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Schiffer G. CORR Insights®: What Is the Diagnostic Performance of Conventional Radiographs and Clinical Reassessment Compared With HR-pQCT Scaphoid Fracture Diagnosis? Clin Orthop Relat Res 2023; 481:105-106. [PMID: 36125460 PMCID: PMC9750552 DOI: 10.1097/corr.0000000000002413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 08/29/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Gereon Schiffer
- Head of Department, GFO Kliniken Rhein Berg, Vinzenz Pallotti Hospital, Bergisch Gladbach, Germany
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Schiffer G. [Edgar-Ungeheuer-Award 2017 - ZFOU Videopaper selected]. Z Orthop Unfall 2017; 155:347. [PMID: 28683494 DOI: 10.1055/s-0043-106896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schiffer G, Berberich P, Stein G, Jubel A. Der posterolaterale Zugang zur Fixation von komplexen Frakturen des oberen Sprunggelenks. Z Orthop Unfall 2017; 155:348-351. [PMID: 28683499 DOI: 10.1055/s-0043-113569] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Gereon Schiffer
- Unfallchirurgie, Handchirurgie und Orthopädie, Vinzenz Pallotti Hospital, Bergisch Gladbach
| | - Peter Berberich
- Unfallchirurgie, Handchirurgie und Orthopädie, Vinzenz Pallotti Hospital, Bergisch Gladbach
| | - Gregor Stein
- Klinik für Orthopädie und Unfallchirurgie, Uniklinik Köln, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Köln
| | - Axel Jubel
- Unfall- und Wiederherstellungschirurgie, Eduardus-Krankenhaus Köln
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Zarghooni K, Beyer F, Papadaki J, Boese C, Siewe J, Schiffer G, Eysel P, Bredow J. Lebensqualität und funktionelles Ergebnis nach mikrochirurgischer Dekompression bei lumbaler Spinalkanalstenose – eine Registerstudie. Z Orthop Unfall 2017; 155:429-434. [DOI: 10.1055/s-0043-103958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Zusammenfassung
Einleitung Die lumbale Spinalkanalstenose (SKS) hat sich in den letzten Jahren durch die gestiegene Lebenserwartung und die höheren Ansprüche an die Lebensqualität zu einer der häufigsten degenerativen Wirbelsäulenveränderungen entwickelt. Bei therapierefraktären Patienten der konservativen Therapie ist die mikrochirurgische Dekompression der Goldstandard in der operativen Behandlung der degenerativen lumbalen Spinalkanalstenose. Ziel der vorgelegten Studie ist die Bewertung der Lebensqualität nach mikrochirurgischer Dekompression bei lumbaler Spinalkanalstenose anhand der Instrumente des DWG-Registers (vorher Spine Tango).
Methode 36 Patienten wurden in diese monozentrische prospektive Beobachtungsstudie von Januar 2013 bis Juni 2014 eingeschlossen. Die Datenerhebung erfolgte über das Spine Tango- bzw. DWG-Register. Es wurden der Core Outcome Measure Index (COMI), Oswestry Disability Index (ODI) und der Lebensqualitätsfragebogen EuroQoL-5D erhoben. Dies erfolgte vor der Operation sowie 6 Wochen, 6 Monate und 12 Monate nach der Operation.
Ergebnisse Im untersuchten Kollektiv fanden sich 13 weibliche und 23 männliche Patienten (36,1 vs. 63,9 %). Für 21 Patienten konnte ein vollständiges Follow-up über den 12-Monats-Zeitraum erhoben werden. Der COMI-Score besserte sich von 8,1 ± 1,5 präoperativ signifikant über das gesamte Follow-up (6 Wochen: 4,5 ± 3,1 (p < 0,001), 6 Monate: 4,8 ± 3,1, 12 Monate: 3,8 ± 3,2). Auch die Beeinträchtigung der Rückenfunktion gemessen im ODI-Score war gegenüber den präoperativen Werten (47,5 ± 17,3) nach 6 Wochen (29,1 ± 22,4; p < 0,005), 6 Monaten (30,0 ± 19,3) und 12 Monaten (23,8 ± 18,2) signifikant besser. Gleichermaßen verhielt es sich mit der Lebensqualität (präoperativ: 0,36 ± 0,38; 6 Wochen: 0,57 ± 0,34 (p < 0,019), 6 Monate: 0,62 ± 0,28, 12 Monate: 0,67 ± 0,31).
Schlussfolgerung Unsere Untersuchung zeigt, dass Patienten ohne Voroperationen und neurologisches Defizit mit lumbaler Spinalkanalstenose eine erhebliche Linderung von Schmerzen und eine Steigerung der Lebensqualität bereits nach 6 Wochen nach stabilitätserhaltender Dekompression erwarten dürfen. Dieser positive postoperative Effekt zeigt sich über 12 Monate weiter progredient. Das DWG-Register bietet eine standardisierte und validierte Möglichkeit, konservative wie operative Behandlungen an der Wirbelsäule langfristig vergleichbar zu machen.
