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Freischmidt H, Guehring T, Thomé P, Armbruster J, Reiter G, Grützner PA, Nolte PC. Treatment of Large Femoral and Tibial Bone Defects With Plate-Assisted Bone Segment Transport. J Orthop Trauma 2024; 38:285-290. [PMID: 38381977 DOI: 10.1097/bot.0000000000002784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/06/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVES The purposes of this study were to assess clinical and radiographic outcomes following plate-assisted bone segment transport (PABST) in large bone defects of the lower extremities. METHODS DESIGN Retrospective study of prospectively collected data. SETTING Level-1 trauma center located in Germany. PATIENT SELECTION CRITERIA Patients who underwent PABST and were at least 1 year postoperatively were included. OUTCOME MEASURES AND COMPARISONS Demographic data were collected. Radiographic apparent bone gap (RABG), time to consolidation, time to full weight-bearing, and consolidation index were calculated. Numeric rating scale, lower extremity functional scale (LEFS), and complications were assessed. RESULTS Fifteen patients [13 male; mean age 51 years (range, 20-75)] underwent PABST and had follow-up at a mean of 29.1 months. The tibia was affected in 8 and the femur in 7 patients. Preoperative RABG was 60 mm [interquartile range (IQR): 40-125], and bone defects were caused by septic nonunions in 73% of patients. Fourteen patients (93%) demonstrated consolidated transport callus at 7.3 months [95% confidence interval (95% CI), 6-8.5], and 9 patients (60%) demonstrated complete consolidation of both docking site and transport callus at 11.5 months (95% CI, 7.3-15.3). Postoperative RABG was 0.1 mm (IQR: 0-0.8), and consolidation index was 1.9 months/cm (95% CI, 1.3-2.5). All patients achieved full weight-bearing at 8.7 months (IQR: 6.5-10.3). LEFS was 42 (95% CI, 34-50), and numeric rating scale was 3 (95% CI, 2-4). Patients treated for tibial defects had a significantly higher consolidation rate compared with patients treated for femoral defects ( P = 0.040). CONCLUSIONS PABST demonstrated high consolidation of transport callus with few complications. Although full weight-bearing was achieved in all patients, complete consolidation of the docking site was only present in 60% of cases. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Holger Freischmidt
- Department of Trauma and Orthopedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany; and
| | - Thorsten Guehring
- Department of Shoulder and Elbow Surgery, Sportsmedicine & Traumatology, Diakonie Clinic Paulinenhilfe, Stuttgart, Germany
| | - Patrick Thomé
- Department of Trauma and Orthopedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany; and
| | - Jonas Armbruster
- Department of Trauma and Orthopedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany; and
| | - Gregor Reiter
- Department of Trauma and Orthopedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany; and
| | - Paul Alfred Grützner
- Department of Trauma and Orthopedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany; and
| | - Philip-Christian Nolte
- Department of Trauma and Orthopedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany; and
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El Barbari JS, Kohlhas L, Franke J, Grützner PA, Schnetzke M, Swartman BJ. Analyzing the reduction quality of the distal radioulnar joint after closed K-wire transfixation in a cadaver model: is supination or neutral position superior? Arch Orthop Trauma Surg 2024; 144:1603-1609. [PMID: 38441618 PMCID: PMC10965740 DOI: 10.1007/s00402-023-05181-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 12/11/2023] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Distal radioulnar joint (DRUJ) instabilities are challenging and their optimal treatment is controversial. In special cases or when reconstruction of the stabilizing triangular fibrocartilage complex (TFCC) fails, K-wire transfixation can be performed. However, no consensus has been reached regarding the rotational position of the forearm in which this should be done. Therefore, it was investigated whether anatomical reduction would best be achieved by transfixation in neutral position or supination of the forearm. MATERIALS AND METHODS Twelve cadaveric upper limbs were examined before dissection of the DRUJ stabilizing ligaments and after closed transfixation in both positions by C-arm cone-beam CT. Whether this was first done in neutral position or in supination was randomized. The change in the radioulnar ratio (RR) in percentage points (%points) was analyzed using Student's t-test. RR was used since it is a common and sensitive method to evaluate DRUJ reduction, expressing the ulnar head's position in the sigmoid notch as a length ratio. RESULTS The analysis showed an increased change in RR in neutral position with 5.4 ± 9.7%points compared to fixation in supination with 0.2 ± 16.1%points, yet this was not statistically significant (p = 0.404). CONCLUSIONS Neither position leads to a superior reduction in general. However, the result was slightly closer to the anatomical position in supination. Thus, transfixation of the DRUJ should be performed in the position in which reduction could best be achieved and based on these data, that tends to be in supination. Further studies are necessary to validate these findings and to identify influential factors.
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Affiliation(s)
- Jan Siad El Barbari
- BG Klinik Ludwigshafen, Department for Orthopaedics and Trauma Surgery, Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Laura Kohlhas
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Jochen Franke
- BG Klinik Ludwigshafen, Department for Orthopaedics and Trauma Surgery, Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Paul Alfred Grützner
- BG Klinik Ludwigshafen, Department for Orthopaedics and Trauma Surgery, Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Marc Schnetzke
- German Joint Center Heidelberg, ATOS Clinic Heidelberg, Heidelberg, Germany
| | - Benedict James Swartman
- BG Klinik Ludwigshafen, Department for Orthopaedics and Trauma Surgery, Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.
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Privalov M, Junge M, Jung MK, Vetter SY, Franke J, Hetjens S, Grützner PA, Stadthalter H. Comparison of T-POD and SAM Pelvic Sling II and the influence of attachment level in the initial management of unstable pelvic type C injuries - a cadaveric study. Int J Emerg Med 2024; 17:34. [PMID: 38438968 PMCID: PMC10910764 DOI: 10.1186/s12245-024-00610-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 02/22/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Type C pelvic fractures (AO/OTA) are severe injuries that frequently lead to bleeding and hemodynamic instability. Pelvic binders play a crucial role in their initial management. Placement at the correct level in the prehospital setting is challenging. The aim of this study was to compare two pelvic binders regarding their effectiveness in reducing intrapelvic volume and increasing intrapelvic pressure in patients with type C pelvic fractures (AO/OTA) when applied at three different levels. METHODS Rotationally and vertically unstable pelvic injuries (AO/OTA classification 61-C1.1) were produced in five fresh-frozen human cadaveric specimens. Intrapelvic volume, vesical pressure and compression pressure within the pubic symphysis and the sacroiliac joint were measured when applying a SAM Pelvic Sling II and a T-POD at the level of the greater trochanter as well as levels higher and lower than recommended. RESULTS Comparison of the two pelvic binders positioned at the recommended level (greater trochanter) showed no significant difference in volume reduction (13.85 ± 31.37 cm3, p = 0.442), however, increase in vesical pressure was significantly higher when using the T-POD (5.80 ± 3.27 cmH2O, p = 0.017). When positioned at the level of the iliac crest, vesical pressure increase and intrapelvic volume reduction were significantly greater with the T-POD (14.00 ± 8.57 cmH2O, p = 0.022 and 10.45 ± 5.45 cm3, p = 0.031 respectively). Application of the SAM Pelvic Sling II below the greater trochanter led to a significantly greater decrease in volume (-32.26 ± 7.52 cm3, p = 0.003) than the T-POD. Comparison of the recommended attachment level with incorrect positioning led to no significant differences for the T-POD, while the SAM Pelvic Sling II achieved a significantly lower volume reduction when placed at the iliac crest (40.15 ± 14.57 cm3, p = 0.012) and a significantly lower increase in vesical pressure when applied below the greater trochanter (3.40 ± 1.52 cmH2O, p = 0.007). CONCLUSION Direct comparison of the two pelvic binders showed that the T-POD achieved significantly greater results when applied at the recommended level and was less susceptible to incorrect positioning. These outcomes support the preferred use of the T-POD for prehospital emergency pelvic stabilisation.
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Affiliation(s)
- Maxim Privalov
- Department for Trauma and Orthopaedic Surgery, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Malte Junge
- Department for Trauma and Orthopaedic Surgery, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Matthias Karl Jung
- Department for Trauma and Orthopaedic Surgery, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Sven Yves Vetter
- Department for Trauma and Orthopaedic Surgery, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Jochen Franke
- Department for Trauma and Orthopaedic Surgery, Tauernklinikum, Paracelsusstraße 8, Zell am See, 5700, Austria
| | - Svetlana Hetjens
- Department of Medical Statistics, Biomathematics and Data Processing, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Paul Alfred Grützner
- Department for Trauma and Orthopaedic Surgery, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Holger Stadthalter
- Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhaus-Str. 12, 91054, Erlangen, Germany.
- Department for Trauma and Orthopaedic Surgery, AUVA Unfallkrankenhaus, Dr.-Franz-Rehrl-Platz 5, Salzburg, 5010, Austria.
