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Fuchs KF, Kerwagen F, Kunz AS, Schulze A, Ullrich M, Ertl M, Gilbert F. [Optimizing radiological diagnostic management via mobile devices in trauma surgery]. Unfallchirurgie (Heidelb) 2024; 127:374-380. [PMID: 38300253 PMCID: PMC11058621 DOI: 10.1007/s00113-024-01410-8] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Time is a scarce resource for physicians. One medical task is the request for radiological diagnostics. This process is characterized by high administrative complexity and sometimes considerable time consumption. Measures that lead to an administrative relief in favor of patient care have so far been lacking. AIM OF THE STUDY Process optimization of the request for radiological diagnostics. As a proof of concept the request for radiological diagnostics was conducted using a mobile, smartphone and tablet-based application with dedicated voice recognition software in the Department of Trauma Surgery at the University Hospital of Würzburg (UKW). MATERIAL AND METHODS In a prospective study, time differences and efficiency of the mobile app-based method (ukw.mobile based Application = UMBA) compared to the PC-based method (PC-based application = PCBA) for requesting radiological services were analyzed. The time from the indications to the completed request and the time required to create the request on the device were documented and assessed. Due to the non-normal distribution of the data, a Mann-Whitney U test was performed. RESULTS The time from the indications to the completed request was significantly (p < 0.05) reduced using UMBA compared to PCBA (PCBA: mean ± standard difference [SD] 19.57 ± 33.24 min, median 3.00 min, interquartile range [IQR] 1.00-30.00 min vs. UMBA: 9.33 ± 13.94 min, median 1.00 min, IQR 0.00-20.00 min). The time to complete the request on the device was also significantly reduced using UMBA (PCBA: mean ± SD 63.77 ± 37.98 s, median 51.96 s, IQR 41.68-68.93 s vs. UMBA: 25.21 ± 11.18 s, median 20.00 s, IQR 17.27-29.00 s). CONCLUSION The mobile, voice-assisted request process leads to a considerable time reduction in daily clinical routine and illustrates the potential of user-oriented, targeted digitalization in healthcare. In future, the process will be supported by artificial intelligence.
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Affiliation(s)
- Konrad F Fuchs
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Würzburg, Deutschland.
- Digitalisierungszentrum Präzisions- und Telemedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland.
| | - Fabian Kerwagen
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Würzburg, Würzburg, Deutschland
- Digitalisierungszentrum Präzisions- und Telemedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Andreas S Kunz
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
- Digitalisierungszentrum Präzisions- und Telemedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Andrés Schulze
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
- Digitalisierungszentrum Präzisions- und Telemedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Melanie Ullrich
- Digitalisierungszentrum Präzisions- und Telemedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Maximilian Ertl
- Digitalisierungszentrum Präzisions- und Telemedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Fabian Gilbert
- Digitalisierungszentrum Präzisions- und Telemedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
- LMU Klinikum Großhadern, Muskuloskelettales Universitätszentrum München, München, Deutschland
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Erber B, Hesse N, Goller S, Gilbert F, Ricke J, Glaser C, Heuck A. Diagnostic performance and interreader agreement of individual and combined non-enhanced and contrast-enhanced MR imaging parameters in adhesive capsulitis of the shoulder. Skeletal Radiol 2024; 53:263-273. [PMID: 37400604 PMCID: PMC10730686 DOI: 10.1007/s00256-023-04391-8] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/13/2023] [Accepted: 06/17/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE The aims of our study were to analyze agreement among readers with different levels of expertise and diagnostic performance of individual and combined imaging signs for the diagnosis of adhesive capsulitis of the shoulder. METHODS In a retrospective study, contrast-enhanced shoulder MRIs of 60 patients with and 120 without clinically diagnosed adhesive capsulitis were evaluated by three readers independently. As non-enhanced imaging signs, readers evaluated signal intensity and thickness of the axillary recess capsule, thickness of the rotator interval capsule and the coracohumeral ligament as well as obliteration of subcoracoid fat. Furthermore, contrast enhancement of axillary recess and rotator interval capsule were evaluated. Data analysis included interreader reliability, ROC analysis, and logistic regression (p < 0.05). RESULTS Contrast-enhanced parameters showed substantially higher agreement among readers (ICC 0.79-0.80) than non-enhanced parameters (0.37-0.45). AUCs of contrast-enhanced signs (95.1-96.6%) were significantly higher (p < 0.01) than of non-enhanced imaging signs (61.5-85.9%) when considered individually. Combined evaluation of axillary recess signal intensity and thicknesses of axillary recess or rotator interval-when at least one of two signs was rated positive-increased accuracy compared to individual imaging signs, however not statistically significant. CONCLUSION Contrast-enhanced imaging signs show both distinctly higher agreement among readers and distinctly higher diagnostic performance compared to non-enhanced imaging signs based on the imaging protocol used in this study. Combined evaluation of parameters showed a tendency to increase discrimination; however, the effect on diagnosis of ACS was not statistically significant.
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Affiliation(s)
- Bernd Erber
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Nina Hesse
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Sophia Goller
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Fabian Gilbert
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Glaser
- Radiologisches Zentrum München, Pippinger Str. 25, 81245, Munich, Germany
| | - Andreas Heuck
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Radiologisches Zentrum München, Pippinger Str. 25, 81245, Munich, Germany
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Fuchs K, Backhaus R, Jordan MC, Lefering R, Meffert RH, Gilbert F. [The severely injured older cyclist-Evaluation of the TraumaRegister DGU® : Retrospective, multicenter cross-sectional study based on the TraumaRegister DGU®]. Unfallchirurgie (Heidelb) 2023; 126:952-959. [PMID: 36988660 PMCID: PMC10682217 DOI: 10.1007/s00113-022-01286-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 03/30/2023]
Abstract
BACKGROUND Contrary to the trend of decreasing traffic fatalities, the number of cyclists killed in Germany has been steadily increasing in recent years. With the increasing popularity of cycling in all age groups, the number of accidents with sometimes serious injuries is rising. In the course of this, the question arises what influence age has on the type and severity of injuries, the probability of survival and the length of hospital stay in seriously injured cyclists. METHODS A retrospective analysis of data from the TraumaRegister DGU® (TR-DGU) from 2010 to 2019 was performed. All severely injured cyclists with a maximum abbreviated injury scale (MAIS) of 3+ (n = 14,651) in the TR-DGU were included in this study and the available parameters were evaluated. A subdivision into three age groups (60-69, 70-79, and ≥ 80 years) and a control group (20-59 years) was carried out. RESULTS Injuries to the head were by far the most common, accounting for 64.2%. There was a marked increase in severe head injuries in the 60-plus years age group. Furthermore, with increasing age, the probability of prehospital intubation, catecholamine requirement, intensive care and hospital length of stay, and mortality increased. CONCLUSION Head injuries represent the most common serious injury, especially among older cyclists. As helmet wearing was not recorded in the TraumaRegister DGU® during the evaluation period, no conclusion can be drawn about its effect. Furthermore, a higher age correlates with a longer hospital stay and a higher mortality, but does not represent an independent risk factor for death in severely injured patients.
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Affiliation(s)
- Konrad Fuchs
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland
| | - Roman Backhaus
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland
| | - Martin C Jordan
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland
| | - Rolf Lefering
- MUM - Muskuloskelettales Universitätszentrum München, Ludwigs-Maximilians-Universität München, Campus Innenstadt, Ziemssenstr. 5, 80336, München, Deutschland
| | - Rainer H Meffert
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland
| | - Fabian Gilbert
- MUM - Muskuloskelettales Universitätszentrum München, Ludwigs-Maximilians-Universität München, Campus Innenstadt, Ziemssenstr. 5, 80336, München, Deutschland.
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Demmer W, Aranda IM, Wiggenhauser PS, Braig D, Gilbert F, Giunta R. [Multidrug-resistant bacterial colonisation in Ukrainian war injuries: a need for multimodal therapy]. HANDCHIR MIKROCHIR P 2023; 55:457-461. [PMID: 37813349 DOI: 10.1055/a-2108-8978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
This case report describes the interdisciplinary treatment of a complex shrapnel injury to the right femur of an 18-year-old Ukrainian soldier. This open multifragmentary fractur of the femur with a large bone defect, soft tissue damage and osteomyelitis was complicated by several multidrug-resistant bacteria, including Acinetobacter baumanii, which could not be eradicated by antibiotic treatment. Sterility was only achieved by multiple radical debridement and by negative pressure wound therapy with instillation (NPWTi) using hypochlorous acid. The femur was then reconstructed with a chimeric double-barrel fibula free flap. This report highlights the importance of multimodal antimicrobial wound treatments in an era of increasing antibiotic resistance to enable a successful und functional reconstruction of complex and infected fractures.
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Affiliation(s)
- Wolfram Demmer
- Abteilung für Hand-, Plastische und Ästhetische Chirurgie, LMU Klinikum, LMU München, München, Deutschland
| | - Irene Mesas Aranda
- Abteilung für Hand-, Plastische und Ästhetische Chirurgie, LMU Klinikum, LMU München, München, Deutschland
| | - Paul Severin Wiggenhauser
- Abteilung für Hand-, Plastische und Ästhetische Chirurgie, LMU Klinikum, LMU München, München, Deutschland
| | - David Braig
- Abteilung für Hand-, Plastische und Ästhetische Chirurgie, LMU Klinikum, LMU München, München, Deutschland
| | - Fabian Gilbert
- Klinik für Orthopädie und Unfallchirurgie, LMU Klinikum, LMU München, München, Deutschland
| | - Riccardo Giunta
- Abteilung für Hand-, Plastische und Ästhetische Chirurgie, LMU Klinikum, LMU München, München, Deutschland
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Fenwick A, Reichel T, Eden L, Schmalzl J, Meffert R, Plumhoff P, Gilbert F. Deltoid Muscle Tension Alterations Post Reverse Shoulder Arthroplasty: An Investigation Using Shear Wave Elastography. J Clin Med 2023; 12:6184. [PMID: 37834827 PMCID: PMC10573934 DOI: 10.3390/jcm12196184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/06/2023] [Accepted: 09/05/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION This study aimed to evaluate the utility of shear wave elastography (SWE) in assessing changes in deltoid muscle properties following reverse shoulder arthroplasty (RSA). METHODS Our cohort consisted of 18 patients who underwent RSA due to various conditions, including osteoarthritis, cuff arthropathy, and irreducible proximal humeral fractures. Pre- and postoperative muscle elasticity and stiffness were measured using SWE and were compared with functional outcomes and radiological parameters. RESULTS Our results showed significant changes in deltoid muscle elasticity after RSA, particularly in the anterior and middle portions. However, these alterations were not correlated with postoperative functional outcomes or specific radiological parameters. The study also underscored the potential of SWE for future applications, including the preoperative assessment of deltoid function, postoperative monitoring, and intraoperative use for optimal component positioning during RSA. CONCLUSION Further research, involving larger, more homogeneous patient cohorts is needed to confirm these findings and to explore the potential influence of these changes on the biomechanical design of implants and prosthesis positioning in RSA.
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Affiliation(s)
- Annabel Fenwick
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Wuerzburg, Oberduerrbacher Str. 6, 97080 Wuerzburg, Germany
- Department of Trauma, Orthopedic, Hand and Plastic Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
| | - Thomas Reichel
- Muskuloskelettales Universitätszentrum München, Unfallchirurgie, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 München, Germany
| | - Lars Eden
- Department of Trauma, Shoulder and Reconstructive Surgery, Krankenhaus Rummelsberg GmbH, Rummelsberg 71, 90592 Schwarzenbruck, Germany
| | - Jonas Schmalzl
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Wuerzburg, Oberduerrbacher Str. 6, 97080 Wuerzburg, Germany
| | - Rainer Meffert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Wuerzburg, Oberduerrbacher Str. 6, 97080 Wuerzburg, Germany
| | - Piet Plumhoff
- Ortho Höchberg, Zentrum für Orthopädie und Unfallchirurgie, Hauptstraße 78, 97204 Höchberg, Germany
| | - Fabian Gilbert
- Muskuloskelettales Universitätszentrum München, Unfallchirurgie, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 München, Germany
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Laubach M, Hildebrand F, Suresh S, Wagels M, Kobbe P, Gilbert F, Kneser U, Holzapfel BM, Hutmacher DW. The Concept of Scaffold-Guided Bone Regeneration for the Treatment of Long Bone Defects: Current Clinical Application and Future Perspective. J Funct Biomater 2023; 14:341. [PMID: 37504836 PMCID: PMC10381286 DOI: 10.3390/jfb14070341] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/31/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023] Open
Abstract
The treatment of bone defects remains a challenging clinical problem with high reintervention rates, morbidity, and resulting significant healthcare costs. Surgical techniques are constantly evolving, but outcomes can be influenced by several parameters, including the patient's age, comorbidities, systemic disorders, the anatomical location of the defect, and the surgeon's preference and experience. The most used therapeutic modalities for the regeneration of long bone defects include distraction osteogenesis (bone transport), free vascularized fibular grafts, the Masquelet technique, allograft, and (arthroplasty with) mega-prostheses. Over the past 25 years, three-dimensional (3D) printing, a breakthrough layer-by-layer manufacturing technology that produces final parts directly from 3D model data, has taken off and transformed the treatment of bone defects by enabling personalized therapies with highly porous 3D-printed implants tailored to the patient. Therefore, to reduce the morbidities and complications associated with current treatment regimens, efforts have been made in translational research toward 3D-printed scaffolds to facilitate bone regeneration. Three-dimensional printed scaffolds should not only provide osteoconductive surfaces for cell attachment and subsequent bone formation but also provide physical support and containment of bone graft material during the regeneration process, enhancing bone ingrowth, while simultaneously, orthopaedic implants supply mechanical strength with rigid, stable external and/or internal fixation. In this perspective review, we focus on elaborating on the history of bone defect treatment methods and assessing current treatment approaches as well as recent developments, including existing evidence on the advantages and disadvantages of 3D-printed scaffolds for bone defect regeneration. Furthermore, it is evident that the regulatory framework and organization and financing of evidence-based clinical trials remains very complex, and new challenges for non-biodegradable and biodegradable 3D-printed scaffolds for bone regeneration are emerging that have not yet been sufficiently addressed, such as guideline development for specific surgical indications, clinically feasible design concepts for needed multicentre international preclinical and clinical trials, the current medico-legal status, and reimbursement. These challenges underscore the need for intensive exchange and open and honest debate among leaders in the field. This goal can be addressed in a well-planned and focused stakeholder workshop on the topic of patient-specific 3D-printed scaffolds for long bone defect regeneration, as proposed in this perspective review.
