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Kabir K, von Rundstedt FC, Roos J, Gathen M. Robotic-assisted plate fixation of the anterior acetabulum - clinical description of a new technique. J Orthop Surg Res 2024; 19:253. [PMID: 38644485 PMCID: PMC11034051 DOI: 10.1186/s13018-024-04731-x] [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: 03/01/2024] [Accepted: 04/11/2024] [Indexed: 04/23/2024] Open
Abstract
INTRODUCTION We present a detailed procedure for the robotic-assisted plate osteosynthesis of an anterior acetabular fracture. The purpose of this work was to describe a robotic-assisted minimally invasive technique as a possible method for reducing complications, pain, and hospitalization. Another goal was to present technical recommendations and to assess potential pitfalls and problems of the new surgical approach. METHODS Surgery was performed in an interdisciplinary setting by an experienced orthopedic surgeon and a urologist. The DaVinci System with standard instruments was used. Reduction was achieved through indirect traction of a pin that was introduced into the femoral neck and direct manipulation via the plate. The plate position and fixation were achieved through 7 additional minimally invasive incisions. RESULTS The technique has multiple advantages, such as no detachment of the rectus abdominal muscle, a small skin incision, and minimal blood loss. Furthermore, this approach might lower the incidence of hernia formation, infection, and postoperative pain. DISCUSSION We see the presented technique as a demanding yet progressive and innovative surgical method for treating acetabular fractures with indications for anterior plate fixation. TRIAL REGISTRATION The study was approved by the local institutional review board (Nr. 248/18).
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Affiliation(s)
- Koroush Kabir
- Centre of Trauma and Orthopaedic Surgery, Helios University Clinic Wuppertal, Wuppertal, Germany
| | | | - Jonas Roos
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, Bonn, 53127, Germany.
| | - Martin Gathen
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, Bonn, 53127, Germany
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Gathen M, Burger C, Kasapovic A, Kabir K. Proximal Femur Fractures - How Decisive are Reduction and the Chosen Implant? Z Orthop Unfall 2024; 162:135-142. [PMID: 36167326 DOI: 10.1055/a-1904-8551] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Proximal femoral fractures are frequent and complex injuries requiring prompt and targeted care. Numerous treatment strategies have been described, some of which have been assessed and clinically implemented clinically. The aim of surgical is always the restoration of a pain-free and stable extremity. Mostly elderly patients are affected and treatment is associated with high postoperative complications and mortality rates. With increasing numbers of patients, the topic is of great medical and economic relevance. In this work, the choice of implants for the osteosynthesis of proximal femoral fractures - as depending on the fracture type - will be examined, as based on a review of current literature. Standard care includes cannulated screws, sliding hips screws and cephalomedullary nails. In addition, the influence of implant positioning, fracture reduction and additional measures such as cement augmentation are evaluated and discussed. Careful fracture reduction and the quality of implant positioning are paramount in order to avoid complications.
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Affiliation(s)
- Martin Gathen
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn Chirurgisches Zentrum, Bonn, Deutschland
| | - Christof Burger
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn Chirurgisches Zentrum, Bonn, Deutschland
| | - Adnan Kasapovic
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn Chirurgisches Zentrum, Bonn, Deutschland
| | - Koroush Kabir
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn Chirurgisches Zentrum, Bonn, Deutschland
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Gathen M, Cucchi D, Kabir K, Welle K, Jaenisch M, Jansen TR, Randau TM. Open Access Redefined: Survey Data and Literature Study on the Impact of Sci-Hub in Orthopaedic Research. Z Orthop Unfall 2023; 161:648-653. [PMID: 35315005 DOI: 10.1055/a-1773-1268] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Since Alexandra Elbanyan founded Sci-Hub in 2011, the website has been used by a growing number of researchers worldwide. Sci-Hub is a so-called shadow library or guerrilla open access format bypassing publishers' paywalls, giving everyone free access to scientific papers. Until today, there have been no publications about usage by orthopaedic and trauma surgeons of Sci-Hub or other "pirate sites" and how it may influence their work. MATERIALS AND METHODS Orthopaedic and trauma surgeons of four university hospitals in Germany and Europe were consulted using a standardised questionnaire containing multiple items about the use and evaluation of Sci-Hub. In addition, the Medline and Cochrane databases were screened for all studies related to Sci-Hub. Two reviewers independently reviewed all articles and the references of these articles. RESULTS Of all orthopaedic surgeons consulted, 69% knew of Sci-Hub and 66.7% used it on a regular basis. Of the younger participants (< 45 years old), 77% knew the webpage, while only 25% of older participants (> 45 years old) knew the webpage. Ninety percent found the quality of their citation and research had been enhanced since using Sci-Hub. On a scale of 1 to 10, user-friendliness was rated with a mean rating of 7.58 (95% CI: 7.262-7.891). Ethical or legal concerns among users seem mixed. On a scale of 1 (no concerns) to 5 (many concerns), the mean score was 2.39 (95% CI: 2.154-2.615). Of doctors using Sci-Hub, 89% would recommend it to other colleagues. CONCLUSION The quality and number of articles in Sci-Hub is outstanding, and the rate of young researchers using the website is high. The most important shift in literature research for decades is a phenomenon mostly used by young researchers and is not the subject of current research itself. Sci-Hub may have already changed how orthopaedic research works.
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Affiliation(s)
- Martin Gathen
- Department of Orthopedics and Trauma Surgery, Universitätsklinikum Bonn, Chirurgisches Zentrum, Bonn, Germany
| | - Davide Cucchi
- Department of Orthopedics and Trauma Surgery, Universitätsklinikum Bonn, Chirurgisches Zentrum, Bonn, Germany
| | - Koroush Kabir
- Department of Orthopedics and Trauma Surgery, Universitätsklinikum Bonn, Chirurgisches Zentrum, Bonn, Germany
| | - Kristian Welle
- Department of Orthopedics and Trauma Surgery, Universitätsklinikum Bonn, Chirurgisches Zentrum, Bonn, Germany
| | - Max Jaenisch
- Department of Orthopedics and Trauma Surgery, Universitätsklinikum Bonn, Chirurgisches Zentrum, Bonn, Germany
| | - Tom Rainer Jansen
- Department of Orthopedics and Trauma Surgery, Universitätsklinikum Bonn, Chirurgisches Zentrum, Bonn, Germany
| | - Thomas Martin Randau
- Department of Orthopedics and Trauma Surgery, Universitätsklinikum Bonn, Chirurgisches Zentrum, Bonn, Germany
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Roos J, Loy T, Ploeger MM, Weinhold L, Schmid M, Mewes M, Prangenberg C, Gathen M. It is (not) always on Friday: inter-hospital patient transfers in orthopedic and trauma surgery. Eur J Trauma Emerg Surg 2023; 49:2605-2613. [PMID: 37599307 PMCID: PMC10728266 DOI: 10.1007/s00068-023-02335-4] [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] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND While inter-hospital transfers for patients who have suffered major trauma have been well investigated, patient flows for other injured patients, or cases with orthopedic complications, are rarely described. This study aims to analyze the affected collective and to show possible reasons, patterns, and pitfalls to optimize the process in future. MATERIALS AND METHODS In a prospective cohort study, all consecutive transfers to a Level I trauma center in Germany were documented and assessed. Patients suffering a major trauma were excluded. Data on the primary treating hospital, patient characteristics, and differences between emergency and elective surgery were analyzed. RESULTS A total of 227 patients were included; 162 were injured, while 65 had suffered a complication after elective orthopedic surgery or had a complex orthopedic pathology. The most common diagnoses leading to transfer were pathologies of the extremities (n = 62), pathologies of the spine (n = 50), and infections (n = 18). The main reasons stated by the transferring hospitals were a lack of expertise (137 cases) and a lack of capacity (43 cases). There was a significantly higher rate of transfers due to trauma (n = 162) than for orthopedic patients (n = 65), p < 0.0001. CONCLUSION There is currently no structured procedure or algorithm for transferring patients in orthopedics and trauma surgery.
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Affiliation(s)
- Jonas Roos
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Thomas Loy
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Milena M Ploeger
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Leonie Weinhold
- Institute for Medical Biometrics, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany
| | - Matthias Schmid
- Institute for Medical Biometrics, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany
| | - Moritz Mewes
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Christian Prangenberg
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Martin Gathen
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Rüwald J, Ploeger MM, Hischebeth GT, Tüllmann M, Roos J, Gathen M, Kabir K. Description of Standardized Planes and Angles for Percutaneous Supra-acetabular Screw Placement. Z Orthop Unfall 2023. [PMID: 37463591 DOI: 10.1055/a-2107-0948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Percutaneous screw fixation for pelvic fractures has become a minimally invasive alternative to an open operation. The complex anatomy of the pelvis renders this procedure challenging. The objective of this study was to assess standardized angles and dimensions of safety zones within a 3 D computed tomography model for optimal supra-acetabular screw placement. METHODS Computed tomography scans of 107 patients that suffered major trauma without showing any bone injury of the pelvis were collected. Using a software-based analysis, raw computed tomography data were transformed into 3 D models to set standardized landmarks and determine the possible insertion corridor. RESULTS Screws not exceeding a length of 97 mm in females and 106.4 mm in males were, in 95% of the evaluated cases, insertable without cortical bone penetration. The safety zone was 6.6 mm for females and 7.9 mm for males. Screws not exceeding these diameters were safely insertable in 95% of the cases. For the midsagittal plane, the angle was 36.4 ± 5.1 on the left and 34.7 ± 2.9 on the right (p = 0.008). For the anterior pelvic plane, the angle was 31.3 ± 4.5° on the left and 34.0 ± 4.8° on the right (p = 0.008). CONCLUSIONS Percutaneous fixation using supra-acetabular screws is a promising method to treat simple supra-acetabular fractures. These results may improve its safe utilization and could facilitate its broader clinical application.
