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Winter P, Klos K, Lambert L, Paulsen F, Landgraeber S, Wagener J. Indications and possible limitations using medio-plantar plate systems in tarsometatarsal 1 fusions - A cadaveric study. Ann Anat 2023; 250:152145. [PMID: 37597823 DOI: 10.1016/j.aanat.2023.152145] [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: 07/07/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND The tarsometatarsal 1 arthrodesis is an adequate treatment for moderate to severe hallux valgus deformity and instability of the first ray. Plantar plating arthrodesis has been shown to provide better mechanical stability and fewer postoperative complications than screw fixation or medial plating. The medio-plantar plate is a new plate design for Lapidus arthrodesis. It could combine the biomechanical advantages of the plantar plate and the anatomical overview of a medial plate. However, the implanted material can cause irritation of the tibialis anterior, which in some cases may require removal of the material. The purpose of this study was to examine the possibility of tendon irritation following medio-plantar first tarsometatarsal joint arthrodesis using cadaveric specimens. METHODS The study involved the simulated surgical procedure of medio-plantar plate arthrodesis on 30 lower extremities. After the plates were fixed, a thorough examination of the feet was conducted to assess any tendon irritation and to determine a recommendation for placement of the medio-plantar plate based on the Olewnik classification. RESULTS Irritation of the tibialis anterior tendon components with the medio-plantar plate depends mainly on the anatomic norm variant, classified according to Olewnik et al. A medio-plantar plate is particularly recommended in TA tendon Olewnik type 3 and type 5. The positioning of a medio-plantar plate in Olewnik type 1 and type 2 tendons depends on the anatomic fit of the medio-plantar plate and the bony configuration of the TMT 1 joint. A large portion of the TA tendon must be detached, so a different plate design may be preferred in these patients. CONCLUSIONS TMT 1 arthrodesis with medio-plantar plating of the first tarsometatarsal joint should be performed considering the anatomic TA tendon variations. LEVEL OF EVIDENCE Level V, Expert Opinion includes Case Reports and Technique Tips.
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Affiliation(s)
- Philipp Winter
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany.
| | - Kajetan Klos
- Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; Gelenkzentrum Rhein-Main, Fuß- Und Sprunggelenkschirurgie, Frankfurter Straße 94, 65239 Hochheim, Germany
| | - Laura Lambert
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Stefan Landgraeber
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany
| | - Joe Wagener
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany; Department of Orthopaedic Surgery, Hôpital Kirchberg, L-2540 Luxembourg, Germany
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Winter P, Najefi AA, Lambert L, Landgraeber S, Tschernig T, Wagener J. Endoscopically Assisted Percutaneous Harvesting of the Flexor Hallucis Tendon in Zone 2: An Anatomical Study. Foot Ankle Int 2023; 44:888-894. [PMID: 37296541 DOI: 10.1177/10711007231177250] [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] [Indexed: 06/12/2023]
Abstract
BACKGROUND Flexor hallucis longus (FHL) transfer is a well-established method for treating chronic Achilles tendon ruptures and tendinopathy. Harvesting of the FHL tendon in zone 2 results in greater length but is also associated with an increased risk of injury to the medial plantar nerve and requires an additional plantar incision. Because of the anatomic proximity of the FHL tendon to the tibial neurovascular bundle in zone 2, the purpose of this study was to investigate the risk of vascular or nerve injury with arthroscopic assisted percutaneous tenotomy in zone 2 of the FHL tendon. METHODS Endoscopically assisted percutaneous FHL transfer was performed on 10 right lower extremities from 10 cadaveric human specimens. The FHL tendon lengths and the relationship between FHL tendon and the tibial neurovascular bundle at zone 2 was analyzed. RESULTS We observed a complete transection of the medial plantar nerve in 1 case (10%). The mean length of the FHL tendon was 54.7 ± 9.5 mm and the mean distance from the distal stump of the FHL tendon to local neurovascular structures was 1.3 ± 0.7 mm. CONCLUSION There is a risk of neurovascular injury after endoscopic FHL tenotomy in zone 2. The tenotomy site is within 2 mm of the local neurovascular structures in the majority of cases. The additional length gained from this technique is unlikely to be required for the majority of FHL tendon transfer procedures. If additional length is needed, we would recommend the use of intraoperative ultrasonography or a mini-open approach to minimize injury risk. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Philipp Winter
