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Truschkat A, Poller M, Berli M, Hasler P. [Think Interdisciplinary to Improve a Complex Multifactorial Gait Disorder of a 28-Year-Old Polio Patient]. Praxis (Bern 1994) 2023; 112:111-116. [PMID: 36722112 DOI: 10.1024/1661-8157/a003986] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Think Interdisciplinary to Improve a Complex Multifactorial Gait Disorder of a 28-Year-Old Polio Patient Abstract. Poliomyelitis with the resulting paralytic sequelae is hardly present in Switzerland anymore and if so, only in elderly persons. The last reported case of poliomyelitis in Switzerland was received by the FOPH in 1982. A 28-year-old patient with paralytic poliomyelitis is extremely rare in this country. A combined multifactorial gait disorder with symptomatic hip dysplasia, pronounced leg length shortening and axial malalignment of the leg on the polio-affected side make this case unique and a special interdisciplinary challenge.
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Affiliation(s)
| | | | - Martin Berli
- Technische Orthopädie, Universitätsklinik Balgrist, Zürich, Schweiz
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Morand R, Brusa T, Schnüriger N, Catanzaro S, Berli M, Koch VM. FeetBack–Redirecting touch sensation from a prosthetic hand to the human foot. Front Neurosci 2022; 16:1019880. [PMID: 36389246 PMCID: PMC9645020 DOI: 10.3389/fnins.2022.1019880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/28/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Adding sensory feedback to myoelectric prosthetic hands was shown to enhance the user experience in terms of controllability and device embodiment. Often this is realized non-invasively by adding devices, such as actuators or electrodes, within the prosthetic shaft to deliver the desired feedback. However, adding a feedback system in the socket adds more weight, steals valuable space, and may interfere with myoelectric signals. To circumvent said drawbacks we tested for the first time if force feedback from a prosthetic hand could be redirected to another similarly sensitive part of the body: the foot. Methods We developed a vibrotactile insole that vibrates depending on the sensed force on the prosthetic fingers. This self-controlled clinical pilot trial included four experienced users of myoelectric prostheses. The participants solved two types of tasks with the artificial hands: 1) sorting objects depending on their plasticity with the feedback insole but without audio-visual feedback, and 2) manipulating fragile, heavy, and delicate objects with and without the feedback insole. The sorting task was evaluated with Goodman-Kruskal's gamma for ranked correlation. The manipulation tasks were assessed by the success rate. Results The results from the sorting task with vibrotactile feedback showed a substantial positive effect. The success rates for manipulation tasks with fragile and heavy objects were high under both conditions (feedback on or off, respectively). The manipulation task with delicate objects revealed inferior success with feedback in three of four participants. Conclusion We introduced a novel approach to touch sensation in myoelectric prostheses. The results for the sorting task and the manipulation tasks diverged. This is likely linked to the availability of various feedback sources. Our results for redirected feedback to the feet fall in line with previous similar studies that applied feedback to the residual arm. Clinical trial registration Name: Sensor Glove and Non-Invasive Vibrotactile Feedback Insole to Improve Hand Prostheses Functions and Embodiment (FeetBack). Date of registration: 23 April 2019. Date the first participant was enrolled: 3 September 2021. ClinicalTrials.gov Identifier: NCT03924310.
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Affiliation(s)
- Rafael Morand
- Biomedical Engineering Lab, Institute for Human Centered Engineering, Bern University of Applied Sciences, Bern, Switzerland
- *Correspondence: Rafael Morand
| | - Tobia Brusa
- Biomedical Engineering Lab, Institute for Human Centered Engineering, Bern University of Applied Sciences, Bern, Switzerland
| | - Nina Schnüriger
- Division of Prosthetics and Orthotics, Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Sabrina Catanzaro
- Division of Prosthetics and Orthotics, Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Martin Berli
- Division of Prosthetics and Orthotics, Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Volker M. Koch
- Biomedical Engineering Lab, Institute for Human Centered Engineering, Bern University of Applied Sciences, Bern, Switzerland
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Scebba G, Zhang J, Catanzaro S, Mihai C, Distler O, Berli M, Karlen W. Detect-and-segment: A deep learning approach to automate wound image segmentation. Informatics in Medicine Unlocked 2022. [DOI: 10.1016/j.imu.2022.100884] [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: 10/19/2022] Open
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Eckers F, Laux CJ, Schaller S, Berli M, Achermann Y, Fucentese SF. Risk factor analysis for above-knee amputation in patients with periprosthetic joint infection of the knee: a case-control study. BMC Musculoskelet Disord 2021; 22:884. [PMID: 34663297 PMCID: PMC8525022 DOI: 10.1186/s12891-021-04757-w] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/28/2021] [Indexed: 11/29/2022] Open
Abstract
Background Periprosthetic joint infection (PJI) is a severe complication following knee arthroplasty. Therapeutic strategies comprise a combination of surgical and antibiotic treatment modalities and aim to eradicate the infection. Sometimes control of the disease can only be attained by above-knee amputation (AKA). While a vast amount of literature exists illuminating predisposing factors for PJI, risk factors favoring the endpoint AKA in this context are sparsely known. Methods The purpose of this investigation was to delineate whether patients with PJI of the knee present specific risk factors for AKA. In a retrospective case-control study 11 cases of PJI treated with AKA were compared to 57 cases treated with limb salvage (LS). The minimum follow-up was 2 years. Comorbidities, signs and symptoms of the current infection, factors related to previous surgeries and the implant, microbiology, as well as therapy related factors were recorded. Comparative analysis was performed using student’s t-test, chi-square test or Fisher’s exact test. Binary differences were calculated using odds ratio (OR). Reoperation frequency was compared using Mann-Whitney U test. In-depth descriptive analysis of 11 amputees was carried out. Results A total of 68 cases aged 71 ± 11.2 years were examined, 11 of which underwent AKA and 57 had LS. Severe comorbidities (p = 0.009), alcohol abuse (p = 0.015), and preoperative anemia (p = 0.022) were more frequently associated with AKA. Preoperative anemia was found in all 11 amputees (100%) and in 33 of 57 LS patients (58%) with an average preoperative hemoglobin of 99.9 ± 15.1 g/dl compared to 118.2 ± 19.9 g/dl (p = 0.011). No other parameters differed significantly. AKA patients underwent a median of eight (range 2–24) reoperations, LS patients a median of five (range 2–15). Conclusion Factors potentially influencing the outcome of knee PJI are diverse. The indication of AKA in this context remains a rarity and a case-by-case decision. Patient-intrinsic systemic factors such as alcohol abuse, severe comorbidities and preoperative anemia may elevate the individual risk for AKA in the setting of PJI. We recommend that anemia, being a condition well amenable to therapeutic measures, should be given special consideration in management of PJI patients. Trial registration This study was registered with Kantonale Ethikkommission Zürich, (BASEC-No. 2016–01048).