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Affiliation(s)
- Julian Rüwald
- Department of Anesthesiology and Intensive Care Medicine, Essen, Germany, University Hospital Essen, Essen, Germany
| | - Milena Maria Ploeger
- Department for Orthopaedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Gunnar T Hischebeth
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Mareike Tüllmann
- Department for Orthopaedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Jonas Roos
- Department for Orthopaedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Martin Gathen
- Department for Orthopaedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Koroush Kabir
- Department for Orthopaedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
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Kleftouris G, Tosounidis TH, Panteli M, Gathen M, Giannoudis PV. Endovis Nail versus Dynamic Hip Screw for Unstable Pertrochanteric Fractures: A Feasibility Randomised Control Trial including Patients with Cognitive Impairment. J Clin Med 2023; 12:4237. [PMID: 37445271 DOI: 10.3390/jcm12134237] [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: 05/17/2023] [Revised: 06/11/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
A prospective, feasibility, randomised study was performed to compare intramedullary versus extramedullary fixation of unstable pertrochanteric fractures and to assess the feasibility of including patients with dementia. From July 2016 to November 2017, 60 consecutive patients with an unstable pertrochanteric (OTA/AO 31-A2) fracture were randomized to either receive a short cephalomedullary nail (Endovis EBA2, Citieffe) or a dynamic hip screw (DHS, Zimmer Biomet). Primary feasibility measures included randomisation, recruitment, and retention rates. Secondary outcomes included peri-operative parameters, patient-reported outcomes and radiographic outcomes. Patients were followed-up at two, four, and twelve weeks. There was no difference in the randomisation rate between patients with and without cognitive impairment. Significantly more patients without cognitive impairment attended the 12-week follow-up. The overall recruitment rate was 0.9 patients per week. Patients treated with the nail had less pain at 2 weeks and less neck collapse, medialisation, and leg shortening at all time points. The rest of secondary outcomes were similar. Patients with dementia can successfully be enrolled in a randomised trial on hip fractures. Patients treated with the Endovis nail had lower levels of pain at two weeks and better radiographic outcomes.
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Affiliation(s)
- George Kleftouris
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds LS2 9LU, UK
| | - Theodoros H Tosounidis
- Department of Orthopaedic Surgery, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Michalis Panteli
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds LS2 9LU, UK
| | - Martin Gathen
- Department of Orthopaedics and Trauma Surgery, University Hospital of Bonn, 53127 Bonn, Germany
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds LS2 9LU, UK
- NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds LS7 4SA, UK
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Jaenisch M, Babasiz M, Ben Amar S, Lück E, Gathen M, Wirtz DC, Randau TM. Surgical technique and preliminary results of a moulded, mobile spacer for the treatment of periprosthetic joint infection of the knee. Oper Orthop Traumatol 2023; 35:163-169. [PMID: 37010531 DOI: 10.1007/s00064-023-00803-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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/01/2022] [Accepted: 08/23/2022] [Indexed: 04/04/2023]
Abstract
OBJECTIVE Mobile knee spacers can be utilized in the first stage of a two-stage exchange in periprosthetic joint infection or septic arthritis of the knee to prevent soft tissue contraction, enable local antibiotic elution, and improve patient mobility. Commercially made moulds enable the surgeon to prepare a reproducible spacer design and match the preparation of the arthroplasty, which will be carried out in a second step. INDICATIONS Periprosthetic joint infection of the knee and severe cases of septic arthritis of the knee with advanced destruction/infiltration of the cartilage. CONTRAINDICATIONS Antibiotic resistance of the microbiological pathogen to available antibiotic agents, incompliant patient, large osseous defect preventing proper fixation, known allergy to polymethylmethacrylate (PMMA) or antibiotic, severe soft tissue damage with high ligament instability, especially deterioration of extensor mechanism and insufficient patella/quadricep tendon. SURGICAL TECHNIQUE After thorough debridement and removal of all foreign material, cutting blocks are used to shape femur and tibia to the implant design required. Using a silicone mould, PMMA with suitable antibiotics is moulded into the shape of the future implant. After polymerization, the implants are fixed onto the bone with additional PMMA without pressurize for the sake of easy removal. POSTOPERATIVE MANAGEMENT Partial weight bearing with no restriction of flexion/extension while spacer is in place; second stage reimplantation as soon as infection is controlled. RESULTS In all, 22 cases were treated, mostly with a PMMA spacer containing gentamicin and vancomycin. Pathogens were detected in 13 of 22 cases (59%). We observed two complications (9%). Twenty of 22 patients (86%) were reimplanted with a new arthroplasty; 16 of the 20 patients remained revision-free and infection-free at the last follow-up (average time to follow-up 13 months, range 1-46 months). Average range of motion in flexion and extension at follow-up was 98°.
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Affiliation(s)
- Max Jaenisch
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universiätsklinik Bonn, Venusberg-Campus 1, 53105, Bonn, Germany
| | - Mari Babasiz
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universiätsklinik Bonn, Venusberg-Campus 1, 53105, Bonn, Germany
| | - Soufian Ben Amar
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universiätsklinik Bonn, Venusberg-Campus 1, 53105, Bonn, Germany
| | - Eva Lück
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universiätsklinik Bonn, Venusberg-Campus 1, 53105, Bonn, Germany
| | - Martin Gathen
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universiätsklinik Bonn, Venusberg-Campus 1, 53105, Bonn, Germany
| | - Dieter Christian Wirtz
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universiätsklinik Bonn, Venusberg-Campus 1, 53105, Bonn, Germany
| | - Thomas Martin Randau
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universiätsklinik Bonn, Venusberg-Campus 1, 53105, Bonn, Germany.
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Kasapovic A, Hischebeth G, Jaenisch M, Ali T, Gathen M, Babasiz M, Bojko J, Roos J, Smajic S. Sonication in Patients With Spinal Cord Stimulation: A New Approach for Infection Diagnostics. Neuromodulation 2023:S1094-7159(23)00107-1. [PMID: 36997452 DOI: 10.1016/j.neurom.2023.02.079] [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: 11/04/2022] [Revised: 01/31/2023] [Accepted: 02/13/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION Spinal cord stimulation (SCS) offers improvement in pain and function for several chronic pain conditions. There are concerns regarding bacterial colonization of the temporary lead extensions and subsequent infection risk in a two-session implantation procedure. Although there is no standardized evaluation of SCS lead contamination, this study evaluates the infection rate and microbial colonization of SCS lead extensions with sonication, a method that is established in implant-related infection diagnostics. MATERIALS AND METHODS This prospective observational study comprised 32 patients with a two-stage SCS implantation procedure. Microbial colonization of the lead extensions was assessed with sonication. The presence of organisms in the subcutaneous tissue was evaluated separately. Surgical-site infections were recorded. Patient demographics and risk factors including diabetes, tobacco use, obesity, trial length, and infection parameters in serum were recorded and analyzed. RESULTS The mean age of the patients was 55 years. On average, the trial length was 13 days. In seven cases (21.9%), a microbial lead colonization was found with sonication. In contrast, there was one positive culture (3.1%) from the subcutaneous tissue samples. The C-reactive protein and leukocyte count remained at the preoperative level. One early surgical-site infection (3.1%) occurred. No other late infections occurred six months after surgery. CONCLUSIONS There is a discrepancy between the presence of microbial colonization and the occurrence of clinically relevant infections. Although the rate of microbial colonization of the lead extensions is high (21.9%), the surgical-site infection rate remained low (3.1%). Therefore, we can conclude that the two-session procedure is a safe approach that is not associated with a higher incidence of infection. Although the sonication method cannot be used as the sole tool for detecting infections in patients with SCS, it can provide additional value in microbial diagnostics in combination with clinical and laboratory parameters and conventional microbiological methods.
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Affiliation(s)
- Adnan Kasapovic
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn Venusberg Campus 1, Bonn, Germany.
| | - Gunnar Hischebeth
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Max Jaenisch
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn Venusberg Campus 1, Bonn, Germany
| | - Thaer Ali
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn Venusberg Campus 1, Bonn, Germany
| | - Martin Gathen
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn Venusberg Campus 1, Bonn, Germany
| | - Mari Babasiz
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn Venusberg Campus 1, Bonn, Germany
| | - Jessica Bojko
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn Venusberg Campus 1, Bonn, Germany
| | - Jonas Roos
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn Venusberg Campus 1, Bonn, Germany
| | - Samir Smajic
- Department of Orthopedic, Trauma and Spine Surgery, St. Josef Hospital, Linnich, Germany
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Jaenisch M, Kohlhof H, Kasapovic A, Gathen M, Randau TM, Kabir K, Roessler PP, Pagenstert G, Wirtz DC. Femoral defects in revision hip arthroplasty: a therapy-oriented classification. Arch Orthop Trauma Surg 2023; 143:1163-1174. [PMID: 34636979 PMCID: PMC9957875 DOI: 10.1007/s00402-021-04201-7] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The complex field of femoral defects in revision hip arthroplasty displays a lack of standardized, intuitive pre- and intraoperative assessment. To address this issue, the femoral defect classification (FDC) is introduced to offer a reliable, reproducible and an intuitive classification system with a clear therapeutic guideline. MATERIALS AND METHODS The FDC is based on the integrity of the main femoral segments which determine function and structural support. It focuses on the femoral neck, the metaphysis consisting of the greater and lesser trochanter, and the femoral diaphysis. The four main categories determine the location of the defect while subcategories a, b and c are being used to classify the extent of damage in each location. In total, 218 preoperative radiographs were retrospectively graded according to FDC and compared to intraoperatively encountered bone defects. To account for inter-rater and intra-rater agreement, 5 different observers evaluated 80 randomized cases at different points in time. RESULTS A Cohens kappa of 0.832 ± 0.028 could be evaluated, accounting for excellent agreement between preoperative radiographs and intraoperative findings. To account for inter-rater reliability, 80 patients have been evaluated by 5 different observers. Testing for inter-rater reliability, a Fleiss Kappa of 0.688 could be evaluated falling into the good agreement range. When testing for intra-rater reliability, Cohens Kappa of each of the 5 raters has been analyzed and the mean was evaluated at 0.856 accounting for excellent agreement. CONCLUSION The FDC is a reliable and reproducible classification system. It combines intuitive use and structured design and allows for consistent preoperative planning and intraoperative guidance. A therapeutic algorithm has been created according to current literature and expert opinion. Due to the combination of the FDC with the recently introduced Acetabular Defect Classification (ADC) a structured approach to the entire field of hip revision arthroplasty is now available.