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Affiliation(s)
- Kourosh Zarghooni
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln
| | - Frank Beyer
- Klinik für Orthopädie und Unfallchirurgie, Marien-Krankenhaus, Bergisch Gladbach
| | - Joanna Papadaki
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln
| | - Christoph Boese
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln
| | - Jan Siewe
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln
| | - Gereon Schiffer
- Unfallchirurgie, Handchirurgie und Orthopädie, Vinzenz-Pallotti-Hospital, Bergisch Gladbach
| | - Peer Eysel
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln
| | - Jan Bredow
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln
- Fachzentrum für Rücken & Wirbelsäule, Schön Klinik Düsseldorf SE & Co. KG
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Prokop A, Schiffer G. Editorial für die Zeitschrift für Orthopädie und Unfallchirurgie. Z Orthop Unfall 2016; 154:559. [PMID: 27975349 DOI: 10.1055/s-0042-120547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stein G, Schiffer G, Bredow J, Meyer C. [3D Fluoroscopy-Navigated Magerl Fusion of the 1st and 2nd Cervical Vertebra]. Z Orthop Unfall 2016; 154:636-637. [PMID: 27975351 DOI: 10.1055/s-0042-118967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Treatment of type II fractures of the odontoid process is still controversial. Besides conservative treatment, there are surgical options, including anterior screw fixation, as first described by Böhler and Magerl, or procedures using a dorsal approach. Many authors prefer dorsal fusion of C1 and 2, due to the reliable, biomechanical stability. In this context, pedicle screw fixation, as described by Harms, and transarticular screw fixation of the atlantoaxial joints, as described by Magerl, have to be mentioned. With the use of intraoperative fluoroscopic navigation, the risk of neurovascular lesions caused by abortive drilling or malposition of screws has been significantly decreased. In 1993, Eysel and Roosen established a subclassification of type II fractures of the odontoid process and gave treatment recommendations for each of the three subtypes. While there was an outcome for type A and B fractures treated by anterior screw fixation, the authors recommended performing dorsal stabilisation at type C fractures. Indication: In accordance with the recommendations of Eysel and Roosen, an 82 year old man, suffering from a type II C fracture of the odontoid process, underwent navigated, transarticular screw fixation of C1 and C2. Method: Once the 3D-fluoroscopy scan had been performed, the correct drilling direction in the axial, coronary and sagittal views of C1 and 2 was found using the navigated drillguide. After K-wires had been inserted in this direction on both sides, a second 3D-scan was performed to recontrol placement of the K-wires. Cannulated screws were introduced and the rods were installed, bearing the atlas hook to fixate the posterior atlas. Conclusion: In summary, dorsal, transarticular fusion of C1 and C2 is a successful treatment option, rarely leading to complications and is accompanied by reduced radiation exposure to the operating team.
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Affiliation(s)
- G Stein
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Uniklinik Köln
| | - G Schiffer
- Unfallchirurgie, Handchirurgie und Orthopädie, Vinzenz-Pallotti Hospital, Bergisch Gladbach
| | - J Bredow
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Uniklinik Köln
| | - C Meyer
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Uniklinik Köln
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Jubel A, Faymonville C, Andermahr J, Boxberg S, Schiffer G. [Conventional X-Rays of Ankle Joint Fractures in Older Patients are Not Always Predictive]. Z Orthop Unfall 2016; 155:45-51. [PMID: 27642700 DOI: 10.1055/s-0042-113879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Ankle fractures are extremely common in the elderly, with an incidence of up to 39 fractures per 100,000 persons per year. We found a discrepancy between intraoperative findings and preoperative X-ray findings. It was suggested that many relevant lesions of the ankle joint in the elderly cannot be detected with plain X-rays. Methods: Complete data sets and preoperative X-rays of 84 patients aged above 60 years with ankle fractures were analysed retrospectively. There were 59 women and 25 men, with a mean age of 69.9 years. Operation reports and preoperative X-rays were analysed with respect to four relevant lesions: multifragmentary fracture pattern of the lateral malleolus, involvement of the medial malleolus, posterior malleolar fractures and bony avulsion of anterior syndesmosis. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and prevalence were calculated. Results: The prevalence of specific ankle lesions in the analyzed cohort was 24 % for the multifragmentary fracture pattern of the lateral malleolus, 38 % for fractures of the medial malleolus, 25 % for posterior malleolar fractures and 22.6 % for bony avulsions of the anterior syndesmosis. Multifragmentary fracture patterns of the lateral malleolus (sensitivity 0 %) and bony avulsions of the anterior syndesmosis (sensitivity 5 %) could not be detected in plain X-rays of the ankle joint at all. Fractures of the medial malleolus and involvement of the dorsal tibial facet were detected with a sensitivity of 96.8 % and 76.2 %, respectively, and specificity of 100 % in both cases. Conclusions: This study confirms that complex fracture patterns, such as multifragmentary involvement of the lateral malleolus, additional fracture of the medial malleolus, involvement of the dorsal tibial facet or bony avulsion of the anterior syndesmosis are common in ankle fractures of the elderly. Therefore, CT scans should be routinely considered for primary diagnosis, in addition to plain X-rays.
