabular screw]. Unfallchirurgie (Heidelb) 2024; 127:44-53. [PMID: 36929038 PMCID: PMC10786994 DOI: 10.1007/s00113-023-01304-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND The principle of joint-preserving treatment of acetabular fractures is the anatomic reduction of joint-bearing elements and internal osteosynthesis. For stabilization of the anterior and posterior columns against each other, the infra-acetabular screw (IAS) is regularly used in the clinical routine. OBJECTIVE The aim of this study was to compare the position of the IAS in the infra-acetabular corridor after navigated placement and after freehand placement. MATERIAL AND METHOD The position of the screw was evaluated in 42 patients using multiplanar reconstructions. The screw was placed freehand in 30 patients and using image-guided navigation in 12 patients. In addition to measurement of the position of the screw, demographic data, operating time, radiation exposure and blood loss were recorded. RESULTS The vast majority of the patients were male (86%), the median age was 67 years and the median body mass index (BMI) was 25 kg/m2. The median operating time was 166 min and the median blood loss was 900 ml. The adjusted values in the whole sample considering the position of the screw were: distance of screw to cartilage mean value (m) = 3.8 mm, distance of screw to corridor center m = 3.5 mm and angle of screw to corridor m = 1.4°. There were no differences between the groups in the demographic parameters and the accuracy of positioning of the screw (p-value > 0.05). There was a longer irradiation time and a higher radiation dose in the navigated group compared to the group without navigation (p-value < 0.001). CONCLUSION With appropriate experience both procedures are comparable taking into account the accuracy. Taking into consideration other perioperative parameters, such as radiation exposure and planned operating time, patient-related factors should be taken into consideration.
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Affiliation(s)
- Stefano Pagano
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - Karolina Müller
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Volker Alt
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Günther Maderbacher
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Dominik E Holzapfel
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Florian Baumann
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Viola Freigang
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
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Lenz JE, Baumann F, Alt V. Therapy of a Chronically Infected Total Femur Prothesis in a 40-year-old Patient. Z Orthop Unfall 2023; 161:678-682. [PMID: 35378563 DOI: 10.1055/a-1754-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We report a case of a patient who was treated in 1999 at the age of 19 years with a proximal femur replacement due to Ewing sarcoma. After several infection-associated exchange procedures, the patient presented with a fistula and chronic infection of a total femur prosthesis in August 2019 at the age of 40 years. Interdisciplinary treatment with a 3-stage exchange procedure and implantation of a silver-coated total femur prosthesis was successfully performed and hip disarticulation could be avoided. After a follow-up of 2 years, the patient showed uneventful wound healing and full weight bearing without crutches.
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Affiliation(s)
- Julia Elisabeth Lenz
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Florian Baumann
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Volker Alt
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
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Freigang V, Walter N, Rupp M, Riedl M, Alt V, Baumann F. Treatment of Fracture-Related Infection after Pelvic Fracture. J Clin Med 2023; 12:6221. [PMID: 37834865 PMCID: PMC10573264 DOI: 10.3390/jcm12196221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The management of pelvic fractures is a significant challenge. Surgical site infection can result in the need for revision surgery, cause functional impairment, and lead to a prolonged length of stay and increased treatment costs. Although reports on fracture-related infection (FRI) after pelvic fracture fixation are sparsely reported in the literature, it is a serious complication. This study analysed patients with FRIs after pelvic fracture regarding patient characteristics, treatment strategies, and an evaluation of risk factors for FRI. METHODS In this retrospective single-centre study, FRI was diagnosed based on clinical symptoms of infection and a positive culture of a bacterial infection. Depending on the severity and acuteness of the infection, osseous stabilization was restored either via implant retention (stable implant, no osteolysis), exchange (loose implant or bony defect), or external fixation (recurrence of infection after prior implant retaining revision). Healing of infection was defined as no sign of recurring infection upon clinical, radiological, and laboratory examination in the last follow-up visit. RESULTS The FRI rate in our patient population was 7.5% (24/316). In 8/24 patients, the FRI occurred within the first three weeks after initial surgery (early) and 16/24 presented with a late onset of symptoms of FRI. A strategy of debridement, antibiotics, and implant retention (DAIR) was successful in 9/24 patients with FRI after pelvic fracture. A total of 10 patients required an exchange of osteo-synthetic implants, whereof three were exchanged to an external fixator. In five patients, we removed the implant because the fracture had already consolidated at the time of revision for infection. A total of 17/24 patients had a poly-microbial infection after a pelvic fracture and 3/24 patients died from post-traumatic multi-organ failure within the first 6 months after trauma. There were no cases of persistent infection within the remaining 21 patients. CONCLUSIONS Although poly-microbial infection is common in FRI after pelvic fracture, the recurrence rate of infection is relatively low. A complex pelvic trauma with significant soft tissue injury is a risk factor for recurrent infection and multiple revisions. A strategy of DAIR can be successful in patients with a stable implant. In cases with recurrent infection or an unstable fracture site, the exchange of implants should be considered.
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Affiliation(s)
- Viola Freigang
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
- Faculty of Interdisciplinary Studies, Landshut University of Applied Sciences, Am Lurzenhof 1, 84036 Landshut, Germany
| | - Nike Walter
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Moritz Riedl
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Florian Baumann
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
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Braun ME, Loose O, Schmittenbecher P, Schneidmüller D, Strüwind C, Schwerk P, Reineke S, Traub F, Ihle C, Lieber J, Rüther H, Baumann F, Marzi I, Tüshaus L, Adrian M, Bergmann F, Graf A, Kaiser M, Fernandez FF. Epidemiology and injury morphology of traumatic hip dislocations in children and adolescents in Germany: a multi-centre study. Eur J Trauma Emerg Surg 2023; 49:1897-1907. [PMID: 37261461 DOI: 10.1007/s00068-023-02280-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/12/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Traumatic hip dislocations are very rare in childhood and adolescence. The aim of this multi-centre study is to analyse the current epidemiology and injury morphology of a large number of traumatic hip dislocations in children. This can provide a better understanding of childhood hip dislocations and contribute to the development of a therapeutic approach in order to prevent long-term impacts. METHODOLOGY This retrospective, anonymised multi-centre study included patients, aged up to 17 years, with acute traumatic hip dislocations and open growth plates. The patients came from 16 German hospitals. Exclusion criteria included insufficient data, a positive history of hip dysplasia, or an association with syndromal, neurological or connective tissue diseases predisposing to hip dislocation. An analysis was carried out on the patients' anthropometric data and scans (X-ray, MRI, CT), which were collected between 1979 and 2021. Gender, age at the time of dislocation, associated fractures, mechanism of injury, initial treatment including time between dislocation and reduction, method of reduction, treatment algorithm following reduction and all documented complications and concomitant injuries were evaluated. RESULTS Seventy-six patients met the inclusion criteria. There were two age peaks at 4-8 years and 11-15 years. There was an increased incidence of girls in the under-eight age group, who had mild trauma, and in the group of over-eights there were more boys, who had moderate and severe trauma. Dorsal dislocation occurred in 89.9% of cases. Mono-injuries dominated across all age groups. Concomitant injuries rarely occurred before the age of eight; however, they increased with increasing ossification of the acetabulum and appeared as avulsion injuries in 32% of 11-15-year-olds. Of the 76 patients, 4 underwent a spontaneous, 67 a closed and 5 a primary open reduction. A reduction was performed within 6 h on 84% of the children; however, in around 10% of cases a reduction was not performed until after 24 h. Concomitant injuries needing intervention were identified in 34 children following reduction. Complications included nerve irritation in the form of sensitivity disorders (n = 6) as well as avascular necrosis (AVN) of the femoral head in 15.8% of the patients (n = 12). CONCLUSIONS Traumatic hip dislocations are rare in childhood and adolescence and have high complication rates. The most severe complication, femoral head necrosis, occurred in 16% of cases. Minor injuries, especially in younger children, are enough to cause a dislocation. Posterior dislocation was more frequent and primarily occurred as a mono-injury; however, concomitant injuries must be considered with increasing age. Children continue to experience delayed reductions. The length of time until reduction, age and the severity of the concomitant injury play a role in the development of femoral head necrosis; however, this topic requires additional investigation.
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Baumann F, Pagano S, Alt V, Freigang V. Bony Sacral Volume after Sacro-Iliac Screw Fixation of Pelvic Fractures Is Dependent on Reduction of the Anterior Pelvic Ring. J Clin Med 2023; 12:4169. [PMID: 37373862 DOI: 10.3390/jcm12124169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Pelvic ring injuries are uncommon but serious injuries. Percutaneous sacro-iliac screw fixation (SSF) is the standard treatment for posterior stabilization of pelvic fractures. Compression forces of the SSF might cause deformity of the sacrum and the pelvic ring. The aim of this radio-volumetric study is to evaluate the morphometry of the sacrum and pelvic ring in SSF for posterior pelvic fractures. (1) Methods: We conducted a radio-volumetric study measuring the bony sacral volume before and after SSF for a pelvic fracture based on a three-dimensional reconstruction of the pre- and postoperative computed tomography scan of 19 patients with a C-type pelvic fracture. In addition to the bony sacral volume, we assessed the pelvic deformity and the load bearing axis. We compared the results of patients without anterior stabilization (Group A) to patients who had additional ORIF of the anterior pelvic ring. (2) Results: Median age of the patients was 41.2 years (±17.8). All patients received percutaneous SSF with partially threaded 7.3 mm screws. The sacral volume decreased from 202.9 to 194.3 cm3 in group A (non-operative treatment anterior, n = 10) and an increase of sacral volume from 229.8 to 250.4 cm3 in group B (anterior ORIF; n = 9). Evaluation of the pelvic deformity also reflected this trend by a decrease of the ipsilateral load-bearing angle in group A (37.0° to 36.4°) and an increase of this angle in group B (36.3 to 39.9°). (3) Conclusions: Bony sacral volume and pelvic deformity after sacro-iliac screw fixation in pelvic fractures depend on treatment of the anterior pelvic ring. Reduction and fixation of the anterior fracture shows an increase of the bony sacral volume and the load bearing angle leading to a closer to normal reconstruction of the pelvic anatomy.
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Affiliation(s)
- Florian Baumann
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Stefano Pagano
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Viola Freigang
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
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Baumann F, Becker C, Freigang V, Alt V. Imaging, post-processing and navigation: Surgical applications in pelvic fracture treatment. Injury 2022; 53 Suppl 3:S16-S22. [PMID: 36028373 DOI: 10.1016/j.injury.2022.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/16/2022] [Accepted: 08/20/2022] [Indexed: 02/02/2023]
Abstract
Technical advancements of the past decade have led to massive improvements regarding imaging and visualization in trauma care. Digital imaging technology has fundamentally changed most processes in fracture management. However, the digital revolution in trauma surgery has just begun. Optical tracking navigation is currently the gold standard for positioning of implants for advanced applications in trauma surgery. Digital technology may enable the surgeon to achieve the same level of safety even in non-navigated placement of screws: We developed a new planning tool to transcript a preoperative into a semi-transparent "fluoroscopic like" image that can be identified intraoperatively and used as a map for the safe placement of sacro-iliac screws based on the "vestibule concept". In the future, development of artificial intelligence algorithms may provide features like automated segmentation of bone-fragments and other applications for a systematic fracture analysis to improve the standard of care in trauma surgery. Digital transformation has massive impact on diagnostics and surgical management of pelvic fractures. Improved visualization technology provides a better understanding of the surgical anatomy of the pelvis and may enable the surgeon to achieve greatest safety in percutaneous placement of screws even without using optical tracking navigation tools. The "para-axial fusion technique" is a useful tool to plan fluoroscopic views based on a 3D dataset prior to the surgery.
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Affiliation(s)
- Florian Baumann
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany.
| | - Claus Becker
- Institute of Diagnostic Radiology, Regensburg University Medical Center, Regensburg, Germany
| | - Viola Freigang
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
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Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE The SCIWORA Syndrome (Spinal Cord Injury Without Radiographic Abnormalities) is a rare but potentially severe injury with a peak in childhood and adolescence. With a better understanding of injury patterns and advances in MRI, there is ongoing discussion regarding the "Real SCIWORA" syndrome, a clinical picture of neurologic deficits on clinical examination but absence of radiographic pathologies even on MRI. The purpose of this study was to evaluate mid-term clinical outcome and the psychological impact of the "Real SCIWORA." METHODS In this retrospective analysis, we evaluated 32 patients treated for "Real SCIWORA" between 2007-2019. Inclusion criteria were: neurologic deficit after trauma, no other cerebral or skeletal injury and a lack of pathological findings in spinal MRI. All patients were followed until complete recovery from initial symptoms. 25/32 patients were re-evaluated after 6.9 years (1-14 years) using the Oswestry Disability Index, the Frankel Score, the EQ-5D score, and the Breslau Short Screening Scale for PTSD. RESULTS Initial neurologic presentation ranged from Frankel Grade A-D. All patients recovered neurologically during 1-13 days to a Frankel Grade E. The analysis of HR-QoL revealed no difference between the cohort of SCIWORA patients and the German population norm, Oswestry Disability Index showed only minimal disabilities. 4/25 patients showed signs of PTSD. CONCLUSIONS The "Real SCIWORA" syndrome is a diagnosis per exclusionem requiring a full spinal MRI to ensure exclusion of structural and potentially serious reasons of the neurologic impairment. Further clinical re-evaluation, psychological support seems to be essential. LEVEL OF EVIDENCE IV-retrospective study.