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Affiliation(s)
- Max Jaenisch
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Hendrik Kohlhof
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Adnan Kasapovic
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Martin Gathen
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Thomas Martin Randau
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Koroush Kabir
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Philip Peter Roessler
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Geert Pagenstert
- CLARAHOF Clinic of Orthopaedic Surgery, University of Basel, Clarahofweg 19a, 4058 Basel, Switzerland
| | - Dieter Christian Wirtz
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
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Gathen M, Jaenisch M, Fuchs F, Weinhold L, Schmid M, Koob S, Wirtz DC, Wimmer MD. Litigations in orthopedics and trauma surgery: reasons, dynamics, and profiles. Arch Orthop Trauma Surg 2022; 142:3659-3665. [PMID: 34043072 PMCID: PMC9596517 DOI: 10.1007/s00402-021-03958-1] [Citation(s) in RCA: 2] [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: 02/06/2021] [Accepted: 05/10/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND In recent literature, the increasing number of medical litigations, both in terms of the number of cases being filed and the substantive costs associated with lawsuits, has been described. This study aims to provide an overview of the profile of litigation for orthopedic and trauma surgery to describe the differences and the development of the number of cases over time. PATIENTS AND MATERIALS A retrospective review of all litigations between 2000 and 2017 was conducted using the institutional legal database. The causes of litigation were documented and classified into seven major categories. In addition to plaintiff characteristics, the litigation outcomes and the differences between emergency and elective surgery were analyzed. RESULTS A total of 230 cases were evaluated. The mean age of the plaintiffs was 44.6 ± 20.1 years, and 56.8% were female. The main reasons for litigation were claimed inappropriate management (46.1%), misdiagnosis (22.6), and poor nursing care (8.3%). Significantly more litigations were filed against surgeons of the orthopedic subspecialty compared with trauma surgeons (78%; p ≤ 0.0001). There were significantly fewer litigations per 1000 cases filed overall in 2009-2017 (65% less; p = 0.003) than in 2000-2008. CONCLUSION Our results could not confirm the often-stated trend of having more litigations against orthopedic and trauma surgeons. Although the absolute numbers increased, the number of litigations per 1000 patients treated declined. Patients who underwent elective surgery were more likely to file complaints than emergency patients.
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Affiliation(s)
- Martin Gathen
- Department of Orthopaedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - M Jaenisch
- Department of Orthopaedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - F Fuchs
- Department of Orthopaedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - L Weinhold
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany
| | - M Schmid
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany
| | - S Koob
- Department of Orthopaedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - D C Wirtz
- Department of Orthopaedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - M D Wimmer
- Department of Orthopaedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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11
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Hackenberg RK, Welle K, Gathen M, Kasapovic A, Kehrer M, Kabir K. Cervical spine injuries in spinal ankylosing disorders: results of single-stage posterior stabilization without posterolateral fusion. Acta Orthop Belg 2022; 88:675-683. [PMID: 36800650 DOI: 10.52628/88.4.9801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Patients with long-segment cervical spinal fusion resulting from spinal ankylosing disorders (SADs) are at high risk for highly unstable cervical spine fractures necessitating surgery as the treatment of choice; however, without an existing gold standard. Specifically, patients without concomitant myelo- pathy, representing a rare entity, may benefit from a minimized surgical approach of a single-stage posterior stabilization without bone grafting for posterolateral fusion. This retrospective monocenter study in a Level I trauma center included all patients treated with navigated posterior stabilization without posterolateral bone grafting between January 2013 and January 2019 for cervical spine fractures in preexisting SADs without myelopathy. The outcomes were analyzed based on complication rates, revision frequency, neurologic deficits, and fusion times and rates. Fusion was evaluated by X-ray and computed tomography. 14 patients (11 male, 3 female) with a mean age of 72.7 ± 17.6 years were included. Five fractures were at the upper and nine at the subaxial cervical spine (predominantly C5-7). There was one surgery-specific complication of postoperative paresthesia. There was no infection, implant loosening, or dislocation, and no revision surgery necessary. All fractures healed after a median time of 4 months and 12 months being the latest time of fusion in one patient. Single-stage posterior stabilization without posterolateral fusion is an alternative for patients with SADs and cervical spine fractures without myelopathy. They can benefit from a minimization of surgical trauma while having equal times of fusion and no increased rate of complications.
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12
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Welle K, Prangenberg C, Hackenberg RK, Gathen M, Dehghani F, Kabir K. Surgical Anatomy of the Radial Nerve at the Dorsal Region of the Humerus: A Cadaveric Study. J Bone Joint Surg Am 2022; 104:1172-1178. [PMID: 35773621 DOI: 10.2106/jbjs.21.00482] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgery for humeral shaft fractures is associated with a high risk of iatrogenic radial nerve palsy (RNP). Plausible causes are difficult anatomical conditions and variants. METHODS We performed a cadaveric study with 23 specimens (13 female and 10 male Caucasian donors) to assess the course and anatomy of the radial nerve (RN) with its branches alongside the humeral shaft. The accuracy of identification of the RN in the surgical field was analyzed by measuring the location, course, diameter, and form of each nerve and vessel of interest. RESULTS The RN is not a single structure running alongside the humeral shaft; at least 4 parallel structures crossed the dorsal humerus in all subjects. The RN was accompanied by 2 vessels and at least 1 other nerve, which we named the musculocutaneous branch (MCB). With an oval profile and an average diameter of 3.1 mm (range, 2.6 to 3.8 mm), the MCB was thinner but, in some cases, close to the average diameter of 4.7 mm (range, 4.0 to 5.2 mm) of the RN, which had a round profile. Both accompanying vessels had similar diameters: 3.5 mm (range, 2.6 to 4.2 mm) for the radial collateral artery and 4.0 mm (range, 2.9 to 4.4 mm) for the medial collateral artery. In 20 (87%) of the cases, the RN ran proximal to and in 3 (13%) of the cases, distal to the MCB. Furthermore, a distal safe zone of at least 110 mm (range, 110 to 160 mm) was found, measured from the radial (lateral) epicondyle proximally. CONCLUSIONS The RN does not cross the dorsal humerus alone, as often stated in anatomical textbooks, but runs parallel to vessels and at least 1 nerve branch with a similar appearance. Thus, for reliable preservation of the RN, we recommend identification and protection of all crossing structures in posterior humeral surgeries 110 mm proximal to the radial epicondyle.
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Affiliation(s)
- Kristian Welle
- Department of Orthopaedics and Trauma Surgery, Bonn University Medical Centre, Bonn, Germany
| | - Christian Prangenberg
- Department of Orthopaedics and Trauma Surgery, Bonn University Medical Centre, Bonn, Germany
| | - Roslind K Hackenberg
- Department of Orthopaedics and Trauma Surgery, Bonn University Medical Centre, Bonn, Germany
| | - Martin Gathen
- Department of Orthopaedics and Trauma Surgery, Bonn University Medical Centre, Bonn, Germany
| | - Faramarz Dehghani
- Institute of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Koroush Kabir
- Department of Orthopaedics and Trauma Surgery, Bonn University Medical Centre, Bonn, Germany
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13
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Wimmer MD, Welle K, Gathen M, Scheidt S, Markowetz A, Wirtz DC, Burger C, Jaenisch M, Kabir K. Video Based Assessment of Treatment Urgency in Outpatient Orthopaedic and Trauma Patients - a Pilot Trial. Z Orthop Unfall 2022. [PMID: 35640641 DOI: 10.1055/a-1696-2433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION When consulting a specialist in orthopaedics and trauma surgery, personal assessment and manual clinical examination by the doctor on site are essential. Nevertheless, implementation of video consultation hours has been made legally easier in Germany. The present pilot study examines the possibility of video-based assessment of the urgency of treatment in outpatient orthopaedic and trauma patients. MATERIALS AND METHODS Within an ex ante study design, 40 patients with an orthopaedic clinical picture for trauma surgery with elective, urgent or emergency indication were selected from consultation hours. A short questionnaire was filled in based on the information provided and a medical colleague simulated a movement sequence based on the patient information. After modification to the "red flags" and "yellow flags" established in spinal orthopaedics, nine short questions were recorded, which inquire about the urgency of a medical consultation. The video-based movement sequence is based on a 60 s long instruction video in which motor tests and movement sequences are demonstrated: Cervical spine movement in all levels, elevation of the upper extremity, test of the finger-floor distance when "bending forward over-bending", possibility of crouching from standing and getting up again, standing on heels and toes. RESULTS In 91.1% (n = 328) of the cases, the diagnosis was associated with the same joint or the same pathological entity. In 37.5% (n = 135) of the cases an emergency indication was seen, in 10.8% (n = 39) of the cases an urgent indication and in 51.6% (n = 186) of the cases it was seen to offer an elective indication. 12.5% (n = 45) of the cases were evaluated as "false positives" with regard to an emergency or urgent presentation. This means that the test persons were classified as "emergency" or "urgent", although there was no preventable dangerous course or medical emergency. 18 cases (5%) were evaluated as "false negative". DISCUSSION The screening questionnaire presented and the short video assessment are technically feasible and practicable method for the initial evaluation in video-based online medical consultation. In addition, the questionnaire presented in combination with the short video assessment was suitable as an instrument for assessing the urgency of the consultation and selecting preventable dangerous processes and acute emergencies. CONCLUSION The questionnaire, in combination with the short video assessment, is a suitable method for the social distancing requirements during limited accessibility of the medical system. Nevertheless, a false negative rate of 5% is too high to implement the questionnaire presented into daily clinics without further optimisation.
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Affiliation(s)
- Matthias D Wimmer
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Kristian Welle
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Martin Gathen
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Sebastian Scheidt
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Alexander Markowetz
- Fachbereich Mathematik und Informatik, Philipps-Universität Marburg, Marburg, Deutschland
| | - Dieter Christian Wirtz
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Christof Burger
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Max Jaenisch
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Koroush Kabir
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
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Gathen M, Welle K, Jaenisch M, Kasapovic A, Rommelspacher C, Novosel S, Roos J, Kabir K. Are orthopaedic surgeons prepared? An analysis of severe casualties from the 2021 flash flood and mudslide disaster in Germany. Eur J Trauma Emerg Surg 2022; 48:4233-4241. [PMID: 35426505 PMCID: PMC9532313 DOI: 10.1007/s00068-022-01967-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/24/2022] [Indexed: 11/25/2022]
Abstract
Abstract
Background
The purpose of this study was to describe and analyse the most severe casualties from the flash flood and mudslides occurring on 14 July 2021 in Germany, focusing on patients who were treated in the closest and largest level I trauma centre in the region the disaster occurred.