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Affiliation(s)
- A Jubel
- Unfall- und Wiederherstellungschirurgie, Eduardus-Krankenhaus, Köln
| | - C Faymonville
- Unfall-, Hand- und Ellenbogenchirurgie, Uniklinik Köln
| | - J Andermahr
- Zentrum für Orthopädie und Unfallchirurgie, Krankenhaus Mechernich
| | - S Boxberg
- Unfall- und Wiederherstellungschirurgie, Eduardus-Krankenhaus, Köln
| | - G Schiffer
- Unfallchirurgie, Handchirurgie und Orthopädie, Vinzenz Pallotti Hospital, Bergisch Gladbach
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Schiffer G, Sayar A, Thelen U. [The Extended Deltoid-Split Approach for Plating Four-Part Proximal Humeral Fractures]. Z Orthop Unfall 2016; 154:406-9. [PMID: 27547979 DOI: 10.1055/s-0042-104730] [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: 10/21/2022]
Abstract
The deltoideopectoral approach is established as the gold standard in the surgical treatment of proximal humeral fractures. As an alternative, we demonstrate the extended deltoid approach with an intraoperative video. A direct lateral incision is performed and the anterior parts of the axillary nerve are identified and preserved. In our experience, this approach allows improved visualisation of the greater tuberosity and easier positioning of locking plates. Clinically relevant neurological injuries cannot be seen in our patients or in the literature.
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Affiliation(s)
- G Schiffer
- Klinik für Unfallchirurgie, Handchirurgie und Orthopädie, Vinzenz Pallotti Hospital, Bergisch Gladbach
| | - A Sayar
- Klinik für Unfallchirurgie, Handchirurgie und Orthopädie, Vinzenz Pallotti Hospital, Bergisch Gladbach
| | - U Thelen
- Klinik für Unfallchirurgie, Handchirurgie und Orthopädie, Vinzenz Pallotti Hospital, Bergisch Gladbach
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Schiffer G, Goldmann S, Faymonville C, Müller L, Stein G. [3D-Navigated Implantation of Pedicle Screws in the Cervical Spine - Experience and Analysis of Complications]. Z Orthop Unfall 2016; 154:483-487. [PMID: 27294480 DOI: 10.1055/s-0042-105957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Placing transpedicular screws in the cervical spine is a special challenge for spine surgeons, due to the anatomical features of this part of the spine. During the last 15 years, computer-aided navigation systems have been developed to facilitate this procedure and to make it safer for patients. One option is navigation by intraoperatively acquired data sets with the use of an 3D C-arm. Patients/Material and methods: Our retrospective study evaluates transpedicular screws in the cervical spine placed by 3D C-arm navigation, within a 6 year period in a level 1 trauma centre. We recorded epidemiological data, operation time and especially general adverse events, as well as revision surgery, including reasons for revision. We used a C-arm Arcardis Orbic 3D (Siemens, Munich), connected to a navigation system (VectorVision, Brainlab, Munich). Results: Between July 2007 and July 2013, 207 transpedicular screws were placed in 58 patients. The main indications were trauma (69 %), rheumatic diseases (20.7 %) and tumour (8.6 %). The most commonly instrumented cervical spine segments were C2 (53.5 %)%), C7 (10.3 %) and C5 (8.6 %). In nearly 95 % of the cases, we performed an intraoperative 3D scan after screw or k-wire placement to control the screw position. We found unacceptable malposition in 7.2 % of patients. This was corrected at once. Ten patients had to be revised: seven times due to wound problems, twice because of implant failure and once for treatment of CSF leakage. Three screws (1.5 %) led to injuries of the vertebral artery, once with a lethal outcome. Analysis of these cases showed that the 3D scan gave reduced data quality, due to reduced bone density or anatomical factors. Conclusion: Intraoperative 3D C-arm navigation seems to be a reliable option for transpedicular screw placement in the cervical spine. Complication rates were comparable to published values. 7.2 % of all screws were corrected intraoperatively after a control scan. Therefore possible revisions could be avoided during primary surgery. Analysis of problematic cases led to a change in our treatment strategy: in patients with poor bone quality and/or anatomical problems which lead to 3D scans of poor quality, we avoid transpedicular screw placement in C6 or higher, in order to prevent injuries of the vertebral artery.
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Affiliation(s)
- G Schiffer
- Unfallchirurgie, Handchirurgie und Orthopädie, Vinzenz Pallotti Hospital, Bergisch Gladbach
| | - S Goldmann
- Unfall-, Hand- und Ellenbogenchirurgie, Uniklinik Köln
| | - C Faymonville
- Unfall-, Hand- und Ellenbogenchirurgie, Uniklinik Köln
| | - L Müller
- Unfall-, Hand- und Ellenbogenchirurgie, Uniklinik Köln
| | - G Stein
- Unfall-, Hand- und Ellenbogenchirurgie, Uniklinik Köln
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Stein G, Meyer C, Ingenhoff L, Bredow J, Müller LP, Eysel P, Schiffer G. [The biomechanics of hyperextension injuries of the subaxial cervical spine]. Unfallchirurg 2016; 120:590-594. [PMID: 27220520 DOI: 10.1007/s00113-016-0167-3] [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] [Indexed: 11/24/2022]
Abstract
Hyperextension injuries of the subaxial cervical spine are potentially hazardous due to relevant destabilization. Depending on the clinical condition, neurologic or vascular damage may occur. Therefore an exact knowledge of the factors leading to destabilization is essential. In a biomechanical investigation, 10 fresh human cadaver cervical spine specimens were tested in a spine simulator. The tested segments were C4 to 7. In the first step, physiologic motion was investigated. Afterwards, the three steps of injury were dissection of the anterior longitudinal ligament, removal of the intervertebral disc/posterior longitudinal ligament, and dissection of the interspinous ligaments/ligamentum flavum. After each step, the mobility was determined. Regarding flexion and extension, an increase in motion of 8.36 % after the first step, 90.45 % after the second step, and 121.67 % after the last step was observed. Testing of lateral bending showed an increase of mobility of 7.88 %/27.48 %/33.23 %; axial rotation increased by 2.87 %/31.16 %/45.80 %. Isolated dissection of the anterior longitudinal ligament led to minor destabilization, whereas the intervertebral disc has to be seen as a major stabilizer of the cervical spine. Few finite-element studies showed comparable results. If a transfer to clinical use is undertaken, an isolated rupture of the anterior longitudinal ligament can be treated without surgical stabilization.
