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Pouymayou B, Perez-Haas Y, Allemann F, Saguner AM, Andratschke N, Guckenberger M, Tanadini-Lang S, Wilke L. Characterization of spatial integrity with active and passive implants in a low-field magnetic resonance linear accelerator scanner. Phys Imaging Radiat Oncol 2024; 30:100576. [PMID: 38644933 PMCID: PMC11031795 DOI: 10.1016/j.phro.2024.100576] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/23/2024] Open
Abstract
Background and Purpose Standard imaging protocols can guarantee the spatial integrity of magnetic resonance (MR) images utilized in radiotherapy. However, the presence of metallic implants can significantly compromise this integrity. Our proposed method aims at characterizing the geometric distortions induced by both passive and active implants commonly encountered in planning images obtained from a low-field 0.35 T MR-linear accelerator (LINAC). Materials and Methods We designed a spatial integrity phantom defining 1276 control points and covering a field of view of 20x20x20 cm3. This phantom was scanned in a water tank with and without different implants used in hip and shoulder arthroplasty procedures as well as with active cardiac stimulators. The images were acquired with the clinical planning sequence (balanced steady-state free-precession, resolution 1.5x1.5x1.5 mm3). Spatial integrity was assessed by the Euclidian distance between the control point detected on the image and their theoretical locations. A first plane free of artefact (FPFA) was defined to evaluate the spatial integrity beyond the larger banding artefact. Results In the region extending up to 20 mm from the largest banding artefacts, the tested passive and active implants could cause distortions up to 2 mm and 3 mm, respectively. Beyond this region the spatial integrity was recovered and the image could be considered as unaffected by the implants. Conclusions We characterized the impact of common implants on a low field MR-LINAC planning sequence. These measurements could support the creation of extra margin while contouring organs at risk and target volumes in the vicinity of implants.
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Affiliation(s)
- Bertrand Pouymayou
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Yoel Perez-Haas
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Florin Allemann
- Department of Traumatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Ardan M. Saguner
- Department of Cardiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Lotte Wilke
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Vetter P, Eckl L, Bellmann F, Allemann F, Scheibel M. [Minimally Invasive Techniques for the Treatment of Acute and Chronic Acromioclavicular Joint Instabilities]. Z Orthop Unfall 2023; 161:219-238. [PMID: 37015240 DOI: 10.1055/a-1781-6153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Acromioclavicular joint instabilities are one of the most common injuries of the shoulder girdle. Diagnostic measures include the vertical and horizontal components of instability. The main goals of treatment include pain reduction, joint stabilization, and return to physical activity. For operative treatment, there are numerous techniques available. Recently, minimally-invasive techniques were developed and showed equal results as with open approach. These procedures facilitate simultaneous treatment of concomitant shoulder lesions and reduce soft tissue trauma as well as the risk of infection. This article presents an overview of such minimally-invasive techniques for both acute and chronic instabilities. Both techniques address the aspect of horizontal instability, which was found to compromise clinical results. For an acute injury, we describe the use of a low-profile button system combined with an additional acromioclavicular cerclage. In the chronic setting with a bidirectional (vertical and horizontal) instability, a free tendon graft combined with a single TightRope augmentation is recommended.
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Buchmann L, van Lieshout EMM, Zeelenberg M, den Hartog D, Pfeifer R, Allemann F, Pape HC, Halvachizadeh S. Proximal humerus fractures (PHFs): comparison of functional outcome 1 year after minimally invasive plate osteosynthesis (MIPO) versus open reduction internal fixation (ORIF). Eur J Trauma Emerg Surg 2022; 48:4553-4558. [PMID: 34216222 PMCID: PMC9712325 DOI: 10.1007/s00068-021-01733-w] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Osteosynthetic treatment strategies of PHFs include MIPO or ORIF techniques. The aim of this study was to compare the 1 year outcome following either technique in type B PHFs. METHODS This study was designed as a retrospective cohort study of patients treated at one academic Level 1 trauma center. Patients from 2009 to 2019 who required surgical treatment of a type B PHF were eligible to be included in this study. Patients with A- or C-type fractures or patients requiring arthroplasty were excluded. All patients were treated with Proximal Humerus Interlocking System (PHILOS) and stratified according the approach into Group MIPO or Group ORIF. Outcome measures include local complications that occurred during hospitalization, nonunion after 12 months, and range of motion after 1 year follow-up. RESULTS This study included 149 (75.3%) patients in Group ORIF, and 49 (24.7%) in Group MIPO. The fracture morphology and concomitant injuries were comparable amongst these groups. When compared with Group MIPO, Group ORIF had a 2.6 (95% CI 0.6-11.7) higher risk of suffering from local complications. The rate of postoperative nerve lesions was comparable (OR 0.9, 95% CI 0.1-9.7) as was the rate of soft tissue complications (OR 2.0, 95% CI 0.2-17.2). The risk for nonunion was 4.5 times higher (95% 1.1-19.5) in Group ORIF when compared with Group MIPO. Group MIPO had a higher chance of flexion above 90° (OR 8.2, 95% CI 2.5-27.7). CONCLUSION This study provides indications that patients following surgical treatment of PHFs in MIPO technique might have favourable outcome. Large-scale and high-quality studies are warranted to confirm these results.
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Affiliation(s)
- Laura Buchmann
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Raemistrasse 75, 8006, Zurich, Switzerland
| | - Esther M M van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Miliaan Zeelenberg
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Dennis den Hartog
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Roman Pfeifer
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Raemistrasse 75, 8006, Zurich, Switzerland
| | - Florin Allemann
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Raemistrasse 75, 8006, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Raemistrasse 75, 8006, Zurich, Switzerland
| | - Sascha Halvachizadeh
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Faculty of Medicine, University of Zurich, Raemistrasse 75, 8006, Zurich, Switzerland.
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Spörri E, Halvachizadeh S, Gamble JG, Berk T, Allemann F, Pape HC, Rauer T. Comparison of Injury Patterns between Electric Bicycle, Bicycle and Motorcycle Accidents. J Clin Med 2021; 10:jcm10153359. [PMID: 34362145 PMCID: PMC8347860 DOI: 10.3390/jcm10153359] [Citation(s) in RCA: 10] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Electric bicycles (E-bikes) are an increasingly popular means of transport, and have been designed for a higher speed comparable to that of small motorcycles. Accident statistics show that E-bikes are increasingly involved in traffic accidents. To test the hypothesis of whether accidents involving E-bikes bear more resemblance to motorcycle accidents than conventional bicyclists, this study evaluates the injury pattern and severity of E-bike injuries in direct comparison to injuries involving motorcycle and bicycle accidents. Methods: In this retrospective cohort study, the data of 1796 patients who were treated at a Level I Trauma Center between 2009 and 2018 due to traffic accident, involving bicycles, E-bikes or motorcycles, were evaluated and compared with regard to injury patterns and injury severity. Accident victims treated as inpatients at least 16 years of age or older were included in this study. Pillion passengers and outpatients were excluded. Results: The following distribution was found in the individual groups: 67 E-bike, 1141 bicycle and 588 motorcycle accidents. The injury pattern of E-bikers resembled that of bicyclists much more than that of motorcyclists. The patients with E-bike accidents were almost 14 years older and had a higher incidence of moderate traumatic brain injuries than patients with bicycle accidents, in spite of the fact that E-bike riders were nearly twice as likely to wear a helmet as compared to bicycle riders. The rate of pelvic injuries in E-bike accidents was twice as high compared with bicycle accidents, whereas the rate of upper extremity injuries was higher following bicycle accidents. Conclusion: The overall E-bike injury pattern is similar to that of cyclists. The differences in the injury pattern to motorcycle accidents could be due to the higher speeds at the time of the accident, the different protection and vehicle architecture. What is striking, however, is the higher age and the increased craniocerebral trauma of the E-bikers involved in accidents compared to the cyclists. We speculate that older and untrained people who have a slower reaction time and less control over the E-bike could benefit from head protection or practical courses similar to motorcyclists.
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Affiliation(s)
- Emilian Spörri
- Department of Trauma Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (E.S.); (S.H.); (T.B.); (F.A.); (H.-C.P.)
| | - Sascha Halvachizadeh
- Department of Trauma Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (E.S.); (S.H.); (T.B.); (F.A.); (H.-C.P.)
| | | | - Till Berk
- Department of Trauma Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (E.S.); (S.H.); (T.B.); (F.A.); (H.-C.P.)
| | - Florin Allemann
- Department of Trauma Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (E.S.); (S.H.); (T.B.); (F.A.); (H.-C.P.)
| | - Hans-Christoph Pape
- Department of Trauma Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (E.S.); (S.H.); (T.B.); (F.A.); (H.-C.P.)
| | - Thomas Rauer
- Department of Trauma Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (E.S.); (S.H.); (T.B.); (F.A.); (H.-C.P.)