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Affiliation(s)
- Markus Laubach
- Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Centre for Biomedical Technologies, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Sinduja Suresh
- Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Centre for Biomedical Technologies, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Michael Wagels
- Department of Plastic Surgery, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia;
- The Herston Biofabrication Institute, The University of Queensland, Herston, QLD 4006, Australia
- Southside Clinical Division, School of Medicine, University of Queensland, Woolloongabba, QLD 4102, Australia
- Department of Plastic and Reconstructive Surgery, Queensland Children’s Hospital, South Brisbane, QLD 4101, Australia
- The Australian Centre for Complex Integrated Surgical Solutions, Woolloongabba, QLD 4102, Australia
| | - Philipp Kobbe
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Fabian Gilbert
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Boris M. Holzapfel
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Dietmar W. Hutmacher
- Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Centre for Biomedical Technologies, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Max Planck Queensland Centre (MPQC) for the Materials Science of Extracellular Matrices, Queensland University of Technology, Brisbane, QLD 4000, Australia
- ARC Training Centre for Cell and Tissue Engineering Technologies (CTET), Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia
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Paul MM, Mieden HJ, Lefering R, Kupczyk EK, Jordan MC, Gilbert F, Meffert RH, Sirén AL, Hoelscher-Doht S. Impact of a Femoral Fracture on Outcome after Traumatic Brain Injury-A Matched-Pair Analysis of the TraumaRegister DGU ®. J Clin Med 2023; 12:jcm12113802. [PMID: 37297997 DOI: 10.3390/jcm12113802] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Traumatic brain injury (TBI) is the leading cause of death and disability in polytrauma and is often accompanied by concomitant injuries. We conducted a retrospective matched-pair analysis of data from a 10-year period from the multicenter database TraumaRegister DGU® to analyze the impact of a concomitant femoral fracture on the outcome of TBI patients. A total of 4508 patients with moderate to critical TBI were included and matched by severity of TBI, American Society of Anesthesiologists (ASA) risk classification, initial Glasgow Coma Scale (GCS), age, and sex. Patients who suffered combined TBI and femoral fracture showed increased mortality and worse outcome at the time of discharge, a higher chance of multi-organ failure, and a rate of neurosurgical intervention. Especially those with moderate TBI showed enhanced in-hospital mortality when presenting with a concomitant femoral fracture (p = 0.037). The choice of fracture treatment (damage control orthopedics vs. early total care) did not impact mortality. In summary, patients with combined TBI and femoral fracture have higher mortality, more in-hospital complications, an increased need for neurosurgical intervention, and inferior outcome compared to patients with TBI solely. More investigations are needed to decipher the pathophysiological consequences of a long-bone fracture on the outcome after TBI.
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Affiliation(s)
- Mila M Paul
- Department of Orthopedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Würzburg, 97080 Würzburg, Germany
- Department of Neurophysiology, Institute for Physiology, Julius-Maximilians-University Würzburg, 97070 Würzburg, Germany
- Department of Neurosurgery, University Hospital of Würzburg, 97080 Würzburg, Germany
| | - Hannah J Mieden
- Department of Orthopedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Würzburg, 97080 Würzburg, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, 51109 Cologne, Germany
| | - Eva K Kupczyk
- Department of Orthopedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Würzburg, 97080 Würzburg, Germany
| | - Martin C Jordan
- Department of Orthopedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Würzburg, 97080 Würzburg, Germany
| | - Fabian Gilbert
- LMU Klinikum Campus Innenstadt, University of München, 80336 Munich, Germany
| | - Rainer H Meffert
- Department of Orthopedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Würzburg, 97080 Würzburg, Germany
| | - Anna-Leena Sirén
- Department of Neurophysiology, Institute for Physiology, Julius-Maximilians-University Würzburg, 97070 Würzburg, Germany
- Department of Neurosurgery, University Hospital of Würzburg, 97080 Würzburg, Germany
| | - Stefanie Hoelscher-Doht
- Department of Orthopedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Würzburg, 97080 Würzburg, Germany
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Fauquembergue L, Le Guen V, Badreau M, Gilbert F, Descatha A. Matrices secteurs-inaptitudes et handicap à la Réunion : de la description, la prédiction par Machine Learning à la prévention de la désinsertion professionnelle. ARCH MAL PROF ENVIRO 2023. [DOI: 10.1016/j.admp.2022.101705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Neudeck R, Daferner MP, Fleischhacker E, Helfen T, Gilbert F, Böcker W, Ockert B, Siebenbürger G. Mid-term functional outcome (minimum 24 months, mean 4 years) after locking plate osteosynthesis for displaced fractures of the proximal humerus in 557 cases. Injury 2023:S0020-1383(23)00289-9. [PMID: 37012129 DOI: 10.1016/j.injury.2023.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/16/2023] [Accepted: 03/23/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND The best surgical management of displaced proximal humeral fractures remains a matter of considerable debate. This study presents mid-term functional outcome (median 4 years) after locking plate osteosynthesis for displaced proximal humeral fractures. METHODS Between February 2002 and December 2014 1031 patients with 1047 displaced proximal humeral fractures were treated by open reduction and locking plate fixation with the same implant and received consecutive prospective follow up at least 24 months after surgical treatment. Clinical follow-up consisted of Constant Murley score (CS), Disabilities of the Arm, Shoulder and Hand score (DASH), and Short Form 36 questionnaire (SF-36). Complete follow-up could be performed in 557 (53.2%) cases, with a mean follow-up of 4.0 ± 2.7 years. RESULTS Of 557 patients (67% women; mean age at time of osteosynthesis: 68.3 ± 15.5 years) absolute CS of all patients 4 ± 2.7 years after surgery was 68.4 ± 20.3 points. Normalized CS according to Katolik was 80.4 ± 23.8 points, and CS in percentage to the contralateral side (%CS) was 87.2 ± 27.9%. DASH score was at 23.8 ± 20.8 points. Osteosynthesis related complications (secondary displacement, screw cutout, avascular necrosis (n = 117 patients) were associated with lower functional scores (mean CS was 54.5 ± 19.0 p.; nCS 64.5 ± 22.9 p.;%CS 71.2 ± 25.0%; DASH score 31.9 ± 22.4 p.). The SF 36 was 66.5 points in the case cohort and a vitality mean of 69.4 points. Patients with a complication showed lower results (SF 36 56.7; vitality mean 64.9 points). CONCLUSIONS Overall, patients following locking plate osteosynthesis of displaced proximal humeral fractures showed good to moderate outcomes four years after surgery. Mid-term functional outcomes correlate significantly with those at 1 year postoperatively. Furthermore, there is a significant negative correlation of midterm functional outcome with the occurrence of complications. LEVEL OF EVIDENCE Level III, prospective nonconsecutive patients.
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Affiliation(s)
- Rouven Neudeck
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Marchioninistr. 15, Munich 81377, Germany
| | | | - Evi Fleischhacker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Marchioninistr. 15, Munich 81377, Germany
| | - Tobias Helfen
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Marchioninistr. 15, Munich 81377, Germany
| | - Fabian Gilbert
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Marchioninistr. 15, Munich 81377, Germany
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Marchioninistr. 15, Munich 81377, Germany
| | - Ben Ockert
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Marchioninistr. 15, Munich 81377, Germany
| | - Georg Siebenbürger
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Marchioninistr. 15, Munich 81377, Germany.
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10
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Weißenberger M, Wagenbrenner M, Nickel J, Ahlbrecht R, Blunk T, Steinert AF, Gilbert F. Comparative in vitro treatment of mesenchymal stromal cells with GDF-5 and R57A induces chondrogenic differentiation while limiting chondrogenic hypertrophy. J Exp Orthop 2023; 10:29. [PMID: 36943593 PMCID: PMC10030724 DOI: 10.1186/s40634-023-00594-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/08/2023] [Indexed: 03/23/2023] Open
Abstract
PURPOSE Hypertrophic cartilage is an important characteristic of osteoarthritis and can often be found in patients suffering from osteoarthritis. Although the exact pathomechanism remains poorly understood, hypertrophic de-differentiation of chondrocytes also poses a major challenge in the cell-based repair of hyaline cartilage using mesenchymal stromal cells (MSCs). While different members of the transforming growth factor beta (TGF-β) family have been shown to promote chondrogenesis in MSCs, the transition into a hypertrophic phenotype remains a problem. To further examine this topic we compared the effects of the transcription growth and differentiation factor 5 (GDF-5) and the mutant R57A on in vitro chondrogenesis in MSCs. METHODS Bone marrow-derived MSCs (BMSCs) were placed in pellet culture and in-cubated in chondrogenic differentiation medium containing R57A, GDF-5 and TGF-ß1 for 21 days. Chondrogenesis was examined histologically, immunohistochemically, through biochemical assays and by RT-qPCR regarding the expression of chondrogenic marker genes. RESULTS Treatment of BMSCs with R57A led to a dose dependent induction of chondrogenesis in BMSCs. Biochemical assays also showed an elevated glycosaminoglycan (GAG) content and expression of chondrogenic marker genes in corresponding pellets. While treatment with R57A led to superior chondrogenic differentiation compared to treatment with the GDF-5 wild type and similar levels compared to incubation with TGF-ß1, levels of chondrogenic hypertrophy were lower after induction with R57A and the GDF-5 wild type. CONCLUSIONS R57A is a stronger inducer of chondrogenesis in BMSCs than the GDF-5 wild type while leading to lower levels of chondrogenic hypertrophy in comparison with TGF-ß1.
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Affiliation(s)
- Manuel Weißenberger
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Julius-Maximilians-University Würzburg, König-Ludwig-Haus, Würzburg, Germany.
- Department of Orthopedic Surgery, University of Wuerzburg, König-Ludwig-Haus, Brettreichstraße 11, 97074, Würzburg, Germany.
| | - Mike Wagenbrenner
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Julius-Maximilians-University Würzburg, König-Ludwig-Haus, Würzburg, Germany
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Joachim Nickel
- Department of Tissue Engineering and Regenerative Medicine, Julius-Maximilians-University Würzburg, University Hospital, Würzburg, Germany
| | - Rasmus Ahlbrecht
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Julius-Maximilians-University Würzburg, König-Ludwig-Haus, Würzburg, Germany
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, Julius-Maximilians-University Würzburg, University Hospital, Würzburg, Germany
| | - Torsten Blunk
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, Julius-Maximilians-University Würzburg, University Hospital, Würzburg, Germany
| | - Andre F Steinert
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Julius-Maximilians-University Würzburg, König-Ludwig-Haus, Würzburg, Germany
- Current address:, Department of Orthopaedic, Trauma, Shoulder and Arthroplasty Surgery, Rhön-Klinikum, Campus Bad Neustadt, Bad Neustadt, Germany
| | - Fabian Gilbert
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, Julius-Maximilians-University Würzburg, University Hospital, Würzburg, Germany
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11
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Kerwagen F, Fuchs KF, Ullrich M, Schulze A, Straka S, Krop P, Latoschik ME, Gilbert F, Kunz A, Fette G, Störk S, Ertl M. Usability of a mHealth Solution using Speech Recognition for Point-of-care Diagnostic Management. J Med Syst 2023; 47:18. [PMID: 36729251 PMCID: PMC9895017 DOI: 10.1007/s10916-022-01896-y] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 11/22/2022] [Indexed: 02/03/2023]
Abstract
The administrative burden for physicians in the hospital can affect the quality of patient care. The Service Center Medical Informatics (SMI) of the University Hospital Würzburg developed and implemented the smartphone-based mobile application (MA) ukw.mobile1 that uses speech recognition for the point-of-care ordering of radiological examinations. The aim of this study was to examine the usability of the MA workflow for the point-of-care ordering of radiological examinations. All physicians at the Department of Trauma and Plastic Surgery at the University Hospital Würzburg, Germany, were asked to participate in a survey including the short version of the User Experience Questionnaire (UEQ-S) and the Unified Theory of Acceptance and Use of Technology (UTAUT). For the analysis of the different domains of user experience (overall attractiveness, pragmatic quality and hedonic quality), we used a two-sided dependent sample t-test. For the determinants of the acceptance model, we employed regression analysis. Twenty-one of 30 physicians (mean age 34 ± 8 years, 62% male) completed the questionnaire. Compared to the conventional desktop application (DA) workflow, the new MA workflow showed superior overall attractiveness (mean difference 2.15 ± 1.33), pragmatic quality (mean difference 1.90 ± 1.16), and hedonic quality (mean difference 2.41 ± 1.62; all p < .001). The user acceptance measured by the UTAUT (mean 4.49 ± 0.41; min. 1, max. 5) was also high. Performance expectancy (beta = 0.57, p = .02) and effort expectancy (beta = 0.36, p = .04) were identified as predictors of acceptance, the full predictive model explained 65.4% of its variance. Point-of-care mHealth solutions using innovative technology such as speech-recognition seem to address the users' needs and to offer higher usability in comparison to conventional technology. Implementation of user-centered mHealth innovations might therefore help to facilitate physicians' daily work.