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Affiliation(s)
- G Stein
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - C Meyer
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - L Ingenhoff
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - J Bredow
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - L P Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - P Eysel
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - G Schiffer
- Abteilung Unfallchirurgie, Handchirurgie und Orthopädie, Vinzenz-Palotti-Hospital, Bergisch-Gladbach, Deutschland
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Schiffer G. CORR Insights: The Minimum Clinically Important Difference of the Patient-rated Wrist Evaluation Score for Patients With Distal Radius Fractures. Clin Orthop Relat Res 2015. [PMID: 26224290 PMCID: PMC4562935 DOI: 10.1007/s11999-015-4452-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Gereon Schiffer
- Department of Orthopaedics, Traumatology and Hand Surgery, Vincent Pallotti Hospital GmbH, Vinzenz-Pallotti-Str. 20-24, 51429 Bergisch Gladbach, Germany
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Stein G, Meyer C, Marlow L, Christ H, Müller L, Isenberg J, Eysel P, Schiffer G, Faymonville C. Typ-II-Densfrakturen des alten Menschen und therapiebedingte Mortalität. Unfallchirurg 2015; 120:122-128. [DOI: 10.1007/s00113-015-0057-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bredow J, Oppermann J, Kraus B, Schiller P, Schiffer G, Sobottke R, Eysel P, Koy T. The accuracy of 3D fluoroscopy-navigated screw insertion in the upper and subaxial cervical spine. Eur Spine J 2015; 24:2967-76. [DOI: 10.1007/s00586-015-3974-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 04/16/2015] [Accepted: 04/16/2015] [Indexed: 11/27/2022]
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Jubel A, Schiffer G, Andermahr J, Ries C, Faymonville C. Verkürzungsfehlstellung des Schlüsselbeins nach diaphysären Klavikulafrakturen. Unfallchirurg 2014; 119:508-16. [DOI: 10.1007/s00113-014-2648-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kersting S, Prokop A, Schiffer G. [Editorial]. Z Orthop Unfall 2013; 151:447-8. [PMID: 24129712 DOI: 10.1055/s-0033-1350865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
With an incidence of 64/100,000, clavicular shaft fractures are one of the most common fractures. Intramedullary fixation with Prevot nails was initially reported in the late 1990s. This procedure offers minimally invasive stabilization of the fracture, thus enabling immediate mobilization and rapid loading capacity. Using a case study, the positioning and procedure are demonstrated on video. The intramedullary implant accommodates the varying tension loading of the clavicle. This treatment is ideal for clavicular fractures with 2-3 fragments. Compared to patients treated conservatively, operated patients achieve more rapid and improved mobility. Employment disability is shorter, and malunion occurs less frequently.
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Affiliation(s)
- A Prokop
- Kliniken für Unfallchirurgie Sindelfingen-Böblingen, Klinikverbund Südwest, Sindelfingen
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Springorum HP, Siewe J, Dargel J, Schiffer G, Michael JWP, Eysel P. [Classification and treatment of patella fractures]. Orthopade 2012; 40:877-80, 882. [PMID: 21938491 DOI: 10.1007/s00132-011-1780-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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
Patella fractures are rare and account for approximately 1% of all fractures. They are classified regarding their localization (proximal, distal) and appearance. The aim of any treatment is reconstruction of the extensor mechanism and joint surface. If dislocation and cartilage steps are less than 2 mm, conservative treatment may be indicated. Operative treatment is only necessary if a dislocation is more than 2 mm or when the extensor mechanism is unstable. Depending on the shape of the fracture, tension band wiring, interfragmentary screw fixation and combinations are the main techniques. Because patellectomy has functionally the worst result it should be avoided. Sleeve fractures (children) need exact reconstruction of the joint surface. In elderly patients conservative treatment or surgical patella-enclosing wiring techniques for stabilization are the best options due to low bone quality.
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Affiliation(s)
- H-P Springorum
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität zu Köln, Köln, Deutschland.
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Stein G, Skouras E, Faymonville C, Thelen U, Schiffer G. [Appearance of complex regional pain syndrome after intramedullary nailing of a clavicle fracture]. Unfallchirurg 2011; 114:922-6. [PMID: 21604036 DOI: 10.1007/s00113-011-1998-6] [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: 11/28/2022]
Abstract
After operative correction of a clavicle fracture using an elastic stable intramedullary nail the patient presented signs of delayed fracture healing after 2 months. During the sixth postoperative month the 28-year-old obviously pain-ridden female patient showed dystonia of the shoulder girdle and allodynia surrounding the operation field. Upon these findings, we decided - as a result of the complex regional pain syndrome that had not been previously described in this location - to treat the patient by administering bisphosphonates, multimodal analgetic therapy, physiotherapy and occupational therapy. Fourteen months after surgery, the patient showed no remaining symptoms, and the fracture had consolidated at that time.
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Affiliation(s)
- G Stein
- Klinik für Orthopädie und Unfallchirurgie, Uniklinik Köln, Kerpener Straße 62, 50924, Köln, Deutschland.