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El Barbari JS, Fikuart M, Beisemann N, Müller M, Syrek H, Grützner PA, Franke J, Vetter SY. Improving Medical Photography in a Level 1 Trauma Center by Implementing a Specialized Smartphone-Based App in Comparison to the Usage of Digital Cameras: Prospective Panel Study. JMIR Form Res 2024; 8:e47572. [PMID: 38271087 PMCID: PMC10853857 DOI: 10.2196/47572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/19/2023] [Accepted: 09/25/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Medical photography plays a pivotal role in modern health care, serving multiple purposes ranging from patient care to medical documentation and education. Specifically, it aids in wound management, surgical planning, and medical training. While digital cameras have traditionally been used, smartphones equipped with specialized apps present an intriguing alternative. Smartphones offer several advantages, including increased usability and efficiency and the capability to uphold medicolegal standards more effectively and consistently. OBJECTIVE This study aims to assess whether implementing a specialized smartphone app could lead to more frequent and efficient use of medical photography. METHODS We carried out this study as a comprehensive single-center panel investigation at a level 1 trauma center, encompassing various settings including the emergency department, operating theaters, and surgical wards, over a 6-month period from June to November 2020. Using weekly questionnaires, health care providers were asked about their experiences and preferences with using both digital cameras and smartphones equipped with a specialized medical photography app. Parameters such as the frequency of use, time taken for image upload, and general usability were assessed. RESULTS A total of 65 questionnaires were assessed for digital camera use and 68 for smartphone use. Usage increased significantly by 5.4 (SD 1.9) times per week (95% CI 1.7-9.2; P=.005) when the smartphone was used. The time it took to upload pictures to the clinical picture and archiving system was significantly shorter for the app (mean 1.8, SD 1.2 min) than for the camera (mean 14.9, SD 24.0 h; P<.001). Smartphone usage also outperformed the digital camera in terms of technical failure (4.4% vs 9.7%; P=.04) and for the technical process of archiving (P<.001) pictures to the picture archiving and communication system (PACS) and display images (P<.001) from it. No difference was found in regard to the photographer's intent (P=.31) or reasoning (P=.94) behind the pictures. Additionally, the study highlighted that potential concerns regarding data security and patient confidentiality were also better addressed through the smartphone app, given its encryption capabilities and password protection. CONCLUSIONS Specialized smartphone apps provide a secure, rapid, and user-friendly platform for medical photography, showing significant advantages over traditional digital cameras. This study supports the notion that these apps not only have the potential to improve patient care, particularly in the realm of wound management, but also offer substantial medicolegal and economic benefits. Future research should focus on additional aspects such as patient comfort and preference, image resolution, and the quality of photographs, as well as seek to corroborate these findings through a larger sample size.
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Affiliation(s)
- Jan Siad El Barbari
- Department of Orthopaedics and Traumatology, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Maxim Fikuart
- Department of Orthopaedics and Traumatology, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Nils Beisemann
- Department of Orthopaedics and Traumatology, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany
| | | | | | - Paul Alfred Grützner
- Department of Orthopaedics and Traumatology, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Jochen Franke
- Department of Orthopaedics and Traumatology, Tauernklinikum, Zell am See, Austria
| | - Sven Yves Vetter
- Department of Orthopaedics and Traumatology, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany
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Beisemann N, Spiller YM, Schnetzke M, Grützner PA, Nolte PC. Hook plate fixation of Neer type II distal clavicle fractures results in satisfactory patient-reported outcomes but complications and revisions are high. BMC Musculoskelet Disord 2023; 24:850. [PMID: 37891527 PMCID: PMC10612360 DOI: 10.1186/s12891-023-06975-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Surgical treatment of distal clavicle fractures Neer type II is challenging. A gold standard has not yet been established, thus various surgical procedures have been described. The purpose of this study is to report the radiological and clinical outcomes using hook plate fixation in Neer type II distal clavicle fractures. METHODS We retrospectively reviewed data of 53 patients who underwent hook plate fixation between December 2009 and December 2019 with ≥ 2 years of follow-up. Patients with preexisting pathologies or concomitant injuries of the ipsilateral shoulder were excluded. Pre- and postoperative coracoclavicular distance (CCD), bony union and patient-reported outcomes were collected, including the Constant Score (CS) and Subjective Shoulder Value (SSV). Complications and revisions were recorded. RESULTS At a mean final follow-up of 6.2 years, mean SSV was 91.0% (range, 20-100) and mean CS was 80.9 points (range, 25-99). The mean preoperative CCD was 19.0 mm (range, 5.7-31.8), the mean postoperative CCD was 8.2 mm (range, 4.4-12.2) and the mean CCD following hardware removal was 9.7 mm (range, 4.7-18.8). The loss of reduction following hardware removal was statistically significant (P = 0.007). Eleven (20.8%) patients had complications, with 5 cases of deep or superficial infection (9.4%), four non-unions (7.5%), one periosteosynthetic fracture, one postoperative seroma, one implant failure and one symptomatic acromioclavicular joint arthritis (all 1.9%). A total of 10 patients (18.9%) underwent revision surgery at a mean of 113 (range, 7-631) days. CONCLUSION Medium-term patient-reported outcomes for hook plate fixation of Neer type II distal clavicle fractures are satisfactory; however, one in five patients suffers a complication with the majority of them requiring revision surgery.
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Affiliation(s)
- Nils Beisemann
- Department for Trauma and Orthopedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Yannik M Spiller
- Department for Trauma and Orthopedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Marc Schnetzke
- German Joint Centre, ATOS Clinic Heidelberg, Heidelberg, Germany
| | - Paul Alfred Grützner
- Department for Trauma and Orthopedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Philip-Christian Nolte
- Department for Trauma and Orthopedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany.
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Wich M, Scholtysik D, Grützner PA, Hoffmann R. [Reduction in Earning Capacity (MdE) Statutory Accident Insurance]. Rehabilitation (Stuttg) 2023; 62:308-318. [PMID: 37848041 DOI: 10.1055/a-2145-4359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Changes in the employment market and improvements in the current prosthetic treatment have encouraged German Statutory Health Insurance e. V. (DGUV) to re-examine the standard values for reduced earning capacity after work related accidents. The new standard values for reduced earning capacity came into force on 01.11.2019. The present article summarises the consensus paper of the group of independent experts.
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Hogan A, Danzer NM, Blaschke L, Grützner PA, Mandelka E, Trinler U, Vetter SY. Influence of quality of reduction using radiological criteria on kinematics and kinetics in ankle fractures with unstable syndesmotic injury. Clin Biomech (Bristol, Avon) 2023; 108:106054. [PMID: 37541033 DOI: 10.1016/j.clinbiomech.2023.106054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND In ankle fractures with syndesmotic injury, the anatomic reduction of the ankle mortise is crucial for preventing osteoarthritis. Yet, no studies have analysed the effect of surgical reduction after unstable ankle fractures on patients' active functional outcome. METHODS The Intraoperative 3D imaging data of patients surgically treated between 2012 and 2019 for ankle fracture with concomitant syndesmotic injury were reviewed. 58 patients were allocated to two groups depending on whether the criteria for radiologically optimal reduction were met (39 patients) or not (19 patients). Criteria for optimal reduction were composed of objectively measured and subjectively rated data. After undertaking the Olerud/Molander ankle score, a gait analysis and several active function tests using 3D motion capture were performed in order to evaluate kinetic and kinematic differences between both groups. FINDINGS Patients showed deficits of range of motion and balance parameters on the injured ankle, however, there were no significant differences between both groups. INTERPRETATION Although, the data did not show that radiological reduction criteria have a statistically significant effect on active functional outcome after a mean follow up time of 5.7 years, tendencies for a better outcome of patients that met the criteria could be seen. It also must be taken into consideration that results are limited by case number and allocation ratio, which made a sub-analysis of the separate reduction criteria unfeasible.
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Affiliation(s)
- Aidan Hogan
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | | | - Laura Blaschke
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | | | - Eric Mandelka
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | - Ursula Trinler
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | - Sven Y Vetter
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany.
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Nolte PC, Kemmerer M, Spranger N, Hackl S, von Recum J, Grützner PA, Reiter G. [Plate-assisted bone segment transport for bone defects of the lower extremities : Possibilities and limitations of treatment]. Unfallchirurgie (Heidelb) 2023; 126:200-207. [PMID: 36715719 DOI: 10.1007/s00113-023-01291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 01/31/2023]
Abstract
Large bone defects of the lower extremities are challenging for both patients and the treating orthopedic surgeons. The treatment is determined by the size and location of the defect; however, patient-specific factors, such as the soft tissue situation and the presence of systemic comorbidities must be taken into consideration in the treatment strategy. Osteodistraction is an excellent technique especially for large bone defects exceeding 3 cm; however, it is time-consuming and required external fixation prior to the development of motorized distraction nails. This article describes the procedure for the treatment of large bone defects of the lower extremities, with its possibilities and limitations, using the novel plate-assisted bone segment transport (PABST) procedure.
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Affiliation(s)
- Philip-Christian Nolte
- Abteilung für Unfallchirurgie und Orthopädie, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland.
| | - Matthias Kemmerer
- Abteilung für Unfallchirurgie und Orthopädie, BG Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland
| | - Nikolai Spranger
- Abteilung für Unfallchirurgie und Orthopädie, BG Klinikum Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Deutschland
| | - Simon Hackl
- Abteilung für Unfallchirurgie und Orthopädie, BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau, Deutschland
| | - Jan von Recum
- Abteilung für Unfallchirurgie und Orthopädie, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
| | - Paul Alfred Grützner
- Abteilung für Unfallchirurgie und Orthopädie, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
| | - Gregor Reiter
- Abteilung für Unfallchirurgie und Orthopädie, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
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Keil H, Beisemann N, Swartman B, Schnetzke M, Vetter SY, Grützner PA, Franke J. Intraoperative revision rates due to three-dimensional imaging in orthopedic trauma surgery: results of a case series of 4721 patients. Eur J Trauma Emerg Surg 2023; 49:373-381. [PMID: 36048181 PMCID: PMC9925545 DOI: 10.1007/s00068-022-02083-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/08/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Intraoperative 3D imaging has become a valued tool in assessing the quality of reduction and implant placement in orthopedic trauma surgery. In our institution, 3D imaging is used routinely since 2001. To evaluate the intraoperative findings and consequences of this technique, intraoperative revision rates in cases with 3D imaging were analyzed. METHODS All operative procedures carried out with intraoperative 3D imaging between August 2001 and December 2016 were included. The scans were assessed intraoperatively and documented thereafter. In case of malreduction or misplaced implants, an immediate revision was performed. The number of scans per case as well as the findings and consequences drawn regarding the anatomical region were analyzed. RESULTS 4721 cases with 7201 3D scans were included in this study. The most common anatomical regions were the ankle (22.3%), the calcaneus (14.8%) and the tibial head (9.5%). In 19.1% of all cases, an intraoperative revision was performed. The highest revision rates were found with 36.0% in calcaneal fractures, 24.8% in fractures of the tibial plateau, 22.3% in injuries of the ankle. In 52.0% of revisions, the reduction was improved regarding intra-articular steps or joint congruency. In 30.5% an implant was corrected. CONCLUSION Intraoperative revision due to results of 3D imaging was performed in almost one-fifth of cases. This illustrates the improved possibilities to detect malreduction and implant misplacements intraoperatively and thus the abilities to improve surgical outcome. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Holger Keil
- grid.5330.50000 0001 2107 3311Department of Trauma and Orthopedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen, Krankenhaus-street. 12, 91054 Erlangen, Germany
| | - Nils Beisemann
- grid.7700.00000 0001 2190 4373BG Trauma Center Ludwigshafen at Ruprecht-Karls-Universität Heidelberg, Ludwig-Guttmann-Street. 13, 67071 Ludwigshafen, Germany
| | - Benedict Swartman
- grid.7700.00000 0001 2190 4373BG Trauma Center Ludwigshafen at Ruprecht-Karls-Universität Heidelberg, Ludwig-Guttmann-Street. 13, 67071 Ludwigshafen, Germany
| | - Marc Schnetzke
- grid.7700.00000 0001 2190 4373BG Trauma Center Ludwigshafen at Ruprecht-Karls-Universität Heidelberg, Ludwig-Guttmann-Street. 13, 67071 Ludwigshafen, Germany
| | - Sven Yves Vetter
- grid.7700.00000 0001 2190 4373BG Trauma Center Ludwigshafen at Ruprecht-Karls-Universität Heidelberg, Ludwig-Guttmann-Street. 13, 67071 Ludwigshafen, Germany
| | - Paul Alfred Grützner
- grid.7700.00000 0001 2190 4373BG Trauma Center Ludwigshafen at Ruprecht-Karls-Universität Heidelberg, Ludwig-Guttmann-Street. 13, 67071 Ludwigshafen, Germany
| | - Jochen Franke
- BG Trauma Center Ludwigshafen at Ruprecht-Karls-Universität Heidelberg, Ludwig-Guttmann-Street. 13, 67071, Ludwigshafen, Germany.