Methods
A single-centre retrospective study design was employed, and all patients treated because of the flooding and mudslides who needed inpatient treatment were documented. Data on each patient’s demographic characteristics, type of injury, number of surgeries, duration of hospitalisation, operation time, revision rate, injury severity score (ISS), and complications were collected. The primary outcome measure was status at discharge.
Results
Within the first week after the flood, a total of 63 patients were documented. Forty-one patients were treated on an outpatient basis in the emergency unit, and 22 patients were hospitalised. Of those hospitalised, 15 patients needed surgical treatment in the operation theatre. The most common injuries were fractures of the lower extremity (n = 7) and soft tissue wounds (n = 4). Overall, 20 surgeries were performed; the mean hospital stay was 7.2 ± 6.4 days, and the mean ISS was 5.7 ± 2.7.
Conclusion
The July 2021 flood disaster was one of the largest in German history. The included patients showed complex injuries of various types. Because of the effects of climate change, orthopaedic surgeons might face higher numbers of casualties affected by natural disasters. Learning more about the management and profile of these injuries can become a future challenge for orthopaedic and trauma surgeons.
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Affiliation(s)
- Martin Gathen
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Kristian Welle
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Max Jaenisch
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Adnan Kasapovic
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Charlotte Rommelspacher
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Suncana Novosel
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Jonas Roos
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Koroush Kabir
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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15
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Koob S, Garbe W, Bornemann R, Ploeger MM, Scheidt S, Gathen M, Placzek R. Is Prematurity a Protective Factor Against Developmental Dysplasia of the Hip? A Retrospective Analysis of 660 Newborns. Ultraschall Med 2022; 43:177-180. [PMID: 32722821 DOI: 10.1055/a-1161-8984] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE In Middle Europe developmental dysplasia of the hip (DDH) has an incidence of up to 5.9 %. The rate of congenital hip dislocation as the worst complication of a growth disorder of the hip is between 1.5 % and 2.5 %. Among known risk factors of DDH are breech position, multiples, foot deformities and family history. The aim of this retrospective study was to investigate prematurity as a risk factor for developmental dysplasia of the hip (DDH). MATERIALS AND METHODS The hips of 283 infants who were born before the 38th week of gestation or earlier, and those of 377 infants who were born after the 37th week of gestation, none of whom had other risk factors for DDH, were compared using the ultrasound technique according to Graf et al., within the first week after birth. Both hips of all infants were included in the study. RESULTS Surprisingly, the difference in alpha angles between the two groups was statistically extremely significant, favoring the preterm infants. Moreover, we found a physiological curve of alpha angle development with a peak after the 31st week of gestation. The incidence of pathological dysplasia was not significantly different in the two groups. CONCLUSION Our results suggest that prematurity is not a predisposing factor for DDH, but rather is protective for hip development.
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Affiliation(s)
- Sebastian Koob
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Werner Garbe
- Neonatology, GFO-Kliniken Bonn Betriebsstätte St. Marien, Bonn, Germany
| | - Rahel Bornemann
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | | | - Sebastian Scheidt
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Martin Gathen
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Richard Placzek
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
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16
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Kasapovic A, Schwetje D, Ali T, Jaenisch M, Gathen M, Bornemann R, Abdallah H, Vieweg U. First clinical results of a novel minimally-invasive fusion system for the sacroiliac joint. Technol Health Care 2022; 30:1139-1145. [PMID: 35342065 DOI: 10.3233/thc-213348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sacroiliac joint (SIJ) painful dysfunction is a common source of low back pain (LBP). Several surgical treatment options for SIJ fusion were described. A promising treatment option with demonstrated clinical improvement is the minimally-invasive SIJ fusion. OBJECTIVE The aim of this case study was to document the effectiveness and safety of the new SIJ system (Torpedo®) over a period of 6 months after the minimally invasive implantation. METHODS Patients with failed conservative treatment of painful SIJ dysfunction were enrolled successively in two centers. The Diagnosis was made by positive response to SIJ-injection with local anesthetic and at least by two positive SIJ provocation tests. The Torpedo® Implant system was used for the implantation. This workpiece made of titanium alloy is characterized by a helical profile geometry (CST: chronical spinal turn) with a hydrophilic surface. The evaluated endpoints LBP and grade of disability were assessed using a 0-10 numerical rating scale (NRS), and Oswestry Disability Index (ODI) preoperatively and at one, three and six months postoperatively. RESULTS 15 patients (10 female, 5 male; mean age 59 ± 13 years) were operated on one after the other. The pain intensity decreased in all 15 patients. After 6 months, a decrease in the median values of 70% (quartiles 1-3: 65-79%) was calculated. The median values of the Oswestry Disability Index after 6 months were 62% (quartiles 1-3: 53-67) lower than before the operation. Before surgery, 13 patients (87%) were taking opioids for pain management. Six months after the operation, opioids were only needed by 3 patients (20%). Implant malpositioning was not detected on plain radiograph. No surgical site infections or perioperative complications occurred. CONCLUSIONS The clinical improvement in early follow up and the absence of surgery related complications demonstrate a high grade of device-related safety and effectiveness of the treatment with a novel minimally-invasive SIJ fusion system.
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Affiliation(s)
- Adnan Kasapovic
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Desirée Schwetje
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Thaer Ali
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Max Jaenisch
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Martin Gathen
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Rahel Bornemann
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Hany Abdallah
- Department of Orthopaedic and Spine Surgery, Wadi al Neel Military, Hospital, Cairo, Egypt
| | - Uwe Vieweg
- Department of Spine Surgery, Sana Hospital Rummelsberg, Schwarzenbruck, Germany
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17
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Kabir K, Lingohr P, Jaenisch M, Hackenberg RK, Sommer N, Ossendorff R, Welle K, Gathen M. Total endoscopic anterior pelvic approach (TAPA) - A new approach to the internal fixation of the symphysis. Injury 2022; 53:802-808. [PMID: 34635336 DOI: 10.1016/j.injury.2021.09.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 09/25/2021] [Accepted: 09/25/2021] [Indexed: 02/02/2023]
Abstract
This study presents a detailed documentation of a total endoscopic anterior pelvic approach (TAPA) for plate fixation of a symphyseal disruption. The purpose of this work is to describe a minimally invasive technique as a possible method for reducing complications and hospitalization. Other goals included giving technical recommendations and assessing potential pitfalls and problems of this new surgical approach. Surgery was performed in an interdisciplinary setting by an experienced orthopaedic and general surgeon. The first endoscopic approach used to visualize the injury was the same as is used for endoscopic hernia surgery. The repositioning of the symphysial rupture was achieved either through external fixation or indirectly with traction and a pelvic binder. Plate positioning and fixation were achieved through two additional, minimally invasive incisions. The endoscopic approach shows multiple advantages, such as no detachment of the rectus abdominis muscle and smaller skin incisions. Furthermore, this approach could lessen the incidence of hernia and postoperative pain. We see the presented technique as a simple and innovative surgical method for treating symphyseal disruption.
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Affiliation(s)
- Koroush Kabir
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn, Germany
| | - Philipp Lingohr
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Max Jaenisch
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn, Germany
| | | | - Nils Sommer
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Robert Ossendorff
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn, Germany
| | - Kristian Welle
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn, Germany
| | - Martin Gathen
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn, Germany.
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18
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Gathen M, Cucchi D, Jansen T, Goost H, Schildberg FA, Burger C, Wirtz DC, Kabir K, Welle K. Practicability of a Virtual Consultation to Evaluate the Shoulder Joint. Z Orthop Unfall 2021; 161:195-200. [PMID: 34544165 DOI: 10.1055/a-1522-9087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE In the course of the corona pandemic, resource conservation and the protection of further infections have made it necessary to break new ground in the organisation of orthopaedic and trauma surgery consultations. One solution is consistent digitisation and the offer of video consultation hours. In this study, non-contact examination of patients with shoulder disorders is described and critically examined. METHODS Thirty patients who presented with pathologies of the shoulder joint in a university outpatient clinic were subjected to a physical examination in a conventional and contactless manner. The data obtained on mobility, function and provocation test of both examinations were compared to draw conclusions about the virtual feasibility. RESULTS 46% of the patients suffered from a traumatic shoulder lesion, and 54% showed degenerative lesions. The assessment of mobility showed a high correlation of 70 - 90% between the two examinations. Common tests to evaluate the supraspinatus, infraspinatus, subscapularis and the long head of the biceps could be adequately performed in a contactless version by more than three quarters of the patients, but with low-to-moderate performance values. CONCLUSION Contact-less examination is particularly disadvantageous when evaluating stability criteria. For the medical history and functional test, there were no significant differences between the classic consultation and contactless consultation. Although virtual consultation is a widespread and valuable addition in pandemic times, it cannot replace a safe assessment and indication by personal examination.
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Affiliation(s)
- Martin Gathen
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Davide Cucchi
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Tom Jansen
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Hans Goost
- Department of Orthopaedics and Trauma Surgery, Krankenhaus Wermelskirchen, Germany
| | | | - Christof Burger
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | | | - Koroush Kabir
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Kristian Welle
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
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19
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Kabir K, Welle K, Lingohr P, Jaenisch M, Roos J, Gathen M. APACHE-Anterior Plating of the Acetabulum in Hemi-Endoscopic Technique: An Alternative Method for Internal Fixation of the Acetabulum. Arthrosc Tech 2021; 10:e1815-e1819. [PMID: 34336580 PMCID: PMC8322669 DOI: 10.1016/j.eats.2021.03.030] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/26/2021] [Indexed: 02/03/2023] Open
Abstract
Injuries of the acetabulum are often challenging in treatment and aftercare. One reason is the required surgical approach, which has high complication rates, including vascular lesion, hernias, and wound infection. We present an alternative endoscopic-assisted approach for the internal fixation of acetabular fractures to avoid the Pfannenstiel incision. An endoscopic approach similar to that used for endoscopic hernia surgery was used. The ilioinguinal approach's lateral window was used to achieve reduction and insertion of a reconstruction plate. The purpose of this study is to describe a minimally invasive technique as a possible method to reduce hospitalization and complications. Another goal is to give detailed technical recommendations and to assess the potential pitfalls of this surgical approach. The APACHE technique is a safe and suitable minimally-invasive approach for the successful treatment of complex acetabular fractures and can be considered in similar cases.