- Department of Orthopaedic Surgery, University of Saarland, Homburg, Germany
| | - Ali-Asgar Najefi
- Department of Trauma and Orthopaedic, London North West University Hospital NHS Trust, London, United Kingdom
| | - Laura Lambert
- Department of Orthopaedic Surgery, University of Saarland, Homburg, Germany
| | - Stefan Landgraeber
- Department of Orthopaedic Surgery, University of Saarland, Homburg, Germany
| | | | - Joe Wagener
- Department of Orthopaedic Surgery, University of Saarland, Homburg, Germany
- Department of Orthopaedic Surgery, Hôpital Kirchberg, Luxembourg
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Wagener J, Schweizer C, Horn Lang T, Zwicky L, Schaefer DJ, Hintermann B. Vascularized Bone Autograft for the Treatment of Chondroblastoma of the Talus at Imminent Risk of Joint Breakdown: Three Case Reports. J Foot Ankle Surg 2019; 58:363-367. [PMID: 30612869 DOI: 10.1053/j.jfas.2018.08.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/28/2017] [Indexed: 02/03/2023]
Abstract
Surgical treatment options in a chondroblastoma of the talus breaching the subchondral layer with imminent risk of talar collapse in the weightbearing area are limited. A joint-preserving surgery should be advocated. Because current treatment options such as curettage, cryosurgery, or radiofrequency ablation may not be able to prevent a talar dome breakdown in large defects, nonvascularized bone grafting has been advocated to fill the void. To overcome the lack of vitality, a vascularized bone autograft might be an attractive alternative. We present 3 cases where a large talar defect owing to a chondroblastoma was treated with a vascularized bone autograft. In 1 of the cases, a free microvascular iliac crest bone graft was used, whereas in the other 2 cases, a vascularized graft was harvested from the medial femoral condyle. Computed tomographic scans demonstrated a stable incorporation of the graft in all cases. All patients were highly satisfied with the obtained results and showed a clinical functional outcome similar to the contralateral foot after 36, 60, and 72 months. At the latest radiographic follow-up, no evidence of recurrence was observed. In conclusion, a free vascularized bone autograft can be used to treat a large talar defect owing to chondroblastoma in young patients.
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Affiliation(s)
- Joe Wagener
- Attending Surgeon, Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland.
| | - Christine Schweizer
- Research Associate, Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Tamara Horn Lang
- Research Associate, Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Lukas Zwicky
- Research Associate, Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | | | - Beat Hintermann
- Professor, Associate Professor, and Chair, Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
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Diallo J, Wagener J, Schweizer C, Lang TH, Ruiz R, Hintermann B. Intraoperative Findings of Lateral Ligament Avulsion Fractures and Outcome After Refixation to the Fibula. Foot Ankle Int 2018. [PMID: 29528723 DOI: 10.1177/1071100718760273] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND An acute ankle sprain can result in a bony avulsion of the lateral ankle ligaments. The extent of concomitant lesions and subsequent instability patterns are not clearly understood. The high incidence of old avulsion fractures found in symptomatic chronic ankle instability may indicate the need for primary fixation. METHODS Ten patients (5 male, 5 female; mean age, 34 years; range, 15-64 years) with bony avulsion fractures of the fibula after acute ankle sprains were included. All patients were treated after a mean of 7.7 days (range, 2-17 days) with screw fixation of the fragment to the fibula. Clinical and radiographic assessments were performed, and the extent of ligament injury was documented. RESULTS The anterior talofibular ligament and calcaneofibular ligament were found to be attached to the avulsion fragment. The average size was 6.3 mm (range, 4-9 mm) in width from anterior to posterior and 5.2 mm (range, 4-7 mm) in length from superior to inferior. The displacement of the fragment increased under varus stress. Two patients had cartilage lesions in the lateral talus. After a mean follow-up period of 2.4 years (range, 2-4 years), all were clinically and radiographically stable, and patients were satisfied. CONCLUSIONS It was observed arthroscopically that the anterior talofibular ligament and calcaneofibular ligament were attached to the fragment. This is critical because motion between the fragment and the fibula may prevent spontaneous healing. Primary fixation of the fragment prevented rotational instability and was efficient to restore function and stability. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Jasmin Diallo
