1
|
Gille J, Reiss E, Behrens P, Jakob RP, Piontek T. Positive outcomes following Autologous Matrix-Induced Chondrogenesis (AMIC) in the treatment of retropatellar chondral lesions: a retrospective analysis of a patient registry. BMC Musculoskelet Disord 2023; 24:964. [PMID: 38082264 PMCID: PMC10712071 DOI: 10.1186/s12891-023-06923-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/25/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The patellofemoral joint is a challenging environment for treating chondral defects. Among the surgical options for the treatment of chondral defects, the single-stage Autologous Matrix-Induced Chondrogenesis (AMIC) procedure uses a porcine collagen I/III membrane to enhance bone-marrow stimulation. However, longer term outcomes data are rare for this specific indication. In order to provide real-world information, an ongoing registry has been established to record patient data and outcomes when AMIC is used to treat chondral and osteochondral lesions. METHODS Patient data were retrieved from an ongoing, prospective, multisite registry of patients who had undergone AMIC treatment of chondral defects. We identified 64 patients who had undergone AMIC for patellofemoral chondral defects and for whom pre-operative and at least 1 post-operative score were available were included in this retrospective data analysis. Outcomes were assessed via the KOOS, VAS pain, and the Lysholm scores. Outcomes at the post-operative time-points were analysed using a factorial ANOVA with post-hoc testing while linear regression was used to assess associations between the change in the Lysholm score and lesion size. RESULTS There was a significant improvement in Lysholm, VAS pain, and KOOS scores from pre-operative to the 1st year post-operative (p < 0.001), and this was maintained during the follow-up. CONCLUSIONS The forces exerted on the patellofemoral joint make this a challenging scenario for chondral repair. Our data demonstrates that the AMIC procedure with a collagen I/III membrane is an effective treatment for retropatellar cartilage lesions, and provides reliable results, with decreased pain and improved function. Importantly, these improvements were maintained through the follow-up period.
Collapse
Affiliation(s)
- J Gille
- Universitätsklinikum Schleswig-Holstein - Campus Lübeck, Lübeck, Germany.
| | - E Reiss
- OrthoPraxis, Zofingen, Switzerland
| | - P Behrens
- ORTHODOK, Tonndorfer Hauptstraße 71, 22045, Hamburg, Germany
| | - R P Jakob
- Orthopaedic Department Kantonsspital Fribourg, University of Berne, Bern, Switzerland
| | - T Piontek
- Department of Spine Disorders and Pediatric Orthopedics, University of Medical Sciences, Poznan, Poland
| |
Collapse
|
2
|
Vogelmann T, Roessler PP, Buhs M, Ostermeier S, Gille J, Hoburg A, Zöllner Y, Schwarz S, Schubert T, Grebe M, Zinser W. Long-term cost-effectiveness of matrix-associated chondrocyte implantation in the German health care system: a discrete event simulation. Arch Orthop Trauma Surg 2023; 143:1417-1427. [PMID: 35064292 PMCID: PMC9957880 DOI: 10.1007/s00402-021-04318-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cartilage defects in the knee can be caused by injury, various types of arthritis, or degeneration. As a long-term consequence of cartilage defects, osteoarthritis can develop over time, often leading to the need for a total knee replacement (TKR). The treatment alternatives of chondral defects include, among others, microfracture, and matrix-associated autologous chondrocyte implantation (M-ACI). The purpose of this study was to determine cost-effectiveness of M-ACI in Germany with available mid- and long-term outcome data, with special focus on the avoidance of TKR. MATERIALS AND METHODS We developed a discrete-event simulation (DES) that follows up individuals with cartilage defects of the knee over their lifetimes. The DES was conducted with a status-quo scenario in which M-ACI is available and a comparison scenario with no M-ACI available. The model included 10,000 patients with articular cartilage defects. We assumed Weibull distributions for short- and long-term effects for implant failures. Model outcomes were costs, number of TKRs, and quality-adjusted life years (QALYs). All analyses were performed from the perspective of the German statutory health insurance. RESULTS The majority of patients was under 45 years old, with defect sizes between 2 and 7 cm2 (mean: 4.5 cm2); average modeled lifetime was 48 years. In the scenario without M-ACI, 26.4% of patients required a TKR over their lifetime. In the M-ACI scenario, this was the case in only 5.5% of cases. Thus, in the modeled cohort of 10,000 patients, 2700 TKRs, including revisions, could be avoided. Patients treated with M-ACI experienced improved quality of life (22.53 vs. 21.21 QALYs) at higher treatment-related costs (18,589 vs. 14,134 € /patient) compared to those treated without M-ACI, yielding an incremental cost-effectiveness ratio (ICER) of 3376 € /QALY. CONCLUSION M-ACI is projected to be a highly cost-effective treatment for chondral defects of the knee in the German healthcare setting.
Collapse
Affiliation(s)
| | | | | | | | - Justus Gille
- University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | | | - York Zöllner
- Hamburg University of Applied Sciences, Hamburg, Germany
| | | | - Tino Schubert
- LinkCare GmbH, Kyffhäuserstr. 64, 70469 Stuttgart, Germany
| | | | - Wolfgang Zinser
- OrthoExpert Fohnsdorf, Austria and GFO-Kliniken Niederrhein, Dinslaken, Germany
| |
Collapse
|
3
|
Gille J, Körner V, Oheim R, Paech A, Mittelstädt H, Schulz AP, Schagemann J. Dynamic Postural Stability after Cartilage Repair in the Knee. Open Orthop J 2022. [DOI: 10.2174/18743250-v16-e2206300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Background:
Articular cartilage has an exceptionally poor capacity for healing, but Autologous Matrix Induced Chondrogenesis is a procedure with a substantial body of literature that demonstrates its performance in chondral and osteochondral repair. However, data concerning dynamic postural stability after cartilage repair procedures is lacking.
Objective:
Therefore, the present study was designed to assess postural stability following cartilage repair in the knee.
Methods:
20 adults had undergone Autologous Matrix Induced Chondrogenesis for the treatment of full-thickness cartilage defects, with minimum 36 months of follow-up. Clinical outcomes were evaluated by patient reported outcome measures while dynamic postural stability was assessed using the star excursion balance test. The untreated, contralateral limbs served as controls.
Results:
At a mean follow-up of 43 months, patients reported a Visual Analog Score for pain of 1.6±2.2, a mean Lysholm score of 78.5±17.9 and a mean Knee Osteoarthritis Outcome Score of 143.3±16.1. The star excursion balance test showed no significant difference between limbs.
Conclusion:
With no difference in dynamic postural stability, our results indicate that this treatment provides a positive clinical outcome, with no deficits in postural stability when compared to the contralateral, untreated leg.
Collapse
|
4
|
Schagemann JC, Galle L, Gille J, Frydrychowicz A, Welsch G, Salzmann G, Paech A, Mittelstaedt H. Correlation of the Histological ICRS II Score and the 3D MOCART Score for the Analysis of Aged Osteochondral Regenerates in a Large Animal Model. Cartilage 2022; 13:19476035211072254. [PMID: 35176894 PMCID: PMC9137325 DOI: 10.1177/19476035211072254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Reliable outcome measures are essential to predict the success of cartilage repair techniques. Histology is probably the gold standard, but magnetic resonance imaging (MRI) has the potential to decrease the need for invasive histological biopsies. The 3D magnetic resonance observation of cartilage repair tissue (MOCART) score is a reliable yet elaborate tool. Moreover, literature is controversial concerning the correlation of histology and MRI. DESIGN To test the applicability of the International Cartilage Regeneration and Joint Preservation Society (ICRS) II and MOCART 3D score for the evaluation of aged osteochondral regenerates in a large animal model, and to identify correlating histological and MRI parameters. Osteochondral defects in medial femoral condyles of n = 12 adult sheep were reconstructed with biodegradable bilayer implants. About 19.5 months postoperation, n = 10 joints were analyzed with MRI (3D MOCART score). Histological samples were analyzed using the ICRS II score; both pre- and post-training. The intraclass correlation coefficient, the inter-rater reliability, and the 95% confidence interval were calculated. Matching histological and MRI parameters were tested for correlation. RESULTS We found a statistically significant correlation of all histological parameters. MRI parameters reflecting "overall" assessments had very strong inter-rater correlations. Statistically significant strong correlations were found for the MRI parameters defect filling, cartilage interface, bone interface, and surface. For defect overall (MRI) and overall assessment (ICRS II), we found a significant yet mild correlation. CONCLUSIONS The ICRS II and the 3D MOCART score are applicable to aged osteochondral regenerates. Prior training on the scoring systems is essential. Select MRI and histological parameters correlate; however, the only statistically significant correlation was found for overall assessment.
Collapse
Affiliation(s)
- J C Schagemann
- Medicine Section, University of Lübeck, Lübeck, Germany.,Christophorus-Kliniken, Coesfeld, Germany
| | - L Galle
- Medicine Section, University of Lübeck, Lübeck, Germany
| | - J Gille
- Medicine Section, University of Lübeck, Lübeck, Germany
| | - A Frydrychowicz
- Department of Radiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - G Welsch
- UKE Athleticum-Center for Athletic Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Salzmann
- Gelenkzentrum Rhein-Main, Frankfurt, Germany
| | - A Paech
- Department for Orthopaedic and Trauma Surgery, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - H Mittelstaedt
- Department for Orthopaedic and Trauma Surgery, University Medical Center Schleswig-Holstein, Lübeck, Germany
| |
Collapse
|
5
|
Steinwachs MR, Gille J, Volz M, Anders S, Jakob R, De Girolamo L, Volpi P, Schiavone-Panni A, Scheffler S, Reiss E, Wittmann U. Systematic Review and Meta-Analysis of the Clinical Evidence on the Use of Autologous Matrix-Induced Chondrogenesis in the Knee. Cartilage 2021; 13:42S-56S. [PMID: 31508990 PMCID: PMC8808829 DOI: 10.1177/1947603519870846] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE A systematic review and meta-analysis of Autologous Matrix-Induced Chondrogenesis (AMIC®) outcomes for grade III/IV chondral and osteochondral lesions of the knee treated with Chondro-Gide®. DESIGN Studies with a minimum follow-up of 1 year providing clinical results of AMIC repair in the knee were included based on PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Methodological quality was assessed by the modified Coleman Methodology Score (mCMS). The meta-analysis was comparing pain VAS (Visual Analog Scale), Lysholm score, and IKDC score (International Knee Documentation Committee) between baseline and follow-up after 1 or 2 years and after >3 years. RESULTS Twelve studies (375 patients) were included. The mCMS demonstrated a suboptimal study design (ranking between 52 and 80). The mean age was 36.2 years (14-70 years). The mean defect size was 4.24 cm2 (0.8-22 cm2). The results from the random effects model indicated a clinically significant (P < 0.05) improvement of pain VAS from baseline to follow-up at year 1 to 2 of -4.02(confidence interval -4.37; -3.67), still significant after 3 years. Lysholm score at year 1 or 2 improved significantly and remained highly significant after 3 years. IKDC score showed highly significant improvement of 32.61 between 1 and 2 years versus baseline values maintained after 3 years. CONCLUSIONS The AMIC procedure significantly improved the clinical status and functional scoring versus preoperative values. Evidence was obtained in a non-selected patient population, corresponding to real-life treatment of knee chondral and osteochondral defects. The evidence is sufficient to recommend AMIC in this indication.