- Correspondence:
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Teuber H, Rauer T, Pape HC, Allemann F. Nonunion After an Open Trimalleolar Ankle Fracture: An Extended Clinical Course and a Novel Approach to Tibio-Talo-Calcaneal Arthrodesis. J Foot Ankle Surg 2021; 60:378-381. [PMID: 33419648 DOI: 10.1053/j.jfas.2020.03.025] [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: 08/15/2019] [Revised: 03/24/2020] [Accepted: 03/29/2020] [Indexed: 02/03/2023]
Abstract
Nonunion in the setting of chronic osteomyelitis after severe open ankle fractures is a feared outcome with severe loss in patient quality of life. Tibio-talo-calcaneal arthrodesis is a good salvage treatment option in this difficult patient cohort. We report a case of chronic osteomyelitis with severe destruction of the ankle joint after failed fracture fixation of an open trimalleolar ankle fracture. Fusion was ultimately achieved 5 years later using a novel-staged Masquelet technique with external ring fixator stabilization and bone graft reconstruction including femoral harvested autograft using reamer-irrigator-aspirator. This case shows that infection free arthrodesis of the ankle can be achieved even years after failed treatment. This procedure restored significant quality of life through pain relief and much improved mobility and may be a helpful technique in complex tibio-talo-calcaneal arthrodesis in the setting of chronic osteomyelitis and significant joint destruction.
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Affiliation(s)
- Henrik Teuber
- Resident, Department of Trauma, University Hospital Zurich, Zurich, Switzerland.
| | - Thomas Rauer
- Attending Surgeon, Department of Trauma, University Hospital Zurich, Zurich, Switzerland
| | - Hans-Christoph Pape
- Professor of Surgery and Program Director, Department of Trauma, University Hospital Zurich, Zurich, Switzerland
| | - Florin Allemann
- Senior Attending Surgeon, Department of Trauma, University Hospital Zurich, Zurich, Switzerland
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Halvachizadeh S, Berk T, Pieringer A, Ried E, Hess F, Pfeifer R, Pape HC, Allemann F. Is the Additional Effort for an Intraoperative CT Scan Justified for Distal Radius Fracture Fixations? A Comparative Clinical Feasibility Study. J Clin Med 2020; 9:jcm9072254. [PMID: 32708535 PMCID: PMC7408788 DOI: 10.3390/jcm9072254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/05/2020] [Accepted: 07/14/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION It is currently unclear whether the additional effort to perform an intraoperative computed tomography (CT) scan is justified for articular distal radius fractures (DRFs). The purpose of this study was to assess radiological, functional, and clinical outcomes after surgical treatment of distal radius fractures when using conventional fluoroscopy vs. intraoperative CT scans. METHODS Inclusion criteria: Surgical treatment of DRF between 1 January 2011 and 31 December 2011, age 18 and above. Group distribution: intraoperative conventional fluoroscopy (Group Conv) or intraoperative CT scans (Group CT). EXCLUSION CRITERIA Use of different image intensifier devices or incomplete data. DRF classification according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification. Outcome variables included requirement of revision surgeries, duration of surgery, absorbed radiation dose, and requirement of additional CT scans during hospitalization. RESULTS A total of 187 patients were included (Group Conv n = 96 (51.3%), Group CT n = 91 (48.7%)). AO Classification: Type A fractures n = 40 (50%) in Group Conv vs. n = 16 (17.6%) in Group CT, p < 0.001; Type B: 10 (10.4%) vs. 11 (12.1%), not significant (n.s.); Type C: 38 (39.6%) vs. 64 (70.3%), p < 0.001. In Group Conv, four (4.2%) patients required revision surgeries within 6 months, but in Group CT no revision surgery was required. The CT scan led to an intraoperative screw exchange/reposition in 23 (25.3%) cases. The duration of the initial surgery (81.7 ± 46.4 min vs. 90.1 ± 43.6 min, n.s.) was comparable. The radiation dose was significantly higher in Group CT (6.9 ± 1.3 vs. 2.8 ± 7.8 mGy, p < 0.001). In Group Conv, 11 (11.5%) patients required additional CT scans during hospitalization. CONCLUSION The usage of intraoperative CT was associated with improved reduction and more adequate positioning of screws postoperatively with comparable durations of surgery. Despite increased efforts by utilizing the intraoperative CT scan, the decrease in reoperations may justify its use.
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Affiliation(s)
- Sascha Halvachizadeh
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (T.B.); (A.P.); (E.R.); (R.P.); (H.-C.P.); (F.A.)
- Harald-Tscherne Research Laboratory, University Hospital Zurich, Sternwartstrasse 14, 8091 Zurich, Switzerland
- Correspondence: ; Tel.: +41-794-648-233
| | - Till Berk
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (T.B.); (A.P.); (E.R.); (R.P.); (H.-C.P.); (F.A.)
| | - Alexander Pieringer
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (T.B.); (A.P.); (E.R.); (R.P.); (H.-C.P.); (F.A.)
| | - Emanuael Ried
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (T.B.); (A.P.); (E.R.); (R.P.); (H.-C.P.); (F.A.)
| | - Florian Hess
- Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501 Frauenfeld, Switzerland;
| | - Roman Pfeifer
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (T.B.); (A.P.); (E.R.); (R.P.); (H.-C.P.); (F.A.)
- Harald-Tscherne Research Laboratory, University Hospital Zurich, Sternwartstrasse 14, 8091 Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (T.B.); (A.P.); (E.R.); (R.P.); (H.-C.P.); (F.A.)
- Harald-Tscherne Research Laboratory, University Hospital Zurich, Sternwartstrasse 14, 8091 Zurich, Switzerland
| | - Florin Allemann
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (T.B.); (A.P.); (E.R.); (R.P.); (H.-C.P.); (F.A.)
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Child C, Müller A, Allemann F, Pape HC, Welter J, Breiding P, Hess F. A retrospective comparison of clinical and radiological outcomes using palmar or dorsal plating to treat complex intraarticular distal radius fractures (AO 2R3 C3). Eur J Trauma Emerg Surg 2020; 48:4357-4364. [PMID: 32415367 DOI: 10.1007/s00068-020-01389-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/02/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Complex intraarticular distal radius fractures are common, and treatment with open reduction and internal fixation (ORIF) can be done through either the palmar or dorsal approach. There is scant evidence, however, indicating which approach is more suitable. We compared clinical and radiological outcomes of patients with AO 2R3 C3 fractures surgically treated with one of these approaches. MATERIALS AND METHODS From January 2015 to November 2018, 72 surgically treated patients with AO 2R3 C3 fractures were radiologically (12 months) and clinically (mean 26 months) evaluated. Forty-one patients underwent ORIF using the palmar approach (Group 1), and the dorsal approach was used in 31 patients (Group 2). Radiological parameters were measured using the AO scoring system immediately following surgery and 12 months later. Clinical assessments included the range of motion, PRWE and DASH scores. RESULTS At the immediate postoperative assessment, the median AO score was 5.5 (IQR 2-9.5, range 0-30.5) for Group 1 and 8 (IQR 5-15, range 0-27) for Group 2, and 12-month follow-up results were 4.5 (IQR 1.5-10, range 0-41) and 6.5 (IQR 5-11, range 0-29.5), respectively. Group 1 had more favorable results for the flexion, extension, radial abduction, PRWE and DASH parameters. The plate removal and reoperation rates were higher in Group 2. DISCUSSION When treating complex intraarticular distal radius fractures, we found the palmar approach was more advantageous for this fracture pattern. Nevertheless, a dorsal approach may still be suitable for intraarticular comminuted distal radius fractures with dorsally displaced joint fragments.
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Affiliation(s)
- Christopher Child
- Department of Orthopedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
| | - Annika Müller
- Department of Orthopedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
| | - Florin Allemann
- Department of Trauma Surgery, University of Zurich, Zurich, Switzerland
| | | | - JoEllen Welter
- Department of Orthopedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
| | - Philipe Breiding
- Department of Radiology, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Florian Hess
- Department of Orthopedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland.
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Halvachizadeh S, Teuber H, Berk T, Allemann F, von Känel R, Zelle B, Cinelli P, Pape HC, Pfeifer R. Prevalence, injury-, and non-injury-related factors associated with anxiety and depression in polytrauma patients - A retrospective 20 year follow-up study. PLoS One 2020; 15:e0232678. [PMID: 32365087 PMCID: PMC7197792 DOI: 10.1371/journal.pone.0232678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 04/20/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Survival rate after polytrauma increased over the past decades resulting in an increase of long-term complaints. These include physical and psychological impairments. The aim of this study was to describe the prevalence and risk factors for developing depression and anxiety more than twenty years after polytrauma. Methods We contacted patients who were treated due to a polytrauma between 1973 and 1990 at one level 1 trauma center after more than 20 years. These patients received a self-administered questionnaire, to assess symptoms of depression and anxiety. Analysis based on multivariable logistic regression models include injury severity and non-injury related factors to determine risk factors associated with the development of depression and anxiety. Results Patients included in this study (n = 337) had a mean ISS of 20.3 (4 to 50) points. In total, 173 (51.3%) showed psychiatric sequelae (depression n = 163, 48.2%; anxiety n = 14, 4.1%). Injury severity was not associated with the development of depression or anxiety. However, the patients, who required psychiatric therapy prior to the injury had higher risk of developing psychiatric symptoms (OR 1.3, 95%CI 1.1 to 1.8, p = 0.018) as did patients who suffered from additional psychiatric insults after the injury (OR 1.4, 95%CI 1.2 to 2.0, p = 0.049). Conclusion More than half of polytrauma patients developed psychiatric sequelae. Risk factors include mainly non-injury related factors such as psychiatric comorbidities and additional psychiatric insults after the injury.