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Affiliation(s)
- Viola Freigang
- Department of Trauma, Regensburg University Medical Center, Regensburg, Germany,Viola Freigang, Department of Trauma Surgery, Regensburg University Medical Center, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany.
| | - Katja Butz
- Department of Trauma, Regensburg University Medical Center, Regensburg, Germany
| | | | - Julia Karnosky
- Department of Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Siegmund Lang
- Department of Trauma, Regensburg University Medical Center, Regensburg, Germany
| | - Volker Alt
- Department of Trauma, Regensburg University Medical Center, Regensburg, Germany
| | - Florian Baumann
- Department of Trauma, Regensburg University Medical Center, Regensburg, Germany
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Baumann F, Pourmoussa A, Ducaud C, Nijhawan A, Powell A. Abstract No. 505 Novel anatomical classification system for femoropopliteal stenosis as a potential predictor of clinical outcomes. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Kalia V, Yuzefpolskiy Y, Vegaraju A, Xiao H, Baumann F, Jatav S, Church C, Prlic M, Jha A, Nghiem P, Riddell S, Sarkar S. Metabolic regulation by PD-1 signaling promotes long-lived quiescent CD8 T cell memory in mice. Sci Transl Med 2021; 13:eaba6006. [PMID: 34644150 DOI: 10.1126/scitranslmed.aba6006] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Vandana Kalia
- Division of Hematology and Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98195, USA.,Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Yevgeniy Yuzefpolskiy
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Adithya Vegaraju
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Hanxi Xiao
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Florian Baumann
- QIAGEN Sciences LLC, 19300 Germantown Rd, Germantown, MD 20874, USA
| | | | - Candice Church
- Dermatology Division, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Martin Prlic
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.,Department of Pathology, University of Washington School of Medicine, Seattle, WA 98195, USA.,Department of Global Health, University of Washington School of Medicine, Seattle, WA 98195, USA
| | | | - Paul Nghiem
- Dermatology Division, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Stanley Riddell
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.,Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Surojit Sarkar
- Division of Hematology and Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98195, USA.,Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA 98101, USA.,Department of Pathology, University of Washington School of Medicine, Seattle, WA 98195, USA
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Rupp M, Walter N, Pfeifer C, Lang S, Kerschbaum M, Krutsch W, Baumann F, Alt V. The Incidence of Fractures Among the Adult Population of Germany – and Analysis From 2009 through 2019. Dtsch Arztebl Int 2021; 118:665-669. [PMID: 34140088 DOI: 10.3238/arztebl.m2021.0238] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/11/2021] [Accepted: 05/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Detailed analyses of epidemiological data on fractures are an important resource for persons and institutions providing health care services, as they yield information on the effects of current treatment strategies and on the need for preventive measures. The epidemiology of fractures in Germany, however, is unknown. The goal of this study is to determine the nationwide fracture burden from 2009 through 2019, as a function of anatomical site, age, and sex. METHODS Annual compilations of ICD-10 diagnosis codes for the years 2009-2019 were made available to us by the German Federal Statistical Office. The prevalence and incidence of fractures at 30 different sites were quantified, and standardized sex and age distributions were calculated. RESULTS A total of 688 403 fractures was registered in 2019. From 2009 to 2019, the incidence of fractures rose by 14%, to 1014 fractures per 100 000 persons per year. The most common fracture types were femoral neck fractures (120 per 100 000 persons per year), pertrochanteric femural fractures (109 per 100 000 persons per year), and distal radius fractures (106 per 100 000 persons per year). All types were more common in women, with incidences that rose with age. The highest incidence was of pertrochanteric femoral fractures in women over age 90, with an incidence of 2550 per 100 000 persons per year. The largest rises in incidence were seen with regard to acetabular fractures (+ 58.16%) and clavicular fractures (+ 44.02%). CONCLUSION The increasing frequency of fractures, particularly among the elderly, presents a challenge to the health care system. Given the high frequency of geriatric fractures, prophylactic measures against fractures ought to be intensified.
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Baumann F, Himstedt M, Möckel D, Thedens M. Charge-separating processes by spraying water under high pressure. J Loss Prev Process Ind 2021. [DOI: 10.1016/j.jlp.2021.104527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Freigang V, Baumann F, Alt V. Bilateral septic arthritis with rapid progressive destruction of the femoral head after joint injection in rheumatoid arthritis. J Bone Jt Infect 2021; 6:255-256. [PMID: 34285867 PMCID: PMC8283516 DOI: 10.5194/jbji-6-255-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022] Open
Abstract
This report is on a 61-year-old patient with steroid therapy for
rheumatoid arthritis and pain in the groin on both sides who got injections
with hyaluronic acid in both hip joints. After 12 weeks the X-ray of the
pelvis showed rapid progressive destruction of both hip joints.
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Affiliation(s)
- Viola Freigang
- Department of Trauma Surgery, Regensburg University Medical Center, 93042 Regensburg, Germany
| | - Florian Baumann
- Department of Trauma Surgery, Regensburg University Medical Center, 93042 Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, Regensburg University Medical Center, 93042 Regensburg, Germany
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Bach AC, Giesler P, Baumann F, Weidlich D, Karampinos DC, Schneider J, Holwein C, Bamberg F, Jungmann PM. Qualitative and Quantitative 3-T MR Imaging Outcome after Reconstruction of the Medial Patellofemoral Ligament. Semin Musculoskelet Radiol 2021. [DOI: 10.1055/s-0041-1731530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sebastian T, Barco S, Engelberger R, Spirk D, Schindewolf M, Baumann F. Duplex Ultrasound Investigation for the Detection of Obstructed Iliocaval Venous Stents. J Vasc Surg Venous Lymphat Disord 2021. [DOI: 10.1016/j.jvsv.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hierl K, Rupp M, Worlicek M, Baumann F, Pfeifer C, Alt V. [Comparison of DRG revenues between fast and slow-track procedures for a two-stage replacement of prostheses for periprosthetic hip infections in the aG-DRG system 2020]. Orthopade 2021; 50:728-741. [PMID: 33881565 PMCID: PMC8058599 DOI: 10.1007/s00132-021-04106-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Abstract
Hintergrund Die Behandlung periprothetischer Hüftinfektionen ist meist kostenintensiv und gilt im Allgemeinen als nicht kostendeckend für die Kliniken. Bei chronischen Infektionen ist oft ein zweizeitiger Prothesenwechsel indiziert, der als Fast-Track mit kurzem prothesenfreiem Intervall (2–4 Wochen) oder als Slow-Track mit langem prothesenfreiem Intervall (über 4 Wochen) erfolgen kann. Ziel Ziel dieser Arbeit war die Erfassung der Erlössituation beider Behandlungsformen im aktuellen aG-DRG-System 2020 unter Berücksichtigung erlösrelevanter Einflussfaktoren. Methoden Für Fast-Track und Slow-Track bei zweizeitigem septischem Hüftprothesenwechsel mit Nachweis eines Staphylococcus aureus (MSSA) wurden mittels einer Grouper-Software (3M KODIP Suite) anhand der Diagnosen (ICD-10-GM) und Prozeduren (OPS) Behandlungsfälle simuliert und in DRG eingruppiert. Erlösrelevante Parameter wie Verweildauer (VWD) und Nebendiagnosen (ND) wurden berücksichtigt. Zusätzlich wurden zwei reale Behandlungsfälle mit Fast-Track und Slow-Track miteinander verglichen. Ergebnisse Die Gesamterlöse betrugen beim Slow-Track bei einer VWD von 25 Tagen (ohne ND) 27.551 € und bei einer VWD von 42 Tagen (mit ND) 40.699 €. Beim Fast-Track hingegen lag der Gesamterlös bei 23.965 € bei einer VWD von 25 Tagen (ohne ND) und bei 27.283 € bei einer VWD von 42 Tagen (mit ND). Bei den realen Behandlungsfällen zeigte sich ebenfalls eine deutliche Differenz des Gesamterlöses von 12.244 € zugunsten des Slow-Tracks. Diskussion Auch im aG-DRG-System 2020 scheint der zweizeitige Hüftprothesenwechsel mit langem Interimsintervall insbesondere bei multimorbiden Patienten aus Krankenhaussicht ökonomisch vorteilhafter zu sein als das Fast-Track-Konzept, wodurch ein finanzielles Hemmnis zur Behandlung solcher Patienten mit kurzem Interimsintervall geschaffen wird.
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Affiliation(s)
- Katja Hierl
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg (UKR), Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Markus Rupp
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg (UKR), Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Michael Worlicek
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg (UKR), Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Florian Baumann
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg (UKR), Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Christian Pfeifer
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg (UKR), Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Volker Alt
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg (UKR), Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
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Rupp M, Kerschbaum M, Freigang V, Bärtl S, Baumann F, Trampuz A, Alt V. [PJI-TNM as new classification system for periprosthetic joint infections : An evaluation of 20 cases]. Orthopade 2021; 50:198-206. [PMID: 32533215 PMCID: PMC8222041 DOI: 10.1007/s00132-020-03933-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Hintergrund Bisherige Klassifikationen für Protheseninfektionen beurteilen die Heterogenität der Infektion nur unzureichend. Die PJI-TNM-Klassifikation berücksichtigt auf Basis der onkologischen TNM-Klassifikation folgende entscheidende Kriterien bei Protheseninfektionen: Implantatart und -stabilität, Weichteilverhältnisse, Biofilmreife, Erregerart, Komorbiditäten des Patienten und Infektrezidive. Ziel dieser Arbeit ist es, die neue PJI-TNM-Klassifikation auf deren Anwendbarkeit in der klinischen Praxis zu überprüfen. Methoden Im Rahmen einer Konzeptionsstudie wurde die PJI-TNM-Klassifikation bei 20 Patienten mit periprothetischen Schulter‑, Hüfte- oder Kniegelenksinfektion angewandt. Anhand der Patientenakte wurde die PJI-TNM-Klassifikation mit den übergeordneten Parametern T („tissue and implants“), N („non-eucaryotic cells and fungi“), M („morbidity“) und r („reinfection“), klassifiziert. Ergebnisse Alle 20 Fälle (12 männlich, 8 weiblich, mittleres Alter 72,2 [40–88 Jahre]), darunter 13 Hüft-, 6 Knie- und eine Schulterprotheseninfektion, konnten mit der PJI-TNM-Klassifikation klassifiziert werden. Insgesamt zeigte sich eine große Heterogenität der Fälle: 12 Prothesen waren fest (T0), 6 gelockert (T1) und bei zwei Prothesen ein Weichteildefekt (T2) vorhanden. Bei 7 Prothesen wurde von unreifem Biofilm (N0) ausgegangen. 13 Prothesen wurden entsprechend eines reifen Biofilms klassifiziert (N1+N2). 9 Patienten waren nur geringgradig (M0), 7 Patienten mäßig (M1) und 3 Patienten schwer vorerkrankt (M2). Ein Patient lehnte die chirurgische Therapie ab (M3a). Bei 3 Fällen handelte es sich um eine Reinfektion (r). Schlussfolgerungen Die aus der Onkologie stammenden Prinzipien der TNM-Klassifikation lassen sich auch bei periprothetischen Infektionen anwenden. Schon bei einer geringen Fallzahl ist eine deutliche Heterogenität periprothetischer Infektionen, wie sie auch im klinischen Alltag generell beobachtet wird, feststellbar. Diese wird durch die PJI-TNM-Klassifikation gut abgebildet und kann dadurch zukünftig eventuell zur Verbesserung bei der Therapieentscheidung beitragen.
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Affiliation(s)
- Markus Rupp
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg (UKR), Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland
| | - Maximilian Kerschbaum
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg (UKR), Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland
| | - Viola Freigang
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg (UKR), Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland
| | - Susanne Bärtl
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg (UKR), Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland
| | - Florian Baumann
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg (UKR), Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland
| | - Andrej Trampuz
- Charité - Universitätsmedizin Berlin und Center for Musculoskeletal Surgery (CMSC), Berlin, Deutschland
| | - Volker Alt
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg (UKR), Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland.
