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Herold J, Notov D, Reeps C, Schaser KD, Kamin K, Mäder M, Kleber C. Limb salvage in traumatic hemipelvectomy: case series with surgical management and review of the literature. Arch Orthop Trauma Surg 2023; 143:6177-6192. [PMID: 37314526 PMCID: PMC10491572 DOI: 10.1007/s00402-023-04913-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/19/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Traumatic hemipelvectomies are rare and serious injuries. The surgical management was described in several case studies, with primary amputation often performed to save the patient's life. METHODS We report of two survivors with complete traumatic hemipelvectomy resulting in ischemia and paralyzed lower extremity. Due to modern emergency medicine and reconstructive surgery, limb salvage could be attained. Long-term outcome with quality of life was assessed one year after the initial accident. RESULTS AND CONCLUSIONS The patients were able to mobilize themselves and live an independent life. The extremities remained without function and sensation. Urinary continence and sexual function were present and the colostomy could be relocated in both patients. Both patients support limb salvage, even having difficulties and follow-up treatments. Concomitant cases are required to consolidate the findings. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- J Herold
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany.
| | - D Notov
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - C Reeps
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - K D Schaser
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - K Kamin
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - M Mäder
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - C Kleber
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
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Schöbel T, Hantusch G, Hennings R, Schleifenbaum S, Kleber C, Spiegl U. Risk factors for revision surgery in operative treatment of traumatic injuries of the olecranon and prepatellar bursa. BMC Musculoskelet Disord 2022; 23:1008. [PMID: 36419124 PMCID: PMC9685846 DOI: 10.1186/s12891-022-05980-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Traumatic lacerations of the prepatellar (PB) and olecranon bursa (OB) are common injuries. The aim of this study was to gain descriptive data and to identify risk factors associated with complications that made revision surgery after primary bursectomy necessary. MATERIAL AND METHODS In this retrospective monocentric study at a level I trauma center, all patients with traumatic lacerations of the PB or OB who were treated with primary surgical bursectomy from 2015 to 2020 were analyzed. RESULTS 150 consecutive patients were included. In 44% of cases, the PB was affected (n = 66), in 56% the OB (n = 84). The reoperation rate after surgical bursectomy was 10.7% (n = 16). The main cause of reoperation was wound infection (50%; n = 8). The most common pathogen of postoperative infections was Staphylococcus aureus (87.5%). Several comorbidities have been identified as risk factors for reoperation after primary surgical bursectomy, such as heart diseases, arterial hypertension, the use of antihypertensives and anticoagulation. In contrast, surgical expertise, use of drains, postoperative immobilization, and postoperative antibiotics had no statistically significant effect. A significantly higher postoperative infection rate (17.6%) was observed in patients who were operated more than 48 h after initial trauma. CONCLUSIONS Given the limited recommendations for therapy of these common injuries, further investigations should focus on standardized therapeutic options for lacerations of the PB or OB. Delayed surgical interventions after trauma were associated with higher complication rates. Therefore, urgent surgery within 48 h after trauma may help to prevent revisions. LEVEL OF EVIDENCE Level of evidence IV.
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Affiliation(s)
- T. Schöbel
- grid.9647.c0000 0004 7669 9786Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany
| | - G. Hantusch
- grid.9647.c0000 0004 7669 9786Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany
| | - R. Hennings
- grid.9647.c0000 0004 7669 9786Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany
| | - S. Schleifenbaum
- grid.9647.c0000 0004 7669 9786Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany ,ZESBO – Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Semmelweisstrasse 14, D-04103 Leipzig, Germany ,grid.461651.10000 0004 0574 2038Fraunhofer Institute for Machine Tools and Forming Technology, Nöthnitzer Straße 44, D-01187 Dresden, Germany
| | - C. Kleber
- grid.9647.c0000 0004 7669 9786Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany
| | - U. Spiegl
- grid.9647.c0000 0004 7669 9786Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany
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Roessler MS, Buschmann C, Gliwitzky B, Hoedtke J, Kulla M, Wurmb T, Kleber C, Roessler M, Buschmann C, Brockmann J, Gliwitzky B, Hoedtke J, Kleber C, Koenig M, Kulla M, Molter E, Münzberg M, Wurmb T. Externe, nichtinvasive Beckenstabilisatoren – wann ist die Anlage indiziert? Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00852-6] [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: 10/22/2022]