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Böcker AH, Gramlich Y, Hoffmann R, Hirche C, Gather A, Grützner PA, Kneser U. Etablierung von interdisziplinären Extremitätenboards: ein wichtiger Beitrag zur Verbesserung der Versorgung von Patienten mit komplexem
Extremitätentrauma. Z Orthop Unfall 2022; 160:607-612. [PMID: 36451608 DOI: 10.1055/a-1924-6581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Arne Hendrik Böcker
- Klinik Für Hand, Plastische und Rekonstruktive Chirurgie, Plastische Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwigshafen, Deutschland
| | - Yves Gramlich
- Klinik für Unfallchirurgie und Orthopädie, BG Klinik Frankfurt, Frankfurt am Main, Deutschland
| | - Reinhard Hoffmann
- Klinik für Unfallchirurgie und Orthopädie, BG Klinik Frankfurt, Frankfurt am Main, Deutschland
| | - Christoph Hirche
- Klinik für Plastische-, Hand- und Rekonstruktive Mikrochirurgie, Handtrauma- und Replantationszentrum, BG Klinik Frankfurt, Frankfurt am Main, Deutschland
| | - Andreas Gather
- Klinik für Unfallchirurgie und Orthopädie, BG Klinik Ludwigshafen, Ludwigshafen, Deutschland
| | - Paul Alfred Grützner
- Klinik für Unfallchirurgie und Orthopädie, BG Klinik Ludwigshafen, Ludwigshafen, Deutschland
| | - Ulrich Kneser
- Klinik Für Hand, Plastische und Rekonstruktive Chirurgie, Plastische Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwigshafen, Deutschland
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11
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Jessen M, Schnetzke M, Studier-Fischer S, Grützner PA, Gühring T, Porschke F. Morphologic Alterations of the Sternoclavicular Joint following Ipsilateral Clavicle Fractures. Int J Environ Res Public Health 2022; 19:15011. [PMID: 36429729 PMCID: PMC9690708 DOI: 10.3390/ijerph192215011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
RATIONALE To our knowledge, no study has investigated concomitant injuries of the sternoclavicular joint (SCJ) in acute clavicle fractures. The purpose of this study was to determine the effect of an ipsilateral clavicle fracture on the SCJ in a systematic computer tomography (CT) morphologic evaluation. METHODS CT scans in the axial and coronal plane of 45 consecutive patients with clavicle fractures were retrospectively analyzed. The scans were assessed regarding anatomic congruence of bilateral SCJs-joint space width (JSW); the position of bilateral medial clavicles (PC); and the non-fusion of epiphyses, arthritis, calcifications, and intra-articular gas. RESULTS The mean SCJ JSW was significantly different in the coronal (cJSW; 8.70 mm ± 2.61 mm in affected vs. 7.63 mm ± 2.58 mm in non-affected side; p = 0.001) and axial plane (aJSW; 9.40 mm ± 2.76 mm in affected vs. 9.02 ± 2.99 in non-affected SCJs; p = 0.044). The position of the medial clavicle showed a significant difference in the coronal plane (cPC; 14.31 mm ± 3.66 mm in the affected vs. 13.49 ± 3.34 in the non-affected side; p = 0.011), indicating a superior shift. CONCLUSION Acute clavicle fractures may be associated with an enlargement of the ipsilateral SCJ space width and a superior shift of the proximal clavicle. Both morphologic alterations could indicate concomitant injuries of the SCJ as well as a potential increase in the risk of SCJ instability.
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Affiliation(s)
- Malik Jessen
- Department of Trauma Surgery, Clinic Rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Marc Schnetzke
- German Joint Center Heidelberg, ATOS Clinic Heidelberg, Bismarckstr. 9-15, 69115 Heidelberg, Germany
| | - Stefan Studier-Fischer
- BG Trauma Center Ludwigshafen, Heidelberg University, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen, Germany
| | - Paul Alfred Grützner
- BG Trauma Center Ludwigshafen, Heidelberg University, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen, Germany
| | - Thorsten Gühring
- Orthopedic Clinic Paulinenhilfe, Diakonieklinikum Stuttgart, Rosenbergstr. 38, 70176 Stuttgart, Germany
| | - Felix Porschke
- BG Trauma Center Ludwigshafen, Heidelberg University, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen, Germany
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12
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Freischmidt H, Armbruster J, Rothhaas C, Titze N, Guehring T, Nurjadi D, Kretzer JP, Schmidmaier G, Grützner PA, Helbig L. Efficacy of an Antibiotic Loaded Ceramic-Based Bone Graft Substitute for the Treatment of Infected Non-Unions. Biomedicines 2022; 10:biomedicines10102513. [PMID: 36289775 PMCID: PMC9599187 DOI: 10.3390/biomedicines10102513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/26/2022] Open
Abstract
The treatment of non-unions is often complicated by segmental bone defects and bacterial colonization. Because of the limited availability of autologous bone grafts, tissue engineering focuses on antibiotic-loaded bone graft substitutes. HACaS+G is a resorbable calcium sulphate-hydroxyapatite loaded with gentamicin. The osteoinductive, osteoconductive, and anti-infective effect of HACaS+G has already been demonstrated in clinical studies on patients with chronic osteomyelitis. However, especially for the treatment of infected non-unions with segmental bone defects by HACaS+G, reliable clinical testing is difficult and sufficient experimental data are lacking. We used an already established sequential animal model in infected and non-infected rat femora to investigate the osteoinductive, osteoconductive, and anti-infective efficacy of HACaS+G for the treatment of infected non-unions. In biomechanical testing, bone consolidation could not be observed under infected and non-infected conditions. Only a prophylactic effect against infections, but no eradication, could be verified in the microbiological analysis. Using µ-CT scans and histology, osteoinduction was detected in both the infected and non-infected bone, whereas osteoconduction occurred only in the non-infected setting. Our data showed that HACaS+G is osteoinductive, but does not have added benefits in infected non-unions in terms of osteoconduction and mechanical bone stability, especially in those with segmental bone defects.
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Affiliation(s)
- Holger Freischmidt
- Department of Trauma and Orthopedic Surgery, BG Klinikum Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany
- Correspondence: (H.F.); (L.H.)
| | - Jonas Armbruster
- Department of Trauma and Orthopedic Surgery, BG Klinikum Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany
| | - Catharina Rothhaas
- Department of Trauma and Orthopedic Surgery, BG Klinikum Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany
| | - Nadine Titze
- Department of Trauma and Orthopedic Surgery, BG Klinikum Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany
| | - Thorsten Guehring
- Trauma Centre, Hospital Paulinenhilfe Stuttgart at Tübingen University Hospital, Rosenbergstr. 38, 70176 Stuttgart, Germany
| | - Dennis Nurjadi
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
- Department of Infectious Diseases and Microbiology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Jan Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Gerhard Schmidmaier
- Clinic for Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany
| | - Paul Alfred Grützner
- Department of Trauma and Orthopedic Surgery, BG Klinikum Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany
| | - Lars Helbig
- Clinic for Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany
- Correspondence: (H.F.); (L.H.)
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13
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Abstract
BACKGROUND When using mobile 3D C-arms, impairments in image quality occur due to artefacts caused by metal implants as well as to the limited field of view. To avoid these restrictions, special computed tomography devices were designed, in order to improve image quality and to meet requirements for intraoperative usage. OBJECTIVES To analyse practicability and benefits of a mobile intraoperative CT device (Airo, Brainlab, Munich, Germany) on the basis of several parameters that were obtained during a 40-month period. MATERIALS AND METHODS All procedures that were performed with usage of intraoperative CT between January 2017 and April 2020 were analysed with respect to anatomical region, count of scans, duration of scans, consequences drawn from the scans and use of navigation. RESULTS 354 CT-scans were performed in 171 patients (mean 2.07 [1 - 6] scans per procedure). 47.81% of the procedures were spinal, 52.19% affected the pelvis. 83% of the procedures were navigated. In 22% of patients, improvement in implant placement or reduction was achieved; in most patients (55%), a guidewire for pedicle screws was corrected. The mean scan duration was 10.33 s (3.54 - 21.72). CONCLUSIONS Use of intraoperative CT was reliable and helpful. Integration in OR standards requires more effort than mobile 3D C-arms. Image quality was outstanding for intraoperative conditions and allowed proper assessment of implant placement and reduction in all cases. Due to the high financial outlay of the system and the good image quality of 3D C-arms in the extremities, we assume that this procedure can be applied in intraoperative CT in traumatological cases in spinal and pelvic surgery in high-level trauma centres.
