1
|
Weenders SGM, Merfort R, Eschweiler J, Hildebrand F, Gruner A, Heller KD. Ten-year follow-up and clinical outcome of a metaphyseal anchoring short hip stem prosthesis: a retrospective single-centre analysis. Int Orthop 2024; 48:419-426. [PMID: 37672119 DOI: 10.1007/s00264-023-05958-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 08/24/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE Short stems for total hip arthroplasty are an alternative to traditional conventional long stems. Short stems are designed to facilitate minimal-invasive surgery, improve bone-stock preservation, and mimic a physiological load distribution. However, there is little evidence of the long-term outcome of short stems. This study aims to analyze the ten year survival rates and clinical outcome of one specific metaphyseal short hip stem implant. METHODS We retrospectively analyzed the patient records of the patients who underwent a total hip arthroplasty with a monoblock partial collum sparing metaphyseal short hip stem prosthesis in 2008 and 2009 in our clinic. Patients were contacted, and clinical follow-up was recorded using the German version of the modified Harris Hip Score. Furthermore, complications, revision surgery, and post-operative radiographs were analyzed. RESULTS Data from 339 primary implantations in 322 patients were retrieved. The mean follow-up was 10.6 years. Seven patients underwent a revision. The ten year survival rate with any revision surgery as the endpoint was 97.5%. The mean modified Harris Hip Score was 86 points (range 30 to 91 points). Five patients had an intraoperative fracture of the femur (1.6%). Two patients (0.6%) had a dislocation of the hip. The stem tip-to-cortex distance, measured in the anterior posterior view, was 2.6 mm (range 0 to 8.3 mm). CONCLUSION The ten year survival rate of our used monoblock partial collum sparing metaphyseal short hip stem implant is comparable to traditional stems for total hip arthroplasty.
Collapse
Affiliation(s)
- S G M Weenders
- Clinic for Orthopaedic Surgery, Herzogin Elisabeth Hospital, Leipzigerstraße 24, 38124, Braunschweig, Germany.
| | - R Merfort
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - J Eschweiler
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - F Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - A Gruner
- Clinic for Orthopaedic Surgery, Herzogin Elisabeth Hospital, Leipzigerstraße 24, 38124, Braunschweig, Germany
| | - K D Heller
- Clinic for Orthopaedic Surgery, Herzogin Elisabeth Hospital, Leipzigerstraße 24, 38124, Braunschweig, Germany
| |
Collapse
|
2
|
Sellei RM, Beckers A, Kobbe P, Weltzien A, Weber CD, Spies CK, Reinhardt N, de la Fuente M, Radermacher K, Hildebrand F. Non-invasive assessment of muscle compartment elasticity by pressure-related ultrasound in pediatric trauma: a prospective clinical study in 25 cases of forearm shaft fractures. Eur J Med Res 2023; 28:296. [PMID: 37626380 PMCID: PMC10463760 DOI: 10.1186/s40001-023-01232-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/15/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Soft-tissue swelling after limb fractures in pediatric patients is well known to be a risk factor for developing acute compartment syndrome (ACS). Clinical assessment alone is uncertain in specific cases. Recently, we proposed a non-invasive ultrasound-based method to objectify muscle compartment elasticity for monitoring. We hypothesize a strong correlation between the soft-tissue swelling after stabilization of upper limb fractures and the compartment elasticity objectified with a novel ultrasound-based approach in pediatric trauma. PATIENTS AND METHODS In a prospective clinical study, children suffering forearm fractures but not developing an ACS were included. The muscle compartment elasticity of the m. flexor carpi ulnaris was assessed after surgical intervention by a non-invasive, ultrasound-based method resulting in a relative elasticity (RE in %) in both the control (healthy limb) and study group (fractured limb). Soft-tissue swelling was categorized in four different levels (0-3) and correlated with the resulting RE (%). RESULTS The RE in the study group (15.67%, SD ± 3.06) showed a significantly decreased level (p < 0.001) compared with the control (22.77%, SD ± 5.4). The categorized grade of soft-tissue swelling resulted in a moderate correlation with the RE (rs = 0.474). CONCLUSIONS The presented study appears to represent a novel approach to assess the posttraumatic pressure changes in a muscle compartment after fracture stabilization non-invasively. In this first clinical study in pediatric cases, our measurement method represents a low-cost, easy, and secure approach that has the potential to substitute invasive measurement of suspected ACS in muscle compartment conditions. Further investigations in lager cohorts are required to prove its daily clinical practicability and to confirm the expected reliability.
Collapse
Affiliation(s)
- R M Sellei
- Department of Orthopaedic Trauma, Sana Klinikum Offenbach, Offenbach am Main, Germany.
- Department of Orthopaedic Trauma and Reconstructive Surgery, University of Aachen Medical Center, Aachen, Germany.
| | - A Beckers
- Department of Orthopaedic Trauma, Sana Klinikum Offenbach, Offenbach am Main, Germany
- Department of Pediatric Surgery, Varisano Klinikum Hoechst, Frankfurt am Main, Germany
| | - P Kobbe
- Department of Orthopaedic Trauma and Reconstructive Surgery, University of Aachen Medical Center, Aachen, Germany
| | - A Weltzien
- Department of Pediatric Surgery, Varisano Klinikum Hoechst, Frankfurt am Main, Germany
| | - C D Weber
- Department of Orthopaedic Trauma and Reconstructive Surgery, University of Aachen Medical Center, Aachen, Germany
| | - C K Spies
- Hand Surgery, Hospital Langenthal, Langenthal, Switzerland
| | - N Reinhardt
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - M de la Fuente
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - K Radermacher
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - F Hildebrand
- Department of Orthopaedic Trauma and Reconstructive Surgery, University of Aachen Medical Center, Aachen, Germany
| |
Collapse
|
3
|
Baroncini A, Migliorini F, Eschweiler J, Hildebrand F, Trobisch P. The timing of tether breakage influences clinical results after VBT. Eur Spine J 2022; 31:2362-2367. [PMID: 35864248 DOI: 10.1007/s00586-022-07321-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/01/2022] [Accepted: 07/06/2022] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Tether breakage is a frequent mechanical complications after vertebral body tethering (VBT), but not all patients with a breakage show loss of correction. The reason of this clinical finding has not yet been clarified. We hypothesized that the integrity of the tether is relevant only in the early stages after VBT, when it drives growth modulation and tissue remodelling. After these mechanisms have taken place, the tether loses its function and a breakage will not alter the new shape of the spine. Thus, tether breakage would have a greater clinical relevance when occurring shortly after surgery. METHODS All consecutive patients who underwent VBT and had a min. 2-year follow-up were included. The difference in curve magnitude between the 1st standing x-ray and the last follow-up was calculated (ΔCobb). For each curve, the presence and timing of tether breakage were recorded. The curves were grouped according to if and when the breakage was observed (no breakage, breakage at 0-6 months, 6-12 months, > 12 months). The ΔCobb was compared among these groups with the analysis of variance (ANOVA). RESULTS Data from 152 curves were available: 68 with no breakage, 12 with a breakage at 0-6 months, 37 at 6-12 months and 35 > 12 months. The ANOVA found significant difference in the ΔCobb among the groups (Sum of square 2553.59; degree of freedom 3; mean of square 851.1; Fisher test 13.8; P < 0.0001). Patients with no breakage or breakage at > 12 months had similar ΔCobb (mean 4.8° and 7.8°, respectively, P = 0.3), smaller than the 0-6 or 6-12 groups (15.8° and 13.8°, respectively). CONCLUSION Tether breakage leads to a consistent loss of correction when occurring within the first 12 months, while it has limited clinical relevance when occurring later on.
Collapse
Affiliation(s)
- A Baroncini
- Department of Orthopaedic Surgery, RWTH Aachen University Clinic, Pauwelsstrasse 30, 52074, Aachen, Germany.
- Department of Spine Surgery, Eifelklinik St. Brigida, Simmerath, Germany.
| | - F Migliorini
- Department of Orthopaedic Surgery, RWTH Aachen University Clinic, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - J Eschweiler
- Department of Orthopaedic Surgery, RWTH Aachen University Clinic, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - F Hildebrand
- Department of Orthopaedic Surgery, RWTH Aachen University Clinic, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - P Trobisch
- Department of Spine Surgery, Eifelklinik St. Brigida, Simmerath, Germany
| |
Collapse
|
4
|
Pishnamaz M, Quack V, Herren C, Hildebrand F, Kobbe P. [Treatment strategies for pathological fractures of the spine]. Unfallchirurg 2021; 124:720-730. [PMID: 34342665 DOI: 10.1007/s00113-021-01052-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pathological fractures and instabilities of the spine are most often caused by primary tumors that hematogenously metastasize into the spine. In this context breast, prostate, kidney cell and bronchial carcinomas are the most relevant causative diseases. Furthermore, multiple myeloma is another frequent entity. Primary tumors of the spine are correspondingly rare and only make up a small proportion of all malignant processes in the spine. DECISION MAKING The main symptom of pain is prognostically unfavorable in this context and is often associated with progressive instability or pathological fractures. To objectify the treatment approach the neurological status, an oncological assessment, the biomechanical stability and (systemic) general condition (NOMS criteria) of the patient have to be considered. Another major factor is the radiation sensitivity of the tumor. The spinal instability neoplastic (SIN) score is recommended to assess stability. Regardless of whether conservative or surgical treatment is carried out, interdisciplinary cooperation between the specialist departments must be guaranteed in order to achieve adequate treatment for the patient. TREATMENT If a curative approach is followed an individualized and interdisciplinary surgical strategy must be performed to achieve an R0 resection, usually as a spondylectomy. In the case of palliative treatment, the goal of surgical treatment must be pain reduction, stability and avoidance or restoration of neurological deficits. This requires stabilization in a percutaneous or open technique, possibly in combination with decompression and local tumor debulking.
Collapse
Affiliation(s)
- M Pishnamaz
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - V Quack
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - C Herren
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - F Hildebrand
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - P Kobbe
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| |
Collapse
|
5
|
Sellei RM, Warkotsch U, Kobbe P, Weber CD, Reinhardt N, de la Fuente M, Radermacher K, Hildebrand F. Non-invasive and reliable assessment of compartment elasticity by pressure related ultrasound: An in-vitro study. Injury 2021; 52:724-730. [PMID: 33902865 DOI: 10.1016/j.injury.2020.10.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/26/2020] [Accepted: 10/15/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The development of acute compartment syndrome is a serious threat to trauma patients. The clinical assessment alone is not reliable enough to determine the need for fasciotomy in many cases. The Physician´s assessment of the elasticity of the muscle compartment might be particularly important to objectively evaluate the pressure in this enclosed space. The purpose of this study was to determine the observer´s reproducibility, of compartment elasticity measurements by a novel ultrasonic approach. METHODS Increasing intra-compartmental pressures (ICP) were simulated in a water filled in-vitro model. Pressure related ultrasound was used to determine the relative elasticity (RE) of soft tissue compartments. A pressure transducing probe head was combined with the ultrasonic probe to obtain cross section views of the simulated compartment and to detect the amount of applied pressure by the observer. In this model, the compartment depth without compression (P0) was set to be 100%. Changes of the compartment depth due to a probe pressure of 80 mmHg (P80) were correlated to P0 and an elasticity quotient as a value for RE (%) was calculated. Twelve blinded observers performed measurements for RE determination (%) under three pressure conditions. Reproducibility was calculated using intraclass correlation coefficient (ICC). RESULTS Measurements (n = 432) revealed that the RE (%) in the control group was 17,06% (SD+/-2,13), whereas the RE of the group ICP30 significantly decreased to 12,66% (SD+/- 1,19) (p<0,001). The ICP50 group revealed a further significant decrease to 8,43% (SD+/- 0,67) (p<0,001). Repeated measurement of RE and ICP showed a high level of correlation (spearman correlation coefficient: roh=0,922). A RE <14% resulted in a sensitivity of 96% and a specificity of 90,3% for diagnosis of an ICP >30 mmHg. ICCinter was 0,986; 95%, CI: 0,977-0,992 (p<0,001). DISCUSSION The presented ultrasound-based approach reliably assesses the elasticity in a simulated compartment model. In this pioneer study investigating the inter- and intra-observer reproducibility, this method of measurement appears to be of low cost in addition to being an easy and secure approach that may have the potential to substitute invasive measurement. Further investigations are required to improve its feasibility and to confirm the reliability under clinical conditions.