- 1 Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Joe Wagener
- 1 Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Christine Schweizer
- 1 Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Tamara Horn Lang
- 1 Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Roxa Ruiz
- 1 Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Beat Hintermann
- 1 Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
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Abstract
Aims Arthroscopically controlled fracture reduction in combination with percutaneous screw fixation may be an alternative approach to open surgery to treat talar neck fractures. The purpose of this study was thus to present preliminary results on arthroscopically reduced talar neck fractures. Patients and Methods A total of seven consecutive patients (four women and three men, mean age 39 years (19 to 61)) underwent attempted surgical treatment of a closed Hawkins type II talar neck fracture using arthroscopically assisted reduction and percutaneous screw fixation. Functional and radiological outcome were assessed using plain radiographs, as well as weight-bearing and non-weight-bearing CT scans as tolerated. Patient satisfaction and pain sensation were also recorded. Results Primary reduction was obtained arthroscopically in all but one patient, for whom an interposed fracture fragment had to be removed through a small arthrotomy to permit anatomical reduction. The quality of arthroscopic reduction and restoration of the talar geometry was excellent in the remaining six patients. There were no signs of talar avascular necrosis or subtalar degeneration in any of the patients. In the whole series, the functional outcome was excellent in five patients but restricted ankle movement was observed in two patients. All patients had a reduction in subtalar movement. At final follow-up, all patients were satisfied and all but one patient were pain free. Conclusion Arthroscopically assisted reduction and fixation of talar neck fractures was found to be a feasible treatment option and allowed early functional rehabilitation. Cite this article: Bone Joint J 2018;100-B:461-7.
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Affiliation(s)
- J Wagener
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, CH-4101 Bruderholz, Switzerland
| | - C Schweizer
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - L Zwicky
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - T Horn Lang
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - B Hintermann
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
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Wagener J, Smith SV, Soni N, Marjanovic-Painter B, Zinn C, Van de Wiele C, D’Asseler Y, Perkins G, Zeevaart JR, Sathekge M. Biodistribution and dosimetry of 195mPt-cisplatin in normal volunteers. Nuklearmedizin 2018; 52:222-7. [DOI: 10.3413/nukmed-0599-13-06] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 09/23/2013] [Indexed: 11/20/2022]
Abstract
Summary
195mPt-cisplatin is regarded as a promising imaging agent for optimizing dosage in patients receiving cisplatin chemotherapy. Methods: We investigated the whole-body distribution and radiation dosimetry of 195mPt-cisplatin in humans. Whole-body scans were obtained up to 144 h after intravenous injection of 112.4 MBq 195mPt-cisplatin in each of five subjects. Blood samples were taken at various times up to 144 h after injection. Urine was collected up to 114 h after injection for calculation of renal clearance and whole-body clearance. Time/activity curves were generated by fitting the organ-specific geometric mean counts, obtained from regions of interest, on the respective images as a function of the time after injection. OLINDA software package was applied to calculate the absorbed radiation dose for various organs. Results: Most of the activity (32 ± 4%) was excreted in the urine during the first 5 h. The effective clearance half-life derived from extrapolation of the whole-body curve was 40 hours (1.7 days). On average, the highest dose was received by the kidneys (mean dose received 2.68 ± 1.5 mGy/MBq), followed by the spleen (mean dose received 1.6 ± 0.8 mGy/MBq) followed by the liver (mean dose received 1.45 ± 0.38 mGy/MBq). The estimated mean effective dose for the adult subject was 0.185 ± 0.034 mSv/MBq. Conclusion: 195mPt-cisplatin proved a safe radiopharmaceutical with a favourable bio distribution for early and delayed imaging of pathology above the diaphragm. The ED obtained was 0.185 ± 0.034 mSv/MBq. The highest organ dose was received by the kidneys (2.68 ± 1.5 mGy/ MBq).