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Affiliation(s)
- Koroush Kabir
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn
| | - Kristian Welle
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn
| | - Philipp Lingohr
- Department of Surgery, University Hospital of Bonn, Bonn, Germany
| | - Max Jaenisch
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn
| | - Jonas Roos
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn
| | - Martin Gathen
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn,Address correspondence to Martin Gathen, M.D., University Hospital of Bonn, Dept. of Orthopedics and Trauma Surgery, Venusberg-Campus 1, 53127 Bonn, Germany.
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20
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Spennacchio P, Seil R, Gathen M, Cucchi D. Diagnosing instability of ligamentous syndesmotic injuries: A biomechanical perspective. Clin Biomech (Bristol, Avon) 2021; 84:105312. [PMID: 33756400 DOI: 10.1016/j.clinbiomech.2021.105312] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND High ankle sprains are insidious injuries associated with a long recovery period, functional impairment and long-term sequelae if mistreated. This systematic review investigates the biomechanical knowledge on the kinematic consequences of sequential syndesmotic ligamentous injuries, aiming to furnish an updated and objective contribution for the critical appraisal and further elaboration of current diagnostic algorithms for high ankle sprains. METHODS A systematic review was performed to identify human biomechanical studies evaluating the stabilizing role of the syndesmotic ligaments. Special attention was paid to identify the smallest lesion within the progressive simulated injuries able to provoke statistically significant changes of the syndesmotic kinematic on the specimen, the mechanical solicitation that provoked it, and the measurement methodology. FINDINGS Fourteen studies were included. In eight articles already an isolated injury to the anterior inferior tibiofibular ligament provoked significant changes of the syndesmotic kinematic, which was always depicted under an external rotation torque. In three articles an isolated deltoid ligament injury provoked significant changes of the syndesmotic kinematic. Four articles described a direct measure of the bony movements, whereas seven collected data through conventional radiography or CT-scan imaging and three via a 3D motion analysis tracking system. INTERPRETATION An isolated lesion of the anterior inferior tibiofibular ligament can provoke significant kinematic modifications in ex vivo syndesmotic models and may be responsible of subtle patterns of dynamic instability, regardless of further syndesmotic ligamentous injuries. The data observed support efforts to define reliable CT imaging parameters to improve non-invasive diagnostic of subtle forms of syndesmotic instability.
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Affiliation(s)
- Pietro Spennacchio
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg.
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg; Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg.
| | - Martin Gathen
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
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21
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Kasapovic A, Rommelspacher Y, Walter S, Gathen M, Pflugmacher R. [Minimally invasive implantation technique of a system for spinal cord stimulation]. Oper Orthop Traumatol 2021; 33:364-373. [PMID: 33666671 DOI: 10.1007/s00064-021-00700-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 01/31/2020] [Accepted: 02/27/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Spinal cord stimulation (SCS) targets structures of the dorsal column and dorsal horn of the spinal cord with electrical impulses, thereby, modulating pain perception. For chronic pain patients, e.g., in failed back surgery syndrome (FBSS), the aim is to achieve pain relief and enable patients to improve their quality of life. INDICATIONS Failed back surgery syndrome, complex regional pain syndrome (CRPS) type I and II, therapy-refractory ischemic pain, neuropathic pain syndromes (e.g., phantom limb pain). CONTRAINDICATIONS Identification of degenerative alterations as the cause of pain; untreated mental illness. SURGICAL TECHNIQUE A two-stage implantation technique is performed. Initially, after percutaneous implantation of epidural leads a trial period with stimulation by an external pulse generator is evaluated. Following verification of pain relief, a subcutaneous internal pulse generator is implanted. FOLLOW-UP Early mobilization and adjustment of stimulation parameters. RESULTS In all, 19 consecutive patients with FBSS were treated by high frequency SCS (HF-SCS) and included in a prospective prognostic study. In 18 patients, an internal pulse generator (IPG) for HF-SCS was permanently implanted. Therapy success was assessed using the Oswestry Disability Index (ODI), visual analogue pain scale (VAS) and painDetect questionnaire. Neuropathic pain of the legs versus the back (median values: VAS leg 71 mm, VAS back 69 mm) was dominant in the patients at a preoperative mean ODI of 63%. With HF-SCS therapy, a pronounced pain reduction was seen and persisted in the follow-up after 6 months (VAS leg 18 mm, VAS back 24 mm). The ODI showed an improvement to a mean of 24% after 6 months.
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Affiliation(s)
- Adnan Kasapovic
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - Yorck Rommelspacher
- Klinik für Orthopädie, Krankenhaus der Augustinerinnen Köln, Jakobstraße 27-31, Köln, 50678, Deutschland
| | - Sebastian Walter
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Martin Gathen
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Robert Pflugmacher
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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Jansen T, Gathen M, Touet A, Goost H, Wirtz DC, Burger C, Pflugmacher R, Welle K, Kabir K. Spine Examination during COVID-19 Pandemic via Video Consultation. Z Orthop Unfall 2021; 159:193-201. [PMID: 33530112 PMCID: PMC8043667 DOI: 10.1055/a-1283-7160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION During the current COVID-19 pandemic video consultations are increasingly common in order to minimize the risk of infection for staff and patients. The aim of this study was to evaluate the feasibility of a spine examination via video. METHODS A total of 43 patients were recruited. Each participant underwent a video-based (VB) and a conventional face-to-face (FTF) spine examination. Pain intensity, active range of motion, inspection, a neurophysiologic basic exam and provocations tests were evaluated using video-based and face-to-face methods. RESULTS The intra-rater reliability (IRR) was measured between both examinations. Good to very good IRR values were obtained in inspection (Kappa between 0,752 und 0,944), active range of motion and basic neurophysiological examination (Kappa between 0,659 und 0,969). Only moderate matches were found in specific provocation tests (Kappa between 0,407 und 0,938). A video-based spine examination is a reliable tool for measuring pain intensity, active range of motion and a basic neurophysiologic exam. CONCLUSION A basic spine examination during a video consultation is possible. A good agreement of the test results between video-based and face-to-face examination could be found.
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Affiliation(s)
- Tom Jansen
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Martin Gathen
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Amadeo Touet
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Hans Goost
- Department of Orthopaedics and Trauma Surgery, Wermelskirchen Hospital, Germany
| | | | - Christof Burger
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Robert Pflugmacher
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Kristian Welle
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Koroush Kabir
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
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Yu H, Li X, Chen S, Zhang L, Yang G, Welle K, Gathen M, Kabir K. Comparative Effectiveness and Safety of Anterior Cervical Corpectomy with Fusion, Laminoplasty, and Laminectomy and Instrumented Fusion for Ossification of the Posterior Longitudinal Ligament: A Systematic Review and Network Meta-Analysis. J INVEST SURG 2021; 35:667-676. [PMID: 33472478 DOI: 10.1080/08941939.2020.1871535] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND To evaluate the comparative effectiveness and safety of anterior cervical corpectomy with fusion (ACCF), laminoplasty (LP), and laminectomy and instrumented fusion (LF) in the treatment of ossification of the posterior longitudinal ligament (OPLL). METHODS Embase, Pubmed, and Cochrane library were searched from their date of inception to June 13, 2020. Relevant randomized controlled trials (RCTs) and cohort studies comparing different procedures among ACCF, LP, and LF were identified, data were extracted to perform a network meta-analysis (NMA). The outcomes were the Japanese Orthopedic Association (JOA) score and complications. RESULTS We deemed 14 trials eligible, including 877 patients. In NMA, ACCF showed a significant improvement of JOA score compared with LP [MD= -0.89, 95% CI (-1.73, -0.18)], but no significant difference was found when compared LF with ACCF or LP. No significant differences in complications were found when compared LF with LP or ACCF, while ACCF showed significantly higher in complications than LP [OR = 1.99, 95% CI (1.10, 3.35)]. The surface under the cumulative ranking curves (SUCRA) showed that the rank of JOA score improvement is as follows: ACCF (82.5%), LF (79.5%), and LP (2.3%). And the rank of complication rate is as follows: LF (65.8%), ACCF (68.4%), and LP (2.1%). LIMITATION The biggest limitation was that none of the included studies were RCTs. CONCLUSIONS Despite the higher probability of complications than LP, ACCF was the more recommended procedure for its highest ranking spectrums of JOA score improvement to treat the OPLL.
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Affiliation(s)
- Hui Yu
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Xian Li
- Department of Orthopedic and Trauma Surgery, Xiyuan Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Shu Chen
- School of Business and Management, Shanghai International Studies University, Shanghai, China
| | - Li Zhang
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Ge Yang
- Department of Orthopedic Surgery, Hunan Children's Hospital, Hunan, People's Republic of China
| | - Kristian Welle
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Martin Gathen
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Koroush Kabir
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
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Scheidt S, Gathen M, Lukas A, Welle K, Kohlhof H, Wirtz DC, Burger C, Kabir K. Erratum zu: Herausforderungen des Entlassmanagements in der Alterstraumatologie. Unfallchirurg 2020; 123:533. [DOI: 10.1007/s00113-020-00837-z] [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: 10/24/2022]
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Wimmer MD, Hischebeth GTR, Randau TM, Gathen M, Schildberg FA, Fröschen FS, Kohlhof H, Gravius S. Difficult-to-treat pathogens significantly reduce infection resolution in periprosthetic joint infections. Diagn Microbiol Infect Dis 2020; 98:115114. [PMID: 32712505 DOI: 10.1016/j.diagmicrobio.2020.115114] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 03/03/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 01/17/2023]
Abstract
Periprosthetic joint infection (PJI) is a feared complication after arthroplasty. Our hypothesis was that PJI caused by difficult-to-treat (DTT) pathogens has a worse outcome compared with non-DTT PJI. Routine clinical data on 77 consecutive patients with confirmed PJI treated with 2-stage exchange arthroplasty were placed in DTT and non-DTT PJI groups and analyzed. The main outcome variable was that the patient was definitively free of infection after 2 years. We found definitive infection resolution in 31 patients in the DTT group (68.9%) and 28 patients (87.5%) in the non-DTT group (P < 0.05). The necessity for revision surgery until assumed resolution of infection was significantly more frequent in the DTT group with 4.72 ± 3.03 operations versus 2.41 ± 3.02 operations in the non-DTT group (P < 0.05). PJI caused by DTT bacteria is associated with significantly higher numbers of revision operations and significantly inferior definitive infection resolution.