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Affiliation(s)
- Franziska Eckers
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Christoph J Laux
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sebastian Schaller
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Martin Berli
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Yvonne Achermann
- Department of Infectious Diseases and Hospital Epidemiologie, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Mirrahimi M, Klein K, Houtman M, Maciukiewicz M, Frank Bertoncelj M, Juengel A, Berli M, Marks M, Distler O, Ospelt C. OP0020 HOMEOBOX D TRANSCRIPTION FACTORS SHAPE DIFFERENTIAL JOINT ENVIRONMENT BETWEEN ANTERIOR FINGER JOINTS AND THUMB. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2095] [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: 11/04/2022]
Abstract
Background:The expression of embryonic Homeobox (HOX) genes is tightly regulated based on anatomic location in human adult dermal and synovial fibroblasts. Previously, we showed that HOX-D10,-D11 and -D13 are higher expressed in synovial fibroblasts from small distal joints from the hands and feet, in particular in digits II-V and wrists compared to thumb and that this expression pattern is epigenetically imprinted1. The consequences of the tightly restricted expression of these transcription factors are largely unknown.Objectives:To elucidate the function of HOXD10, -D11 and -D13 in synovial fibroblasts.Methods:Synovial tissues were isolated from paws of naïve C57BL/6 mice (n=8), from patients with rheumatoid arthritis (RA), osteoarthritis (OA) and from healthy controls. Synovial fibroblasts were cultured and transfected with GapmeR to silence HOXD10, -D11, and -D13, respectively or with control GapmeR. RNA sequencing was performed on the NovaSeq platform and pathway analysis was done using R packages and web-based tools (GSEA, EnrichR, Cytoscape). HOXD target gene expression was measured by qPCR (n=3-6).Results:To confirm and further analyze the distinctive expression pattern of HOXD genes, we measured their expression in healthy synovial tissues of different joints of human feet and mouse paws. Similar to what we had found in hands, HOXD10, -D11 and -D13 were less abundant in the joints of the first digit of human feet compared to digits II-V (n=3-4 in each joint). Measurements in joints of mouse paws showed lower expression of HoxD10, -D11 and -D13 in distal interphalangeal joints compared to proximal interphalangeal joints and metacarpophalangeal (MCP) joints, respectively. Silencing of HOXD10, -D11 and –D13, affected the expression of 5333, 2217 and 7347 genes, respectively, in cultured RA synovial fibroblasts from human wrists (n=3).There were more transcripts equally regulated by HOXD10 and -D13 (40% of all HOXD10 and 31% of all HOXD13 regulated transcripts), than by HOXD11 and either -D10 or -D13 (18% of all HOXD10 regulated genes and 16% of all HOXD13 regulated genes), suggesting most redundancy between HOXD10 and -D13 (Figure 1). Among genes differentially expressed in SF isolated from MCP II-V versus thumb joints, 19%, 4% and 33% were regulated by HOXD10, -D11 or –D13, respectively, supporting a role for HOXD13 in particular in shaping the joint specific environment. All three HOXD transcription factors regulated genes involved in cell cycle progression, demonstrating dependence of synovial fibroblasts on these HOX genes for cell division. Other enriched pathways were Toll-like receptor and integrin signaling pathways, regulation of unsaturated fatty acid synthesis and autophagy and extra-cellular matrix protein organization. We could confirm several targets of HOXD10, -D11, and –D13 by qPCR, e.g. NR4A1, ROR2, LIF, ATF3.Figure 1.Comparison of the genes which were differentially expressed after HOXD10-11-13 silencingConclusion:The expression of HOXD10, -D11 and –D13 in synovial fibroblasts and tissues strikinglyoverlaps with predilection sites for RA. Silencing experiments suggested that these embryonic HOX transcription factors have a crucial role in regulating fibroblast functions and might shape a joint specific environment that modulates the development and course of RA in specific joints.References:[1]Klein K, et al. Ann Rheum Dis 2018;77(Suppl 1):P126Disclosure of Interests:Masoumehalsadat Mirrahimi: None declared, Kerstin Klein: None declared, Miranda Houtman: None declared, Malgorzata Maciukiewicz: None declared, Mojca Frank Bertoncelj: None declared, Astrid Juengel: None declared, Martin Berli: None declared, Miriam Marks: None declared, Oliver Distler Speakers bureau:1-Speaker fee on Scleroderma and related complications: Bayer, Boehringer Ingelheim, Medscape, Novartis, Roche• Speaker fee on rheumatology topic other than Scleroderma: MSD, iQone, Novartis, Pfizer, Roche, Consultant of: • Consultancy fee for Scleroderma and its complications: Abbvie, Acceleron Pharma, Amgen, AnaMar, Arxx Therapeutics, Bayer, Baecon Discovery, Boehringer, CSL Behring, ChemomAb, Corbus Pharmaceuticals, Horizon Pharmaceuticals, Galapagos NV, GSK, Glenmark Pharmaceuticals, Inventiva, Italfarmaco, iQvia, Kymera, Medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Roche, Roivant