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Affiliation(s)
- Holger Keil
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Department of Trauma and Orthopaedic Surgery, University Hospital Erlangen, Germany
| | - Sven Y Vetter
- BG Trauma Center at Ruprecht-Karls-Universität Heidelberg, Ludwigshafen, Germany
| | - Paul Alfred Grützner
- BG Trauma Center at Ruprecht-Karls-Universität Heidelberg, Ludwigshafen, Germany
| | - Jochen Franke
- BG Trauma Center at Ruprecht-Karls-Universität Heidelberg, Ludwigshafen, Germany
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14
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Wölfl C, Schweppenhäuser D, Gühring T, Takur C, Höner B, Kneser U, Grützner PA, Kolios L. Correction: Characteristics of bone turnover in the long bone metaphysis fractured patients with normal or low Bone Mineral Density (BMD). PLoS One 2022; 17:e0270079. [PMID: 35696449 PMCID: PMC9191733 DOI: 10.1371/journal.pone.0270079] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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15
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Freischmidt H, Armbruster J, Rothhaas C, Titze N, Guehring T, Nurjadi D, Sonntag R, Schmidmaier G, Grützner PA, Helbig L. Treatment of Infection-Related Non-Unions with Bioactive Glass-A Promising Approach or Just Another Method of Dead Space Management? Materials (Basel) 2022; 15:ma15051697. [PMID: 35268930 PMCID: PMC8911496 DOI: 10.3390/ma15051697] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 12/17/2022]
Abstract
The treatment of infected and non-infected non-unions remains a major challenge in trauma surgery. Due to the limited availability of autologous bone grafts and the need for local anti-infective treatment, bone substitutes have been the focus of tissue engineering for years. In this context, bioactive glasses are promising, especially regarding their anti-infective potential, which could reduce the need for local and systemic treatment with conventional antibiotics. The aim of this study was to investigate the osteoinductive and osteoconductive effects, as well as the anti-infectious potential, of S53P4 using a standardized non-union model, which had not been investigated previously. Using an already established sequential animal model in infected and non-infected rat femora, we were able to investigate bioactive glass S53P4 under realistic non-union conditions regarding its osteoinductive, osteoconductive and anti-infective potential with the use of µCT scans, biomechanical testing and histological, as well as microbiological, analysis. Although S53P4 did not lead to a stable union in the non-infected or the infected setting, µCT analysis revealed an osteoinductive effect of S53P4 under non-infected conditions, which was diminished under infected conditions. The osteoconductive effect of S53P4 remained almost negligible in histological analysis, even 8 weeks after treatment. Additionally, the expected anti-infective effect could not be demonstrated. Our data suggested that S53P4 should not be used in infected non-unions, especially in those with large bone defects.
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Affiliation(s)
- Holger Freischmidt
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany; (H.F.); (J.A.); (C.R.); (N.T.); (P.A.G.)
| | - Jonas Armbruster
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany; (H.F.); (J.A.); (C.R.); (N.T.); (P.A.G.)
| | - Catharina Rothhaas
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany; (H.F.); (J.A.); (C.R.); (N.T.); (P.A.G.)
| | - Nadine Titze
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany; (H.F.); (J.A.); (C.R.); (N.T.); (P.A.G.)
| | - Thorsten Guehring
- Trauma Centre, Hospital Paulinenhilfe Stuttgart at Tübingen University Hospital, Rosenbergstr. 38, 70176 Stuttgart, Germany;
| | - Dennis Nurjadi
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany;
| | - Robert Sonntag
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany;
| | - Gerhard Schmidmaier
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany;
| | - Paul Alfred Grützner
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany; (H.F.); (J.A.); (C.R.); (N.T.); (P.A.G.)
| | - Lars Helbig
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany;
- Correspondence:
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16
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Beisemann N, Mandelka E, El Barbari JS, Kreher B, Vetter SY, Grützner PA, Franke J. Software-Automated Implant Detection for Intraoperative 3D Imaging-First Clinical Evaluation on 214 Data Sets. J Digit Imaging 2022; 35:514-523. [PMID: 35146612 PMCID: PMC9156648 DOI: 10.1007/s10278-022-00588-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 12/03/2021] [Accepted: 01/14/2022] [Indexed: 11/16/2022] Open
Abstract
Previous studies have demonstrated a frequent occurrence of screw/K-wire malpositioning during surgical fracture treatment under 2D fluoroscopy and a correspondingly high revision rate as a result of using intraoperative 3D imaging. In order to facilitate and accelerate the diagnosis of implant malpositioning in 3D data sets, this study investigates two versions of an implant detection software for mobile 3D C-arms in terms of their detection performance based on comparison with manual evaluation. The 3D data sets of patients who had received surgical fracture treatment at five anatomical regions were extracted from the research database. First, manual evaluation of the data sets was performed, and the number of implanted implants was assessed. For 25 data sets, the time required by four investigators to adjust each implant was monitored. Subsequently, the evaluation was performed using both software versions based on the following detection parameters: true-positive-rate, false-negative-rate, false-detection-rate and positive predictive value. Furthermore, the causes of false positive and false negative detected implants depending on the anatomical region were investigated. Two hundred fourteen data sets with overall 1767 implants were included. The detection parameters were significantly improved (p<.001) from version 1 to version 2 of the implant detection software. Automatic evaluation required an average of 4.1±0.4 s while manual evaluation was completed in 136.15±72.9 s (p<.001), with a statistically significant difference between experienced and inexperienced users (p=.005). In summary, version 2 of the implant detection software achieved significantly better results. The time saved by using the software could contribute to optimizing the intraoperative workflow.
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Affiliation(s)
- Nils Beisemann
- Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Eric Mandelka
- Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Jan S El Barbari
- Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | | | - Sven Y Vetter
- Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Paul Alfred Grützner
- Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Jochen Franke
- Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.
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17
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Swartman B, Pelzer J, Beisemann N, Schnetzke M, Keil H, Vetter SY, Grützner PA, Franke J. Fracture reduction and screw position after 3D-navigated and conventional fluoroscopy-assisted percutaneous management of acetabular fractures: a retrospective comparative study. Arch Orthop Trauma Surg 2021; 141:593-602. [PMID: 32519074 DOI: 10.1007/s00402-020-03502-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 05/31/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Navigational techniques in orthopaedic trauma surgery have developed over the last years leaving the question of really improving quality of treatment. Especially in marginal surgical indications, their benefit has to be evident. The aim of this study was to compare reduction and screw position following 3D-navigated and conventional percutaneous screw fixation of acetabular fractures. The study hypothesis postulated that better fracture reduction and better screw position are obtained with 3D navigation. MATERIALS AND METHODS Preoperative and postoperative CT scans of 37 acetabular fractures treated by percutaneous screw fixation (24 3D-navigated, 13 conventional) were evaluated. Differences in pre- and postoperative fracture gaps and steps were compared in all reconstructions as well as the screw position relative to the joint and the fracture. RESULTS The differences in fracture gaps and fracture steps with and without 3D navigation were not significantly different. Distance of the screw from the joint line, angle difference between screw and ideal angle relative to the fracture line, length of the possible corridor used and position of the screw thread did not show any significant differences. CONCLUSION Comparison of 3D-navigated and conventional percutaneous surgery of acetabular fractures on the basis of pre- and postoperative CTs revealed no significant differences in terms of fracture reduction and screw position.
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Affiliation(s)
- B Swartman
- Department for Trauma and Orthopaedic Surgery, BG-Klinik Ludwigshafen, Trauma Surgery Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - J Pelzer
- Department for Trauma and Orthopaedic Surgery, BG-Klinik Ludwigshafen, Trauma Surgery Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - N Beisemann
- Department for Trauma and Orthopaedic Surgery, BG-Klinik Ludwigshafen, Trauma Surgery Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - M Schnetzke
- Department for Trauma and Orthopaedic Surgery, BG-Klinik Ludwigshafen, Trauma Surgery Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - H Keil
- Department for Trauma and Orthopaedic Surgery, BG-Klinik Ludwigshafen, Trauma Surgery Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - S Y Vetter
- Department for Trauma and Orthopaedic Surgery, BG-Klinik Ludwigshafen, Trauma Surgery Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - P A Grützner
- Department for Trauma and Orthopaedic Surgery, BG-Klinik Ludwigshafen, Trauma Surgery Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Jochen Franke
- Department for Trauma and Orthopaedic Surgery, BG-Klinik Ludwigshafen, Trauma Surgery Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.
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18
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Biglari B, Heller RA, Hörner M, Sperl A, Bock T, Reible B, Haubruck P, Grützner PA, Moghaddam A. Novel approach to an early assessment of a patient's potential for neurological remission after acute spinal cord injury: Analysis of hemoglobin concentration dynamics. J Spinal Cord Med 2021; 44:229-240. [PMID: 31211658 PMCID: PMC7952079 DOI: 10.1080/10790268.2019.1632060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Context/objective: Examining hemoglobin (Hb) dynamics with regard to the potential of neurological remission in patients with traumatic spinal cord injury (TSCI).Design: Prospective Clinical Observational Study.Setting: BG Trauma Centre Ludwigshafen, Department of Paraplegiology, Rhineland-Palatinate, Germany.Methods: From 2011 to 2017 a total of 80 patients with acute spinal injury were enrolled and divided into three groups: initial neurological impairment either with (G1; n = 33) or without subsequent neurological remission (G0; n = 35) and vertebral fractures without initial neurological impairment as control group (C; n = 12). Blood samples were taken for 3 months at 11 time-points after injury. Analyses were performed using routine diagnostics.Outcome measures: Multiple logistic regression was used to determine the prognostic value of Hb regarding neurological remission respecting clinical covariates.Results: Data showed elevated mean Hb concentrations in G1 from the third day to 1 month compared to G0, Hb levels were significantly higher in G1 after 3 days (P = 0.03, G1 > G0). The final multiple logistic regression model based on this data predicting the presence of neurological remission resulted in an AUC (area under the curve) of 80.5% (CI: 67.8%-93.2%) in the ROC (receiver operating characteristic) analysis.Conclusion: Elevated Hb concentrations are associated with a higher likelihood of neurological remission. Elevated concentrations of Hb in G1 compared to G0 over time might be linked to both a better initial oxygen supply response and a decreased ECM (extracellular matrix) degradation highlighting the role of Hb as a valuable biomarker for neural regeneration after TSCI.