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Affiliation(s)
- Fabian Kerwagen
- University Hospital Würzburg: Universitätsklinikum Würzburg, Würzburg, Germany.
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany.
| | - Konrad F Fuchs
- University Hospital Würzburg: Universitätsklinikum Würzburg, Würzburg, Germany
| | - Melanie Ullrich
- University Hospital Würzburg: Universitätsklinikum Würzburg, Würzburg, Germany
| | - Andres Schulze
- University Hospital Würzburg: Universitätsklinikum Würzburg, Würzburg, Germany
| | - Samantha Straka
- University of Würzburg: Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Philipp Krop
- University of Würzburg: Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Marc E Latoschik
- University of Würzburg: Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Fabian Gilbert
- University Hospital Würzburg: Universitätsklinikum Würzburg, Würzburg, Germany
| | - Andreas Kunz
- University Hospital Würzburg: Universitätsklinikum Würzburg, Würzburg, Germany
| | - Georg Fette
- University Hospital Würzburg: Universitätsklinikum Würzburg, Würzburg, Germany
| | - Stefan Störk
- University Hospital Würzburg: Universitätsklinikum Würzburg, Würzburg, Germany
| | - Maximilian Ertl
- University Hospital Würzburg: Universitätsklinikum Würzburg, Würzburg, Germany
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12
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Jordan MC, Bröer D, Fischer C, Heilig P, Gilbert F, Hölscher-Doht S, Kalogirou C, Popp K, Grunz JP, Huflage H, Jakubietz RG, Ergün S, Meffert RH. Development and preclinical evaluation of a cable-clamp fixation device for a disrupted pubic symphysis. Commun Med (Lond) 2022; 2:164. [PMID: 36550296 PMCID: PMC9780275 DOI: 10.1038/s43856-022-00227-z] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Traumatic separation of the pubic symphysis can destabilize the pelvis and require surgical fixation to reduce symphyseal gapping. The traditional approach involves open reduction and the implantation of a steel symphyseal plate (SP) on the pubic bone to hold the reposition. Despite its widespread use, SP-fixation is often associated with implant failure caused by screw loosening or breakage. METHODS To address the need for a more reliable surgical intervention, we developed and tested two titanium cable-clamp implants. The cable served as tensioning device while the clamp secured the cable to the bone. The first implant design included a steel cable anterior to the pubic symphysis to simplify its placement outside the pelvis, and the second design included a cable encircling the pubic symphysis to stabilize the anterior pelvic ring. Using highly reproducible synthetic bone models and a limited number of cadaver specimens, we performed a comprehensive biomechanical study of implant stability and evaluated surgical feasibility. RESULTS We were able to demonstrate that the cable-clamp implants provide stability equivalent to that of a traditional SP-fixation but without the same risks of implant failure. We also provide detailed ex vivo evaluations of the safety and feasibility of a trans-obturator surgical approach required for those kind of fixation. CONCLUSION We propose that the developed cable-clamp fixation devices may be of clinical value in treating pubic symphysis separation.
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Affiliation(s)
- Martin C Jordan
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - David Bröer
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Christian Fischer
- Headmade Materials, Langhausstraße 9, 97294, Unterpleichfeld, Germany
| | - Philipp Heilig
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Fabian Gilbert
- Center of Musculoskeletal Medicine, University Hospital LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Stefanie Hölscher-Doht
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Charis Kalogirou
- Department of Urology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Kevin Popp
- Additive Manufacturing Research Unit, SKZ Technology Center, Friedrich-Bergius-Ring 22, 97076, Würzburg, Germany
| | - Jan-Peter Grunz
- Department of Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Henner Huflage
- Department of Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Rafael G Jakubietz
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Süleyman Ergün
- Institute of Anatomy, Julius-Maximilians-University Würzburg, Koellikerstraße 6, 97070, Würzburg, Germany
| | - Rainer H Meffert
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
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13
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Rubion E, Fouquet N, Gilbert F, Roquelaure Y. Fractions de risque attribuable aux douleurs chroniques ou intenses de l’épaule en France à partir de la cohorte Constances. ARCH MAL PROF ENVIRO 2022. [DOI: 10.1016/j.admp.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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14
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Fleischhacker E, Siebenbürger G, Gleich J, Böcker W, Gilbert F, Helfen T. The Accuracy of Distal Clavicle Fracture Classifications-Do We Need an Amendment to Imaging Modalities or Fracture Typing? J Clin Med 2022; 11:jcm11195638. [PMID: 36233506 PMCID: PMC9572249 DOI: 10.3390/jcm11195638] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/11/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Despite its fair-to-moderate reliability, the “modified Neer classification” is widely accepted and used. The purpose of this study was to reevaluate its applicability. Methods: Of n = 59 patients with distal clavicle fractures, fractures were classified on standard radiographs. Afterwards, an MRI examination was performed, and fractures reclassified. The primary outcome parameter was quantifying the rate of misclassification. The secondary outcome parameters were the evaluation of the ligamentous injury constellations. Results: In all cases, the fracture course and ligamental integrity could be assigned to the fracture type. Correction of the classification was necessary in n = 5 (8.5%) cases. In n = 3 (5%) cases, a correction was necessary from Neer I to Craig IIc and thus from conservative to operative treatment. Mean coracoclavicular distance (CCD) in Neer I was 10.2 ± 2.1 mm versus 14.2 ± 3.9 mm in Craig IIc (p = 0.02). The mean fracture angle in Neer I was 25.1 ± 3.3° versus 36.8 ± 4.4° in Craig IIc (p = 0.02). Conclusion: Cross-sectional imaging resulted in higher precision. Nevertheless, recommendations remain for standard radiographs. The CCD and fracture angle should be considered. An angle of >30° can be assumed as a parameter of instability. A previously undescribed fracture type does not seem to exist. The modified Neer classification is an appropriate and complete fracture classification.
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15
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Sevin F, Naidati A, Miganeh Hadi S, Perez C, Maugeais M, Lahrach M, Gilbert F, Pradeau C, Lesaine E. Traitement automatisé des textes médicaux pour le repérage des patients dans un registre. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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16
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Schmalzl J, Graf A, Kimmeyer M, Gilbert F, Gerhardt C, Lehmann LJ. Treatment of avascular necrosis of the humeral head - Postoperative results and a proposed modification of the classification. BMC Musculoskelet Disord 2022; 23:396. [PMID: 35477459 PMCID: PMC9047346 DOI: 10.1186/s12891-022-05338-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Avascular necrosis of the humeral head after proximal humeral fracture i.e. type 1 fracture sequelae (FS) according to the Boileau classification is a rare, often painful condition and treatment still remains a challenge. This study evaluates the treatment of FS type 1 with anatomic and reverse shoulder arthroplasty and a new subclassification is proposed. METHODS This single-center, retrospective, comparative study, included all consecutive patients with a proximal humeral FS type 1 treated surgically in a four-year period. All patients were classified according to the proposed 3 different subtypes. Constant score (CS), Quick DASH score, subjective shoulder value (SSV) as well as revision and complication rate were analyzed. In the preoperative radiographs the acromio-humeral interval (AHI) and greater tuberosity resorption were examined. RESULTS Of 27 with a FS type 1, 17 patients (63%) with a mean age of 64 ± 11 years were available for follow-up at 24 ± 10 months. 7 patients were treated with anatomic and 10 with reverse shoulder arthroplasty. CS improved significantly from 16 ± 7 points to 61 ± 19 points (p < 0.0001). At final follow-up the mean Quick DASH Score was 21 ± 21 and the mean SSV was 73 ± 21 points. The mean preoperative AHI was 9 ± 3 mm, however, 8 cases presented an AHI < 7 mm. 4 cases had complete greater tuberosity resorption. The complication and revision rate was 19%; implant survival was 88%. CONCLUSION By using the adequate surgical technique good clinical short-term results with a relatively low complication rate can be achieved in FS type 1. The Boileau classification should be extended for fracture sequelae type 1 and the general recommendation for treatment with hemiarthroplasty or total shoulder arthroplasty has to be relativized. Special attention should be paid to a decreased AHI and/or resorption of the greater tuberosity as indirect signs for dysfunction of the rotator cuff. To facilitate the choice of the adequate prosthetic treatment method the suggested subclassification system should be applied.
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Affiliation(s)
- Jonas Schmalzl
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University Wuerzburg, Oberduerrbacher Straße 6, 97080, Wuerzburg, Germany. .,Department of Traumatology, Hand Surgery and Sports Medicine, St. Vincentius Clinic, Teaching Hospital Albert-Ludwigs-University Freiburg, Karlsruhe, Germany.
| | - Annika Graf
- Department of Traumatology, Hand Surgery and Sports Medicine, St. Vincentius Clinic, Teaching Hospital Albert-Ludwigs-University Freiburg, Karlsruhe, Germany.,Medical Faculty Mannheim, Karls-Ruprecht-University Heidelberg, Mannheim, Germany
| | - Michael Kimmeyer
- Department of Traumatology, Hand Surgery and Sports Medicine, St. Vincentius Clinic, Teaching Hospital Albert-Ludwigs-University Freiburg, Karlsruhe, Germany
| | - Fabian Gilbert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University Wuerzburg, Oberduerrbacher Straße 6, 97080, Wuerzburg, Germany.,Musculoskeletal University Center, Ludwigs-Maximilians-University Munich, Munich, Germany
| | - Christian Gerhardt
- Department of Traumatology, Hand Surgery and Sports Medicine, St. Vincentius Clinic, Teaching Hospital Albert-Ludwigs-University Freiburg, Karlsruhe, Germany
| | - Lars-Johannes Lehmann
- Department of Traumatology, Hand Surgery and Sports Medicine, St. Vincentius Clinic, Teaching Hospital Albert-Ludwigs-University Freiburg, Karlsruhe, Germany.,Medical Faculty Mannheim, Karls-Ruprecht-University Heidelberg, Mannheim, Germany
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17
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Stevens I, Gilbert F. International Regulatory Standards for the Qualitative Measurement of Deep Brain Stimulation in Clinical Research. J Empir Res Hum Res Ethics 2022; 17:228-241. [DOI: 10.1177/15562646221094922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Deep brain stimulation (DBS) has progressed to become a promising treatment modality for neurologic and psychiatric disorders like epilepsy and major depressive disorder due to its growing personalization. Despite evidence pointing to the benefits of DBS if tested on these personalized qualitative metrics, rather than randomized-control trial quantitative standards, the evaluation of these novel devices appears to be based on the latter. This study surveyed the presence of this trend in the national regulatory guidelines of the prominent DBS researching countries. It was found that two governing bodies, in the European Union and Australia, acknowledged the option for qualitative measures. These findings support further development of national regulatory guidelines, so the neuroscientific community developing these neurotechnologies can better understand the impact their treatments have on patients.
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Affiliation(s)
- I. Stevens
- School of Humanities, University of Tasmania, Hobart, Tasmania, Australia
| | - F. Gilbert
- School of Humanities, University of Tasmania, Hobart, Tasmania, Australia
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18
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Huflage H, Fieber T, Färber C, Knarr J, Veldhoen S, Jordan MC, Gilbert F, Bley TA, Meffert RH, Grunz JP, Schmalzl J. Interobserver reliability of scapula fracture classifications in intra- and extra-articular injury patterns. BMC Musculoskelet Disord 2022; 23:189. [PMID: 35232415 PMCID: PMC8886840 DOI: 10.1186/s12891-022-05146-7] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Morphology and glenoid involvement determine the necessity of surgical management in scapula fractures. While being present in only a small share of patients with shoulder trauma, numerous classification systems have been in use over the years for categorization of scapula fractures. The purpose of this study was to evaluate the established AO/OTA classification in comparison to the classification system of Euler and Rüedi (ER) with regard to interobserver reliability and confidence in clinical practice. Methods Based on CT imaging, 149 patients with scapula fractures were retrospectively categorized by two trauma surgeons and two radiologists using the classification systems of ER and AO/OTA. To measure the interrater reliability, Fleiss kappa (κ) was calculated independently for both fracture classifications. Rater confidence was stated subjectively on a five-point scale and compared with Wilcoxon signed rank tests. Additionally, we computed the intraclass correlation coefficient (ICC) based on absolute agreement in a two-way random effects model to assess the diagnostic confidence agreement between observers. Results In scapula fractures involving the glenoid fossa, interrater reliability was substantial (κ = 0.722; 95% confidence interval [CI] 0.676–0.769) for the AO/OTA classification in contrast to moderate agreement (κ = 0.579; 95% CI 0.525–0.634) for the ER classification system. Diagnostic confidence for intra-articular fracture patterns was superior using the AO/OTA classification compared to ER (p < 0.001) with higher confidence agreement (ICC: 0.882 versus 0.831). For extra-articular fractures, ER (κ = 0.817; 95% CI 0.771–0.863) provided better interrater reliability compared to AO/OTA (κ = 0.734; 95% CI 0.692–0.776) with higher diagnostic confidence (p < 0.001) and superior agreement between confidence ratings (ICC: 0.881 versus 0.912). Conclusions The AO/OTA classification is most suitable to categorize intra-articular scapula fractures with glenoid involvement, whereas the classification system of Euler and Rüedi appears to be superior in extra-articular injury patterns with fractures involving only the scapula body, spine, acromion and coracoid process.