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Popp D, Weber J, Kerschbaum M, Schicho A, Baumann F, Hilber F, Krutsch W, Alt V, Pfeifer C. Early functional treatment or trivialization? - current treatment strategies in lateral ligament injuries of the ankle. Eur J Sport Sci 2021; 21:1469-1476. [PMID: 33131454 DOI: 10.1080/17461391.2020.1845813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Ankle injuries are common in daily orthopaedic trauma practice, with a high incidence of lateral ligament complex (lat-lig-com) injuries of the ankle joint (AJ). Primarily, these lat-lig-com injuries heal sufficiently, although there is a risk of developing chronic ankle instability. However, there is a lack of knowledge about the clinical application and routine for rehabilitation strategies so as to prevent chronic instability. This study investigates the current rehabilitation concepts in clinical routine after ligament injuries of the AJ. Methods: Rehabilitation protocols, provided by orthopaedic and trauma surgery institutions in German speaking countries, were analysed in terms of weight-bearing, range of motion (ROM), physiotherapy and choice of orthosis. All protocols for operatively and non-operatively (nop) treated ligament ruptures of the AJ were included. Results: 120 of 213 institutions provided protocols of lat-lig-com injuries of the AJ. Regarding the orthosis, the nop-treatment group mainly used ankle braces; in contrast, the operative group preferred the use of an ankle boot. The operative group recommends 6-12 weeks for duration of orthosis in contrast to only 6 weeks in the nop group. Significant differences prevail in ROM, with free ROM in non-operative treatment from the first day after trauma (p<0.001) in contrast to a careful increase in ROM in the first 6 weeks post-operatively. Conclusion: Early functional treatment is clinical standard in rehabilitation after lat-lig-com injuries of the ankle. Regarding current literature the differences of restrictions in ROM and orthosis treatment after lat-lig-com injuries suggest a trivialization of conservative treatment in the first period after trauma compared to post-operative aftercare.
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Affiliation(s)
- Daniel Popp
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Johannes Weber
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Maximilian Kerschbaum
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Andreas Schicho
- Department of Radiology, University Medical Centre Regensburg, Regensburg, Germany
| | - Florian Baumann
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Franz Hilber
- Spine Center, Schulthess Clinic Zurich, Zurich, Switzerland
| | - Werner Krutsch
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Christian Pfeifer
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
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Kerschbaum M, Lang S, Baumann F, Alt V, Worlicek M. Two-Dimensional Visualization of the Three-Dimensional Planned Sacroiliac Screw Corridor with the Slice Fusion Method. J Clin Med 2021; 10:jcm10020184. [PMID: 33419193 PMCID: PMC7825576 DOI: 10.3390/jcm10020184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 12/03/2022] Open
Abstract
Insertion of sacro-iliac (SI) screws for stabilization of the posterior pelvic ring without intraoperative navigation or three-dimensional imaging can be challenging. The aim of this study was to develop a simple method to visualize the ideal SI screw corridor, on lateral two-dimensional images, corresponding to the lateral fluoroscopic view, used intraoperatively while screw insertion, to prevent neurovascular injury. We used multiplanar reconstructions of pre- and postoperative computed tomography scans (CT) to determine the position of the SI corridor. Then, we processed the dataset into a lateral two-dimensional slice fusion image (SFI) matching head and tip of the screw. Comparison of the preoperative SFI planning and the screw position in the postoperative SFI showed reproducible results. In conclusion, the slice fusion method is a simple technique for translation of three-dimensional planned SI screw positioning into a two-dimensional strict lateral fluoroscopic-like view.
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20
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Freigang V, Rupp M, Pfeifer C, Worlicek M, Radke S, Deckelmann S, Alt V, Baumann F. Patient-reported outcome after patient-specific unicondylar knee arthroplasty for unicompartmental knee osteoarthritis. BMC Musculoskelet Disord 2020; 21:773. [PMID: 33234122 PMCID: PMC7686700 DOI: 10.1186/s12891-020-03776-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 11/05/2020] [Indexed: 12/02/2022] Open
Abstract
Background Unicondylar knee arthroplasty was introduced in the late 1960s and remains a topic of controversial discussion. Patient-specific instruments and patient-specific implants are not yet the standard of care. The question remains whether this time-consuming and costly technique can be beneficial for the patient. The aim of this study was to evaluate whether a custom-made unicondylar knee arthroplasty leads to improved patient-reported outcome. Methods This retrospective study evaluates the patient-reported outcome after custom-made unicondylar knee arthroplasty (CM-UKA, ConforMIS™ iUni® G2, ConforMIS Inc., Billerica, MA, USA). We evaluated 29 patients (31 knees) at an average of 2.4 years (range 1.2–3.6 years) after operation for unicondylar osteoarthritis of the knee. The target zone for the postoperative leg axis was a slight under-correction of 0–2° varus. Follow-up evaluation included the Forgotten Joint Score (FJS), the Knee Society Score (KSS), a Visual Analogue Scale (VAS) and a radiographic evaluation including a long-leg radiograph. Primary outcome measure was patient satisfaction based on the Forgotten Joint Score. Results We found an excellent postoperative health-related quality of life with a mean FJS of 76.8 (SD 17.9) indicating a low level of joint awareness after CM-UKA. The mean preoperative KSS was 66.0 (SD 13.71) and 59.4 (17.9) for the KSS function score. The increase was 22.8 points for the KSS knee score (p < 0.0001) and 34.8 points for the KSS function score (p < 0.0001). The VAS for pain decreased from a mean of 5.4 (SD 1.8) to 1.1 (SD 1.2) (p < 0.0001). The malalignment rate with a postoperative deviation of more than 2° in the leg axis was 29%. There was no evidence of component loosening after a mean follow-up of 2.4 years. Conclusions Custom-made unicondylar knee arthroplasty (CM-UKA) can provide improved clinical and functional outcomes for patients with isolated knee osteoarthritis of the medial compartment. We found excellent results regarding patient satisfaction and a low malalignment rate for CM-UKA. Further studies are needed to investigate long-term survivorship of the implant. Level of evidence Level IV. Trial registration Trial Registration number: Z-2014-0389-10 Regensburg Clinical Studies Center (REGCSC) 09/07/2014.
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Affiliation(s)
- Viola Freigang
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Christian Pfeifer
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Michael Worlicek
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Stefan Radke
- Department of Orthopaedic Surgery, Rotkreuzklinikum Munich, Munich, Germany
| | - Stephan Deckelmann
- Department of Orthopaedic Surgery, Rotkreuzklinikum Munich, Munich, Germany
| | - Volker Alt
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Florian Baumann
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany.
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Freigang V, Müller K, Ernstberger A, Kaltenstadler M, Bode L, Pfeifer C, Alt V, Baumann F. Reduced Recovery Capacity After Major Trauma in the Elderly: Results of a Prospective Multicenter Registry-Based Cohort Study. J Clin Med 2020; 9:jcm9082356. [PMID: 32717963 PMCID: PMC7464491 DOI: 10.3390/jcm9082356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/09/2020] [Accepted: 07/21/2020] [Indexed: 01/07/2023] Open
Abstract
AIMS Considering the worldwide trend of an increased lifetime, geriatric trauma is moving into focus. Trauma is a leading cause of hospitalization, leading to disability and mortality. The purpose of this study was to compare the global health-related quality of life (HRQoL) of geriatric patients with adult patients after major trauma. METHODS This multicenter prospective registry-based observational study compares HRQoL of patients aged ≥65 years who sustained major trauma (Injury Severity Score (ISS) ≥ 16) with patients <65 years of age within the trauma registry of the German Trauma Society (DGU). The global HRQoL was measured at 6, 12, and 24 months post trauma using the EQ-5D-3L score. RESULTS We identified 405 patients meeting the inclusion criteria with a mean ISS of 25.6. Even though the geriatric patients group (≥65 years, n = 77) had a lower ISS (m = 24, SD = 8) than patients aged <65 years (n = 328), they reported more difficulties in each EQ dimension compared to patients <65 years. Contrary to patients < 65, the EQ-5D Index of the geriatric patients did not improve at 12 and 24 months after trauma. CONCLUSIONS We found a limited HRQoL in both groups after major trauma. The group of patients ≥65 showed no improvement in HRQoL from 6 to 24 months after trauma.
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Affiliation(s)
- Viola Freigang
- Department of Trauma, Regensburg University Medical Center, 93053 Regensburg, Germany; (A.E.); (C.P.); (V.A.); (F.B.)
- Correspondence: ; Tel.: +49-094-1944-6805
| | - Karolina Müller
- Center for Clinical Studies, Regensburg University Medical Center, 93053 Regensburg, Germany;
| | - Antonio Ernstberger
- Department of Trauma, Regensburg University Medical Center, 93053 Regensburg, Germany; (A.E.); (C.P.); (V.A.); (F.B.)
| | - Marlene Kaltenstadler
- Department of Surgery, Regensburg University Medical Center, 93053 Regensburg, Germany;
| | - Lisa Bode
- Department of Orthopaedics and Trauma Surgery, Faculty of Medicine, Medical Center—Albert-Ludwigs-University of Freiburg, 79085 Freiburg im Breisgau, Germany;
| | - Christian Pfeifer
- Department of Trauma, Regensburg University Medical Center, 93053 Regensburg, Germany; (A.E.); (C.P.); (V.A.); (F.B.)
| | - Volker Alt
- Department of Trauma, Regensburg University Medical Center, 93053 Regensburg, Germany; (A.E.); (C.P.); (V.A.); (F.B.)
| | - Florian Baumann
- Department of Trauma, Regensburg University Medical Center, 93053 Regensburg, Germany; (A.E.); (C.P.); (V.A.); (F.B.)
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Abstract
Cite this article:Bone Joint Res. 2020;9(2):79–81.
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Affiliation(s)
- Volker Alt
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Martin Langer
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Florian Baumann
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Andrej Trampuz
- Charité - Universitätsmedizin Berlin, Berlin, Germany; Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany
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23
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Abstract
Cite this article: Bone Joint Res. 2020;9(2):77–78.
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Affiliation(s)
- Volker Alt
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Martin Langer
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Florian Baumann
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Andrej Trampuz
- Charité - Universitätsmedizin Berlin, Berlin, Germany; Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany
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Sarkar S, Yuzefpolskiy Y, Vegaraju A, Xiao H, Baumann F, Jatav S, Church C, Earnest-bernhart K, Prlic M, Jha A, Nghiem P, Riddell S, Sedensky M, Morgan P, Kalia V. PD-1 Signals are Critical for Homeostatic Maintenance of Memory CD8 T Cells. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.81.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Inhibitory signaling in dysfunctional CD8 T cells through the PD-1 axis is well established in chronic viral infections and cancers. PD-1 is also transiently induced to high levels during priming of acute infections and immunizations, yet its impact on the development of long-lived antigen-independent T cell memory remains unclear. Here we show that in addition to its expected role in restraining clonal expansion, PD-1 expression on antigen-specific CD8 T cells during priming and activation is critically required for the development of a durable CD8 T cell memory pool after antigen clearance. Loss of T cell-specific PD-1 signaling led to increased contraction and a striking defect in antigen-independent renewal of memory CD8 T cells in response to homeostatic cytokine signals, thus resulting in attrition and near ablation of the memory pool over time. Notably, in the setting of PD-1 checkpoint blockade immunotherapy of chronic viral infection, while the exhausted CTLs expectedly regained function, the pre-existing pool of resting functional memory cells established in response to a previously administered vaccine underwent attrition. Metabolically, PD-1 signals were necessary for regulating the critical balance of anabolic glycolysis and fatty acid oxidation programs through mTOR to meet the bioenergetics needs of quiescent memory. These studies define PD-1 as a key metabolic regulator of protective T cell immunity, and have potential clinical implications for pre-existing T cell memory to prior infections and vaccinations during PD-1 checkpoint-blockade immunotherapy in cancer.
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Riedl M, Witzmann C, Koch M, Lang S, Kerschbaum M, Baumann F, Krutsch W, Docheva D, Alt V, Pfeifer C. Attenuation of Hypertrophy in Human MSCs via Treatment with a Retinoic Acid Receptor Inverse Agonist. Int J Mol Sci 2020; 21:ijms21041444. [PMID: 32093330 PMCID: PMC7073129 DOI: 10.3390/ijms21041444] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 02/07/2023] Open
Abstract
In vitro chondrogenically differentiated mesenchymal stem cells (MSCs) have a tendency to undergo hypertrophy, mirroring the fate of transient “chondrocytes” in the growth plate. As hypertrophy would result in ossification, this fact limits their use in cartilage tissue engineering applications. During limb development, retinoic acid receptor (RAR) signaling exerts an important influence on cell fate of mesenchymal progenitors. While retinoids foster hypertrophy, suppression of RAR signaling seems to be required for chondrogenic differentiation. Therefore, we hypothesized that treatment of chondrogenically differentiating hMSCs with the RAR inverse agonist, BMS204,493 (further named BMS), would attenuate hypertrophy. We induced hypertrophy in chondrogenic precultured MSC pellets by the addition of bone morphogenetic protein 4. Direct activation of the RAR pathway by application of the physiological RAR agonist retinoic acid (RA) further enhanced the hypertrophic phenotype. However, BMS treatment reduced hypertrophic conversion in hMSCs, shown by decreased cell size, number of hypertrophic cells, and collagen type X deposition in histological analyses. BMS effects were dependent on the time point of application and strongest after early treatment during chondrogenic precultivation. The possibility of modifing hypertrophic cartilage via attenuation of RAR signaling by BMS could be helpful in producing stable engineered tissue for cartilage regeneration.