Collapse
Affiliation(s)
- R M Sellei
- Department of Orthopaedic Trauma, Sana Hospital Offenbach, Offenbach am Main, Germany; Department of Orthopaedic Trauma and Reconstructive Surgery, University of Aachen Medical Center, Aachen, Germany.
| | - U Warkotsch
- Department of Vascular Surgery, Sana Hospital Offenbach, Offenbach am Main, Germany
| | - P Kobbe
- Department of Orthopaedic Trauma and Reconstructive Surgery, University of Aachen Medical Center, Aachen, Germany
| | - C D Weber
- Department of Orthopaedic Trauma and Reconstructive Surgery, University of Aachen Medical Center, Aachen, Germany
| | - N Reinhardt
- Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - M de la Fuente
- Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - K Radermacher
- Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - F Hildebrand
- Department of Orthopaedic Trauma and Reconstructive Surgery, University of Aachen Medical Center, Aachen, Germany
| |
Collapse
|
6
|
Kaczmarek C, Andruszkow H, Herren C, Pishnamaz M, Hildebrand F, Röhl A, Lichte P. [Medical ID and emergency apps: A useful tool in emergency situations or a waste of time?]. Med Klin Intensivmed Notfmed 2020; 116:339-344. [PMID: 32270256 PMCID: PMC8102457 DOI: 10.1007/s00063-020-00675-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/23/2019] [Accepted: 12/22/2019] [Indexed: 11/26/2022]
Abstract
Hintergrund Um in Notfallsituationen eine effektive Versorgung des Patienten zu gewährleisten, sind Informationen über Vorerkrankungen und bisherige Medikamenteneinnahme essenziell. Daher haben Smartphonehersteller entsprechende Anwendungssoftware (App) entwickelt, auf die im Notfall zugegriffen werden kann, um jene Informationen zu erhalten. Ziel der Studie war es herauszufinden, ob Notfall-Apps von Smartphoneinhabern aktiv genutzt werden und ob diese in Notfallsituationen von den behandelnden Notärzten eingesehen werden. Methode Zur Datenerhebung wurde eine anonymisierte Umfrage über das Nutzungsverhalten der Notfall-Apps bei verunfallten Patienten der unfallchirurgischen Ambulanz eines universitären Maximalversorgers über einen Zeitraum von 3 Monaten durchgeführt. Parallel fand eine Befragung von Notärzten verschiedener Standorte zu ihren beruflichen Erfahrungen mit den Apps statt. Ergebnisse Insgesamt wurden 192 Patienten und 103 Notärzte befragt. Die Notfall-Apps waren 45 % (n = 79) der Befragten nicht bekannt; nur bei 10 % (n = 19) der Befragten war die App mit Daten hinterlegt. Weiterhin zeigte sich, dass insgesamt 21 % (n = 41) der Personen einen Notizzettel mit Vorerkrankungen und Medikamenten bei sich trugen. Von den Befragten Ärzten gaben 42 % (n = 44) an, schon einmal von der App gehört zu haben; nur 6 % (n = 5) durchsuchten jedoch routinemäßig bei nichtansprechbaren Patienten das Smartphone. Erfolgreich genutzt wurde die App bisher nur von 14 % der Ärzte (n = 14). Schlussfolgerung Aufgrund der geringen Bekanntheit erscheint es in zeitkritischen Situationen nicht empfehlenswert, das Smartphone der Patienten nach Notfall-Apps zu durchsuchen. Bei Patienten über 55 ist es zurzeit erfolgsversprechender, die Brieftasche nach Informationen zu Vorerkrankungen zu kontrollieren.
Collapse
Affiliation(s)
- C Kaczmarek
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
- St. Elisabeth-Krankenhaus Geilenkirchen, Geilenkirchen, Deutschland.
| | - H Andruszkow
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - C Herren
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - M Pishnamaz
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - F Hildebrand
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - A Röhl
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - P Lichte
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| |
Collapse
|
7
|
Wally N, Schneider M, Thannesberger J, Kastner MT, Bakonyi T, Indik S, Rattei T, Bedarf J, Hildebrand F, Law J, Jovel J, Steininger C. Plasmid DNA contaminant in molecular reagents. Sci Rep 2019; 9:1652. [PMID: 30733546 PMCID: PMC6367390 DOI: 10.1038/s41598-019-38733-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 12/19/2018] [Indexed: 02/06/2023] Open
Abstract
Background noise in metagenomic studies is often of high importance and its removal requires extensive post-analytic, bioinformatics filtering. This is relevant as significant signals may be lost due to a low signal-to-noise ratio. The presence of plasmid residues, that are frequently present in reagents as contaminants, has not been investigated so far, but may pose a substantial bias. Here we show that plasmid sequences from different sources are omnipresent in molecular biology reagents. Using a metagenomic approach, we identified the presence of the (pol) of equine infectious anemia virus in human samples and traced it back to the expression plasmid used for generation of a commercial reverse transcriptase. We found fragments of multiple other expression plasmids in human samples as well as commercial polymerase preparations. Plasmid contamination sources included production chain of molecular biology reagents as well as contamination of reagents from environment or human handling of samples and reagents. Retrospective analyses of published metagenomic studies revealed an inaccurate signal-to-noise differentiation. Hence, the plasmid sequences that seem to be omnipresent in molecular biology reagents may misguide conclusions derived from genomic/metagenomics datasets and thus also clinical interpretations. Critical appraisal of metagenomic data sets for the possibility of plasmid background noise is required to identify reliable and significant signals.
Collapse
Affiliation(s)
- N Wally
- Division of Infectious Diseases, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - M Schneider
- Division of Infectious Diseases, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - J Thannesberger
- Division of Infectious Diseases, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - M T Kastner
- Division of Infectious Diseases, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - T Bakonyi
- University of Veterinary Medicine, Department of Virology, Vienna, Austria
| | - S Indik
- University of Veterinary Medicine, Department of Virology, Vienna, Austria
| | - T Rattei
- CUBE-Division of Computational Systems Biology, Department of Microbiology and Ecosystem Science, University of Vienna, Vienna, Austria
| | - J Bedarf
- German Centre for neurodegenerative disease research (DZNE), Department of Neurology, University of Bonn, Bonn, Germany
| | - F Hildebrand
- European Molecular Biology Laboratory, EMBL, Heidelberg, Germany
| | - J Law
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - J Jovel
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - C Steininger
- Division of Infectious Diseases, Department of Medicine 1, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
8
|
Eschbach D, Horst K, Sassen M, Andruszkow J, Mohr J, Debus F, Vogt N, Steinfeldt T, Hildebrand F, Schöller K, Uhl E, Wulf H, Ruchholtz S, Pape H, Frink M. Hypothermia does not influence liver damage and function in a porcine polytrauma model. Technol Health Care 2018; 26:209-221. [PMID: 28968251 DOI: 10.3233/thc-171043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previous studies revealed evidence that induced hypothermia attenuates ischemic organ injuries after severe trauma. In the present study, the effect of hypothermia on liver damage was investigated in a porcine long term model of multi-system injury, consisting of blunt chest trauma, penetrating abdominal trauma, musculoskeletal injury, and hemorrhagic shockMETHODS: In 30 pigs, a standardized polytrauma including blunt chest trauma, penetrating abdominal trauma, musculoskeletal injury, and hemorrhagic shock of 45% of total blood volume was induced. Following trauma, hypothermia of 33∘C was induced for 12 h and intensive care treatment was evaluated for 48 h. As outcome parameters, we assessed liver function and serum transaminase levels as well as a histopathological analysis of tissue samples. A further 10 animals served as controls. RESULTS Serum transaminase levels were increased at the end of the observation period following hypothermia without reaching statistical significance compared to normothermic groups. Liver function was preserved (p⩽ 0.05) after the rewarming period in hypothermic animals but showed no difference at the end of the observation period. In H&E staining, cell death was slightly increased hypothermic animals and caspase-3 staining displayed tendency towards more apoptosis in hypothermic group as well. CONCLUSIONS Induction of hypothermia could not significantly improve hepatic damage during the first 48 h following major trauma. Further studies focusing on multi-organ failure including a longer observation period are required to illuminate the impact of hypothermia on hepatic function in multiple trauma patients.
Collapse
Affiliation(s)
- D Eschbach
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - K Horst
- Trauma Department, University of Aachen, Aachen, Germany
| | - M Sassen
- Department of Anesthesiology and Critical Care, University Hospital Giessen and Marburg, Marburg, Germany
| | - J Andruszkow
- Institute of Pathology, University of Aachen, Aachen, Germany
| | - J Mohr
- Department of Trauma Surgery, University of Magdeburg, Magdeburg, Germany
| | - F Debus
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - N Vogt
- Department of Neurosurgery, University Hospital Giessen and Marburg, Giessen, Germany
| | - T Steinfeldt
- Department of Anesthesiology and Critical Care, Diakonie-Klinikum Schwäbisch Hall, Germany
| | - F Hildebrand
- Trauma Department, University of Aachen, Aachen, Germany
| | - K Schöller
- Department of Neurosurgery, University Hospital Giessen and Marburg, Giessen, Germany
| | - E Uhl
- Department of Neurosurgery, University Hospital Giessen and Marburg, Giessen, Germany
| | - H Wulf
- Department of Anesthesiology and Critical Care, University Hospital Giessen and Marburg, Marburg, Germany
| | - S Ruchholtz
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - H Pape
- Department of Trauma, University of Zurich, Zurich, Switzerland
| | - M Frink
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| |
Collapse
|
9
|
Jones JC, Fruciano C, Marchant J, Hildebrand F, Forslund S, Bork P, Engel P, Hughes WOH. The gut microbiome is associated with behavioural task in honey bees. Insectes Soc 2018; 65:419-429. [PMID: 30100619 PMCID: PMC6061168 DOI: 10.1007/s00040-018-0624-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 05/06/2018] [Accepted: 05/08/2018] [Indexed: 05/25/2023]
Abstract
The gut microbiome is recognised as playing an integral role in the health and ecology of a wide variety of animal taxa. However, the relationship between social behavioural traits and the microbial community has received little attention. Honey bees are highly social and the workers perform different behavioural tasks in the colony that cause them to be exposed to different local environments. Here we examined whether the gut microbial community composition of worker honey bees is associated with the behavioural tasks they perform, and therefore also the local environment they are exposed to. We set up five observation hives, in which all workers were matched in age and observed the behaviour of marked bees in each colony over 4 days. The gut bacterial communities of bees seen performing predominantly foraging or predominantly in nest tasks were then characterised and compared based on amplicon sequencing of the 16S rRNA gene. Our results show that some core members of the unique honey bee gut bacterial community are represented in different relative abundances in bees performing different behavioural tasks. The differentially represented bacterial taxa include some thought to be important in carbohydrate metabolism and transport, and also linked to bee health. The results suggest an influence of task-related local environment exposure and diet on the honey bee gut microbial community and identify focal core taxa for further functional analyses.