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Affiliation(s)
- Sascha Halvachizadeh
- Department of Trauma, UniversitätsSpital Zürich, Zürich, Switzerland
- Harald Tscherne Laboratory, Department of Trauma, University Zurich, University Hospital Zurich, Zurich, Switzerland
- * E-mail:
| | - Henrik Teuber
- Department of Trauma, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Till Berk
- Department of Trauma, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Florin Allemann
- Department of Trauma, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Boris Zelle
- University of Texas Health Science Centre at San Antonio, San Antonio, TX, United States of America
| | - Paolo Cinelli
- Department of Trauma, UniversitätsSpital Zürich, Zürich, Switzerland
- Harald Tscherne Laboratory, Department of Trauma, University Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, UniversitätsSpital Zürich, Zürich, Switzerland
- Harald Tscherne Laboratory, Department of Trauma, University Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Roman Pfeifer
- Department of Trauma, UniversitätsSpital Zürich, Zürich, Switzerland
- Harald Tscherne Laboratory, Department of Trauma, University Zurich, University Hospital Zurich, Zurich, Switzerland
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Halvachizadeh S, Berk T, Rauer T, Hierholzer C, Pfeifer R, Pape HC, Allemann F. Treatment of proximal humerus fractures in geriatric patients - Can pathological DEXA results help to guide the indication for allograft augmentation? PLoS One 2020; 15:e0230789. [PMID: 32271792 PMCID: PMC7145012 DOI: 10.1371/journal.pone.0230789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 03/08/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Reconstruction of proximal humerus fracture continues to represent a challenge, especially in severe osteopenia. However, there still is a lack of consensus and clear indication on use of allograft augmentation. Therefore, this study aims to investigate outcome after osteosynthesis with and without allograft augmentation. It focuses on bone density results obtained by DEXA as potential examination that might help decision-making. METHODS This study included patients aged 65 years and older that were treated at one Level 1 trauma center between 2007 and 2018. Inclusion criteria: Proximal humerus fracture treated with or without allograft, conclusive data-sets. Exclusion criteria: prior surgical treatment of the proximal humerus, open fracture with bone loss, neurological damage. Patients were stratified according to the use of allograft augmentation in two groups: Group NA (no allograft augmented PHILOS) and Group A (PHILOS with allograft augmentation). Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Fractures were graded according to the classification by Neer. Radiographic union was analyzed at 6 weeks, 12 weeks, and at year follow up. Complications include surgical site infection, implant failure, humeral head necrosis, or delayed union. Allograft was used in cases of 1inch/3cm3 bone-loss or an egg-shell situation, where the patient refused arthroplasty. RESULTS This study included 167 patients, with 143 (85%) in the Group NA, and 24 (15%) in the Group A. There were no significant differences in age, gender, injury distribution, and distribution of Neer classification or CCI. Patients in Group A had significantly lower T-scores preoperatively (-2.87 ± 1.08 versus -0.9 ± 2.12, p = 0.003). No difference occurred in any of the complications. At one-year follow-up, the range of motion was comparable in both groups. CONCLUSION In patients with allograft augmentation and severe osteopenia, similar clinical and radiological results were obtained when compared with patients with better preoperative bone density scores (T-scores, DEXA). In view of a lack of guidelines indicating the indication for the use of allograft, this difference may be worth further study.
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Affiliation(s)
- Sascha Halvachizadeh
- Department of Trauma, University Zurich, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Till Berk
- Department of Trauma, University Zurich, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Thomas Rauer
- Department of Trauma, University Zurich, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Christian Hierholzer
- Department of Trauma, University Zurich, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Roman Pfeifer
- Department of Trauma, University Zurich, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Zurich, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Florin Allemann
- Department of Trauma, University Zurich, UniversitätsSpital Zürich, Zurich, Switzerland
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Müller A, Child C, Allemann F, Pape HC, Breiding P, Hess F. Using mini-arthrotomy for dorsal plating to treat intraarticular distal radius fractures: can it improve radiological and clinical outcomes? Eur J Trauma Emerg Surg 2020; 47:1971-1978. [PMID: 32236690 DOI: 10.1007/s00068-020-01354-9] [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] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/19/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Using palmar plating to treat complex intraarticular distal radius fractures is standard of care. However, fracture fragments can also be managed using a dorsal approach with arthrotomy, which is useful when treating fractures involving the dorsal joint aspect. We compared radiological and clinical outcomes after dorsal plating with or without an intraoperative arthrotomy. METHODS 31 of the 359 patients with a distal radius fracture had an AO Type 2R3 C3 fracture surgically treated using a dorsal approach (01/2015-10/2018). Fractures other than C3 were excluded from this analysis. Group 1 (n = 14) had no arthrotomy, Group 2 (n = 17) underwent intraoperative dorsal mini-arthrotomy. Clinical results were measured by range of motion (ROM), Patient-rated wrist evaluation (PRWE) and Disabilities of arm, shoulder and hand (DASH) scores. Radiological results were evaluated using the AO scoring system. RESULTS ROM, DASH and PRWE did not differ significantly between groups. Joint surface restoration was insufficient in five patients in Group 1 (p = 0.05). A trend towards better radiological results, although not statistically significant, was noted in Group 2 (p = 0.06). Plate removal was performed in 12 patients due to limited ROM (6 patients in each group). One patient (Group 2) with chronic pain and step off in the joint line underwent corrective osteotomy. CONCLUSIONS We did not detect a difference in patient outcomes using the dorsal longitudinal mini-arthrotomy; however, it may prevent incongruent joint reconstruction since all cases occurred in Group 1. In the absence of intraoperative CT scan, longitudinal mini-arthrotomy may be used to enhance visualization and achieve joint surface reconstruction.
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Affiliation(s)
- Annika Müller
- Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
| | - Christopher Child
- Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
| | - Florin Allemann
- Department of Trauma Surgery, University of Zurich, Zurich, Switzerland
| | | | - Philipe Breiding
- Department of Radiology, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Florian Hess
- Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland.
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Rauer T, Boos M, Neuhaus V, Ellanti P, Kaufmann RA, Pape HC, Allemann F. Inter- and intraobserver agreement of three classification systems for lateral clavicle fractures - reliability comparison between two specialist groups. Patient Saf Surg 2020; 14:4. [PMID: 31911821 PMCID: PMC6945566 DOI: 10.1186/s13037-019-0228-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/30/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although of great value in the management of lateral clavicle fractures, substantial variation in their classification exists. We performed a retrospective study to address the inter- and intraobserver reliability of three different classification systems for lateral clavicle fractures. METHODS Radiographs of 20 lateral clavicle fractures that represented a full spectrum of adult fracture patterns were graded by five experienced radiologists and five experienced trauma surgeons according to the Orthopaedic Trauma Association (OTA), the Neer, and the Jäger/Breitner classification systems. This evaluation was performed at two different time points separated by 3 months. To measure the observer agreement, the Fleiss kappa coefficient (κ) was applied and assessed according to the grading of Landis and Koch. RESULTS The overall interobserver reliability showed a fair agreement in all three classification systems. For the OTA classification system, the interobserver agreement showed a mean kappa value of 0.338 ranging from 0.350 (radiologists) to 0.374 (trauma surgeons). Kappa values of the interobserver agreement for the Neer classification system ranged from 0.238 (trauma surgeons) to 0.276 (radiologists) with a mean κ of 0.278. The Jäger/Breitner classification system demonstrated a mean kappa value of 0.330 ranging from 0.306 (trauma surgeons) to 0.382 (radiologists).The overall intraobserver reliability was moderate for the OTA and the Jäger/Breitner classification systems, while the overall intraobserver reliability for the Neer classification system was fair.The kappa values of the intraobserver agreements showed, in all classification systems, a wide range with the OTA classification system ranging from 0.086 to 0.634, the Neer classification system ranging from 0.137 to 0.448, and a range from 0.154 to 0.625 of the Jäger/Breitner classification system. CONCLUSIONS The low inter- and intraobserver agreement levels exhibited in all three classification systems by both specialist groups suggest that the tested lateral clavicle fracture classification systems are unreliable and, therefore, of limited value. We should recognize there is considerable inconsistency in how physicians classify lateral clavicle fractures and therefore any conclusions based on these classifications should be recognized as being somewhat subjective.
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Affiliation(s)
- Thomas Rauer
- Department of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, Zurich, Switzerland
| | - Matthias Boos
- Department of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, Zurich, Switzerland
| | - Valentin Neuhaus
- Department of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, Zurich, Switzerland
| | - Prasad Ellanti
- Department of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, Zurich, Switzerland
| | | | - Hans-Christoph Pape
- Department of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, Zurich, Switzerland
| | - Florin Allemann
- Department of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, Zurich, Switzerland
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Allemann F, Halvachizadeh S, Rauer T, Pape HC. Clinical outcomes after carbon-plate osteosynthesis in patients with distal radius fractures. Patient Saf Surg 2019; 13:30. [PMID: 31516553 PMCID: PMC6727488 DOI: 10.1186/s13037-019-0210-8] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/27/2019] [Indexed: 01/10/2023] Open
Abstract
Background Surgical implant material has changed over time, from metal to stainless steel to titanium. In recent decades a new material, carbon-fibre-reinforced polyether ether ketone, has been introduced. The aim of this study was to assess the clinical and radiological feasibility and functional outcome after treatment of distal radius fractures with this new implant. Methods Inclusion criteria: AO type B distal radius fractures treated with 2.7 mm CF/PEEK plates at one Level 1 trauma centre between 2016 and 2017. Follow-up period 1 year, measurement of range of motion and radiographic assessment, histological analysis of debris only after plate removal. Results Out of 112 eligible patients, 10 (8.9%) patients were included. Mean operation time was 65 ± 10 min. Radiographic healing was confirmed by radiologists at 6 weeks follow-up. During one-year follow-up, no adverse events were reported and functionality and patients subjective satisfaction improved significantly (p < 0.05). Only one plate was removed, with no histological signs of inflammation or allergic reaction. Conclusions The 2.7 mm CF/PEEK plate osteosynthesis appears to be a reliable and safe implant for certain types of distal radius fracture. Assessment of fracture union is substantially more practical and functionality improved significantly over 1 year.