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Affiliation(s)
- Moritz Riedl
- Department of Trauma Surgery, Regensburg University Medical Center, 93053 Regensburg, Germany; (M.R.); (M.K.); (S.L.); (M.K.); (F.B.); (W.K.); (V.A.)
- Laboratory of Experimental Trauma Surgery, Department of Trauma Surgery, Regensburg University Medical Center, 93053 Regensburg, Germany; (C.W.); (D.D.)
| | - Christina Witzmann
- Laboratory of Experimental Trauma Surgery, Department of Trauma Surgery, Regensburg University Medical Center, 93053 Regensburg, Germany; (C.W.); (D.D.)
| | - Matthias Koch
- Department of Trauma Surgery, Regensburg University Medical Center, 93053 Regensburg, Germany; (M.R.); (M.K.); (S.L.); (M.K.); (F.B.); (W.K.); (V.A.)
- Laboratory of Experimental Trauma Surgery, Department of Trauma Surgery, Regensburg University Medical Center, 93053 Regensburg, Germany; (C.W.); (D.D.)
| | - Siegmund Lang
- Department of Trauma Surgery, Regensburg University Medical Center, 93053 Regensburg, Germany; (M.R.); (M.K.); (S.L.); (M.K.); (F.B.); (W.K.); (V.A.)
- Laboratory of Experimental Trauma Surgery, Department of Trauma Surgery, Regensburg University Medical Center, 93053 Regensburg, Germany; (C.W.); (D.D.)
| | - Maximilian Kerschbaum
- Department of Trauma Surgery, Regensburg University Medical Center, 93053 Regensburg, Germany; (M.R.); (M.K.); (S.L.); (M.K.); (F.B.); (W.K.); (V.A.)
- Laboratory of Experimental Trauma Surgery, Department of Trauma Surgery, Regensburg University Medical Center, 93053 Regensburg, Germany; (C.W.); (D.D.)
| | - Florian Baumann
- Department of Trauma Surgery, Regensburg University Medical Center, 93053 Regensburg, Germany; (M.R.); (M.K.); (S.L.); (M.K.); (F.B.); (W.K.); (V.A.)
| | - Werner Krutsch
- Department of Trauma Surgery, Regensburg University Medical Center, 93053 Regensburg, Germany; (M.R.); (M.K.); (S.L.); (M.K.); (F.B.); (W.K.); (V.A.)
| | - Denitsa Docheva
- Laboratory of Experimental Trauma Surgery, Department of Trauma Surgery, Regensburg University Medical Center, 93053 Regensburg, Germany; (C.W.); (D.D.)
| | - Volker Alt
- Department of Trauma Surgery, Regensburg University Medical Center, 93053 Regensburg, Germany; (M.R.); (M.K.); (S.L.); (M.K.); (F.B.); (W.K.); (V.A.)
| | - Christian Pfeifer
- Department of Trauma Surgery, Regensburg University Medical Center, 93053 Regensburg, Germany; (M.R.); (M.K.); (S.L.); (M.K.); (F.B.); (W.K.); (V.A.)
- Laboratory of Experimental Trauma Surgery, Department of Trauma Surgery, Regensburg University Medical Center, 93053 Regensburg, Germany; (C.W.); (D.D.)
- Correspondence:
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Freigang V, Gschrei F, Bhayana H, Schmitz P, Weber J, Kerschbaum M, Nerlich M, Baumann F. Risk factor analysis for delayed union after subtrochanteric femur fracture: quality of reduction and valgization are the key to success. BMC Musculoskelet Disord 2019; 20:391. [PMID: 31470831 PMCID: PMC6717321 DOI: 10.1186/s12891-019-2775-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/22/2019] [Indexed: 12/18/2022] Open
Abstract
Background Subtrochanteric femur fractures (SFF) are uncommon, but have a high complication rate concerning non-union and mechanical complications. There is ongoing discussion about risk factors for delayed fracture healing after SFF. The purpose of this study was to evaluate potential risk factors for delayed fracture healing after SFF. Methods This retrospective radio-morphometric case control study compares 61 patients after SFF in two groups (uncomplicated healing within 6 months postoperatively vs. delayed union) concerning radiographical properties. The patients were analyzed concerning the following parameter: Quality of the reduction according to Baumgaertner, CCD-angle, Tip-Apex Distance, leg-length shortening and fracture healing according to the RUSH Score. Results The mean RUSH-Score at 6 months postoperatively was 21.32(±4.57). At that point of time, only 29/61 fractures were radiographically fully consolidated (timely fracture healing) and 32 patients were rated as delayed union. The total revision rate was 9/61 (14.7%), whereof four patients required revision for symptomatic non-union of the SFF. The results of the radio-morphometric measurement showed a significant difference between both groups concerning the degree of reduction measured according to Baumgaertner (p = 0.022). The postoperative ipsilateral CCD-angle was different between the two groups (p = 0.019). After 12 months postoperatively, 48/61 (78.6%) of fractures were rated healed without any further intervention. Conclusions Delayed union after SFF occurs frequently. In our patient population, the quality of reduction and the postoperative CCD-angle were the key factors to avoid delayed union. Level of evidence Level III, Therapeutic study. Trial registration Clinical Trial Registry University of Regensburg Z-2018-1074-1. Registered 04. Aug 2018. https://studienanmeldung.zks-regensburg.de
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Affiliation(s)
- Viola Freigang
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Franziska Gschrei
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Himanshu Bhayana
- Department of Orthopaedics, UCMS and GTB Hospital, Delhi, 110095, India
| | - Paul Schmitz
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Johannes Weber
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Maximilian Kerschbaum
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Michael Nerlich
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Florian Baumann
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany.
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Hilber F, Pfeifer C, Memmel C, Zellner J, Angele P, Nerlich M, Kerschbaum M, Popp D, Baumann F, Krutsch W. Early functional rehabilitation after patellar dislocation-What procedures are daily routine in orthopedic surgery? Injury 2019; 50:752-757. [PMID: 30717889 DOI: 10.1016/j.injury.2018.10.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/17/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Patellar dislocation and rupture of the medial patellofemoral ligament (MPFL) are frequently seen in daily orthopedic practice. Besides initial non-surgical treatment, surgery and subsequent rehabilitation are crucial for restoring stability in the femoropatellar joint. This study investigated current rehabilitation strategies after patellar dislocation because knowledge on this topic has been severely limited so far. MATERIALS AND METHODS The current rehabilitation protocols of 42 orthopedic and trauma surgical institutions were analyzed regarding their recommendations on weight bearing, range of motion (ROM), and use of movement devices and orthosis. All protocols for conservative treatment and postoperative rehabilitation after MPFL reconstruction were compared. Descriptive and statistical analyses were carried out when appropriate. RESULTS The different rehabilitation strategies for conservative and surgical treatment after patellar dislocation showed a tendency towards earlier functional rehabilitation after surgical MPFL reconstruction than after conservative treatment. Both surgical and conservative treatment involved initial restrictions in weight bearing, ROM, and use of movement devices and orthosis at the beginning of rehabilitation. The rehab protocols showed a significant earlier full weight bearing after surgical MPFL reconstruction (p > 0.001). Due to the presence of other parameters for early functional treatment, the absence of an indication for using orthosis (surgical: 44%, conservative: 33%; p = 0.515) or start of unlimited ROM of the knee (surgical: 4.9 weeks, conservative: 5.7 weeks; p = 0.076) showed by trend an earlier functional strategy after MPFL reconstruction than after conservative therapy. CONCLUSIONS Both conservative and surgical treatment after patellar dislocation showed restrictions in the early phase of the rehabilitation. Earlier functional therapy was more common after MPFL reconstruction than after conservative treatment. Further clinical and biomechanical studies on rehabilitation strategies after patellar dislocation are needed to improve patient care und individualized therapy.
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Affiliation(s)
- Franz Hilber
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany.
| | - Christian Pfeifer
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Clemens Memmel
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Johannes Zellner
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Peter Angele
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Michael Nerlich
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Maximilian Kerschbaum
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Daniel Popp
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Florian Baumann
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Werner Krutsch
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
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Mahr D, Freigang V, Bhayana H, Kerschbaum M, Frankewycz B, Loibl M, Nerlich M, Baumann F. Comprehensive treatment algorithm for atlanto-axial rotatory fixation (AARF) in children. Eur J Trauma Emerg Surg 2019; 47:713-718. [PMID: 30783696 DOI: 10.1007/s00068-019-01096-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 02/18/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atlanto-axial rotatory fixation (AARF) is an uncommon condition in children presenting with torticollis. Many studies have elaborated on the diagnostic sequence of AARF. However, there is no consensus for the algorithm of management of AARF. METHODS This study proposes to provide a comprehensive step-by-step guideline which aims to achieve and retain anatomic reduction of the atlanto-axial joint (AAJ). We recommend a 'therapeutic crescendo': closed reduction and immobilization in a rigid cervical collar (step I). In cases of re-dislocation, a second attempt of closed reduction and immobilization in a Halo-jacket (step II). Cases of recurrent dislocations due to persistent instability require open reduction and internal fixation. We present a new surgical technique of transverse suture transfixation (TSF) of C1/C2 (step III). Alternatively, a dorsal stabilization of C1/C2 is indicated after open reduction (step IV). 13 patients with radiologically confirmed AARF were included in this study. These patients were treated as per the above mentioned algorithm. All these patients were serially evaluated with a minimum follow-up of 1 year. RESULTS Clinical data of 10/13 patients were available for follow-up evaluation at mean 4.6 years after the onset of symptoms. Two patients were managed surgically. We recorded good clinical results in all patients treated according to the algorithm. CONCLUSIONS AARF is a subacute pediatric emergency. Reduction and maintenance of joint congruency of the AAJ are the treatment goals. The comprehensive therapeutic algorithm presented in this study is applicable in patients with AARF to achieve excellent long-term results. LEVEL OF EVIDENCE IV, Retrospective cohort study. TRIAL REGISTRATION NUMBER Clinical Trial Registry University of RegensburgZ-2014-0453-4. Registered 01 December 2014.
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Affiliation(s)
- Daniel Mahr
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Viola Freigang
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Himanshu Bhayana
- Department of Orthopaedics, UCMS and GTB Hospital, New Delhi, Delhi, 110095, India
| | - Maximilian Kerschbaum
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Borys Frankewycz
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Markus Loibl
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Michael Nerlich
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Florian Baumann
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany.
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Bhayana H, Pandey R, Dhammi IK, Baumann F, Bhatia U. Comparative Study for Assessment of Functional Outcome of Intraarticular AO Type C Distal Humerus Fractures Treated by Parallel Plating. Indian J Orthop 2019; 53:190-195. [PMID: 30906001 PMCID: PMC6394173 DOI: 10.4103/ortho.ijortho_298_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Complex distal end of humerus fractures are one of the most challenging cases in orthopedics. There is a paucity of literature on outcomes of parallel reconstruction plates using olecranon osteotomy technique along with large sample size. This study focuses primarily on rate of various complications encountered in intraarticular AO Type C distal humerus fractures. MATERIALS AND METHODS In this prospective study, we included 94 patients with isolated closed intraarticular AO type C distal and humerus injuries. Exclusion criteria were polytrauma, open injuries, and pathological fractures (except osteoporosis). The followup was done immediate postoperatively, 6 weeks, 6 months, 1 year and at 2 years. Range of motion (ROM), Mayo Elbow Performance Score (MEPS), and Disabilities of the Arm, Shoulder, and Hand (DASH) score was recorded at each visit. Assessment of union was done based on X-ray. Patients were classified into two groups; Group 1 - patients without complications (n = 64) and Group 2 - with one or more complications. RESULTS The average duration of surgery was 2 h and 15 min. The complication rate was 31.9% (30/94), however, a total of 45 complications were noted. The difference between ROM in the two groups was statistically significant (P < 0.05), however, the difference between MEPS and DASH score was not statistically significant. The most common complication found was ulnar nerve neuropathy. CONCLUSION Parallel plating using olecranon osteotomy is an acceptable approach for this fracture, but due to inherent nature of this injury, it has its own set of complications which must be counseled before surgery and active participation of patient is required to obtain realistic expectations and goals for the future.