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Rebholz H, Pfaffeneder-Mantai F, Knoll W, Hassel AW, Frank W, Kleber C. Olfactory dysfunction in SARS-CoV-2 infection: Focus on odorant specificity and chronic persistence. Am J Otolaryngol 2021; 42:103014. [PMID: 33873048 PMCID: PMC8041855 DOI: 10.1016/j.amjoto.2021.103014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/28/2021] [Indexed: 01/11/2023]
Abstract
Background Smell dysfunction has been recognized as an early symptom of SARS-CoV-2 infection, often occurring before the onset of core symptoms of the respiratory tract, fever or muscle pain. In most cases, olfactory dysfunction is accompanied by reduced sense of taste, is partial (microsmia) and seems to normalize after several weeks, however, especially in cases of virus-induced complete smell loss (anosmia), there are indications of persisting deficits even 2 months after recovery from the acute disease, pointing towards the possibility of chronic or even permanent smell reduction for a significant part of the patient population. To date, we have no knowledge on the specificity of anosmia towards specific odorants or chemicals and about the longer-term timeline of its persistence or reversal. Methods In this longitudinal study, 70 participants from a community in Lower Austria that had been tested positive for either IgG or IgM SARS-CoV-2 titers in June 2020 and a healthy control cohort (N = 348) underwent smell testing with a 12-item Cross-Cultural Smell Identification Test (CC-SIT), based upon items from the University of Pennsylvania Smell Identification Test (UPSIT). The test was performed in October 2020, i.e. 4 months after initial diagnosis via antibody testing. Results were analyzed using statistical tests for contingency for each smell individually in order to detect whether reacquisition of smell is dependent on specific odorant types. Results For all odorants tested, except the odor “smoke”, even 4 months or more after acute SARS-CoV-2 infection, participants with a positive antibody titer had a reduced sense of smell when compared to the control group. On average, while the control cohort detected a set of 12 different smells with 88.0% accuracy, the antibody-positive group detected 80.0% of tested odorants. A reduction of accuracy of detection by 9.1% in the antibody-positive cohort was detected. Recovery of the ability to smell was particularly delayed for three odorants: strawberry (encoded by the aldehyde ethylmethylphenylglycidate), lemon (encoded by citronellal, a monoterpenoid aldehyde), and soap (alkali metal salts of the fatty acids plus odorous additives) exhibit a sensitivity of detection of an infection with SARS-CoV-2 of 31.0%, 41.0% and 40.0%, respectively. Conclusion Four months or more after acute infection, smell performance of SARS-CoV-2 positive patients with mild or no symptoms is not fully recovered, whereby the ability to detect certain odors (strawberry, lemon and soap) is particularly affected, suggesting the possibility that these sensitivity to these smells may not only be lagging behind but may be more permanently affected.
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Affiliation(s)
- H Rebholz
- Center of Neurodegeneration, Faculty of Medicine/Dental Medicine, Danube Private University, Krems, Austria; Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, Université de Paris, Paris, France; GHU Psychiatrie et Neurosciences, Paris, France
| | - F Pfaffeneder-Mantai
- Department of Physics and Chemistry of Materials, Faculty of Medicine/Dental Medicine, Danube Private University, Krems, Austria.
| | - W Knoll
- Department of Physics and Chemistry of Materials, Faculty of Medicine/Dental Medicine, Danube Private University, Krems, Austria; AIT Austrian Institute of Technology GmbH, Biosensor Technologies, 3430 Tulln, Austria
| | - A W Hassel
- Department of Physics and Chemistry of Materials, Faculty of Medicine/Dental Medicine, Danube Private University, Krems, Austria; Institute of Chemical Technology of Inorganic Materials, Johannes Kepler University Linz, Linz, Austria
| | - W Frank
- Center of Health Systems Research, Faculty of Medicine/Dental Medicine, Danube Private University, Krems, Austria
| | - C Kleber
- Department of Physics and Chemistry of Materials, Faculty of Medicine/Dental Medicine, Danube Private University, Krems, Austria; Institute of Chemical Technology of Inorganic Materials, Johannes Kepler University Linz, Linz, Austria
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Schimrigk J, Baulig C, Buschmann C, Ehlers J, Kleber C, Knippschild S, Leidel BA, Malysch T, Steinhausen E, Dahmen J. [Indications, procedure and outcome of prehospital emergency resuscitative thoracotomy-a systematic literature search]. Unfallchirurg 2020; 123:711-723. [PMID: 32140814 DOI: 10.1007/s00113-020-00777-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 11/25/2022]
Abstract