Collapse
Affiliation(s)
- Matthias R. Steinwachs
- SportClinic Zurich Hirslanden Clinic,
Zurich, Switzerland,M.R. Steinwachs, MD, SportClinic Zurich
Hirslanden Clinic, Witellikerstrasse, 40, Zurich, 8032, Switzerland.
| | - Justus Gille
- University of Schleswig-Holstein, Campus
Luebeck, Luebeck, Germany
| | | | | | | | | | | | | | | | | | - Udo Wittmann
- Consult AG Statistical Services,
Zurich, Switzerland
| |
Collapse
|
6
|
Filardo G, Andriolo L, Angele P, Berruto M, Brittberg M, Condello V, Chubinskaya S, de Girolamo L, Di Martino A, Di Matteo B, Gille J, Gobbi A, Lattermann C, Nakamura N, Nehrer S, Peretti GM, Shabshin N, Verdonk P, Zaslav K, Kon E. Scaffolds for Knee Chondral and Osteochondral Defects: Indications for Different Clinical Scenarios. A Consensus Statement. Cartilage 2021; 13:1036S-1046S. [PMID: 31941355 PMCID: PMC8808892 DOI: 10.1177/1947603519894729] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To develop patient-focused consensus guidelines on the indications for the use of scaffolds to address chondral and osteochondral femoral condyle lesions. DESIGN The RAND/UCLA Appropriateness Method (RAM) was used to develop patient-specific recommendations by combining the best available scientific evidence with the collective judgement of a panel of experts guided by a core panel and multidisciplinary discussers. A list of specific clinical scenarios was produced regarding adult patients with symptomatic lesions without instability, malalignment, or meniscal deficiency. Each scenario underwent discussion and a 2-round vote on a 9-point Likert-type scale (range 1-3 "inappropriate," 4-6 "uncertain," 7-9 "appropriate"). Scores were pooled to generate expert recommendations. RESULTS Scaffold (chondral vs. osteochondral), patient characteristics (age and sport activity level), and lesion characteristics (etiology, size, and the presence of osteoarthritis [OA]) were considered to define 144 scenarios. The use of scaffold-based procedures was considered appropriate in all cases of chondral or osteochondral lesions when joints are not affected by OA, while OA joints presented more controversial results. The analysis of the evaluated factors showed a different weight in influencing treatment appropriateness: the presence of OA influenced 58.3% of the indications, while etiology, size, and age were discriminating factors in 54.2%, 29.2%, and 16.7% of recommendations, respectively. CONCLUSIONS The consensus identified indications still requiring investigation, but also the convergence of the experts in several scenarios defined appropriate or inappropriate, which could support decision making in the daily clinical practice, guiding the use of scaffold-based procedures for the treatment of chondral and osteochondral knee defects.
Collapse
Affiliation(s)
- Giuseppe Filardo
- Applied and Translational Research (ATR)
Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Andriolo
- Clinica Ortopedica e Traumatologica 2,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy,Luca Andriolo, Clinica Ortopedica e
Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano, 1/10,
Bologna 40136, Italy.
| | - Peter Angele
- Clinic for Trauma and Reconstructive
Surgery, University Hospital Regensburg, Regensburg, Bayern, Germany,Sporthopaedicum Regensburg, Regensburg,
Germany
| | - Massimo Berruto
- UOS Knee SURGERY-1st University Clinic
of Orthopaedics, ASST Pini-CTO, Milan, Italy
| | - Mats Brittberg
- Cartilage Research Unit, University of
Gothenburg, Gothenburg, Sweden,Region Halland Orthopaedics, Kungsbacka
Hospital, Kungsbacka, Sweden
| | - Vincenzo Condello
- Joint Preservation and Reconstructive
Surgery and Sports Medicine Unit, Humanitas Castelli Clinic, Bergamo, Lombardy,
Italy
| | - Susan Chubinskaya
- Department of Pediatrics, Orthopedic
Surgery & Medicine (Section of Rheumatology), Rush University Medical Center,
Chicago, IL, USA
| | - Laura de Girolamo
- Orthopaedic Biotechnology Laboratory,
IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Alessandro Di Martino
- Clinica Ortopedica e Traumatologica 2,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Berardo Di Matteo
- Department of Biomedical Sciences,
Humanitas University, Rozzano, Milan, Italy,Humanitas Clinical and Research
Center- IRCCS, Via Manzoni 56, 20089, Rozzano - Milan, Italy
| | - Justus Gille
- Department of Trauma and Orthopaedic
Surgery, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck,
Germany
| | - Alberto Gobbi
- Orthopaedic Arthroscopic Surgery
International (OASI) Bioresearch Foundation, Milan, Italy
| | - Christian Lattermann
- Department of Orthopaedic Surgery,
Division of Sports Medicine, Center for Cartilage Repair, Brigham and Women’s
Hospital, Harvard Medical School, Boston, MA, USA
| | - Norimasa Nakamura
- Institute for Medical Science in
Sports, Osaka Health Science University, Osaka, Japan
| | - Stefan Nehrer
- Center for Regenerative Medicine,
Danube University, Krems an der Donau, Austria
| | - Giuseppe M. Peretti
- IRCCS Istituto Ortopedico Galeazzi,
Milan, Italy,Department of Biomedical Sciences for
Health, University of Milan, Milan, Italy
| | - Nogah Shabshin
- Department of Radiology, Emek Medical
Center, Clalit Healthcare Services, Afula, Israel,Department of Radiology, PennMedicine,
Philadelphia, PA, USA
| | - Peter Verdonk
- ORTHOCA, AZ Monica Hospitals, Antwerp,
Belgium,Aspetar Hospital, Doha, Qatar
| | - Kenneth Zaslav
- Ortho Virginia, Virginia Commonwealth
University, Richmond, VA, USA
| | - Elizaveta Kon
- Department of Biomedical Sciences,
Humanitas University, Rozzano, Milan, Italy,Humanitas Clinical and Research
Center- IRCCS, Via Manzoni 56, 20089, Rozzano - Milan, Italy,Department of Traumatology,
Orthopedics and Disaster Surgery, First Moscow State Medical University of the
Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian
Federation
| |
Collapse
|
7
|
Schagemann J, Koebrich T, Wendlandt R, Schulz AP, Gille J, Oheim R. Comparison of hamstring and quadriceps tendon autografts in anterior cruciate ligament reconstruction with gait analysis and surface electromyography. J Orthop Traumatol 2021; 22:20. [PMID: 34021423 PMCID: PMC8140171 DOI: 10.1186/s10195-021-00581-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/27/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tear is the most frequent ligamentous injury of the knee joint. Autografts of hamstring (HS) or quadriceps tendons (QT) are used for primary ACL reconstruction. In this study, we planned to examine whether harvesting an HS graft is related to a deficit in dynamic knee stabilisation and strength revealed by dynamic valgus as compared with QT graft or the uninjured leg. Furthermore, if this deficit exists, is it compensated by higher neuromuscular activity of the quadriceps muscle? MATERIALS AND METHODS Adult patients who had undergone ACL reconstruction with QT or HS autografts were included in this two-armed cohort study. Clinical outcome was assessed by clinical data analysis, physical examination and the Lysholm Score and Knee Injury and Osteoarthritis Score (KOOS). In addition, gait analysis and non-invasive surface electromyography were performed. RESULTS A complete data set of 25 patients (QT: N = 8, HS: N = 17) was analysed. There was no significant demographic difference between the groups. Time between surgery and follow-up was significantly longer for the QT group. Significant differences regarding clinical outcome were not found between the treated and untreated leg or between the two groups, with excellent scores at the time of follow-up. Gait analysis revealed no significant differences of varus-valgus angles. Significant differences in surface electromyography were only found in the QT group with increased vastus medialis obliquus activity of the treated legs (p < 0.01). CONCLUSIONS Our results suggest that harvesting of HS grafts for primary ACL reconstruction will not lead to a medial collapse and consequently impaired medial stabilisation of the knee when compared with QT grafts. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- J Schagemann
- Clinic for Orthopedics and Trauma Surgery, University Medical Center Schleswig Holstein UKSH Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
| | - T Koebrich
- Clinic for Orthopedics and Trauma Surgery, University Medical Center Schleswig Holstein UKSH Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - R Wendlandt
- Clinic for Orthopedics and Trauma Surgery, Laboratory for Biomechanics, University Medical Center Schleswig Holstein UKSH Campus Luebeck, Ratzeburger Allee, 160, 23538, Luebeck, Germany
| | - A P Schulz
- Clinic for Orthopedics and Trauma Surgery, University Medical Center Schleswig Holstein UKSH Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.,Clinic for Orthopedics and Trauma Surgery, Laboratory for Biomechanics, University Medical Center Schleswig Holstein UKSH Campus Luebeck, Ratzeburger Allee, 160, 23538, Luebeck, Germany.,BG Klinikum Hamburg, Bergedorfer Straße 10, 21033, Hamburg, Germany
| | - J Gille
- Clinic for Orthopedics and Trauma Surgery, University Medical Center Schleswig Holstein UKSH Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.,BG Klinikum Hamburg, Bergedorfer Straße 10, 21033, Hamburg, Germany
| | - R Oheim
- Clinic for Orthopedics and Trauma Surgery, University Medical Center Schleswig Holstein UKSH Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.,BG Klinikum Hamburg, Bergedorfer Straße 10, 21033, Hamburg, Germany
| |
Collapse
|
8
|
Gille J, Reiss E, Freitag M, Schagemann J, Steinwachs M, Piontek T, Reiss E. Autologous Matrix-Induced Chondrogenesis for Treatment of Focal Cartilage Defects in the Knee: A Follow-up Study. Orthop J Sports Med 2021; 9:2325967120981872. [PMID: 33738308 PMCID: PMC7934047 DOI: 10.1177/2325967120981872] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/17/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Autologous matrix-induced chondrogenesis (AMIC) is a well-established treatment for full-thickness cartilage defects. Purpose: To evaluate the long-term clinical outcomes of AMIC for the treatment of chondral lesions of the knee. Study Design: Case series; Level of evidence, 4. Methods: A multisite prospective registry recorded demographic data and outcomes for patients who underwent repair of chondral defects. In total, 131 patients were included in the study. Lysholm, Knee injury and Osteoarthritis Outcome Score (KOOS), and visual analog scale (VAS) score for pain were used for outcome analysis. Across all patients, the mean ± SD age of patients was 36.6 ± 11.7 years. The mean body weight was 80.0 ± 16.8 kg, mean height was 176.3 ± 7.9 cm, and mean defect size was 3.3 ± 1.8 cm2. Defects were classified as Outerbridge grade III or IV. A repeated-measures analysis of variance was used to compare outcomes across all time points. Results: The median follow-up time for the patients in this cohort was 4.56 ± 2.92 years. Significant improvement (P < .001) in all scores was observed at 1 to 2 years after AMIC, and improved values were noted up to 7 years postoperatively. Among all patients, the mean preoperative Lysholm score was 46.9 ± 19.6. At the 1-year follow-up, a significantly higher mean Lysholm score was noted, with maintenance of the favorable outcomes at 7-year follow-up. The KOOS also showed a significant improvement of postoperative values compared with preoperative data. The mean VAS had significantly decreased during the 7-year follow-up. Age, sex, and defect size did not have a significant effect on the outcomes. Conclusion: AMIC is an effective method of treating chondral defects of the knee and leads to reliably favorable results up to 7 years postoperatively.