Sciences, Sanofi, UCB• Consultancy fee for rheumatology topic other than Scleroderma: Abbvie, Amgen, Lilly, Pfizer, Grant/research support from:. OD has/had consultancy relationship and/or has received research funding in the area of potential treatments for systemic sclerosis and its complications from (last three years):• Abbvie, Acceleron Pharma, Amgen, AnaMar, Arxx Therapeutics, Baecon Discovery, Blade Therapeutics, Bayer, Boehringer Ingelheim, ChemomAb, Corbus Pharmaceuticals, CSL Behring, Galapagos NV, Glenmark Pharmaceuticals, GSK, Horizon (Curzion) Pharmaceuticals, Inventiva, iQvia, Italfarmaco, iQone, Kymera Therapeutics, Lilly, Medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Novartis, Pfizer, Roche, Sanofi, Serodapharm, Topadur, Target Bioscience and UCB. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143).• Research Grants to investigate the pathophysiology and potential treatment of Scleroderma and its complications: Kymera Therapeutics, Mitsubishi Tanabe, Caroline Ospelt: None declared
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Waibel F, Berli M, Catanzaro S, Sairanen K, Schöni M, Böni T, Burkhard J, Holy D, Huber T, Bertram M, Läubli K, Frustaci D, Rosskopf A, Botter S, Uçkay I. Optimization of the antibiotic management of diabetic foot infections: protocol for two randomized controlled trials. Trials 2020; 21:54. [PMID: 31915048 PMCID: PMC6950867 DOI: 10.1186/s13063-019-4006-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/16/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Few studies have addressed the appropriate duration of antibiotic therapy for diabetic foot infections (DFI) with or without amputation. We will perform two randomized clinical trials (RCTs) to reduce the antibiotic use and associated adverse events in DFI. METHODS We hypothesize that shorter durations of postdebridement systemic antibiotic therapy are noninferior (10% margin, 80% power, alpha 5%) to existing (long) durations and we will perform two unblinded RCTs with a total of 400 DFI episodes (randomization 1:1) from 2019 to 2022. The primary outcome for both RCTs is remission of infection after a minimal follow-up of 2 months. The secondary outcomes for both RCTs are the incidence of adverse events and the overall treatment costs. The first RCT will allocate the total therapeutic amputations in two arms of 50 patients each: 1 versus 3 weeks of antibiotic therapy for residual osteomyelitis (positive microbiological samples of the residual bone stump); or 1 versus 4 days for remaining soft tissue infection. The second RCT will randomize the conservative approach (only surgical debridement without in toto amputation) in two arms with 50 patients each: 10 versus 20 days of antibiotic therapy for soft tissue infections; and 3 versus 6 weeks for osteomyelitis. All participants will have professional wound debridement, adequate off-loading, angiology evaluation, and a concomitant surgical, re-educational, podiatric, internist and infectiology care. During the surgeries, we will collect tissues for BioBanking and future laboratory studies. DISCUSSION Both parallel RCTs will respond to frequent questions regarding the duration of antibiotic use in the both major subsets of DFIs, to ensure the quality of care, and to avoid unnecessary excesses in terms of surgery and antibiotic use. TRIAL REGISTRATION ClinicalTrials.gov, NCT04081792. Registered on 4 September 2019.
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Affiliation(s)
- Felix Waibel
- Team Technical Orthopedics, Department of Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Martin Berli
- Team Technical Orthopedics, Department of Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Sabrina Catanzaro
- Unit for Clinical and Applied Research, Balgrist University Hospital, Zurich, Switzerland
| | - Kati Sairanen
- Unit for Clinical and Applied Research, Balgrist University Hospital, Zurich, Switzerland
| | - Madlaina Schöni
- Team Technical Orthopedics, Department of Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Thomas Böni
- Team Technical Orthopedics, Department of Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Jan Burkhard
- Internal Medicine, Balgrist University Hospital, Zurich, Switzerland
| | - Dominique Holy
- Internal Medicine, Balgrist University Hospital, Zurich, Switzerland
| | - Tanja Huber
- Hospital Pharmacy, Balgrist University Hospital, Zurich, Switzerland
| | - Maik Bertram
- Nursing Department, Balgrist University Hospital, Zurich, Switzerland
| | - Karin Läubli
- Physiotherapy, Balgrist University Hospital, Zurich, Switzerland
| | - Dario Frustaci
- Unit for Clinical and Applied Research, Balgrist University Hospital, Zurich, Switzerland.,BioBanking, Balgrist Campus AG, Balgrist University Hospital, Zurich, Switzerland
| | - Andrea Rosskopf
- Radiology, Balgrist University Hospital, Zurich, Switzerland
| | - Sander Botter
- BioBanking, Balgrist Campus AG, Balgrist University Hospital, Zurich, Switzerland
| | - Ilker Uçkay
- Unit for Clinical and Applied Research, Balgrist University Hospital, Zurich, Switzerland. .,Infectiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.