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Affiliation(s)
- Bahram Biglari
- Department of Paraplegiology, BG Trauma Centre Ludwigshafen, Ludwigshafen, Germany,Correspondence to: Bahram Biglari, Head of the Department, Department of Paraplegiology, BG Trauma Centre Ludwigshafen, Ludwig-Guttmann-Straße 13, Ludwigshafen am Rhein67071, Germany; Ph: +49/(0) 621 6810-2571.
| | - Raban Arved Heller
- Heidelberg Trauma Research Group, Department of Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and SCI, Heidelberg University Hospital, Heidelberg, Germany
| | - Manuel Hörner
- Heidelberg Trauma Research Group, Department of Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and SCI, Heidelberg University Hospital, Heidelberg, Germany
| | - Andre Sperl
- Heidelberg Trauma Research Group, Department of Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and SCI, Heidelberg University Hospital, Heidelberg, Germany
| | - Tobias Bock
- Heidelberg Trauma Research Group, Department of Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and SCI, Heidelberg University Hospital, Heidelberg, Germany
| | - Bruno Reible
- Heidelberg Trauma Research Group, Department of Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and SCI, Heidelberg University Hospital, Heidelberg, Germany
| | - Patrick Haubruck
- Heidelberg Trauma Research Group, Department of Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and SCI, Heidelberg University Hospital, Heidelberg, Germany
| | - Paul Alfred Grützner
- Department of Trauma Surgery and Orthopaedics, BG Trauma Centre Ludwigshafen, Ludwigshafen, Germany
| | - Arash Moghaddam
- Aschaffenburg Trauma and Orthopaedic Research Group, Center for Orthopaedics, Trauma Surgery and Sports Medicine, Hospital Aschaffenburg-Alzenau, Aschaffenburg, Germany
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Abstract
BACKGROUND Pseudarthrosis can develop as a complication after conservative or operative fracture treatment and after elective orthopedic surgery. The treatment is challenging and is made more difficult when accompanied by large soft tissue defects or impairments in wound healing. In this case close and early coordination between trauma and plastic surgeons is crucial in order to develop a coherent and interdisciplinary treatment plan. METHODS Due to the positive effects on bone consolidation and osteomyelitis, timely soft tissue reconstruction via a pedicled vascularized flap or free flap coverage should be preferred. If blood circulation in the affected extremity appears to be compromised, this should first be optimized by vascular intervention or bypass surgery. In atrophic, aseptic pseudarthrosis, bone and soft tissue reconstruction can be performed consecutively in one single procedure, whereas septic pseudarthrosis always require complete resection of all infected debris prior to wound closure. Examples of two commonly used free flaps are the latissimus dorsi muscle flap and the fasciocutaneous anterolateral thigh (ALT) flap. As multiple variations have been described for both procedures, the reconstructive portfolio lists many additional options available for soft tissue reconstruction. Fasciocutaneous flaps should be preferred whenever bone consolidation requires additional surgical interventions in the future.
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Affiliation(s)
- T Cordts
- Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie - Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
| | - A K Bigdeli
- Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie - Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
| | - C Hirche
- Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie - Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
| | - J F Hernekamp
- Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Martin Luther Krankenhaus, Berlin, Deutschland
| | - P A Grützner
- Klinik für Unfallchirurgie und Orthopädie, BG Klinik Ludwigshafen, Ludwigshafen, Deutschland
| | - G Reiter
- Klinik für Unfallchirurgie und Orthopädie, BG Klinik Ludwigshafen, Ludwigshafen, Deutschland
| | - U Kneser
- Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie - Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
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20
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Freischmidt H, Armbruster J, Reiter G, Grützner PA, Helbig L, Guehring T. Individualized Techniques of Implant Coating with an Antibiotic-Loaded, Hydroxyapatite/Calcium Sulphate Bone Graft Substitute. Ther Clin Risk Manag 2020; 16:689-694. [PMID: 32848402 PMCID: PMC7425659 DOI: 10.2147/tcrm.s242088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 06/28/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The treatment of fracture- or non-union-related infections has persistently been a major challenge for both patients and treating surgeons. With rising aging of patients and increasing comorbidities, combined with the heterogeneity of germs and any number of multi-resistance against standard antibiotics, a successful treatment is increasingly difficult. One potential solution could be a custom-made individualized antibacterial coating of standard implants with a biphasic degradable biocarrier (Cerament G/V, supplied by Bonesupport AB, Lund, Sweden) that releases high doses of antibiotics around the bone-implant-interface. Here, we describe our technique of coating intramedullary nails, plates and press-fit shoulder endoprostheses which may prevent bacterial adhesion and biofilm formation. So far, there is very limited experience in individual coating of implants in hip or knee endoprostheses to prevent reoccurrence of surgical-site infection. Currently, no reports are available for coating of stems of shoulder prosthesis and nails or plates for fracture fixation. METHODS Here, we show our first experiences with a new individualized surgical technique of coating these implants with a resorbable antibiotic-loaded hydroxyapatite/calcium sulphate biocomposite to prevent biofilm formation and thereby recurrence of bone or joint infection. We describe three cases for coating of plates and nails for fracture fixation and coating of stems of a shoulder prosthesis. RESULTS No adverse events of the resorbable bone graft substitute were observed. In all of the cases, no recurrence of the infection was observed and osseointegration was achieved. After implant coating of the shoulder prosthesis, no radiological signs of loosening were detected. CONCLUSION We present a new surgical approach of a surface coating of plates, intramedullary nails or prostheses. The osteoconductive- and anti-inflammatory effect of the gentamicin- or vancomycin-loaded hydroxyapatite/calcium sulphate bone graft substitutes shows promising results.
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Affiliation(s)
- Holger Freischmidt
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen am Rhein 67071, Germany
| | - Jonas Armbruster
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen am Rhein 67071, Germany
| | - Gregor Reiter
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen am Rhein 67071, Germany
| | - Paul Alfred Grützner
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen am Rhein 67071, Germany
| | - Lars Helbig
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg69118, Germany
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21
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Luxenhofer M, Beisemann N, Schnetzke M, Vetter SY, Grützner PA, Franke J, Keil H. Diagnostic accuracy of intraoperative CT-imaging in complex articular fractures - a cadaveric study. Sci Rep 2020; 10:4530. [PMID: 32161337 PMCID: PMC7066240 DOI: 10.1038/s41598-020-61267-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/25/2020] [Indexed: 11/09/2022] Open
Abstract
Anatomic reconstruction of articular fractures is one of the critical factors in later achieving good functional outcome. Intraoperative 3D imaging has been shown to offer better evaluation and therefore can significantly improve the results. The purpose of this study was to assess the difference between intraoperative three-dimensional fluoroscopy (3D) and intraoperative computed tomography (iCT) imaging regarding fracture reduction, implant placement and articular impressions in a distal humeral fracture model. AO type 13-B2 fracture pattern were created in upper extremity cadaver specimens. Articular step-offs, intra-articular screw placement and intraarticular impressions of different degrees of severity were created. All specimens had imaging performed. For each articular pattern 3D fluoroscopy in standard (3Ds) and high quality (3Dh) were performed (Arcadis Orbic, Siemens, Germany) as well as an intraoperative CT scan (iCT, Airo, Brainlab, Germany). Three observers evaluated all imaging studies regarding subjective and objective parameters. iCT is more precise than 3D fluoroscopic imaging for detection of articular impressions. Articular step-offs and intraarticular screw placement are similar for iCT and 3D. Subjective imaging quality is the highest for iCT and lowest for 3Ds. Intraoperative CT may be particularly useful in assessing articular impressions and providing a good subjective image quality for the surgeon.
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Affiliation(s)
- M Luxenhofer
- MINTOS research group - Medical Imaging and Navigation in Trauma and Orthopedic Surgery, Department for Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
- AGiTEC - Working Group for intraoperative imaging and integration of technologies of the DGOU, Berlin, Germany
| | - N Beisemann
- MINTOS research group - Medical Imaging and Navigation in Trauma and Orthopedic Surgery, Department for Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
- AGiTEC - Working Group for intraoperative imaging and integration of technologies of the DGOU, Berlin, Germany
| | - M Schnetzke
- MINTOS research group - Medical Imaging and Navigation in Trauma and Orthopedic Surgery, Department for Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
- AGiTEC - Working Group for intraoperative imaging and integration of technologies of the DGOU, Berlin, Germany
| | - S Y Vetter
- MINTOS research group - Medical Imaging and Navigation in Trauma and Orthopedic Surgery, Department for Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
- AGiTEC - Working Group for intraoperative imaging and integration of technologies of the DGOU, Berlin, Germany
| | - P A Grützner
- MINTOS research group - Medical Imaging and Navigation in Trauma and Orthopedic Surgery, Department for Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
- AGiTEC - Working Group for intraoperative imaging and integration of technologies of the DGOU, Berlin, Germany
| | - J Franke
- MINTOS research group - Medical Imaging and Navigation in Trauma and Orthopedic Surgery, Department for Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
- AGiTEC - Working Group for intraoperative imaging and integration of technologies of the DGOU, Berlin, Germany
| | - H Keil
- MINTOS research group - Medical Imaging and Navigation in Trauma and Orthopedic Surgery, Department for Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.
- AGiTEC - Working Group for intraoperative imaging and integration of technologies of the DGOU, Berlin, Germany.