Collapse
Affiliation(s)
- Justus Gille
- Department of Orthopaedic and Trauma Surgery, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | | | - Moritz Freitag
- Department of Orthopaedic and Trauma Surgery, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Jan Schagemann
- Department of Orthopaedic and Trauma Surgery, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | | | - Tomasz Piontek
- Sport Medicine Lab, Department of Spine Disorders and Pediatric Orthopaedics, University of Medical Sciences Poznań, Poznán, Poland
| | | |
Collapse
|
9
|
Bouva M, Heijnen ML, Jakobs B, van der Ploeg K, Gille J, Gulmans V, Verschoof-Puite R, deWinter-de Groot K. P013 Evaluation of improvements of the cystic fibrosis newborn screening protocol in the Netherlands. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01040-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
10
|
Roser P, Wehrhahn T, Krogmann H, Riedel N, Marshall R, Gille J, Flitsch J, Aberle J. Somatotrope Pituitary Function in Professional Soccer Players. Exp Clin Endocrinol Diabetes 2017; 126:306-308. [DOI: 10.1055/s-0043-119876] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstract
Background and objective Soccer is associated with repetitive head trauma, which, as it is known from sports like football and boxing, can result in hypopituitarism. Gonadotropins and GH are the most common pituitary hormones to become deficient. GH deficiency is associated with an increased risk of cardiovascular mortality and has negative influence on body mass index, visceral fat mass, insulin resistance and sensitivity, bone mineral density and inflammatory markers. Therefore the aim of this study was to evaluate the somatotrope pituitary function in professional soccer players.
Research design and methods This clinical study included 15 male, professional soccer players with at least 10 years of professional training. Basal hormonal parameters of the pituitary axis were obtained from the participants. To assess GH-IGF-I axis, glucagon stimulation tests were used. Rise in growth hormone during glucagon test was analyzed and the prevalence of newly diagnosed hormone deficiencies was evaluated.
Results Mean age of all participants was 31±10 years. None of the 15 soccer players had GH deficiency. Mean rising factor of GH after stimulation with glucagon was 100 in all participants. We did not find signs of ACTH, TSH or LH/FSH deficiency in any player.
Conclusions In this small collective of soccer players we did not find playing soccer to be a risk factor for the development of GH-deficiency. According to our data screening for somatotrope deficiency is not necessary. Further investigations in larger cohorts are needed.
Collapse
Affiliation(s)
- Pia Roser
- Department of Endocrinology and Diabetology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
| | - Tatiana Wehrhahn
- Department of Endocrinology and Diabetology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
| | - Henry Krogmann
- Department of Endocrinology and Diabetology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
| | - Nina Riedel
- Department of Endocrinology and Diabetology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
| | - Robert Marshall
- Department of Endocrinology and Diabetology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
| | - Justus Gille
- Department of Trauma and Orthopedic Surgery, University Hospital Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, Luebeck
| | - Jörg Flitsch
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, Germany
| | - Jens Aberle
- Department of Endocrinology and Diabetology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
| |
Collapse
|
11
|
Gille J, Dietz A, Taha H, Sablotzki A. A sirs-based automated alarm system for the diagnosis of sepsis after burn injury. Ann Burns Fire Disasters 2017; 30:177-184. [PMID: 29849519 PMCID: PMC5946747] [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] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/11/2017] [Indexed: 06/08/2023]
Abstract
The present study examined the effectiveness of an automated systemic inflammatory response syndrome (SIRS)-based alarm system for the early detection of sepsis in adult burn patients. In addition, the relevance of the sepsis criteria from the American Burn Association (ABA) and the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) for this patient group was determined. In this prospective observational study, we included 41 consecutive patients who were admitted to our burn ICU within a one-year period. SIRS alarms were calculated for these patients according to predefined criteria using the PREDEC ALARM automated alarm system and alarms generated according to ABA criteria and daily Sequential Organ Failure Assessment (SOFA) results. The alarms were not visible to the treating doctors and nurses. The alarms identified were related to episodes of sepsis with positive blood cultures. Twenty-one sepsis events were recorded in 41 patients. The receiver operating characteristic (ROC) curve revealed an area under the curve (AUC) of 0.72 for alarms using 2 SIRS criteria, 0.77 for 3 SIRS criteria, and 0.61 for 4 SIRS criteria. AUC values of 0.53 and 0.59 were calculated for the ABA criteria and Sepsis-3 definition, respectively. An alarm system using 3 SIRS criteria proved to be suitable for the early detection of sepsis in burn patients. The frequent number of false alarms requires further refinement of the alarm system. Based on the results of our study, the ABA criteria and the Sepsis-3 definition provide no advantages over the SIRS criteria in the early diagnosis of sepsis after burn injury.
Collapse
Affiliation(s)
- J. Gille
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, St. Georg Hospital gGmbH Leipzig, Germany
| | - A. Dietz
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, St. Georg Hospital gGmbH Leipzig, Germany
| | - H. Taha
- Department of Plastic and Hand Surgery, St. Georg Hospital gGmbH Leipzig, Germany
| | - A. Sablotzki
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, St. Georg Hospital gGmbH Leipzig, Germany
| |
Collapse
|
12
|
Kienast B, Mohsen H, Wendlandt R, Reimers N, Schulz AP, Heuer H, Gille J, Neumann H. Biomechanical evaluation of novel ultrasound-activated bioresorbable pins for the treatment of osteochondral fractures compared to established methods. BIOMED ENG-BIOMED TE 2017; 62:365-373. [PMID: 27626763 DOI: 10.1515/bmt-2016-0041] [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: 02/26/2016] [Accepted: 07/27/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Osteochondral injuries often lead to osteoarthritis of the affected joint. All established systems for refixation of osteochondral defects show certain disadvantages. To address the problem of reduced stability in resorbable implants, ultrasound-activated pins were developed. By ultrasound-activated melting of the tip of these implants, a more secure anchoring is assumed. MATERIALS AND METHODS The aim of the study was to investigate if ultrasound-activated pins can provide secure fixation of osteochondral fragments compared to screws and conventional resorbable pins. In a biomechanical laboratory setting, osteochondral fragments of the medial femoral condyle of sheep were refixated with ultrasound-activated pins [US fused poly(L-lactide-co-D,L-lactide) (PLDLLA) pins], polydioxanone (PDA) pins and conventional titanium screws. Anchoring forces of the different fixation methods were examined, registered and compared concerning shear force and tensile force. RESULTS Concerning the pull out test, the US fused PLDLLA pins and titanium screws (~122 N and ~203 N) showed comparable good results, while the PDA pins showed significantly lower anchoring forces (~18 N). Examination of shear forces showed a significantly higher anchoring of the screws (~248 N) than the US fused PLDLLA pins (~218 N). Nevertheless, the US fused PLDLLA pins could significantly outperform the PDA pins (~68 N) concerning shear forces. CONCLUSION The US fused PLDLLA pins demonstrated a comparable anchorage to the fixation with screws, but were free from the disadvantages of metal implants, i.e. the need for implant removal. The PDA pin application showed inferior biomechanical properties.
Collapse
|
13
|
Neumann H, Stadler A, Heuer H, Auerswald M, Gille J, Schulz AP, Kienast B. Complications during removal of conventional versus locked compression plates: is there a difference? Int Orthop 2016; 41:1513-1519. [PMID: 28012049 DOI: 10.1007/s00264-016-3352-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/14/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Osteosynthesis plate removal is one of the most commonly performed procedures in orthopaedic surgery. Due to technological advances and the quality of increasing osteosynthesis material, more and more locked plates have been implanted over the last 20 years. The aim of this study was to determine whether the complication rate during plate removal differs between conventional and locked plates. MATERIAL AND METHODS In this retrospective cohort study, 620 patients were included and divided into two groups based on the type of plate (locked and conventional). Technical complications during implant removal included screw breakage, destroyed screw head, implant breakage, remaining implant material, refracture, bony or soft tissue overgrowth. The following plate-associated complications were identified: osteosynthesis plate not detachable, plate bent or broken, necessity of special tools or plate loosened. Three types of screw-related complications were observed: screw not detachable, screw broken or screw dislocated. RESULTS Overall, complications related to the plate or screws were documented in 110 of the 620 cases. These complications occurred in 48 of the 382 cases involving conventional osteosynthesis (7.7% of all removals, 12.6% of all conventional removals) and in 62 of the 238 cases involving locked plate osteosynthesis (10.0% of all removals, 26.1% of all locked plate removals). The statistical analysis showed a significantly higher implant-related complication rate with locked plates compared to the conventional plates (p < 0.01). CONCLUSIONS Hardware removal can be a complication-afflicted operation, especially cases involving locked-plate removal should only be performed if a strong indication is evident. Possible benefits of the procedure should be considered carefully, taking the cost-benefit ratio into account.
Collapse
Affiliation(s)
- Hanjo Neumann
- Department of Traumatology, Orthopaedics and Sports Traumatology, BG Trauma Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Anne Stadler
- Department of Orthopaedics and Trauma Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Hinrich Heuer
- Department of Traumatology, Orthopaedics and Sports Traumatology, BG Trauma Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Marc Auerswald
- Department of Traumatology, Orthopaedics and Sports Traumatology, BG Trauma Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Justus Gille
- Department of Orthopaedics and Trauma Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Arndt Peter Schulz
- Department of Orthopaedics and Trauma Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Benjamin Kienast
- Department of Traumatology, Orthopaedics and Sports Traumatology, BG Trauma Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany.
- Department of Orthopaedics and Trauma Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
| |
Collapse
|
14
|
Abstract
INTRODUCTION A prospective clinical investigation was carried out in order to clarify whether Matrix-associated autologous chondrocyte implantation (MACI) results in clinical improvement at long-term follow-up. HYPOTHESIS MACI will result in clinical improvement at long-term follow-up. STUDY DESIGN Case series; level of evidence, 4. METHODS Thirty-eight patients were treated with MACI. These patients were evaluated for up to a mean of 16 years (range 15-17 years) after the intervention. Three different scores (Lysholm-Gilquist score, International Cartilage Repair Society score, and Tegner score) formed the basis of this study. Overall, we were able to obtain valid preoperative and postoperative results from 18 (47%) of 38 patients. In 1 patient, both knees were treated. In 4 patients, an arthroplasty was implanted over the course of time; thus they were excluded from this case series. In conclusion, follow-up of 15 knees was performed in the recent series. RESULTS In subjective rating, 12 out of 14 patients (86%) rated the function of their knee as much better or better than before the index procedure. All numerical outcome scores showed significant improvement compared to the preoperative value (preoperative/postoperative at 5 years/postoperative at 15 years): Lysholm score 59.6 (±24.6)/78.6 (±21.5)/82.7 (±11.3), International Knee Documentation Committee score 50.6 (±22.7)/64.7 (±21.6)/69.7 (±18.7), Tegner score 3.0 (±2.2)/3.6 (±1.5)/5.2 (±1.7). CONCLUSION The significantly improved results on 3 scores after 15 years suggest that MACI represents a suitable treatment of local cartilage defects in the knee.