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Plate A, Weichselbaumer V, Schüpbach R, Fucentese SF, Berli M, Hüllner M, Achermann Y. Diagnostic accuracy of 99mTc-antigranulocyte SPECT/CT in patients with osteomyelitis and orthopaedic device-related infections: A retrospective analysis. Int J Infect Dis 2019; 91:79-86. [PMID: 31759168 DOI: 10.1016/j.ijid.2019.11.017] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/11/2019] [Accepted: 11/15/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Conventional imaging techniques are routinely used in the diagnostic work-up of patients with suspected osteomyelitis or orthopaedic implant-associated infections. Hybrid nuclear medicine imaging techniques are a suitable alternative to routine imaging modalities as they provide anatomical and functional information within one procedure. Our study investigated the performance of anti-granulocyte SPECT/CT using 99mTc-labelled monoclonal antibodies in the diagnosis of osteomyelitis and orthopaedic implant-associated infections. METHODS In this retrospective analysis, we included patients with 99mTc-antigranulocyte SPECT/CT acquired in the context of a suspected bone and joint infection. All patients underwent routine diagnostics and/or had a clinical follow-up of at least 12months. RESULTS 26 episodes were included. Fifteen exams were performed for suspected osteomyelitis, and 11 for suspected orthopaedic implant-associated infection. SPECT/CT was ordered most often if standard diagnostic tests or conventional imaging modalities remained inconclusive. The overall sensitivity and specificity for the diagnosis of an infection were 77.8% and 94.1%, respectively. The positive predictive value was 87.5% and the negative predictive value 88.9%. Diagnostic accuracy was 88.5%. CONCLUSIONS 99mTc-antigranulocyte SPECT/CT imaging has a high accuracy in the diagnosis of osteomyelitis and orthopaedic implant-associated infections and is a suitable non-invasive diagnostic tool if standard diagnostic examinations are inconclusive or not applicable.
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Affiliation(s)
- A Plate
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich, 8091, Switzerland.
| | - V Weichselbaumer
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich, 8091, Switzerland
| | - R Schüpbach
- Department of Orthopaedics, University Hospital Balgrist, University of Zurich, Forchstrasse 340, Zurich, 8008 Switzerland
| | - S F Fucentese
- Department of Orthopaedics, University Hospital Balgrist, University of Zurich, Forchstrasse 340, Zurich, 8008 Switzerland
| | - M Berli
- Department of Orthopaedics, University Hospital Balgrist, University of Zurich, Forchstrasse 340, Zurich, 8008 Switzerland
| | - M Hüllner
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich, 8091, Switzerland
| | - Y Achermann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich, 8091, Switzerland
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Kaiser P, Häller TV, Uçkay I, Kaiser D, Berli M, Böni T, Waibel F. Revision After Total Transmetatarsal Amputation. J Foot Ankle Surg 2019; 58:1171-1176. [PMID: 31679669 DOI: 10.1053/j.jfas.2019.03.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 01/16/2019] [Revised: 03/19/2019] [Accepted: 03/28/2019] [Indexed: 02/03/2023]
Abstract
Total transmetatarsal amputation (TMA) can be an option for foot salvage in gangrene, sepsis, or infected necrosis. However, the literature concerning predictive outcome factors and bacterial sampling is scarce. To identify potential associations between revision surgery and underlying bacteria or other preoperative selection criteria, we reviewed all patients with TMA who were treated at our institution. We compared the patients with remissions with surgical revisions. Among 96 adult patients with TMA (105 amputations), 42 required a revision surgery (40%), 18 had a further minor proximal surgical reamputation (17%) and 18 had a major proximal surgical reamputation (14%). In group comparisons, a previous infection with Staphylococcus aureus was protective with a lower revision risk (4/26 with revision surgery vs 22/26 without revisions; p = .03). This was the opposite for postoperative persistent soft tissue or bone infections (p < .01) and delayed wound healing (p < .01), which were positively associated with a revision risk. The American Society of Anesthesiologists Score, sex, age, body mass index, diabetes, polyneuropathy, chronic renal failure, dialysis, peripheral arterial disease, smoking status, and antibiotic regimen did not influence this revision risk. These results must be interpreted cautiously because no multiple variable calculations could be conducted as a result of the paucity of cases and confounding could not be evaluated sufficiently. TMA is an option to prevent major amputations, but it may be associated with a subsequent revision risk of 40% in adult patients. In our cohort study, persistent postamputation infection and delayed wound healing were associated with revision. However, no preoperative selection criteria were found that lead to revision surgery except for an infection with Staphylococcus aureus, which protected against revision surgery.