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Affiliation(s)
- Matthias D Wimmer
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Gunnar T R Hischebeth
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany.
| | - Thomas M Randau
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Martin Gathen
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Frank A Schildberg
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Frank S Fröschen
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Hendrik Kohlhof
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Sascha Gravius
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany; Department of Orthopaedics and Trauma Surgery, University Medical Center Mannheim of the University of Heidelberg, Mannheim, Germany
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26
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Scheidt S, Gathen M, Lukas A, Welle K, Kohlhof H, Wirtz DC, Burger C, Kabir K. [Challenges of discharge management in geriatric traumatology : Example of an integrated orthogeriatric service]. Unfallchirurg 2020; 123:534-540. [PMID: 32405653 DOI: 10.1007/s00113-020-00812-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Geriatric patients are currently responsible for almost one third of all emergency hospital admissions. An increase of 50% is expected in the next decade. This age redistribution poses new challenges for inpatient care and discharge management. The requirements of an orthopedic trauma surgery clinic in the care of this patient group can be clarified with the help of this first collaboratively created geriatric orthopedic trauma surgery complex treatment unit of a university hospital. OBJECTIVE What influence do age and delirium have on discharge management, length of inpatient stay and discharge destination in a geriatric cohort? MATERIAL AND METHODS All patients who received inpatient treatment as part of the orthopedic trauma surgery geriatric complex treatment (GKB) between May 2017 and December 2019 were evaluated. An analysis of the demographics, length of inpatient stay, discharge destinations and evaluation of the Barthel index collected on admission and discharge, the mini-mental state examination (MMSE) and the geriatric depression scale (GDS) were carried out. RESULTS Out of 312 patients, 110 men and 193 women with a median age of 81 years, 77 patients (24.6%) showed delirium when enrolled in the GKB and 39 (12.5%) dementia. Older patients presented more often with delirium than younger people (p = 0.013), especially those aged 70-79 years (p = 0.037). Dementia patients suffered more frequently from postoperative delirium (p < 0.01). The mean hospital stay was 17.79 days (±4.6 days). The GKB was regularly completed in 60.7% of all cases and 39.3% patients dropped out early. Patients with delirium were discharged significantly less often into their own home but into short-term care or nursing homes (p = 0.038). A general correlation between delirium development and the discharge destination was noticeable (p = 0.004). CONCLUSION Patients with dementia are more likely to develop delirium postoperatively, which leads to an increase in the length of inpatient stay, an increase in treatment costs and more work for the discharge management team. In addition, the discharge to the patients' home is impaired by delirium, which means that the growing need for places in short-term care and nursing homes also creates socioeconomic burdens.
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Affiliation(s)
- S Scheidt
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - M Gathen
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - A Lukas
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
- Malteser Krankenhaus Seliger Gerhard Bonn/Rhein-Sieg, Bonn, Deutschland
| | - K Welle
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - H Kohlhof
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - D C Wirtz
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - C Burger
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - K Kabir
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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Wirtz DC, Jaenisch M, Osterhaus TA, Gathen M, Wimmer M, Randau TM, Schildberg FA, Rössler PP. Acetabular defects in revision hip arthroplasty: a therapy-oriented classification. Arch Orthop Trauma Surg 2020; 140:815-825. [PMID: 32100108 PMCID: PMC7244606 DOI: 10.1007/s00402-020-03379-6] [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: 11/12/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The treatment of severe acetabular bone loss remains a difficult challenge. No classification system is available that combines intuitive use, structured design and offers a therapeutic recommendation according to the current literature and modern state of the art treatment options. The goal of this study is to introduce an intuitive, reproducible and reliable guideline for the evaluation and treatment of acetabular defects. METHODS The proposed Acetabular Defect Classification (ADC) is based on the integrity of the acetabular rim and supporting structures. It consists of 4 main types of defects ascending in severity and subdivisions narrowing down-defect location. Type 1 presents an intact acetabular rim, type 2 includes a noncontained defect of the acetabular rim ≤ 10 mm, in type 3 the rim defect exceeds 10 mm and type 4 includes different kinds of pelvic discontinuity. A collective of 207 preoperative radiographs were graded according to ADC and correlated with intraoperative findings. Additionally, a randomized sample of 80 patients was graded according to ADC by 5 observers to account for inter- and intra-rater reliability. RESULTS We evaluated the agreement of preoperative, radiographic grading and intraoperative findings presenting with a k value of 0.74. Interobserver agreement presented with a k value of 0.62 and intraobserver at a k value of 0.78. CONCLUSION The ADC offers an intuitive, reliable and reproducible classification system. It guides the surgeon pre- and intraoperatively through a complex field of practice.
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Affiliation(s)
- Dieter Christian Wirtz
- Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
| | - Max Jaenisch
- Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
| | - Thiemo Antonius Osterhaus
- Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
| | - Martin Gathen
- Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
| | - Matthias Wimmer
- Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
| | - Thomas Martin Randau
- Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
| | - Frank Alexander Schildberg
- Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
| | - Philip Peter Rössler
- Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
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Ploeger MM, Gathen M, Struwe C, Placzek R. Proximal Femoral Osteotomies in the Adolescence: Indications and Treatment Strategies. Z Orthop Unfall 2019; 159:153-163. [PMID: 31777029 DOI: 10.1055/a-1023-4679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Proximal femoral osteotomies are common surgical interventions to treat hip deformities in pediatric orthopedics. The aim of proximal femoral osteotomies is to optimise hip containment by using varus or valgus osteotomy, flexion or extension osteotomy with shortening, lengthening or derotation of the femoral neck. Furthermore improved muscular dysbalance by enhancing the femoral offset, extension of the range of motion and pain reduction are important surgical intentions. In the long term, a proximal femoral osteotomy is meant to minimize the probability of an early osteoarthritis of the hip. In the current literature many different types of proximal femoral osteotomies are described. They can be divided concerning their anatomical localization into subcapital, base of the femoral neck, intertrochanteric and subtrochanteric osteotomies. A profound knowledge about the deformity and the anatomical situation is essential to choose the appropriate osteotomy. The aim of this review is to show the different ways of proximal femoral osteotomies and their indications after having done a selective literature research. Furthermore over the last years the osteosynthesis materials have changed from blade plates (non-locking) to locking compression plates which allow an early re-mobilization without hip spica casts.
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Affiliation(s)
- Milena M Ploeger
- Department of Orthopaedics and Trauma Surgery, Bonn University Hospital
| | - Martin Gathen
- Department of Orthopaedics and Trauma Surgery, Bonn University Hospital
| | - Charlotte Struwe
- Department of Orthopaedics and Trauma Surgery, Bonn University Hospital
| | - Richard Placzek
- Department of Orthopaedics and Trauma Surgery, Bonn University Hospital
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Gathen M, Ploeger MM, Jaenisch M, Koob S, Cucchi D, Kasapovic A, Randau T, Placzek R. Outcome evaluation of new calcium titanate schanz-screws for external fixators. First clinical results and cadaver studies. J Mater Sci Mater Med 2019; 30:124. [PMID: 31705395 DOI: 10.1007/s10856-019-6325-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 10/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE External fixators are important for correcting length discrepancies and axis deformities in pediatric or trauma orthopedic surgery. Pin loosening is a common pitfall during therapy that can lead to pain, infection, and necessary revisions. This study aims to present clinical data using calcium titanate (CaTiO3) Schanz screws and to measure the fixation strength. PATIENTS AND METHODS 22 titanate screws were used for external fixators in 4 pediatric patients. Therapy was initiated to lengthen or correct axial deformities after congenital abnormalities. The maximum tightening torque was measured during implantation, and the loosening torque was measured during explantation. In addition, screws of the same type were used in a cadaver study and compared with stainless steel and hydroxyapatite-coated screws. 12 screws of each type were inserted in four tibias, and the loosening and tightening torque was documented. RESULTS The fixation index in the in vivo measurement showed a significant increase between screw insertion and extraction in three of the four patients. The pins were in situ for 91 to 150 days, and the torque increased significantly (P = 0.0004) from insertion to extraction. The cadaveric study showed lower extraction torques than insertion torques, as expected in this setting. The calculated fixation index was significantly higher in the CaTiO3 group than in the other groups (P = 0.0208 vs. HA and P < 0.0001 vs. steel) and in the HA group vs. plain steel group (P = 0.0448). CONCLUSION The calcium titanate screws showed favorable fixation strength compared to HA and stainless steel screws and should be considered in long-term therapy of external fixation.
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Affiliation(s)
- Martin Gathen
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn, Germany.
| | - Milena Maria Ploeger
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn, Germany
| | - Max Jaenisch
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn, Germany
| | - Sebastian Koob
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn, Germany
| | - Davide Cucchi
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn, Germany
| | - Adnan Kasapovic
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn, Germany
| | - Thomas Randau
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn, Germany
| | - Richard Placzek
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn, Germany
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Kasapovic A, Rommelspacher Y, Gathen M, Cucchi D, Bornemann R, Pflugmacher R, Walter SG. High-Frequency Spinal Cord Stimulation for the Treatment of Chronic Low Back and Leg Pain: Implantation Technique of Percutaneous Leads and Implantable Pulse Generator. Arthrosc Tech 2019; 8:e1125-e1129. [PMID: 31921585 PMCID: PMC6948134 DOI: 10.1016/j.eats.2019.05.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/27/2019] [Indexed: 02/03/2023] Open
Abstract
Spinal cord stimulation (SCS) is an evidence-based, reversible but invasive procedure for the treatment of chronic pain syndromes: for example, in patients with failed-back-surgery syndrome or complex regional pain syndrome. A more recent, similar technique uses high-frequency stimulation for SCS and follows a different mechanism of action that does not result in paresthesia. This Technical Note and video present surgical instructions of a "2-way cut-down" technique for a high-frequency SCS trial period and permanent implantation of an implantable pulse generator.