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22
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Vetter SY, Euler J, Beisemann N, Swartman B, Keil H, Grützner PA, Franke J. Validation of radiological reduction criteria with intraoperative cone beam CT in unstable syndesmotic injuries. Eur J Trauma Emerg Surg 2020; 47:897-903. [PMID: 32100086 PMCID: PMC8321975 DOI: 10.1007/s00068-020-01299-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 01/03/2020] [Indexed: 12/11/2022]
Abstract
Purpose Acute unstable syndesmotic lesions are regularly treated with closed or open reduction and fixation with either a positioning screw or tight rope. Conventional fluoroscopy is limited to identify a malreduction of the ankle mortise. The aim of the study was to validate the reduction criteria of intraoperative cone beam CT in unstable syndesmotic injuries by analyzing the clinical outcome. Methods Acute unstable syndesmotic injuries were treated with a positioning screw fixation, and the reduction in the ankle mortise was evaluated with intraoperative cone beam CT. The patients were grouped postoperatively according to the radiological reduction criteria in the intraoperative 3D images. The reduction criteria were unknown to the surgeons. Malreduction was assumed if one or more reduction criteria were not fulfilled. Results Seventy-three of the 127 patients could be included in the study (follow-up rate 57.5%). For 41 patients (56.2%), a radiological optimal reduction was achieved (Group 1), and in 32 patients (43.8%) a radiological adverse reduction was found (Group 2). Group 1 scored significantly higher in the Olerud/Molander score (92.44 ± 10.73 vs. 65.47 ± 28.77) (p = 0.003), revealed a significantly higher range of motion (ROM) (53.44 vs. 24.17°) (p = 0.001) and a significantly reduced Kellgren/Lawrence osteoarthritis score (1.24 vs. 1.79) (p = 0.029). The linear regression analysis revealed a correlation for the two groups with the values scored in the Olerud/Molander score (p < 0.01). Conclusion The reduction criteria in intraoperative cone beam CT applied to unstable syndesmotic injuries could be validated. Patients with an anatomic reduced acute unstable syndesmotic injury according to the criteria have a significantly better clinical outcome.
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Affiliation(s)
- Sven Yves Vetter
- MINTOS-Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen At Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Jeannie Euler
- MINTOS-Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen At Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Nils Beisemann
- MINTOS-Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen At Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Benedict Swartman
- MINTOS-Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen At Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Holger Keil
- MINTOS-Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen At Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Paul Alfred Grützner
- MINTOS-Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen At Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Jochen Franke
- MINTOS-Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen At Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany.
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23
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Nolte PC, Franke J, Grützner PA, Keil H. [Reconstruction of a fracture of the posterior acetabular wall with Pipkin fracture and lesion of the sciatic nerve after dorsal hip dislocation]. Unfallchirurg 2020; 123:413-418. [PMID: 32060596 DOI: 10.1007/s00113-020-00783-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A 50-year-old male suffered a crash landing while paragliding and sustained a posterior dislocation of the hip with a Pipkin fracture type 4 (fracture of the posterior acetabular wall and Pipkin fracture type 2) and a lesion of the sciatic nerve. After primary treatment in an external hospital, the patient was transferred to this hospital 4 days following the trauma. An operative stabilization of the acetabular fracture and the Pipkin fracture was performed using a trochanter flip osteotomy. Despite a large central defect of the femoral head it was decided to attempt a reconstruction. Following fixation of the Pipkin fragment an autologous bone graft harvested from the intertrochanteric region was used to fill the defect. Subsequently, a collagen matrix was applied onto the filled defect and a perineural adaptation of the sciatic nerve was performed.
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Affiliation(s)
- Philip-Christian Nolte
- Abteilung für Unfallchirurgie und Orthopädie, BG Klinik Ludwigshafen, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen am Rhein, Deutschland.
| | - Jochen Franke
- Abteilung für Unfallchirurgie und Orthopädie, BG Klinik Ludwigshafen, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen am Rhein, Deutschland
| | - Paul Alfred Grützner
- Abteilung für Unfallchirurgie und Orthopädie, BG Klinik Ludwigshafen, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen am Rhein, Deutschland
| | - Holger Keil
- Abteilung für Unfallchirurgie und Orthopädie, BG Klinik Ludwigshafen, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen am Rhein, Deutschland
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24
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Privalov M, Euler F, Keil H, Swartman B, Beisemann N, Franke J, Grützner PA, Vetter SY. Influence of reduction quality on functional outcome and quality of life in treatment of tibial plafond fractures: a retrospective cohort study. BMC Musculoskelet Disord 2019; 20:534. [PMID: 31722696 PMCID: PMC6854804 DOI: 10.1186/s12891-019-2932-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/01/2019] [Indexed: 11/21/2022] Open
Abstract
Background The aim of the study was to evaluate the impact of reduction quality, using intraoperative 3D imaging, on quality of life and functional outcome in the operative treatment of tibial plafond fractures. Methods A group of patients with tibial plafond fractures was re-examined. The operative treatment was performed between September 2001 and October 2011. The follow-up examination was at least 2 years after the final surgical procedure. Final reduction result was assessed intraoperatively using a mobile 3D C-arm. A categorization with regard to descriptive parameters as well as type and size of joint surface irregularities was performed. Follow-up results were evaluated using: Olerud and Molander (O & M) score, Short-Form-36 (SF-36) score, movement deficit, Kellgren and Lawrence grade of osteoarthritis, and pain intensity. Results 34 patients with operatively treated tibial plafond fracture could be re-examined. Reduction quality had the greatest influence on functional result measured by the O & M score (p = 0.001) and the PCS domain of the SF-36 score (p = 0.018). Significant differences with regard to O & M score (p = 0.000), SF-36 score (p = 0.001 to p = 0.02; without MCS domain), movement deficit (p = 0.001), grade of osteoarthritis (p = 0.005) and pain (p = 0.001) could be verified under consideration of the reduction quality. The group with the anatomically more accurate reduction also showed a better result for clinical follow-up and quality of life. Furthermore, it is not the type of joint surface irregularity that is always decisive, but rather the size. Conclusions Despite other relevant factors, it appears that reduction quality –which can be analyzed with intraoperative 3D imaging– plays the most important role in postoperative quality of life and functional outcome. Corrections should therefore be performed on joint surface irregularities with a size above 2 mm.
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Affiliation(s)
- Maxim Privalov
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Finn Euler
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Holger Keil
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Benedict Swartman
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Nils Beisemann
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Jochen Franke
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Paul Alfred Grützner
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Sven Y Vetter
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.
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Abstract
The geriatric fracture patient is becoming more and more in the forefront due to the demographic development. It is expected that the number of polytraumatized geriatric patients in the coming years will rise in line with demographic trends. The TraumaRegister DGU® of the German Trauma Society (DGU) provides interesting insights into the age structure and patient outcome. In 2017 in total 26.2% of the patients included were over 70 years old. Geriatric polytraumatized patients show significant differences in the injury patterns as well as in the treatment strategy compared to younger patients. This is often due to the pre-existing diseases and various drugs that alter the physiology. With respect to the injury patterns an increase in severe head injuries and a decrease in severe abdominal injuries can be seen with increasing age. Hospitals and professional societies are currently dealing with numerous challenges. The implementation of the General Data Protection Regulation leads to conflicts and uncertainties. The further development of the TraumaRegister DGU® is important in order to collect more outcome-relevant data from patients because more than ever the objective should be the survival of an accident with a high quality of life. To measure this, a structured survey of patients is necessary. The TraumaRegister DGU® is one of the most important tools to make treatment comparable and to measure structural changes.
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Affiliation(s)
- A Gather
- Klinik für Unfallchirurgie und Orthopädie, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
| | - P A Grützner
- Klinik für Unfallchirurgie und Orthopädie, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
| | - M Münzberg
- Klinik für Unfallchirurgie und Orthopädie, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
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26
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Vetter SY, Beisemann N, Keil H, Schnetzke M, Swartman B, Franke J, Grützner PA, Privalov M. Comparison of three different reduction methods of the ankle mortise in unstable syndesmotic injuries. Sci Rep 2019; 9:15445. [PMID: 31659196 PMCID: PMC6817893 DOI: 10.1038/s41598-019-51988-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 10/10/2019] [Indexed: 12/02/2022] Open
Abstract
In order to achieve a clinically satisfying result and to prevent posttraumatic osteoarthritis in the treatment of unstable syndesmotic injuries, anatomically correct reduction is crucial. The objective of the study was to investigate three different reduction methods of the ankle mortise in unstable syndesmotic injuries. In a specimen model with 38 uninjured fresh-frozen lower legs, a complete syndesmotic dissection was performed. The ankle mortise was reduced with either a collinear reduction clamp, a conventional reduction forceps or manually with crossing K-wires. The reduction clamps and the K-wires were placed in a 0°-angle to the leg axis. The clamps were positioned on the posterolateral ridge of the fibula 20 mm proximal to the ankle joint line. A cone beam computed tomography was performed after dissection and after each reduction. Tibio-fibular distances and angles were determined. Despite significant differences in terms of overcompression (0.09–0.33 mm; p = 0.000–0.063) and the slight external rotation (0.29–0.47°; p = 0.014–0.07), the results show a satisfying reduction of the ankle mortise. There were no considerable differences between the reduction methods. It can therefore be concluded that the ankle mortise can be reduced with any of the methods used, but that the positioning and the contact pressure must be considered.
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Affiliation(s)
- Sven Yves Vetter
- BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Nils Beisemann
- BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Holger Keil
- BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Marc Schnetzke
- BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Benedict Swartman
- BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Jochen Franke
- BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Paul Alfred Grützner
- BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Maxim Privalov
- BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany.
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27
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Gather A, Spancken E, Münzberg M, Grützner PA, Kreinest M. Spinal Immobilization in the Trauma Room - a Survey-Based Analysis at German Level I Trauma Centers. Z Orthop Unfall 2019; 158:597-603. [PMID: 31634951 DOI: 10.1055/a-1007-2092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Spinal immobilization is a standard procedure in daily out-of-hospital emergency care. Homogenous recommendations concerning the immobilization of trauma patients during the first therapy in the emergency department do not exist. The aim of the current study was the analysis of the existing strategies concerning spinal immobilization in German level I trauma centers by an internet-based survey. MATERIALS AND METHODS The current study is a survey-based analysis of the current strategies concerning spinal immobilization in all 107 level I trauma centers in Germany. The internet-based survey consists of 6 items asking about immobilization in the emergency department. RESULTS The return rate was 47.7%. In 14 (28.6%) level I trauma centers the patients remained immobilized on the immobilization tool used by the professional emergency care providers. In 19 (38.8%) level I trauma centers the patients were transferred to a stretcher with a soft positioning mattress on it. Patient transfer to a spineboard or to a TraumaMattress was performed in 11 (22.4%) and 7 (14.3%) level I trauma centers, respectively. Trauma patients were never transferred to a vacuum mattress. Cervical spine protection was most of the time performed by a cervical collar (n = 48; 98.0%). In general, the survey's participants were mainly satisfied (mean = 84/100) with the current strategy of spinal immobilization. The satisfaction was best if the spineboard is used. DISCUSSION Patient positioning during initial emergency therapy in the emergency department of German level I trauma centers is highly heterogenous. Besides complete full body immobilization, also the lack of any immobilization was reported by the survey's participants.