Collapse
Affiliation(s)
- Justus Gille
- University of Schleswig-Holstein, Luebeck, Germany,Justus Gille, University of Schleswig-Holstein, Ratzeburger Allee 160, Luebeck, 23538, Germany.
| | | | | | - Ralf Oheim
- BG Trauma Hospital Hamburg, Hamburg, Germany
| | | |
Collapse
|
15
|
Kienast B, Kowald B, Seide K, Aljudaibi M, Faschingbauer M, Juergens C, Gille J. An electronically instrumented internal fixator for the assessment of bone healing. Bone Joint Res 2016; 5:191-7. [PMID: 27226357 PMCID: PMC4921051 DOI: 10.1302/2046-3758.55.2000611] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 03/17/2016] [Indexed: 11/21/2022] Open
Abstract
Objectives The monitoring of fracture healing is a complex process. Typically, successive radiographs are performed and an emerging calcification of the fracture area is evaluated. The aim of this study was to investigate whether different bone healing patterns can be distinguished using a telemetric instrumented femoral internal plate fixator. Materials and Methods An electronic telemetric system was developed to assess bone healing mechanically. The system consists of a telemetry module which is applied to an internal locking plate fixator, an external reader device, a sensor for measuring externally applied load and a laptop computer with processing software. By correlation between externally applied load and load measured in the implant, the elasticity of the osteosynthesis is calculated. The elasticity decreases with ongoing consolidation of a fracture or nonunion and is an appropriate parameter for the course of bone healing. At our centre, clinical application has been performed in 56 patients suffering nonunion or fracture of the femur. Results A total of 39 cases of clinical application were reviewed for this study. In total, four different types of healing curves were observed: fast healing; slow healing; plateau followed by healing; and non-healing. Conclusion The electronically instrumented internal fixator proved to be valuable for the assessment of bone healing in difficult healing situations. Cost-effective manufacturing is possible because the used electronic components are derived from large-scale production. The incorporation of microelectronics into orthopaedic implants will be an important innovation in future clinical care. Cite this article: B. Kienast, B. Kowald, K. Seide, M. Aljudaibi, M. Faschingbauer, C. Juergens, J. Gille. An electronically instrumented internal fixator for the assessment of bone healing. Bone Joint Res 2016;5:191–197. DOI: 10.1302/2046-3758.55.2000611.
Collapse
Affiliation(s)
- B Kienast
- BG Trauma Hospital Hamburg, Bergedorfer Str. 10, 21033 Hamburg, Germany
| | - B Kowald
- BG Trauma Hospital Hamburg, Bergedorfer Str. 10, 21033 Hamburg, Germany
| | - K Seide
- BG Trauma Hospital Hamburg, Bergedorfer Str. 10, 21033 Hamburg, Germany
| | - M Aljudaibi
- BG Trauma Hospital Hamburg, Bergedorfer Str. 10, 21033 Hamburg, Germany
| | - M Faschingbauer
- BG Trauma Hospital Hamburg, Bergedorfer Str. 10, 21033 Hamburg, Germany
| | - C Juergens
- BG Trauma Hospital Hamburg, Bergedorfer Str. 10, 21033 Hamburg, Germany
| | - J Gille
- BG Trauma Hospital Hamburg, Bergedorfer Str. 10, 21033 Hamburg, Germany
| |
Collapse
|
16
|
Seyfarth HJ, Wirtz H, Gille J, Gerlach S, Grachtrup S, Winkler J, Sablotzki A. [Management and Outcome of Surgery in Patients with Severe Pulmonary Hypertension--A Single-Center Experience]. Pneumologie 2016; 70:117-22. [PMID: 26894393 DOI: 10.1055/s-0041-110294] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients with pulmonary hypertension (PH) are at high risk when undergoing surgery. Up to one-third of patients suffer complications; recent studies report a mortality rate of 1 to 7%. Frequent events are deterioration of right heart function and infectious or bleeding complications. METHODS Data of patients (age ≥ 18) with precapillary PH who need to undergo elective surgery between January 2006 and March 2015 were included in this retrospective analysis. All patients who were planned for surgery underwent the same procedure. First, patients were evaluated in the PH center. Thereafter, PH-relevant data were discussed with the surgeon/anesthesiologist team for risk-adapted planning of anesthesia and intervention. The present analysis comprises patient characteristics and information about surgery and post-interventional course. RESULTS This study analyzes 31 surgical procedures carried out in PH patients (male: n = 8; PH-group I: n = 23, group III: n = 3, group IV: n = 5, mean age: 59.5 ± 15.3 years). Patients were characterized by compromised hemodynamics and exercise capacity: pulmonary vascular resistance: 805.4 ± 328.5 dyn*s*cm(-5), mean pulmonary arterial pressure: 46.3 ± 9.3 mmHg, 6-minute walking distance: 350.3 ± 123.3 m.The majority of interventions were performed under general anesthesia (n = 24). In 25 cases, the intraoperative monitoring was complemented with right heart catheterization.Eight interventions were associated with complications, three of which were serious. One patient died postoperatively owing to sepsis and right heart failure. CONCLUSION A careful and structured planning of surgical interventions in patients with PH and the choice of surgical procedure and anesthesia adapted to the conditions of PH might help avoid complications. Further multicentric studies are needed.
Collapse
Affiliation(s)
- H-J Seyfarth
- Abteilung Pneumologie; Department Innere Medizin, Neurologie und Dermatologie; Universitätsklinikum Leipzig AöR
| | - H Wirtz
- Abteilung Pneumologie; Department Innere Medizin, Neurologie und Dermatologie; Universitätsklinikum Leipzig AöR
| | - J Gille
- Klinik für Anästhesiologie, Intensiv- und Schmerztherapie; Klinikum St. Georg Leipzig gGmbH
| | - S Gerlach
- Klinik für Anästhesiologie, Intensiv- und Schmerztherapie; Klinikum St. Georg Leipzig gGmbH
| | - S Grachtrup
- Abteilung Pneumologie; Department Innere Medizin, Neurologie und Dermatologie; Universitätsklinikum Leipzig AöR
| | - J Winkler
- Praxis für Pneumologie/Allergologie Leipzig
| | - A Sablotzki
- Klinik für Anästhesiologie, Intensiv- und Schmerztherapie; Klinikum St. Georg Leipzig gGmbH
| |
Collapse
|
17
|
Malcharek MJ, Herbst V, Bartz GJ, Manceur AM, Gille J, Hennig G, Sablotzki A, Schneider G. Multimodal evoked potential monitoring in asleep patients versus neurological evaluation in awake patients during carotid endarterectomy: a single-centre retrospective trial of 651 patients. Minerva Anestesiol 2015; 81:1070-1078. [PMID: 25658171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND A controversy exists regarding which monitoring technique is superior in cases in which general anesthesia (GA) is necessary for carotid endarterectomy (CEA). Multimodal evoked potential (mEP) monitoring was investigated under GA during CEA and compared with a historical control group undergoing neurological evaluations awake under loco-regional anesthesia (LA). METHODS We retrospectively studied 651 patients undergoing elective CEA. In groupHISTORY (N.=349; 1997-1999) LA was provided using superficial or deep/superficial cervical plexus blocks. In groupmEP, (N.=302; 2009-2013) GA was performed by administering remifentanil/propofol infusion. The multimodal EPs included the median-nerve-somatosensory and motor evoked potentials. The primary outcome was the rate of technical failure. The arterio-arterial shunt rate and immediate postoperative motor outcomes were also compared. RESULTS GroupmEP showed a significantly lower rate of technical failure (OR 0.17; CI 0.03-0.6; P=0.002). Because the groups differed systematically, logistic regression analysis was used to compare shunt rates and motor outcomes. Since shunt rates were 8.3% (groupmEP) versus 8.2% (groupHISTORY), but logistic regression model showed significant differences (OR 3.77; CI 1.67-8.95; P=0.001) correct comparison was impossible. Immediate postoperative deficits were 4.3% (groupmEP) and 4.9% (groupHISTORY); logistic regression analysis: transient OR 0.77, CI 0.28 to 0.22, P=0.61 and permanent OR 0.37, CI 0.02-7.74, P=0.49. CONCLUSION Monitoring mEPs was associated with less technical failure than awake evaluation and showed similar motor outcomes. Because the groups differed systematically, the interpretation of shunt rates was impossible. Monitoring mEP should be considered to detect intraoperative ischemia in cases in which patients undergo CEA under GA.
Collapse
Affiliation(s)
- M J Malcharek
- Department of Anesthesiology, Intensive Care and Pain Therapy, Klinikum St. Georg gGmbH, Leipzig, Germany -
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Malcharek M, Loeffler S, Schiefer D, Manceur M, Sablotzki A, Gille J, Pilge S, Schneider G. Transcranial motor evoked potentials during anesthesia with desflurane versus propofol – A prospective randomized trial. Clin Neurophysiol 2015; 126:1825-32. [DOI: 10.1016/j.clinph.2014.11.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 11/16/2014] [Accepted: 11/30/2014] [Indexed: 10/24/2022]
|
19
|
McAleer SS, Gille J, Bark S, Riepenhof H. Management of chronic recurrent osteitis pubis/pubic bone stress in a Premier League footballer: Evaluating the evidence base and application of a nine-point management strategy. Phys Ther Sport 2015; 16:285-99. [PMID: 26150099 DOI: 10.1016/j.ptsp.2015.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 03/26/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND/AIM The aim of this paper was to use a clinical example to describe a treatment strategy for the management of recurrent chronic groin pain and evaluate the evidence of the interventions. METHODS A professional footballer presented with chronic recurrent OP/PBS. The injury was managed successfully with a nine-point programme - 1. Acute pharmacological management. 2. Tone reduction of over-active structures. 3. Improved ROM at hips, pelvis and thorax. 4. Adductor strength. 5. Functional movement assessment. 6. Core stability. 7. Lumbo-pelvic control. 8. Gym-based strengthening. 9. Field-based conditioning/rehabilitation. The evidence for these interventions is reviewed. RESULTS The player returned to full training and match play within 41 and 50 days, respectively, and experienced no recurrence of his symptoms in follow up at 13 months. CONCLUSION This case report displays a nine-point conservative management strategy for OP/PBS, with non-time dependent clinical objective markers as the progression criteria in a Premier League football player.
Collapse
Affiliation(s)
- Stephen S McAleer
- Department of Sports Medicine and Science, Brighton and Hove Albion Football Club, Brighton, UK; British Athletics, University of Bath Sports Training Village, Bath, BA2 7AY, UK.
| | - Justus Gille
- Sektion Unfallchirurgie, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Stefan Bark
- Sektion Unfallchirurgie, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Helge Riepenhof
- Department of Sports Medicine and Science, Brighton and Hove Albion Football Club, Brighton, UK; Sektion Unfallchirurgie, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| |
Collapse
|
20
|
Bark S, Piontek T, Behrens P, Mkalaluh S, Varoga D, Gille J. Enhanced microfracture techniques in cartilage knee surgery: Fact or fiction? World J Orthop 2014; 5:444-449. [PMID: 25232520 PMCID: PMC4133450 DOI: 10.5312/wjo.v5.i4.444] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 03/14/2014] [Accepted: 06/11/2014] [Indexed: 02/06/2023] Open
Abstract
The limited intrinsic healing potential of human articular cartilage is a well-known problem in orthopedic surgery. Thus a variety of surgical techniques have been developed to reduce joint pain, improve joint function and delay the onset of osteoarthritis. Microfractures as a bone marrow stimulation technique present the most common applied articular cartilage repair procedure today. Unfortunately the deficiencies of fibrocartilaginous repair tissue inevitably lead to breakdown under normal joint loading and clinical results deteriorate with time. To overcome the shortcomings of microfracture, an enhanced microfracture technique was developed with an additional collagen I/III membrane (Autologous, Matrix-Induced Chondrogenesis, AMIC®). This article reviews the pre-clinical rationale of microfractures and AMIC®, presents clinical studies and shows the advantages and disadvantages of these widely used techniques. PubMed and the Cochrane database were searched to identify relevant studies. We used a comprehensive search strategy with no date or language restrictions to locate studies that examined the AMIC® technique and microfracture. Search keywords included cartilage, microfracture, AMIC®, knee, Chondro-Gide®. Besides this, we included our own experiences and study authors were contacted if more and non published data were needed. Both cartilage repair techniques represent an effective and safe method of treating full-thickness chondral defects of the knee in selected cases. While results after microfracture deteriorate with time, mid-term results after AMIC® seem to be enduring. Randomized studies with long-term follow-up are needed whether the grafted area will maintain functional improvement and structural integrity over time.