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Affiliation(s)
- Florin Allemann
- Department of Traumatology, University of Zurich, University Hospital Zurich, Raemistrasse 100, 8091 Zürich, Switzerland
| | - Sascha Halvachizadeh
- Department of Traumatology, University of Zurich, University Hospital Zurich, Raemistrasse 100, 8091 Zürich, Switzerland
| | - Thomas Rauer
- Department of Traumatology, University of Zurich, University Hospital Zurich, Raemistrasse 100, 8091 Zürich, Switzerland
| | - Hans-Christoph Pape
- Department of Traumatology, University of Zurich, University Hospital Zurich, Raemistrasse 100, 8091 Zürich, Switzerland
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Manz MH, Jensen KO, Allemann F, Simmen HP, Rauer T. If there is smoke, there must be fire - Isolated distal, non-displaced, intraarticular ulna fracture: A case report. Int J Surg Case Rep 2019; 60:145-147. [PMID: 31226646 PMCID: PMC6586919 DOI: 10.1016/j.ijscr.2019.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 05/31/2019] [Accepted: 06/07/2019] [Indexed: 12/04/2022] Open
Abstract
Isolated distal ulna styloid fractures are a rarity. Timely diagnosis and appropriate therapy reduce posttraumatic morbidity. High level of suspicion should be maintained in the presence of nonspecific pain, even if the initial X-ray is inconspicuous.
Introduction Falling on the outstretched arm is a frequent trauma. The consequences can be isolated fractures of the distal radius, combined fractures of the distal radius and distal ulna - whereas the isolated fracture of the distal ulna is an uncommon trauma. Presentation of case We report on a 20- year- old male who presented at the emergency department after a motorcycle accident, suffering pain at his left forearm and left wrist. After an unremarkable x-ray in two planes, a CT- scan of the left wrist was performed and detected an isolated distal ulna fracture. The patient was treated with a forearm cast which led to a satisfying long term outcome. Discussion Based on the presented case the anatomical peculiarities of the distal radioulnar joint and the different trauma mechanisms as well as the resulting lesions, the diagnostic modalities and the treatment options are discussed. Conclusion We recommend performing an additional CT scan of the wrist in case of credible complaints after trauma to avoid baulking this very rare type of fracture.
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Affiliation(s)
- Marie Hélène Manz
- University Hospital Zurich, Division of Trauma Surgery, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Kai Oliver Jensen
- University Hospital Zurich, Division of Trauma Surgery, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Florin Allemann
- University Hospital Zurich, Division of Trauma Surgery, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Hans-Peter Simmen
- University Hospital Zurich, Division of Trauma Surgery, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Thomas Rauer
- University Hospital Zurich, Division of Trauma Surgery, Rämistrasse 100, 8091 Zurich, Switzerland.
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Halvachizadeh S, Teuber H, Allemann F, Luidl AT, von Känel R, Zelle B, Tiziani S, Rauen K, Pape HC, Pfeifer R. Psychiatric outcome at least 20 years after trauma: A survey on the status of subjective general health and psychiatric symptoms with a focus on posttraumatic stress disorder. J Trauma Acute Care Surg 2019; 86:1027-1032. [PMID: 31124902 DOI: 10.1097/ta.0000000000002232] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Information on long-term psychiatric sequelae after severe trauma is sparse. We therefore performed a survey addressing several symptoms related to posttraumatic stress disorder (PTSD) in patients who sustained multiple injuries more than 20 years after trauma. METHODS Patients injured between January 1, 1973, and December 31, 1990, were contacted at least 20 years later. We included multiply injured patients aged between 3 and 60 years from a single level 1 trauma center. A questionnaire based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria for PTSD, including individual symptoms related to intrusion, avoidance, and hyperarousal was sent to all patients. RESULTS A total of 359 patients (56.35%) received a questionnaire. Of these, 337 patients (93.87%) returned the questionnaire and were included in the study (223 males [66.17%] and 114 females [33.82%]). Mean ± SD follow-up was 29.5 ± 8.5 years. Nearly half the study population (47.18%) experienced lasting psychiatric sequelae, such as intrusive recollection (n = 65, 19.28%), avoidance (n = 92, 27.29%), or hyperarousal (n = 95, 28.18%) at least monthly. Ten patients (2.96%) fulfilled all Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria for PTSD. A total of 131 patients (38.87%) reported fair or poor general health status. There was no difference in injury severity in patients with or without PTSD (injury severity score, 8.33 vs. 20.36, respectively; p = 0.52) or PTSD-related symptoms including intrusion (19.88 vs. 20.32, p = 0.74), avoidance (19.99 vs. 20.3, p = 0.79), and hyperarousal (19.36 vs. 20.68, p = 0.26). CONCLUSION At least 20 years after injury, no correlation was found between the development of psychiatric complications and the severity of injury. While the rate of full-blown PTSD was low, nearly half the study population regularly suffered from at least one psychiatric symptom attributable to the initial trauma. Awareness for the development of psychiatric complications and early initiation of psychiatric counseling are advisable. LEVEL OF EVIDENCE Prognostic and epidemiologic, level II.
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Affiliation(s)
- Sascha Halvachizadeh
- From the Department of Trauma (S.H., H.T., F.A., S.T., H.-C.P., R.P.), University Hospital Zurich, University of Zurich, Zurich, Switzerland; Medical University RWTH Aachen (A.T.L.), Aachen, Germany; Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine (R.v.K., K.R.), University Hospital Zurich, University of Zurich, Zurich, Switzerland; and Department of Orthopedic Surgery, University of Texas Health Science Center at San Antonio (B.Z.), San Antonio, Texas
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Schäfer FP, Sander V, Pothmann CEM, Allemann F, Simmen HP, Pape HC. Anterior Rectus Sheath Autograft in WRAP-Augmentation of Achilles Tendon Rupture. J Foot Ankle Surg 2019; 58:562-566. [PMID: 30683517 DOI: 10.1053/j.jfas.2018.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Indexed: 02/03/2023]
Abstract
Achilles tendon ruptures can be counted as the most common traumatic ankle injuries. As such, there is a comparatively large set of treatment options including surgical and nonsurgical approaches. The purpose of this case report is to demonstrate a new technique for a specific subgroup of Achilles tendon ruptures that present with a large tendinous gap. We used a 2-step procedure designed to grant additional stability through an autograft from the anterior rectus sheath of the patient. Two patients were treated after suffering traumatic Achilles tendon ruptures on the left side with a gap of >3.5 cm and a high demand in daily activities. The reconstruction was performed using an upper quadrant recuts sheath as a WRAP-augmentation. After securing the transplant tissue, the abdominal wall was reconstructed using a Vicryl™-Prolene™ mesh (VYPRO®, Johnson & Johnson Medical GmbH, Ethicon Deutschland, Norderstedt, Germany). After, a standard approach to the Achilles tendon was performed with a Kirchmayr-Kessler suture. The end result was then stabilized with a rectus sheath WRAP over a length of 14 to 15 cm. On the cases reported here, multiple clinical follow-ups were performed over a 5-year period. We can report highly satisfying results, with a return to sports activity after 6 months and no complications. As such we believe the rectus sheath autograft an effective solution for Achilles tendon ruptures with large gaps in healthy patients that demonstrate a high demand in daily activities.
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Affiliation(s)
- Frank P Schäfer
- Attending Physician, Department of Trauma Surgery, University Hospital Zurich, Switzerland.
| | - Victor Sander
- Medical Resident, Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Carina E M Pothmann
- Medical Resident, Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Florin Allemann
- Senior Attending Physician, Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Hans-Peter Simmen
- Former Chief of Surgery and Clinical Director, Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Hans-Christoph Pape
- Current Chief of Surgery and Clinical Director, Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
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Allemann F, Halvachizadeh S, Waldburger M, Schaefer F, Pothmann C, Pape HC, Rauer T. Different treatment strategies for acromioclavicular dislocation injuries: a nationwide survey on open/minimally invasive and arthroscopic concepts. Eur J Med Res 2019; 24:18. [PMID: 30904018 PMCID: PMC6431035 DOI: 10.1186/s40001-019-0376-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 03/14/2019] [Indexed: 12/15/2022] Open
Abstract
Background Injuries to the acromioclavicular (AC) joint are one of the most common among sporting injuries of the upper extremity. Several studies investigated different treatment options comparing surgical and non-surgical treatment, and type of operative interventions. This study aims to evaluate treatment decisions regarding injuries of the AC joint and to compare different treatment strategies depending on the specific training of the treating physician. Methods We performed a nationwide survey by contacting different experienced physicians and sending them questionnaires. The questionnaire included 37 questions that assessed preferred treatment strategies in AC joint injuries. We addressed different surgical and nonsurgical options as well as level of experience and factors that might influence the decision on treatment strategy. The physicians were stratified according to their training into general surgeons (group trauma associated) and orthopedic surgeons (orthopedic associated). The AC joint lesions were categorized according to the widely used Rockwood classification. Results This study analyses 96 questionnaires. We included 46 (47.9%) colleagues in group trauma and 50 (52.1%) in group orthopedics. Most of the colleagues (98.9%) prefer non-operative treatment of type I and type II AC lesions. Similarly, 96.8% agree on surgical treatment of types IV, V, and VI lesions. The treatment of type III lesions is performed in 41.6% of cases non-operatively and in 58.4% of cases surgically. Trauma-associated colleagues are 3.4 times more likely to treat AC lesions with a hook plate compared to orthopedic-associated colleagues (p = 0.05). In decreasing order, the most commonly used non-surgical technique is sling immobilization (63.7%), and the most commonly performed surgical treatment is the hook plate (41.1%) in treating type III injuries. Conclusion This study shows a distinct difference in treatment of AC joint injuries depending on the training of the physician. Further, the need for high-quality studies arises to define the optimal treatment of type III lesions.