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Affiliation(s)
- Adnan Kasapovic
- Department for Orthopedic Surgery, University Hospital Bonn, Bonn, Germany
| | - Yorck Rommelspacher
- Department for Orthopedic Surgery, Krankenhaus der Augustinerinnen, Cologne, Germany
| | - Martin Gathen
- Department for Orthopedic Surgery, University Hospital Bonn, Bonn, Germany
| | - Davide Cucchi
- Department for Orthopedic Surgery, University Hospital Bonn, Bonn, Germany
| | - Rahel Bornemann
- Department for Orthopedic Surgery, University Hospital Bonn, Bonn, Germany
| | - Robert Pflugmacher
- Department for Orthopedic Surgery, University Hospital Bonn, Bonn, Germany
| | - Sebastian G. Walter
- Department for Orthopedic Surgery, University Hospital Bonn, Bonn, Germany,Address correspondence to Sebastian G. Walter, M.D., Department for Orthopedic Surgery, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
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Gathen M, Ploeger MM, Peez C, Weinhold L, Schmid M, Wirtz DC, Burger C, Kabir K. Comparison of the Subjective Elbow Value with the DASH, MEPS und Morrey Score after Olecranon Fractures. Z Orthop Unfall 2019; 158:208-213. [DOI: 10.1055/a-0946-2649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Abstract
Background Olecranon fractures are common injuries that can occur in patients of any age. To assess the postoperative outcome, multiple scoring systems like the DASH, MEPS und Morrey Score have been described. The goal of this paper is to compare the subjective elbow value (SEV) to these commonly used scoring systems. We hypothesized that the SEV would have a high correlation and practicability for the evaluation of elbow function after isolated olecranon injury.
Patients and Methods Clinical data of 40 patients were collected and retrospectively analysed. All patients suffered an isolated olecranon fracture and were surgically treated by tension band wiring or plate fixation. In the follow-up examinations the Mayo Score, DASH Score, Morrey Score and SEV were measured for correlation purposes.
Results The mean follow-up time was 70.5 ± 45.6 months. The median DASH Score was 9.9 (4.1 – 20.4) and 100 (85 – 100) for the MEPS. The median Morrey Score was 98 (92 – 100). The median SEV was 90% (80 – 95%). The Pearson correlation between the DASH and SEV was −0.85 and 0.80 between the MEPS and the SEV.
Conclusions The SEV shows a high correlation to the most commonly used scoring systems for outcome evaluation after elbow injury. It is easy to use and can be seen as a valuable tool to assess patients after olecranon fractures.
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Affiliation(s)
- Martin Gathen
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Chirurgisches Zentrum Universitätsklinikum Bonn
| | - Milena Maria Ploeger
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Chirurgisches Zentrum Universitätsklinikum Bonn
| | - Christian Peez
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Chirurgisches Zentrum Universitätsklinikum Bonn
| | - Leonie Weinhold
- Institut für Medizinische Biometrie, Informatik und Epidemiologie, Universitätsklinikum Bonn
| | - Matthias Schmid
- Institut für Medizinische Biometrie, Informatik und Epidemiologie, Universitätsklinikum Bonn
| | - Dieter Christian Wirtz
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Chirurgisches Zentrum Universitätsklinikum Bonn
| | - Christof Burger
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Chirurgisches Zentrum Universitätsklinikum Bonn
| | - Koroush Kabir
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Chirurgisches Zentrum Universitätsklinikum Bonn
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Cucchi D, Deharde L, Kasapovic A, Gathen M, Rommelspacher Y, Bornemann R, Wirtz D, Pflugmacher R. Treatment of infections of the lumbar spine with single-staged posterior instrumentation, disc debridement and interbody fusion with titanium cages. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.03.2019.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- D. Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - L. Deharde
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - A. Kasapovic
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - M. Gathen
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Y. Rommelspacher
- Krankenhaus der Augustinerinnen Klinik für Orthopädie,Spezielle Orthopädische Chirurgie, Jakobstraße 27 – 31 50678 Köln, Germany
| | - R. Bornemann
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - D.C. Wirtz
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - R. Pflugmacher
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
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Gathen M, Norris G, Kay S, Giannoudis PV. Recalcitrant distal humeral non-union following previous Leiomyosarcoma excision treated with retainment of a radiated non-angiogenic segment augmented with 20 cm free fibula composite graft: A case report. World J Orthop 2019; 10:212-218. [PMID: 31041163 PMCID: PMC6475814 DOI: 10.5312/wjo.v10.i4.212] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/27/2019] [Accepted: 03/12/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Leiomyosacromas in the Extremities are rare malignant smooth muscle tumors. Adjuvant radiation therapy, in combination with wide surgical excision allows the best chance of treatment. During the follow up pathological fractures are common complications that can be accompanied by Implant failure and defect situations that are most challenging in their management.
CASE SUMMARY We present a case of a 52-year-old female suffering from a pathological fracture of the humeral shaft 10 yr after resection of a Leiomyosarcoma and postoperative radiotherapy. She developed implant failure after retrograde nailing and another failure after revision to double plate fixation. In a two-stage revision, the implants were removed and the huge segmental defect created after debridement was bridged by a compound osteosynthesis with nancy nails and bone cement for formation of the induced membrane. Due to the previous radiotherapy treatment, 20 cm of the humeral shaft were declared devascularized but were left in situ as a scaffold. In the second stage, a vascularized fibula graft was used in combination with a double plate fixation and autologous spongiosa grafts for final reconstruction.
CONCLUSION This combinatory treatment approach led to a successful clinical outcome and can be considered in similar challenging cases.
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Affiliation(s)
- Martin Gathen
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn 53129, Germany
| | - Grayson Norris
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds LS3 3EX, United Kingdom
| | - Simon Kay
- Plastic and Reconstructive Surgery, School of Medicine, University of Leeds, Leeds LS3 3EX, United Kingdom
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds LS3 3EX, United Kingdom
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Placzek R, Gathen M, Koob S, Jacobs C, Ploeger MM. Erratum to: Modified neck-lengthening osteotomy after Morscher in children and adolescents. Oper Orthop Traumatol 2018; 30:478. [DOI: 10.1007/s00064-018-0572-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gathen M, Wimmer MD, Ploeger MM, Weinhold L, Schmid M, Wirtz DC, Gravius S, Friedrich MJ. Comparison of two-stage revision arthroplasty and intramedullary arthrodesis in patients with failed infected knee arthroplasty. Arch Orthop Trauma Surg 2018; 138:1443-1452. [PMID: 30054812 DOI: 10.1007/s00402-018-3007-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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] [Received: 01/27/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Failed total knee arthroplasty (TKA) with significant bone loss and compromised soft-tissues is challenging and the final results are often inferior to patient's expectation. The objective of this study was to present a comparison of outcomes in patients with failed infected TKA treated with two-stage revision TKA or knee arthrodesis and to assess clinical and functional results, implant survival and infection recurrence. The hypothesis was that an arthrodesis may result in beneficial effects on patients' outcome. METHODS Clinical data of 81 patients with periprosthetic joint infection (PJI) of the knee joint were collected and analyzed retrospectively. Between 2008 and 2014, a total of 36 patients had been treated within a two-stage exchange procedure and reimplantation of a modular intramedullary arthodesis nail and 45 patients with revision TKA. Patients were treated according to the same structured treatment algorithm. Clinical and functional evaluation was performed using the Oxford knee score (OKS) and the visual analogue scale (VAS). RESULTS The mean follow-up was 32.9 ± 14.0 months. The rate of definitely free of infection at last follow-up in the arthrodesis group was 32 of 36 (88.9%) and 36 of 45 (80.0%) in the revision TKA group (p = 0.272). Mean VAS for pain in the arthrodesis group was 3.1 ± 1.4 compared to 3.2 ± 1.6 in the revision TKA group (p = 0.636). The OKS in the arthrodesis group was 38.7 ± 8.9 and 36.5 ± 8.9 (p = 0.246) in patients with revision TKA. Rate of revisions in the revision-TKA group was 2.8 ± 3.7 compared to 1.2 ± 2.4 in the arthrodesis group (p = 0.021). CONCLUSION Treatment of PJI needs a distinct therapy with possible fallback strategies in case of failure. A knee arthrodesis is a limb salvage procedure that showed no significant benefits on the considered outcome factors compared to revision TKA but is associated with significantly lower revision rate. After exhausted treatment modalities, a knee arthrodesis should be considered as an option in selected patients. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Martin Gathen
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Matthias D Wimmer
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Milena M Ploeger
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Leonie Weinhold
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Matthias Schmid
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Dieter C Wirtz
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Sascha Gravius
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Max J Friedrich
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
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Ploeger MM, Jacobs C, Gathen M, Kaup E, Randau TM, Friedrich MJ, Hischebeth GT, Wimmer MD. Fluid collection bags pose a threat for bacterial contamination in primary total hip arthroplasty: a prospective, internally controlled, non-blinded trial. Arch Orthop Trauma Surg 2018; 138:1159-1163. [PMID: 29948224 DOI: 10.1007/s00402-018-2970-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Surgical equipment, and especially the so-called 'splash basins' that are used intraoperatively, are a potential source of bacterial contamination in primary total hip arthroplasty (THA). With this risk in mind, many commercially available draping kits include plastic bags that can be used to collect fluid or to temporarily store instruments. Following this rationale, we hypothesised that first: the fluid collection bags are a potential reservoir of bacteria and second: there is a time dependency for bacterial contamination. MATERIALS AND METHODS After ethics approval, we investigated in a prospective, internally controlled, non-blinded trial 43 patients who received primary THA. At the beginning of the surgery, we took deep, representative, intracapsular tissue samples, which served as negative controls. At the end of surgery, tissue samples were taken from the bottom of the 'fluid collection bag' for microbiological analysis. RESULTS All 86 control samples were negative. Out of the samples taken from the bags, a pathogen could be detected in four patients (9.3%). All pathogens were detected after a surgery time lasting longer than 90 min. CONCLUSION We were able to show that fluid collection bags are a potential reservoir for bacteria in THA when surgery time was greater than a 90-min threshold. Our data suggest that the risks from fluid collection bags outweigh the advantages of using them. Therefore, we recommend against the use of fluid collection bags intraoperatively in primary THA.