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Affiliation(s)
- Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Tabea Fieber
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Christian Färber
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Jonas Knarr
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Simon Veldhoen
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Martin C Jordan
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Fabian Gilbert
- Department of Orthopaedics and Trauma Surgery, University Hospital, LMU Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Rainer H Meffert
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Jonas Schmalzl
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
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19
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Endres F, Spiro JE, Bolt TA, Tufman A, Ockert B, Helfen T, Gilbert F, Holzapfel BM, Böcker W, Siebenbürger G. One-year follow-up-case report of secondary tension pneumothorax in a COVID-19 pneumonia patient. Infection 2021; 50:525-529. [PMID: 34625910 PMCID: PMC8500466 DOI: 10.1007/s15010-021-01711-9] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/24/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The Coronavirus Disease 2019 (COVID-19) may result not only in acute symptoms such as severe pneumonia, but also in persisting symptoms after months. Here we present a 1 year follow-up of a patient with a secondary tension pneumothorax due to COVID-19 pneumonia. CASE PRESENTATION In May 2020, a 47-year-old male was admitted to the emergency department with fever, dry cough, and sore throat as well as acute chest pain and shortness of breath. Sputum testing (polymerase chain reaction, PCR) and computed tomography (CT) confirmed infection with the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). Eleven days after discharge, the patient returned to the emergency department with pronounced dyspnoea after coughing. CT showed a right-sided tension pneumothorax, which was relieved by a chest drain (Buelau) via mini open thoracotomy. For a period of 3 months following resolution of the pneumothorax the patient complained of fatigue with mild joint pain and dyspnoea. After 1 year, the patient did not suffer from any persisting symptoms. The pulmonary function and blood parameters were normal, with the exception of slightly increased levels of D-Dimer. The CT scan revealed only discrete ground glass opacities (GGO) and subpleural linear opacities. CONCLUSION Tension pneumothorax is a rare, severe complication of a SARS-CoV-2 infection but may resolve after treatment without negative long-term sequelae. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Felix Endres
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Judith Eva Spiro
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Toki Anna Bolt
- Department of Medicine V, University Hospital, Member of the German Center for Lung Research (DZL), LMU Munich, Munich, Germany
| | - Amanda Tufman
- Department of Medicine V, University Hospital, Member of the German Center for Lung Research (DZL), LMU Munich, Munich, Germany
| | - Ben Ockert
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Tobias Helfen
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Fabian Gilbert
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Boris M Holzapfel
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Georg Siebenbürger
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Ziemssenstraße 5, 80336, Munich, Germany.
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Monaghan O, O’Dwyer N, Dunne M, Nugent J, Coughlan N, Nolan A, Gilbert F, Glynn A, Duane F, Parkes C, Brennan S. PO-0967 Factors associated with feeding tube requirement in Oropharyngeal Cancer treated with IMRT. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07418-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Jordan MC, Jäckle V, Scheidt S, Gilbert F, Hölscher-Doht S, Ergün S, Meffert RH, Heintel TM. Trans-obturator cable fixation of open book pelvic injuries. Sci Rep 2021; 11:13463. [PMID: 34188088 PMCID: PMC8241833 DOI: 10.1038/s41598-021-92755-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/15/2021] [Indexed: 01/13/2023] Open
Abstract
Operative treatment of ruptured pubic symphysis by plating is often accompanied by complications. Trans-obturator cable fixation might be a more reliable technique; however, have not yet been tested for stabilization of ruptured pubic symphysis. This study compares symphyseal trans-obturator cable fixation versus plating through biomechanical testing and evaluates safety in a cadaver experiment. APC type II injuries were generated in synthetic pelvic models and subsequently separated into three different groups. The anterior pelvic ring was fixed using a four-hole steel plate in Group A, a stainless steel cable in Group B, and a titan band in Group C. Biomechanical testing was conducted by a single-leg-stance model using a material testing machine under physiological load levels. A cadaver study was carried out to analyze the trans-obturator surgical approach. Peak-to-peak displacement, total displacement, plastic deformation and stiffness revealed a tendency for higher stability for trans-obturator cable/band fixation but no statistical difference to plating was detected. The cadaver study revealed a safe zone for cable passage with sufficient distance to the obturator canal. Trans-obturator cable fixation has the potential to become an alternative for symphyseal fixation with less complications.
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Affiliation(s)
- Martin C Jordan
- Department of Orthopaedic Traumatology, University Hospital Würzburg, Julius-Maximilians-University Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - Veronika Jäckle
- Department of Orthopaedic Traumatology, University Hospital Würzburg, Julius-Maximilians-University Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Sebastian Scheidt
- Department of Orthopaedic Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Fabian Gilbert
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital LMU München, Marchioninistr. 15, 81377, München, Germany
| | - Stefanie Hölscher-Doht
- Department of Orthopaedic Traumatology, University Hospital Würzburg, Julius-Maximilians-University Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Süleyman Ergün
- Institute of Anatomy, Julius-Maximilians-University Würzburg, Koellikerstraße 6, 97070, Würzburg, Germany
| | - Rainer H Meffert
- Department of Orthopaedic Traumatology, University Hospital Würzburg, Julius-Maximilians-University Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Timo M Heintel
- Department of Orthopaedic Traumatology, University Hospital Würzburg, Julius-Maximilians-University Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
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22
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Schmalzl J, Graf A, Gilbert F, Kimmeyer M, Gerhardt C, Lehmann LJ. Locked fracture dislocations of the proximal humerus: postoperative results and a proposed modification of the classification. Eur J Orthop Surg Traumatol 2021; 32:683-692. [PMID: 34089131 PMCID: PMC9001205 DOI: 10.1007/s00590-021-03022-z] [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] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/24/2021] [Indexed: 11/25/2022]
Abstract
Background Locked dislocations of the glenohumeral joint are disabling and often painful conditions and the treatment is challenging. This study evaluates the functional outcome and the different prosthetic treatment options for chronic locked dislocations of the glenohumeral joint and a subclassification is proposed. Methods In this single-center retrospective case series, all patients with a chronic locked dislocation treated surgically during a four-year period were analyzed. Constant score (CS), Quick Disabilities of Shoulder and Hand Score (DASH), patient satisfaction (subjective shoulder value (SSV)), revision rate and glenoid notching were analyzed. Results 26 patients presented a chronic locked dislocation of the glenohumeral joint. 16 patients (62%) with a mean age of 75 [61–83] years were available for follow-up at 24 ± 18 months. CS improved significantly from 10 ± 6 points to 58 ± 21 points (p < 0.0001). At the final follow-up, the mean DASH was 27 ± 23 and the mean SSV was 58 ± 23 points. The complication rate was 19% and the revision rate was 6%; implant survival was 94%. Scapular notching occurred in 2 (13%) cases (all grade 1). Conclusion With good preoperative planning and by using the adequate surgical technique, good clinical short-term results with a low revision rate can be achieved. The authors suggest extending the Boileau classification for fracture sequelae type 2 and recommend using a modified classification to facilitate the choice of treatment as the suggested classification system includes locked posterior and anterior dislocations with and without glenoid bone loss. Level of evidence: IV.
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Affiliation(s)
- Jonas Schmalzl
- Department of Traumatology, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University Wuerzburg, University Hospital Wuerzburg, Josef-Schneider-Str. 2, 97080, Wuerzburg, Germany.
- Department of Traumatology and Hand Surgery, St. Vincentius Clinic, Teaching Hospital Albert-Ludwigs-University Freiburg, Karlsruhe, Germany.
| | - Annika Graf
- Department of Traumatology and Hand Surgery, St. Vincentius Clinic, Teaching Hospital Albert-Ludwigs-University Freiburg, Karlsruhe, Germany
- Medical Faculty Mannheim, Karls-Ruprecht-University Heidelberg, Mannheim, Germany
| | - Fabian Gilbert
- Department of Traumatology, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University Wuerzburg, University Hospital Wuerzburg, Josef-Schneider-Str. 2, 97080, Wuerzburg, Germany
| | - Michael Kimmeyer
- Department of Traumatology and Hand Surgery, St. Vincentius Clinic, Teaching Hospital Albert-Ludwigs-University Freiburg, Karlsruhe, Germany
| | - Christian Gerhardt
- Department of Traumatology and Hand Surgery, St. Vincentius Clinic, Teaching Hospital Albert-Ludwigs-University Freiburg, Karlsruhe, Germany
| | - Lars-Johannes Lehmann
- Department of Traumatology and Hand Surgery, St. Vincentius Clinic, Teaching Hospital Albert-Ludwigs-University Freiburg, Karlsruhe, Germany
- Medical Faculty Mannheim, Karls-Ruprecht-University Heidelberg, Mannheim, Germany
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Thevenet V, Maugeais M, Lesaine E, Miganeh Hadi S, Gilbert F, Rouanet F, Sibon I, Saillour-Glénisson F. Prise en charge hospitalière des infarctus cérébraux : lien entre caractéristiques structurelles des établissements de santé et délais intrahospitaliers. Rev Epidemiol Sante Publique 2021. [DOI: 10.1016/j.respe.2021.04.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Schmalzl J, Fenwick A, Reichel T, Schmitz B, Jordan M, Meffert R, Plumhoff P, Boehm D, Gilbert F. Anterior deltoid muscle tension quantified with shear wave ultrasound elastography correlates with pain level after reverse shoulder arthroplasty. Eur J Orthop Surg Traumatol 2021; 32:333-339. [PMID: 33884494 PMCID: PMC8783907 DOI: 10.1007/s00590-021-02987-1] [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] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Reverse shoulder arthroplasty (RSA) leads to medialization and distalization of the centre of rotation of the shoulder joint resulting in lengthening of the deltoid muscle. Shear wave ultrasound elastography (SWE) is a reliable method for quantifying tissue stiffness. The purpose of this study was to analyse if deltoid muscle tension after RSA correlates with the patients' pain level. We hypothesized that higher deltoid muscle tension would be associated with increased pain. MATERIAL AND METHODS Eighteen patients treated with RSA were included. Constant score (CS) and pain level on the visual analogue scale (VAS) were analysed and SWE was performed on both shoulders. All three regions of the deltoid muscle were examined in resting position and under standardized isometric loading. RESULTS Average patient age was 76 (range 64-84) years and average follow-up was 15 months (range 4-48). The average CS was 66 points (range 35-89) and the average pain level on the VAS was 1.8 (range 0.5-4.7). SWE revealed statistically significant higher muscle tension in the anterior and middle deltoid muscle region in patients after RSA compared to the contralateral non-operated side. There was a statistically significant correlation between pain level and anterior deltoid muscle tension. CONCLUSION SWE revealed increased tension in the anterior and middle portion of the deltoid muscle after RSA in a clinical setting. Increased tension of the anterior deltoid muscle portion significantly correlated with an increased pain level. SWE is a powerful, cost-effective, quick, dynamic, non-invasive, and radiation-free imaging technique to evaluate tissue elasticity in the shoulder with a wide range of applications. LEVEL OF EVIDENCE Diagnostic study, Level III.
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Affiliation(s)
- Jonas Schmalzl
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany.
- Department of Traumatology, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Josef-Schneider-Str. 2, 97080, Wuerzburg, Germany.
| | - Annabel Fenwick
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany
- Department of Trauma, Orthopedic, Hand - and Plastic Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Thomas Reichel
- Orthopedic Surgery, König Ludwig Haus, University of Wuerzburg, Brettreichstrasse 11, 97074, Wuerzburg, Germany
| | - Benedikt Schmitz
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany
| | - Martin Jordan
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany
| | - Rainer Meffert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany
| | - Piet Plumhoff
- Orthopedic Surgery, König Ludwig Haus, University of Wuerzburg, Brettreichstrasse 11, 97074, Wuerzburg, Germany
- Hoechberg Orthopaeden, Hauptstraße 78, 97204, Hoechberg, Germany
| | - Dirk Boehm
- Ortho Mainfranken Wuerzburg, Bismarckstraße 16, 97080, Wuerzburg, Germany
| | - Fabian Gilbert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany
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Schmalzl J, Jessen M, Gilbert F, Gerhardt C, Lehmann LJ. Proximal humeral fracture morphology in patients with advanced osteoarthritis: An observational study in a surgically treated cohort. J Orthop Surg (Hong Kong) 2021; 28:2309499020944114. [PMID: 32996369 DOI: 10.1177/2309499020944114] [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] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Several factors affect proximal humeral fracture (PHF) morphology. In the presence of glenohumeral osteoarthritis (GOA), the joint kinematics is alternated which might influence fracture configuration. The purpose of this study was to identify fracture patterns in patients with advanced osteoarthritis to facilitate recognition and treatment. METHODS In this retrospective analysis, and computed tomography (CT) scans of all patients undergoing surgical treatment for a PHF during a 5-year period were analyzed. Fracture pattern according to the AO Foundation/Orthopaedic Trauma Association (AO-OTA) classification and the presence of GOA were evaluated. In addition, critical shoulder angle (CSA), glenoid configuration, and glenoid inclination (GI) were measured. RESULTS Of the 713 patients, 574 met the inclusion criteria. A total of 166 patients showed radiological signs of GOA (28.9%). Advanced GOA (stage 2 or 3) was identified in 23 patients (4.0%). In this group, the mean age was 77 ± 10 years, mean CSA was 28.8 ± 4.2°, and the mean GI was 19.0 ± 7.8°. All fractures were extra-articular metaphyseal fractures (5 A2, 11 A3, 7 B1.1). Patients with advanced GOA had more than threefold risk (risk ratio 3.2; confidence interval 95% 2.80-3.74; p < 0.0001) for sustaining a metaphyseal fracture. In patients with GOA grade 1 compared to patients with no radiographic signs of GOA, this could not be observed. CONCLUSION Patients experiencing PHF with radiological signs of advanced GOA have a higher risk of sustaining a metaphyseal fracture compared to individuals with the absence of or mild GOA. To date, no classification system for PHFs takes preexisting osteoarthritis into account, although it might indicate a different treatment and therefore the recognition is crucial.