Collapse
Affiliation(s)
- J. C. Jones
- School of Life Sciences, University of Sussex, Falmer, Brighton, BN1 9QG UK
- Present Address: Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - C. Fruciano
- School of Earth, Environment and Biological Sciences, Queensland University of Technology, Gardens Point, Brisbane, 4000 Australia
- Institut de biologie de l’Ecole normale supérieure (IBENS), Ecole normale supérieure, CNRS, INSERM, PSL Université Paris, 75005 Paris, France
| | - J. Marchant
- School of Life Sciences, University of Sussex, Falmer, Brighton, BN1 9QG UK
| | - F. Hildebrand
- Structural and Computational Biology Unit, European Molecular Biology Laboratory, 69117 Heidelberg, Germany
| | - S. Forslund
- Structural and Computational Biology Unit, European Molecular Biology Laboratory, 69117 Heidelberg, Germany
| | - P. Bork
- Structural and Computational Biology Unit, European Molecular Biology Laboratory, 69117 Heidelberg, Germany
- Max Delbrück Centre for Molecular Medicine, 13125 Berlin, Germany
- Department of Bioinformatics, University of Würzburg, 97074 Würzburg, Germany
| | - P. Engel
- Department of Fundamental Microbiology, University of Lausanne, 1015 Lausanne, Switzerland
| | - W. O. H. Hughes
- School of Life Sciences, University of Sussex, Falmer, Brighton, BN1 9QG UK
| |
Collapse
|
10
|
Affiliation(s)
- S Kalverkamp
- Klinik für Thorax‑, Herz- und Gefäßchirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - J Spillner
- Klinik für Thorax‑, Herz- und Gefäßchirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - P Kobbe
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - F Hildebrand
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - P Lichte
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Aachen, Deutschland
| |
Collapse
|
11
|
Kalbitz M, Schwarz S, Weber B, Bosch B, Pressmar J, Hoenes FM, Braun CK, Horst K, Simon TP, Pfeifer R, Störmann P, Hummler H, Gebhard F, Pape HC, Huber-Lang M, Hildebrand F. Cardiac Depression in Pigs after Multiple Trauma - Characterization of Posttraumatic Structural and Functional Alterations. Sci Rep 2017; 7:17861. [PMID: 29259232 PMCID: PMC5736586 DOI: 10.1038/s41598-017-18088-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 06/14/2017] [Accepted: 12/06/2017] [Indexed: 12/17/2022] Open
Abstract
The purpose of this study was to define the relationship between cardiac depression and morphological and immunological alterations in cardiac tissue after multiple trauma. However, the mechanistic basis of depressed cardiac function after trauma is still elusive. In a porcine polytrauma model including blunt chest trauma, liver laceration, femur fracture and haemorrhage serial trans-thoracic echocardiography was performed and correlated with cellular cardiac injury as well as with the occurrence of extracellular histones in serum. Postmortem analysis of heart tissue was performed 72 h after trauma. Ejection fraction and shortening fraction of the left ventricle were significantly impaired between 4 and 27 h after trauma. H-FABP, troponin I and extracellular histones were elevated early after trauma and returned to baseline after 24 and 48 h, respectively. Furthermore, increased nitrotyrosine and Il-1β generation and apoptosis were identified in cardiac tissue after trauma. Main structural findings revealed alteration of connexin 43 (Cx43) and co-translocation of Cx43 and zonula occludens 1 to the cytosol, reduction of α-actinin and increase of desmin in cardiomyocytes after trauma. The cellular and subcellular events demonstrated in this report may for the first time explain molecular mechanisms associated with cardiac dysfunction after multiple trauma.
Collapse
Affiliation(s)
- M Kalbitz
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany.
| | - S Schwarz
- Division of Neonatology and Pediatric Critical Care, University of Ulm, Ulm, Germany
| | - B Weber
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - B Bosch
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - J Pressmar
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - F M Hoenes
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - C K Braun
- Institute of Clinical and Experimental Trauma-Immunology, University of Ulm, Ulm, Germany
| | - K Horst
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - T P Simon
- Department of Intensive Care and Intermediate Care, RWTH Aachen University, Aachen, Germany
| | - R Pfeifer
- Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
| | - P Störmann
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - H Hummler
- Division of Neonatology and Pediatric Critical Care, University of Ulm, Ulm, Germany
| | - F Gebhard
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - H C Pape
- Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
| | - M Huber-Lang
- Institute of Clinical and Experimental Trauma-Immunology, University of Ulm, Ulm, Germany
| | - F Hildebrand
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | | |
Collapse
|
12
|
Bedarf JR, Hildebrand F, Coelho LP, Sunagawa S, Bahram M, Goeser F, Bork P, Wüllner U. Erratum to: Functional implications of microbial and viral gut metagenome changes in early stage L-DOPA-naïve Parkinson's disease patients. Genome Med 2017; 9:61. [PMID: 28662719 PMCID: PMC5492116 DOI: 10.1186/s13073-017-0451-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 06/16/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- J R Bedarf
- Department of Neurology, University of Bonn, Bonn, Germany.,German Centre for neurodegenerative disease research (DZNE), Bonn, Germany
| | - F Hildebrand
- European Molecular Biology Laboratory, EMBL, Heidelberg, Germany
| | - L P Coelho
- European Molecular Biology Laboratory, EMBL, Heidelberg, Germany
| | - S Sunagawa
- European Molecular Biology Laboratory, EMBL, Heidelberg, Germany.,ETH Zurich, Institute of Microbiology, Vladimir-Prelog-1-5/10, 8093, Zurich, Switzerland
| | - M Bahram
- Evolutionary Biology Centre, Uppsala University, Norbyva gen 18D, 75236, Uppsala, Sweden.,Institute of Ecology and Earth Sciences, University of Tartu, 40 Lai St., 51005, Tartu, Estonia
| | - F Goeser
- Department of Internal Medicine I, University of Bonn, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - P Bork
- European Molecular Biology Laboratory, EMBL, Heidelberg, Germany. .,Molecular Medicine Partnership Unit (MMPU), University of Heidelberg and European Molecular Biology Laboratory, Heidelberg, Germany. .,Max Delbrück Centre for Molecular Medicine, 13125, Berlin, Germany. .,Department of Bioinformatics, University of Würzburg, 97074, Würzburg, Germany. .,, Meyerhofstraße 1, 69117, Heidelberg, Germany.
| | - U Wüllner
- Department of Neurology, University of Bonn, Bonn, Germany. .,German Centre for neurodegenerative disease research (DZNE), Bonn, Germany. .,, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| |
Collapse
|
13
|
Bedarf JR, Hildebrand F, Coelho LP, Sunagawa S, Bahram M, Goeser F, Bork P, Wüllner U. Functional implications of microbial and viral gut metagenome changes in early stage L-DOPA-naïve Parkinson's disease patients. Genome Med 2017; 9:39. [PMID: 28449715 PMCID: PMC5408370 DOI: 10.1186/s13073-017-0428-y] [Citation(s) in RCA: 342] [Impact Index Per Article: 48.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 04/08/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) presently is conceptualized as a protein aggregation disease in which pathology involves both the enteric and the central nervous system, possibly spreading from one to another via the vagus nerves. As gastrointestinal dysfunction often precedes or parallels motor symptoms, the enteric system with its vast diversity of microorganisms may be involved in PD pathogenesis. Alterations in the enteric microbial taxonomic level of L-DOPA-naïve PD patients might also serve as a biomarker. METHODS We performed metagenomic shotgun analyses and compared the fecal microbiomes of 31 early stage, L-DOPA-naïve PD patients to 28 age-matched controls. RESULTS We found increased Verrucomicrobiaceae (Akkermansia muciniphila) and unclassified Firmicutes, whereas Prevotellaceae (Prevotella copri) and Erysipelotrichaceae (Eubacterium biforme) were markedly lowered in PD samples. The observed differences could reliably separate PD from control with a ROC-AUC of 0.84. Functional analyses of the metagenomes revealed differences in microbiota metabolism in PD involving the ẞ-glucuronate and tryptophan metabolism. While the abundances of prophages and plasmids did not differ between PD and controls, total virus abundance was decreased in PD participants. Based on our analyses, the intake of either a MAO inhibitor, amantadine, or a dopamine agonist (which in summary relates to 90% of PD patients) had no overall influence on taxa abundance or microbial functions. CONCLUSIONS Our data revealed differences of colonic microbiota and of microbiota metabolism between PD patients and controls at an unprecedented detail not achievable through 16S sequencing. The findings point to a yet unappreciated aspect of PD, possibly involving the intestinal barrier function and immune function in PD patients. The influence of the parkinsonian medication should be further investigated in the future in larger cohorts.
Collapse
Affiliation(s)
- J R Bedarf
- Department of Neurology, University of Bonn, Bonn, Germany.,German Centre for neurodegenerative disease research (DZNE), Bonn, Germany
| | - F Hildebrand
- European Molecular Biology Laboratory, EMBL, Heidelberg, Germany
| | - L P Coelho
- European Molecular Biology Laboratory, EMBL, Heidelberg, Germany
| | - S Sunagawa
- European Molecular Biology Laboratory, EMBL, Heidelberg, Germany.,ETH Zurich, Institute of Microbiology, Vladimir-Prelog-1-5/10, 8093, Zurich, Switzerland
| | - M Bahram
- Evolutionary Biology Centre, Uppsala University, Norbyva ̈gen 18D, 75236, Uppsala, Sweden.,Institute of Ecology and Earth Sciences, University of Tartu, 40 Lai St., 51005, Tartu, Estonia
| | - F Goeser
- Department of Internal Medicine I, University of Bonn, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - P Bork
- European Molecular Biology Laboratory, EMBL, Heidelberg, Germany. .,Molecular Medicine Partnership Unit (MMPU), University of Heidelberg and European Molecular Biology Laboratory, Heidelberg, Germany. .,Max Delbrück Centre for Molecular Medicine, 13125, Berlin, Germany. .,Department of Bioinformatics, University of Würzburg, 97074, Würzburg, Germany. .,, Meyerhofstraße 1, 69117, Heidelberg, Germany.
| | - U Wüllner
- Department of Neurology, University of Bonn, Bonn, Germany. .,German Centre for neurodegenerative disease research (DZNE), Bonn, Germany. .,, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| |
Collapse
|
14
|
Sellei RM, Andruszkow H, Weber C, Damen TO, Pape HC, Hildebrand F. [Diagnostics and treatment decisions in acute compartment syndrome. Results of a survey in German hospitals]. Unfallchirurg 2017; 119:125-32. [PMID: 25015736 DOI: 10.1007/s00113-014-2609-0] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES The presented survey was intended to evaluate whether a standardization of diagnostics and therapy for acute compartment syndrome has been achieved. MATERIALS AND METHODS University hospitals, academic teaching hospitals, and county hospitals in Germany were included. RESULTS A total of 38% (n=120) of all contacted hospitals participated in this study with questions mainly answered by consulting physicians (68%). In general the importance of the clinical examination was considered as being more important than other diagnostic measures. In cases where further diagnostics were necessary, the intramuscular pressure measurement was used most frequently. Of the participants 50% performed surgical fasciotomy based on the clinical examination in combination with the intramuscular pressure measurement; however, there were considerable differences between the participating hospitals with respect to the anatomical position of intramuscular measurements, the limiting value of the intramuscular pressure and the surgical technique for performing fasciotomy. CONCLUSION According to the presented analysis the diagnosis and indications for surgical treatment in patients developing an acute compartment syndrome do not seem to be sufficiently clarified. The establishment of unified treatment guidelines could help to reduce the number of delayed diagnoses of compartment syndrome.
Collapse
Affiliation(s)
- R M Sellei
- Klinik für Unfallchirurgie und Orthopädische Chirurgie, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Deutschland. .,Klinik für Unfall- und Wiederherstellungschirurgie , Universitätsklinikum Aachen, Aachen, Deutschland.
| | - H Andruszkow
- Klinik für Unfall- und Wiederherstellungschirurgie , Universitätsklinikum Aachen, Aachen, Deutschland
| | - C Weber
- Klinik für Unfall- und Wiederherstellungschirurgie , Universitätsklinikum Aachen, Aachen, Deutschland
| | - T O Damen
- Klinik für Unfall- und Wiederherstellungschirurgie , Universitätsklinikum Aachen, Aachen, Deutschland
| | - H-C Pape
- Klinik für Unfall- und Wiederherstellungschirurgie , Universitätsklinikum Aachen, Aachen, Deutschland
| | - F Hildebrand
- Klinik für Unfall- und Wiederherstellungschirurgie , Universitätsklinikum Aachen, Aachen, Deutschland
| |
Collapse
|
15
|
Almahmoud K, Pfeifer R, Al-Kofahi K, Hmedat A, Hyderabad W, Hildebrand F, Peitzman AB, Pape HC. Impact of pelvic fractures on the early clinical outcomes of severely injured trauma patients. Eur J Trauma Emerg Surg 2017; 44:155-162. [PMID: 28091737 DOI: 10.1007/s00068-016-0754-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 12/23/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pelvic fractures contribute to morbidity and mortality following injury. We sought to study the impact of pelvic fractures on the clinical course and outcomes of trauma patients with a pelvic fracture in comparison to patients with similar injury severity without pelvic fracture to identify potential parameters to track patients' clinical course post-injury. METHODS A cohort of 206 consecutive blunt trauma survivors, studied over a 5-year period in a level I trauma center of which 75 patients (36.4%) had a pelvic fracture, was included in the study. To perform a retrospective cohort study with matched controls, 60 patients of the pelvic fracture group [(PF), 41 males and 19 females; age: 40 ± 17; injury severity score (ISS): 26.6 ± 9.3] were compared to 60 patients without pelvic fracture (non-PF) trauma as controls (41 males and 19 females; age: 40 ± 13; ISS: 26.9 ± 7.7), both with matching age (±5 years), sex, and ISS (±5 points). RESULTS Statistically significant differences were observed in Intensive Care Unit (ICU) length of stay (LOS), total LOS, and Marshall MOD score between PF and non-PF groups, respectively. Acid-base markers such as pH, lactate, LDH, and base deficit were all significantly altered in PF compared to non-PF cohort upon admission. Moreover, our analysis showed significant differences in inflammatory biomarkers (Prolactin, CRP, and IL-6), and clinical parameters (CPK, Hgb, Platelets count, and WBC) over the 7-day clinical course in patients with PF when compared to non-PF cohort. CONCLUSION In this matched cohort, patients with pelvic fractures exhibited biochemical and physiological alterations upon admission. Furthermore, our results suggest that pelvic fracture affects the clinical outcomes in severely injured patients, independently of injury severity, mechanism of injury, age or gender.