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Affiliation(s)
- Andreas Gather
- Department of Trauma Surgery and Orthopaedics, BG Klinik Ludwigshafen
| | - Elena Spancken
- Department of Trauma Surgery and Orthopaedics, BG Klinik Ludwigshafen
| | - Matthias Münzberg
- Department of Trauma Surgery and Orthopaedics, BG Klinik Ludwigshafen
| | | | - Michael Kreinest
- Department of Trauma Surgery and Orthopaedics, BG Klinik Ludwigshafen
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Perka C, Grützner PA, Möller T. DKOU 2019: Wissen braucht Werte. Z Orthop Unfall 2019; 157:499-500. [PMID: 31594003 DOI: 10.1055/a-0853-2691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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29
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Affiliation(s)
- P A Grützner
- Klinik für Unfallchirurgie und Orthopädie, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
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30
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Beisemann N, Keil H, Swartman B, Schnetzke M, Franke J, Grützner PA, Vetter SY. Intraoperative 3D imaging leads to substantial revision rate in management of tibial plateau fractures in 559 cases. J Orthop Surg Res 2019; 14:236. [PMID: 31340818 PMCID: PMC6657091 DOI: 10.1186/s13018-019-1286-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 03/31/2019] [Accepted: 07/19/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction The aim of this study was to evaluate the intraoperative revision rate and reasons for revision following 3D imaging in the management of dislocated articular tibial plateau fractures based on a large patient sample. Methods This retrospective cohort study included all patients who underwent open reduction and internal fixation due type B or C tibial plateau fracture according to the AO/OTA classification between August 2001 and December 2017 using intraoperative cone beam CT (3D imaging) for the analysis of fracture reduction and implant placement. The findings of the 3D scan were categorized regarding the amount and type of revision. Furthermore, demographic data was examined. Results Five hundred and fifty-nine consecutive fractures were included in the study. Evaluation of the image data records revealed an intraoperative revision due to the usage of 3D imaging in 148 out of 559 cases (26.5%). The most common reasons for an intraoperative revision were insufficient fracture reduction (114 cases) and screw length (21 cases). Conclusion This study reveals indications for a limited analysis of fracture reduction and implant placement during the operative treatment of dislocated articular tibial plateau fractures using conventional fluoroscopy. In view of the high revision rate during open reduction and internal fixation of tibial plateau fractures due to 3D imaging the usage of intraoperative cone beam, CT may be considered. If this is not possible, a postoperative computed tomography may therefore be reasonable.
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Affiliation(s)
- Nils Beisemann
- MINTOS-Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Holger Keil
- MINTOS-Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Benedict Swartman
- MINTOS-Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Marc Schnetzke
- MINTOS-Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Jochen Franke
- MINTOS-Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Paul Alfred Grützner
- MINTOS-Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Sven Y Vetter
- MINTOS-Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany.
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31
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Oppelt K, Hogan A, Stief F, Grützner PA, Trinler U. Movement Analysis in Orthopedics and Trauma Surgery - Measurement Systems and Clinical Applications. Z Orthop Unfall 2019; 158:304-317. [PMID: 31291674 DOI: 10.1055/a-0873-1557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Technical development lead to an enhancement of clinical movement analysis in the last few decades and expanded its research and clinical applications. Since the mid 20th century, human movement analysis has made its way into clinical practice, e.g. in treating poliomyelitis and infantile cerebral palsy. Today, it has a wide range of applications in various clinical areas. The aim of this narrative review is to illustrate the variety of camera-based systems for human movement analysis and their clinical applications, specifically in the field of orthopaedics and trauma surgery (O/U). Benefits and limitations of each system are shown. Future development and necessary improvements are discussed. MATERIAL AND METHODS A selective literature review was undertaken with the databases PubMed and Google Scholar using keywords related to clinical human movement analysis in the field of orthopaedics and trauma surgery. Furthermore standard book references were included. RESULTS Common video camera systems (VS) are used for basic visual movement analysis. Instrumented movement analysis systems include marker-based systems (MBS), markerless optical systems (MLS) and rasterstereographic analysis systems (VRS). VS, MBS and MLS have clinical use for dynamic examination of patients with various disorders in movement and gait. Among such are e.g. neuro-orthopaedic disorders, muscular insufficiencies, degenerative and post-trauma deficiencies with e.g. resultant pathologic leg axis. Besides the measurement of kinematic data by MBS and MLS, the combination with kinetic measurements to detect abnormal loading patterns as well as the combination with electromyography (EMG) to detect abnormal muscle function is a great advantage. Validity and reliability of kinematic measurements depend on the camera systems (MBS, MLS), the applied marker models, the joints of interest and the observed movement plane. Movements in the sagittal plane of the hip and knee joint, pelvic rotation and tilt as well as hip abduction are generally measured with high reliability. In the frontal and transverse planes of the knee and ankle joint substantial angular variabilities were noted due to the small range of motion of the joints in these planes. Soft tissue artefacts and marker placement are the biggest sources of errors. So far MLS did not improve these limitations. MBS are most accurate and remain the gold-standard in clinical and scientific movement analysis. VRS is used clinically for static 3D-analysis of the trunk posture and spine deformities. Current systems allow the dynamic measurement and visualisation of trunk and spine movement in 3D during gait and running. Planar x-ray-imaging (Cobb's angle) and to some extent cross sectional imaging with CT-scan or MRI are commonly used for the evaluation of patients with spinal deformities. VRS offers functional 3D data of trunk and spine deformities without radiation exposure, thus allowing safer clinical monitoring of the mainly infantile and adolescent patients. The accuracy, validity and reliability of measurements of different VRS-systems for the clinical use has been proven by several studies. CONCLUSION The instrumented movement analysis is an additional tool that aids clinical practitioners of O/U in the dynamic assessment of pathologic movement and loading patterns. In conjunction with common radiologic imaging it aids in the planning of type and extent of corrective surgical interventions. In the field of orthopaedics and trauma surgery movement analysis can help as an additional diagnostic tool to develop therapeutic strategies and evaluate clinical outcomes.
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Affiliation(s)
- Konrad Oppelt
- Abteilung für Berufsgenossenschaftliche Rehabilitation und Heilverfahrenssteuerung, BG Unfallklinik Ludwigshafen
| | - Aidan Hogan
- Klinik für Unfallchirurgie und Orthopädie, BG Unfallklinik Ludwigshafen
| | - Felix Stief
- Bewegungsanalyse und Biomechanik, Orthopädische Universitätsklinik Friedrichsheim gGmbH, Frankfurt am Main
| | | | - Ursula Trinler
- Klinik für Unfallchirurgie und Orthopädie, BG Unfallklinik Ludwigshafen
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Vetter SY, Privalov M, Beisemann N, Swartman B, Keil H, Kirsch J, Grützner PA, Franke J. Influence of ankle joint position on angles and distances of the ankle mortise using intraoperative cone beam CT: A cadaveric study. PLoS One 2019; 14:e0217737. [PMID: 31150469 PMCID: PMC6544278 DOI: 10.1371/journal.pone.0217737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 05/18/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The precise anatomical reduction of the ankle mortise is crucial for the clinical outcome in unstable syndesmotic injuries. Intraoperative cone beam computed tomography (CT), in addition to two-dimensional fluoroscopy, provides detailed information about the reduction and implant placement. The aim of this study was to analyze the influence of the joint position on the fibula position in the incisural notch and to determine the inter- and intraindividual anatomical differences in the intact ankle joints. METHODS A total of 20 fresh-frozen lower legs disarticulated in the knee joint of 10 individuals were included. The measurements were performed using a cone beam CT. The distances and angles were measured in the standard imaging planes. The mean values of distances and angles were compared during the different joint positions: 10° dorsiflexion, 0° neutral position and 20° plantar flexion. RESULTS The influence of the joint position was on average as follows: The anterior tibiofibular distance was 3.68 mm in 10° dorsiflexion, 3.66 mm (0° neutral position) and 3.59 mm (20° plantar flexion). The posterior tibiofibular distance measured 7.82mm, 7.76mm and 7.82mm. The rotation of the fibula measured ten millimeters proximal the joint line was 1.2°, 1.3° and 1.05°. The fibular rotation determined 4mm was 9.3°, 9.4° and 9.4°. On average, the following intraindividual variations were observed: superior tibiotalar clear space of 0.27mm and 0.15mm medial; and anterior tibiofibular distance of 0.42mm, 0.38mm posterior and 0.24mm in the incisural notch. The proximal angle of the fibular rotation was 0.2° and distal 0.4°. The interindividual variations of the angles and distances exceeded the intraindividual values partly by 3 to 4 fold. CONCLUSIONS Within the scope of this study neither the tibiofibular distance, nor the tibiofibular angle changed significantly through the different joint positions. The intraindividual differences were little while the interindividual variations of the parameters were distinctive.