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Affiliation(s)
- Jonas Schmalzl
- Department of Traumatology and Hand Surgery, Teaching Hospital Albert-Ludwigs-University, Freiburg, Germany
| | - Malik Jessen
- Department of Traumatology and Hand Surgery, Teaching Hospital Albert-Ludwigs-University, Freiburg, Germany.,Orthopaedic and Trauma Surgery Centre (OUZ), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Fabian Gilbert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Wuerzburg, Wuerzburg, Germany
| | - Christian Gerhardt
- Department of Traumatology and Hand Surgery, Teaching Hospital Albert-Ludwigs-University, Freiburg, Germany
| | - Lars-Johannes Lehmann
- Department of Traumatology and Hand Surgery, Teaching Hospital Albert-Ludwigs-University, Freiburg, Germany.,Orthopaedic and Trauma Surgery Centre (OUZ), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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26
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Fuchs KF, Eden L, Gilbert F, Bernuth S, Wurmb T, Meffert RH, Jordan MC. [Do COVID-19 restrictions lead to a decrease in severely injured patients at a level 1 trauma center in Germany?]. Unfallchirurg 2020; 124:352-357. [PMID: 33252703 PMCID: PMC7702725 DOI: 10.1007/s00113-020-00924-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 01/07/2023]
Abstract
Hintergrund Intensiv- und Beatmungskapazitäten sind für die Behandlung COVID-19-erkrankter Patienten essenziell. Unabhängig davon beanspruchen auch schwer verletzte Patienten häufig Intensiv- und Beatmungskapazitäten. Daraus ergibt sich folgende Fragestellung: Führt eine Ausgangsbeschränkung zu einer Reduktion schwer verletzter Patienten, und kann hierdurch mit frei werdenden Intensivkapazitäten gerechnet werden? Material und Methoden Es erfolgte eine retrospektive Auswertung schwer verletzter Patienten mit einem Injury Severity Score (ISS) ≥16 zwischen dem 17.03.2020 und 30.04.2020 (landesweiter Shutdown) an einem überregionalen Traumazentrum. Erfasst wurden der Unfallmechanismus, ISS, Versicherungsträger (BG vs. GKV/PKV), ob es sich um einen dokumentierten Suizidversuch handelte, und ob eine operative Intervention innerhalb der ersten 24 h erforderlich war. Als Kontrollgruppe wurden die Daten des gleichen Zeitraums der Jahre 2018 und 2019 ausgewertet. Ergebnisse Es konnte keine wesentliche Veränderung bezüglich der Anzahl an schwer verletzten Patienten festgestellt werden (2018 n = 30, 2019 n = 23, 2020 n = 27). Es zeigten sich insgesamt keine deutlichen Veränderungen der absoluten Zahlen bezüglich der Intensivpflichtigkeit in den ersten 24 h und der Beatmungspflichtigkeit beim Verlassen des Schockraums. Die Anzahl an Patienten, die eine Operation innerhalb der ersten 24 h nach Eintreffen im Schockraum benötigten, war 2020 sogar leicht erhöht, jedoch nicht statistisch signifikant. Der durchschnittliche ISS blieb konstant. Bezüglich der Unfallursache zeigte sich 2020 kein Motorradfahrer, der einen nicht berufsgenossenschaftlich versicherten Unfall erlitt (2018 n = 5, 2019 n = 4, 2020 n = 0). Es wurde 2020 ein erhöhter Anteil an Arbeitsunfällen mit einem ISS ≥16 festgestellt (2018: 10 %, 2019: 26,1 %, 2020: 44,4 %). Diskussion Eine Ausgangsbeschränkung führte zu keiner Reduktion verletzter- und intensivpflichtiger Patienten am untersuchten Zentrum. Auch unter einer landesweiten Ausgangsbeschränkung muss für dieses Patientenkollektiv eine ausreichende Menge an Intensiv- und OP-Kapazitäten vorgehalten werden. Die Bestätigung dieser Ergebnisse durch Auswertung nationaler Register steht noch aus.
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Affiliation(s)
- Konrad F Fuchs
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland.
| | - Lars Eden
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland
| | - Fabian Gilbert
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland
| | - Silvia Bernuth
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland
| | - Thomas Wurmb
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland
| | - Rainer H Meffert
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland
| | - Martin C Jordan
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland
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27
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Abstract
Hintergrund Die Symphysensprengung mit entsprechender Diastase kann durch eine Symphysenplatte stabilisiert werden. Fragestellung Welche Beckenverletzungen werden mit einer Symphysenplatte stabilisiert und wie ist das Outcome? Material und Methoden Retrospektive Auswertung von 64 Patienten über einen Untersuchungszeitraum von 24 Monaten. Ergebnisse Es waren 56 Patienten männlich, 8 weiblich und das mittlere Alter betrug 44 Jahre (SD ± 17). Unfälle im Straßenverkehr waren der führende Grund für die Beckenverletzung. Die Verteilung nach AO-Klassifikation zeigte sich wie folgt: 14-mal B1-, 10-mal B2-, 5‑mal B3-, 23-mal C1-, 9‑mal C2- und 3‑mal C3-Verletzungen. Die Verteilung nach Young und Burgess ergab: 9‑mal APC-I-, 18-mal APC-II-, 13-mal APC-III-, 9‑mal LC-I-, 3‑mal LC-II-, 2‑mal LC-III- und 10-mal VS-Verletzungen. Der mittlere Injury Severity Score (ISS) betrug 32 und die mittlere stationäre Verweildauer 29 Tage (pos. Korrelation p ≤ 0,001). Im Verlauf war eine radiologische Implantatlockerung bei 52 Patienten nachweisbar. Therapierelevante Komplikationen gab es in 14 Fällen. Hierbei war das Implantatversagen (n = 8) der Hauptgrund für eine operative Revision. Diskussion Obwohl die radiologische Implantatlockerung häufig beobachtet wird, ist sie nur selten Grund für einen Revisionseingriff. Kommt es hingegen zum vollständigen Implantatversagen, tritt dies meist innerhalb der ersten postoperativen Wochen auf und ist revisionsbedürftig. Eine frühzeitige Abklärung durch Röntgenbildgebung sollte bei Verdacht erfolgen.
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Affiliation(s)
- Martin C Jordan
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 8, 97080, Würzburg, Deutschland.
| | - Veronika Jäckle
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 8, 97080, Würzburg, Deutschland
| | - Sebastian Scheidt
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Lars Eden
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 8, 97080, Würzburg, Deutschland
| | - Fabian Gilbert
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 8, 97080, Würzburg, Deutschland
| | - Timo M Heintel
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 8, 97080, Würzburg, Deutschland
| | - Hendrik Jansen
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 8, 97080, Würzburg, Deutschland
| | - Rainer H Meffert
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 8, 97080, Würzburg, Deutschland
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28
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Arnholdt J, Kamawal Y, Horas K, Holzapfel BM, Gilbert F, Ripp A, Rudert M, Steinert AF. Accurate implant fit and leg alignment after cruciate-retaining patient-specific total knee arthroplasty. BMC Musculoskelet Disord 2020; 21:699. [PMID: 33092567 PMCID: PMC7583183 DOI: 10.1186/s12891-020-03707-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/09/2020] [Indexed: 01/18/2023] Open
Abstract
Background For improved outcomes in total knee arthroplasty (TKA) correct implant fitting and positioning are crucial. In order to facilitate a best possible implant fitting and positioning patient-specific systems have been developed. However, whether or not these systems allow for better implant fitting and positioning has yet to be elucidated. For this reason, the aim was to analyse the novel patient-specific cruciate retaining knee replacement system iTotal™ CR G2 that utilizes custom-made implants and instruments for its ability to facilitate accurate implant fitting and positioning including correction of the hip-knee-ankle angle (HKA). Methods We assessed radiographic results of 106 patients who were treated with the second generation of a patient-specific cruciate retaining knee arthroplasty using iTotal™ CR G2 (ConforMIS Inc.) for tricompartmental knee osteoarthritis (OA) using custom-made implants and instruments. The implant fit and positioning as well as the correction of the mechanical axis (hip-knee-ankle angle, HKA) and restoration of the joint line were determined using pre- and postoperative radiographic analyses. Results On average, HKA was corrected from 174.4° ± 4.6° preoperatively to 178.8° ± 2.2° postoperatively and the coronal femoro-tibial angle was adjusted on average 4.4°. The measured preoperative tibial slope was 5.3° ± 2.2° (mean +/− SD) and the average postoperative tibial slope was 4.7° ± 1.1° on lateral views. The joint line was well preserved with an average modified Insall-Salvati index of 1.66 ± 0.16 pre- and 1.67 ± 0.16 postoperatively. The overall accuracy of fit of implant components was decent with a measured medial overhang of more than 1 mm (1.33 mm ± 0.32 mm) in 4 cases only. Further, a lateral overhang of more than 1 mm (1.8 mm ± 0.63) (measured in the anterior-posterior radiographs) was observed in 11 cases, with none of the 106 patients showing femoral notching. Conclusion The patient-specific iTotal™ CR G2 total knee replacement system facilitated a proper fitting and positioning of the implant components. Moreover, a good restoration of the leg axis towards neutral alignment was achieved as planned. Nonetheless, further clinical follow-up studies are necessary to validate our findings and to determine the long-term impact of using this patient- specific system.
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Affiliation(s)
- Jörg Arnholdt
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, D-97074, Würzburg, Germany.
| | - Yama Kamawal
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, D-97074, Würzburg, Germany
| | - Konstantin Horas
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, D-97074, Würzburg, Germany
| | - Boris M Holzapfel
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, D-97074, Würzburg, Germany.,Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, 4059, Australia
| | - Fabian Gilbert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, D-97074, Würzburg, Germany.,Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University Würzburg, D-97080, Würzburg, Germany
| | - Axel Ripp
- Department of Trauma and Orthopaedic Surgery, Elblandklinikum Radebeul, Heinrich-Zille-Straße 13, D-01445, Radebeul, Germany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, D-97074, Würzburg, Germany
| | - Andre F Steinert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, D-97074, Würzburg, Germany.,Rhön-Klinikum Campus Bad Neustadt, Department of Orthopaedic, Trauma, Shoulder and Arthroplasty Surgery, Von-Guttenberg-Straße 11, D-97616, Bad Neustadt a. d. Saale, Germany
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Schmalzl J, Jessen M, Gilbert F, Gerhardt C, Lehmann LJ. Proximal humeral fracture morphology in patients with advanced cuff tear arthropathy: an observational study in a surgically treated cohort. Eur J Orthop Surg Traumatol 2020; 31:517-524. [PMID: 33025159 DOI: 10.1007/s00590-020-02801-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/23/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND In the presence of cuff tear arthropathy (CTA), joint kinematics is alternated and fracture configuration might be different. The purpose of this study was to identify fracture patterns in patients with advanced CTA to facilitate recognition and treatment. METHODS Radiographs and computed tomography scans of all patients undergoing surgical treatment for a proximal humeral fracture (PHF) in our institution during a 5-year period were retrospectively analyzed. Fracture pattern according to the AO-OTA and Resch classification and the presence of CTA were evaluated. Glenoid configuration according to Walch, fatty atrophy of the supraspinatus muscle and the centrum-collum-diaphyseal (CCD) angle were analyzed. RESULTS A total of 574 out of 713 patients were included. Twenty-three patients (4%) with a mean age of 82 ± 8 years showed advanced CTA with acetabularization of the acromion (≥ stage 3 according to Hamada/Fukuda). There were exclusively valgus fractures with a mean CCD angle of 158° ± 18°. Patients with CTA ≥ grade 3 had a nearly twofold greater risk (risk ratio: 1.8; confidence interval (CI): 95% 1.6-1.9; p < 0.0001) of sustaining a valgus fracture compared to patients without or with CTA < grade 3. The risk for a tuberosity fracture was nearly twofold greater in patients without or with mild CTA (risk ratio: 1.68; confidence interval (CI): 95% 1.17-2.40; p = 0.0046) compared to those with advanced CTA. CONCLUSION In advanced CTA, a predominantly valgus fracture pattern can be observed. In addition, fractures of the greater tuberosity were significantly less frequent and were rarely displaced. Up to date, no classification system for PHF has been developed in the setting of CTA although it might indicate a different treatment, and therefore, recognition is crucial. However, when present, this changes the fracture pattern and ability to treat the fracture as the rotator cuff can no longer be utilized as a means of reducing the fragments.