Collapse
Affiliation(s)
- K Almahmoud
- Department of Orthopaedic Trauma Surgery, University of Aachen Medical Centre, 52074, Aachen, Germany.,Department of Surgery, Division of Trauma and Critical Care Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA.,Department of General Surgery, Methodist Dallas Health System, Dallas, TX, 75203, USA
| | - R Pfeifer
- Department of Orthopaedic Trauma Surgery, University of Aachen Medical Centre, 52074, Aachen, Germany
| | - K Al-Kofahi
- Department of Molecular Bioscience, University of Kansas, Kansas, 66045, USA
| | - A Hmedat
- Department of Orthopaedic Trauma Surgery, University of Aachen Medical Centre, 52074, Aachen, Germany
| | - W Hyderabad
- Department of Orthopaedic Trauma Surgery, University of Aachen Medical Centre, 52074, Aachen, Germany
| | - F Hildebrand
- Department of Orthopaedic Trauma Surgery, University of Aachen Medical Centre, 52074, Aachen, Germany
| | - A B Peitzman
- Department of Surgery, Division of Trauma and Critical Care Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - H-C Pape
- Department of Orthopaedic Trauma Surgery, University of Aachen Medical Centre, 52074, Aachen, Germany.
| |
Collapse
|
16
|
Horst K, Simon TP, Pfeifer R, Teuben M, Almahmoud K, Zhi Q, Santos SA, Wembers CC, Leonhardt S, Heussen N, Störmann P, Auner B, Relja B, Marzi I, Haug AT, van Griensven M, Kalbitz M, Huber-Lang M, Tolba R, Reiss LK, Uhlig S, Marx G, Pape HC, Hildebrand F. Characterization of blunt chest trauma in a long-term porcine model of severe multiple trauma. Sci Rep 2016; 6:39659. [PMID: 28000769 PMCID: PMC5175194 DOI: 10.1038/srep39659] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/24/2016] [Indexed: 12/20/2022] Open
Abstract
Chest trauma has a significant relevance on outcome after severe trauma. Clinically, impaired lung function typically occurs within 72 hours after trauma. However, the underlying pathophysiological mechanisms are still not fully elucidated. Therefore, we aimed to establish an experimental long-term model to investigate physiological, morphologic and inflammatory changes, after severe trauma. Male pigs (sus scrofa) sustained severe trauma (including unilateral chest trauma, femur fracture, liver laceration and hemorrhagic shock). Additionally, non-injured animals served as sham controls. Chest trauma resulted in severe lung damage on both CT and histological analyses. Furthermore, severe inflammation with a systemic increase of IL-6 (p = 0.0305) and a local increase of IL-8 in BAL (p = 0.0009) was observed. The pO2/FiO2 ratio in trauma animals decreased over the observation period (p < 0.0001) but not in the sham group (p = 0.2967). Electrical Impedance Tomography (EIT) revealed differences between the traumatized and healthy lung (p < 0.0001). In conclusion, a clinically relevant, long-term model of blunt chest trauma with concomitant injuries has been developed. This reproducible model allows to examine local and systemic consequences of trauma and is valid for investigation of potential diagnostic or therapeutic options. In this context, EIT might represent a radiation-free method for bedside diagnostics.
Collapse
Affiliation(s)
- K Horst
- Department of Orthopaedic Trauma, RWTH Aachen University, Germany.,Harald Tscherne Research Laboratory, RWTH Aachen University, Germany
| | - T P Simon
- Department of Intensive Care and Intermediate Care, RWTH Aachen University, Germany
| | - R Pfeifer
- Department of Orthopaedic Trauma, RWTH Aachen University, Germany.,Harald Tscherne Research Laboratory, RWTH Aachen University, Germany
| | - M Teuben
- Department of Orthopaedic Trauma, RWTH Aachen University, Germany.,Harald Tscherne Research Laboratory, RWTH Aachen University, Germany
| | - K Almahmoud
- Department of Orthopaedic Trauma, RWTH Aachen University, Germany.,Harald Tscherne Research Laboratory, RWTH Aachen University, Germany
| | - Q Zhi
- Harald Tscherne Research Laboratory, RWTH Aachen University, Germany
| | - S Aguiar Santos
- Chair for Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - C Castelar Wembers
- Chair for Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - S Leonhardt
- Chair for Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - N Heussen
- Department of Medical Statistics, RWTH Aachen University, Germany.,Medical School, Sigmund Freud Private University, Vienna, Austria
| | - P Störmann
- Department of Trauma-, Hand- and Reconstructive Surgery, University of Frankfurt/Main, Germany
| | - B Auner
- Department of Trauma-, Hand- and Reconstructive Surgery, University of Frankfurt/Main, Germany
| | - B Relja
- Department of Trauma-, Hand- and Reconstructive Surgery, University of Frankfurt/Main, Germany
| | - I Marzi
- Department of Trauma-, Hand- and Reconstructive Surgery, University of Frankfurt/Main, Germany
| | - A T Haug
- Experimental Trauma Surgery, Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - M van Griensven
- Experimental Trauma Surgery, Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - M Kalbitz
- Department of Orthopedic Trauma, Hand-, Plastic-, and Reconstructive Surgery, University of Ulm, Germany
| | - M Huber-Lang
- Department of Orthopedic Trauma, Hand-, Plastic-, and Reconstructive Surgery, University of Ulm, Germany
| | - R Tolba
- Institute for Laboratory Animal Science and Experimental Surgery, RWTH Aachen University, Germany
| | - L K Reiss
- Institute of Pharmacology and Toxicology, RWTH Aachen University, Germany
| | - S Uhlig
- Institute of Pharmacology and Toxicology, RWTH Aachen University, Germany
| | - G Marx
- Department of Intensive Care and Intermediate Care, RWTH Aachen University, Germany
| | - H C Pape
- Department of Orthopaedic Trauma, RWTH Aachen University, Germany
| | - F Hildebrand
- Department of Orthopaedic Trauma, RWTH Aachen University, Germany
| |
Collapse
|
17
|
Relja B, Taraki R, Teuben MPJ, Mörs K, Wagner N, Wutzler S, Hildebrand F, Perl M, Marzi I. Sera from severe trauma patients with pneumonia and without infectious complications have differential effects on neutrophil biology. BMC Pulm Med 2016; 16:171. [PMID: 27905913 PMCID: PMC5131406 DOI: 10.1186/s12890-016-0329-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 11/22/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Major trauma patients (TP) developing imbalanced immune response are at high risk for infectious post-injury complications including pneumonia. Neutrophils play a central role in the host defense against bacteria and thereby pathogenesis of infections. While there are numerous studies about neutrophil function after trauma, data about their biology in patients who suffer from pneumonia following trauma are sparse. Here, we studied the effect of serum isolated from patients who do and do not develop infection (inf.) on the biology of neutrophils from healthy volunteers. METHODS Sera samples from eighteen TP with an injury severity score above 16 were obtained. Nine patients were grouped to no inf. group (TP without pneumonia), and nine to inf. group (TP with pneumonia). Samples were obtained at admission to emergency department (ED), a day prior pneumonia diagnosis (1 d prior inf) or at the day of diagnosis (1 d prior inf). Samples from the equal post-injury days in the corresponding no inf. group were used. Neutrophils from nine healthy volunteers were isolated. Effects for sera isolated from infected and non-infected patients on neutrophil biology were analyzed. Migratory capacity of neutrophils towards TP's serum, their CD11b and CD62L membrane receptor expression and oxidative burst activity after stimulation with TP's serum were determined and compared between groups. RESULTS Migratory capacity of neutrophils was significantly increased after trauma and persisted during the study period. CD11b expression in all groups was significantly increased. CD62L expression decreased generally in samples from ED and recovered later to baseline. Stratifying no inf. and inf. groups showed significantly decreased migratory capacity, increased CD11b and significantly decreased CD62L expression in the no inf. group. These differences persisted during the complete observational period. ROS production was strongly reduced in the no inf. group compared to the inf. group at later experimental time points. CONCLUSIONS This data indicate that patients at risk for pneumonia development have differentially and early activated neutrophils following trauma compared to patients who are not at risk for post-injury complication. Studies about the differential biology of neutrophils and their immediately after trauma modified activity depending on the post-injury clinical course are warranted, and may deliver predictive or even therapeutic strategies to control inflammation.
Collapse
Affiliation(s)
- B Relja
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University, Theodor-Stern Kai 7, 60590, Frankfurt, Germany.
| | - R Taraki
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - M P J Teuben
- Department of Orthopaedic Trauma, University Clinic RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - K Mörs
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - N Wagner
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - S Wutzler
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - F Hildebrand
- Department of Orthopaedic Trauma, University Clinic RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - M Perl
- Department of Trauma Surgery, Trauma Center Murnau, Murnau, Germany
| | - I Marzi
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| |
Collapse
|
18
|
Maier KJ, Bücking B, Horst K, Andruszkow H, Hildebrand F, Knobe M. [The rotationally stable screw-anchor with trochanteric stabilizing plate (RoSA/TSP) : First results in unstable trochanteric femur fractures]. Unfallchirurg 2016; 120:1054-1064. [PMID: 27770169 DOI: 10.1007/s00113-016-0265-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND In unstable trochanteric fractures, the extramedullary rotationally stable screw-anchor (RoSA) combines the benefits of the load and rotational stability of the blade with the advantages of the screw (pull-out resistance, compression capability) in a single load carrier, and was designed to prevent femoral neck shortening by using an additional locked trochanteric stabilizing plate (TSP). OBJECTIVES The aim of the current prospective cohort study was the clinical evaluation of the RoSA/TSP system regarding the mechanical re-operation rate and the amount of postoperative femoral neck shortening. METHODS From September 2011 to January 2014 80 patients with unstable trochanteric fractures underwent internal extramedullary fixation with the RoSA/TSP (Königsee Implantate GmbH, Allendorf, Germany). Due to fracture stability and after induction of compression, additional long locked antitelescoping screws (AT, n = 1-4) were placed reaching the femoral head. Radiological (femoral neck shortening) and clinical re-examination of patients (n = 61) was performed 6-10 weeks and 6-10 months later. RESULTS In the 61 re-examined patients (76 %) femoral neck shortening was very low with 2 mm 6-10 months after operation. Re-operations occurred in 8 % (n = 6) and in 4 % (n = 3) as prophylactic surgical intervention. Whereas one-third (4 %) of re-operations occurred due to iatrogenic surgical problems from the first operation two-thirds of patients (8 %) had a re-operation due to delay of bone union (3× nonunion, 3 planned removals of AT-screws to improve healing). The in-hospital mortality was 3 % (n = 2). CONCLUSIONS The fixation of unstable trochanteric femur fractures using the RoSA/TSP in a first clinical setting led to a great primary stability, with significant advantages with regard to limited femoral neck shortening. However, the rigidity of the construct with its consequences regarding bone healing can be challenging for the surgeon. Nevertheless, in some cases of revision it could be beneficial for stability.