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Affiliation(s)
- M M Ploeger
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - C Jacobs
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - M Gathen
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - E Kaup
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - T M Randau
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - M J Friedrich
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - G T Hischebeth
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - M D Wimmer
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany.
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Abstract
BACKGROUND The use of Ceramic-on-Ceramic (CoC) bearings in primary total hip arthroplasty (THA) is increasing and has been intensively analysed. This bearing plays a particularly relevant role in young, active patients and shows advantages over other bearings in biocompatibility, wear rate and lubrication properties. On the contrary, CoC bearings in revision THA are seldom used and scarcely analysed. The aim of this study is to systematically review the available literature on CoC bearings in revision THA. METHODS A systematic research in the English literature was performed to identify all studies reporting results of THA revisions using ceramic-on-ceramic bearing. The initial search strategy revealed 555 articles for consideration. On the basis of eligibility criteria, 26 studies were included in this review. RESULTS Twenty-six studies, accounting for 1846 procedures, were eligible and included in the review. No studies of Level I were identified. Eighteen studies reported on revisions of CoC implants for various reasons, performed either with CoC or different bearings. In 111 patients a CoC bearing was used for the revision. Six studies consistently reported outcome measures for CoC bearing THA revisions, so that a quantitative synthesis of the data was possible. The range of follow-up across the six studies varied between 2.1 and 19 years, with a cumulative avearage follow-up of 9.3 years. A good functional result was documented, with a cumulative weighted mean for postoperative Harris Hip Score (HHS) of 87 points. The rate of dislocation in this group was 3.45% and the risk of fracture of an alumina ceramic head was 0.35% (1 study). Squeaking was reported as complication of CoC bearing THA revisions in three studies, with a calculated incidence of 0.52%. CONCLUSION Modern CoC bearings show advantages in preclinical and retrospective studies over other bearings also in revision cases and are therefore to be considered a promising alternative for this kind of operation. Reasonable indications for CoC bearing in revision THA are revisions for aseptic loosening or recurrent dislocation in young patients, fractures of ceramic components, large acetabular defects or in patients that are allergic to bone cement components. Nevertheless, prospectively designed or randomized studies are lacking and needed to confirm CoC as optimal solution for revision THA cases.
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Affiliation(s)
- Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Germany
| | - Martin Gathen
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Germany
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Koob S, Scheidt S, Randau TM, Gathen M, Wimmer MD, Wirtz DC, Gravius S. [Biological downsizing : Acetabular defect reconstruction in revision total hip arthroplasty]. Orthopade 2017; 46:158-167. [PMID: 28074234 DOI: 10.1007/s00132-016-3379-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Periacetabular bony defects remain a great challenge in revision total hip arthroplasty. After assessment and classification of the defect and selection of a suitable implant the primary stable fixation and sufficient biological reconstitution of a sustainable bone stock are essential for long term success in acetabular revision surgery. Biological defect reconstruction aims for the down-sizing of periacetabular defects for later revision surgeries. TECHNIQUE In the field of biological augmentation several methods are currently available. Autologous transplants feature a profound osseointegrative capacity. However, limitations such as volume restrictions and secondary complications at the donor site have to be considered. Structural allografts show little weight bearing potential in the long term and high failure rates. In clinical practice, the usage of spongious chips implanted via impaction bone grafting technique in combination with antiprotrusio cages for the management of contained defects have shown promising long time results. Nevertheless, when dealing with craniolateral acetabular and dorsal column defects, the additional implantation of macroporous metal implants or augments should be considered since biological augmentation has shown little clinical success in these particular cases. PROSPECT This article provides an overview of the current clinically available biological augmentation methods of peri-acetabular defects. Due to the limitations of autologous and allogeneic bone transplants in terms of size and availability, the emerging field of innovative implantable tissue engineering constructs gains interest and will also be discussed in this article.
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Affiliation(s)
- S Koob
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland
| | - S Scheidt
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland
| | - T M Randau
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland
| | - M Gathen
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland
| | - M D Wimmer
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland
| | - D C Wirtz
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland
| | - S Gravius
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland.
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Müller MC, Frege S, Strauss AC, Gathen M, Windemuth M, Striepens EN. Evaluation of the new C-arm guiding system ClearGuide® in an orthopaedic and trauma operating theatre. Int J Med Robot 2017; 13. [PMID: 28371198 DOI: 10.1002/rcs.1820] [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: 08/03/2016] [Revised: 02/18/2017] [Accepted: 02/21/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND The objective was to evaluate whether the new intraoperative C-arm guiding system ClearGuide® (CG) reduces radiation exposure of the staff in an Orthopaedic and Trauma operation theatre. METHODS Data of 95 patients CG was used were retrospectively compared using matched-pair analysis with controls without CG. Radiation dose (RD), fluoroscopic time (FT) and operation time (OT) were analysed in ten types of operative procedures. RESULTS Use of CG led to a significant reduction (p ≤ 0.05) of the RD in intramedullary nailing and plate fixation of femoral shaft fractures as well as plating of tibia shaft fractures. Concerning FT, use of CG led to a significant reduction (p ≤ 0.05) while performing kyphoplasties and plate fixation of femoral shaft fractures. Regarding OT, no statistical significance was observed. CONCLUSIONS CG as a simple, reproducible and intuitive communication tool for C-arm guidance reduces intraoperative staff radiation exposure especially while fixation of long bone fractures and in spine surgery.
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Affiliation(s)
- Marcus Christian Müller
- Department of Orthopaedics and Trauma Surgery, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - Sophie Frege
- Department of Orthopaedics and Trauma Surgery, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - Andreas Christian Strauss
- Department of Orthopaedics and Trauma Surgery, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - Martin Gathen
- Department of Orthopaedics and Trauma Surgery, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - Michael Windemuth
- Department of Orthopaedics and Trauma Surgery, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - Eva Nadine Striepens
- Department of Psychiatry and Psychotherapy, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
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Omar M, Gathen M, Liodakis E, Suero EM, Krettek C, Zeckey C, Petri M. A comparative study of negative pressure wound therapy with and without instillation of saline on wound healing. J Wound Care 2017; 25:475-8. [PMID: 27523660 DOI: 10.12968/jowc.2016.25.8.475] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 11/11/2022]
Abstract
OBJECTIVE Negative pressure wound therapy (NPWT) has become an established treatment of traumatic and infected wounds. Negative pressure wound therapy with instillation (NPWTi) is a further development that combines the conventional NPWT with instillation of different fluids which continuously administer therapeutic reagents to the wound. The aim of this study was to compare the impact of additional saline instillation in NPWTi to NPWT alone. METHOD Between January and July 2014, consecutive patients with acute wounds of the lower limb were treated with NPWTi with saline instillation. The number of revision surgeries, length of hospital stay, and duration of treatment until final healing were recorded and compared with matched patients undergoing NPWT without instillation. RESULTS There were 10 patients recruited with 10 matched controls examined restrospectivley. Patients who received NPWTi were found to have decreased time of hospitalisation (21.5 versus 26.5 days, p=0.43), and accelerated wound healing (9.0 versus 12.5 days, p=0.36) than patients who received NPWT. However, the difference in the outcomes of the patients who received NPWTi and patients who received NPWT was not found to be statisticallly significant. CONCLUSION NPWTi with instillation of saline is a promising method and its effectiveness needs to be tested in a randomised controlled trial compared with NPWT alone. DECLARATION OF INTEREST This study obtained support by KCI (Wiebsaden, Germany) for the surgical material.
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Affiliation(s)
- M Omar
- Hannover Medical School, Trauma Department
| | - M Gathen
- Hannover Medical School, Trauma Department
| | - E Liodakis
- Hannover Medical School, Trauma Department
| | - E M Suero
- Hannover Medical School, Trauma Department
| | - C Krettek
- Hannover Medical School, Trauma Department
| | - C Zeckey
- Hannover Medical School, Trauma Department
| | - M Petri
- Hannover Medical School, Trauma Department
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Biancosino C, Krüger M, Kühn C, Zinne N, Wilhelmi M, Zeckey C, Krettek C, Gathen M. First Successful Surgical Reconstruction of Bilateral Transected Main Bronchi With Extracorporeal Membrane Oxygenation Support. Ann Thorac Surg 2016; 102:e135-7. [DOI: 10.1016/j.athoracsur.2016.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/25/2015] [Accepted: 01/04/2016] [Indexed: 11/16/2022]
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Gathen M, Petri M, Krettek C, Omar M. [Negative Pressure Wound Therapy with Instillation in the Treatment of Critical Wounds]. Z Orthop Unfall 2016; 154:122-7. [PMID: 26844855 DOI: 10.1055/s-0041-109328] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND In recent decades, negative pressure wound therapy (NPWT) has become the gold standard in the treatment of infected wounds. Negative pressure wound therapy with instillation (NPWTi) is a new development, that combines conventional NPWT with instillation of fluids. OBJECTIVES The purpose of this study was to review the results of current literature on the clinical use of NPWTi in acute and chronic wounds. MATERIAL AND METHODS A literature search was performed using Pubmed and the Cochrane Library, including articles in English and German. RESULTS The data suggest that NPWTi is a promising therapeutic option in the treatment of wounds, and applicable in various fields. CONCLUSIONS NPWTi appears to be a useful adjunct in the treatment of critical wounds. However, data from prospective randomised trials to support the validity of the results are sparse.
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Affiliation(s)
- M Gathen
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover
| | - M Petri
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover
| | - C Krettek
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover
| | - M Omar
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover
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