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Affiliation(s)
- Jonas Schmalzl
- Department of Traumatology and Hand Surgery, St. Vincentius Clinic, ViDia Clinics, Suedendstraße 32, 76137, Karlsruhe, Germany. .,Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany.
| | - Malik Jessen
- Department of Traumatology and Hand Surgery, St. Vincentius Clinic, ViDia Clinics, Suedendstraße 32, 76137, Karlsruhe, Germany.,Orthopaedic and Trauma Surgery Centre (OUZ), Medical Faculty Mannheim, Ruprecht-Karls-University, Heidelberg, Germany
| | - Fabian Gilbert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany
| | - Christian Gerhardt
- Department of Traumatology and Hand Surgery, St. Vincentius Clinic, ViDia Clinics, Suedendstraße 32, 76137, Karlsruhe, Germany
| | - Lars-Johannes Lehmann
- Department of Traumatology and Hand Surgery, St. Vincentius Clinic, ViDia Clinics, Suedendstraße 32, 76137, Karlsruhe, Germany.,Orthopaedic and Trauma Surgery Centre (OUZ), Medical Faculty Mannheim, Ruprecht-Karls-University, Heidelberg, Germany
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Jordan MC, Jovic S, Gilbert F, Kunz A, Ertl M, Strobl U, Jakubietz RG, Jakubietz MG, Meffert RH, Fuchs KF. [Smartphone-based photographic wound documentation improves the quality of medical accounting in orthopedic and plastic surgery]. Unfallchirurg 2020; 124:366-372. [PMID: 32935138 PMCID: PMC8099820 DOI: 10.1007/s00113-020-00866-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2020] [Indexed: 12/28/2022]
Abstract
Hintergrund Die Fotodokumentation von offenen Frakturen, Wunden, Dekubitalulzera, Tumoren oder Infektionen ist ein wichtiger Bestandteil der digitalen Patientenakte. Bisher ist unklar, welchen Stellenwert diese Fotodokumentation bei der Abrechnungsprüfung durch den Medizinischen Dienst der Krankenkassen (MDK) hat. Fragestellung Kann eine Smartphone-basierte Fotodokumentation die Verteidigung von erlösrelevanten Diagnosen und Prozeduren sowie der Verweildauer verbessern? Material und Methoden Ausstattung der Mitarbeiter mit digitalen Endgeräten (Smartphone/Tablet) in den Bereichen Notaufnahme, Schockraum, OP, Sprechstunden sowie auf den Stationen. Retrospektive Auswertung der Abrechnungsprüfung im Jahr 2019 und Identifikation aller Fallbesprechungen, in denen die Fotodokumentation eine Erlösveränderung bewirkt hat. Ergebnisse Von insgesamt 372 Fallbesprechungen half die Fotodokumentation in 27 Fällen (7,2 %) zur Bestätigung eines Operationen- und Prozedurenschlüssels (OPS) (n = 5; 1,3 %), einer Hauptdiagnose (n = 10; 2,7 %), einer Nebendiagnose (n = 3; 0,8 %) oder der Krankenhausverweildauer (n = 9; 2,4 %). Pro oben genanntem Fall mit Fotodokumentation ergab sich eine durchschnittliche Erlössteigerung von 2119 €. Inklusive Aufwandpauschale für die Verhandlungen wurde somit ein Gesamtbetrag von 65.328 € verteidigt. Diskussion Der Einsatz einer Smartphone-basierten Fotodokumentation kann die Qualität der Dokumentation verbessern und Erlöseinbußen bei der Abrechnungsprüfung verhindern. Die Implementierung digitaler Endgeräte mit entsprechender Software ist ein wichtiger Teil des digitalen Strukturwandels in Kliniken.
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Affiliation(s)
- Martin C Jordan
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland.
| | - Sebastian Jovic
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland
| | | | - Andreas Kunz
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland
| | - Maximilian Ertl
- Servicezentrum Medizin-Informatik (SMI), Universitätsklinikum Würzburg, Schweinfurter Str. 4, 97080, Würzburg, Deutschland
| | - Ute Strobl
- Verwaltung, Referat 3.3.2 - Medizincontrolling, Universitätsklinikum Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Deutschland
| | - Rafael G Jakubietz
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland
| | | | - Rainer H Meffert
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland
| | - Konrad F Fuchs
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland
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Sevin F, Gilbert F, Domecq S, Jouson D, Lesaine E, Saillour-Glenisson F. Mise en place du système d’information régional de l’Observatoire des accidents vasculaires cérébraux en Nouvelle-Aquitaine (ObA2-NA). Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Domecq S, Saillour-Glénisson F, Lesaine E, Gilbert F, Maugeais M, Rouanet F. Description des délais de prise en charge des patients victimes d’un accident vasculaire cérébral entre l’apparition des symptômes et le traitement dans 11 établissements de santé entre 2012 et 2019 en ex-Aquitaine. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.03.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Schmalzl J, Plumhoff P, Gilbert F, Gohlke F, Konrads C, Brunner U, Jakob F, Ebert R, Steinert AF. The inflamed biceps tendon as a pain generator in the shoulder: A histological and biomolecular analysis. J Orthop Surg (Hong Kong) 2020; 27:2309499018820349. [PMID: 30739571 DOI: 10.1177/2309499018820349] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The long head of the biceps (LHB) is often resected in shoulder surgery. However, its contribution to inflammatory processes in the shoulder remains unclear. In the present study, inflamed and noninflamed human LHBs were comparatively characterized for features of inflammation. MATERIALS AND METHODS Twenty-two resected LHB tendons were classified into inflamed ( n = 11) and noninflamed ( n = 11) samples. For histological examination, samples were stained with hematoxylin eosin, Azan, van Gieson, and Masson Goldner trichrome. Neuronal tissue was immunohistochemically visualized. In addition, specific inflammatory marker gene expression of primary LHB-derived cell cultures were analyzed. RESULTS Features of tendinopathy, such as collagen disorganization, infiltration by inflammatory cells, neovascularization, and extensive neuronal innervation were found in the tendinitis group. Compared to noninflamed samples, inflamed LHBs showed a significantly increased inflammatory marker gene expression. CONCLUSION Structural and biomolecular differences of both groups suggest that the LHB tendon acts as an important pain generator in the shoulder joint. These findings can, on the one hand, contribute to the understanding of the biomolecular genesis of LHB tendinitis and, on the other hand, provide possibilities for new therapeutic approaches.
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Affiliation(s)
- J Schmalzl
- 1 Department of Orthopaedic Surgery, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany.,2 Department of Traumatology and Hand Surgery, St. Vincentius Clinic, Suedendstraße Karlsruhe, Germany
| | - P Plumhoff
- 1 Department of Orthopaedic Surgery, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany
| | - F Gilbert
- 1 Department of Orthopaedic Surgery, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany.,3 Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - F Gohlke
- 1 Department of Orthopaedic Surgery, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany.,4 Clinic for Shoulder Surgery, Rhoen Klinikum AG, Bad Neustadt/Saale, Germany
| | - C Konrads
- 1 Department of Orthopaedic Surgery, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany
| | - U Brunner
- 5 Department of Orthopaedic and Trauma Surgery, Norbert-Kerkel-Platz, Krankenhaus Agatharied GmbH, Hausham, Germany
| | - F Jakob
- 1 Department of Orthopaedic Surgery, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany
| | - R Ebert
- 1 Department of Orthopaedic Surgery, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany
| | - A F Steinert
- 1 Department of Orthopaedic Surgery, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany.,5 Department of Orthopaedic and Trauma Surgery, Norbert-Kerkel-Platz, Krankenhaus Agatharied GmbH, Hausham, Germany
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Domecq S, Saillour-Glenisson F, Lesaine E, Gilbert F, Maugeais M, Rouanet F. Description des délais de prise en charge des patients victimes d’un accident vasculaire cérébral entre l’apparition des symptômes et le traitement dans six établissements de santé aquitains entre 2012 et 2017. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Weissenberger M, Weissenberger MH, Gilbert F, Groll J, Evans CH, Steinert AF. Reduced hypertrophy in vitro after chondrogenic differentiation of adult human mesenchymal stem cells following adenoviral SOX9 gene delivery. BMC Musculoskelet Disord 2020; 21:109. [PMID: 32066427 PMCID: PMC7026978 DOI: 10.1186/s12891-020-3137-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/12/2020] [Indexed: 01/03/2023] Open
Abstract
Background Mesenchymal stem cell (MSC) based-treatments of cartilage injury are promising but impaired by high levels of hypertrophy after chondrogenic induction with several bone morphogenetic protein superfamily members (BMPs). As an alternative, this study investigates the chondrogenic induction of MSCs via adenoviral gene-delivery of the transcription factor SOX9 alone or in combination with other inducers, and comparatively explores the levels of hypertrophy and end stage differentiation in a pellet culture system in vitro. Methods First generation adenoviral vectors encoding SOX9, TGFB1 or IGF1 were used alone or in combination to transduce human bone marrow-derived MSCs at 5 × 102 infectious particles/cell. Thereafter cells were placed in aggregates and maintained for three weeks in chondrogenic medium. Transgene expression was determined at the protein level (ELISA/Western blot), and aggregates were analysed histologically, immunohistochemically, biochemically and by RT-PCR for chondrogenesis and hypertrophy. Results SOX9 cDNA was superior to that encoding TGFB1, the typical gold standard, as an inducer of chondrogenesis in primary MSCs as evidenced by improved lacuna formation, proteoglycan and collagen type II staining, increased levels of GAG synthesis, and expression of mRNAs associated with chondrogenesis. Moreover, SOX9 modified aggregates showed a markedly lower tendency to progress towards hypertrophy, as judged by expression of the hypertrophy markers alkaline phosphatase, and collagen type X at the mRNA and protein levels. Conclusion Adenoviral SOX9 gene transfer induces chondrogenic differentiation of human primary MSCs in pellet culture more effectively than TGFB1 gene transfer with lower levels of chondrocyte hypertrophy after 3 weeks of in vitro culture. Such technology might enable the formation of more stable hyaline cartilage repair tissues in vivo.
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Affiliation(s)
- M Weissenberger
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Center for Musculoskeletal Research, Julius-Maximilians-University, Brettreichstrasse 11, D-97074, Würzburg, Germany.
| | - M H Weissenberger
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Center for Musculoskeletal Research, Julius-Maximilians-University, Brettreichstrasse 11, D-97074, Würzburg, Germany.,Department of Pathology, Caritas-Hospital, Bad Mergentheim, Germany
| | - F Gilbert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Center for Musculoskeletal Research, Julius-Maximilians-University, Brettreichstrasse 11, D-97074, Würzburg, Germany.,Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Würzburg, Germany
| | - J Groll
- Department of Functional Materials in Medicine and Dentistry, Julius-Maximilians-University, Würzburg, Germany
| | - C H Evans
- Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, USA
| | - A F Steinert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Center for Musculoskeletal Research, Julius-Maximilians-University, Brettreichstrasse 11, D-97074, Würzburg, Germany.,Present address: Department of Orthopaedic, Trauma, Shoulder and Arthroplasty Surgery, Rhön-Klinikum Campus Bad Neustadt, Bad Neustadt a.d. Saale, Germany
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Jakubietz RG, Erguen S, Bernuth S, Meffert RH, Gilbert F, Jakubietz M. An anatomical study on the Stener-type lesion of the radial collateral ligament of the metacarpophalangeal joint of the thumb. J Hand Surg Eur Vol 2020; 45:131-135. [PMID: 31739733 DOI: 10.1177/1753193419887344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The Stener-type lesion of the radial collateral ligament is rare. The insertion of the abductor pollicis brevis is believed to preclude its occurrence. The aim of this study was to determine whether this lesion can be induced mechanically. Four specimens were tested in neutral rotation and 20° of supination, in 45° and 30° of flexion, and in the neutral position. The angle of ulnar adduction to form a Stener-type lesion was measured. The lesion occurred only in 45° flexion in all specimens. A lesser angle of flexion decreased the rate of ligament displacement. In the neutral position no ligament displacement was found. A Stener-type lesion of the radial collateral ligament can occur in ulnar adduction and flexion of the metacarpophalangeal joint. Supination of the joint increases the likelihood of ligament displacement. As distal ruptures of the radial collateral ligament are uncommon, a high index of suspicion is required for diagnosis.
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Affiliation(s)
- Rafael G Jakubietz
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Sueleyman Erguen
- Institute for Anatomy and Cellbiology, University Wuerzburg, Wuerzburg, Germany
| | - Silvia Bernuth
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Rainer H Meffert
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Fabian Gilbert
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Michael Jakubietz
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
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Eden L, Frey SP, Gilbert F, Jordan MC, Fenwick A, Meffert RH. Anatomically shaped locking plates for radial head and olecranon fracture fixation in Monteggia-like lesions. Technol Health Care 2019; 28:193-201. [PMID: 31594272 DOI: 10.3233/thc-191812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Monteggia-like lesions are rare injuries. We retrospectively reviewed 40 consecutive patients with Monteggia-like lesions treated at a level I trauma center from 2009 to 2016. Clinical results were evaluated with a focus on the use of modern locking plates. OBJECTIVE AND METHODS Twenty-eight patients had Bado type II fractures, 11 had Bado type I, and 1 had Bado type III. All patients were treated by plate fixation of the ulna with a locking compression plate or double mini-plates. Fixation or replacement was performed for radial head fractures. We characterized all fractures and recorded the range of motion (ROM); 100-point visual analog scale (VAS) scores for pain and function; Disabilities of the Arm, Shoulder and Hand (DASH) score; and Mayo Elbow Performance Score (MEPS). A follow-up rate of 78% was reached at an average of 36 months (range, 12-95 months). RESULTS Stable fixation without recurrent instability was accomplished. The average ROM for flexion reached 130∘ with an extension deficit of 13∘. The sum of supination and pronation was 136∘. The VAS scores for pain and function were 20 and 75, respectively. The average MEPS and DASH scores were 84 and 28, respectively. Bado type I fractures had better outcomes for all variables, especially forearm rotation (p< 0.05). The complication rate was 22.5% and revision rate was 17.5%. CONCLUSION This fracture repair technique can safely achieve good and excellent outcomes in most cases and is partly superior to previously published techniques. However, Bado type II fractures still have a risk of poor results.