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Affiliation(s)
- F Allemann
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - S Halvachizadeh
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - M Waldburger
- Medical School, University of Zurich, Zurich, Switzerland
| | - F Schaefer
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - C Pothmann
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - H C Pape
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - T Rauer
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
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Halvachizadeh S, Teuber H, Cinelli P, Allemann F, Pape HC, Neuhaus V. Does the time of day in orthopedic trauma surgery affect mortality and complication rates? Patient Saf Surg 2019; 13:8. [PMID: 30766615 PMCID: PMC6362600 DOI: 10.1186/s13037-019-0186-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/21/2019] [Indexed: 12/17/2022] Open
Abstract
Background Orthopedic trauma surgery has multiple, both patient-based and surgeon-based risk factors. Evaluating and modifying certain patient safety factors could mitigate some of these risks. This study investigates the influence that the time of day of surgery has on mortality and complication rates. Question/purpose This study evaluates whether the time of day of orthopedic trauma surgery influences complication or mortality rates. Patients and methods A prospective Swiss surgical database developed as a nationwide quality assurance project was reviewed retrospectively. All patients with trauma-coded diagnoses that were surgically treated in Swiss hospitals between 2004 and 2014 were evaluated. Surgery times were stratified into morning, afternoon, evening and night. The primary outcomes were in-hospital mortality and complication rates. Co-factors were sought in bivariate and multivariable analysis. Results Of 31,692 patients, 13,969 (44.3%) were operated in the morning, 12,696 (40.3%) in the afternoon, 4,331 (13.7%) in the evening, and 550 (1.7%) at night. Mortality rates were significantly higher in nighttime (2.4%, OR 1.26, p=0.04) and afternoon surgery (1.7%, OR 1.94, p=0.03) vs. surgery in the morning (1.1%). Surgery performed in the afternoon and at night showed significantly increased general complication rates vs. surgery performed in the morning. (OR 1.22, p=0.006 and OR 1.51, p=0.021, respectively). Conclusion This study observed higher complication and mortality rates for surgery performed after-hours, which correlates with other recent studies. Surgeon fatigue is a potential contributing factor for these increased risks. Other potential factors include surgeon experience, surgery type, and the potential for more severe or emergent injuries occurring after-hours.
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Affiliation(s)
- Sascha Halvachizadeh
- Department of Trauma, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, ZH Switzerland
| | - Henrik Teuber
- Department of Trauma, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, ZH Switzerland
| | - Paolo Cinelli
- Department of Trauma, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, ZH Switzerland
| | - Florin Allemann
- Department of Trauma, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, ZH Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, ZH Switzerland
| | - Valentin Neuhaus
- Department of Trauma, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, ZH Switzerland
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Allemann F, Heining S, Zelle B, Probst C, Pape HC. Risk factors for complications and adverse outcomes in polytrauma patients with associated upper extremity injuries. Patient Saf Surg 2019; 13:7. [PMID: 30740144 PMCID: PMC6360674 DOI: 10.1186/s13037-019-0187-3] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 01/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background In terms of upper extremity fractures by patients with multiple injuires, a lot of studies have assessed the functional outcome following trauma to have less favorable outcomes in regards to functional recovery. We tested the hypothesis that differences in clinical outcome occur between shaft and articular injuries of the upper extremity, when patients that sustained neurologic deficits (e.g. brachial plexus lesions) are excluded. Methods We involved Patients with isolated or combined upper extremity fracture, ISS > 16 in a level one trauma center. The follow up was at least 10 years after the initial injury. Both clinical examination (range of motion, instability, contractures, peripheral nerve damage) and radiographic analysis were carried out. We evaluated also the development of heterotopic ossifications. To analyse patients were subdivided into 3 different subgroups (articular [IA], shaft [IS], and combined [C]). Results A statistically significant difference was found when ROM was compared between Group IS and C (p = 0.012), for contractures between Groups IA and C (p = 0.009) and full muscle elbow forces between Groups IS and C (p = 0.005) and Group IA and IS (p = 0.021). There was a significantly increased incidence in heterotopic ossifications when articular involvement was present. This applied for the isolated (p < 0.02) and the combined group (Group C vs Group IS, p = 0.003).When Brooker type I/II in group IA and Brooker types III/IV were combined, there was a significant difference (p < 0.001). In group IA (n = 1) and in group C (n = 6), HO developed or worsened after revision surgery, all of which were performed for malunion or nonunion. Conclusions In this study, patients with isolated shaft fractures of the upper extremity tend to have a more favorable outcome in comparison with combined to isolated articular fractures in terms of range of motion, pain and the ability to use the arm for everyday activities.In the clinical practice of the treatment of polytraumatized patients with upper extremity injuries, we feel that the relevance of these injuries should not be underestimated. They are especially prone to development of heterotopic ossifications, thus requiring prophylactic measures, if necessary. As their incidence increases with the rate of reoperations, we feel that even during initial care, meticulous surgery is required to avoiding the necessity of revision surgeries. Similar to injuries below the knee, upper extremity injuries, should be treated to avoid any functional disability.
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Affiliation(s)
- Florin Allemann
- 1Department of Trauma, Universitaetsspital, University of Zurich, Raemistr.100, 8091 Zurich, Switzerland
| | - Sandro Heining
- 1Department of Trauma, Universitaetsspital, University of Zurich, Raemistr.100, 8091 Zurich, Switzerland
| | - Boris Zelle
- 2University of Texas Science Center at San Antonio, Floyd Curl Dr., 7703, San Antonio, TX 78229 USA
| | - Christian Probst
- Department of Trauma, Cologne-Merheim Med. Center, Ostmerheimerstr. 200, 51109 Koln, Germany
| | - Hans-Christoph Pape
- 1Department of Trauma, Universitaetsspital, University of Zurich, Raemistr.100, 8091 Zurich, Switzerland
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Hammerle D, Osterhoff G, Allemann F, Werner CML. Comparison of intraoperative 2D vs. 3D imaging in open reduction and fixation of distal radius fractures. Eur J Trauma Emerg Surg 2018; 46:557-563. [PMID: 30350005 DOI: 10.1007/s00068-018-1036-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE In the volar plating of distal radius fractures, intraoperative three-dimensional (3D) imaging is designed to allow better judgment regarding screw and implant positioning compared with conventional intraoperative two-dimensional (2D) imaging. We evaluated the impact of these two imaging modalities on the rates of intraoperative revision and secondary surgery, as well as the need for implant removal during follow-up. METHODS A retrospective analysis of consecutive patients who underwent volar plate osteosynthesis for isolated distal radius fractures between January 2008 and April 2016 was performed. Patient files were evaluated for intraoperative imaging findings, intraoperative and postoperative revision rates, and implant removal during follow-up. Additional analyses of radiation exposure, operation time, and hospitalization time were performed. RESULTS A total of 314 patients were analyzed (mean age: 54 ± 19 years; 210 females). For 246 patients, only 2D imaging was performed, while the remaining 68 patients underwent both 2D and 3D imaging (O-Arm, Medtronic). The intraoperative revision rate was significantly (p < 0.001) higher with 3D imaging (32.4%) compared with 2D imaging (2.0%). The postoperative revision rates were similar between both the groups (2.9% vs. 2.0%; p = 0.674). Compared with 2D imaging, the use of the Medtronic O-Arm resulted in a significantly lower implant removal rate (8.8% vs. 18.7%; p = 0.036) during follow-up. CONCLUSION Compared with conventional 2D imaging, the use of intraoperative 3D imaging significantly increased the intraoperative revision rate and has the potential for positive long-term effects for lowering the risk of requiring an implant removal.