BACKGROUND Prehospital resuscitative thoracotomy (PHRT) is a controversially discussed measure for the acute treatment of traumatic cardiac arrest (TCA) recommended by the current guidelines of the European Resuscitation Council (ERC). The aim of this work is the comprehensive presentation and summary of the available literature with the underlying hypothesis that the available publications show the feasibility and survival following PHRT in patients with TCA with a good neurological outcome. METHOD A systematic literature search was performed in the databases PubMed, EMBASE, Google Scholar, Springer LINK and Cochrane. The study selection, data extraction and evaluation of bias potential were performed independently by two authors. The outcome of patients with TCA after PHRT was selected as the primary endpoint. RESULTS A total of 4616 publications were found of which 21 publications with a total of 287 patients could be included in the analyses. For a detailed descriptive analysis, 15 publications with a total of 205 patients were suitable. The TCA of these patients was most commonly caused by pericardial tamponade, thoracic vascular injuries and severe extrathoracic multiple injuries. In 24% of the cases TCA occurred in the presence of the emergency physician. Clamshell thoracotomy (53%) was used preclinically more often than anterolateral thoracotomy (47%). Of the PHRT patients after TCA 12% (25/205) left the hospital alive, 9% (n = 19/205) with good neurological outcome and 1% (n = 3/205) with poor neurological outcome (according to the Glasgow outcome scale, GOS). CONCLUSION The prognosis of TCA seems to be much better than has long been assumed. Decisive for the success of resuscitation efforts in TCA seems to be the immediate, partly invasive treatment of all reversible causes. The measures for TCA recommended by the ERC resuscitation guidelines, seem to be poorly implemented, especially in the preclinical setting. A controversy regarding the recommendations of the guidelines is the question of whether a PHRT can be successfully implemented and if the comprehensive introduction in Germany seems to be meaningful. Despite the recommendation of the guidelines, this systematic review and meta-analysis underlines the lack of high-quality evidence on PHRT, whereby a survival probability to hospital discharge of 12% was reported, of which 75% had a good neurological outcome. The risk of bias of the results in individual publications as well as in this review is high. Further systematic research in the field of preclinical trauma resuscitation is particularly necessary also for acceptance of the guidelines.
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Affiliation(s)
- J Schimrigk
- Lehrstuhl für Didaktik und Bildungsforschung im Gesundheitswesen, Department Humanmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - C Baulig
- Institut für Medizinische Biometrie und Epidemiologie (IMBE), Department Humanmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - C Buschmann
- Institut für Rechtsmedizin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Deutschland
- AG Trauma, Deutscher Rat für Wiederbelebung - German Resuscitation Council (GRC), Ulm, Deutschland
| | - J Ehlers
- Lehrstuhl für Didaktik und Bildungsforschung im Gesundheitswesen, Department Humanmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - C Kleber
- AG Trauma, Deutscher Rat für Wiederbelebung - German Resuscitation Council (GRC), Ulm, Deutschland
- Chirurgische Notaufnahme, Universitätszentrum für Orthopädie & Unfallchirurgie, Universitätsklinikum TU Dresden, Dresden, Deutschland
| | - S Knippschild
- Institut für Medizinische Biometrie und Epidemiologie (IMBE), Department Humanmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - B A Leidel
- Zentrale Notaufnahme, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - T Malysch
- Klinik für Anästhesiologie und Intensivtherapie, Klinikum Brandenburg, Medizinische Hochschule Brandenburg, Brandenburg, Deutschland
| | - E Steinhausen
- Klinik für Orthopädie und Unfallchirurgie, BG Klinikum Duisburg, Duisburg, Deutschland
- Ärztliche Leitung Rettungsdienst Berlin, Fakultät für Gesundheit, Department Humanmedizin, Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Deutschland
| | - J Dahmen
- Klinik für Orthopädie und Unfallchirurgie, BG Klinikum Duisburg, Duisburg, Deutschland.
- Ärztliche Leitung Rettungsdienst Berlin, Fakultät für Gesundheit, Department Humanmedizin, Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Deutschland.
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Voltairestraße 2, 10179, Berlin, Deutschland.
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Bretschneider H, Helbig S, Kleber C, de With K, Stiehler M. Mimicry of surgical site infection - Case report. Int J Surg Case Rep 2020; 72:212-214. [PMID: 32544831 PMCID: PMC7298546 DOI: 10.1016/j.ijscr.2020.05.034] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/06/2020] [Accepted: 05/21/2020] [Indexed: 11/20/2022] Open
Abstract
Calciphylaxis may cause severe soft tissue complications after total joint arthroplasty. Caliphylaxis is a potential differential diagnosis to surgical site infection in patients with chronic kidney disease. Skin biopsy should be taken in case of suspected calciphylaxis to confirm the diagnosis.