Collapse
Affiliation(s)
- K-J Maier
- Abteilung für Allgemein-, Viszeral- und Unfallchirurgie, RoMed Klinik, Bad Aibling, Deutschland
| | - B Bücking
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Gießen und Marburg GmbH, Marburg, Deutschland
| | - K Horst
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - H Andruszkow
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - F Hildebrand
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - M Knobe
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| |
Collapse
|
19
|
Hildebrand F, Gebhard F, Reichel H, Nerlich M, Loibl M. [Not Available]. Z Orthop Unfall 2016; 154:330-1. [PMID: 27575418 DOI: 10.1055/s-0042-112172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- F Hildebrand
- Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Aachen
| | - F Gebhard
- Klinik für Unfall-, Hand-, Plastische- und Wiederherstellungschirurgie, Universitätsklinikum Ulm
| | - H Reichel
- Ärztlicher Direktor, Orthopädische Universitätsklinik, Universitäts- und Rehabilitationskliniken Ulm
| | - M Nerlich
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg
| | - M Loibl
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg
| |
Collapse
|
20
|
Herren C, Dienstknecht T, Siewe J, Kobbe P, Pape HC, Hildebrand F. [Chronic instability of the pubic symphysis : Etiology, diagnostics and treatment management]. Unfallchirurg 2016; 119:433-46. [PMID: 27146805 DOI: 10.1007/s00113-016-0166-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The most frequent causes of chronic instability of the pubic symphysis are sports-related continual overload and traumatic symphyseal injuries. Acute injury of the pubic symphysis may be the result of external forces acting on the anterior pelvic ring or the result of internal forces, such as those arising during parturition. The postpartum form of instability following a complication-free birth is reversible and usually returns to normal within a few months through strengthening of the pelvic floor muscles. Residual instability of the pubis symphysis is on the whole a rare complication. Although established therapy options for acute symphyseal separation can be found in the literature, there are only a few case reports on chronic symphyseal instability. There are no guidelines on standardized therapy options. This review article examines the etiology, clinical findings, diagnostic techniques and management options for patients suffering from chronic symphyseal instability.
Collapse
Affiliation(s)
- C Herren
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - T Dienstknecht
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - J Siewe
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - P Kobbe
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - H C Pape
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - F Hildebrand
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| |
Collapse
|
21
|
Pape HC, Andruszkow H, Pfeifer R, Hildebrand F, Barkatali BM. Options and hazards of the early appropriate care protocol for trauma patients with major fractures: Towards safe definitive surgery. Injury 2016; 47:787-91. [PMID: 27090109 DOI: 10.1016/j.injury.2016.03.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- H C Pape
- Department of Orthopedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | - H Andruszkow
- Department of Orthopedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | - R Pfeifer
- Department of Orthopedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | - F Hildebrand
- Department of Orthopedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | - B M Barkatali
- Department of Trauma and Orthopaedics, University Teaching Hospital, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, United Kingdom.
| |
Collapse
|
22
|
Zeckey C, Wendt K, Mommsen P, Winkelmann M, Frömke C, Weidemann J, Stübig T, Krettek C, Hildebrand F. Kinetic therapy in multiple trauma patients with severe blunt chest trauma: an analysis at a level-1 trauma center. Technol Health Care 2015; 23:63-73. [PMID: 25391530 DOI: 10.3233/thc-140869] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Chest trauma is a relevant risk factor for mortality after multiple trauma. Kinetic therapy (KT) represents a potential treatment option in order to restore pulmonary function. Decision criteria for performing kinetic therapy are not fully elucidated. The purpose of this study was to investigate the decision making process to initiate kinetic therapy in a well defined multiple trauma cohort. METHODS A retrospective analysis (2000-2009) of polytrauma patients (age > 16 years, ISS ⩾ 16) with severe chest trauma (AIS(Chest) ⩾ 3) was performed. Patients with AIS(Head) ⩾ 3 were excluded. Patients receiving either kinetic (KT+) or lung protective ventilation strategy (KT-) were compared. Chest trauma was classified according to the AIS(Chest), Pulmonary Contusion Score (PCS), Wagner Jamieson Score and Thoracic Trauma Severity Score (TTS). There were multiple outcome parameters investigated included mortality, posttraumatic complications and clinical data. A multivariate regression analysis was performed. RESULTS Two hundred and eighty-three patients were included (KT+: n=160; KT-: n=123). AIS(Chest), age and gender were comparable in both groups. There were significant higher values of the ISS, PCS, Wagner Jamieson Score and TTS in group KT+. The incidence of posttraumatic complications and mortality was increased compared to group KT- (p< 0.05). Despite that, kinetic therapy failed to be an independent risk factor for mortality in multivariate logistic regression analysis. CONCLUSIONS Kinetic therapy is an option in severely injured patients with severe chest trauma. Decision making is not only based on anatomical aspects such as the AIS(Chest), but on overall injury severity, pulmonary contusions and physiological deterioration. It could be assumed that the increased mortality in patients receiving KT is primarily caused by these factors and does not reflect an independent adverse effect of KT. Furthermore, KT was not shown to be an independent risk factor for mortality.
Collapse
Affiliation(s)
- C Zeckey
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - K Wendt
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - P Mommsen
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - M Winkelmann
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - C Frömke
- Institute of Biostatistics, Hannover Medical School, Hannover, Germany
| | - J Weidemann
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - T Stübig
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - C Krettek
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - F Hildebrand
- Department of Orthopedic Trauma, University Hospital Aachen, Aachen, Germany
| |
Collapse
|
23
|
Hildebrand F, Venner M, Giguère S. Efficacy of gamithromycin for the treatment of foals with mild to moderate bronchopneumonia. J Vet Intern Med 2015; 29:333-8. [PMID: 25619521 PMCID: PMC4858060 DOI: 10.1111/jvim.12504] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/13/2014] [Accepted: 10/13/2014] [Indexed: 12/02/2022] Open
Abstract
Background Gamithromycin is active in vitro against the bacterial agents most commonly associated with bronchopneumonia in older foals. However, the clinical efficacy and safety of this drug have not been investigated. Hypothesis Gamithromycin is effective for the treatment of bronchopneumonia in foals. Animals One hundred and twenty‐one foals on a farm endemic for infections caused by Rhodococcus equi. Methods In a controlled, randomized, and double blinded clinical trial, foals with ultrasonographic evidence of pulmonary abscesses (abscess score 8.0–20 cm) were randomly allocated in 3 treatment groups: (1) gamithromycin IM q7 days (n = 40); (2) azithromycin with rifampin, PO q24h (n = 40); or (3) no antimicrobial treatment (controls; n = 41). Physical examination and thoracic ultrasonography were performed by individuals unaware of treatment group assignment. Foals that worsened were removed from the study. Results The proportion of foals that recovered without the need to be removed from the study was significantly higher for foals treated with gamithromycin (38 of 40) or azithromycin with rifampin (39 of 40) than for controls (32 of 41). Treatment with gamithromycin or with azithromycin‐rifampin resulted in a significantly faster decrease in the clinical score and abscess score compared to the controls. Adverse reactions characterized by colic (n = 18) and hind limb lameness (n = 14) were observed only in foals treated with gamithromycin. Conclusion and Clinical Importance Gamithromycin was noninferior to azithromycin with rifampin for the treatment of bronchopneumonia in the study population but had a higher frequency of adverse reactions.
Collapse
Affiliation(s)
- F Hildebrand
- Equine Clinic, School of Veterinary Medicine, Hanover, Germany
| | | | | |
Collapse
|
24
|
Eschbach D, Steinfeldt T, Hildebrand F, Frink M, Schöller K, Sassen M, Wiesmann T, Debus F, Vogt N, Uhl E, Wulf H, Ruchholtz S, Pape HC, Horst K. A porcine polytrauma model with two different degrees of hemorrhagic shock: outcome related to trauma within the first 48 h. Eur J Med Res 2015; 20:73. [PMID: 26338818 PMCID: PMC4559152 DOI: 10.1186/s40001-015-0162-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/11/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND An animal polytrauma model was developed, including trunk and extremity injuries combined with hemorrhagic shock and a prolonged post-traumatic phase. This could be useful for the assessment of different therapeutic approaches during intensive care therapy. METHODS A standardized polytrauma including lung contusion, liver laceration and lower leg fracture was applied in 25 pigs. They underwent controlled haemorrhage either with a blood volume loss of 45 % and a median arterial pressure (MAP) <30 mmHg/90 min (group L, n = 15) or a 50 % blood loss of and an MAP <25 mmHg/120 min (group H, n = 10). Five non-traumatized pigs served as a control (group C). Subsequently, intensive care treatment was given for an observational period of 48 h. RESULTS Both trauma groups showed signs of shock and organ injury (heart rate, MAP and lactate). The frequency of cardiopulmonary resuscitation (CPR) and lung injury was directly related to the severity of the haemorrhagic shock (CPR-group L: 4 of 15 pigs, group H: 4 of 10 pigs; Respiratory failure-group L: 3 of 13, group H: 3 of 9. There was no difference in mortality between trauma groups. CONCLUSION The present data suggest that our model reflects the mortality and organ failure of polytrauma in humans during shock and the intensive care period. This suggests that the experimental protocol could be useful for the assessment of therapeutic approaches during the post-traumatic period.
Collapse
Affiliation(s)
- D Eschbach
- Center for Orthopaedics and Trauma Surgery; University Hospital Giessen and Marburg, Marburg, Germany.
| | - T Steinfeldt
- Department of Anaesthesiology and Critical Care, University of Marburg, Marburg, Germany.
| | - F Hildebrand
- Trauma Department, University of Aachen, Aachen, Germany.
| | - M Frink
- Center for Orthopaedics and Trauma Surgery; University Hospital Giessen and Marburg, Marburg, Germany.
| | - K Schöller
- Department of Neurosurgery, University of Giessen, Giessen, Germany.
| | - M Sassen
- Department of Anaesthesiology and Critical Care, University of Marburg, Marburg, Germany.
| | - T Wiesmann
- Department of Anaesthesiology and Critical Care, University of Marburg, Marburg, Germany.
| | - F Debus
- Center for Orthopaedics and Trauma Surgery; University Hospital Giessen and Marburg, Marburg, Germany.
| | - N Vogt
- Department of Neurosurgery, University of Giessen, Giessen, Germany.
| | - E Uhl
- Department of Neurosurgery, University of Giessen, Giessen, Germany.
| | - H Wulf
- Department of Anaesthesiology and Critical Care, University of Marburg, Marburg, Germany.
| | - S Ruchholtz
- Center for Orthopaedics and Trauma Surgery; University Hospital Giessen and Marburg, Marburg, Germany.
| | - H C Pape
- Trauma Department, University of Aachen, Aachen, Germany.
| | - K Horst
- Trauma Department, University of Aachen, Aachen, Germany.
| |
Collapse
|
25
|
Hildebrand F, Pape HC, Horst K, Andruszkow H, Kobbe P, Simon TP, Marx G, Schürholz T. Impact of age on the clinical outcomes of major trauma. Eur J Trauma Emerg Surg 2015; 42:317-32. [PMID: 26253883 DOI: 10.1007/s00068-015-0557-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/31/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE In view of demographic changes over the past few decades, the average age of trauma patients is progressively increasing. We therefore aimed to summarize the specific characteristics of geriatric trauma and to identify potential fields for further research to improve the care of elderly trauma patients. METHODS Review of the literature. RESULTS Due to the diverse risk factors (e.g., pre-existing conditions, limited physiological reserve), geriatric patients are prone to developing severe complications, even after less severe trauma. Yet, age is not considered as the only predictor of worse outcomes, and it should not be considered the only criterion for limiting care in those patients. It is crucial that age-specific treatment guidelines are developed to optimize the outcomes for senior trauma patients. Based on the current literature, these guidelines should emphasize the importance of field triage directly to a trauma center, along with the activation of the trauma team. Furthermore, early intensive monitoring, aggressive resuscitation, and time of surgical intervention are of upmost importance to reduce mortality. CONCLUSION The impact of several factors [age, premedical conditions (PMC), decreased physiological reserves, and impaired immune function] on the post-traumatic course of elderly trauma patients needs to be clarified in future experimental and clinical studies for the early identification of geriatric high-risk patients and for the development of age-adapted therapeutic strategies.