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Stein G, Koebke J, Faymonville C, Dargel J, Müller LP, Schiffer G. The relationship between the medial collateral ligament and the medial meniscus: a topographical and biomechanical study. Surg Radiol Anat 2011; 33:763-6. [DOI: 10.1007/s00276-011-0814-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 04/02/2011] [Indexed: 11/29/2022]
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Schiffer G, Faymonville C, Skouras E, Andermahr J, Jubel A. Midclavicular fracture: not just a trivial injury: current treatment options. Dtsch Arztebl Int 2010; 107:711-7. [PMID: 21046002 DOI: 10.3238/arztebl.2010.0711] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 01/11/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Conservative treatment was long recommended for midclavicular fractures because of the excellent results that were reported in the 1960's and 70's. Recently, however, the rucksack bandage has received competition from surgical treatment. The spectrum of operations ranges from classic plate osteosynthesis to intramedullary techniques and angle-stable implants. METHODS We present and evaluate the current treatment options on the basis of a selective review of the literature. RESULTS Recent studies have confirmed some long-held concepts and refuted others. The risk of non-union after conservative treatment was previously reported as 1% to 2% but has turned out to be much higher in selected subgroups such as in patients with severe displacement, female patients, and patients of advanced age. Furthermore, new implants and techniques have made surgery safer and more likely to result in bony union. CONCLUSION In any case of midclavicular fracture, the type of fracture should be precisely analyzed and an individual treatment strategy should be developed in view of the patient's particular situation. Current studies show with a high level of evidence (level 1) that patients with dislocated fractures benefit from surgery.
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Affiliation(s)
- Gereon Schiffer
- Klinik für Orthopädie und Unfallchirurgie, Schwerpunkt Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937 Köln, Germany.
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Abstract
Elastically stable intramedullary nailing is a safe surgical procedure used to treat mid-shaft clavicular fractures of types A and B according to the Orthopaedic Trauma Association (OTA) classification. In the case reported intramedullary fixation with a Kirschner wire and an incorrectly performed surgical technique led to pseudoarthrosis (non-union). After revision surgery with an elastically stable titanium nail and a correct surgical technique, fracture healing was achieved.
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Affiliation(s)
- C Faymonville
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Univ.-Klinikum Köln, Kerpener Str. 62, 50924, Köln, Deutschland.
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Skouras E, Merkel D, Grosheva M, Angelova SK, Schiffer G, Thelen U, Kaidoglou K, Sinis N, Igelmund P, Dunlop SA, Pavlov S, Irintchev A, Angelov DN. Manual stimulation, but not acute electrical stimulation prior to reconstructive surgery, improves functional recovery after facial nerve injury in rats. Restor Neurol Neurosci 2009; 27:237-51. [PMID: 19531878 DOI: 10.3233/rnn-2009-0474] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED The outcome of peripheral nerve injuries requiring surgical repair is poor. Recent work suggested that electrical stimulation (ES) of the proximal nerve stump to produce repeated discharges of the parent motoneurons for one hour could be a beneficial therapy if delivered immediately prior to reconstructive surgery of mixed peripheral nerves. PURPOSE We tested whether ES has a positive influence on functional recovery after repair of a purely motor nerve, the facial nerve. METHODS Electrical stimulation (20 Hz) was delivered to the proximal nerve stump of the transected facial nerve for 1 hour prior to nerve reconstruction by end-to-end suture (facial-facial anastomosis, FFA). For manual stimulation (MS), animals received daily rhythmic stroking of the whisker pads. Restoration of vibrissal motor performance following ES or MS was evaluated using video-based motion analysis. We also assessed the degree of collateral axonal branching at the lesion site, by counting motoneuronal perikarya after triple retrograde labeling, and estimated the quality of motor end-plate reinnervation in the target musculature. Outcomes at 4 months were compared to animals receiving sham stimulation (SS) or MS. RESULTS Neither protocol reduced the degree of collateral sprouting. ES did not improve functional outcome and failed to reduce the proportion of polyinnervated motor end-plates. By contrast, MS restored normal whisking function and reduced polyinnervation. CONCLUSION Whereas acute ES is not beneficial for facial nerve repair, MS provides long-term benefits.
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Affiliation(s)
- Emmanouil Skouras
- Department of Trauma, Hand and Reconstructive Surgery, University of Cologne, Cologne, Germany
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Jubel A, Andermahr J, Schiffer G, Fischer J, Rehm KE, Stoddart MJ, Häuselmann HJ. Transplantation of de novo scaffold-free cartilage implants into sheep knee chondral defects. Am J Sports Med 2008; 36:1555-64. [PMID: 18658022 DOI: 10.1177/0363546508321474] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND New cell-based treatments for articular cartilage repair are needed. As the optimal scaffold for cartilage repair has yet to be developed, scaffold-free cartilage implants may remove the complications caused by suboptimal scaffolds. HYPOTHESIS The implantation of a scaffold-free, autologous de novo cartilage implant into standardized full-thickness cartilage defects of femoral condyles in sheep leads to a qualitatively better regenerative tissue than does periosteal flap alone or no treatment. STUDY DESIGN Controlled laboratory study. METHODS Chondral defects 4 mm in diameter (1 per sheep) were created in the center of 1 medial femoral condyle of 48 sheep. Twelve defects were allowed to heal spontaneously, 16 defects were covered with periosteal flaps alone, and 20 defects were filled with autologous de novo cartilage graft and overlaid with a periosteal flap. Differences were assessed macroscopically using the International Cartilage Repair Society score and microscopically using the International Cartilage Repair Society histological score and Mankin score at 26 and 52 weeks. RESULTS The results of the International Cartilage Repair Society Cartilage repair assessment showed that the transplant group was better than was the untreated control at both time periods but not significantly different than was the periosteal flap group. Implanted groups demonstrated a marked improvement in grade of defect filling, cartilage stability, cell distribution, and matrix assessments in each method of assessment. In the transplant group, 2 defects were filled with hyaline cartilage, 5 with mixed hyaline and fibrocartilage, and 2 with fibrocartilage alone. CONCLUSION Chondral defects treated with de novo cartilage transplantation show qualitatively better microscopic and macroscopic regeneration than do those treated with periosteal flaps alone. CLINICAL RELEVANCE Results of the current study show that third-generation autologous chondrocyte transplantation is a promising development in the field of biologic cartilage regeneration. Future studies should compare this technique with the original Brittberg technique.