Collapse
|
21
|
Schulz AP, Lange V, Gille J, Voigt C, Fröhlich S, Stuhr M, Jürgens C. Anterior cruciate ligament reconstruction using bone plug-free quadriceps tendon autograft: intermediate-term clinical outcome after 24-36 months. Open Access J Sports Med 2013; 4:243-9. [PMID: 24379730 PMCID: PMC3873799 DOI: 10.2147/oajsm.s49223] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Although known as a possible graft option for decades, quadriceps tendon grafts have often been termed a second-line graft option. We report a consecutive case series using this method as the primary treatment line. The rationale for this study was to evaluate the midterm results of this method in a prospective and consecutive case series. The primary study question was to determine the clinical results 24–36 months after primary anterior cruciate ligament (ACL) reconstruction using a bone plug-free quadriceps tendon autograft fixed with bioabsorbable cross-pins. Materials and methods The study population included 55 patients, of whom 24 were female (43.6%). The mean age at the index procedure was 31.7 years (15–58 years). All patients received an ACL construction using a bone block-free quadriceps tendon graft fixed with resorbable cross-pins. The postoperative regimen included partial weight-bearing for 3 weeks and flexion limited to 90° for six weeks; an orthosis was not used. The mean follow-up duration was 29.5 months (24.3–38.5 months) after the index procedure. The International Knee Documentation Committee (IKDC) subjective score and examination form was assessed, as well as the Lysholm and Gillquist score and the Tegner activity index. The Rolimeter arthrometer was used to assess the anterior laxity of the knee. Results Graft harvesting was possible in all cases; a bony extension was never required. On average, graft length was measured at 8.8 cm (7.5–10 cm). The mean IKDC subjective score at follow-up was 80.44 points (55.17–100 points, standard deviation [SD] 12.05). The mean preinjury Tegner activity index was 4.98 (2–7) compared to a mean value of 4.16 (2–7, SD 0.8) at follow-up. There was a mean loss of 0.82 index points. The average Lysholm and Gillquist score was 89 points (65–100, SD 17.7). Of the results, 89.1% were in the good or very good groups; in one case (1.8%), the result was poor, while the rest were fair. Conclusion ACL reconstruction using a bone plug-free quadriceps tendon autograft achieved satisfactory results in a midterm review.
Collapse
Affiliation(s)
- Arndt P Schulz
- Department of Orthopedics, Trauma, and Sports Medicine, University Hospital Lübeck, Lübeck, Germany
| | - Vivien Lange
- Department of Rehabilitation, Sana Regio Klinikum, Wedel, Germany
| | - Justus Gille
- Department of Orthopedics, Trauma, and Sports Medicine, University Hospital Lübeck, Lübeck, Germany
| | - Christine Voigt
- Department of Sports Medicine and Arthroscopy, Diakoniekrankenhaus Friederikenstift, Hannover, Germany
| | - Susanne Fröhlich
- Department of Orthopedics, University of Rostock, Rostock, Germany
| | - Markus Stuhr
- Department of Orthopedics, Trauma, and Sports Medicine, University Hospital Lübeck, Lübeck, Germany
| | - Christian Jürgens
- Department of Orthopedics, Trauma, and Sports Medicine, BG Trauma Hospital Hamburg, Hamburg, Germany
| |
Collapse
|
22
|
Struck M, Gille J. Fungal infections in burns: a comprehensive review. Ann Burns Fire Disasters 2013; 26:147-153. [PMID: 24563641 PMCID: PMC3917146] [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] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Indexed: 06/03/2023]
Abstract
Burn wound infections remain the most important factor limiting survival in burn intensive care units. Large wound surface, impaired immune systems, and broad-spectrum antibiotic therapy contribute to the growth of opportunistic fungal species. Faced with challenging fluid resuscitation, wound excision and cardiopulmonary stabilization, mycosis in burns are likely to be underestimated. Diagnostic performance can sometimes be delayed because clinical signs are unspecific and differentiation between colonization and infection is difficult. Therapeutic measures range from infection prophylaxis over treatment with antifungal agents towards radical amputation of infected limbs. New methods of early and reliable detection of fungal organisms, as well as the use of novel antifungal substances, are promising but require wider establishment to confirm the beneficial effects in burn patients. This review aims to highlight the main important aspects of fungal infections in burns including incidence, infection control, diagnostic and therapeutic approaches, prognosis and outcomes.
Collapse
Affiliation(s)
- M.F. Struck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Germany
| | - J. Gille
- Department of Anesthesiology and Intensive Care Medicine, Burn Center, St. Georg Hospital, Leipzig, Germany
| |
Collapse
|
23
|
Oheim R, Behrens P, Volpi P, Girolamo LD, Reiss Eric E, Zoch W, Anders S, Gille J. MID-TERM RESULTS OF AUTOLOGOUS MATRIX INDUCED CHONDROGENESIS (AMIC) IN CARTILAGE KNEE SURGERY. Br J Sports Med 2013. [DOI: 10.1136/bjsports-2013-092558.6] [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: 02/06/2023]
|
24
|
Neumann H, Schulz AP, Gille J, Klinger M, Jürgens C, Reimers N, Kienast B. Refixation of osteochondral fractures by ultrasound-activated, resorbable pins: An ovine in vivo study. Bone Joint Res 2013; 2:26-32. [PMID: 23610699 PMCID: PMC3626216 DOI: 10.1302/2046-3758.22.2000099] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 12/17/2012] [Indexed: 11/22/2022] Open
Abstract
Objectives Osteochondral injuries, if not treated adequately, often lead
to severe osteoarthritis. Possible treatment options include refixation
of the fragment or replacement therapies such as Pridie drilling,
microfracture or osteochondral grafts, all of which have certain
disadvantages. Only refixation of the fragment can produce a smooth
and resilient joint surface. The aim of this study was the evaluation
of an ultrasound-activated bioresorbable pin for the refixation of
osteochondral fragments under physiological conditions. Methods In 16 Merino sheep, specific osteochondral fragments of the medial
femoral condyle were produced and refixed with one of conventional
bioresorbable pins, titanium screws or ultrasound-activated pins.
Macro- and microscopic scoring was undertaken after three months. Results The healing ratio with ultrasound-activated pins was higher than
with conventional pins. No negative heat effect on cartilage has
been shown. Conclusion As the material is bioresorbable, no further surgery is required
to remove the implant. MRI imaging is not compromised, as it is
with implanted screws. The use of bioresorbable pins using ultrasound
is a promising technology for the refixation of osteochondral fractures.
Collapse
Affiliation(s)
- H Neumann
- Berufsgenossenschaftliches Unfallkrankenhaus Hamburg, Department of Traumatology, Orthopaedics and Sports Medicine, Bergedorfer Straße 10, 21033 Hamburg, Germany
| | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
Infections are a great diagnostic and therapeutic challenge in intensive care patients with burn injuries. The major problems are due to bacteria with hospital-acquired multiresistance to antibiotics but fungal and viral infections may also be life-threatening. The main key points addressing pharmacotherapy with antibiotic, antifungal and antiviral agents in this special setting are exact diagnosis, early therapy with suitable drugs, adequate duration of treatment and adequate doses based on pharmacokinetic and pharmacodynamic characteristics of these compounds. The latter parameters are significantly altered in burn patients and show a wide interindividual and intraindividual variation in drug response as a result of the characteristic phases of burn injury. Drug concentration analysis may help to avoid inadequate dosing. In this review the main characteristics of burn injuries and the pharmacology of antibiotics, antifungal and antiviral agents in these patients are presented.
Collapse
Affiliation(s)
- T Trupkovic
- Abteilung für Anästhesie, Intensivmedizin und Schmerztherapie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Deutschland
| | | | | | | |
Collapse
|
26
|
Gille J, Oheim R, Riepenhof H, Voigt C, Juergens C. Arthroscopic-assisted removal of proximal tibia locking plates. Sports Med Arthrosc Rehabil Ther Technol 2012; 4:18. [PMID: 22640526 PMCID: PMC3470974 DOI: 10.1186/1758-2555-4-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 04/26/2012] [Indexed: 11/16/2022]
Abstract
We present a new technique to remove plates from the proximal tibia arthroscopic-assisted with all advantages of the minimally invasive surgery and the possibility to treat concomitant intraarticular pathologies. The initial results (n = 7) are promising with an increase of the Lysholm score in all cases studied [preop. median 78 (range 32–100), postop. median 89 (range 60–100)]. In conclusion, arthroscopic-assisted hardware removal at the proximal tibia is feasible and may provide patients with all the benefits of minimal-invasive hardware removal. The described technique can be recommended for all surgeons familiar with arthroscopic surgery.
Collapse
Affiliation(s)
- Justus Gille
- Department of Trauma and Reconstructive Surgery, University of Schleswig-Holstein, Campus Luebeck, 23538 Luebeck, Germany.
| | | | | | | | | |
Collapse
|
27
|
Gille J, Wallstabe S, Schulz AP, Paech A, Gerlach U. Is non-union of tibial shaft fractures due to nonculturable bacterial pathogens? A clinical investigation using PCR and culture techniques. J Orthop Surg Res 2012; 7:20. [PMID: 22607715 PMCID: PMC3489544 DOI: 10.1186/1749-799x-7-20] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 05/02/2012] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Non-union continues to be one of the orthopedist's greatest challenges. Despite effective culture methods, the detection of low-grade infection in patients with non-union following tibial fracture still presents a challenge. We investigated whether "aseptic" tibial non-union can be the result of an unrecognized infection. METHODS A total of 23 patients with non-union following tibial shaft fractures without clinical signs of infection were investigated. Intraoperative biopsy samples obtained from the non-union site were examined by means of routine culture methods and by polymerase chain reaction (PCR) for the detection of 16 S ribosomal RNA (rRNA). Control subjects included 12 patients with tibial shaft fractures. RESULTS 23 patients (8 women and 15 men; mean age: 47.4 years) were included into this study. Preoperative C-reactive protein levels (mean: 20.8 mg/l) and WBC counts (mean: 8,359/μl) in the study group were not significantly higher than in the control group. None of the samples of non-union routine cultures yielded microorganism growth. Bacterial isolates were found by conventional culturing methods in only 1 case of an open fracture from the control group. In this case, PCR yielded negative results. 16 S rRNA was detected in tissue specimens from 2 patients (8.7%) with non-union. The analysis of these variable species-specific sequences enabled the identification of specific microorganisms (1x Methylobacterium species, 1x Staphylococcus species). Both PCR-positive patients were culture-negative. CONCLUSIONS The combination of microbiological culture and broad-range PCR seems to substantially add to the number of microbiological diagnoses obtained and may improve the clinician's ability to tailor therapy to the individual patient's needs.