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Affiliation(s)
- Himanshu Bhayana
- Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Rohit Pandey
- Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India,Address for correspondence: Dr. Rohit Pandey, Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, New Delhi - 110 095, India. E-mail:
| | - Ish Kumar Dhammi
- Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Florian Baumann
- Department of Trauma Surgery, University Hospital Regensburg, Germany
| | - Urveshi Bhatia
- Department of Community Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
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Baumann F. Bicruciate-retaining total knee arthroplasty compared to cruciate-sacrificing TKA: what are the advantages and disadvantages? Expert Rev Med Devices 2018; 15:615-617. [PMID: 30132366 DOI: 10.1080/17434440.2018.1514256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Florian Baumann
- a Department of Trauma Surgery , Regensburg University Medical Center , Regensburg , Germany
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Schmitz P, Lüdeck S, Baumann F, Kretschmer R, Nerlich M, Kerschbaum M. Patient-related quality of life after pelvic ring fractures in elderly. Int Orthop 2018; 43:261-267. [PMID: 29946740 DOI: 10.1007/s00264-018-4030-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Pelvic ring fractures, occurring in elderly patients are a challenging problem. Little known is about the patient-related outcome after these injuries. The primary objective of this study is to evaluate the quality of life after pelvic ring injuries in patients aged over 60 years. METHODS Patients (≥ 60 years) with pelvic ring fractures treated in our trauma department between 2004 and 2014 were included. Next to patient data, injury-related details as well as treatment details were assessed. After a follow-up of at least two years, the survival rate and the patient-related outcome were evaluated using the SF-36 and the EQ-5D score. RESULTS One hundred ninety-six patients (138 women; 58 men; mean age 75.3 ± 7.8 years) were identified. Ninety-six patients were treated operatively, 100 patients conservatively. The overall complication rate was significantly lower for conservatively compared to operatively treated patients (conservatively 18% vs. operatively 33%; p = 0.014). The total mortality rate over 2 years is 29% with no significant difference of the two-year survival rate (2-year survival rate: operatively 77% vs. non-operatively 65%; p = 0.126). Fifty-five patients completed the SF-36 and EQ-5D score after a mean follow-up of 4.2 ± 2.9 years. The mean physical component score of the SF-36 is 33.6 ± 8.3, and the mean mental component score is 45.3 ± 8.4. The mean EQ-5D VAS reached 62.5 ± 27.9. CONCLUSION Elderly patients with pelvic ring fractures show a high mortality rate and a limited patient-related outcome. While the complication rate of conservatively treated patients is lower compared to operated patients, the two year survival rate is steady.
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Affiliation(s)
- Paul Schmitz
- Clinic of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Stephan Lüdeck
- Clinic of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Florian Baumann
- Clinic of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Rainer Kretschmer
- Caritas-Krankenhaus St. Josef, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Michael Nerlich
- Clinic of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Maximilian Kerschbaum
- Clinic of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
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Schmitz P, Baumann F, Acklin YP, Gueorguiev B, Nerlich M, Grechenig S, Müller MB. Clinical application of a minimally invasive cement-augmentable Schanz screw rod system to treat pelvic ring fractures. Int Orthop 2018; 43:697-703. [PMID: 29785590 DOI: 10.1007/s00264-018-3988-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 05/13/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of this study is to analyze the results using the USS fracture MIS system (DePuy Synthes) to treat instable pelvic ring fractures. As its outstanding feature, it is the only Schanz screw and rod system at present that combines angular stability, perforation/fenestration of the screws for cement-augmentation, a variable screw length, and a large screw diameter. MATERIALS AND METHODS Retrospective investigation of 134 pelvic ring fractures treated in 2012-2013. Twenty-five patients obtained the abovementioned implant. Besides baseline characteristics of the included patients and the surgical procedure, a clinical/radiological follow-up of six months was analyzed. RESULTS Dividing the collective into two groups, I high-energy trauma and II fragility fracture of the pelvis, the following results were recorded: group I: ten patients, six male, age 48.4 ± 19.7 years. Mean ISS 41 ± 22.5, fracture classification: AO/OTA type 61 B1/C1/C3 = 1/5/4. Operative treatment: three transiliac internal fixator, seven iliolumbar fixation, one implant was cement-augmented. Group II: 15 patients, 14 female, age 77.5 ± 10.1 years. Fracture classification according to Rommens: FFPII/III/IV = 6/1/8. Operative treatment: eight transiliac internal fixator, seven iliolumbar fixation, 14 implants were cement-augmented. Overall surgical side complications: 16%. Radiological examination: correct positioning of all ilium screws. Follow-up after six month (16 patients): all showed fracture consolidation. One ilium screw was broken close to the connecting clamp. CONCLUSION The investigated Schanz screw rod system is a suitable implant to broaden the established procedures to stabilize dorsal pelvic ring fractures. TRIAL REGISTRATION The study is registered at the Clinical Trial Registry University of Regensburg (Number Z-2017-0878-3).
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Affiliation(s)
- Paul Schmitz
- Clinic of Traumatology, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany.
| | - Florian Baumann
- Clinic of Traumatology, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
| | - Yves P Acklin
- AO Research Institute Davos, Clavadelerstr. 8, CH-7270, Davos, Switzerland
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstr. 8, CH-7270, Davos, Switzerland
| | - Michael Nerlich
- Clinic of Traumatology, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
| | - Stephan Grechenig
- Clinic of Traumatology, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
| | - Michael Bernd Müller
- Klinik für Unfall- und Wiederherstellungschirurgie, Klinikum Bayreuth, Preuschwitzer Str. 101, 95445, Bayreuth, Germany
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Krutsch W, Krutsch V, Hilber F, Pfeifer C, Baumann F, Weber J, Schmitz P, Kerschbaum M, Nerlich M, Angele P. 11.361 sports injuries in a 15-year survey of a Level I emergency trauma department reveal different severe injury types in the 6 most common team sports. Sportverletz Sportschaden 2018; 32:111-119. [PMID: 29734457 DOI: 10.1055/s-0583-3792] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Severe sports-related injuries are a common affliction treated in Level I trauma departments. Detailed knowledge on injury characteristics from different medical settings is essential to improve the development of injury prevention strategies in different team sports. METHODS Team sport injuries were retrospectively analysed in a Level I trauma department registry over 15 years. Injury and treatment data were compared with regard to competition and training exposure. Injury data such as "time of visitation", "type of injury", "multiple injured body regions" and "immediate hospitalisation" helped to define the severity level of each team sports injury. RESULTS At the Level I trauma department, 11.361 sports-related injuries were seen over 15 years, of which 34.0 % were sustained during team sports. Soccer injuries were the most common injuries of all team sports (71.4 %). The lower extremity was the most affected body region overall, followed by the upper extremity. Head injuries were mainly seen in Ice hockey and American football and concussion additionally frequently in team handball. Slight injuries like sprains or contusions occurred most frequently in all team sports. In soccer and team handball, injuries sustained in competition were significantly more severe (p < 0.001) than those sustained in practice.Volleyball and basketball had a trend to higher rate of severe injuries sustained during practice sessions. CONCLUSION Depending on the specific injury profile of each team sports, injury prevention strategies should address competitive as well as training situations, whichmay need different strategies.
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Affiliation(s)
- Werner Krutsch
- Department of Trauma Surgery, University Medical Centre Regensburg
| | | | - Franz Hilber
- Department of Trauma Surgery, University Medical Centre Regensburg
| | | | - Florian Baumann
- Department of Trauma Surgery, University Medical Centre Regensburg
| | - Johannes Weber
- Department of Trauma Surgery, University Medical Centre Regensburg
| | - Paul Schmitz
- Department of Trauma Surgery, University Medical Centre Regensburg
| | | | - Michael Nerlich
- Department of Trauma Surgery, University Medical Centre Regensburg
| | - Peter Angele
- Department of Trauma Surgery, University Medical Centre Regensburg
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Baumann F, Schmitz P, Mahr D, Kerschbaum M, Gänsslen A, Nerlich M, Worlicek M. A guideline for placement of an infra-acetabular screw based on anatomic landmarks via an intra-pelvic approach. J Orthop Surg Res 2018; 13:77. [PMID: 29631637 PMCID: PMC5892032 DOI: 10.1186/s13018-018-0786-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 03/25/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Due to demographic changes, more and more fracture patterns involving anterior acetabular structures occur. The infra-acetabular screw is seen a useful tool to increase stability in fixation of the acetabular cup. However, the exact position of this screw in relation to anatomic landmarks which are intra-operatively palpable via an intra-pelvic approach has not yet been determined. METHODS This biomorphometric experimental study references the ideal screw position of an infra-acetabular screw to anatomic landmarks palpable via an intra-pelvic approach. Therefore, we created a computer tomography-based 3D-model of 40 patients (20 women, 20 men) who received a computer tomography (CT) scan of the pelvis for any other reason than an acetabular fracture. RESULTS The entry point of an ideal infra-acetabular was of high constancy. At mean, this point was 10.2 mm caudal and 10.4 mm medial of the ilio-pubic/ilio-pectineal eminence. This reference is independent of age, gender, or physical dimensions. However, we found gender-dependent differences for the angulation and the length of the screw. CONCLUSIONS This study provides a comprehensive guideline to determine the ideal entry point for an infra-acetabular screw via an intra-pelvic approach. The entry point is located 10.2 mm caudal and 10.4 mm medial of the ilio-pubic/ilio-pectineal eminence. TRIAL REGISTRATION Clinical Trial Registry University of Regensburg Z-2017-0930-1 . Registered 04. Dec 2017.
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Affiliation(s)
- Florian Baumann
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany.
| | - Paul Schmitz
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Daniel Mahr
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Maximilian Kerschbaum
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Axel Gänsslen
- Clinic for Trauma Surgery, Orthopedics and Hand Surgery, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Michael Nerlich
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Michael Worlicek
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
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Baumann F, Krutsch W, Worlicek M, Kerschbaum M, Zellner J, Schmitz P, Nerlich M, Tibesku C. Reduced joint-awareness in bicruciate-retaining total knee arthroplasty compared to cruciate-sacrificing total knee arthroplasty. Arch Orthop Trauma Surg 2018; 138:273-279. [PMID: 29124363 DOI: 10.1007/s00402-017-2839-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE There is rising impact of patient-reported outcome (PRO) measurement in joint arthroplasty over the past years. Bicruciate-retaining implants have shown more physiologic knee kinematics and provide superior proprioceptive capacities. The aim of this study was to evaluate if the functional properties of this new implant design lead to improved PRO results after total knee arthroplasty (TKA). METHODS This prospective, controlled trial compares PRO of bicruciate-retaining total knee arthroplasty (BCR-TKA) to unicondylar knee arthroplasty (UKA) and standard posterior-stabilized total knee arthroplasty (PS-TKA). We evaluated 102 patients (34 patients in each group) 18 months postoperatively after knee arthroplasty. Primary outcome measure was the Forgotten Joint Score (FJS). RESULTS The BCR-group showed the same level of joint awareness as the UKA-group (p = 0.999). The second control group of PS-TKA patients had a lower mean score value in the FJS compared to the BCR-group (p = 0.035) and UKA-group (p = 0.031). There was no correlation of age, gender, body mass index (BMI) and the FJS. No relevant floor- or ceiling effects occurred. CONCLUSIONS This study found reduced joint awareness for BCR-TKA compared to a standard total knee arthroplasty. The score values of the BCR-group were equal to the UKA-group. Further prospective, randomized studies to investigate long-term survivorship of bicruciate-retaining implants are needed. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Florian Baumann
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany.
| | - Werner Krutsch
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Michael Worlicek
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Maximilian Kerschbaum
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Johannes Zellner
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Paul Schmitz
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Michael Nerlich
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
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Baumann F, Weber J, Mahr D, Bäumlein M, Kerschbaum M, Müller K, Rillmann P, Nerlich M, Loibl M. Joint awareness in posttraumatic osteoarthritis of the knee: validation of the forgotten joint score in long term condition after tibial plateau fracture. Health Qual Life Outcomes 2017; 15:233. [PMID: 29197416 PMCID: PMC5712162 DOI: 10.1186/s12955-017-0801-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 11/16/2017] [Indexed: 11/17/2022] Open
Abstract
Background Evaluating patient-reported outcomes (PRO) in early osteoarthritis (OA) of the knee is difficult. Established measurement tools are focused on one of the two major patient groups in knee surgery: young, highly active patients, or older patients with advanced degenerative OA of the knee. Joint awareness in everyday life is a crucial criterion in measuring PRO. The purpose of this study was to validate a German version of the “Forgotten Joint Score” (FJS) in patients after surgical treatment of tibial plateau fractures. Methods In this prospective cohort study, clinical and radiological outcomes data were collected from patients after surgical treatment of tibial plateau fractures following a skiing accident. Functional outcome questionnaires were administered including the FJS, the Lysholm-Score, the Tegner-Activity Scale (TAS), the EuroQol-5D (EQ 5-D), and a subjective rating of change. The validation study was carried out according to the COSMIN checklist protocol. The KLS was used to measure the presence and severity of OA on knee radiographs, and correlation with the FJS was measured. Results Cronbach‘s alpha was .96 (95%-CI .92, .99) confirming good internal consistency. Test-retest reliability of the FJS was high with an ICC(67) = .91 (95%-CI .85,.95). Furthermore, no relevant floor or ceiling effects were observed. FJS significantly differed in patients with different OA degrees (p = .041). Symptomatic patients had significant lower FJS than asymptomatic patients (p < .001). Conclusions This is the first study validating a disease-specific PRO, the FJS, in long-term outcomes after joint fracture. We demonstrated good psychometric properties and a significant correlation between the FJS and the radiologic degree of OA in patients with a history of tibial plateau fracture. Trial registration Clinical Trial Registry University of Regensburg Z-2015-0872-2. Registered 01. October 2015.