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Affiliation(s)
- Peter Kaiser
- Resident, Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Thomas Vincent Häller
- Resident, Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Ilker Uçkay
- Head of Infectiology, Unit for Clinical and Applied Research, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Dominik Kaiser
- Surgeon, Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Martin Berli
- Surgeon, Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Thomas Böni
- Surgeon and Head of Technical Orthopedics, Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Felix Waibel
- Surgeon, Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Hafner J, Buset C, Anzengruber F, Barysch-Bonderer M, Läuchli S, Müller H, Oleg Meier T, Ulmer N, Reutter D, Kucher N, Rancic Z, Kopp R, Hofmann M, Mayer D, Berli M, Böni T, Frueh FS, Besmens I, Calcagni M, Kockaert M. [Leg ulcers (ulcus cruris): The frequent macrovascular causes]. Ther Umsch 2019; 75:506-514. [PMID: 31038048 DOI: 10.1024/0040-5930/a001032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Leg ulcers (ulcus cruris): The frequent macrovascular causes Abstract. Four pathologies make up the macrovascular etiologies of leg uclers: Venous leg ulcers (50 %), mixed venous-arterial leg ulcers (20 %), arterial leg ulcers (5 %), and Martorell hypertensive ischemic leg ulcer (5 %). The remaining 20 % concern a large array of other etiologies. Every leg ulcer requires vascular (arterial and venous) work-up, that can be completed with microbiology, biopsy, and more in-depth internal diagnostics, as indicated. Venous leg ulcers are treated with compression therapy. Incompetent saphenous veins and tributaries are abolished if the deep venous system is patent. Occluded iliac veins are recanalised and stented, as possible. Refractory venous leg ulcers are grafted with split skin or punch grafts, depending on their surface. Extensive dermatolipofasciosclerosis may be tangentially removed by shave therapy or fasciectomy, that can be combined with negative pressure wound treatment (NPWT). Skin equivalents are an alternative to treat superficial venous leg ulcers that fail to epithelialise. Their indication in the treatment of more complex leg ulcers still needs to be better investigated and understood. The use of dermal matrices leads to more stable scars. Mixed venous-arterial leg ulcers heal slower and recur more frequently. Compression needs to be reduced. Refractory cases require arterial revascularisation, to transform the mixed venous-arterial into a venous leg ulcer. Arterial leg ulcers require arterial revascularization and split skin graft. Martorell hypertensive ischemic leg ulcer is still underrecognised and often confounded with with pyoderma gangrenosum, which leads therapy into a wrong direction. Necrosectomy, antibiotic treatment in the presence of relevant bacterial superinfection, and repeated split skin grafts eventually heal the vast majority of these extremely painful and potentially mortal wounds.
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Affiliation(s)
- Jürg Hafner
- 1 Dermatologische Klinik, UniversitätsSpital Zürich
| | | | | | | | | | - Heiko Müller
- 1 Dermatologische Klinik, UniversitätsSpital Zürich
| | | | | | - Daniela Reutter
- 2 Angiologische Klinik, UniversitätsSpital Zürich.,3 Angiologie, Klinik für Innere Medizin, Spital Uster
| | - Nils Kucher
- 2 Angiologische Klinik, UniversitätsSpital Zürich
| | - Zoran Rancic
- 4 Abteilung Gefässchirurgie, Klinik für Herz- und Gefässchirurgie, UniversitätsSpital Zürich
| | - Reinhard Kopp
- 4 Abteilung Gefässchirurgie, Klinik für Herz- und Gefässchirurgie, UniversitätsSpital Zürich
| | - Michael Hofmann
- 4 Abteilung Gefässchirurgie, Klinik für Herz- und Gefässchirurgie, UniversitätsSpital Zürich
| | - Dieter Mayer
- 5 Gefässchirurgie, Département de Chirurgie, Hôpital Cantonal de Fribourg
| | - Martin Berli
- 6 Abteilung für Technische Orthopädie, Orthopädische Universitätsklinik Balgrist
| | - Thomas Böni
- 6 Abteilung für Technische Orthopädie, Orthopädische Universitätsklinik Balgrist
| | - Florian S Frueh
- 7 Klinik für Plastische Chirurgie und Handchirurgie, UniversitätsSpital Zürich
| | - Inga Besmens
- 7 Klinik für Plastische Chirurgie und Handchirurgie, UniversitätsSpital Zürich
| | - Maurizio Calcagni
- 7 Klinik für Plastische Chirurgie und Handchirurgie, UniversitätsSpital Zürich
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Gariani K, Lebowitz D, Kressmann B, von Dach E, Sendi P, Waibel F, Berli M, Huber T, Lipsky BA, Uçkay I. Oral amoxicillin-clavulanate for treating diabetic foot infections. Diabetes Obes Metab 2019; 21:1483-1486. [PMID: 30719838 DOI: 10.1111/dom.13651] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/24/2019] [Accepted: 02/04/2019] [Indexed: 12/24/2022]
Abstract
AIM To assess amoxicillin-clavulanate (AMC) for the oral therapy of diabetic foot infections (DFIs), especially for diabetic foot osteomyelitis (DFO). METHODS We performed a retrospective cohort analysis among 794 DFI episodes, including 339 DFO cases. RESULTS The median duration of antibiotic therapy after surgical debridement (including partial amputation) was 30 days (DFO, 30 days). Oral AMC was prescribed for a median of 20 days (interquartile range, 12-30 days). The median ratio of oral AMC among the entire antibiotic treatment was 0.9 (interquartile range, 0.7-1.0). After a median follow-up of 3.3 years, 178 DFIs (22%) overall recurred (DFO, 75; 22%). Overall, oral AMC led to 74% remission compared with 79% with other regimens (χ2 -test; P = 0.15). In multivariate analyses and stratified subgroup analyses, oral AMC resulted in similar clinical outcomes to other antimicrobial regimens, when used orally from the start, after an initial parenteral therapy, or when prescribed for DFO. CONCLUSIONS Oral AMC is a reasonable option when treating patients with DFIs and DFOs.