Collapse
Affiliation(s)
- Justus Gille
- Department of Trauma and Reconstructive Surgery, University of Schleswig-Holstein, Campus Luebeck, Luebeck, 23538, Germany
| | - Steffen Wallstabe
- Department of Trauma Surgery and Sportsmedicine, BG-Traumahospital Hamburg, Hamburg, 21033, Germany
| | - Arndt-Peter Schulz
- Department of Trauma and Reconstructive Surgery, University of Schleswig-Holstein, Campus Luebeck, Luebeck, 23538, Germany
| | - Andreas Paech
- Department of Trauma and Reconstructive Surgery, University of Schleswig-Holstein, Campus Luebeck, Luebeck, 23538, Germany
| | - Ulf Gerlach
- Department of Trauma Surgery and Sportsmedicine, BG-Traumahospital Hamburg, Hamburg, 21033, Germany
| |
Collapse
|
28
|
Lill H, Katthagen C, Hertel A, Gille J, Voigt C. All-arthroscopic intramedullary nailing of 2- and 3-part proximal humeral fractures: a new arthroscopic technique and preliminary results. Arch Orthop Trauma Surg 2012; 132:641-7. [PMID: 22101409 DOI: 10.1007/s00402-011-1430-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Indexed: 02/09/2023]
Abstract
PURPOSE The most criticism of antegrade humeral nailing is the potentially deleterious effect on the shoulder function, which is caused by the trauma to the M. supraspinatus (SSP) at the nail insertion site. We describe a new technique of all-arthroscopical intramedullary nailing, which preserves the rotator cuff, and compare it with the conventional open procedure. METHODS From 11/2009 to 12/2010 82 patients with unstable, displaced proximal humeral fractures were treated surgically. Twenty-one of these patients received an intramedullary nailing. Sixteen of 21 met the inclusion criteria. Based on the surgeon's arthroscopic experience, patients were assigned to the arthroscopic (group I, n = 8) or open group (group II, n = 8). Both groups were compared due to the replacement results, complications, time of surgery and fluoroscopy. Concomitant intraarticular pathologies were assessed (group I). First clinical results after a median follow-up of 13 months (group I) and 14 months (group II) were reported. RESULTS Between group I and II, no significant differences were seen in patients age [77 years (range 45-90 years) vs. 76 years (range 65-92 years)], gender (6 female/2 male vs. 5 female/3 male) and fracture pattern (six 2-/two 3-part fractures vs. five 2-/three 3-part fractures). The reduction was evaluated by the caput-diaphysis-angle, which was median 137° (range 120-147°) in group I and 132° (range 120-158°) in group II (p = 0.959). Postoperatively, group I showed one varus-, group II two varus- and valgus deformities. Median time of surgery was 75 min (range 45-182 min) versus 70 min (range 40-146 min) (p = 0.442), fluoroscopy time 1.5 min (range, 0.6-3.7 min) versus 1.2 min (range 0.3-2.2 min) in group I and II (p = 0.336). Concomitant pathologies like one traumatic bicipital tendon-lesion and three partial lesions of the SSP were observed and treated in group I. Constant Scores and Visual Analogue Scale did not differ significantly between both groups at the time of follow-up. CONCLUSIONS All-arthroscopical humeral nailing is possible, preserves the rotator cuff and provides equal replacement and functional results like the open technique. An arthroscopically visualized optimal nail insertion point provides less frequent head deformities. Level of evidence Level III.
Collapse
Affiliation(s)
- Helmut Lill
- Department of Trauma and Reconstructive Surgery, Friederikenstift Hospital Hannover, Humboldtstraße 5, 30169, Hannover, Germany,
| | | | | | | | | |
Collapse
|
29
|
Oheim R, Schulz AP, Schoop R, Grimme CH, Gille J, Gerlach UJ. Medium-term results after total clavicle resection in cases of osteitis: a consecutive case series of five patients. Int Orthop 2012; 36:775-81. [PMID: 21881884 PMCID: PMC3311807 DOI: 10.1007/s00264-011-1342-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 08/10/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE Claviculectomy is a rare and poorly described event in the surgical therapy of diseases of the clavicle. We present a case series and functional results of patients who underwent total claviculectomy. METHODS From 1995 to 2006 a total of 26 patients diagnosed with osteitis of the clavicle underwent surgery in our unit. Of these, five patients (all female) needed a total resection of the clavicle in order to ensure permanent healing from infection. The data collection was prospective. The data gathered preoperatively and at follow-up included clinical examinations, laboratory findings, radiographs and the Constant shoulder scores. The mean follow-up period was 7.5 months. RESULTS The surgical concept described was able to eliminate infection in all cases studied within an average hospital stay of 13.4 days (8-18 days). Only one patient showed complications; suffering from chronic pain syndrome requiring surgical revision. After total resection of the clavicle four of five patients showed very good functional results. The average Constant score showed a significant increase from 82 before surgery to 95 at follow-up. CONCLUSIONS The surgical technique described for total claviculectomy, along with the insertion of local antibiotic beads, was able to eliminate infection in every case. Good functional results and a low complication rates were observed. For good functional results and the permanent elimination of infection, adjacent joints have to be addressed, the periosteal tube should be preserved and early functional treatment is essential.
Collapse
Affiliation(s)
- Ralf Oheim
- Septic Bone and Joint Surgery, BG Trauma Hospital Hamburg, Bergedorfer Straße 10, 21033 Hamburg, Germany.
| | | | | | | | | | | |
Collapse
|
30
|
Gille J, Taha H, Blankenburg R, Raff T, Sablotzki A. Reducing the indication of ventilatory support in the severely burnt patient and improving outcomes: Results of a new protocol approach within a regional burns centre. Crit Care 2012. [PMCID: PMC3363884 DOI: 10.1186/cc11073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
31
|
Oheim R, Gille J, Schoop R, Mägerlein S, Grimme CH, Jürgens C, Gerlach UJ. Surgical therapy of hip-joint empyema. Is the Girdlestone arthroplasty still up to date? Int Orthop 2011; 36:927-33. [PMID: 21986890 DOI: 10.1007/s00264-011-1351-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 08/22/2011] [Indexed: 12/26/2022]
Abstract
PURPOSE Hip-joint empyema is a severe local infection that can cause general illness and, in the worst-case scenario, death by septic complications. For severe hip-joint infections, the Girdlestone arthroplasty has been an established treatment option for many decades. We describe functional midterm results after treatment of haematological and postoperative hip-joint infections. METHODS From 2000 to 2010, 24 patients underwent surgical treatment for 27 hip-joint empyemas. The surgical procedures included radical debridement, implantation of local antibiotic beads and soft tissue management. Besides clinical, laboratory and imaging parameters, we analysed the Harris hip score (HHS). RESULTS Twenty-three patients (26 hips) were followed up after a mean of 30 (3.1-126.8) months. The study group consists of 12 men and 11 women, with an average height of 1.71 m, weight of 84.7 kg and body mass index (BMI) of 28.6 kg/m(2). Hip-joint empyema was due to haematological septic spread in eight patients, surgery related in 12 hips and other causes in six cases. One patient died due to septic complications during the hospital stay. Intraoperative bacterial culture was positive in 50%, with Staphylococcus aureus as the most common organism (n = 11). Average hospital stay was 35 days. HHS significantly improved from 18.2 preoperatively to 47.8 at follow-up. Functional results were mainly poor, but pain relief increased significantly. The infection control rate was 96% with four (15%) complications. CONCLUSION Resection arthroplasty by Girdlestone is able to control infection in most cases with an acceptable complication rate but poor functional results. In conclusion, the Girdlestone arthroplasty still is an essential surgical strategy for treating hip-joint empyema in cases in which functional outcome is of lesser priority.
Collapse
Affiliation(s)
- Ralf Oheim
- BG Trauma Hospital Hamburg, Septic Bone and Joint Surgery, Bergedorfer Straße 10, 21033, Hamburg, Germany.
| | | | | | | | | | | | | |
Collapse
|
32
|
Meissner M, Berlinski B, Gille J, Doll M, Kaufmann R. Peroxisome proliferator activated receptor-α agonists suppress transforming growth factor-α-induced matrix metalloproteinase-9 expression in human keratinocytes. Clin Exp Dermatol 2011; 36:911-4. [PMID: 21790722 DOI: 10.1111/j.1365-2230.2011.04125.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The peroxisome proliferator-activated receptors (PPARs), PPARα, PPARδ, and PPARγ, are nuclear ligand-activated transcription factors that are best known as regulators of glucose and lipid metabolism. PPARα agonists have been shown to have profound anti-inflammatory and antiproliferative effects on human keratinocytes, and are important for maintaining homeostasis of the skin. To better characterize the mechanisms underlying these phenomena, we analysed the effects of PPARα agonists on transforming growth factor (TGF)-α-induced expression of matrix metalloproteinase (MMP)-9. MMP-9 expression in keratinocytes has previously been linked to inflammatory skin diseases, regenerative skin mechanisms, and tumour development and metastasis. We found that PPARα agonists effectively inhibited TGF-α-induced MMP-9 expression in human keratinocytes via a post-transcriptional mechanism, revealing a novel and important aspect of the anti-inflammatory and anticarcinogenic action of these compounds.
Collapse
Affiliation(s)
- M Meissner
- Department of Dermatology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany.
| | | | | | | | | |
Collapse
|
33
|
Kienast B, Thietje R, Queitsch C, Gille J, Schulz AP, Meiners J. Mid-term results after operative treatment of rockwood grade III-V acromioclavicular joint dislocations with an AC-hook-plate. Eur J Med Res 2011; 16:52-6. [PMID: 21463981 PMCID: PMC3353421 DOI: 10.1186/2047-783x-16-2-52] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Acromioclavicular joint dislocations often occur in athletic, young patients after blunt force to the shoulder. Several static and dynamic operative procedures with or without primary ligament replacement have been described. Between February 2003 and March 2009 we treated 313 patients suffering from Rockwood III-V lesions of the AC joint with an AC-hook plate. 225 (72 %) of these patients could be followed up. Mean operation time was 42 minutes in the conventional group and 47 minutes in the minimal invasive group. The postoperative pain on a scale from 1 to 10 (VAS-scale) was rated 2.7 in the conventional group and 2.2 in the minimal invasive group. Taft score showed very good and good results in 189 patients (84%). Constant score showed an average of 92.4 of 100 possible points with 89 % excellent and good results and 11 % satisfying results. All patients had some degree of pain or discomfort with the hook-plate in place. These symptoms were relieved after removal of the plate. The overall complication rate was 10.6 %. There were 6 superficial soft tissue infections, 1 fracture of the acromion, 7 redislocations after removal of the hook-plate. We observed 4 broken hooks which could be removed at the time of plate removal, 4 seromas and 2 cases of lateral clavicle bone infection, which required early removal of the plate. We can conclude that clavicle hook plate is a convenient device for the surgical treatment of Rockwood Grade III-V dislocations, giving good mid-term results with a low overall complication rate compared to the literature. Early functional therapy is possible and can avoid limitations in postoperative shoulder function.