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Jubel A, Fischer J, Andermahr J, Isenberg J, Schiffer G, Stoddart M, Rehm KE, Häuselmann HJ. [Implantation of matrix-free cartilage transplants in standardized defects in sheep knee joints]. Orthopade 2007; 35:1246-57. [PMID: 17111166 DOI: 10.1007/s00132-006-1021-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The goal of the current investigation was to make a comparative analysis of regenerative tissue after autologous de novo cartilage transplantation on the femoral condyles of sheep after a chondral defect. One chondral defect measuring 4 mm in diameter was placed in the center of one medial femoral condyle of each of 48 Suffolk sheep. Twelve defects were left to heal spontaneously, 16 defects were covered with periosteal flaps, and 20 defects were filled with autologous de novo cartilage graft. Macroscopic and microscopic assessments were performed at 26 and at 52 weeks. Regeneration was significantly better (p<0.05) in the transplant group than in the control groups at both 26 weeks and 52 weeks. The differences were most evident in the grade of defect filling, cartilage stability, cell distribution, and matrix assessments. Transplantation of immature, autologous de novo cartilage leads to qualitatively better regeneration both macro- and microscopically than does periosteal flap placement alone. The transplanted, immature cartilage tissue undergoes maturation in vivo. The regenerated tissue has hyaline-like features.
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Affiliation(s)
- A Jubel
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universität Köln, Josef-Stelzmann-Str. 9, 50924 Köln, Deutschland.
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Abstract
BACKGROUND Although the anatomy and physiology of the venous circulation of the ankle and midfoot are well documented, the physiologic importance of forefoot mobility has not been reported in the literature. The question of this study was whether the first metatarsophalangeal (MTP) joint may operate, like the ankle, as a "pump" to encourage venous return. METHODS Forty-nine cadaver foot specimens were examined using dissection, plastination, vessel infiltration, and maceration, and radiographic (including venography, MRI, and magnetic resonance angiography) techniques. The anatomy and physiology were described and compared to the ankle joint. Forty patients had biphasic Doppler flow studies. RESULTS The major finding was the medial drainage of the plantar venous sinus, which is fibrotically bound to the joint capsule. Functional venous valves were evident distally and within fibrous vascular lumens. Mobilization of the first MTP joint led to compression and emptying of the veins. Passive mobilization of the first MTP joint led to an average flow increase of 55% +/- 7 (p < 0.0001), while active movement led to an average increase of 78% +/- 7 (p < 0.0001). CONCLUSIONS Our described connection between the joint capsule and veins indicates a "toe-ankle pump" with a significant increase of venous blood flow during motion of the MTP joint. Possible clinical applications for an external MTP pump include anti-edema or thromboprophylactic therapy, especially in patients with foot or ankle injuries. A new toe-pump has been designed based on these results.
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Affiliation(s)
- Andreas Elsner
- Orthopaedic and Traumatologic Clinic, Kantonsspital Liestal, Liestal, Switzerland.
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Abstract
Avascular necrosis is a well-known, severe complication postfracture or subluxation of the talus. Type and localization of injury often permit conclusions regarding the probability of bone necrosis. In the following case, talar neovascularization was demonstrated after severe trauma, resulting in an open pilon fracture of the right tibia and complete talar dislocation with consequent destruction of the most relevant blood supply. This example shows that even after apparently irreversible injury to the arterial circulation, immediate bony reconstruction with comprehensive soft tissue management is indicated and can lead to bony healing. The anatomy of intraosseus vascularization is reviewed and discussed.
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Affiliation(s)
- Gereon Schiffer
- Department of Trauma, Hand, and Reconstructive Surgery, University of Cologne, Germany.
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Andermahr J, Jubel A, Elsner A, Schulz-Algie PR, Schiffer G, Koebke J. Die Hautspaltlinien und die Schnittführung bei Fußoperationen. Orthopäde 2007; 36:265-8, 270-2. [PMID: 17262181 DOI: 10.1007/s00132-007-1048-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND In the constantly evolving, increasingly important field of foot surgery, the question arises as to whether the incision types currently in use are adequate. Whether Langer's lines should be considered during the operative approach to the foot is examined here. The goal of the current study was to investigate the pattern of skin cleavage lines of cadaveric feet and to establish the optimal incision type for surgical approaches to the foot. MATERIALS AND METHODS Twelve feet from older deceased subjects were examined. The samples were fixed. The cleavage lines of the individual skin regions were outlined and evaluated. To emphasize the significance of the investigative findings, the cleavage lines and the current, relevant operative approaches were compared. RESULTS Standard current approaches often ignore skin cleavage lines, understandably resulting in cosmetically unsatisfactory scars. A chart with ideal incision types for individual operations was created. CONCLUSION The ideal incision should run parallel to skin cleavage lines. If this is not completely possible due to operative requirements, then at least a large part of the incision should follow these lines.