Background context Calciphylaxis is a rare complication of secondary hyperparathyroidism caused by calcifications of small blood vessels in the skin and soft tissue. The disease occurs almost exclusively in patients with chronic kidney disease and has an incidence of approximately 50 cases per year in Germany [1]. Purpose We present a case of a 61-year-old woman with calciphylaxis in connection with a primary knee endoprosthesis implantation. Study design Case report. Methods A review of the medical records since the time of initial hospital admission throughout the entire hospitalization until the death of the patient was performed. Results Calciphylaxis caused severe soft tissue complications after total joint arthroplasty. Despite interdisciplinary therapy, including revision and plastic surgery as well as intensive care, the patient died 4 months after primary total knee arthroplasty due to septic multi-organ failure. Conclusion Calciphylaxis may cause severe soft tissue complications after total joint arthroplasty and should be considered as potential differential diagnosis to surgical site infection. This is the first case report on calciphylaxis as direct complication of total joint replacement surgery.
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Affiliation(s)
- H Bretschneider
- University Centre for Orthopaedics and Trauma Surgery, University Hospital Carl Gustav Carus Dresden and Faculty of Medicine of Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - S Helbig
- Division of Infectious Diseases, University Hospital Carl Gustav Carus Dresden and Faculty of Medicine of Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - C Kleber
- University Centre for Orthopaedics and Trauma Surgery, University Hospital Carl Gustav Carus Dresden and Faculty of Medicine of Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - K de With
- Division of Infectious Diseases, University Hospital Carl Gustav Carus Dresden and Faculty of Medicine of Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - M Stiehler
- University Centre for Orthopaedics and Trauma Surgery, University Hospital Carl Gustav Carus Dresden and Faculty of Medicine of Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany.
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Disch AC, Kleber C, Redemann D, Druschel C, Liljenqvist U, Schaser KD. Current surgical strategies for treating spinal tumors: Results of a questionnaire survey among members of the German Spine Society (DWG). Eur J Surg Oncol 2019; 46:89-94. [PMID: 31506180 DOI: 10.1016/j.ejso.2019.08.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 06/03/2019] [Accepted: 08/23/2019] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Questionnaire survey among the members of the German Spine Society (Deutsche Wirbelsäulen-Gesellschaft, DWG) to objectify oncological infrastructure and current standard of care in spinal tumor treatment in Germany. METHODS All DWG-members were contacted via the society's e-mail and asked to respond in anonymized form to a related questionnaire. Questions were asked regarding surgical specialty, type of institution involved, numbers of spinal procedures, as well as questions on treatment for primary tumors, whether the respondent belonged to a tumor center, decision-making procedures for surgery, and the type of procedure. RESULTS 84 centers providing surgical treatment for spinal tumors in their departments were identified. 52.6% were carrying out more than 500 spinal procedures per year. There was a significant association (P ≤ 0.05) between the numbers of spinal surgeries, the number of treated tumor patients per year, the organisation in a tumor center and the treatment of primary tumors. 76% are part of a local tumor center for interdisciplinary decision making (i.e.surgical treatment and adjuvant therapy). 74% of the institutions stated that conventional postoperative radiotherapy is standardly administered in the case of secondary lesions, with 24% of them referring patients to external services for radiotherapy. CONCLUSION In spite of often large numbers of spinal operations, the centers perform relatively small numbers of tumor operations, particularly for primary tumors. A nearly three-quarter majority of the departments are integrated into interdisciplinary tumor care. However, there is a marked number that do not belong to an interdisciplinary organisation. Further advances in multidisciplinarity and oncology training are a continuous issue to increase treatment quality in spinal tumor patients.
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Affiliation(s)
- A C Disch
- University Comprehensive Spine Center (UCSC), University Center for Orthopaedics and Traumatology, Carl Gustav Carus University Hospital at the TU Dresden, Germany.
| | - C Kleber
- University Comprehensive Spine Center (UCSC), University Center for Orthopaedics and Traumatology, Carl Gustav Carus University Hospital at the TU Dresden, Germany
| | - D Redemann
- University Comprehensive Spine Center (UCSC), University Center for Orthopaedics and Traumatology, Carl Gustav Carus University Hospital at the TU Dresden, Germany
| | - C Druschel
- University Comprehensive Spine Center (UCSC), University Center for Orthopaedics and Traumatology, Carl Gustav Carus University Hospital at the TU Dresden, Germany
| | - U Liljenqvist
- Orthopaedic Department II, Spine Surgery, St. Franziskus Hospital Münster, Germany
| | - K D Schaser
- University Comprehensive Spine Center (UCSC), University Center for Orthopaedics and Traumatology, Carl Gustav Carus University Hospital at the TU Dresden, Germany
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Abstract
A mass casualty event (MCE) poses an enormous challenge for rescue services and hospitals. In addition to a hospital emergency plan, employee training and practice exercises are essential to be prepared for such an event. The organizational and financial burden of MCE exercises in a hospital is extraordinarily high. In a retrospective analysis of several large hospital exercises, the magnitude of the necessary financial means for the preparation and execution of such drills is outlined. Depending on the size (number of patients) and scope (extent of departments involved) of the MCE exercise in a hospital, a full-size MCE drill may entail costs between 10,000 and 100,000€. Since the execution of such exercises is essential in the sense of preparedness and considering quality management aspects, possibilities of refinancing and more cost-efficient training must be developed.