Collapse
Affiliation(s)
- Benjamin Kienast
- BG Trauma Hospital Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany.
| | | | | | | | | | | |
Collapse
|
34
|
Queitsch C, Kienast B, Voigt C, Gille J, Jürgens C, Schulz AP. Treatment of posttraumatic sternal non-union with a locked sternum-osteosynthesis plate (TiFix). Injury 2011; 42:44-6. [PMID: 20828691 DOI: 10.1016/j.injury.2010.08.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 08/09/2010] [Accepted: 08/10/2010] [Indexed: 02/02/2023]
Abstract
Only a minority of sternal fractures require osteosynthesis. Unstable non-union of the sternum is a very disabling condition which often requires treatment. The method most often used is tension-wiring. Due to loosening of the tensile strength or wire cut-out, this method often fails. We report the results of locked plate osteosynthesis of sternal non-union and displaced fractures. Over a five-year period, 12 patients have been treated using this method in a multicentre trial. Mean age at trauma was 32.8 years, the implant used in all cases was an 8-hole titanium plate, the fixation of the screws is based on the principles of angular stable fixation.In all cases the index procedure was possible, in all cases there was bony healing at follow-up examination.Multidirectional locked plating offers a reliable method for the successful treatment of sternal nonunion and displaced fractures.
Collapse
Affiliation(s)
- Christian Queitsch
- Department of Trauma and Orthopaedic Surgery, Regio Klinik, Wedel, Germany
| | | | | | | | | | | |
Collapse
|
35
|
Abstract
AIM Osteitis of the clavicle is rare and not well described in the international literature. We describe a concept of surgical treatment with medium-term observations. METHOD A total of 22 patients (12 women, 10 men; BMI Ø 24.6 kg/m(2), age Ø 48 years) with osteitis of the clavicle were included in the series. The treatment regime consisted of a surgical approach. Data collection was prospective. Data gathered preoperatively and at follow-up included clinical examination, laboratory findings, radiographs and the Constant scoring system. The mean follow-up period was 13.3 (3-53) months. RESULTS The described surgical concept was able to permanently eliminate infection in all cases studied. Surgical revisions were required in six patients. The average Constant score showed a significant increase from 66 to 84 at follow-up. Patients also showed good functional results after total resection of the clavicle. CONCLUSION The reported treatment regime provides reliable results in terms of eliminating infection with good clinical results. Neighboring joints were frequently also involved in the infection and needed to be surgically addressed.
Collapse
Affiliation(s)
- R Oheim
- BG-Unfallkrankenhaus Hamburg, Bergedorfer Straße 10, 21033, Hamburg, Deutschland.
| | | | | | | | | | | |
Collapse
|
36
|
Kienast B, Kiene J, Gille J, Thietje R, Gerlach U, Schulz AP. Posttraumatic severe infection of the ankle joint - long term results of the treatment with resection arthrodesis in 133 cases. Eur J Med Res 2010; 15:54-8. [PMID: 20452884 PMCID: PMC3352045 DOI: 10.1186/2047-783x-15-2-54] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Although there is a clear trend toward internal fixation for ankle arthrodesis, there is general consensus that external fixation is required for cases of posttraumatic infection. We retrospectively evaluated the technique and clinical long term results of external fixation in a triangular frame for cases of posttraumatic infection of the ankle. From 1993 to 2006 a consecutive series of 155 patients with an infection of the ankle was included in our study. 133 cases of the advanced "Gächter" stage III and IV were treated with arthrodesis. We treated the patients with a two step treatment plan. After radical debridement and sequestrectomy the malleoli and the joint surfaces were resected. An AO fixator was applied with two Steinmann-nails inserted in the tibia and in the calcaneus and the gap was temporary filled with gentamicin beads as the first step. In the second step we performed an autologous bone graft after a period of four weeks. The case notes were evaluated regarding trauma history, medical complaints, further injuries and illnesses, walking and pain status and occupational issues. Mean age at the index procedure was 49.7 years (18-82), 104 patients were male (67,1%). Follow up examination after mean 4.5 years included a standardised questionnaire and a clinical examination including the criteria of the AO-FAS-Score and radiographs. 92,7% of the cases lead to a stable arthrodesis. In 5 patients the arthrodesis was found partly-stable. In six patients (4,5%) the infection was not controllable during the treatment process. These patients had to be treated with a below knee amputation. The mean AOFAS score at follow up was 63,7 (53-92). Overall there is a high degree of remaining disability. The complication rate and the reduced patient comfort reserve this method mainly for infection. Joint salvage is possible in the majority of cases with an earlier stage I and II infection.
Collapse
Affiliation(s)
- Benjamin Kienast
- BG Trauma Center Hamburg, Bergedorfer Str. 10, 21033 Hamburg, Germany.
| | | | | | | | | | | |
Collapse
|
37
|
Gille J, Kunow J, Boisch L, Behrens P, Bos I, Hoffmann C, Köller W, Russlies M, Kurz B. Cell-Laden and Cell-Free Matrix-Induced Chondrogenesis versus Microfracture for the Treatment of Articular Cartilage Defects: A Histological and Biomechanical Study in Sheep. Cartilage 2010; 1:29-42. [PMID: 26069534 PMCID: PMC4440609 DOI: 10.1177/1947603509358721] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the regenerative potential of cell-laden and cell-free collagen matrices in comparison to microfracture treatment applied to full-thickness chondral defects in an ovine model. METHODS Animals (n = 30) were randomized into 5 treatment groups, and 7-mm full-cartilage-thickness defects were set at the trochlea and medial condyle of both knee joints and treated as follows: 2 scaffolds in comparison (collagen I/III, Chondro-Gide(®); collagen II, Chondrocell(®)) for covering microfractured defects (autologous matrix-induced chondrogenesis), both scaffolds colonized in vitro with autologous chondrocytes (matrix-associated chondrocyte transplantation), or scaffold-free microfracture technique. One year after surgery, cartilage lesions were biomechanically (indentation test), histologically (O'Driscoll score), and immunohistochemically (collagen type I and II staining) evaluated. RESULTS All treatment groups of the animal model induced more repair tissue and showed better histological scores and biomechanical properties compared to controls. The average thickness of the repair tissue was significantly greater when a scaffold was used, especially the collagen I/III membrane. However, none of the index procedures surpassed the others from a biomechanical point of view or based on the histological scoring. Collagen type II expression was better in condylar defects compared to the trochlea, especially in those treated with collagen I/III membranes. CONCLUSION Covering of defects with suitable matrices promotes repair tissue formation and is suggested to be a promising treatment option for cartilage defects. However, it failed to improve the biomechanical and histological properties of regenerated articular cartilage compared to microfracture alone in an ovine model under the given circumstances.
Collapse
Affiliation(s)
- Justus Gille
- Department of Trauma and Orthopaedic Surgery, University of Schleswig-Holstein, Campus Lübeck, Germany,Justus Gille, MD, University of Schleswig-Holstein, Campus Lübeck, Department of Trauma and Orthopaedic Surgery, Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Julius Kunow
- Department of Trauma and Orthopaedic Surgery, University of Schleswig-Holstein, Campus Lübeck, Germany
| | - Luer Boisch
- Institute of Anatomy, University of Schleswig-Holstein, Campus Kiel, Germany
| | - Peter Behrens
- Department of Trauma and Orthopaedic Surgery, University of Schleswig-Holstein, Campus Lübeck, Germany
| | - Ingeborg Bos
- Institute of Pathology, University of Schleswig-Holstein, Campus Lübeck, Germany
| | - Christiane Hoffmann
- Institute of Anatomy, University of Schleswig-Holstein, Campus Kiel, Germany
| | - Wolfgang Köller
- Department of Trauma and Orthopaedic Surgery, University of Schleswig-Holstein, Campus Lübeck, Germany
| | - Martin Russlies
- Department of Trauma and Orthopaedic Surgery, University of Schleswig-Holstein, Campus Lübeck, Germany
| | - Bodo Kurz
- Institute of Anatomy, University of Schleswig-Holstein, Campus Kiel, Germany
| |
Collapse
|
38
|
Abstract
Medial clavicle fractures are the least common type of clavicular fractures. Although rare, such injuries deserve rapid diagnosis and effective treatment to avoid future complications. An optimal, standardized operative treatment has not been yet established. We report a case of medial clavicle fracture, where primary operative treatment was indicated due to gross dislocation. An open reduction and osteosynthesis with a modified hook plate was performed, leading to an excellent postoperative outcome after a sixteen-month follow-up. The hook plate seems to be a promising approach for the operative treatment of medial clavicle fractures.
Collapse
Affiliation(s)
- J Gille
- Department of Trauma and Reconstructive Surgery, BG- Trauma Hospital Hamburg, Bergedorfer Str. 10, 21033 Hamburg, Germany,Address for correspondence: Dr. Justus Gille, Department of Trauma and Reconstructive Surgery, BG-Trauma Hospital Hamburg, Bergedorfer Str. 10, 21033 Hamburg, Germany. E-mail:
| | - AP Schulz
- Department of Trauma and Reconstructive Surgery, BG- Trauma Hospital Hamburg, Bergedorfer Str. 10, 21033 Hamburg, Germany
| | - S Wallstabe
- Department of Trauma and Reconstructive Surgery, BG- Trauma Hospital Hamburg, Bergedorfer Str. 10, 21033 Hamburg, Germany
| | - A Unger
- Department of Trauma and Reconstructive Surgery, BG- Trauma Hospital Hamburg, Bergedorfer Str. 10, 21033 Hamburg, Germany
| | - C Voigt
- Friederikenstift GmbH Hannover, Humboldstr. 5, 30169 Hannover, Germany
| | - M Faschingbauer
- Department of Trauma and Reconstructive Surgery, BG- Trauma Hospital Hamburg, Bergedorfer Str. 10, 21033 Hamburg, Germany
| |
Collapse
|
39
|
Gille J, Suehwold J, Schulz AP, Kienast B, Unger A, Jürgens C. Deltoid muscular flap transfer for the treatment of irreparable rotator cuff tears. Orthop Rev (Pavia) 2009; 1:e15. [PMID: 21808677 PMCID: PMC3143977 DOI: 10.4081/or.2009.e15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 07/17/2009] [Accepted: 07/20/2009] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to evaluate the outcome of deltoid muscle flap transfer for the treatment of irreparable rotator cuff tears. In a retrospective study 20 consecutive patients were evaluated. The index procedure took place between 2000 and 2003. Fifteen patients were male, mean age was 62 years. Inclusion criterion was a rotator cuff defect Bateman grade IV. Exclusion criteria were smaller defects, shoulder instability and fractures of the injured shoulder. An open reconstruction with acromioplasty and a pedicled delta flap was performed. Follow up period was mean 42 months. Follow-up included clinical examination, Magnetic Resonance Imaging (MRI) and the Constant and Simple (CS) shoulder tests. According to the Constant shoulder test the results were good in 13 patients, fair in 5 and unsatisfactory in 2. The pre-operative Constant Score improved from mean 25.7 points (±5.3) to 72.3 (±7.8) at follow-up. The mean values for the subcategories of CS increased significantly from 3.9 to 14.4 points for pain and from 4.2 to 15.9 points for activities daily routine (p<0.05). The change in range of motion and strength were not significant (p>0.05). Results of the Simple Shoulder Test showed a significant increase of the mean values from pre-operative 4.3 to 14.7 points post-operatively. MRI showed a subacromial covering of the defect in all cases, all flaps where intact on MRI but always the flap showed marked fatty degeneration. In conclusion, the delta flap is a simple method for the repair of large defects of the rotator cuff leading to satisfying medium results.