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Affiliation(s)
- J Andermahr
- Chirurgie, Orthopädie und Unfallchirurgie, Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie, Klinikum der Universität zu Köln, 50931, Köln.
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Prokop A, Rehm KE, Isenberg J, Hahn U, Schiffer G. [Lecture disasters - and how to prevent them]. Zentralbl Chir 2006; 131:358-61. [PMID: 17004198 DOI: 10.1055/s-2006-933464] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Presentations at medical conferences can sometimes confuse or compromise understanding of current topics. Although considerable time and financial costs may be taken to be present at such events, all too often one must go through inferior presentations that are poorly structured and do not contribute to one's understanding of the topic at hand. A good presentation is distinguishable by the clear intentions of the speaker to give a good lecture. The presenter has worked extensively with his topic and is familiar with the audience. The presentation has a clear structure and finishes with a take-home message. The speaker takes the listener from his previous level of knowledge to a new understanding. To do so, both voice and body language are used. The supporting slides are simple and direct, and not overloaded with information. The speech conforms exactly with the pre-determined time limit.
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Affiliation(s)
- A Prokop
- Fachhochschule Bonn-Rhein-Sieg, Unfallmedizin und Sozialversicherung, Hennef.
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Abstract
BACKGROUND In severely injured patients, diagnostic procedures should be as brief as possible. With the use of spiral CT technology, the time required for diagnosis is minimized. QUESTION Do severely injured patients benefit when primary diagnostic examinations are completed in less than 30 min? How much time is required for primary emergency department (ED) care and how much in the CT scanner? MATERIAL AND METHODS Between 31 July 2001 and 31 December 2003, severely injured patients with ISS scores over 16 underwent total body spiral CT scans (Siemens Somatom Volume Zoom Multislice CT) after initial ultrasonography. One hundred patients (M:F=25:75) with an average age of 42 years (range: 3-81 years) were evaluated retrospectively. The average ISS score was 32.8+/-12 points (range: 17-75 points). RESULTS The average time in the ED, prior to CT, was 33+/-14 min. The CT scans lasted 16+/-5 min and the total diagnostic time was 48+/-14 min. Fifty percent of patients were taken immediately to the operating room. The mortality rate in hospital was 13%. The average hospital stay was 30 days, with an average ICU stay of 10 days. CONCLUSION The shorter the time spent in the ED, the shorter the stays in ICU and in total hospitalization were, regardless of injury severity. With structured management and shortening of diagnostic time with spiral CT, the time in the ED was decreased from 85 to 48 min.
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Affiliation(s)
- A Prokop
- Fachbereich Unfallmedizin und Sozialversicherung, Fachhochschule Bonn-Rhein-Sieg, Hennef.
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Abstract
OBJECTIVES The aim of this prospective study was to compare the results achieved in two groups of patients treated for mid-clavicular fracture. METHODS The first group of 27 patients was treated nonoperatively with a rucksack bandage, whereas the second group underwent intramedullary fixation with a titanium pin, using a minimally invasive technique. Within the follow-up period of 6 months, results were evaluated seven times. RESULTS During the whole period significantly (p<0.05) better results were observed in the group of operated patients concerning shoulder function, Constant score, DASH score, personal satisfaction, pain, and cosmetic result. In the second group return to work occurred in less than half the time of the first group. CONCLUSION Intramedullary nailing of mid-clavicular fractures is a safe and minimally invasive operation technique. Early functional and cosmetic results are not worse than results after nonoperative treatment with a rucksack bandage.
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Affiliation(s)
- A Jubel
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universität Köln.
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Abstract
This prospective clinical trial was performed to assess healing, clinical outcome and complications after intramedullary nailing of midshaft clavicular nonunions. Over 2.5 years, 14 patients were included. Exclusion criteria were pathological fractures, bony defects, previous operative therapy, atrophic and infection pseudarthrosis and the patient's age: <18 years or >70 years. Results were evaluated after 3, 6, 12 and 18 months. Beginning 3 months after the operation, pain (VAS), subjective satisfaction, Constant score and DASH score were significantly better than preoperatively during the follow-up period (p<0.001). There were no infections, no implant displacements or refractures.Intramedullary fixation of midshaft clavicular nonunions with an elastic titanium nail is a safe, minimally invasive surgical technique, producing excellent functional and cosmetic results without additional bone grafting.
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Affiliation(s)
- A Jubel
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie der Universität zu Köln.