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Wagener J, Schweizer C, Zwicky L, Hintermann B. Ligament Balancing During TAR in Varus Deformity by Open Wedge Osteotomy of the Medial Malleolus. Foot & Ankle Orthopaedics 2017. [DOI: 10.1177/2473011417s000079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Category: Ankle Arthritis Introduction/Purpose: After reducing the tilted talus during total ankle replacement (TAR) in severe varus deformities, the surgeon is faced to a contract medial joint and an abducted medial malleolus leaving a wide gutter. A sliding osteotomy will release the deltoid ligament but the “horizontal” position of the medial malleolus remains and bony containment of the ankle joint is not restored. We propose an open wedge osteotomy, which will both lengthen and adduct the medial malleolus and restore ligament balancing. Fixation is done by either screw or plate fixation. We present our primary results with this new technique. Methods: From 2008-2015 Total Ankle Replacement combined with open wedge medial malleolar osteotomy was done in 50 ankles (48 patients). Inclusion criteria: Takakura stages 3 and 4 ankle arthritis. Minimum follow-up was defined as one year. Results: Neutral alignment was achieved in all ankles at last follow-up. AOFAS score increased from 36 preoperative to 82 at last follow-up. In 15 Ankles an additional bony procedure was done during the TAR surgery (Calcaneus Osteotomy: 5, Dorsiflexion Osteotomy of first ray: 6, Fibula Osteotomy: 4, peritalar fusion: 4) Complications included one non-union of the medial malleolus, which resolved after revision. One deep infection that was treated in a staged procedure with reimplantation of a TAR and no recurrence of infection. Two luxations of the polyethylene due to insufficient lateral ligaments and syndesmotic dehiscence, both were stable at final follow-up after revision (ligament reconstruction and tight-rope Fixation). Conclusion: Open wedge osteotomy of the medial malleolus restores the bony containment of the ankle joint and decreases the tension of the deltoid ligament. It is a valuable tool for ligament balancing during TAR.
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Wagener J, Gross CE, Schweizer C, Lang TH, Hintermann B. Custom-made total ankle arthroplasty for the salvage of major talar bone loss. Bone Joint J 2017; 99-B:231-236. [DOI: 10.1302/0301-620x.99b2.bjj-2016-0504.r2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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] [Received: 05/29/2016] [Accepted: 09/23/2016] [Indexed: 12/14/2022]
Abstract
Aims A failed total ankle arthroplasty (TAA) is often associated with much bone loss. As an alternative to arthrodesis, the surgeon may consider a custom-made talar component to compensate for the bone loss. Our aim in this study was to assess the functional and radiological outcome after the use of such a component at mid- to long-term follow-up. Patients and Methods A total of 12 patients (five women and seven men, mean age 53 years; 36 to77) with a failed TAA and a large talar defect underwent a revision procedure using a custom-made talar component. The design of the custom-made components was based on CT scans and standard radiographs, when compared with the contralateral ankle. After the anterior talocalcaneal joint was fused, the talar component was introduced and fixed to the body of the calcaneum. Results At a mean follow-up of 6.9 years (1 to 13), 11 ankles were stable with no radiological evidence of loosening. Only one was lost to follow-up. The mean arc of movement was 21° (10° to 35°). A total of nine patients (75%) were satisfied or very satisfied with the outcome, two (17%) were satisfied but with reservations and one (8%) was not satisfied. All but one patient had an improvement in the American Orthopaedic Foot and Ankle Society hindfoot score (p = 0.01). Just one patient developed deep infection, leading to arthrodesis. Conclusion A custom-made talar component yielded satisfactory results with regard to function, stability and satisfaction. This should encourage the use of such components as an alternative to arthrodesis of the ankle in patients with a failed TAA. Cite this article: Bone Joint J 2017;99-B:231–6.