Collapse
Affiliation(s)
- F Hildebrand
- Department of Orthopaedic Trauma, Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany. .,Harald Tscherne Research Laboratory for Orthopaedic Trauma, Aachen University, Aachen, Germany.
| | - H-C Pape
- Department of Orthopaedic Trauma, Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - K Horst
- Department of Orthopaedic Trauma, Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.,Harald Tscherne Research Laboratory for Orthopaedic Trauma, Aachen University, Aachen, Germany
| | - H Andruszkow
- Department of Orthopaedic Trauma, Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.,Harald Tscherne Research Laboratory for Orthopaedic Trauma, Aachen University, Aachen, Germany
| | - P Kobbe
- Department of Orthopaedic Trauma, Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - T-P Simon
- Department of Intensive Care Medicine, Aachen University, Aachen, Germany
| | - G Marx
- Department of Intensive Care Medicine, Aachen University, Aachen, Germany
| | - T Schürholz
- Department of Intensive Care Medicine, Aachen University, Aachen, Germany
| |
Collapse
|
26
|
Herren C, Pishnamaz M, Lichte P, Hildebrand F, Sellei R, Pape HC, Kobbe P. Die ventrale „Triple-/Quadruple“-Schraubenosteosynthese für die traumatische C1–C2-Kombinationsverletzung des geriatrischen Patienten: erste operative Erfahrungen mit 16 Patienten. Z Orthop Unfall 2015; 153:533-9. [DOI: 10.1055/s-0035-1546133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- C. Herren
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen
| | - M. Pishnamaz
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen
| | - P. Lichte
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen
| | - F. Hildebrand
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen
| | - R. Sellei
- Unfallchirurgie und Orthopädische Chirurgie, Sana Klinikum Offenbach
| | - H.-C. Pape
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen
| | - P. Kobbe
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen
| |
Collapse
|
27
|
Horst K, Hildebrand F, Pfeifer R, Hübenthal S, Almahmoud K, Sassen M, Steinfeldt T, Wulf H, Ruchholtz S, Pape HC, Eschbach D. Impact of haemorrhagic shock intensity on the dynamic of alarmins release in porcine poly-trauma animal model. Eur J Trauma Emerg Surg 2015; 42:67-75. [PMID: 26038024 DOI: 10.1007/s00068-015-0504-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 09/24/2014] [Accepted: 02/23/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Traumatic insults result in an altered inflammatory response, in which alarmins release has a central role. The impact of haemorrhagic shock intensity on the long-term kinetics of alarmins is not yet fully elucidated. We investigated these aspects in a combined trauma (chest, abdominal, and extremities injury) porcine model with different severities and durations of haemorrhagic shock. METHODS After induction of combined trauma (tibia fracture, lung contusion, and liver laceration), haemorrhagic shock was induced at different intensities: moderate haemorrhage (MH; n = 15): mean arterial pressure (MAP) <30 ± 5 mmHg [maximum loss of total blood volume (TBVmax): 45 %] for 90 min, and severe haemorrhage (SH; n = 10): MAP <25 ± 5 mmHg (TBVmax 50 %) for 120 min. Resuscitation was performed using a standardized crystalloid infusion protocol. Animals were mechanically ventilated and underwent ICU-monitoring for 48 h (MH) and 48.5 h (SH). Blood samples were collected over the clinical time course, and systemic levels of serum alarmins [High-Mobility Group Protein B-1 (HMGB-1) and Heat Shock Protein 70 (HSP70)] were measured using an ELISA kit. RESULTS Heart rate, systemic blood pressure, lactate, and base excess were significantly altered as a function of haemorrhagic shock in both trauma groups (MH and SH). Systemic HMGB-1 levels were significantly elevated in both trauma groups when compared to the sham group. Haemorrhagic shock severity and duration were positively correlated with HMGB-1 levels and compared to baseline values, concentrations remained significantly increased in SH when compared to MH. On the other hand, we observed a significant decrease in the systemic HSP70 levels of trauma groups (MH, and SH) when compared to the sham group, which was significantly decreased compared to baseline values in SH over the entire time course. CONCLUSION Our data show that haemorrhagic shock duration and severity affect the systemic levels of HMGB-1 and HSP70. This early alarmins release after trauma can be used to guide the treatment strategies (e.g. surgical procedures) of polytrauma patients.
Collapse
Affiliation(s)
- K Horst
- Department of Orthopaedic Trauma, Harald Tscherne Research Laboratory, University Hospital Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - F Hildebrand
- Department of Orthopaedic Trauma, Harald Tscherne Research Laboratory, University Hospital Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - R Pfeifer
- Department of Orthopaedic Trauma, Harald Tscherne Research Laboratory, University Hospital Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - S Hübenthal
- Department of Orthopaedic Trauma, Harald Tscherne Research Laboratory, University Hospital Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - K Almahmoud
- Department of Orthopaedic Trauma, Harald Tscherne Research Laboratory, University Hospital Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - M Sassen
- Department of Anaesthesiology, University Hospital Marburg, Marburg, Germany
| | - T Steinfeldt
- Department of Anaesthesiology, University Hospital Marburg, Marburg, Germany
| | - H Wulf
- Department of Anaesthesiology, University Hospital Marburg, Marburg, Germany
| | - S Ruchholtz
- Department of Hand, Traumatology and Reconstructive Surgery, University Hospital Marburg, Marburg, Germany
| | - H C Pape
- Department of Orthopaedic Trauma, Harald Tscherne Research Laboratory, University Hospital Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - D Eschbach
- Department of Hand, Traumatology and Reconstructive Surgery, University Hospital Marburg, Marburg, Germany
| |
Collapse
|
28
|
Hildebrand F, Giguère S, Venner M. Treatment with gamithromycin in foals with pneumonia: comparative efficacy and adverse effects of i.m. versus i.v. administration. PFERDEHEILKUNDE 2015. [DOI: 10.21836/pem20150209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
29
|
Sellei RM, Hingmann SJ, Kobbe P, Weber C, Grice JE, Zimmerman F, Jeromin S, Gansslen A, Hildebrand F, Pape HC. Measurement of compartment elasticity using pressure related ultrasound: a method to identify patients with potential compartment syndrome. Acta Chir Orthop Traumatol Cech 2015; 82:198-202. [PMID: 26317290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE OF THE STUDY Decision-making in treatment of an acute compartment syndrome is based on clinical assessment, supported by invasive monitoring. Thus, evolving compartment syndrome may require repeated pressure measurements. In suspected cases of potential compartment syndromes clinical assessment alone seems to be unreliable. The objective of this study was to investigate the feasibility of a non-invasive application estimating whole compartmental elasticity by ultrasound, which may improve accuracy of diagnostics. MATERIAL AND METHODS In an in-vitro model, using an artificial container simulating dimensions of the human anterior tibial compartment, intracompartmental pressures (p) were raised subsequently up to 80 mm Hg by infusion of saline solution. The compartmental depth (mm) in the cross-section view was measured before and after manual probe compression (100 mm Hg) upon the surface resulting in a linear compartmental displacement (Δd). This was repeated at rising compartmental pressures. The resulting displacements were related to the corresponding intra-compartmental pressures simulated in our model. A hypothesized relationship between pressures related compartmental displacement and the elasticity at elevated compartment pressures was investigated. RESULTS With rising compartmental pressures, a non-linear, reciprocal proportional relation between the displacement (mm) and the intra-compartmental pressure (mm Hg) occurred. The Pearson's coefficient showed a high correlation (r2 = -0.960). The intraobserver reliability value kappa resulted in a statistically high reliability (κ = 0.840). The inter-observer value indicated a fair reliability (κ = 0.640). CONCLUSIONS Our model reveals that a strong correlation between compartmental strain displacements assessed by ultrasound and the intra-compartmental pressure changes occurs. Further studies are required to prove whether this assessment is transferable to human muscle tissue. Determining the complete compartmental elasticity by ultrasound enhancement, this application may improve detection of early signs of potential compartment syndrome. Key words: compartment syndrome, intra-compartmental pressure, non-invasive diagnostic, elasticity measurement, elastography.
Collapse
Affiliation(s)
- R M Sellei
- Department of Orthopaedic Trauma, RWTH Aachen University Hospital, Aachen, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Affiliation(s)
- F Hildebrand
- Department of Orthopedic Trauma, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
- Harald Tscherne Research Laboratory, University Hospital Aachen, Aachen, Germany.
| | - H-C Pape
- Department of Orthopedic Trauma, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Harald Tscherne Research Laboratory, University Hospital Aachen, Aachen, Germany
| |
Collapse
|
31
|
Sellei RM, Waehling A, Weber CD, Jeromin S, Zimmermann F, McCann PA, Hildebrand F, Pape HC. Contrast enhanced ultrasound (CEUS) reliably detects critical perfusion changes in compartmental muscle: a model in healthy volunteers. Eur J Trauma Emerg Surg 2014; 40:535-9. [DOI: 10.1007/s00068-014-0443-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 08/05/2014] [Indexed: 10/24/2022]
|
32
|
Affiliation(s)
- H. Andruszkow
- Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Aachen
| | - F. Hildebrand
- Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Aachen
| |
Collapse
|
33
|
Gänsslen A, Gösling T, Hildebrand F, Pape HC, Oestern HJ. Femoral shaft fractures in adults: treatment options and controversies. Acta Chir Orthop Traumatol Cech 2014; 81:108-117. [PMID: 25105784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Antegrade reamed femoral nailing via the piriformis entry point is the technique of choice in treating femoral shaft fractures, with retrograde nailing as an alternative. The supine position is favored to reduce complications, especially rotational malalignment. With navigation and robotic assistance fracture reduction can be supported and the rate of rotational, axis and length malalignement can potentially further reduced. Careful reaming is the procedure of choice to optimize bony healing and reduce systemic and local complications. In multiply injured patients reamed nailing can be safely integrated in the DCO- or ETC-concept and can be performed in the majority of patients, even when additional severe chest and head injuries are present. Initial resuscitation should focus on general stabilization before definitive femur fixation. Plate osteosynthesis of the femur can be an option in selected patients.
Collapse
Affiliation(s)
- A Gänsslen
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum der Stadt Wolfsburg, Wolfsburg, Germany
| | | | | | | | | |
Collapse
|
34
|
Abstract
Treatment of patients with multiple trauma is known to require validated established algorithms, experienced medical staff and intensive interdisciplinary cooperation between the medical disciplines. In order to predict the risk for potential complications and mortality, adequate assessment of patients with multiple trauma is crucial for further treatment decisions. Therefore, different scoring systems have been developed to assess injury severity and to predict the potential outcome after multiple trauma. These scores have in common that the severity of trauma is converted to a numeric value simplifying the physiological reality in general. But the anatomic as well as physiological impact after multiple trauma can hardly be represented comprehensively by a single numeric value. Consequently, the established scores can only be safely interpreted, if the individual limitations of each scoring system are known.
Collapse
Affiliation(s)
- H Andruszkow
- Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Aachen, Pauwelsstrasse 30, 52074, Aachen, Deutschland.
| | | | | | | |
Collapse
|
35
|
Andruszkow H, Scharff B, Zapf A, Klein M, Lechler P, Hildebrand F, Frink M. Der Einfluss von Begleiterkrankungen und operativem Versorgungszeitpunkt auf die Mortalität bei Patienten mit Schenkelhalsfraktur. Z Orthop Unfall 2013; 151:338-42. [DOI: 10.1055/s-0032-1328665] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- H. Andruszkow
- Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Aachen
| | - B. Scharff
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover
| | - A. Zapf
- Institut für Medizinische Statistik, Universitätsklinikum Göttingen
| | - M. Klein
- Klinik für Orthopädie und Unfallchirurgie, Sana Klinikum Hameln-Pyrmont, Hameln
| | - P. Lechler
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Marburg
| | - F. Hildebrand
- Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Aachen
| | - M. Frink
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover
| |
Collapse
|
36
|
Hildebrand F, Shin HO, Flötotto L, Krettek C, Gerich T. [The prevalence of reduced acetabular anteversion in asymptomatic patients: a retrospective analysis]. Z Orthop Unfall 2013; 150:601-6. [PMID: 23296556 DOI: 10.1055/s-0032-1327795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND In patients with unilateral femoroacetabular impingement (FAI), bony characteristics predisposing to FAI (e.g., acetabular retroversion) are also commonly observed in the contralateral asymptomatic hip. This study investigated the prevalence of these characteristics in an asymptomatic population and the influence of pelvic inclination and tilt on acetabular anteversion. PATIENTS AND METHODS In this study, patients with unspecific abdominal pain in whom CT including the hip was performed to aid diagnosis were included. Exclusion criteria were previous fractures of the acetabulum or the femur and surgical pretreatment of the hip. AV, CE angle, CCD angle and the distance between the anterior and posterior acetabular rims were determined. RESULTS 11.5 % of the 400 included hip joints had a central AV of < 15°. A central retroversion was not found. Female patients had a significantly higher AV compared to males (p < 0.05). Pelvic tilt and inclination had a significant influence on the AV. CONCLUSION Correct assessment of AV is dependent on a correct pelvic radiograph. 16.5 % of the hips of asymptomatic patients had at least one bony characteristic predisposing to FAI.