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Jubel A, Andermahr J, Isenberg J, Schiffer G, Prokop A, Rehm KE. [Experience with elastic stable intramedullary nailing (ESIN) of shaft fractures in children]. Orthopade 2004; 33:928-35. [PMID: 15156310 DOI: 10.1007/s00132-004-0662-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this prospective clinical controlled trial was to investigate the early and midterm results of shaft fractures in children treated with elastic stable intramedullary nailing (ESIN). From January 1997 to December 2001, elastic stable intramedullary nailing was carried out on 112 children with 118 diaphyseal fractures. The mean age was 7.7 years. There were 51 fractures of the lower arm, 46 femoral fractures, 14 of the lower leg, and 7 of the humerus. A total of 92 children have been followed up for more than 12 months. The mean time of follow-up was 38 months.The mean time of fluoroscopy was 2.2 min. Open reduction was necessary in 3.4 %. In children with injuries of the lower extremity, full weight bearing was achieved after a mean period of 9.3 days. In 1.8% of the children, reoperation was necessary within the first 10 days after the operation. In 3.6 % there was painful skin irritation due to the protruding end of a nail. No infection or delayed union was observed. Implant removal was done after a mean time of 5.6 months. There was no rotational or angular deformity of more than 5 degrees in children with isolated fractures of the lower extremity. Mean lengthening of the injured leg was 2.4 mm. In three children who had fractures of the upper extremity, a deficit in range of motion of the adjacent joints was detected. The current results show that intramedullary fixation of displaced diaphyseal fractures in children with a flexible titanium nail is a safe, minimally invasive surgical technique producing excellent functional and cosmetic results.
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Affiliation(s)
- A Jubel
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie der Universität zu Köln.
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Abstract
This study presents the results of a minimally invasive operative treatment for markedly displaced midclavicular fractures. In all patients a flexible titanium nail was inserted in an unreamed technique from the sternal end of the clavicle. The result of surgery was determined with clinical and radiographic controls. The clinical outcome was evaluated 12 months after hardware removal using the scoring system of Constant and Murley. Fifty-eight fractures in 55 patients were treated with intramedullary fixation. Postoperatively on Day 3, the mean subjective pain was significantly lower and range of motion was improved compared with the day before surgery. One nonunion occurred. There was no infection and no implant displacement or refracture. Intramedullary nailing of midclavicular fractures with a flexible titanium nail is a safe minimally invasive surgical technique with excellent functional and cosmetic results compared with plate fixation or conservative treatment. Marked pain reduction along with early restoration of shoulder function and early mobilization are advantageous for patients. This technique can be used as an alternative treatment to conservative procedures or plate fixation in patients with markedly displaced midclavicular fractures, multiple trauma, fractures of the lower extremities, or associated shoulder girdle injuries.
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Affiliation(s)
- Axel Jubel
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Cologne, Germany.
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Abstract
This prospective controlled clinical trial was performed to assess fracture healing and clinical outcome after intramedullary nailing of midclavicular fractures. Within 3.5 years elastic-stable intramedullary nailing was performed in 62 patients with 65 midclavicular fractures. Surgery was performed in supine position. The ventral cortex of the proximal clavicle was opened using a 2.5 mm drill. The nail was advanced laterally under fluoroscopic control. If closed reduction failed, an additional incision was made to enable direct manipulation of the fragments. There were no infections, no implant displacements or refractures. Postoperatively, the mean subjective pain was significantly lower, and the range of motion improved. We observed one nonunion. The mean Constant-score 6 months after hardware removal was 96.9 +/- 3.3 points. Intramedullary fixation of midclavicular fractures with an elastic titanium nail is a safe minimally invasive surgical technique, producing excellent functional and cosmetic results.
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Affiliation(s)
- A Jubel
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie der Universität Köln, Kerpener Str. 61, 50931 Köln.
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Abstract
Two cases of severe spinal cord injuries to professional horse-racing jockeys are presented. There is only one comprehensive study conducted to ascertain the nature and incidence of injuries in the literature. The pathomechanism and surgical therapy of vertebral trauma in jockeys was analysed.
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Affiliation(s)
- J Andermahr
- Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie, Medizinische Einrichtungen, Universität zu Köln.
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Schiffer G, Höltje JV. Cloning and characterization of PBP 1C, a third member of the multimodular class A penicillin-binding proteins of Escherichia coli. J Biol Chem 1999; 274:32031-9. [PMID: 10542235 DOI: 10.1074/jbc.274.45.32031] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
All proteins of Escherichia coli that covalently bind penicillin have been cloned except for the penicillin-binding protein (PBP) 1C. For a detailed understanding of the mode of action of beta-lactam antibiotics, cloning of the gene encoding PBP1C was of major importance. Therefore, the structural gene was identified in the E. coli genomic lambda library of Kohara and subcloned, and PBP1C was characterized biochemically. PBP1C is a close homologue to the bifunctional transpeptidases/transglycosylases PBP1A and PBP1B and likewise shows murein polymerizing activity, which can be blocked by the transglycosylase inhibitor moenomycin. Covalently linked to activated Sepharose, PBP1C specifically retained PBP1B and the transpeptidases PBP2 and -3 in addition to the murein hydrolase MltA. The specific interaction with these proteins suggests that PBP1C is assembled into a multienzyme complex consisting of both murein polymerases and hydrolases. Overexpression of PBP1C does not support growth of a PBP1A(ts)/PBP1B double mutant at the restrictive temperature, and PBP1C does not bind to the same variety of penicillin derivatives as PBPs 1A and 1B. Deletion of PBP1C resulted in an altered mode of murein synthesis. It is suggested that PBP1C functions in vivo as a transglycosylase only.
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Affiliation(s)
- G Schiffer
- Max-Planck-Institut für Entwicklungsbiologie, Abteilung Biochemie, D-72076 Tübingen, Germany
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