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Affiliation(s)
- Karim Gariani
- Service of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Service of Diabetology and Endocrinology, Geneva University Hospitals, Geneva, Switzerland
| | - Dan Lebowitz
- Service of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Service of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Benjamin Kressmann
- Service of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Elodie von Dach
- Service of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Parham Sendi
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Felix Waibel
- Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Martin Berli
- Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Tanja Huber
- Pharmacology, Balgrist University Hospital, Zurich, Switzerland
| | - Benjamin A Lipsky
- Service of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Department of Medicine, University of Washington, Seattle, WA
| | - Ilker Uçkay
- Service of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Infectiology, Balgrist University Hospital, Zurich, Switzerland
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Berli M, Vlachopoulos L, Leupi S, Böni T, Baltin C. Treatment of Charcot Neuroarthropathy and osteomyelitis of the same foot: a retrospective cohort study. BMC Musculoskelet Disord 2017; 18:460. [PMID: 29145857 PMCID: PMC5691862 DOI: 10.1186/s12891-017-1818-4] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 11/08/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We evaluated treatment of osteomyelitis in the foot in the presence of Charcot neuroarthropathy, a devastating condition with progressive degeneration and joint destruction. We hypothesized that there was a difference in (1) amputation rate, (2) amputation level, (3) duration of antibiotic therapy, and (4) duration of immobilization for treatment of osteomyelitis within versus outside the Charcot zone. METHODS Forty patients (43 ft) diagnosed with Charcot neuroarthropathy and osteomyelitis of the same foot were retrospectively analyzed. Some patients were successfully treated for osteomyelitis at different sites on the same foot at different times, thus 60 cases of osteomyelitis were identified in 40 treated patients. Cases were divided according to osteomyelitis localization: Group 1 had osteomyelitis outside the active Charcot region; Group 2 had osteomyelitis within the active Charcot region. RESULTS Male patients (n = 29; mean age 58.2, range 40.1 to 77.5 years) were younger than female patients (n = 11; mean age 70.4, range 51.4 to 87.5, p = 0.02 years). Amputation rate was 52% overall (26/40 patients; 26/43 ft): 63% of 30 Group 1 cases and 40% of 30 Group 2 cases (p = 0.09). Amputation level (p = 0.009), duration of antibiotic treatment (p = 0.045) and duration of immobilization (p = 0.01) differed significantly between the groups. CONCLUSIONS Osteomyelitis within the Charcot region is associated with a higher level of amputation and longer durations of antibiotic therapy and immobilization. Osteomyelitis outside and within the Charcot affected region should be considered separately. If osteomyelitis occurs outside the active Charcot region, primary amputation may be preferred to internal resection. LEVEL OF EVIDENCE Retrospective cohort chart review study.
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Affiliation(s)
- Martin Berli
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, -8008, Zurich, CH, Switzerland.
| | - Lazaros Vlachopoulos
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, -8008, Zurich, CH, Switzerland
| | - Sabra Leupi
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, -8008, Zurich, CH, Switzerland
| | - Thomas Böni
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, -8008, Zurich, CH, Switzerland
| | - Charlotte Baltin
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, -8008, Zurich, CH, Switzerland
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Mauler F, Wanivenhaus F, Böni T, Berli M. Nonsurgical Treatment of Osteomyelitis of the Hallux Sesamoids: A Case Series and Literature Review. J Foot Ankle Surg 2017; 56:666-669. [PMID: 28476396 DOI: 10.1053/j.jfas.2017.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Indexed: 02/03/2023]
Abstract
The aim of the present study was to determine the effectiveness of nonsurgical treatment for osteomyelitis of the hallucal sesamoids. Osteomyelitis of the hallucal sesamoids in young and healthy patients is rare and might originate from hematogenous spread or after a puncture wound. In diabetic patients with peripheral neuropathy, it often results from direct contiguous seeding from adjacent ulceration. The superiority of surgical versus nonsurgical therapy is still debated. In our institution, all patients presenting with osteomyelitis of the hallucal sesamoids are first treated nonsurgically but eventually usually require a surgical procedure. We reviewed 18 patients with a clinical and radiologic diagnosis of osteomyelitis of the hallucal sesamoids treated in our institution during a 13-year period (from January 2000 to December 2012). The inclusion criteria were a signal alteration on magnetic resonance imaging or bone lesions on computed tomography or conventional radiographs, combined with a deep ulcer with a positive probe-to-bone test. Nonsurgical therapy consisted of frequent wound treatment, immobilization, offloading in a cast or other orthotic device, and oral antibiotics. Of the 18 patients, 11 had diabetes, 16 had peripheral neuropathy, 11 had peripheral arterial disease, and 5 had immunosuppression. After a period of nonsurgical therapy ranging from 4 weeks to 9 months, 15 of 18 patients required surgical excision, internal resection, or amputation. In this patient population, we no longer consider nonsurgical therapy a viable option. Patients should be advised, before starting nonsurgical treatment, that the therapy will be long and demanding and very often results in a surgical procedure.
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Affiliation(s)
- Flavien Mauler
- Orthopaedic Surgeon, Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland.
| | - Florian Wanivenhaus
- Orthopaedic Surgeon, Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
| | - Thomas Böni
- Attending Surgeon, Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
| | - Martin Berli
- Attending Surgeon, Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
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Renner N, Wirth SH, Osterhoff G, Böni T, Berli M. Outcome after protected full weightbearing treatment in an orthopedic device in diabetic neuropathic arthropathy (Charcot arthropathy): a comparison of unilaterally and bilaterally affected patients. BMC Musculoskelet Disord 2016; 17:504. [PMID: 28031030 PMCID: PMC5198505 DOI: 10.1186/s12891-016-1357-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 12/05/2016] [Indexed: 12/04/2022] Open
Abstract
Background Charcot neuropathic arthropathy (CN) is a chronic, progressive, destructive, non-infectious process that most frequently affects the bone architecture of the foot in patients with sensory neuropathy. We evaluated the outcome of protected weightbearing treatment of CN in unilaterally and bilaterally affected patients and secondarily compared outcomes in protected versus unprotected weightbearing treatment. Methods Patient records and radiographs from 2002 to 2012 were retrospectively analyzed. Patients with Type 1 or Type 2 diabetes with peripheral neuropathy were included. Exclusion criteria included immunosuppressive or osteoactive medication and the presence of bone tumors. Ninety patients (101 ft), mean age 60.7 ± 10.6 years at first diagnosis of CN, were identified. Protected weightbearing treatment was achieved by total contact cast or custom-made orthosis. Ulcer, infection, CN recurrence, and amputation rates were recorded. Mean follow-up was 48 (range 1–208) months. Results Per the Eichenholtz classification, 9 ft were prodromal, 61 in stage 1 (development), 21 in stage 2 (coalescence) and 10 in stage 3 (reconstruction). Duration of protected weightbearing was 20 ± 21 weeks and 22 ± 29 weeks in patients with unilateral and bilateral CN, respectively. In bilaterally affected patients, new ulcers developed in 9/22 (41%) feet. In unilaterally affected patients, new ulcers developed in 5/66 (8%) protected weightbearing feet and 4/13 (31%) unprotected, full weightbearing feet (p = 0.036). The ulceration rate was significantly higher in bilaterally versus unilaterally affected patients with a protected weightbearing regimen (p = 0.004). Soft tissue infection occurred in 1/13 (8%) unprotected weightbearing feet and 1/66 (2%) protected weightbearing feet in unilaterally affected patients, and in 1/22 (4%) protected weightbearing feet of bilaterally affected patients. Recurrence and amputation rates were similar across treatment modalities. Conclusions Bilateral CN results in significantly more ulcers than unilateral CN and leads to slightly higher soft tissue infections. Protected weightbearing in an orthopedic device can reduce the risk for complications in acute CN of the foot and ankle.