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Affiliation(s)
- Diego Hammerle
- Klinik für Orthopädische Chirurgie und Traumatologie des Bewegungsapparates, Kantonsspital St.Gallen, Rorschacher Strasse 95, 9007, St.gallen, Switzerland.
| | - Georg Osterhoff
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinik Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Florin Allemann
- Klinik für Traumatologie, Universitätsspital Zürich, Rämistrasse 100, 8091, Zurich, Switzerland
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Pothmann CEM, Sprengel K, Alkadhi H, Osterhoff G, Allemann F, Jentzsch T, Jukema G, Pape HC, Simmen HP, Neuhaus V. [Abdominal injuries in polytraumatized adults : Systematic review]. Unfallchirurg 2018; 121:159-173. [PMID: 29350250 DOI: 10.1007/s00113-017-0456-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abdominal injuries are potentially life-threatening and occur in 20-25% of all polytraumatized patients. Blunt trauma is the main mechanism. The liver and spleen are most commonly injured and much less often the intestines. The clinical evaluation proves equivocal in many cases; therefore, the gold standard is computed tomography (CT), which has been increasingly used even in hemodynamically weakly stable or sometimes even unstable patients because it promptly provides precise diagnostic findings, which present the basis for successful therapy. Hemodynamically unstable patients always need an exploratory laparotomy (EL). An EL should also be carried out with a positive focused assessment with sonography for trauma (FAST) or CT for severe parenchymal lesions, hollow organ lesions, intraperitoneal bladder lesions, peritonitis and organ evisceration, impalement injuries and lesions of the abdominal fascia. Hemodynamically stable patients without signs of peritonitis and a lack of such findings can often be treated conservatively irrespective of the extent of an injury. Angiography (and if needed embolization) can additionally be diagnostically and therapeutically utilized.
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Affiliation(s)
- C E M Pothmann
- Klinik für Traumatolgie, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
| | - K Sprengel
- Klinik für Traumatolgie, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
| | - H Alkadhi
- Institut für Diagnostische und Interventionelle Radiologie, UniversitätsSpital Zürich, Zürich, Schweiz
| | - G Osterhoff
- Klinik für Traumatolgie, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
| | - F Allemann
- Klinik für Traumatolgie, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
| | - T Jentzsch
- Klinik für Traumatolgie, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
| | - G Jukema
- Klinik für Traumatolgie, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
| | - H C Pape
- Klinik für Traumatolgie, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
| | - H-P Simmen
- Klinik für Traumatolgie, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz.
| | - V Neuhaus
- Klinik für Traumatolgie, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
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Allemann F. [Not Available]. Praxis (Bern 1994) 2017; 106:285. [PMID: 28299995 DOI: 10.1024/1661-8157/a002641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Florin Allemann
- 1 Spezialsprechstunde Obere Extremitäten/Sportverletzungen, Klinik für Unfallchirurgie, Universitätsspital Zürich
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Fourati Ben Mustapha S, Khrouf M, Kacem Ben Rejeb K, Elloumi Chaabene H, Merdassi G, Wahbi D, Ben Meftah M, Zhioua F, Zhioua A, Azzarello A, Host T, Mikkelsen AL, Theofanakis CP, Dinopoulou V, Mavrogianni D, Partsinevelos GA, Drakakis P, Stefanidis K, Bletsa A, Loutradis D, Rienzi L, Cobo A, Paffoni A, Scarduelli C, Capalbo A, Garrido N, Remohi J, Ragni G, Ubaldi FM, Herrer R, Quera M, GIL E, Serna J, Grondahl ML, Bogstad J, Agerholm IE, Lemmen JG, Bentin-Ley U, Lundstrom P, Kesmodel US, Raaschou-Jensen M, Ladelund S, Guzman L, Ortega C, Albuz FK, Gilchrist RB, Devroey P, Smitz J, De Vos M, Bielanska M, Leveille MC, Borghi E, Magli MC, Figueroa MJ, Mascaretti G, Ferraretti AP, Gianaroli L, Szlit E, Leocata Nieto F, Maggiotto G, Arenas G, Tarducci Bonfiglio N, Ahumada A, Asch R, Sciorio R, Dayoub N, Thong J, Pickering S, Ten J, Carracedo MA, Guerrero J, Rodriguez-Arnedo A, Llacer J, Bernabeu R, Tatone C, Heizenrieder T, Di Emidio G, Treffon P, Seidel T, Eichenlaub-Ritter U, Cortezzi SS, Cabral EC, Ferreira CR, Trevisan MG, Figueira RCS, Braga DPAF, Eberlin MN, Iaconelli Jr. A, Borges Jr. E, Zabala A, Pessino T, Blanco L, Rey Valzacchi G, Leocata F, Ahumada A, Vanden Meerschaut F, Heindryckx B, Qian C, Deforce D, Leybaert L, De Sutter P, De las Heras M, De Pablo JL, Navarro B, Agirregoikoa JA, Barrenetxea G, Cruz M, Perez-Cano I, Gadea B, Herrero J, Martinez M, Roldan M, Munoz M, Pellicer A, Meseguer M, Munoz M, Cruz M, Roldan M, Gadea B, Galindo N, Martinez M, Pellicer A, Meseguer M, Perez-Cano I, Scarselli F, Alviggi E, Colasante A, Minasi MG, Rubino P, Lobascio M, Ferrero S, Litwicka K, Varricchio MT, Giannini P, Piscitelli P, Franco G, Zavaglia D, Nagy ZP, Greco E, Urner F, Wirthner D, Murisier F, Mock P, Germond M, Amorocho Llanos B, Calderon G, Lopez D, Fernandez L, Nicolas M, Landeras J, Finn-Sell SL, Leandri R, Fleming TP, Macklon NS, Cheong YC, Eckert JJ, Lee JH, Jung YJ, Hwang HK, Kang A, An SJ, Jung JY, Kwon HC, Lee SJ, Palini S, Zolla L, De Stefani S, Scala V, D'Alessandro A, Polli V, Rocchi P, Tiezzi A, Pelosi E, Dusi L, Bulletti C, Fadini R, Lain M, Mignini Renzini M, Brambillasca F, Coticchio G, Merola M, Guglielmo MC, Dal Canto M, Figueira R, Setti AS, Braga DPAF, Iaconelli Jr. A, Borges Jr. E, Worrilow KC, Uzochukwu CD, Eid S, Le Gac S, Esteves TC, van Rossem F, van den Berg A, Boiani M, Kasapi E, Panagiotidis Y, Goudakou M, Papatheodorou A, Pasadaki T, Prapas N, Prapas Y, Panagiotidis Y, Kasapi E, Goudakou M, Papatheodorou A, Pasadaki T, Vanderzwalmen P, Prapas N, Prapas Y, Norasing S, Atchajaroensatit P, Tawiwong W, Thepmanee O, Saenlao S, Aojanepong J, Hunsajarupan P, Sajjachareonpong K, Punyatanasakchai P, Maneepalviratn S, Jetsawangsri U, Herrero J, Cruz M, Tejera A, Rubio I, Romero JL, Meseguer M, Nordhoff V, Schlatt S, Schuring AN, Kiesel L, Kliesch S, Azambuja R, Okada L, Lazzari V, Dorfman L, Michelon J, Badalotti M, Badalotti F, Petracco A, Schwarzer C, Esteves TC, Nordhoff V, Schlatt S, Boiani M, Versieren K, Heindryckx B, De Croo I, Lierman S, De Vos W, Van den Abbeel E, Gerris J, De Sutter P, Milacic I, Borogovac D, Veljkovic M, Arsic B, Jovic Bojovic D, Lekic D, Pavlovic D, Garalejic E, Guglielmo MC, Coticchio G, Albertini DF, Dal Canto M, Brambillasca F, Mignini Renzini M, De Ponti E, Fadini R, Sanges F, Talevi R, Capalbo A, Papini L, Mollo V, Ubaldi FM, Rienzi LF, Gualtieri R, Albuz FK, Guzman L, Orteg C, Gilchrist RB, Devroey P, De Vos M, Smitz J, Choi J, Lee H, Ku S, Kim S, Choi Y, Kim J, Moon S, Demilly E, Assou S, Moussaddykine S, Dechaud H, Hamamah S, Takisawa T, Doshida M, Hattori H, Nakamura Y, Kyoya T, Shibuya Y, Nakajo Y, Tasaka A, Toya M, Kyono K, Novo S, Penon O, Gomez R, Barrios L, Duch M, Santalo J, Esteve J, Nogues C, Plaza JA, Perez-Garcia L, Ibanez E, Chavez S, Loewke K, Behr B, Reijo Pera R, Huang S, Wang H, Soong Y, Chang C, Okimura T, Kuwayama M, Mori C, Morita M, Uchiyama K, Aono F, Kato K, Takehara Y, Kato O, Minasi M, Casciani V, Scarselli F, Rubino P, Colasante A, Arizzi L, Litwicka K, Ferrero S, Mencacci C, Piscitelli C, Giannini P, Cucinelli F, Tocci A, Nagy ZP, Greco E, Wydooghe E, Vandaele L, Dewulf J, Van den Abbeel E, De Sutter P, Van Soom A, Moon JH, Son WY, Mahfoudh A, Henderson S, Jin SG, Shalom-Paz E, Dahan M, Holzer H, Mahmoud K, Triki-Hmam C, Terras K, Zhioua F, Hfaiedh T, Ben Aribia MH, Otsubo H, Egashira A, Tanaka K, Matsuguma T, Murakami M, Murakami K, Otsuka M, Yoshioka N, Araki Y, Kuramoto T, Smit JG, Sterrenburg MD, Eijkemans MJC, Al-Inany HG, Youssef MAFM, Broekmans FJM, Willoughby K, DiPaolo L, Deys L, Lagunov A, Amin S, Faghih M, Hughes E, Karnis M, Ashkar F, King WA, Neal MS, Antonova I, Veleva L, Petkova L, Shterev A, Nogales C, Martinez E, Ariza M, Cernuda D, Gaytan M, Linan A, Guillen A, Bronet F, Cottin V, Fabian D, Allemann F, Koller A, Spira JC, Agudo D, Martinez-Burgos M, Arnanz A, Basile