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Affiliation(s)
- Lars Eden
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University, Wuerzburg, Germany.,Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| | - Sönke P Frey
- Department of Orthopedics and Trauma Surgery, St. Josef-Hospital Bochum, Katholisches Klinikum Bochum, Ruhr-University Bochum, Germany.,Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| | - Fabian Gilbert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| | - Martin C Jordan
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| | - Annabel Fenwick
- Department of Trauma Surgery, Klinikum Augsburg, Augsburg, Germany
| | - Rainer H Meffert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University, Wuerzburg, Germany
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Schmalzl J, Plumhoff P, Gilbert F, Gohlke F, Konrads C, Brunner U, Jakob F, Ebert R, Steinert AF. Tendon-derived stem cells from the long head of the biceps tendon: Inflammation does not affect the regenerative potential. Bone Joint Res 2019; 8:414-424. [PMID: 31588358 PMCID: PMC6775540 DOI: 10.1302/2046-3758.89.bjr-2018-0214.r2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objectives The long head of the biceps (LHB) is often resected in shoulder surgery and could therefore serve as a cell source for tissue engineering approaches in the shoulder. However, whether it represents a suitable cell source for regenerative approaches, both in the inflamed and non-inflamed states, remains unclear. In the present study, inflamed and native human LHBs were comparatively characterized for features of regeneration. Methods In total, 22 resected LHB tendons were classified into inflamed samples (n = 11) and non-inflamed samples (n = 11). Proliferation potential and specific marker gene expression of primary LHB-derived cell cultures were analyzed. Multipotentiality, including osteogenic, adipogenic, chondrogenic, and tenogenic differentiation potential of both groups were compared under respective lineage-specific culture conditions. Results Inflammation does not seem to affect the proliferation rate of the isolated tendon-derived stem cells (TDSCs) and the tenogenic marker gene expression. Cells from both groups showed an equivalent osteogenic, adipogenic, chondrogenic and tenogenic differentiation potential in histology and real-time polymerase chain reaction (RT-PCR) analysis. Conclusion These results suggest that the LHB tendon might be a suitable cell source for regenerative approaches, both in inflamed and non-inflamed states. The LHB with and without tendinitis has been characterized as a novel source of TDSCs, which might facilitate treatment of degeneration and induction of regeneration in shoulder surgery. Cite this article: J. Schmalzl, P. Plumhoff, F. Gilbert, F. Gohlke, C. Konrads, U. Brunner, F. Jakob, R. Ebert, A. F. Steinert. Tendon-derived stem cells from the long head of the biceps tendon: Inflammation does not affect the regenerative potential. Bone Joint Res 2019;8:414–424. DOI: 10.1302/2046-3758.89.BJR-2018-0214.R2.
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Affiliation(s)
- Jonas Schmalzl
- Department of Orthopaedic Surgery, Julius-Maximilians-University, Wuerzburg, Germany; Department of Traumatology and Hand Surgery, St. Vincentius Clinic, ViDia Clinis, Teaching Hospital Albert-Ludwigs University Freiburg, Karlsruhe, Germany
| | - Piet Plumhoff
- Department of Orthopaedic Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| | - Fabian Gilbert
- Department of Orthopaedic Surgery, Julius-Maximilians-University, Wuerzburg, Germany; Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital, Wuerzburg, Germany
| | - Frank Gohlke
- Department of Orthopaedic Surgery, Julius-Maximilians-University, Wuerzburg, Germany; Clinic for Shoulder Surgery, Rhoen Klinikum AG, Bad Neustadt an der Saale, Germany
| | - Christian Konrads
- Department of Orthopaedic Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| | - Ulrich Brunner
- Department of Orthopaedic and Trauma Surgery, Krankenhaus Agatharied GmbH, Hausham, Germany
| | - Franz Jakob
- Department of Orthopaedic Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| | - Regina Ebert
- Department of Orthopaedic Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| | - Andre F Steinert
- Department of Orthopaedic Surgery, Julius-Maximilians-University, Wuerzburg, Germany; Department of Orthopaedic and Trauma Surgery, Krankenhaus Agatharied GmbH, Hausham, Germany
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Affiliation(s)
- F Gilbert
- Centre for Neurotechnology, University of Washington, Seattle, USA
- School of Humanities, CALE, University of Tasmania, Hobart, Australia
| | - C Pham
- Centre for Neurotechnology, University of Washington, Seattle, USA
| | - Jnm Viaña
- School of Humanities, CALE, University of Tasmania, Hobart, Australia
| | - W. Gillam
- Centre for Neurotechnology, University of Washington, Seattle, USA
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Eden L, Kühn A, Gilbert F, Meffert RH, Lefering R. Increased Mortality Among Critically Injured Motorcyclists Over 65 Years of Age. Dtsch Arztebl Int 2019; 116:479-485. [PMID: 31431237 DOI: 10.3238/arztebl.2019.0479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 05/15/2019] [Accepted: 05/15/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Motorcycle accidents account for a large fraction of the patients with polytrauma treated in German hospitals. Clinical experience indicates that an in- creasing number of older motorcyclists are having accidents. We studied whether such individuals are subject to higher mortality and longer hospital stays. METHODS We retrospectively evaluated data from the Traumaregister DGU® (TR- DGU) concerning all patients (n = 13 850) who were registered in the TR-DGU as having sustained trauma in a motorcycle accident from 2002 to 2015 and who had an Injury Severity Score (ISS) greater than 8. The patients were divided into four age groups for further study. RESULTS Despite a nearly identical severity of anatomical injury according to the ISS, persons sustaining trauma in motorcycle accidents who were over 65 years of age (n = 892) needed longer and more intensive treatment than their younger counter- parts. They were invasively ventilated for a longer time (+ 1.2 days), kept for a longer time on the intensive care unit (+ 1.7 days), and stayed in the hospital three days longer. These older persons injured in motorcycle accidents had a disproportionate mortality in comparison to other polytrauma patients and a significantly elevated mor- tality in comparison to their younger counterparts-15.8%, compared to 7.2% among patients aged 45 to 64. Older trauma patients are more likely than younger ones to develop lethal complications in the later course of their hospitalization, while younger trauma patients who die generally do so as a direct result of the traumatic injury. CONCLUSION Patients over age 65 who sustain trauma in motorcycle accidents have a higher mortality, a longer duration of ventilation, and longer stays in the intensive care unit and in the hospital overall than their younger counterparts. These patients present a special challenge to the treating medical team.
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Affiliation(s)
- Lars Eden
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius Maximilians University Würzburg; Department of Orthopedics and Trauma Surgery, Robert-Bosch-Krankenhaus Stuttgart; Committee on Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU)
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Gilbert F, Cook M, O’Brien T, Illes J. Embodiment and Estrangement: Results from a First-in-Human "Intelligent BCI" Trial. Sci Eng Ethics 2019; 25:83-96. [PMID: 29129011 PMCID: PMC6418065 DOI: 10.1007/s11948-017-0001-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 10/31/2017] [Indexed: 05/21/2023]
Abstract
While new generations of implantable brain computer interface (BCI) devices are being developed, evidence in the literature about their impact on the patient experience is lagging. In this article, we address this knowledge gap by analysing data from the first-in-human clinical trial to study patients with implanted BCI advisory devices. We explored perceptions of self-change across six patients who volunteered to be implanted with artificially intelligent BCI devices. We used qualitative methodological tools grounded in phenomenology to conduct in-depth, semi-structured interviews. Results show that, on the one hand, BCIs can positively increase a sense of the self and control; on the other hand, they can induce radical distress, feelings of loss of control, and a rupture of patient identity. We conclude by offering suggestions for the proactive creation of preparedness protocols specific to intelligent-predictive and advisory-BCI technologies essential to prevent potential iatrogenic harms.
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Affiliation(s)
- F. Gilbert
- Centre for Sensorimotor Neural Engineering, Department of Philosophy, University of Washington, Seattle, WA USA
- National Core for Neuroethics, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC USA
- Australian Research Council DECRA Fellow, University of Tasmania, Hobart, Australia
| | - M. Cook
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
- Department of Neurology, St. Vincent’s Hospital, Melbourne, Australia
| | - T. O’Brien
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - J. Illes
- National Core for Neuroethics, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC USA
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Gilbert F, Schneemann C, Scholz CJ, Kickuth R, Meffert RH, Wildenauer R, Lorenz U, Kellersmann R, Busch A. Clinical implications of fracture-associated vascular damage in extremity and pelvic trauma. BMC Musculoskelet Disord 2018; 19:404. [PMID: 30458745 PMCID: PMC6247697 DOI: 10.1186/s12891-018-2333-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 10/31/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Vascular damage in polytrauma patients is associated with high mortality and morbidity. Therefore, specific clinical implications of vascular damage with fractures in major trauma patients are reassessed. METHODS This comprehensive nine-year retrospective single center cohort study analyzed demography, laboratory, treatment and outcome data from 3689 patients, 64 patients with fracture-associated vascular injuries were identified and were compared to a control group. RESULTS Vascular damage occurred in 7% of patients with upper and lower limb and pelvic fractures admitted to the trauma room. Overall survival was 80% in pelvic fracture and 97% in extremity fracture patients and comparable to non-vascular trauma patients. Additional arterial damage required substantial fluid administration and was visible as significantly anemia and disturbed coagulation tests upon admission. Open procedures were done in over 80% of peripheral extremity vascular damage. Endovascular procedures were predominant (87%) in pelvic injury. CONCLUSION Vascular damage is associated with high mortality rates especially in combination with pelvic fractures. Initial anemia, disturbed coagulation tests and the need for extensive pre-clinical fluid substitution were observed in the cohort with vascular damage. Therefore, fast diagnosis and early interventional and surgical procedures are necessary to optimize patient-specific outcome.
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Affiliation(s)
- F. Gilbert
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Würzburg, Germany
- Department of Trauma Hand Plastic and Reconstructive Surgery, University Munich Germany, Julius-Maximilians-University of Würzburg Oberdürrbacherstr, 6 D-, 97080 Würzburg, Germany
| | - C. Schneemann
- Department for General Visceral, Vascular & Paediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - C. J. Scholz
- Core Unit Systems Medicine IZKF, University Hospital Würzburg, Würzburg, Germany
| | - R. Kickuth
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - R. H. Meffert
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Würzburg, Germany
| | - R. Wildenauer
- Department for General Visceral, Vascular & Paediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - U. Lorenz
- Department for General Visceral, Vascular & Paediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - R. Kellersmann
- Department of Vascular Surgery, Klinikum Fulda, Fulda, Germany
| | - A. Busch
- Department for General Visceral, Vascular & Paediatric Surgery, University Hospital Würzburg, Würzburg, Germany
- Department for Vascular and Endovascular Surgery Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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Sturla Lompré J, Nievas M, Franco M, Grossi V, Ferrando A, Militon C, Gilbert F, Cuny P, Stora G, Sepúlveda M, Esteves J, Commendatore M. Fate of petroleum hydrocarbons in bioturbated pristine sediments from Caleta Valdés (Patagonia Argentina): An ex situ bioassay. Ecotoxicol Environ Saf 2018; 162:673-682. [PMID: 30025591 DOI: 10.1016/j.ecoenv.2018.06.069] [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: 12/12/2017] [Revised: 06/12/2018] [Accepted: 06/22/2018] [Indexed: 06/08/2023]
Abstract
Petroleum can pollute pristine shorelines as a consequence of accidental spills or chronic leaks. In this study, the fate of petroleum hydrocarbons in soft pristine sediment of Caleta Valdés (Argentina) subject to ex situ simulated oil pollution was assessed. Sedimentary columns were exposed to medium and high concentrations of Escalante Crude Oil (ECO) and incubated in the laboratory during 30 days. Levels of aliphatic hydrocarbons at different depths of the sedimentary column were determined by gas chromatography. Oil penetration was limited to the first three centimetres in both treatments, and under this depth, hydrocarbons were clearly biogenic (terrestrial plants) as in the whole sedimentary column of the control assay. Bioturbation by macrobenthic infauna was strongly impacted by oil pollution which resulted in reduced sediment oxygenation and low burial of petroleum hydrocarbons. This may partly explain the limited hydrocarbon biodegradation observed, as indicated by the relatively high values of the ratios nC17/pristane, nC18/phytane, and total resolved aliphatic hydrocarbons/unresolved complex mixture. Correspondingly, at the end of the experiment the most probable number of hydrocarbon-degrading bacteria reached ~ 103 MPN g-1 dry weight. These values were lower than those found in chronically polluted coastal sediments, reflecting a low activity level of the oil-degrading community. The results highlight the low attenuation capacities of Caleta Valdés pristine sediments to recover its original characteristics in a short time period if an oil spill occurs. In this work, we present a novel and integrative tool to evaluate the fate of petroleum hydrocarbons and their potential damage on pristine sediments.