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Affiliation(s)
- J. Wagener
- Clinic of Orthopaedic Surgery, Kantonsspital
Baselland, CH-4410 Liestal, Switzerland
| | - C. E. Gross
- Medical University of South Carolina, Department
of Orthopaedic Surgery, Charleston, South
Carolina, USA
| | - C. Schweizer
- Clinic of Orthopaedic Surgery, Kantonsspital
Baselland, CH-4410 Liestal, Switzerland
| | - T. Horn Lang
- Clinic of Orthopaedic Surgery, Kantonsspital
Baselland, CH-4410 Liestal, Switzerland
| | - B. Hintermann
- Clinic of Orthopaedic Surgery, Kantonsspital
Baselland, CH-4410 Liestal, Switzerland
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Wagener J, Schweizer C, Zwicky L, Hintermann B. The Syndesmotic Insufficiency in Mobile Bearing TAR – A Challenging and Underestimated Problem. Foot & Ankle Orthopaedics 2016. [DOI: 10.1177/2473011416s00308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Category: Ankle Arthritis Introduction/Purpose: The consequence of a missed syndesmotic insufficiency during mobile bearing total ankle replacement (TAR) surgery is subsequent valgus deformity leading to dissociation of the distal tibiofibular joint and failure of the TAR. The purpose of this study was to retrospectively review the patients who developed a syndesmotic insufficiency, which lead to a revision surgery, after primary TAR in our centre. The primary goal was to identify red-flags for possible syndesmotic insufficiency in preoperative planning of TAR, in order to reduce this type of complication. Methods: We identified twenty patients (12 females and 8 males) with a missed instability of the distal tibio-fibular joint appearing 3.5 years (range 0.8-9.5 years) after primary TAR. Patient’s records, preoperative and postoperative radiographs and intraoperative fluoroscope images were reviewed especially with regard to previous ankle or lower leg fractures. Functional outcome was assessed with the use of the American Orthopaedic Foot&Ankle (AOFAS) hindfoot score. Results: The mean follow-up after last revision surgery was 3.5 years. The median AOFAS Score at last follow-up was 72.5. We could identify 3 risk factors for possible failure: (a) The nature of trauma: Weber-C-Type fractures or Maisonneuve-Type fractures were found in 13 of 20 cases. (b) A defect in the lateral tibial plafond after for example, a pilon fracture or arising due to cyst formation, was found in 3 cases. Here we concluded that the defect lead to a subsequent valgus tilt of the tibial component, acting as a stress riser in the distal tibio-fibular joint. (c) The remaining 4 cases showed a high tibial resection probably leading to an iatrogenic lesion of the anterior and posterior distal tibio-fibular ligaments. Conclusion: Knowing the etiology of posttraumatic osteoarthritis of the ankle joint is mandatory to identify a syndesmotic insufficiency in the preoperative work-up for mobile bearing three-component TAR. Due to these findings, our surgical protocol for TAR was adapted accordingly. If one or more of the risk factors are present during surgery we suggest performing distal tibio- fibular fusion.
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O'Sullivan A, Middleton P, Berthiaume Y, Poplawska K, Prados C, Salvatore D, Wagener J. 142 Clinical burden among patients with cystic fibrosis (CF) who are homozygous for the F508del-CFTR mutation. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30380-0] [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: 11/29/2022]
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McKone E, Sawicki G, Millar S, Pasta D, Rubin J, Konstan M, Wagener J. ePS03.4 Improved rate of decline in percent predicted FEV 1 (ppFEV 1 ) is not associated with acute improvement in ppFEV 1 in patients with cystic fibrosis (CF) treated with ivacaftor. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30208-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hintermann B, Wagener J, Knupp M, Schweizer C, J Schaefer D. Treatment of extended osteochondral lesions of the talus with a free vascularised bone graft from the medial condyle of the femur. Bone Joint J 2015; 97-B:1242-9. [PMID: 26330592 DOI: 10.1302/0301-620x.97b9.35292] [Citation(s) in RCA: 20] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Large osteochondral lesions (OCLs) of the shoulder of the talus cannot always be treated by traditional osteochondral autograft techniques because of their size, articular geometry and loss of an articular buttress. We hypothesised that they could be treated by transplantation of a vascularised corticoperiosteal graft from the ipsilateral medial femoral condyle. Between 2004 and 2011, we carried out a prospective study of a consecutive series of 14 patients (five women, nine men; mean age 34.8 years, 20 to 54) who were treated for an OCL with a vascularised bone graft. Clinical outcome was assessed using a visual analogue scale (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score. Radiological follow-up used plain radiographs and CT scans to assess graft incorporation and joint deterioration. At a mean follow-up of 4.1 years (2 to 7), the mean VAS for pain had decreased from 5.8 (5 to 8) to 1.8 (0 to 4) (p = 0.001) and the mean AOFAS hindfoot score had increased from 65 (41 to 70) to 81 (54 to 92) (p = 0.003). Radiologically, the talar contour had been successfully reconstructed with stable incorporation of the vascularised corticoperiosteal graft in all patients. Joint degeneration was only seen in one ankle. Treatment of a large OCL of the shoulder of the talus with a vascularised corticoperiosteal graft taken from the medial condyle of the femur was found to be a safe, reliable method of restoring the contour of the talus in the early to mid-term.