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Affiliation(s)
- Florian Baumann
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany.
| | - Johannes Weber
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Daniel Mahr
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Martin Bäumlein
- Center for Orthopaedics and Trauma Surgery; University Hospital Giessen and Marburg, Marburg, Germany.,Spital Davos, Department of Orthopedic Trauma Surgery, Davos, Switzerland
| | - Maximilian Kerschbaum
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Karolina Müller
- Center for Clinical Studies, Regensburg University Medical Center, Regensburg, Germany
| | - Paavo Rillmann
- Spital Davos, Department of Orthopedic Trauma Surgery, Davos, Switzerland
| | - Michael Nerlich
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Markus Loibl
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany.,Spital Davos, Department of Orthopedic Trauma Surgery, Davos, Switzerland
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Spiessberger A, Baumann F, Nevzati E, Kothbauer KF, Fandino J, Muroi C. Minimally invasive medial supraorbital, combined subfrontal-interhemispheric approach to the anterior communicating artery complex-a cadaveric study. Acta Neurochir (Wien) 2017; 159:1079-1085. [PMID: 28386838 DOI: 10.1007/s00701-017-3159-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION In selected cases, microsurgical clipping remains a valuable treatment alternative to endovascular occlusion of anterior communicating artery (AComA) aneurysms. Their clipping is challenging and carries a risk of postsurgical cognitive impairment. We evaluate the microsurgical anatomy of a new, minimally invasive combined interhemispheric-subfrontal approach to the AComA complex via a medial supraorbital craniotomy. METHODS In this descriptive anatomic study, four alcohol-embedded, silicon-injected human cadaver heads were used. In each of the two cadavers, the AComA complex was approached from either the right or left side. An operating microscope and standard microsurgical instruments were used. RESULTS After a medial eyebrow incision, a medial supraorbital minicraniotomy was performed. The frontal sinus was opened and cranialized. Following the dural opening, a subfrontal arachnoid dissection was performed to identify the optico-carotid complex. By following the A1 segment, a low-lying AComA complex could be visualized. Shifting the corridor towards the midline enabled an interhemispheric dissection. This dissection resulted in a wide superior-inferior corridor. Higher-lying AComA complexes could also be visualized. The achieved exposure of the AComA complex would allow safe dissection and clipping of low- and high-lying AComA aneurysms, with minimal retraction and preservation of the surrounding anatomical structures, in particular the perforators. CONCLUSIONS We demonstrate the anatomy of a novel approach for surgical clipping of AComA aneurysms. Our study suggests that this approach provides good exposure without concomitant structural and vascular injury and thus might reduce the risk of procedure-related morbidity.
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Baumann F, Bahadin Ö, Krutsch W, Zellner J, Nerlich M, Angele P, Tibesku CO. Proprioception after bicruciate-retaining total knee arthroplasty is comparable to unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:1697-1704. [PMID: 27145774 DOI: 10.1007/s00167-016-4121-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 03/29/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE Rising expectations in functional performance of total knee joints are inciting further improvement of knee arthroplasty implants. From a patient-centred view, bicruciate-retaining models provide a more natural feeling knee. However, there is no evidence of functional advantage for these implants. The aim of this study was to evaluate balance ability as a measure of proprioception in patients with a bicruciate-retaining total knee arthroplasty. METHODS A prospective, controlled trial was conducted to compare balance ability in 60 patients after arthroplasty of the knee for osteoarthritis. We compared patients with a bicruciate-retaining knee arthroplasty (BCR group) to a control group of patients with a medial unicompartmental knee arthroplasty (UKA group) and another control group of patients with a posterior stabilized total knee arthroplasty (PS group). The patient population comprised 30 women (50.0 %) and 30 men in three cohorts of 20 each. The mean age was 62.1 ± 8.0 years (range 43-78). Patients were evaluated preoperatively and 9 months post-operatively. The evaluation included clinical, radiological, and balance testing-a single-leg stance with eyes closed compared to eyes open. The difference in area of sway between eyes closed and eyes open represents static balance ability after knee arthroplasty. RESULTS Perioperative data showed that there was no intra-operative fracture of the intercondylar eminence. There was a decreased post-operative knee extension 9 months post-operative in the BCR group, which was not clinically relevant in any case. We recorded a lower difference in the area of sway between eyes closed and eyes open (ΔA (ec-eo)) for the BCR group (p = 0.01) and the UKA group (p = 0.04) compared to the PS group. CONCLUSIONS This study found superior static balance ability after preservation of both cruciate ligaments in arthroplasty of the knee, indicating superior proprioceptive function. Hence, BCR implants could provide improved functional properties. Superior proprioceptive function of bicruciate-retaining implants can be an important factor in implant selection. Further prospective, randomized studies to investigate kinematics and long-term survivorship of bicruciate-retaining implants are needed. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Florian Baumann
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany.
| | - Özkan Bahadin
- Sporthopaedicum Regensburg, Hildegard-vn-Bingen-Str. 1, 93053, Regensburg, Germany
| | - Werner Krutsch
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Johannes Zellner
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Michael Nerlich
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Peter Angele
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany.,Sporthopaedicum Regensburg, Hildegard-vn-Bingen-Str. 1, 93053, Regensburg, Germany
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Krutsch W, Zellner J, Baumann F, Pfeifer C, Nerlich M, Angele P. Timing of anterior cruciate ligament reconstruction within the first year after trauma and its influence on treatment of cartilage and meniscus pathology. Knee Surg Sports Traumatol Arthrosc 2017; 25:418-425. [PMID: 26475153 DOI: 10.1007/s00167-015-3830-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Anterior cruciate ligament (ACL) ruptures are often associated with primary meniscal and cartilage lesions. Late reconstruction of ACL-deficient knees may increase the risk of developing secondary meniscal and cartilage lesions; hence, the timing of ACL repair is of the utmost importance. Because meniscus outcome is also a potential predictor for osteoarthritis (OA), this study compared ACL repair within the first 6 months after injury to that of surgery conducted 7-12 months after injury with regard to the incidence of meniscal and cartilage lesions. METHODS This prospective cross-sectional study included all complete isolated primary ACL ruptures treated in our institution within 1 year after trauma over a 12-month period. Exclusion criteria were revision ACL, complex ligament injuries, previous knee surgery, and missing injury data. Cartilage lesions were classified according to the score established by the International Cartilage Repair Society (ICRS score) and meniscal tears according to their treatment options. RESULTS Two hundred and thirty-three of 730 patients (162 men, 71 women) with ACL repair met the inclusion criteria. 86.3 % of surgical interventions were conducted within 6 months and 13.7 % after 6 months of trauma. Severe cartilage lesions grade III-IV did not significantly differ between the different time points of ACL repair (<6 months 39.9 %; >6 months 31.3 %; p = n.s.). Medial meniscus lesions received significantly higher meniscal repair in early compared to delayed ACL repair. Significantly higher rate of meniscal repair of the medial meniscus was seen in cases of early ACL repair compared to delayed (<6 months 77.2 %, >6 months 46.7; p = 0.022). The rate of medial meniscal repair in early ACL repair was significantly higher for women (89.5-0 %; p = 0.002), however, not for men (73.3-53.8 %; p = n.s.). No differences were found for lateral meniscal lesions, with regard to neither the different time points (p = n.s.) nor the sex (p = n.s.). CONCLUSIONS Because of the significantly higher rate of prognostically advantageous meniscal repair, the recommendation for an ACL reconstruction within 6 months after trauma was made to preserve the meniscus and reduce the risk of developing OA. LEVEL OF EVIDENCE Prospective cross-sectional cohort study, Level II.
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Affiliation(s)
- Werner Krutsch
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany.
| | - J Zellner
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - F Baumann
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - C Pfeifer
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - M Nerlich
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - P Angele
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany.,Sporthopaedicum, Straubing/Regensburg, Germany
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Loibl M, Lang S, Brockhoff G, Gueorguiev B, Hilber F, Worlicek M, Baumann F, Grechenig S, Zellner J, Huber M, Valderrabano V, Angele P, Nerlich M, Prantl L, Gehmert S. The effect of leukocyte-reduced platelet-rich plasma on the proliferation of autologous adipose-tissue derived mesenchymal stem cells. Clin Hemorheol Microcirc 2017; 61:599-614. [PMID: 25536920 DOI: 10.3233/ch-141920] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Clinical application of platelet-rich plasma (PRP) and stem cells has become more and more important in regenerative medicine during the last decade. However, differences in PRP preparations may contribute to variable PRP compositions with unpredictable effects on a cellular level. In the present study, we modified the centrifugation settings in order to provide a leukocyte-reduced PRP and evaluated the interactions between PRP and adipose-tissue derived mesenchymal stem cells (ASCs).PRP was obtained after modification of three different centrifugation settings and investigated by hemogram analysis, quantification of protein content and growth factor concentration. ASCs were cultured in serum-free α-MEM supplemented with autologous 10% or 20% leukocyte-reduced PRP. Cell cycle kinetics of ASCs were analyzed using flow cytometric analyses after 48 hours.Thrombocytes in PRP were concentrated, whereas erythrocytes, and white blood cells (WBC) were reduced, independent of centrifugation settings. Disabling the brake further reduced the number of WBCs. A higher percentage of cells in the S-phase in the presence of 20% PRP in comparison to 10% PRP and 20% fetal calf serum (FCS) advocates the proliferation stimulation of ASCs.These findings clearly demonstrate considerable differences between three PRP separation settings and assist in safeguarding the combination of leukocyte-reduced PRP and stem cells for regenerative therapies.
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Affiliation(s)
- Markus Loibl
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Siegmund Lang
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Gero Brockhoff
- Department of Obstetrics and Gynecology, University Medical Center Regensburg, Regensburg, Germany
| | | | - Franz Hilber
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Michael Worlicek
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Florian Baumann
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Stephan Grechenig
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Johannes Zellner
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Michaela Huber
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Victor Valderrabano
- Department of Orthopedic Surgery, University Hospital Basel, Basel, Switzerland
| | - Peter Angele
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Michael Nerlich
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Lukas Prantl
- Center of Plastic, Hand and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Sebastian Gehmert
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany.,Department of Orthopedic Surgery, University Hospital Basel, Basel, Switzerland.,Center of Plastic, Hand and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
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Baumann F, Ernstberger T, Neumann C, Nerlich M, Schroeder GD, Vaccaro AR, Loibl M. Pediatric Cervical Spine Injuries: A Rare But Challenging Entity. ACTA ACUST UNITED AC 2016; 28:E377-84. [PMID: 26165728 DOI: 10.1097/bsd.0000000000000307] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Injuries to the cervical spine in pediatric patients are uncommon. A missed injury can have devastating consequences in this age group. Because of the lack of routine in diagnosis and management of pediatric cervical spine injuries (PCSI), each of these cases represents a logistic and personal challenge. METHODS By means of clinical cases, we demonstrate key points in diagnostics and treatment of pediatric spine injuries. We highlight typical pediatric injury patterns and more adult-like injuries. RESULTS The most common cause of injury is blunt trauma. There is an age-related pattern of injuries in pediatric patients. Children under the age of 8 frequently sustain ligamentous injuries in the upper cervical spine. After the age of 8, the biomechanics of the cervical spine are similar to adults, and therefore, bony injuries of the subaxial cervical spine are most likely to occur. Clinical presentation of PCSI is heterogeneous. Younger children can neither interpret nor communicate neurological abnormalities, which make timely and accurate diagnosis difficult. Plain radiographs are often misinterpreted. We find different types of injuries at different locations, because of different biomechanical properties of the immature spine. We outline that initial management is crucial for long-term outcome. CONCLUSIONS Knowledge of biomechanical properties and radiographic presentation of the immature spine can improve the awareness for PCSI. Diagnosis and management of pediatric patients after neck trauma can be demanding. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Florian Baumann
- *Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany †The Rothman Institute at Thomas Jefferson University, Philadelphia, PA
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Bloch W, Baumann F, Zimmer P, Grischke EM, Fasching PA, Decker T, Uleer C, Schneeweiss A, Salat C, Wimberger P, Mundhenke C, Förster F, Kluth-Pepper B, Schubert J, Tesch H, Schütz F, Lüftner D, Jackisch C. Abstract P4-13-07: Impact of physical activity/exercise on adverse events and quality of life during treatment with everolimus and exemestane for ER+ women - Results of the 3rd interim analysis of BRAWO. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p4-13-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
BRAWO is a non-interventional study collecting data of 3000 breast cancer patients treated with everolimus and exemestane (advanced or metastatic, hormone-receptor-positive, HER2-negative breast cancer). We introduce results of the 3rd preplanned interim analysis with data cut-off 08/01/ 2015, including 1300 patients. Since physical activity/exercise was reported to influence side effects as well as quality of life (QoL) of various cancer types and therapies, this analysis focuses on the impact of the physical activity/exercise history, development on adverse effects (AE) of the medical treatment and QoL.