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Affiliation(s)
- U Schweigkofler
- Abteilung für Unfallchirurgie und orthopädische Chirurgie, BG Unfallklinik Frankfurt am Main gGmbH, Friedberger Landstraße 430, 60389, Frankfurt am Main, Deutschland.
| | - C Kleber
- UniversitätsCentrum für Orthopädie und Unfallchirurgie (OUC), Carl Gustav Carus Universitätsklinikum, Technische Universität Dresden, Dresden, Deutschland
| | - T C Auhuber
- Medizinmanagement, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Deutschland.,Hochschule der Deutschen Gesetzlichen Unfallversicherung (HGU), Bad Hersfeld, Deutschland
| | - H G Jung
- Gesundheitsamt Frankfurt am Main, Frankfurt am Main, Deutschland
| | - D Cwojdzinski
- Senatsverwaltung für Gesundheit, Pflege und Gleichstellung, Berlin, Deutschland
| | - R Hoffmann
- Abteilung für Unfallchirurgie und orthopädische Chirurgie, BG Unfallklinik Frankfurt am Main gGmbH, Friedberger Landstraße 430, 60389, Frankfurt am Main, Deutschland
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Ondruschka B, Baier C, Dreßler J, Höch A, Bernhard M, Kleber C, Buschmann C. [Additional emergency medical measures in trauma-associated cardiac arrest]. Anaesthesist 2017; 66:924-935. [PMID: 29143074 DOI: 10.1007/s00101-017-0383-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/17/2017] [Accepted: 10/23/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION More than half of all traumatic deaths happen in prehospital settings. Until now, there have been no long-term studies examining the actual additive treatment during trauma-associated cardiopulmonary resuscitation (tCPR), including pleural decompression, pericardiocentesis, tourniquets and external stabilization of the pelvis. The present cohort study evaluated forensic autopsy reports of trauma deaths occurring at the scene with respect to additive actions in preclinical tCPR as well as the potentially preventable nature of the individual death cases. MATERIAL AND METHODS All autopsy protocols from the Institutes of Legal Medicine in Leipzig and Chemnitz, Germany within the years 2011-2017 were retrospectively examined and all trauma deaths with professional prehospital tCPR at the scene, during transport or shortly after arriving at the emergency room were analyzed. In addition to epidemiological parameters all forms of medical procedure performed by emergency physicians and the injury patterns were recorded. Thus, the questions whether any of the trauma deaths were preventable and if failures in work-flow management were evident could be retrospectively answered through a structured Delphi method. RESULTS Overall, 3795 autopsy protocols were listed containing 154 trauma cases (4.1%) with various preclinical tCPR attempts (male patients 70.1%; mean age 48 ± 21 years). Most of them died at the accident site (84.4%), some during transport (2.6%) or directly after admission to a hospital (13.0%). Only 23 patients (14.9%) received 25 additional interventions exceeding the normal scope (pleural decompression 80.0%, pericardiocentesis 8.0% and external stabilization of the pelvis 12.0%). A relevant number of potentially reversible causes for trauma-associated cardiac arrest was determined. There were deficits in the performance of pleural decompression in cases of tension pneumothorax. Even if isolated traumatic hemopericardium was a rare occurrence in the examined cases, the rate of pericardiocentesis was still too low. Also, more focus needs to be placed on provisional external pelvic stabilization of trauma patients which was performed too rarely even though an instable pelvic ring was apparent during the postmortem external examination. None of the cases received a rescue thoracotomy even if a few patients might have derived benefit from this and none of the cases showed injury patterns with tourniquet indications. Furthermore, no single case of death due to incorrect or missing airway management was determined. Errors in work-flow management were found in 37.0% and potentially preventable deaths occurred cumulatively in 12.3% of the cases. The potentially preventable deaths were particularly related to penetrating chest injuries caused by a sharp force. DISCUSSION The percentage of patients who might benefit from additive treatment implemented in tCPR efforts was shown to be equal between the local situations in Leipzig and Chemnitz compared to previous reports in Berlin. A need for optimizing the professional resuscitation process still remains as not all reversible causes were appropriately addressed. Further training and education should intensively address the mentioned deficits and continuous awareness of necessary additional medical procedures in the preclinical setting in cases of traumatic cardiac arrest is inevitable. Cooperation with forensic institutes can help to impart particular issues and treatment options of emergency medicine in cases of potentially reversible causes of traumatic cardiac arrest.