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Affiliation(s)
- B Hintermann
- Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - J Wagener
- Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - M Knupp
- Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - C Schweizer
- Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - D J Schaefer
- University Hospital, Spital Strasse 21, CH-4056, Basel, Switzerland
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Sawicki G, McKone E, Pasta D, Wagener J, Johnson C, Konstan M. WS3.1 The effect of ivacaftor on the rate of lung function decline in CF patients with a G551D-CFTR mutation. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60019-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Methicillin-resistant Staphyococcus aureus strains remain a challenge to both patient care and infection control efforts. In addition to the defining resistance to beta-lactams several other antibiotic classes may be ineffective. Some resistance phenotypes exhibit a characteristic distribution pattern between healthcare-associated, community-associated, and livestock-associated MRSA strains. For patients with defined risk factors a search-, destroy-, follow-up-strategy is recommended in order to identify and eliminate MRSA colonization. Mupirocin nasal ointment and extensive hygiene measures are the mainstays of decolonization efforts. Besides vancomycin several other antimicrobials such as rifampin, trimethoprim-sulfamethoxazol, clindamycin, linezolid, and daptomycin are used to treat specific MRSA infections.
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Affiliation(s)
- J Wagener
- Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Ludwig-Maximilians-Universität München
| | - U Seybold
- Sektion Klinische Infektiologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München
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Abstract
A 51-year-old woman presented with a non-specific tumor of the iris and intraocular inflammation of the left eye. The patient had a history of surgery for metastatic bowel cancer and was on chemotherapy. The lesion was excised and was found to contain fungal spores and hyphae. Microbiological testing identified growth of Candida albicans and the patient was treated with local and systemic voriconazole. After combined vitrectomy with cataract surgery, the patient's condition improved.
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Affiliation(s)
- J Rueping
- Augenklinik[Symbol: see text]der[Symbol: see text]LMU, Klinikum[Symbol: see text]der[Symbol: see text]Universität[Symbol: see text]München, Campus[Symbol: see text]Innenstadt, Mathildenstr.[Symbol: see text]8, 80336, München, Deutschland,
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Shukla P, Twomey E, Wagener J. 217 Use of liver ultrasound in assessment of cystic fibrosis liver disease in children. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60386-5] [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: 10/28/2022]
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Abstract
The human pathogenic fungus Candida albicans is the predominant cause of both superficial and invasive forms of candidiasis. Clinical observations indicate that mucocutaneous Candida infections are commonly associated with defective cell-mediated immune responses. The importance of the innate immune system as a first-line defense against pathogenic challenge has long been recognized. Over the last decade, many key molecules mediating innate host defense have been identified. Central to these developments is the discovery of pattern recognition receptors such as Toll-like receptors and C-type lectin-receptors that induce innate immune responses and also modulate cellular and humoral adaptive immunity during Candida infections. Although a large amount of information is now available in systemic infections, little is known about localized infections. We address the most relevant pattern recognition receptors and their signaling mechanisms in oral epithelial cells, to gain a better understanding of their contributions to antifungal innate immunity.