Methods
Patients were asked to complete the EORTC QLQ-C30 QoL questionnaire and visual analogue scales (VAS-KAS) measuring their present-, past ten year- and lifetime physical activity/exercise level. To differentiate between activity/exercise levels, VAS were divided in three equal components (inactive, somewhat active, very active). Questionnaires and information about AE (e. g. stomatitis, fatigue, nausea, diarrhea, etc.) were collected before starting the medical treatment and were repeated each three months. Logistic regression model was used to estimate the impact of baseline physical activity/exercise on AE at any time point of the therapy. ANOVA models were used to calculate the impact of the baseline activity/exercise level on QoL at the last completed data set of each patient.
Results
Median age of patients was 66 years, median weight was 70 kg, median BMI was 25.9, median time since primary diagnosis was 6.2 years, and 54.4% had visceral metastases at baseline. The median PFS for the first 1300 patients was 7.1 months (95% CI, 6.5-8.0). Patients who reported to be very active (exercise) at the week prior to baseline (4.4%) showed significant lower numbers of AE compared to patients who indicate to be somewhat (14.8%) or inactive (80.8%). In contrast to the exercise level, physical activity in everyday life did not affect the AE incidence. Neither lifetime nor past ten year activity/exercise level is associated with the occurrence of AE. Regarding QoL, very active as well as somewhat active women (measured at baseline for almost each time period) showed significant higher QoL values compared to inactive women during the last assessment before death/progress.
Conclusion
Exercise prior to medical treatment with Everolimus and Exemestane may impact AE during therapy. Since physical activity did not show such a relation, this analysis highlights the importance of specific guidelines for preventive/rehabilitative exercise programs. More knowledge about dose-response relationships is needed. Furthermore a livelong healthy, "active" lifestyle may increase QoL, even in patients with advanced and terminal breast cancer disease.
Citation Format: Bloch W, Baumann F, Zimmer P, Grischke E-M, Fasching PA, Decker T, Uleer C, Schneeweiss A, Salat C, Wimberger P, Mundhenke C, Förster F, Kluth-Pepper B, Schubert J, Tesch H, Schütz F, Lüftner D, Jackisch C. Impact of physical activity/exercise on adverse events and quality of life during treatment with everolimus and exemestane for ER+ women - Results of the 3rd interim analysis of BRAWO. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-13-07.
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Affiliation(s)
- W Bloch
- University Cologne, Cologne, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Erlangen, Erlangen, Germany; Medical Center Onkologie Ravensburg, Ravensburg, Germany; Medical Center Hildesheim, Hildesheim, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Hämato-Onkologische Schwerpunktpraxis, Munich, Germany; Technical University Dresden, Dresden, Germany; University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Novartis Pharma GmbH, Nuremberg, Germany; Onkologie Bethanien, Frankfurt, Germany; University Hospital Heidelberg, Heidelberg, Germany; Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany
| | - F Baumann
- University Cologne, Cologne, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Erlangen, Erlangen, Germany; Medical Center Onkologie Ravensburg, Ravensburg, Germany; Medical Center Hildesheim, Hildesheim, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Hämato-Onkologische Schwerpunktpraxis, Munich, Germany; Technical University Dresden, Dresden, Germany; University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Novartis Pharma GmbH, Nuremberg, Germany; Onkologie Bethanien, Frankfurt, Germany; University Hospital Heidelberg, Heidelberg, Germany; Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany
| | - P Zimmer
- University Cologne, Cologne, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Erlangen, Erlangen, Germany; Medical Center Onkologie Ravensburg, Ravensburg, Germany; Medical Center Hildesheim, Hildesheim, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Hämato-Onkologische Schwerpunktpraxis, Munich, Germany; Technical University Dresden, Dresden, Germany; University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Novartis Pharma GmbH, Nuremberg, Germany; Onkologie Bethanien, Frankfurt, Germany; University Hospital Heidelberg, Heidelberg, Germany; Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany
| | - E-M Grischke
- University Cologne, Cologne, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Erlangen, Erlangen, Germany; Medical Center Onkologie Ravensburg, Ravensburg, Germany; Medical Center Hildesheim, Hildesheim, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Hämato-Onkologische Schwerpunktpraxis, Munich, Germany; Technical University Dresden, Dresden, Germany; University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Novartis Pharma GmbH, Nuremberg, Germany; Onkologie Bethanien, Frankfurt, Germany; University Hospital Heidelberg, Heidelberg, Germany; Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany
| | - PA Fasching
- University Cologne, Cologne, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Erlangen, Erlangen, Germany; Medical Center Onkologie Ravensburg, Ravensburg, Germany; Medical Center Hildesheim, Hildesheim, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Hämato-Onkologische Schwerpunktpraxis, Munich, Germany; Technical University Dresden, Dresden, Germany; University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Novartis Pharma GmbH, Nuremberg, Germany; Onkologie Bethanien, Frankfurt, Germany; University Hospital Heidelberg, Heidelberg, Germany; Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany
| | - T Decker
- University Cologne, Cologne, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Erlangen, Erlangen, Germany; Medical Center Onkologie Ravensburg, Ravensburg, Germany; Medical Center Hildesheim, Hildesheim, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Hämato-Onkologische Schwerpunktpraxis, Munich, Germany; Technical University Dresden, Dresden, Germany; University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Novartis Pharma GmbH, Nuremberg, Germany; Onkologie Bethanien, Frankfurt, Germany; University Hospital Heidelberg, Heidelberg, Germany; Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany
| | - C Uleer
- University Cologne, Cologne, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Erlangen, Erlangen, Germany; Medical Center Onkologie Ravensburg, Ravensburg, Germany; Medical Center Hildesheim, Hildesheim, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Hämato-Onkologische Schwerpunktpraxis, Munich, Germany; Technical University Dresden, Dresden, Germany; University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Novartis Pharma GmbH, Nuremberg, Germany; Onkologie Bethanien, Frankfurt, Germany; University Hospital Heidelberg, Heidelberg, Germany; Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany
| | - A Schneeweiss
- University Cologne, Cologne, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Erlangen, Erlangen, Germany; Medical Center Onkologie Ravensburg, Ravensburg, Germany; Medical Center Hildesheim, Hildesheim, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Hämato-Onkologische Schwerpunktpraxis, Munich, Germany; Technical University Dresden, Dresden, Germany; University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Novartis Pharma GmbH, Nuremberg, Germany; Onkologie Bethanien, Frankfurt, Germany; University Hospital Heidelberg, Heidelberg, Germany; Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany
| | - C Salat
- University Cologne, Cologne, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Erlangen, Erlangen, Germany; Medical Center Onkologie Ravensburg, Ravensburg, Germany; Medical Center Hildesheim, Hildesheim, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Hämato-Onkologische Schwerpunktpraxis, Munich, Germany; Technical University Dresden, Dresden, Germany; University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Novartis Pharma GmbH, Nuremberg, Germany; Onkologie Bethanien, Frankfurt, Germany; University Hospital Heidelberg, Heidelberg, Germany; Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany
| | - P Wimberger
- University Cologne, Cologne, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Erlangen, Erlangen, Germany; Medical Center Onkologie Ravensburg, Ravensburg, Germany; Medical Center Hildesheim, Hildesheim, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Hämato-Onkologische Schwerpunktpraxis, Munich, Germany; Technical University Dresden, Dresden, Germany; University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Novartis Pharma GmbH, Nuremberg, Germany; Onkologie Bethanien, Frankfurt, Germany; University Hospital Heidelberg, Heidelberg, Germany; Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany
| | - C Mundhenke
- University Cologne, Cologne, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Erlangen, Erlangen, Germany; Medical Center Onkologie Ravensburg, Ravensburg, Germany; Medical Center Hildesheim, Hildesheim, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Hämato-Onkologische Schwerpunktpraxis, Munich, Germany; Technical University Dresden, Dresden, Germany; University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Novartis Pharma GmbH, Nuremberg, Germany; Onkologie Bethanien, Frankfurt, Germany; University Hospital Heidelberg, Heidelberg, Germany; Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany
| | - F Förster
- University Cologne, Cologne, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Erlangen, Erlangen, Germany; Medical Center Onkologie Ravensburg, Ravensburg, Germany; Medical Center Hildesheim, Hildesheim, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Hämato-Onkologische Schwerpunktpraxis, Munich, Germany; Technical University Dresden, Dresden, Germany; University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Novartis Pharma GmbH, Nuremberg, Germany; Onkologie Bethanien, Frankfurt, Germany; University Hospital Heidelberg, Heidelberg, Germany; Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany
| | - B Kluth-Pepper
- University Cologne, Cologne, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Erlangen, Erlangen, Germany; Medical Center Onkologie Ravensburg, Ravensburg, Germany; Medical Center Hildesheim, Hildesheim, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Hämato-Onkologische Schwerpunktpraxis, Munich, Germany; Technical University Dresden, Dresden, Germany; University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Novartis Pharma GmbH, Nuremberg, Germany; Onkologie Bethanien, Frankfurt, Germany; University Hospital Heidelberg, Heidelberg, Germany; Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany
| | - J Schubert
- University Cologne, Cologne, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Erlangen, Erlangen, Germany; Medical Center Onkologie Ravensburg, Ravensburg, Germany; Medical Center Hildesheim, Hildesheim, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Hämato-Onkologische Schwerpunktpraxis, Munich, Germany; Technical University Dresden, Dresden, Germany; University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Novartis Pharma GmbH, Nuremberg, Germany; Onkologie Bethanien, Frankfurt, Germany; University Hospital Heidelberg, Heidelberg, Germany; Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany
| | - H Tesch
- University Cologne, Cologne, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Erlangen, Erlangen, Germany; Medical Center Onkologie Ravensburg, Ravensburg, Germany; Medical Center Hildesheim, Hildesheim, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Hämato-Onkologische Schwerpunktpraxis, Munich, Germany; Technical University Dresden, Dresden, Germany; University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Novartis Pharma GmbH, Nuremberg, Germany; Onkologie Bethanien, Frankfurt, Germany; University Hospital Heidelberg, Heidelberg, Germany; Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany
| | - F Schütz
- University Cologne, Cologne, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Erlangen, Erlangen, Germany; Medical Center Onkologie Ravensburg, Ravensburg, Germany; Medical Center Hildesheim, Hildesheim, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Hämato-Onkologische Schwerpunktpraxis, Munich, Germany; Technical University Dresden, Dresden, Germany; University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Novartis Pharma GmbH, Nuremberg, Germany; Onkologie Bethanien, Frankfurt, Germany; University Hospital Heidelberg, Heidelberg, Germany; Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany
| | - D Lüftner
- University Cologne, Cologne, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Erlangen, Erlangen, Germany; Medical Center Onkologie Ravensburg, Ravensburg, Germany; Medical Center Hildesheim, Hildesheim, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Hämato-Onkologische Schwerpunktpraxis, Munich, Germany; Technical University Dresden, Dresden, Germany; University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Novartis Pharma GmbH, Nuremberg, Germany; Onkologie Bethanien, Frankfurt, Germany; University Hospital Heidelberg, Heidelberg, Germany; Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany
| | - C Jackisch
- University Cologne, Cologne, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Erlangen, Erlangen, Germany; Medical Center Onkologie Ravensburg, Ravensburg, Germany; Medical Center Hildesheim, Hildesheim, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Hämato-Onkologische Schwerpunktpraxis, Munich, Germany; Technical University Dresden, Dresden, Germany; University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Novartis Pharma GmbH, Nuremberg, Germany; Onkologie Bethanien, Frankfurt, Germany; University Hospital Heidelberg, Heidelberg, Germany; Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany
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Baumann F, Ernstberger T, Loibl M, Zeman F, Nerlich M, Tibesku C. Validation of the German Forgotten Joint Score (G-FJS) according to the COSMIN checklist: does a reduction in joint awareness indicate clinical improvement after arthroplasty of the knee? Arch Orthop Trauma Surg 2016; 136:257-64. [PMID: 26646846 DOI: 10.1007/s00402-015-2372-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE Evaluation of further improvement in treatment of patients with osteoarthritis of the knee requires measurement tools with a high discriminatory power. In this context, joint awareness in everyday life is seen as crucial criterion. Purpose of this study was to adapt and validate a German version of the "Forgotten Joint Score" (FJS) according to the COSMIN checklist. METHODS We evaluated a German translation of the FJS for reliability, validity and responsiveness according to the COSMIN checklist. Therefore, patients with an artificial knee joint completed the G-FJS questionnaire twice at intervals of at least 2 weeks. In addition, the Knee Society Score, the Oxford Knee Score, the Tegner Activity Scale, a Visual Analogue Scale, the EuroQol-5D (EQ 5-D), and a subjective assessment of the limitations were recorded. RESULTS Between June and December 2014, one hundred and five patients (average age 65.2 years) completed both questionnaires and were available for data analysis. Test-retest reliability of the FJS was high with an ICC = 0.80 (95 % CI 0.69, 0.90) and with a Cronbach's alpha of 0.95 (95 % CI 0.92, 0.99). CONCLUSIONS The German translation of the FJS is a viable tool for the postoperative monitoring after arthroplasty of the knee. This is the first study providing data on test-retest reliability of the FJS. The FJS is a reliable and valid measurement tool for evaluation of patient rated outcome in patients with an artificial knee joint. LEVEL OF EVIDENCE Validating cohort study, Level 1b.