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Affiliation(s)
- Niklas Renner
- Orthopädische Klinik Luzern AG, Hirslanden Klinik St.Anna, Luzern, Switzerland.
| | - Stephan Hermann Wirth
- Department of Orthopedics, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Georg Osterhoff
- Department of Trauma Surgery, University Hospital of Zürich, Zürich, Switzerland
| | - Thomas Böni
- Department of Orthopedics, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Martin Berli
- Department of Orthopedics, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
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Hingsammer AM, Bauer D, Renner N, Borbas P, Boeni T, Berli M. Correlation of Systemic Inflammatory Markers With Radiographic Stages of Charcot Osteoarthropathy. Foot Ankle Int 2016; 37:924-8. [PMID: 27162224 DOI: 10.1177/1071100716649173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Charcot osteoarthropathy (COA) is characterized by a progressive destruction of bone and joint associated with neuropathy and is most common in the foot and ankle. Clinical manifestation of COA is frequently indistinguishable from other causes of pain, swelling, and erythema of the affected extremity, in particular, infection. Diagnosis of COA can be challenging in particular in early stages where radiographic changes are sparse. The presence of elevated systemic inflammatory parameters in the context of suspected infection may delay early diagnosis and treatment of COA. The aim of this retrospective analysis was to assess whether elevated systemic inflammatory parameters may be present, in particular in early stages of COA and thus not be used as an exclusion criterion for the diagnosis of COA. METHODS Forty-two patients (mean age 48.2 ± 9.4 years, 36 male, 6 female) with a diagnosis of unilateral COA were the subject of this retrospective study. The diagnosis of COA was confirmed by plain radiographs, magnetic resonance imaging and clinical course. Systemic inflammatory parameters were recorded at the time of referral. Acute stages (stages 0 and 1) were treated with a total contact cast (TCC) and protected weight bearing for a minimum of 6 weeks. For chronic stages (stages 2 and 3) custom-made shoes were prescribed. The feet were stratified into "acute" (Eichenholz stages 0 and 1) and "subacute/chronic" (Eichenholz stages 2 and 3) groups. RESULTS Statistically significant differences were observed for all recorded systemic inflammatory parameters (C-reactive protein level, WBC count, erythrocyte sedimentation rate) between the acute and subacute/chronic groups. No statistical difference was observed considering the anatomic pattern of involvement. CONCLUSION The present study demonstrated that elevated systemic inflammatory parameters may be present in COA and can further be used to distinguish between acute and subacute stages of COA, based on the Eichenholtz classification. Thus, we suggest that elevated inflammatory markers should not be considered an exclusion criterion for the diagnosis of COA. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- Andreas M Hingsammer
- Balgrist University Hospital Zurich, University of Zurich, Forchstrasse, Zurich, Switzerland
| | - David Bauer
- Balgrist University Hospital Zurich, University of Zurich, Forchstrasse, Zurich, Switzerland
| | - Niklas Renner
- Balgrist University Hospital Zurich, University of Zurich, Forchstrasse, Zurich, Switzerland
| | - Paul Borbas
- Balgrist University Hospital Zurich, University of Zurich, Forchstrasse, Zurich, Switzerland
| | - Thomas Boeni
- Balgrist University Hospital Zurich, University of Zurich, Forchstrasse, Zurich, Switzerland
| | - Martin Berli
- Balgrist University Hospital Zurich, University of Zurich, Forchstrasse, Zurich, Switzerland
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Sprengel K, Simmen H, Werner CM, Jensen KO, Keller C, Wirth SH, Berli M, Mica L. Analysis of fluid resuscitation in critically injured patients—A central role of saline solutions. J Acute Med 2016. [DOI: 10.1016/j.jacme.2016.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
BACKGROUND Charcot neuropathic osteoarthropathy (CN) is a chronic, progressive-destructive process affecting the feet of patients with sensory neuropathy. Data on CN recurrence are underrepresented in the literature. The aim of the present study was to evaluate the rate of CN recurrence after its treatment and to find predisposing factors. METHODS Fifty-two patients (age 59 ± 11 years, 16 female) with acute CN with 57 affected feet were enrolled. Comorbidities, localization, and stage of disease at first diagnosis as well as ulcerations, need for surgery, noncompliance, and subsequent treatment (orthopedic footwear or orthotic treatment) during the course of therapy were recorded. During follow-up, the incidence of recurrence of CN was observed. Mean follow-up was 47 ± 40 months. RESULTS Diabetes was the most common reason for sensory neuropathy (79%). Recurrence of CN was seen in 13 feet (23%) with an interval of 27 ± 31 months (range, 3-102 months) after the end of initial immobilization. Patients with recurrence were immobilized for a shorter period of time and had a more advanced stage of CN at time of first diagnosis. Predictors of recurrence were noncompliance (odds ratio 19.7; confidence interval, 4.1-94.4; P < .001) and obesity (odds ratio 6.4; confidence interval, 1.6-25.9; P = .06). CONCLUSIONS Recurrence of osteoarthropathic activity is a possible complication after conservative treatment of CN. Obesity and noncompliance are strong predictors for the recurrence of CN. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Georg Osterhoff
- Department of Orthopedics, University of Zurich, Balgrist, Zurich, Switzerland