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Affiliation(s)
- G Weindl
- Department of Pharmacology and Toxicology, Institute of Pharmacy, Freie Universität Berlin, 14195 Berlin, Germany
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Quittnert A, Schechter M, Rasoulivan L, Pasta D, Wagener J. 465 Effects of socioeconomic status, race and ethnicity on quality of life in a national database. J Cyst Fibros 2006. [DOI: 10.1016/s1569-1993(06)80391-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Rosenfeld M, Emerson J, Accurso F, Armstrong D, Castile R, Grimwood K, Hiatt P, McCoy K, McNamara S, Ramsey B, Wagener J. Diagnostic accuracy of oropharyngeal cultures in infants and young children with cystic fibrosis. Pediatr Pulmonol 1999; 28:321-8. [PMID: 10536062 DOI: 10.1002/(sici)1099-0496(199911)28:5<321::aid-ppul3>3.0.co;2-v] [Citation(s) in RCA: 257] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The objective of this study was to assess the diagnostic accuracy of oropharyngeal (OP) cultures relative to simultaneous bronchoalveolar lavage (BAL) cultures in very young children with CF, and to examine the effects of bacterial density, age, and study cohort on diagnostic accuracy. Respiratory culture data were analyzed from three independent, prospective studies involving simultaneous collection of 286 OP and BAL cultures from 141 children with CF <5 years of age. For predicting any growth of Pseudomonas aeruginosa (Pa) from the lower airway in subjects </=18 months of age (mean age, 8 +/- 5 months), OP cultures had a sensitivity of 44% (95% CI 14%, 79%), specificity of 95% (90%, 99%), positive predictive value of 44% (14%, 79%), and negative predictive value of 95% (90%, 99%). Diagnostic accuracy was similar for Haemophilus influenzae (Hi). Specificity was significantly lower for Staphylococcus aureus (Sa). Sensitivity for all organisms improved if a positive lower airway culture was defined as >/=10(3) or >/=10(5) cfu/mL. Specificity for Pa declined significantly with increasing age. In children with CF <5 years of age, the specificity and negative predictive value of OP cultures for Pa are high, while the sensitivity and positive predictive value are poor. Thus, in this age range, a negative throat culture is helpful in "ruling out" lower airway infection with Pa. However, a positive culture does not reliably "rule in" the presence of Pa in the lower respiratory tract. These findings may have implications for study design and interpretation as well as clinical management of young children with CF.
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Affiliation(s)
- M Rosenfeld
- University of Washington, Seattle, Washington.
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Rothenberg SS, Bratton D, Larsen G, Deterding R, Milgrom H, Brugman S, Boguniewicz M, Copenhaver S, White C, Wagener J, Fan L, Chang J, Stathos T. Laparoscopic fundoplication to enhance pulmonary function in children with severe reactive airway disease and gastroesophageal reflux disease. Surg Endosc 1997; 11:1088-90. [PMID: 9348380 DOI: 10.1007/s004649900536] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [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: 02/05/2023]
Abstract
BACKGROUND The relationship between severe reactive airway disease (RAD) and gastroesophageal reflux disease (GERD) has been noted but the relationship is poorly understood. This study reports our experience with laparoscopic fundoplication and its effect on the pulmonary status of children with severe steroid-dependent reactive airway disease. METHODS Fifty-six patients with severe steroid-dependent RAD and medically refractory GERD underwent laparoscopic Nissen fundoplications. Mean age was 7 years and mean weight was 20 kg. All patients had the procedure completed successfully laparoscopically with an average operative time of 62 min. Average hospital stay was 1.6 days. RESULTS Forty-eight of 56 patients noted significant improvement in their respiratory symptoms in the first week. Fifty of 56 patients have been weaned off their oral steroids and four others have had a greater than 50% decrease in their dose. Sixteen patients had a documented increase in their FEV1 in the initial postoperative period (avg. 26%). CONCLUSION Patients with steroid-dependent RAD and GERD refractory to medical management show improvement in their respiratory status following fundoplication and the majority can be weaned off of their oral steroids. Laparoscopic techniques allow this procedure to be performed safely even in this high-risk group of patients.