Collapse
Affiliation(s)
- Justus Gille
- Department of Trauma and Reconstructive Surgery, University of Schleswig-Holstein, Germany
| | | | | | | | | | | |
Collapse
|
40
|
Gille J, Bisping OJ, Queitsch C, Voigt C, Jürgens C, Schulz AP. [Single bundle anterior cruciate ligament reconstruction using quadriceps tendon autografts]. Z Orthop Unfall 2009; 147:570-6. [PMID: 19806525 DOI: 10.1055/s-0029-1185696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM The purpose of this study was to evaluate postoperative outcome and functional scores after single bundle anterior cruciate ligament (ACL) reconstruction with the use of quadriceps tendon autografts after a 16 (12-24) month follow-up. METHOD 54 patients (9 women, 45 men, body mass index [BMI] 25.3 [18.1-36.3 kg/m (2)]) were included in this prospective series, treated between January 2004 and December 2005. Ligament stability was assessed with the Lachmann and pivot-shift tests and a KT 1000 arthrometer. Tegner index, Lysholm-Gilquist score and the International Knee Documentation Committee (IKDC) were employed to evaluate the functional outcomes. In addition, the single leg hop test was performed. RESULTS Ligament arthrometry using the KT 1000 arthrometer demonstrated a mean side-to-side difference of 1.53 mm (0.2-4.1 mm). Regarding the Lachmann test, 17 patients (32%) showed 1+ laxity and no patient had an abnormal pivot-shift. The mean Tegner activity score was 4.22 (1-10), the mean Lysholm score was 80.8 (20-100) and the mean IKDC score 68.1 (29-87). Results of the single leg hop test revealed a mean decline of the treated leg to 87.7% (70-100%) of the contralateral side. The mean extension was reduced by 1.7 degrees (0-10 degrees) on the treated knee and the flexion by 2.1 degrees (0-10 degrees), compared to the contralateral knee. CONCLUSION Single bundle anterior cruciate ligament reconstruction using quadriceps tendon demonstrates highly satisfactory results. Due to a moderate donor site morbidity and preservation of the medial stabilizing structures of the knee a wider use in primary cruciate ligament reconstruction may arise in the future.
Collapse
Affiliation(s)
- J Gille
- Abteilung für Unfallchirurgie, Orthopädie und Sporttraumatologie, BG-Unfallkrankenhaus Hamburg.
| | | | | | | | | | | |
Collapse
|
41
|
Kienast B, Gille J, Queitsch C, Kaiser MM, Thietje R, Juergens C, Schulz AP. Early Weight Bearing of Calcaneal Fractures Treated by Intraoperative 3D-Fluoroscopy and Locked-Screw Plate Fixation. Open Orthop J 2009; 3:69-74. [PMID: 19750017 PMCID: PMC2738828 DOI: 10.2174/1874325000903010069] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 07/21/2009] [Accepted: 07/24/2009] [Indexed: 11/24/2022] Open
Abstract
Operative therapy of intraarticular fractures of the calcaneus is an established surgical standard. The aim is an accurate reduction of the fracture with reconstruction of Boehler’s angle, length, axis and subtalar joint surface. Intraoperative 3D-fluoroscopy with the Siremobil Iso-C 3D® mobile C-arm system is a valuable assistant for accurate reconstruction of these anatomical structures. Remaining incongruities can be recognized and corrected intraoperatively. The achieved reduction can be fixed by the advantages of an internal fixator (locked-screw plate interface). In the period of October 2002 until April 2007 we operated 136 patients with intraarticular fractures of the calcaneus by means of anatomical reduction, and internal plate fixator under intraoperative control of 3D-fluoroscopy. All patients were supplied with an orthesis after the operation which allowed weight bearing of 10 kg for 12 weeks for the patients operated between October 2002 and October 2004 (Group A). Transient local osteoporosis was observed in all X-Rays at follow-up after an average of 8,6 months. Therefore we changed our postoperative treatment plan for the patients operated between November 2004 and April 2007 (Group B). Weight bearing started with 20 KG after 6 weeks, was increased to 40 KG after 8 weeks and full weight bearing was allowed after 10 weeks for these patients. In no case a secondary dislocation of the fracture was seen. No bone graft was used. At follow up the average American Foot and Ankle Society Score (AOFAS) were 81 for Group_A, compared to 84 for Group B, treated with earlier weight bearing. Autologous bone graft was not necessary even if weight bearing was started after a period of six weeks postoperatively. The combination of 3D-fluoroscopy with locked internal fixation showed promising results. If the rate of patients developing subtalar arthrosis will decrease by this management will have to be shown in long term follow up.
Collapse
Affiliation(s)
- B Kienast
- Department of Traumatology, Orthopaedics and Sports Medicine, BG Trauma Center Hamburg, Germany
| | | | | | | | | | | | | |
Collapse
|
42
|
Stuhr M, Gille J, Lüthke M, Kappus S, Püschel K, Faschingbauer M. Herzbeuteltamponade nach thorakaler Stichverletzung bei einem Kind. Notf Rett Med 2009. [DOI: 10.1007/s10049-009-1200-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
43
|
Gille J, Gille M, Gahr R, Wiedemann B. [Acute pain management in proximal femoral fractures: femoral nerve block (catheter technique) vs. systemic pain therapy using a clinic internal organisation model]. Anaesthesist 2009; 55:414-22. [PMID: 16320011 DOI: 10.1007/s00101-005-0949-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of this study was to compare safety and efficacy of catheter-mediated femoral nerve block analgesia with systemic pain therapy in patients with proximal femoral fractures in the pre-operative and post-operative setting using a protocol for coordinating pain management. METHODS In a prospective randomised trial of patients attending the emergency department, 100 individuals were selected with a clinically diagnosed proximal femoral fracture. Patients were divided into two equal groups A and B. Group A (n=50) received a catheter-mediated femoral nerve block with 1% prilocaine (40 ml) and post-operatively 0.2% ropivacaine (30 ml) 6 hourly. Group B (n=50) initially received intravenous metamizol (1 g) and a fixed combination of oral tilidine (100 mg) + naloxone (8 mg). Patients aged 90 years or more received a reduced dose (tilidine 75 mg + naloxone 6 mg). In the post-operative period regular oral ibuprofen (400 mg, 8 hourly) in addition to oral tilidine (50 mg) + naloxone (4 mg) was given as required for break through pain. Pain intensity was measured using a verbal rating scale (VRS) from 1 to 5: pain free (=1), mild pain (=2), moderate pain (=3), severe pain (=4), excruciating pain (=5). Pain scores were recorded at rest (R), during passive anteflection (30 degrees) of the hip (PA) on arrival and at 15 and 30 min after initial administration of analgesia. Thereafter, recordings were made 4 times a day up to the third post-operative day. RESULTS Pain scores were comparable for both groups on admission (VRS in R 2.50 vs. 2.46; VRS during PA 4.30 vs. 4.34). Significant pain relief was achieved in both groups following initial administration of analgesia, but the total pain scores in group A were significantly lower than in group B (VRS in R 1.22 vs. 1.58, p<0.01 and VRS during PA 2.66 vs. 3.26; p<0.001). No difference was noted between the two groups during the first 3 post-operative days. No severe complications occurred as a result of analgesia, however, the catheter was dislodged in 20% of patients in group A resulting in the need for systemically administered analgesia. CONCLUSION All patients presenting with proximal femoral fractures should receive adequate analgesia within the emergency department even prior to radiographic imaging. Femoral nerve block should be considered as the method of choice. The insertion of a femoral nerve block catheter has the dual advantage of early analgesia permitting repeated clinical examination in addition to continued post-operative pain management. The cumbersome logistics inherent in this technique within the clinical setting limits its practical application. An initial single-shot regional nerve block followed by a systemic post-operative analgesia protocol was considered an appropriate alternative. The execution of safe, consistent and appropriate regional nerve block anaesthesia is reliant on formal guidelines and protocols as agreed by the multidisciplinary teams involved with patient-directed pain management and good clinical practice.
Collapse
Affiliation(s)
- J Gille
- Klinik für Anästhesiologie, Intensiv- und Schmerztherapie, Städt Klinikum St Georg, Leipzig, Germany. Jochen.Gille@sankt georg.de
| | | | | | | |
Collapse
|
44
|
|
45
|
Abstract
Fractures of the humeral head account for 5% of all fractures and incidence increases with age. Depending on fracture form and patients age a wide variety of therapeutical options exist. Stable fractures can be treated conservatively, while the majority of unstable and displaced fractures require surgical treatment. Many different surgical options are available; open reduction and internal fixation are widely preferred. The S3 Proximal Humerus Plate is a contoured plate to match the complex shape of the proximal humerus. It is designed to be positioned distal to the greater tuberosity preventing subacromial impingement. Between august 1 and 30, 2007, 5 patients meeting the inclusion criteria (that is primary operative stabilization within 7 days after trauma in a standardized way and minimal follow up period of 3 month) with acute fractures of the proximal humerus were treated with S3 Proximal Humerus Plate. Follow up was performed using the Constant Score. The mean age was 59.0 years. According to the Neer classification fractures were rated as Neer 2,3 and 4. A mean Constant score of 72.3 (57-86) points was obtained. We did not observe any complications like humeral head necroses, loss of reduction, deep infection or breakage of the plate.
Collapse
Affiliation(s)
- J Gille
- BG-Trauma Hospital Hamburg, Bergedorfer Str., 10, D-21033 Hamburg, Germany
| | | | | | | | | |
Collapse
|
46
|
Kinnison DE, Gille J, Barnett J, Randall C, Harvey VL, Lambert A, Khosravi R, Alexander MJ, Bernath PF, Boone CD, Cavanaugh C, Coffey M, Craig C, Dean VC, Eden T, Ellis D, Fahey DW, Francis G, Halvorson C, Hannigan J, Hartsough C, Hepplewhite C, Krinsky C, Lee H, Mankin B, Marcy TP, Massie S, Nardi B, Packman D, Popp PJ, Santee ML, Yudin V, Walker KA. Global observations of HNO3from the High Resolution Dynamics Limb Sounder (HIRDLS): First results. ACTA ACUST UNITED AC 2008. [DOI: 10.1029/2007jd008814] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
47
|
|
48
|
Alexander MJ, Gille J, Cavanaugh C, Coffey M, Craig C, Eden T, Francis G, Halvorson C, Hannigan J, Khosravi R, Kinnison D, Lee H, Massie S, Nardi B, Barnett J, Hepplewhite C, Lambert A, Dean V. Global estimates of gravity wave momentum flux from High Resolution Dynamics Limb Sounder observations. ACTA ACUST UNITED AC 2008. [DOI: 10.1029/2007jd008807] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
49
|
Spieth K, Kaufmann R, Dummer R, Garbe C, Becker J, Hauschild A, Tilgen W, Ugurel S, Beyeler M, Bröcker E, Kaehler K, Pföhler C, Gille J, Leiter U, Schadendorf D. Temozolomide plus pegylated interferon alfa-2b as first-line treatment for stage IV melanoma: a multicenter phase II trial of the Dermatologic Cooperative Oncology Group (DeCOG). Ann Oncol 2008; 19:801-6. [DOI: 10.1093/annonc/mdm565] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
50
|
Affiliation(s)
- M Meissner
- Zentrum für Dermatologie und Venerologie, Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main.
| | | | | | | | | |
Collapse
|