N, Rodriguez A, Bronet F, Cho YS, Filioli Uranio M, Ambruosi B, Paternoster MS, Totaro P, Sardanelli AM, Dell'Aquila ME, Zollner U, Hofmann T, Zollner KP, Kovacic B, Roglic P, Vlaisavljevic V, Sole M, Santalo J, Boada M, Coroleu B, Veiga A, Martiny G, Molinari M, Revelli A, Chimote NM, Chimote M, Mehta B, Chimote NN, Sheikh N, Nath N, Mukherjee A, Rakic K, Reljic M, Kovacic B, Vlaisavljevic V, Ingerslev HJ, Kirkegaard K, Hindkjaer J, Grondahl ML, Kesmodel US, Agerholm I, Kitasaka H, Fukunaga N, Nagai R, Yoshimura T, Tamura F, Kitamura K, Hasegawa N, Nakayama K, Katou M, Itoi F, Asano E, Deguchi N, Ooyama K, Hashiba Y, Asada Y, Michaeli M, Rotfarb N, Karchovsky E, Ruzov O, Atamny R, Slush K, Fainaru O, Ellenbogen A, Chekuri S, Chaisrisawatsuk T, Chen P, Pangestu M, Jansen S, Catt S, Molinari E, Racca C, Revelli A, Ryu C, Kang S, Lee J, Chung D, Roh S, Chi H, Yokota Y, Yokota M, Yokota H, Sato S, Nakagawa M, Komatsubara M, Makita M, Araki Y, Yoshimura T, Asada Y, Fukunaga N, Nagai R, Kitasaka H, Itoi F, Tamura F, Kitamura K, Hasegawa N, Katou M, Nakayama K, Asano E, Deguchi N, Oyama K, Hashiba Y, Naruse K, Kilani S, Chapman MG, Kwik M, Chapman M, Guven S, Odaci E, Yildirim O, Kart C, Unsal MA, Yulug E, Isachenko E, Maettner R, Strehler E, Isachenko V, Hancke K, Kreienberg R, Sterzik K, Coticchio G, Guglielmo MC, Dal Canto M, Albertini DF, Brambillasca F, Mignini Renzini M, Fadini R, Zheng XY, Wang LN, Liu P, Qiao J, Inoue F, Dashtizad M, Wahid H, Rosnina Y, Daliri M, Hajarian H, Akbarpour M, Abbas Mazni O, Knez K, Tomaevic T, Vrtacnik Bokal E, Zorn B, Virant Klun I, Koster M, Liebenthron J, Nicolov A, van der Ven K, van der Ven H, Montag M, Fayazi M, Salehnia M, Beigi Boroujeni M, Khansarinejad B, Deignan K, Emerson G, Mocanu E, Wang JJ, Andonov M, Linara E, Ahuja KK, Nachef S, Figueira RCS, Braga DPAF, Setti AS, Iaconelli Jr. A, Pasqualotto FF, Borges Jr. E, Pasqualotto E, Borges Jr. E, Pasqualotto FF, Chang CC, Bernal DP, Elliott TA, Shapiro DB, Toledo AA, Nagy ZP, Economou K, Davies S, Argyrou M, Doriza S, Sisi P, Moschopoulou M, Karagianni A, Mendorou C, Polidoropoulos N, Papanicopoulos C, Stefanis P, Karamalegos C, Cazlaris H, Koutsilieris M, Mastrominas M, Gotts S, Doshi A, Harper J, Serhal P, Borini A, Guzeloglu-Kayisli O, Bianchi V, Seli E, Bianchi V, Lappi M, Bonu MA, Borini A, Mizuta S, Hashimoto H, Kuroda Y, Matsumoto Y, Mizusawa Y, Ogata S, Yamada S, Kokeguchi S, Noda Y, Shiotani M, Stojkovic M, Ilic M, Markovic N, Stojkovic P, Feng G, Zhang B, Zhou H, Zhou L, Gan X, Qin X, Shu J, Wu F, Molina Botella I, Lazaro Ibanez E, Debon Aucejo A, Pertusa J, Fernandez Colom PJ, Pellicer A, Li C, Zhang Y, Cui Y, Zhao H, Liu J, Oliveira JBA, Petersen CG, Mauri AL, Massaro FC, Silva LFI, Ricci J, Cavagna M, Pontes A, Vagnini LD, Baruffi RLR, Franco Jr. JG, Massaro FC, Petersen CG, Vagnini LD, Mauri AL, Silva LFI, Felipe V, Cavagna M, Pontes A, Baruffi RLR, Oliveira JBA, Franco Jr. JG, Vilela M, Tiveron M, Lombardi C, Viglierchio MI, Marconi G, Rawe V, Wale PL, Gardner DK, Nakagawa K, Sugiyama R, Nishi Y, Kuribayashi Y, Jyuen H, Yamashiro E, Shirai A, Sugiyama R, Inoue M, Salehnia M, Hovatta O, Tohonen V, Inzunza J, Parmegiani L, Cognigni GE, Bernardi S, Ciampaglia W, Infante FE, Tabarelli de Fatis C, Pocognoli P, Arnone A, Maccarini AM, Troilo E, Filicori M, Radwan P, Polac I, Borowiecka M, Bijak M, Radwan M. POSTER VIEWING SESSION - EMBRYOLOGY. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Glisenti P, Allemann F, Kunz-Caflisch I. [Acute abdominal pain]. Praxis (Bern 1994) 2010; 99:949-959. [PMID: 20700869 DOI: 10.1024/1661-8157/a000222] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- P Glisenti
- Klinik und Poliklinik für Innere Medizin, Universitätsspital Zürich, Zürich.
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Yates KE, Allemann F, Glowacki J. Phenotypic analysis of bovine chondrocytes cultured in 3D collagen sponges: effect of serum substitutes. Cell Tissue Bank 2005; 6:45-54. [PMID: 15735900 PMCID: PMC1242111 DOI: 10.1007/s10561-005-5810-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2004] [Accepted: 10/28/2004] [Indexed: 11/26/2022]
Abstract
Repair of damaged cartilage usually requires replacement tissue or substitute material. Tissue engineering is a promising means to produce replacement cartilage from autologous or allogeneic cell sources. Scaffolds provide a three-dimensional (3D) structure that is essential for chondrocyte function and synthesis of cartilage-specific matrix proteins (collagen type II, aggrecan) and sulfated proteoglycans. In this study, we assessed porous, 3D collagen sponges for in vitro engineering of cartilage in both standard and serum-free culture conditions. Bovine articular chondrocytes (bACs) cultured in 3D sponges accumulated and maintained cartilage matrix over 4 weeks, as assessed by quantitative measures of matrix content, synthesis, and gene expression. Chondrogenesis by bACs cultured with Nutridoma as a serum replacement was equivalent or better than control cultures in serum. In contrast, chondrogenesis in insulin-transferrin-selenium (ITS(+3)) serum replacement cultures was poor, apparently due to decreased cell survival. These data indicate that porous 3D collagen sponges maintain chondrocyte viability, shape, and synthetic activity by providing an environment favorable for high-density chondrogenesis. With quantitative assays for cartilage-specific gene expression and biochemical measures of chondrogenesis in these studies, we conclude that the collagen sponges have potential as a scaffold for cartilage tissue engineering.
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Affiliation(s)
- Karen E. Yates
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
- Skeletal Biology Research Center, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston MA, USA
| | - Florin Allemann
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
- Skeletal Biology Research Center, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston MA, USA
| | - Julie Glowacki
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
- Skeletal Biology Research Center, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston MA, USA
- *Author for correspondence (e-mail:
; phone: +1-617-732-5397; fax:+1-617-732-6937)
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Zaleske D, Peretti G, Allemann F, Strongin D, MacLean R, Yates KE, Glowacki J. Engineering a Joint: A Chimeric Construct with Bovine Chondrocytes in a Devitalized Chick Knee. ACTA ACUST UNITED AC 2003; 9:949-56. [PMID: 14633379 DOI: 10.1089/107632703322495592] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study assessed the feasibility of a devitalized knee as a scaffold for an engineered chimeric joint. Embryonic chick knees (19 days old), devitalized by lyophilization or multiple freeze-thaw cycles, were tested as scaffolds for repopulation with bovine articular chondrocytes (bACs). bACs were seeded into porous three-dimensional collagen sponges and were cultured for 1 day before fabrication of chimeric constructs. A pair of cell-seeded sponges was inserted into the joint space to contact preshaved articular surfaces. In some constructs, a sterile membrane of expanded polytetrafluoroethylene (ePTFE) was inserted between the collagen sponges. Histologic analysis showed that at 1 week, sponges with bACs were adherent to the shaved articular surfaces of the joint with accumulation of metachromatic extracellular matrix. Penetration of bACs and neomatrix into the devitalized matrix appeared to begin in preexistent epiphyseal canals and was observed to some extent in all specimens. Membranes of ePTFE maintained a joint space at 2 and 3 weeks, whereas there was fusion across the two sponges in many specimens lacking the membrane. Gene expression analysis demonstrated that lyophilization, but not multiple freeze-thaw cycles, completely devitalized the chick knees. These studies identified several design parameters crucial for successful engineering of a chimeric joint.
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Affiliation(s)
- D Zaleske
- Skeletal Biology Research Center, Massachusetts General Hospital, and Department of Orthopedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Affiliation(s)
- J Glowacki
- MGH Skeletal Biology Research Center, Massachusetts General Hospital, Boston, MA 02115, USA.