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Affiliation(s)
- S S Rothenberg
- National Jewish Center for Immunology and Respiratory Medicine, The Children's Hospital, Columbia Presbyterian/St Luke's Medical Center for Children, Denver, CO, 80218 USA
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Abstract
OBJECTIVE The objective of this study was to assess respiratory responses of newborn infants with myelomeningocele through pneumograms and carbon dioxide challenge, and to evaluate the possibility of predicting which patients with myelomeningocele acquired respiratory symptoms related to the Arnold-Chiari deformity and brain-stem dysfunction. METHODS All surviving infants with spina bifida who were born at the University of Iowa Hospitals and Clinics (UIHC) or were transferred there on the first day of life between January 1987 and January 1991 were assessed with a pneumogram and CO2 challenge once they were medically stable, and were followed for a mean of 30 months (10 to 53 months). RESULTS Thirty patients met the inclusion criteria for this study; four died before being studied. Of the 26 remaining patients, 12 were born at the UIHC and 14 were transferred to the UIHC on the first day of life. Of the 26 infants studied, 12 (46%) had abnormalities on the pneumogram, including 2 with significant periodic breathing and 10 with episodes of desaturation below 87%. Of the 26 infants studied, 4 had no detectable response to an increasing fraction of CO2 in inspired air on the CO2 challenge and 12 had an increase in exhaled minute ventilation per increase in the alveolar fraction of CO2 in exhaled air more than 2 SD below the mean. Only 10 patients (38.5%) had normal ventilatory responses to the increasing fraction of CO2 in inspired air. On follow-up, only one study patient had symptoms related to Arnold-Chiari deformity and brain-stem dysfunction (bilateral vocal cord paralysis). His neonatal CO2 challenge results and his pneumogram were normal. CONCLUSION We conclude that these two tests are not useful in predicting which patients will have symptoms related to Arnold-Chiari deformity. Specificity for the pneumogram and the CO2 challenge was 0.52 and 0.36, respectively. Sensitivity was zero for both tests, although this result is limited by the low incidence of symptomatic Arnold-Chiari deformity in this sample. As previous investigators have found, a significant number of patients with meningomyelocele had abnormal ventilatory patterns. These ventilatory abnormalities indicate that even in the absence of severe symptoms, the control of the ventilatory response is somewhat impaired in many patients with meningomyelocele. This alteration in ventilatory control is probably related to abnormalities in the development of the brain stem.
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Affiliation(s)
- M C Petersen
- Department of Pediatrics, University of Iowa, Iowa City, USA
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Wagener J, Beyrich T. [Radiosensitizers--biochemical and tumor therapy experiences]. Pharmazie 1992; 47:815-24. [PMID: 1492110] [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] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- J Wagener
- Fachrichtung Pharmazie, Ernst-Moritz-Arndt-Universität Greifswald
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Frey EE, Smith WL, Grandgeorge S, McCray P, Wagener J, Franken EA, Sato Y. Chronic airway obstruction in children: evaluation with cine-CT. AJR Am J Roentgenol 1987; 148:347-52. [PMID: 3492113 DOI: 10.2214/ajr.148.2.347] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The radiographic diagnosis of airway lesions, especially laryngomalacia and tracheomalacia, often is imprecise. Endoscopy, which allows detailed examination of the upper airway, is an invasive procedure requiring sedation or anesthesia. A prospective study was undertaken to show the value of cine-CT (Imatron) scanning in diagnosing airway lesions in children. Eleven patients, aged 10 days to 4 years old, with a history of stridor were evaluated by both cine-CT and flexible fiberoptic endoscopy. Cine-CT studies of 12 children imaged for other reasons and without clinical evidence of airway disease served as controls to assess normal airway motion. Endoscopy identified 13 abnormalities, 11 of which were identified by cine-CT. Cine-CT has the capacity to image common causes of chronic stridor in children. It is rapid, noninvasive, and requires no sedation in most children. Although additional work is needed to clarify the role of cine-CT, this study suggests that cine-CT is a sensitive and specific imaging technique for evaluation of chronic stridor in infants and children.
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Abstract
This report documents the use of a Cine CT scanner for documentation of pulmonary artery sling. The examination can be carried out on outpatients and involves only a peripheral venous contrast injection. Excellent visualization of the anatomy is obtained.
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