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Affiliation(s)
- B Ondruschka
- Institut für Rechtsmedizin, Universität Leipzig, Medizinische Fakultät, Johannisallee 28, 04103, Leipzig, Deutschland.
| | - C Baier
- Institut für Rechtsmedizin, Universität Leipzig, Medizinische Fakultät, Johannisallee 28, 04103, Leipzig, Deutschland
| | - J Dreßler
- Institut für Rechtsmedizin, Universität Leipzig, Medizinische Fakultät, Johannisallee 28, 04103, Leipzig, Deutschland
| | - A Höch
- Klinik für Orthopädie, Unfall- und Plastische Chirurgie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| | - M Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| | - C Kleber
- UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - C Buschmann
- Institut für Rechtsmedizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
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Boehler C, Kleber C, Martini N, Xie Y, Dryg I, Stieglitz T, Hofmann U, Asplund M. Actively controlled release of Dexamethasone from neural microelectrodes in a chronic in vivo study. Biomaterials 2017; 129:176-187. [DOI: 10.1016/j.biomaterials.2017.03.019] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/08/2017] [Accepted: 03/12/2017] [Indexed: 10/20/2022]
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Abstract
There are considerable similarities and intersections between forensic medicine and emergency medicine. This applies especially to frustraneously resuscitated patients or other lethal clinical courses of traumatized patients who are subject to latter forensic autopsy. Cooperation between departments of emergency and forensic medicine not only has emergency medical training potential, but also the possibility of retrospective evaluation of medical emergency measures - both in individual cases and with regard to epidemiological aspects. In particular, the widespread registration of autopsied pre-hospital trauma deaths that occurred despite on-scene resuscitation attempts is useful. The pre-hospital situation represents a hotspot, but also a blind spot in the overall trauma mortality. In recent clinical registers, preclinical deaths go mostly unrecorded, despite the undisputed benefits of clinical registers.
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Affiliation(s)
- C Buschmann
- Institut für Rechtsmedizin, Charité - Universitätsmedizin Berlin, Turmstr. 21, Haus N, 10559, Berlin, Deutschland.
| | - C Kleber
- UniversitätsCentrum für Orthopädie und Unfallchirurgie, AG Polytrauma, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - M Tsokos
- Institut für Rechtsmedizin, Charité - Universitätsmedizin Berlin, Turmstr. 21, Haus N, 10559, Berlin, Deutschland
| | - T Kerner
- Abteilung für Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie, Asklepios Klinikum Harburg, Hamburg, Deutschland
| | - K Püschel
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - U Schmidt
- Institut für Rechtsmedizin, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - H Fischer
- Brandenburgisches Landesinstitut für Rechtsmedizin, Potsdam, Deutschland
| | - M Stuhr
- Abteilung für Anästhesie, Intensiv- und Rettungsmedizin, Zentrum für Schmerztherapie, Berufsgenossenschaftliches Unfallkrankenhaus Hamburg, Hamburg, Deutschland
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Kleber C, Giesecke MT, Haas NP, Buschmann CT. Reply to letter: Requirement for a structured algorithm in cardiac arrest following major trauma: epidemiology, management errors, and preventability of traumatic deaths in Berlin. Resuscitation 2014; 85:e107-8. [PMID: 24709617 DOI: 10.1016/j.resuscitation.2014.03.311] [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] [Received: 03/30/2014] [Accepted: 03/31/2014] [Indexed: 10/25/2022]
Affiliation(s)
- C Kleber
- Center for Musculoskeletal Surgery, AG Polytrauma, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - M T Giesecke
- Center for Musculoskeletal Surgery, AG Polytrauma, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - N P Haas
- Center for Musculoskeletal Surgery, AG Polytrauma, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - C T Buschmann
- Institute of Legal Medicine and Forensic Sciences, Charité - Universitätsmedizin Berlin, Turmstrasse 21 (Building N), 10559 Berlin, Germany