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Allemann F, Mizuno S, Eid K, Yates KE, Zaleske D, Glowacki J. Effects of hyaluronan on engineered articular cartilage extracellular matrix gene expression in 3-dimensional collagen scaffolds. J Biomed Mater Res 2001; 55:13-9. [PMID: 11426390 DOI: 10.1002/1097-4636(200104)55:1<13::aid-jbm20>3.0.co;2-g] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Hyaluronan (HA) is a component of cartilage matrix with known effects on chondrocytes. We tested the effects of adding HA to 3-dimensional (3-D) collagen. sponges on chondrocyte function in vitro. Bovine articular chondrocytes isolated by collagenase digestion were injected into either collagen or HA/collagen scaffolds comprising different amounts of HA (2, 5, 10, and 14% w/w). Expression of aggrecan and type II collagen genes was measured by gene-specific quantitative competitive reverse transcriptase-polymerase chain reactions, and the extracellular matrix was estimated by histomorphometrical analyses. After 7-day culture, the chondrocytes in 2% (w/w) HA sponges expressed fourfold more mRNA transcripts for type II collagen (p = 0.002) and twofold more mRNA transcripts for aggrecan (p = 0.022) than in control collagen sponges. Furthermore, there was 45% more extracellular matrix in 2% (w/w) HA sponges and 43% less matrix in the 10% (w/w) HA sponges compared with plain collagen sponges (p > 0.05). In sum, a small amount of HA in 3-D collagen scaffolds enhanced chondrogenesis, but a greater amount was inhibitory. This 3-D system represents a novel tool to identify mechanisms by which extracellular matrix molecules influence chondrocyte function. Further, these results show the potential for modifying scaffolds to improve production of engineered cartilage for in vivo applications.
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Affiliation(s)
- F Allemann
- Department of Orthopedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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Abstract
Various culture systems have been used for examining the anabolic and catabolic functions of isolated chondrocytes as well as for tissue engineering purposes. Perfusion or frequent medium change is beneficial for three-dimensional (3D) cultures of many cell types. In this study, bovine articular chondrocytes (bACs) were grown in 3D collagen sponges with or without medium perfusion (0.33 mL/min) for up to 15 days. The influence of medium perfusion was evaluated using markers of cartilage matrix accumulation, synthesis, and gene expression. Metachromatic matrix, collagen type II, and hyaluronan accumulated around the cells within the collagen sponges. Sulfated glycosaminoglycans (S-GAGs) that accumulated in the sponge exposed to nonperfused control were 130% of that in the perfused sponge at day 7. S-GAG accumulation after 15 days in the nonperfused control was 230% more than at day 7 (p < 0.01). (35)S-sulfate incorporation during the final 18 h of culture in the sponge exposed to nonperfusion was 180% greater than that in the perfused sponge (p < 0.01). Quantitative analyses show that at day 7, aggrecan and collagen type II gene expression were 350% and 240% greater, respectively, in the nonperfused culture than in the perfused one. These results indicate that perfused conditions that are beneficial for other cell types inhibit chondrogenesis by articular chondrocytes in 3D culture.
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Affiliation(s)
- S Mizuno
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Allemann F, Cassina P, Röthlin M, Largiadèr F. Ultrasound scans done by surgeons for patients with acute abdominal pain: a prospective study. Eur J Surg 1999; 165:966-70. [PMID: 10574106 DOI: 10.1080/110241599750008099] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To evaluate the routine use of abdominal ultrasonography (US) in patients admitted to the surgical emergency unit with acute abdominal pain. DESIGN Prospective study with a three-step evaluation of patients over a 12-month period. SETTING University hospital, Switzerland. SUBJECTS 496 patients (male/female = 234/262; mean age 45 years) who presented with acute abdominal pain. INTERVENTIONS Every patient underwent routine investigations and had an abdominal US by the attending surgeon. MAIN OUTCOME MEASURES Clinical diagnosis, post-ultrasonography diagnosis and final diagnosis. RESULTS US improved the correct diagnostic rate from 348 (70%) to 414 (83%). The diagnostic accuracy for acute appendicitis and biliary tract disease improved after US from 455 (92%) to 488 (98%) and from 463 (93%) to 490 (99%), respectively; the corresponding sensitivities and specificities were 91% and 99% and 94% and 99%. CONCLUSIONS Ultrasonography should be part of routine surgical investigation and should be mastered and used by surgeons.
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Affiliation(s)
- F Allemann
- Department of Surgery, University Hospital, Zurich, Switzerland
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Steinert HC, Hauser M, Allemann F, Engel H, Berthold T, von Schulthess GK, Weder W. Non-small cell lung cancer: nodal staging with FDG PET versus CT with correlative lymph node mapping and sampling. Radiology 1997; 202:441-6. [PMID: 9015071 DOI: 10.1148/radiology.202.2.9015071] [Citation(s) in RCA: 269] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To prospectively compare the accuracy of positron emission tomography (PET) with 2-[fluorine-18] fluoro-2-deoxy-D-glucose (FDG) with that of computed tomography (CT) in the nodal staging of non-small cell lung cancer. MATERIALS AND METHODS PET and contrast material-enhanced CT were performed in 47 patients suspected of having or with newly diagnosed non-small cell lung cancer. Each imaging study was evaluated separately, and nodal stations were localized according to the American Thoracic Society mapping system. Extensive lymph node sampling (599 nodes from 191 nodal stations) of the ipsi- and contralateral tracheobronchial and mediastinal nodal stations was performed at thoracotomy and/or mediastinoscopy. Imaging findings were correlated with histopathologic staging results. RESULTS The sensitivity of PET and CT was 89% and 57%, respectively, for the staging of N2 or N3 disease in mediastinal nodes; specificity was 99% and 94%, respectively; positive predictive value was 96% and 76%, respectively; negative predictive value was 97% and 87%, respectively; and accuracy was 96% and 85%, respectively. In assigning the correct N stage, PET was correct in 96% and CT in 79% of cases. CONCLUSION PET with FDG appears to be superior to CT for nodal staging of non-small cell lung cancer.
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Affiliation(s)
- H C Steinert
- Department of Medical Radiology, University Hospital, Zürich, Switzerland
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van Kooij R, Allemann F, Herbst S, Eppenberger U. [Biological aspects in extracorporeal fertilization]. Schweiz Rundsch Med Prax 1983; 72:813-5. [PMID: 6878164] [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: 01/22/2023]
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Allemann F, Herbst S, van Kooij R, Käser O. [In vitro fertilization and embryo transfer. 1st results at the Basel University Obstetrics and Gynecology department]. Schweiz Rundsch Med Prax 1983; 72:816-9. [PMID: 6192427] [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: 01/18/2023]
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Herbst S, Allemann F, van Kooij R. [Pregnancy following microsurgical operation, aspiration of oocytes, in vitro fertilization and embryo transfer]. Schweiz Rundsch Med Prax 1983; 72:561-2. [PMID: 6866937] [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: 01/22/2023]
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34
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Allemann F, Ramzin MS. [The clinical significance of post-term pregnancy after prospective determination of delivery date (author's transl)]. Z Geburtshilfe Perinatol 1981; 185:262-7. [PMID: 7198336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
From 1978 to 1980, 3300 patients had their delivery terms prospectively determined by ultrasonic measuring the first half of pregnancy. - 18.4% had a pregnancy of 281-293 days. Post-terms were found in 1.5%. - Care during pregnancy followed a standardised scheme, beginning on the 281st day. Statistical evaluation of all delivery terms shows an asymmetrical Gaussian distribution. In pregnancies up to 293 days abnormal CTG was found in 7.7%, a prepathological, resp. pathological oxytocin sensitivity test observed in 1.5%. With frequent parallel CTG-checks, amnioscopy is of lesser clinical relevance. Deliveries by forceps or vacuum extraction as well as caesarian sections were not more frequent than in a 280-days-term population. No higher perinatal mortality was observed. - In post-terms meconium was found sub partu in 31.4%. The rate of caesarian sections in post-terms shows an increase to 19.6%, but only to 10.5% in prolonged terms. 1 min. post partum the newborns show a slightly accentuated clinical depression (Apgar 4-6) compared with the control group. However, 5 min. post partum Apgar figures as well as umbilical arterial ph indicate no significant difference. No occurrence of perinatal mortality was registered. With appropriate control (resp. CTG) and management of delivery, higher risks are not to be anticipated for mothers and newborns.
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Allemann F, Jenny P. [Idiopathic varicocele with special reference to childhood and adolescence]. Z Kinderchir Grenzgeb 1980; 29:336-42. [PMID: 7415541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In the past 20 years, we have treated 28 patients with idiopathic varicocele. The cases are described and the literature is reviewed in relation to clinical presentation and treatment. Since there is a correlation between varicocele and sub-fertility early surgical treatment is advocated for children and adolescents. The surgical approach described by Ivanissevich with an inguinal approach and high ligation of the testicularis vein is preferred and this allows access for associated conditions which we found in one third of our patients.
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Müller J, Roth B, Allemann F, Terbrüggen D. [Primary surgical stabilization of open shaft fractures]. Helv Chir Acta 1976; 43:461-4. [PMID: 1002498] [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: 12/25/2022]
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Roth B, Müller J, Allemann F. [The open tibial-head fracture, its osteosynthesis and late results]. Hefte Unfallheilkd 1975:262-3. [PMID: 1234178] [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: 12/26/2022]
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