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Affiliation(s)
- J Sturla Lompré
- Centro para el Estudio de Sistema Marinos, CONICET, Bvd. Brown 2915, Puerto Madryn 9120, Argentina.
| | - M Nievas
- Centro para el Estudio de Sistema Marinos, CONICET, Bvd. Brown 2915, Puerto Madryn 9120, Argentina; Universidad Tecnológica Nacional, Facultad Regional Chubut, Av. del Trabajo 1536, Puerto Madryn 9120, Argentina
| | - M Franco
- Universidad Tecnológica Nacional, Facultad Regional Chubut, Av. del Trabajo 1536, Puerto Madryn 9120, Argentina; Centro Nacional Patagónico, CONICET, Bvd. Brown 2915, Puerto Madryn 9120, Argentina
| | - V Grossi
- Laboratoire de Géologie de Lyon, Université Claude Bernard, Lyon 1, Campus Scientifique de la Doua, 69622 Villeurbanne, France
| | - A Ferrando
- Centro para el Estudio de Sistema Marinos, CONICET, Bvd. Brown 2915, Puerto Madryn 9120, Argentina; Universidad Tecnológica Nacional, Facultad Regional Chubut, Av. del Trabajo 1536, Puerto Madryn 9120, Argentina
| | - C Militon
- Aix-Marseille Université, CNRS, Université de Toulon, IRD, MIO UM 110, 13288 Marseille, France
| | - F Gilbert
- Laboratoire Ecologie Fonctionnelle et Environnement, Université de Toulouse, INP, UPS, 118 Route de Narbonne, 31062 Toulouse, France; CNRS, EcoLab, 31062 Toulouse, France
| | - P Cuny
- Aix-Marseille Université, CNRS, Université de Toulon, IRD, MIO UM 110, 13288 Marseille, France
| | - G Stora
- Aix-Marseille Université, CNRS, Université de Toulon, IRD, MIO UM 110, 13288 Marseille, France
| | - M Sepúlveda
- Centro para el Estudio de Sistema Marinos, CONICET, Bvd. Brown 2915, Puerto Madryn 9120, Argentina
| | - J Esteves
- Centro para el Estudio de Sistema Marinos, CONICET, Bvd. Brown 2915, Puerto Madryn 9120, Argentina
| | - M Commendatore
- Centro para el Estudio de Sistema Marinos, CONICET, Bvd. Brown 2915, Puerto Madryn 9120, Argentina
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Paluch-Shimon S, Cardoso F, Sessa C, Balmana J, Cardoso MJ, Gilbert F, Senkus E. Prevention and screening in BRCA mutation carriers and other breast/ovarian hereditary cancer syndromes: ESMO Clinical Practice Guidelines for cancer prevention and screening. Ann Oncol 2018; 27:v103-v110. [PMID: 27664246 DOI: 10.1093/annonc/mdw327] [Citation(s) in RCA: 244] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- S Paluch-Shimon
- Division of Oncology and the Dr Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel
| | - F Cardoso
- Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal
| | - C Sessa
- Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - J Balmana
- Vall d`Hebron University Hospital Institut d'Oncologia, Barcelona, Spain
| | - M J Cardoso
- Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal
| | - F Gilbert
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - E Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
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Papalouka V, Kilburn-Toppin F, Gaskarth M, Gilbert F. MRI-guided breast biopsy: a review of technique, indications, and radiological-pathological correlations. Clin Radiol 2018; 73:908.e17-908.e25. [PMID: 30041954 DOI: 10.1016/j.crad.2018.05.029] [Citation(s) in RCA: 6] [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] [Received: 12/09/2017] [Accepted: 05/24/2018] [Indexed: 10/28/2022]
Abstract
Breast magnetic resonance imaging (MRI) is the technique of choice in detection, local staging, and monitoring of breast cancer; however, breast MRI results in the detection of more indeterminate/suspicious lesions that need to be histopathologically proven to guide patient management than any other breast imaging method. If such abnormalities are not detectable in any of the conventional imaging tools (mammography (MMG) or ultrasound) then an MRI-guided biopsy needs to be performed to obtain a diagnosis. Breast MRI-guided biopsy is a time-consuming and complex procedure that requires specific equipment and experienced, well-trained staff. This review article explores and illustrates the indications, the currently available technologies, and the technique of breast MRI-guided biopsy, and explains the importance of careful imaging review and selection of cases. We correlate the radiological-pathological findings and highlight the impact on patient management in a multidisciplinary setting.
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Affiliation(s)
- V Papalouka
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK
| | - F Kilburn-Toppin
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK.
| | - M Gaskarth
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK
| | - F Gilbert
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK
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Gilbert F, Meffert RH, Schmalzl J, Weng AM, Köstler H, Eden L. Grade of retraction and tendon thickness correlates with MR-spectroscopically measured amount of fatty degeneration in full thickness supraspinatus tears. BMC Musculoskelet Disord 2018; 19:197. [PMID: 30037322 PMCID: PMC6055352 DOI: 10.1186/s12891-018-2096-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/16/2018] [Indexed: 12/11/2022] Open
Abstract
Background The amount of fatty degeneration (FD) has major impact on the clinical result and cuff integrity after rotator cuff repair. A quantitative analysis with magnet resonance imaging (MRI) spectroscopy was employed to analyze possible correlation of FD with tendon retraction, tendon thickness and patients’ characteristics in full thickness supraspinatus tears. Methods Forty-two patients with full-thickness supraspinatus tears underwent shoulder MRI including an experimental spectroscopic sequence allowing quantification of the fat fraction in the supraspinatus muscle belly. The amount of fatty degeneration was correlated with tendon retraction, tendon thickness, patients’ age, gender, smoker status, symptom duration and body mass index (BMI). Patients were divided in to three groups of retraction (A) 0-10 mm (n=), (B) 11-20 mm (n=) and (C) < 21 mm (n=) and the means of FD for each group were calculated. Results Tendon retraction (R = 0.6) and symptom duration (R = 0.6) correlated positively, whereas tendon thickness correlated negatively (R = − 0.6) with the amount of FD. The fat fraction increased significantly with tendon retraction: Group (A) showed a mean fat mount of 3.7% (±4%), group (B) of 16.7% (±8.2%) and group (C) of 37.5% (±19%). BMI, age and smoker-status only showed weak to moderate correlation with the amount of FD in this cohort. Conclusion MRI spectroscopy revealed significantly higher amount of fat with increasing grade of retraction, symptom duration and decreased tendon thickness. Thus, these parameters may indirectly be associated with the severity of tendon disease.
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Affiliation(s)
- F Gilbert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany.
| | - R H Meffert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - J Schmalzl
- Department of Traumatology and Hand Surgery, St. Vincentius Klinik, ViDia Kliniken, Suedendstraße 32, D-76137, Karlsruhe, Germany
| | - A M Weng
- Department of Radiology, Julius-Maximilians-University of Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - H Köstler
- Department of Radiology, Julius-Maximilians-University of Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - L Eden
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
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Zavidovique L, Gilbert F, Vercambre-Jacquot MN. Bien-être au travail et qualité de vie des enseignants : quelles différences selon l’ancienneté ? ARCH MAL PROF ENVIRO 2018. [DOI: 10.1016/j.admp.2017.09.005] [Citation(s) in RCA: 4] [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] [Indexed: 10/18/2022]
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Gilbert F, Eden L, Meffert R, Konietschke F, Lotz J, Bauer L, Staab W. Intra- and interobserver reliability of glenoid fracture classifications by Ideberg, Euler and AO. BMC Musculoskelet Disord 2018; 19:89. [PMID: 29580228 PMCID: PMC5870213 DOI: 10.1186/s12891-018-2016-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/21/2018] [Indexed: 01/24/2023] Open
Abstract
Background Representing 3%–5% of shoulder girdle injuries scapula fractures are rare. Furthermore, approximately 1% of scapula fractures are intraarticularfractures of the glenoid fossa. Because of uncertain fracture morphology and limited experience, the treatment of glenoid fossa fractures is difficult. The glenoid fracture classification by Ideberg (1984) and Euler (1996) is still commonly used in literature. In 2013 a new glenoid fracture classification was introduced by the AO. The purpose of this study was to examine the new AO classification in clinical practice in comparison with the classifications by Ideberg and Euler. Methods In total CT images of 84 patients with glenoid fossa fractures from 2005 to 2018 were included. Parasagittal, paracoronary and axial reconstructions were examined according to the classifications of Ideberg, Euler and the AO by 3 investigators (orthopedic surgeon, radiologist, student of medicine) at three individual time settings. Inter- and intraobserver reliability of the three classification systems were ascertained by computing Inter- and Intraclass (ICCs) correlation coefficients using Spearman’s rank correlation coefficient, 95%-confidence intervals as well as F-tests for correlation coefficients. Results Inter- and intraobserver reliability for the AO classification showed a perspicuous coherence (R = 0.74 and R = 0.79). Low to moderate intraobserver reliability for Ideberg (R = 0.46) and Euler classification (R = 0.41) was found. Furthermore, data show a low Interobserver reliability for both Ideberg and Euler classification (R < 0.2). Both the Inter- and Intraclass reliability using AO is significantly higher than those using Ideberg and Euler (p < 0.05). Using the new AO classification, it was possible to find a proper class for every glenoid fossa fracture. On average, according to Euler classification 10 of 84 fractures were not classifiable whereas to Ideberg classification 21 of 84 fractures were not classifiable. Conclusion The new AO classification system introduced 2013 facilitates reliable grading of glenoid fossa fractures with high inter- and intraobserver reliability in 84 patients using CT images. It should possibly be applied in order to enable a valid, reliable and consistent academic description of glenoid fossa fractures. The established classifications by Euler and Ideberg are not capable of providing a similar reliability.
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Affiliation(s)
- F Gilbert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Würzburg, Würzburg, Germany.
| | - L Eden
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - R Meffert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - F Konietschke
- Department of Mathematical Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - J Lotz
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - L Bauer
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - W Staab
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
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Gilbert F, Heintel TM, Jakubietz MG, Köstler H, Sebald C, Meffert RH, Weng AM. Quantitative MRI comparison of multifidus muscle degeneration in thoracolumbar fractures treated with open and minimally invasive approach. BMC Musculoskelet Disord 2018. [PMID: 29514622 PMCID: PMC5842610 DOI: 10.1186/s12891-018-2001-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Minimally invasive pedicle screw fixation has less approach-related morbidity than open screw placement and is allegedly less traumatizing on paravertebral muscles, as there is no requirement to mobilize and retract the adjacent muscle portion. The approach-related long-term effects to the morphology of the paravertebral muscles are unknown. The purpose of this study was to compare the long-term amount of fatty degeneration of the multifidus muscle in patients treated with a classical open or a minimally invasive approach. Methods Fourteen Patients meeting inclusion criteria were selected. In all patients a singular fracture of the thoracolumbar spine with a two-level posterior instrumentation was treated, either using an open approach or a minimally invasive approach. All patients underwent quantitative MRI spectroscopy for quantification of the fatty degeneration in the multifidus muscle as a long-term proof for muscle loss after minimum 4-year follow-up. Clinical outcome was assessed using Oswestry Low Back Pain Disability Questionnaire, SF-36 and VA-scale for pain. Results The minimally invasive approach group failed to show less muscle degeneration in comparison to the open group. Total amount of fatty degeneration was 14.22% in the MIS group and 12.60% in the open group (p = 0.64). In accordance to MRI quantitative results there was no difference in the clinical outcome after a mean follow up of 5.9 years (±1.8). Conclusion As short-term advantages of minimal invasive screw placement have been widely demonstrated, no advantage of the MIS, displaying a significant difference in the amount of fatty degeneration and resulting in a better clinical outcome could be found. Besides the well-known short-term advantage of minimally invasive pedicle screw placement, a long-term advantage, such as less muscle degeneration and thus superior clinical results, compared to the open approach could not be shown.
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Affiliation(s)
- F Gilbert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany.
| | - T M Heintel
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - M G Jakubietz
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - H Köstler
- Department of Radiology Julius-Maximilians-University of Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - C Sebald
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - R H Meffert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - A M Weng
- Department of Radiology Julius-Maximilians-University of Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
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Vercambre-Jacquot MN, Gilbert F, Billaudeau N. [Teacher sick leave: Prevalence, duration, reasons and covariates]. Rev Epidemiol Sante Publique 2017; 66:19-31. [PMID: 29290454 DOI: 10.1016/j.respe.2017.10.005] [Citation(s) in RCA: 3] [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] [Received: 09/30/2016] [Revised: 08/03/2017] [Accepted: 10/20/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Absences from work have considerable social and economic impact. In the education sector, the phenomenon is particularly worrying since teacher sick leave has an impact on the overall performance of the education system. Yet, available data are scarce. METHODS In April-June 2013, 2653 teachers responded to a population-based postal survey on their quality of life (enquête Qualité de vie des enseignants, MGEN Foundation/Ministry of education, response rate 53 %). Besides questions on work environment and health, teachers were asked to describe their eventual sick leave(s) since the beginning of the school year: duration, type and medical reasons. Self-reported information was reinforced by administrative data from ministerial databases and weighted to be extrapolated to all French teachers. Tobit models adjusted for individual factors of a private nature were used to investigate different occupational risk factors of teacher sick leave, taking into account both the estimated effect on the probability of sick leave and the length of it. RESULTS More than one in three teachers (36 %) reported having had at least one day of sick leave since the beginning of the school year. Respiratory/ENT diseases were the leading reason for sick leave (37 %). However, and because sick leave duration depended on the underlying health problem, such diseases came in third place among justifications of sick leave days (14 %), far behind musculoskeletal problems (27 %) and neurological and psychological disorders (25 %). Tobit models suggested that some occupational factors significantly associated with the risk of sick leave may represent promising preventive targets, including high psychological demand, workplace violence and unfavorable socio-environmental context. CONCLUSION Our study provides objective evidence about the issue of sick leave among French teachers, highlighting the usefulness of implementing actions to minimize its weight. To this end, the study findings point-out the importance of considering not only the probability of sick leave, but also its duration.
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Affiliation(s)
- M-N Vercambre-Jacquot
- Fondation d'entreprise MGEN pour la santé publique, 3, square Max-Hymans, 75748 Paris cedex 15, France.
| | - F Gilbert
- Fondation d'entreprise MGEN pour la santé publique, 3, square Max-Hymans, 75748 Paris cedex 15, France
| | - N Billaudeau
- Fondation d'entreprise MGEN pour la santé publique, 3, square Max-Hymans, 75748 Paris cedex 15, France
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