Collapse
Affiliation(s)
- F Hildebrand
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover.
| | | | | | | | | |
Collapse
|
37
|
Mommsen P, Andruszkow H, Frömke C, Zeckey C, Wagner U, van Griensven M, Frink M, Krettek C, Hildebrand F. Effects of accidental hypothermia on posttraumatic complications and outcome in multiple trauma patients. Injury 2013; 44:86-90. [PMID: 22040695 DOI: 10.1016/j.injury.2011.10.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2011] [Revised: 10/10/2011] [Accepted: 10/11/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Accidental hypothermia seems to predispose multiple trauma patients to the development of posttraumatic complications, such as Systemic Inflammatory Response Syndrome (SIRS), sepsis, Multiple Organ Dysfunction Syndrome (MODS), and increased mortality. However, the role of accidental hypothermia as an independent prognostic factor is controversially discussed. The aim of the present study was to evaluate the incidence of accidental hypothermia in multiple trauma patients and its effects on the development of posttraumatic complications and mortality. PATIENTS AND METHODS Inclusion criteria for patients in this retrospective study (2005-2009) were an Injury Severity Score (ISS) ≥16, age ≥16 years, admission to our Level I trauma centre within 6h after the accident. Accidental hypothermia was defined as body temperature less than 35°C measured within 2 h after admission, but always before first surgical procedure in the operation theatre. The association between accidental hypothermia and the development of posttraumatic complications as well as mortality was investigated. Statistical analysis was performed with χ(2)-test, Student's t-test, ANOVA and logistic regression. Statistical significance was considered at p<0.05. RESULTS 310 multiple trauma patients were enrolled in the present study. Patients' mean age was 41.9 (SD 17.5) years, the mean injury severity score was 29.7 (SD 10.2). The overall incidence of accidental hypothermia was 36.8%. The overall incidence of posttraumatic complications was 77.4% (SIRS), 42.9% (sepsis) and 7.4% (MODS), respectively. No association was shown between accidental hypothermia and the development of posttraumatic complications. Overall, 8.7% died during the posttraumatic course. Despite an increased mortality rate in hypothermic patients, hypothermia failed to be an independent risk factor for mortality in multivariate analysis. CONCLUSIONS Accidental hypothermia is very common in multiply injured patients. However, it could be assumed that the increase of mortality in hypothermic patients is primarily caused by the injury severity and does not reflect an independent adverse effect of hypothermia. Furthermore, hypothermia was not shown to be an independent risk factor for posttraumatic complications.
Collapse
Affiliation(s)
- P Mommsen
- Trauma Department, Hannover Medical School, 30625 Hannover, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Gänsslen A, Hildebrand F, Kretek C. Transverse + posterior wall fractures of the acetabulum: epidemiology, operative management and long-term results. Acta Chir Orthop Traumatol Cech 2013; 80:27-33. [PMID: 23452418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
UNLABELLED PURPOUSE OF THE STUDY: Associated transverse and posterior wall fractures account for approximately 20% of all acetabular fractures. To asses the risk of these concommitant bone injuries on early joint failure despite a high rate of postoperative congruency. MATERIAL The analysis of 104 surgically treated patients with associated transverse and posterior wall fractures showed that more than half of these patients had associated injuries. The mean age was 35 years, and > 75% of these patients were male. A high energy trauma was the trauma mechanism in 94.2%. The mean ISS was 26.3 points. The majority of patients showed a juxta- or transtectal fracture line. The mean articular fracture displacement was 13.5 mm. 87.5% of the patients showed a femoral head dislocation. An acetabular roof comminution was present in 16.3%. 20.2% of patients received a fracture related preoperative nerve injury to the sciatic nerve. METHODS Osteosynthesis was performed 9.9 days after trauma. The Kocher-Langenbeck approach was used in > 90% for stabilization with a combination of plate and screw fixation in 71.1%. The mean operative time was 190 minutes with a blood loss of 855 ml. Postoperatively the hip joint was congruent in 90.3% with anatomical or near-anatomical joint reconstruction in > 90%. Iatrogenic nerve injury occurred in 12 patients (8.9%). RESULTS 67 patients (67.7%) could be followed after a mean of 42.7 months. The average subjective Visual Analog Scale pain score was 42.7. Mild or no pain was seen in 58.2%. The mean Merle d'Aubigné score was 15.4 with 56.7% of patients having a functionally perfect or good result. 52.2% had no post-traumatic osteoarthritic changes of their hip joint. A joint failure was diagnosed in 32.8% of the patients. Analyzing only patients with anatomically reconstructed hip joints, patients showed comparable results with 61.3% having no or mild pain and 59.2% a good or excellent functional result. Posttraumatic arthrotic changes occur in only 26.5% of these patients. A joint failure was present in 32.7%. In this group, a joint failure was significantly more likely to be present with an additional acetabular comminution zone. CONCLUSION Associated transverse and posterior wall fractures have a significant risk of early joint failure despite a high rate of postoperative congruency.
Collapse
MESH Headings
- Acetabuloplasty/adverse effects
- Acetabuloplasty/instrumentation
- Acetabuloplasty/methods
- Acetabulum/injuries
- Adult
- Bone Plates
- Bone Screws
- Female
- Fracture Fixation, Internal/adverse effects
- Fracture Fixation, Internal/instrumentation
- Fracture Fixation, Internal/methods
- Fractures, Bone/complications
- Fractures, Bone/diagnostic imaging
- Fractures, Bone/epidemiology
- Fractures, Bone/surgery
- Fractures, Comminuted
- Germany/epidemiology
- Hip Dislocation/diagnosis
- Hip Dislocation/etiology
- Hip Dislocation/surgery
- Hip Joint/diagnostic imaging
- Hip Joint/surgery
- Humans
- Joint Instability/diagnosis
- Joint Instability/epidemiology
- Joint Instability/etiology
- Male
- Osteoarthritis, Hip/diagnosis
- Osteoarthritis, Hip/epidemiology
- Osteoarthritis, Hip/etiology
- Postoperative Complications/diagnosis
- Postoperative Complications/epidemiology
- Radiography
- Risk Factors
- Trauma Severity Indices
- Treatment Outcome
Collapse
Affiliation(s)
- A Gänsslen
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum der Stadt Wolfsburg, Wolfsburg, Germany
| | | | | |
Collapse
|
39
|
Gänsslen A, Hildebrand F, Kretek C. Supraacetabular external fixation for pain control in geriatric type B pelvic injuries. Acta Chir Orthop Traumatol Cech 2013; 80:101-105. [PMID: 23562252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
UNLABELLED PURPOUSE OF THE STUDY: Pelvic ring fractures in the geriatric population are of increasing frequency. Often insufficiency fractures or occult fractures are described. With a classical injury mechanism the majority of these injuries are the result of a low energy trauma, typically a fall from standing or during walking.Clinically, many patients report immediate anterior groin pain but detailed clinical examination often shows significant posterior pelvic pain. CT evaluation often reveals posterior pelvic ring injury, in the majority of cases a sacral compression fracture. Despite adequate diagnostics, many of these patients suffer from persistent pain, which can be observed up to 8 weeks after injury. To asses the role of external fixator in pain relief and early mobilisation in this group of patients the study was performed. MATERIAL AND METHODS From the database of all patients with pelvic ring and acetabular injuries 25 patients > 65 years with type B injuries stabilized by a supraacetabular external fixator were analyzed. Prospectively demographic data including sex, patient age, cause of injury, frequency and type of concomitant injuries and diseases, injury severity,fracture type and complications were recorded. For evaluation of the pain course, the visual analog scale was used. Preoperative and postoperative mobility and the type of post-treatment were evaluated. RESULTS Stabilizing the pelvic ring with a simple external fixation procedure (supraacetabular one pin external fixator) allows immediate relief of pain, which allows early and successful mobilization of these patients. Normally, adequate mobilization is possible immediate after application of the fixator. CONCLUSIONS This simple operative procedure, therefore, can be used for pain control and sufficient mobilization to avoid secondary medical complications.
Collapse
Affiliation(s)
- A Gänsslen
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum der Stadt Wolfsburg, Wolfsburg, Germany.
| | | | | |
Collapse
|
40
|
Gänsslen A, Hildebrand F, Heidari N, Weinberg AM. Pelvic ring injuries in children. Part II: Treatment and results. A review of the literature. Acta Chir Orthop Traumatol Cech 2013; 80:241-249. [PMID: 24119471] [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: 06/02/2023]
Affiliation(s)
- A Gänsslen
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum der Stadt Wolfsburg, Wolfsburg, Germany
| | | | | | | |
Collapse
|
41
|
Gänsslen A, Hildebrand F, Heidari N, Weinberg AM. Acetabular fractures in children: a review of the literature. Acta Chir Orthop Traumatol Cech 2013; 80:10-14. [PMID: 23452416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Injury to the acetabular growth plate is rare. Accordingly, data on the incidence in the literature are controverse. Other difficulties include the clear definition of a pediatric acetabular injury. The modified classification according to Salter-Harris described by Bucholz is used in immature patients. The majority of these injuries can be treated conservatively. In severely displaced injuries or in the presence of intra-articular pathologies open procedures are recommended. The main long-term complication is the development of posttraumatic acetabular dysplasia which should be early detected by regular check-ups until the completion of growth. Overall, the long-term results are satisfactory.
Collapse
Affiliation(s)
- A Gänsslen
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum der Stadt Wolfsburg, Wolfsburg, Germany
| | | | | | | |
Collapse
|
42
|
Adams H, Baumann G, Cascorbi I, Emmel M, Fischer D, Fries D, Gänsslen A, Heller A, Hildebrand F, Klar E, Klippe H, Knoefel W, Krettek C, Lampl L, Maul H, Prange H, Rolle U, Sarrafzadeh A, Sasse M, Standl T, Teske W, Zerkowski H. Stellungnahme der Sektion „Schock“ der DIVI zur Schocklage. Notarzt 2012. [DOI: 10.1055/s-0031-1292880] [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] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
43
|
Gänsslen A, Hildebrand F, Heidari N, Weinberg AM. Pelvic ring injuries in children. Part I: Epidemiology and primary evaluation. A review of the literature. Acta Chir Orthop Traumatol Cech 2012; 79:493-498. [PMID: 23286680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Pediatric pelvic injury is of major significance despite these injuries in children are rare with a suspected yearly rate of 3% of all pelvic injuries. The special pediatric bone anatomy of the pelvis is responsible for different fracture patterns, and overall, a bony or joint injury of the pelvis is an indicator of a severe trauma. The vast majority of pediatric pelvic fractures is the result of a high-energy trauma, especially after strucking by a car or injured as motor vehicle passengers. Additional injuries are common, but additional head injury is only present in 1/3 of patients. An adequate structured primary diagnosis must therefore be mandatory. The a.p. X-ray of the pelvis is still the gold standard to evaluate these injuries. The majority of injuries is mechanically stable with 85-90% expected type A- and B-injuries. Primary management of these injuries is orientated to that of adults. The standard emergency fixation procedure is the external fixator. Definitive treatment depends on the displacement of fractures and the instability of the pelvic ring. In displaced and unstable fractures, today, anatomic reconstruction of the pelvic ring by osteosynthesis is favoured. Due to the potential negative long term consequences of mal-healing child-adapted stabilization techniques should be used. Moratlity is related to concomitant injuries, e.g. severe head injury. Risk factors of mortality are the overall injury severity, additional complex pelvic trauma and the type of pelvic fracture. Nevertheless, growth disturbances occur in rare cases. Therefore, frequent clinical and radiological controls are proposed until the completion of growth. Overall, good and excellent long-term results can be expected in most patients, especially after type A-injuries. But several long-term sequelae can occur in unstable pelvic injuries depending on the instability of the child's pelvis at the time of injury. Overall, there is a good correlation between the clinical and radiological result. Risk factors for a worse result can be additional significant peripelvic injuries (complex pelvic trauma).