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Kleber C, Giesecke MT, Kollow G, Haas NP, Buschmann CT. Reply to letter: Tactical Combat Casualty Care rules applied to civilian traumatic cardiopulmonary resuscitation: synergism of civilian and military trauma management. Resuscitation 2014; 85:e87-8. [PMID: 24602870 DOI: 10.1016/j.resuscitation.2014.01.035] [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] [Received: 01/27/2014] [Accepted: 01/28/2014] [Indexed: 10/25/2022]
Affiliation(s)
- C Kleber
- Center for Musculoskeletal Surgery, AG Polytrauma, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - M T Giesecke
- Center for Musculoskeletal Surgery, AG Polytrauma, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - G Kollow
- Department of Emergency Medicine, Bundeswehrkrankenhaus Berlin, Scharnhorststrasse 13, 10115 Berlin, Germany
| | - N P Haas
- Center for Musculoskeletal Surgery, AG Polytrauma, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - C T Buschmann
- Institute of Legal Medicine and Forensic Sciences, Charité - Universitätsmedizin Berlin, Turmstrasse 21, Building N, 10559 Berlin, Germany
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Kleber C, Giesecke MT, Lindner T, Haas NP, Buschmann CT. Requirement for a structured algorithm in cardiac arrest following major trauma: epidemiology, management errors, and preventability of traumatic deaths in Berlin. Resuscitation 2013; 85:405-10. [PMID: 24287328 DOI: 10.1016/j.resuscitation.2013.11.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 07/28/2013] [Accepted: 11/07/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite continuous innovation in trauma care, fatal trauma remains a significant medical and socioeconomic problem. Traumatic cardiac arrest (tCA) is still considered a hopeless situation, whereas management errors and preventability of death are neglected. We analyzed clinical and autopsy data from tCA patients in an emergency-physician-based rescue system in order to reveal epidemiologic data and current problems in the successful treatment of tCA. MATERIAL AND METHODS Epidemiological and autopsy data of all unsuccessful tCPR cases in a one-year-period in Berlin, Germany (n=101, Group I) and clinical data of all cases of tCPR in a level 1 trauma centre in an 6-year period (n=52, Group II) were evaluated. Preventability of traumatic deaths in autopsy cases (n=22) and trauma-management failures were prospectively assessed. RESULTS In 2010, 23% of all traumatic deaths in Berlin received tCPR. Death after tCPR occurred predominantly prehospital (PH;74%) and only 26% of these patients were hospitalized. Of 52 patients (Group II), 46% required tCPR already PH and 81% in the emergency department (ED). In 79% ROSC was established PH and 53% in the ED. The survival rate after tCPR was 29% with 27% good neurological outcome. Management errors occurred in 73% PH; 4 cases were judged as potentially or definitive preventable death. CONCLUSION Trauma CPR is beyond routine with the need for a tCPR-algorithm, including chest/pericardial decompression, external pelvic stabilization and external bleeding control. The prehospital trauma management has the highest potential to improve tCPR and survival. Therefore, we suggested a pilot prehospital tCPR-algorithm.
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Affiliation(s)
- C Kleber
- Center for Musculoskeletal Surgery, AG Polytrauma, Charité - Universitätsmedizin, Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin, Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - M T Giesecke
- Center for Musculoskeletal Surgery, AG Polytrauma, Charité - Universitätsmedizin, Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - T Lindner
- Departement for Emergency Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - N P Haas
- Center for Musculoskeletal Surgery, AG Polytrauma, Charité - Universitätsmedizin, Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - C T Buschmann
- Institute of Legal Medicine and Forensic Sciences, Charité - Universitätsmedizin Berlin, Turmstrasse 21 (Building N), 10559 Berlin, Germany
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Buschmann C, Kleber C. No more tension pneumothorax in unsuccessfully resuscitated patients with penetrating chest trauma at autopsy! Injury 2013; 44:1659-60. [PMID: 23618783 DOI: 10.1016/j.injury.2013.03.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 03/20/2013] [Indexed: 02/02/2023]
Affiliation(s)
- C Buschmann
- Charité - University of Berlin, Institute of Legal Medicine and Forensic Sciences, Turmstr. 21, Building N, 10559 Berlin, Germany.