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Abstract
BACKGROUND Patients with a personal or familial history of thromboembolism are considered at higher risk for thromboembolic disease after knee arthroplasty. While it remains unclear why some patients develop deep vein thrombosis (DVT) or pulmonary embolism (PE) despite similar operative procedures and the same prophylactic regimen, we presume one explanation would be genetic predisposition. QUESTIONS/PURPOSES We determined the frequency of 12 factors including antithrombin III activity, prothrombin gene mutations, and the presence of phospholipid antibodies in a high-risk patient cohort and compared those findings with the known prevalence in the population at large. PATIENTS AND METHODS Patients identified preoperatively as having a personal or familial history of DVT and/or PE were referred for hemostatic serum and genetic tests, including % antithrombin III activity (ATIII), protein C and protein S activities, APC resistance, Factor V gene (Leiden) mutations, prothrombin gene mutations, lupus anticoagulant antibody presence, cardiolipin antibody presence, phosphatidyl antibody presence, β2-glycoprotein antibody presence, and serum homocysteine and lipoprotein(a) levels The frequencies of varying abnormalities were identified and compared to the prevalence reported in the literature. RESULTS Forty-three of 1944 patients undergoing knee arthroplasty had a history of DVT or PE. Sixteen of 43 (37%) patients had an abnormality and eight of these (19%) had two or more abnormalities. The frequency of nine of the 12 tests appeared to be greater in this cohort than in the population at large. CONCLUSIONS Patients with a personal or familial history of DVT or PE appear to have a high frequency of hereditary prothrombotic abnormalities. Preoperative evaluation by a hematologist may be warranted in patients with a personal or familial history of DVT or PE as the postoperative anticoagulation protocols may be altered and identification of these abnormalities may affect a patient's risk for other disease states. LEVEL OF EVIDENCE Level IV, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hany Bedair
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA USA ,Massachusetts General Hospital, Boston, MA USA ,Center for Joint Reconstruction, 2014 Washington Street, Newton, MA 02462 USA
| | - Martin Berli
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL USA
| | - Sefer Gezer
- Department of Hematology, Rush University Medical Center, Chicago, IL USA
| | - Joshua J. Jacobs
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL USA
| | - Craig J. Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL USA
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van Aaken J, Kämpfen S, Berli M, Fritschy D, Della Santa D, Fusetti C. Outcome of boxer's fractures treated by a soft wrap and buddy taping: a prospective study. Hand (N Y) 2007; 2:212-7. [PMID: 18780055 PMCID: PMC2527222 DOI: 10.1007/s11552-007-9054-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [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: 01/24/2007] [Accepted: 05/21/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The ideal treatment for a boxer's fracture remains controversial, particularly the degree of volar dislocation considered acceptable for nonoperative treatment. PATIENTS AND METHODS From December 2003 to December 2004, 25 patients who sustained a subcapital metacarpal fracture of the little finger with volar angulation between 30 to 75 degrees were prospectively enrolled in the study. All patients were treated with a circular self-adherent wrap covering metacarpal bones II-V and buddy taping of the ring and little fingers for a period of 3 weeks while allowing immediate free range of motion. RESULTS Final evaluation at a mean of 5 months revealed all patients to be satisfied without subjective functional impairment. All fractures healed, and the angulation of the fracture remained unchanged, but moderate shortening was observed. Active flexion of the metacarpophalangeal (MCP) joint was significantly lower on the fracture side, but as the median degree of MCP flexion was the same, this statistical difference was without clinical relevance. There was no loss in grip strength. A subjective long-term evaluation was performed by phone; at a median of 3 years, a QuickDash score gave a median of 0 point. CONCLUSION Treating a boxer's fracture with angulation of up to 75 degrees by soft wrap and buddy taping resulted in satisfied patients and good clinical results.
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Affiliation(s)
- Jan van Aaken
- Unité de chirurgie de la main, Hôpital Universitaire de Genève (HUG), 24 rue Micheli-du-Crest, 1211, Geneva 14, Switzerland.
| | - Stephan Kämpfen
- Unité de chirurgie de la main, Hôpital Universitaire de Genève (HUG), 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland
| | - Martin Berli
- Policlinique des services de chirurgie, Hôpital Universitaire de Genève (HUG), 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland
| | - Daniel Fritschy
- Policlinique des services de chirurgie, Hôpital Universitaire de Genève (HUG), 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland
| | - Dominique Della Santa
- Unité de chirurgie de la main, Hôpital Universitaire de Genève (HUG), 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland
| | - Cesare Fusetti
- Chirurgia della mano, Ospedale San Giovanni, 6500 Bellinzona, Switzerland
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Berli M. [Establishing standards in nursing of cancer patients]. Fag Tidsskr Sykepleien 1990; 78:32-4. [PMID: 2252830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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