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Affiliation(s)
- Florian Baumann
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany.
| | - Toni Ernstberger
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Markus Loibl
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, Regensburg University Medical Center, Regensburg, Germany
| | - Michael Nerlich
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
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Oliver Effenberg A, Schmitz G, Baumann F, Rosenhahn B, Kroeger D. SoundScript – Supporting the Acquisition of Character Writing by Multisensory Integration. ACTA ACUST UNITED AC 2015. [DOI: 10.2174/1874350101508010230] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This work is introducing a new movement sonification method called ´SoundScript´ to support the acquisition
of character writing by children. SoundScript creates ´sound traces´ from the writing trace in real-time during the process
of handwriting. The structural correlation of both – optic and acoustic – traces leads to an integrated audio-visual perception
of writing with the expected stimulation of multisensory integration sites of the CNS. Data of a pilot study are introduced
indicating that the writing kinematics is reproduced more adequately if additional sound traces are available during
writing. In the future SoundScript shall be applied to verify if the establishment of internal character representations can
be accelerated, if the conciseness of the specific shape of the particular characters can be made stronger and if thereby the
efficiency of the handwriting learning process can be enhanced.
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Loibl M, Korsun M, Reiss J, Gueorguiev B, Nerlich M, Neumann C, Baumann F. Spinal fracture reduction with a minimal-invasive transpedicular Schanz Screw system: clinical and radiological one-year follow-up. Injury 2015; 46 Suppl 4:S75-82. [PMID: 26542870 DOI: 10.1016/s0020-1383(15)30022-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgical management of thoracolumbar trauma involves correction of posttraumatic deformity and placement of transpedicular instrumentation. The aim of this prospective cohort study was to generate first results reflecting the clinical and radiological outcome of patients treated with percutaneous dorsal instrumentation for fractures of the thoracic and lumbar spine with the use of a transpedicular new Schanz Screw system (USS Fracture MIS, DePuy Synthes). METHODS A total of 26 patients with fractures of the thoracic and lumbar spine were operatively treated with bi-segmental dorsal instrumentation between January and December 2012. Radiological data acquisition was performed pre- and postoperatively, after six weeks, three, six, and twelve months. The radiological parameter of interest was the bi-segmental kyphotic end plate angle (Cobb angle). The Chronic Disability Index (CDI), the Oswestry Disability Index (ODI), and the Spine Tango Core Outcome Measurement Index (COMI) were applied to investigate the clinical outcome. RESULTS The clinical follow-up was completed by 22 patients (84.6%), and the radiological follow-up by 21 (80.8%) patients. Our patient population had a mean age of 47.4 ± 4.1 years. Twelve patients received dorsal instrumentation, and 14 patients were treated with an additional ventral reconstruction. Intraoperative reduction was 11.5 ± 1.5° among all patients (p < 0.01). A considerable amount of the operative correction was lost after six weeks with a loss of reduction of 4.6 ± 1.4° (p < 0.01). At one year follow-up, the measured loss of reduction was significant in comparison to the postoperative state, 6.9 ± 1.3° among all patients, 8.7 ± 2.1° after dorsal and 4.9 ± 1.1° after dorsoventral stabilisation (all p < 0.01). Moreover, all patients had minimal to moderate disability with a CDI of 1.8 ± 0.4 (0 - 7), and an ODI of 15.6 ± 3.6 (0 - 60). CONCLUSION The new transpedicular Schanz screw system can deliver a correction and stabilization of thoracic and lumbar spine fractures. Patients report minimal to moderate disability as a result of their severe injury one year after trauma. We advocate the use of the transpedicular Schanz screw system to correct posttraumatic kyphotic deformity, with secondary anterior fusion in our treatment strategy of thoracolumbar incomplete burst fractures in patients without a neurologic deficit.
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Affiliation(s)
- Markus Loibl
- Department of Trauma Surgery, Regensburg University Medical Center, Davos, Switzerland.
| | - Mariya Korsun
- Department of Trauma Surgery, Regensburg University Medical Center, Davos, Switzerland
| | - Julian Reiss
- Department of Trauma Surgery, Regensburg University Medical Center, Davos, Switzerland
| | | | - Michael Nerlich
- Department of Trauma Surgery, Regensburg University Medical Center, Davos, Switzerland
| | - Carsten Neumann
- Department of Trauma Surgery, Regensburg University Medical Center, Davos, Switzerland
| | - Florian Baumann
- Department of Trauma Surgery, Regensburg University Medical Center, Davos, Switzerland
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Schmitz P, Baumann F, Grechenig S, Gaensslen A, Nerlich M, Müller MB. The cement-augmented transiliacal internal fixator (caTIFI): an innovative surgical technique for stabilization of fragility fractures of the pelvis. Injury 2015; 46 Suppl 4:S114-20. [PMID: 26542856 DOI: 10.1016/s0020-1383(15)30029-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Analyzing the different age groups in a population who suffered a pelvic ring fracture it becomes obvious that there are important differences between the pelvic ring lesions of an elderly patient compared to a young adult concerning trauma mechanism, fracture pattern and therapeutic options. In the elderly patient it is very important to achieve maximum of stability if surgery is necessary in order to avoid early failure of the ostheosynthesis under mobilization with full weight bearing. PATIENTS AND METHODS 15 patients (14 female) with fragility fractures of the pelvis that required surgical stabilization were eligible to participate in this study from December 2012 to December 2014. Such details were documented and analysed as patient demographics, mechanism of injury, fracture classification, operative treatment and postoperative radiological parameters of achieved bone-implant interface. RESULTS The average age of the patients was 79.9 years (SD 9.0 years). According to Rommens five patients had a fragility fracture of the pelvis Type II-c, one a Type III-c, six a Type IV-b and three a Type IV-c. Four patients were treated by a cement augmented transiliac internal fixation (caTIFI). Seven patients received a cement augmented iliolumbar fixation. In all these patients the Schanz screws applied to the ilium were placed in an oblique dorsoventral direction into the supraacetabular bone canal (mean length of screws 100 ± 20mm, max. 135 mm, min. 70 mm). Even though in four patients the iliosacral joint was hit tangential and one cortex perforation without any cement leakage appeared no revision surgery was necessary. Overall the clinical findings including mobilisation with full weight bearing showed a sufficient mechanically stability in all patients. CONCLUSION The focus of this study was to describe the modified surgical technique of the caTIFI with placing the Schanz screws from the posterior superior iliac spine to the anterior inferior iliac spine into the supraacetabular bone canal. Usage of cannulated and perforated Schanz screws gives the opportunity to control the correct position of the screws before implanting them. Another advantage is that additional stability can be obtained by cement augmentation. We believe that the new technique of the caTIFI provides a greater intraoperative versatility and a greater mechanical stability for fragility fractures of the pelvis.
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Affiliation(s)
- Paul Schmitz
- Clinic of Trauma Surgery, University of Regensburg, Regensburg, Germany.
| | - Florian Baumann
- Clinic of Trauma Surgery, University of Regensburg, Regensburg, Germany
| | - Stephan Grechenig
- Clinic of Trauma Surgery, University of Regensburg, Regensburg, Germany
| | - Axel Gaensslen
- Department of Trauma Surgery, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Michael Nerlich
- Clinic of Trauma Surgery, University of Regensburg, Regensburg, Germany
| | - Michael B Müller
- Clinic of Trauma Surgery, University of Regensburg, Regensburg, Germany
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Parsch W, Hilber F, Schmucker U, Baumann F, Nerlich M, Ernstberger A. [While Others are Sleeping - Performance of Major Trauma Care at Night]. Zentralbl Chir 2015; 141:660-665. [PMID: 26344501 DOI: 10.1055/s-0035-1546262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Introduction: The literature indicates that medical staff suffer from a decline in cognitive and physical performance at night. This study evaluates the process quality and outcomes of emergency care during night-time and daytime. Method: Out of 1,226 prospectively registered patients, 420 were included into this study (observation period: 76 months). Inclusion criteria were an ISS ≥ 16 and admission to trauma room during "DAY" (8 am to 4 : 49 pm) or "NIGHT" (9 pm to 5 : 59 am). The fundamental part was the 130 items of the TraumaRegister DGU. The additional 350 items contain data about prehospital treatment, trauma room management and intensive care. Data were collected by a research assistant over a 24-h period. Results: The study sample contained 268 DAY-patients and 152 NIGHT-patients. Patients admitted during night were injured more severely: ISS 34.9 (± 16.4) vs. 31.1 (± 14.2), p = 0.015 and younger: 33.3 (± 16.6) vs. 43.6 (± 22.3) years old, p < 0.001. However, this had no impact on outcome prediction scores like RISC, RISC2 or TRISS, p ≥ 0.775. Furthermore, no difference in process quality was observed like the time to gain an arterial access: NIGHT 4.5 (± 3.7) vs. DAY 5.0 (± 3.7) min, p = 0.116, time for splinting 3.8 (± 3.7) vs. 3.4 (± 3.1) min, p = 0.922, or other parameters, like time to CT: 26.9 (± 11.2) vs. 26.6 (± 14.5) min, p = 0.520. Nor was there any difference in outcome: 17.8 % of the NIGHT-patients (RISC-prognosis: 23.8 %, SMR 0.74) died in hospital, and 18.3 % of the DAY-patients (RISC-prognosis: 24.0 %, SMR 0.77), p = 0.894. As well the comparison of the Glasgow Outcome Scale revealed no difference: NIGHT 3.8 (± 1.5) vs. DAY 3.8 (± 1.6), p = 0.491. Discussion: Although evidence suggests a drop of performance by medical staff at night, this effect could not be demonstrated. Considering this, the level of process quality and outcome - regardless of the time of arrival - remained constant on a high level. These results might be attributable to the quality management and the standardisation of the treatment.
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Affiliation(s)
- W Parsch
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Deutschland
| | - F Hilber
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Deutschland
| | - U Schmucker
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Deutschland
| | - F Baumann
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Deutschland
| | - M Nerlich
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Deutschland
| | - A Ernstberger
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Deutschland
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Abstract
Intraoperative assessment of the femoral axis, length and torsion can be difficult. A postoperative torsional discrepancy is a common but rarely diagnosed condition. A clinical evaluation of femoral torsion is limited, especially in the early postoperative period. Conventional radiographs are a reliable diagnostic tool for evaluation of discrepancies of leg length and axis. Computed tomography remains the gold standard for assessment of torsional discrepancies. Because of the wide variability of the physiological femoral torsion, the clinical impact of a torsional discrepancy in individual cases remains unclear. There is a general recommendation for revision in cases of intraindividual deviations of more than 15°; however, most patients with deviations even greater than 15° are asymptomatic. Therefore, the indications for correction should be carefully considered in each individual case. The patient level of activity is a crucial point in decision-making for correction osteotomy. Before correction osteotomy, the surgeon has to make a detailed biomechanical analysis of the leg. Early correction is recommended in most cases. Detailed knowledge of the patient medical history is needed for preoperative planning. Prior surgeries can have a significant impact on the choice of the surgical approach and stabilization technique.
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Affiliation(s)
- F Baumann
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, 93042, Regensburg, Deutschland.
| | - K Angerpointner
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, 93042, Regensburg, Deutschland
| | - M Nerlich
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, 93042, Regensburg, Deutschland
| | - C Neumann
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, 93042, Regensburg, Deutschland
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Zimmer P, Bloch W, Schenk A, Zopf EM, Hildebrandt U, Streckmann F, Beulertz J, Koliamitra C, Schollmayer F, Baumann F. Exercise-induced Natural Killer Cell Activation is Driven by Epigenetic Modifications. Int J Sports Med 2015; 36:510-5. [PMID: 25714571 DOI: 10.1055/s-0034-1398531] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Exercise has been proven to reduce the risk and progression of various diseases, such as cancer, diabetes and neurodegenerative disorders. Increasing evidence suggests that exercise affects the cytokine profile and changes distribution and function of tumor-competitive immune cells. Initial studies have shown that different exercise interventions are associated with epigenetic modifications in different tissues and cell types, such as muscle, fat, brain and blood. The present investigation examines the effect of an intense endurance run (half marathon) on global epigenetic modifications in natural killer (NK) cells in 14 cancer patients compared to 14 healthy controls. We were able to show that histone acetylation and NKG2D expression, a functional NK cell marker, were elevated for at least 24 h after the run. Thus, this is the first study to present a potential mechanism of how exercise may impact NK cell activity on the subcellular level. Further studies should focus on epigenetic mechanisms and dose-dependent effects of exercise.
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Affiliation(s)
- P Zimmer
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - W Bloch
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - A Schenk
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - E M Zopf
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - U Hildebrandt
- Department of Preventive and Rehabilitative Sport Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, German Sport University Cologne, Cologne, Germany
| | - F Streckmann
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - J Beulertz
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - C Koliamitra
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - F Schollmayer
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - F Baumann
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
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