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Lindner T, Doyscher R, Tsitsilonis S, Kleber C, Weber W, Wichlas F, Möckel M. Aktive Tetanusimmunisierung im Verletzungsfall – machen wir es richtig? Notf Rett Med 2013. [DOI: 10.1007/s10049-013-1723-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- C. Buschmann
- Charité - Universitätsmedizin Berlin, Institut für Rechtsmedizin (Direktor: Prof. Dr. med. M. Tsokos), Berlin
| | - S. Poloczek
- Berliner Feuerwehr, Ärztlicher Leiter Rettungsdienst, Berlin
| | - M. Giesecke
- Charité - Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie, Berlin
| | - C. Kleber
- Charité - Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie, Berlin
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Kleber C, Becker C, van Scherpenzeel KM, Weidemann H, Deja M, Haas NP. [Coincidence of traumatic tracheal rupture accompanied by ARDS. Illustrated by the example of a 17-year-old patient with multiple injuries]. Unfallchirurg 2012; 115:546-51. [PMID: 21584704 DOI: 10.1007/s00113-011-1995-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Treatment and diagnosis of a traumatic tracheal rupture is a challenge. Due to the rarity of such injuries and the subtle and delayed clinical presentation it is difficult to diagnose. We present for the first time the successful management of a 17-year-old multiply injured patient with coincidental tracheal rupture and ARDS (acute respiratory distress syndrome) after a fall. Besides the case report and pathogenesis the essential diagnostic and therapeutic measures are mentioned and discussed. The circumstances surrounding the accident have to be balanced with the severity of the trauma to also exclude rare injuries with certainty. Finally level 1 trauma centers specialized in ARDS provide the best clinical setting for successful treatment of these life-threatening injuries.
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Affiliation(s)
- C Kleber
- Klinik für Unfall- und Wiederherstellungschirurgie, Operative Intensiv- und Notfallmedizin, Centrum für Muskuloskeletale Chirurgie, Campus Virchow Klinikum, Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
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Kleber C, Gesslein M. [Injuries of the upper ankle joint]. MMW Fortschr Med 2012; 154:58-59. [PMID: 23088038 DOI: 10.1007/s15006-012-1211-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- C Kleber
- Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum.
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Affiliation(s)
- C. Buschmann
- Charité - Universitätsmedizin Berlin, Institut für Rechtsmedizin (Direktor: Prof. Dr. med. M. Tsokos), Berlin
| | - M. Tsokos
- Charité - Universitätsmedizin Berlin, Institut für Rechtsmedizin (Direktor: Prof. Dr. med. M. Tsokos), Berlin
| | - M. Peters
- Charité - Universitätsmedizin Berlin, Institut für Rechtsmedizin (Direktor: Prof. Dr. med. M. Tsokos), Berlin
| | - C. Kleber
- Charité - Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie, Berlin
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Quehl E, Manthey M, Giesecke M, Disch A, Kleber C. Management eines offenen Pneumothorax mit intrathorakalem Fremdkörper im Rahmen schizophrener Wahnvorstellungen. Notf Rett Med 2012. [DOI: 10.1007/s10049-011-1532-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kleber C, Gesslein M, Czabanka M, Arnholdt J, Schaser KD. [Traumatic brain injury]. MMW Fortschr Med 2011; 153:38-39. [PMID: 21991835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- C Kleber
- Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin-Campus Virchow Klinikum, Berlin.
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Kleber C, Gesslein M, Bail HJ, Schaser KD. [Emergency checklist: pelvic ring fractures]. MMW Fortschr Med 2011; 153:42-3. [PMID: 21682034 DOI: 10.1007/bf03368479] [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: 10/21/2022]
Affiliation(s)
- C Kleber
- Centrum für Muskuloskelatare Chirurgie, Charité, Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin.
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Kleber C, Kleber A. Opiatintoxikation beim älteren Notfallpatienten. Notf Rett Med 2009. [DOI: 10.1007/s10049-008-1119-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Scholz M, Kleber C, Sentürk U, Haas NP, Kandziora F, Melcher I. [Ventral stabilization of the lumbar spine of a 2-year-old boy with an expandable cage : 7-year course]. Orthopade 2008; 37:153-6. [PMID: 18210086 DOI: 10.1007/s00132-008-1192-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This case report describes the first implantation of an expandable cage into the lumbar spine of a 2-year-old boy. Due to incomplete remission of a teratoma, it was necessary to replace the second lumbar vertebral body with an expandable cage implantation and subsequent dorsoventral stabilization. During the follow-up period with annual x-ray examinations, a loss of correction without increased pain or neurological deficits could be shown in the now 9-year-old boy.
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Affiliation(s)
- M Scholz
- Zentrum für Wibelsäulenchirurgie und Neurotraumatologie , Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstrasse 430, 60389, Frankfurt am Main, Deutschland.
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Kleber C. Decathlon dentists achieve fulfillment. Dent Econ 1995; 85:79-80, 82. [PMID: 8612914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Kleber C. Dentists form group to cover for members. Dent Econ 1992; 82:57-8, 60, 62. [PMID: 1499812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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