Collapse
Affiliation(s)
- A Gänsslen
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum der Stadt Wolfsburg, Germany
| | | | | | | |
Collapse
|
44
|
Gänsslen A, Frink M, Hildebrand F, Krettek C. Both column fractures of the acetabulum: epidemiology, operative management and long-term-results. Acta Chir Orthop Traumatol Cech 2012; 79:107-113. [PMID: 22538099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE OF THE STUDY Both column fractures, defined as an acetabular fracture with no articular fragment in connection with the axial skeleton account for approximately 20% of all acetabular fractures. The typical type of a both column acetabular fracture is the C1.2 fracture with a multifragmentary anterior column fracture extending to the iliac crest and a large posterior column fragment in more than half of the patients. MATERIAL AND METHODS The analysis of 135 surgically treated patients with both column fractures showed that more than half of these patients had associated injuries. The mean age was 40 years, and two thirds of these patients were male. A high energy trauma was the trauma mechanism in 87.4%. The mean ISS was 14.2 points. The mean articular fracture displacement was 14.8 mm. 65.9% of the patients showed a central femoral head dislocation. An associated posterior wall fracture was present in 34.8% and an acetabular roof comminution in 34.1%. 8.9% of patients had a fracture related nerve damage. RESULTS Osteosynthesis was performed 9.6 days after trauma. Several approaches were used for stabilization with a combination of plate and screw fixation in 71.9%. The mean operative time was 287 minutes with a blood loss of 1796 ml. Post operatively the hip joint was congruent in 94.7% with anatomical or near-anatomical joint reconstruction in 75.6%. Iatrogenic nerve injury occurred in 12 patients (8.9%). 89 patients (66.4%) could be followed after a mean of 54.6 months. The average subjective Visual Analog Scale pain score was 27.6. Mild or no pain was seen in 60.7%. The mean Merle d'Aubigné score was 15 with 60.7% of patients having a functionally perfect or good result. 61.8% had no post-traumatic osteoarthritic changes of their hip joint. A joint failure was diagnosed in 25.8% of the patients. DISCUSSION Analysing only patients with anatomically reconstructed hip joints patients had better results with 69,8% having no or mild pain and a good or excellent functional result. Post-traumatic arthrotic changes occued in only 17.5% of these patients. A joint failure was present in 25.4%. In this group, a joint failure was significantly more likely to be present with an additional lesion of the femoral head and severe primary articular fracture displacement. CONCLUSIONS In contrast to other acetabular fracture types, both column fractures show worser results regarding joint reconstruction, and functional and radiological long-term results. The optimal results can be achieved with anatomic joint reconstruction.
Collapse
Affiliation(s)
- A Gänsslen
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum der Stadt Wolfsburg, Wolfsburg, Germany
| | | | | | | |
Collapse
|
45
|
Gänsslen A, Hildebrand F, Pohlemann T. Management of hemodynamic unstable patients "in extremis" with pelvic ring fractures. Acta Chir Orthop Traumatol Cech 2012; 79:193-202. [PMID: 22840950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The hemodynamic status in patients with pelvic ring injuries is a major prognostic factor of an immediate mortality risk. Especially, patients "in extremis" are of high risk to die. This patient group is characterized by absent vital signs or being in severe shock with initial systolic blood pressure .70 mm Hg and/or requiring mechanical resuscitation or catecholamines despite >12 blood transfusions within the first two hours after admission. The sources of pelvic bleeding is in approximately 80-90% of venous origin and relevant arterial bleeding accounts for 10-20%. Important parts of the initial treatment treatment concept include mechanical pelvic ring stabilization combined with hemorrhage control concepts. Mechanical stabilization is performed non-invasively by pelvic binder application or invasively by classical anterior pelvic fixation or posterior pelvic C-clamp, depending on the local available resources. In patients "in extremis" the concept of direct extraperitoneal pelvic packing is recommended, whereas in moderately unstable patients or in patients where persistant hemodynamic instability occurs despite shock therapy and mechanical stabilization and pelvic packing, arterial injury is ruled out by angiography followed by selected embolization of pelvic vessels.
Collapse
Affiliation(s)
- A Gänsslen
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum der Stadt Wolfsburg, Wolfsburg, Germany
| | | | | |
Collapse
|
46
|
Gänsslen A, Hildebrand F, Krettek C. Conservative treatment of acetabular both column fractures: does the concept of secondary congruence work? Acta Chir Orthop Traumatol Cech 2012; 79:411-415. [PMID: 23140596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Complete separation of all bony fragments around the acetabulum in both column fractures can lead to extra-anatomical orientation of these fragments around the femoral head with the potential of a "secondary congruence". No long-term data are known in the literature. We could follow 35 patients were a both column fracture was treated non-operatively due to different reasons. Demographics, fracture type, additional fracture lesions (comminution, marginal impaction), the clinical and radiological result and joint failure (severe arthrosis, FHN, esc. THR) were analyzed. The mean age was 38 years, 27 patients were male, eight female. All but four were multiply injured with a mean ISS of 22 points. 16 patients had additional pelvic ring injuries The majority of patients showed a C1-fracture of the acetabulum (anterior column multifragmentary, posterior column simple). 31 patients healed in secondary congruence (88%). Primary displacement was half (11,4 mm, 3-27 mm) compared to patients without secondary congruence (20 mm, 17-22 mm). 80% of the patients had none or only slight pain and 77% had an excellent or good functional result (Merle d'Aubigné Score). The rate of joint failure due to non-union, femoral head necrosis, posttraumatic degenerative changes or pain was relatively low with 17% after a mean of 5 years following trauma. In selected patients, conservative treatment of both column fractures can lead to acceptable long-term results with a high rate of secondary congruence.
Collapse
Affiliation(s)
- A Gänsslen
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum der Stadt Wolfsburg, Wolfsburg, Germany
| | | | | |
Collapse
|
47
|
Zeckey C, Vanin N, Neitzke G, Mommsen P, Bachmann S, Frink M, Wilhelmi M, Krettek C, Hildebrand F. [Jehova's Witnesses and severe injury with impending hemorrhaging : how complex is the treatment?]. Chirurg 2011; 82:531-5. [PMID: 21088815 DOI: 10.1007/s00104-010-1999-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hemorrhage is frequently seen during the early phases of polytrauma management and intensive care treatment of the severely injured. Traumatic coagulopathy as well as the sometimes overlooked hyperfibrinolysis may lead to further complications. Therefore, transfusion of blood products and coagulation factors is often crucial. Jehova's Witnesses reject transfusions of blood and blood products due to religious convictions. In this case report a therapeutic approach of a multiple trauma patient suffering from traumatic brain injury, blunt chest trauma and liver laceration is described, who has been treated without blood products. As one main focus, ethical as well as legal aspects are discussed. Beside therapeutic concepts, such as the administration of coagulation factors, recombinant erythropoietin and iron, ethical and legal aspects remain part of the controversial discussion.
Collapse
Affiliation(s)
- C Zeckey
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Deutschland.
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Stübig T, Mommsen P, Krettek C, Probst C, Frink M, Zeckey C, Andruszkow H, Hildebrand F. [Comparison of early total care (ETC) and damage control orthopedics (DCO) in the treatment of multiple trauma with femoral shaft fractures: benefit and costs]. Unfallchirurg 2011; 113:923-30. [PMID: 20960146 DOI: 10.1007/s00113-010-1887-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Femoral fractures are common injuries in multiple trauma patients. The treatment concept of damage control orthopedics (DCO) is in competition with the concept of early total care (ETC). PATIENTS AND METHODS In a retrospective study (2003-2007) 73 multiple trauma patients with femoral shaft fractures were included. The cohort was subdivided according to the Injury Severity Score (ISS) (16-24, 25-39 and more than 40) and treatment strategy (ETC versus DCO). Patients were analyzed for outcome and cost aspects. RESULTS In the patient group with an ISS 16-24 ventilation time and intensive care treatment were longer after DCO treatment, overall costs and deficient cost cover were higher in the DCO group. In the patient group with an ISS 25-39 cost aspects showed a higher cover deficient in the DCO group. CONCLUSION From an economic point of view the cost deficits for the ETC group were lower than in the DCO group. The treatment strategy should be selected by the pattern of injuries. The costs should be addressed by the Institute for the Hospital Remuneration System (INEK).
Collapse
Affiliation(s)
- T Stübig
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Abstract
BACKGROUND Hypothermia, defined as a body core temperature below 35 °C, could be divided into an endogeneous, therapeutic and accidental hypothermia. At admission in the emergency room multiple trauma patients show a hypothermic core temperature in up to 66 %. A core temperature below 34 °C seems to be critical in these patients as this temperature limit has been demonstrated to be associated with an increased risk for post-traumatic complications and a decreased survival. In polytraumatised patients with a core temperature below 32 °C a mortality rate of 100 % has been described. MATERIAL AND METHODS The main pathophysiological effects of hypothermia concern the haemo-dynamic, coagulatory and immune systems. Mild hypothermia (35-32 °C) leads to a vasoconstriction, tachycardia and increased cardiac output. After an increasing arrhythmia and bradycardia severe hypothermia (< 32 °C) finally results in a cardiac arrest. Hypothermia-induced coagulopathy comprises a dysfunction of the cellular and plasmatic coagulation with an increased blood loss. Due to the attenuation of the post-traumatic, pro-inflammatory immune response and enhancement of anti-inflammatory reactions, hypothermia counteracts an overwhelming systemic inflammation, concomitantly resulting in an increased susceptibility for infectious complications. RESULTS Because of the negative effects of the -accidental hypothermia, effective rewarming is essential for adequate bleeding control and successful resuscitation. As aggressive rewarming (> 0.5 °C / h) has been reported to be associated with an increased mortality during the further course, this procedure should only be applied in hypothermic multiple trauma patients with haemorrhagic shock. CONCLUSION Accidental hypothermia represents a serious problem in multiple trauma patients due to its frequency and negative pathophysiological effects. Therefore, early and effective re-warm-ing is essential in the treatment of hypothermic trauma patients. Possible protective effects of a therapeutic hypothermia in the treatment of trauma patients after initial resuscitation and operative bleeding control have to be clarified in further experimental and clinical studies.
Collapse
Affiliation(s)
- P Mommsen
- Medizinische Hochschule Hannover, Unfallchirurgische Klinik, Hannover, Deutschland.
| | | | | | | | | |
Collapse
|
50
|
Gaulke R, Abdulkareem M, O'Loughlin PF, Oszwald M, Probst C, Hildebrand F, Krettek C. First clinical experience with a novel forearm boom. Technol Health Care 2011; 18:317-24. [PMID: 21209480 DOI: 10.3233/thc-2010-0595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The optimal forearm boom should facilitate dynamic investigation of the wrist and approaches for wrist arthroscopy. It should be safely fixed at the operating table without any contact with the patient. It must be compatible with the arm of any patient and should be sterilisable. Repositioning of distal radius fractures, fluoroscopy and insertion of Kirschner-wires should not be restricted. According to these criteria the current investigators designed a new forearm boom which was subsequently used in 19 wrist arthroscopies and 9 distal radius fracture fixations. Twenty-eight patients with heights between 150 and 205 cm and forearm lengths between 17.5 to 37 cm were treated. Preoperatively, wrist motion was tested in those 19 wrists, that underwent wrist arthroscopy, before and after fixation by the forearm boom and any restriction due to usage of the novel device was found. The new forearm boom satisfied all of the criteria cited above. Therefore the current authors believe the new forearm boom may be valuable for the indications mentioned.
Collapse
Affiliation(s)
- R Gaulke
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Germany.
| | | | | | | | | | | | | |
Collapse
|