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Affiliation(s)
- Sven Y. Vetter
- BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Maxim Privalov
- BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Nils Beisemann
- BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Benedict Swartman
- BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Holger Keil
- BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Joachim Kirsch
- Institute for Anatomy and Cell Biology, University of Heidelberg, Heidelberg, Germany
| | - Paul Alfred Grützner
- BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Jochen Franke
- BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
- * E-mail:
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Vetter SY, Steffen K, Swartman B, Schnetzke M, Keil H, Franke J, Grützner PA, Beisemann N. Influence of intraoperative conventional fluoroscopy versus cone beam CT on long-term clinical outcome in isolated displaced talar fractures. J Orthop Surg Res 2019; 14:8. [PMID: 30621768 PMCID: PMC6323861 DOI: 10.1186/s13018-018-1043-3] [Citation(s) in RCA: 3] [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: 07/16/2018] [Accepted: 12/18/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The objective of the study was to compare the radiologic and clinical outcome of patients with an isolated displaced talus fracture treated intra-operatively with either conventional fluoroscopy or additional cone beam computed tomography (CT). METHODS Conventional intraoperative fluoroscopy was performed in group 1 and cone beam CT was added in group 2. Clinical outcome was assessed using the Foot Function Index (FFI), American Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, and the Short-Form 12 (SF-12) survey. In addition, the Kellgren-Lawrence score using X-rays was determined. RESULTS Overall, 24 cases were examined (group 1: 8 cases; group 2: 16 cases), with a mean follow up of 6.66 years. The FFI (group 1: 28.85 ± 22.78; group 2: 14.96 ± 15.11 points; p = 0.768), the AOFAS (group 1: 69.00 ± 24.71; group 2: 78.79 ± 17.07 points; p = 0.438), and the physical and mental component of the SF-12 (group 1: 44.79 ± 12.55; group 2: 47.63 ± 10.69 points; p = 0.136) (group 1: 46.19 ± 9.72; group 2: 53.57 ± 8.51; p = 0.242) did not differ significantly. Osteoarthritis of the talonavicular, subtalar, and ankle joints assessed using the Kellgren-Lawrence score appeared to be minor in the cone beam CT group but did not show significant differences (p = 0.309; p = 0.663; p = 0.082 respectively). DISCUSSION Intraoperative cone beam CT in addition to conventional fluoroscopy might be beneficial in the operative treatment of talar fractures but a statistical significance could not be demonstrated.
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Affiliation(s)
- Sven Y Vetter
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Kira Steffen
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Benedict Swartman
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Marc Schnetzke
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Holger Keil
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Jochen Franke
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Paul Alfred Grützner
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Nils Beisemann
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany.
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Heller RA, Seelig J, Bock T, Haubruck P, Grützner PA, Schomburg L, Moghaddam A, Biglari B. Relation of selenium status to neuro-regeneration after traumatic spinal cord injury. J Trace Elem Med Biol 2019; 51:141-149. [PMID: 30466924 DOI: 10.1016/j.jtemb.2018.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/07/2018] [Accepted: 10/04/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The trace element selenium (Se) is crucial for the biosynthesis of selenoproteins. Both neurodevelopment and the survival of neurons that are subject to stress depend on a regular selenoprotein biosynthesis and sufficient Se supply by selenoprotein P (SELENOP). HYPOTHESIS Neuro-regeneration after traumatic spinal cord injury (TSCI) is related to the Se status. STUDY DESIGN Single-centre prospective observational study. PATIENTS AND METHODS Three groups of patients with comparable injuries were studied; vertebral fractures without neurological impairment (n = 10, group C), patients with TSCI showing no remission (n = 9, group G0), and patients with remission developing positive abbreviated injury score (AIS) conversion within 3 months (n = 10, group G1). Serum samples were available from different time points (upon admission, and after 4, 9 and 12 h, 1 and 3 days, 1 and 2 weeks, and 1, 2 and 3 months). Serum trace element concentrations were determined by total reflection X-ray fluorescence, SELENOP by ELISA, and further parameters by laboratory routine. RESULTS Serum Se and SELENOP concentrations were higher on admission in the remission group (G1) as compared to G0. During the first week, both parameters remained constant in C and G0, whereas they declined significantly in the remission group. Similarly, the concentration changes between admission and 24 h were most pronounced in this group of recovering patients (G1). Binary logistic regression analysis including the delta of Se and SELENOP within the first 24 h indicated an AUC of 90.0% (CI: 67.4%-100.0%) with regards to predicting the outcome after TSCI. CONCLUSION A Se deficit might constitute a risk factor for poor outcome after TSCI. A dynamic decline of serum Se and SELENOP concentrations after admission may reflect ongoing repair processes that are associated with higher odds for a positive clinical outcome.
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Affiliation(s)
- Raban Arved Heller
- Heidelberg Trauma Research Group, Department of Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Julian Seelig
- Institute for Experimental Endocrinology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Bock
- Heidelberg Trauma Research Group, Department of Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Patrick Haubruck
- Heidelberg Trauma Research Group, Department of Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Paul Alfred Grützner
- BG Trauma Centre Ludwigshafen, Department of Trauma Surgery and Orthopedics, Medical Director, Ludwigshafen, Germany
| | - Lutz Schomburg
- Institute for Experimental Endocrinology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Arash Moghaddam
- Heidelberg Trauma Research Group, Department of Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Bahram Biglari
- BG Trauma Centre Ludwigshafen, Department of Paraplegiology, Ludwigshafen, Germany
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Abstract
AbstractPelvic fractures may range from highly severe, life-threatening injuries to less acute clinical entities. There are several sub-entities that are summed up as pelvic injuries. Anatomically, there are fractures of the anterior or posterior pelvic ring. Apart from these, there are fractures of the acetabulum that make up about one fifth of all pelvic injuries. The indication for surgical treatment of pelvic ring injuries depends on the type of injury, involvement of anterior and/or posterior elements of the pelvic ring, demands and the general condition of the patient. In acetabular fractures, indications depend on the dislocation of the fracture and of course also the needs of the patient and his general condition. An intraarticular step-off of more than 2 mm is usually considered as an indication for open reduction and osteosynthesis. Usually in all these injuries, a preoperative CT scan is mandatory to allow precise planning of the operative approach and technique. Intraoperatively, the surgeon should be familiar with the acquisition of the 2D standard views, including 2D imaging of the pelvic ring and the acetabulum. These consist of the anteroposterior view for both pelvic ring and acetabular osteosyntheses. For further assessment of pelvic ring treatments, inlet and outlet views are achievable by angulating the C-arm cranially and caudally. To assess aspects of the anterior and posterior column of the acetabulum, iliac oblique views are used. Here, the C-arm is rotated laterally. As evaluation of 2D views can be limited due to anatomy and superposing structures, intraoperative 3D imaging has become common in the last decade. Special C-arms allow the automatic acquisition of large numbers of projections and create CT-like views of the central volume. Although this method has significantly widened the possibilities of intraoperative imaging, some issues remain. Depending on the amount of implants placed in the imaging field, assessment can be seriously impaired due to artefacts caused by the implants. Intraoperative CT imaging promises enhanced image quality for artefacts and allows a considerably larger field of view. The use of radiation-free navigation facilitates implant placement in minimally invasive procedures like screw placement in the sacroiliacal joint or the acetabulum by visualisation of instruments and implants in a pre- or intraoperative 3D data set.
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Affiliation(s)
- Holger Keil
- Klinik für Unfall- und orthopädische Chirurgie, BG Unfallklinik Ludwigshafen
| | - Sara Aytac
- Klinik für Unfall- und orthopädische Chirurgie, BG Unfallklinik Ludwigshafen
| | | | - Jochen Franke
- Klinik für Unfall- und orthopädische Chirurgie, BG Unfallklinik Ludwigshafen
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Abstract
The reconstruction of anatomical joint surfaces, limb alignment and rotational orientation are crucial in the treatment of fractures in terms of preservation of function and range of motion. To assess reduction and implant position intra-operatively, mobile C-arms are mandatory to immediately and continuously control these parameters.Usually, these devices are operated by OR staff or radiology technicians and assessed by the surgeon who is performing the procedure. Moreover, due to special objectives in the intra-operative setting, the situation cannot be compared with standard radiological image acquisition. Thus, surgeons need to be trained and educated to ensure correct technical conduct and interpretation of radiographs.It is essential to know the standard views of the joints and long bones and how to position the patient and C-arm in order to acquire these views. Additionally, the operating field must remain sterile, and the radiation exposure of the patient and staff must be kept as low as possible.In some situations, especially when reconstructing complex joint fractures or spinal injuries, complete evaluation of critical aspects of the surgical results is limited in two-dimensional views and fluoroscopy. Intra-operative three-dimensional imaging using special C-arms offers a valuable opportunity to improve intra-operative assessment and thus patient outcome.In this article, common fracture situations in trauma surgery as well as special circumstances that the surgeon may encounter are addressed. Cite this article: EFORT Open Rev 2018;3:541-549. DOI: 10.1302/2058-5241.3.170074.
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Häske D, Beckers SK, Hofmann M, Lefering R, Preiser C, Gliwitzky B, Grützner PA, Stöckle U, Münzberg M. Performance Assessment of Emergency Teams and Communication in Trauma Care (PERFECT checklist)-Explorative analysis, development and validation of the PERFECT checklist: Part of the prospective longitudinal mixed-methods EPPTC trial. PLoS One 2018; 13:e0202795. [PMID: 30142204 PMCID: PMC6108494 DOI: 10.1371/journal.pone.0202795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/09/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Trainings in emergency medicine are well structured, but examinations are rarely validated. We are evaluating the impact of pre-hospital emergency trainings on participants and patient care and developed and validated a checklist to assess emergency trainings. METHODS We used videos recorded at the time points directly before (t0), directly after (t1), and one year after (t2) training to develop the PERFECT checklist (Performance Assessment of Emergency Teams and Communication in Trauma Care). The videos were assessed using semi-qualitative/linguistic analysis as well as expert panel appraisal and recommendations using the Delphi method. The checklist was tested for validity and reliability. RESULTS The inter-rater reliability (ICC = 0.99) and internal consistency (α = 0.99) were high. Concurrent validity was moderate to high (r = 0.65 -r = 0.93 (p<0.001)). We included scales for procedures, non-technical skills, technical skills and global performance. The procedures were done faster in the mean over the timeline (t0: 2:29, 95%CI 1:54-3:03 min., t1: 1:11, 95%C 0:53-1:30 min, t2: 1:14, 95%CI 0:56-1:31 min.). All experts rated the recorded scenarios at t0 with the lowest sum score (mean 31±8), with a significantly better performance of the teams at t1 (mean 69±7). The performance at t2 (mean 66 ± 13) was slightly lower than at t1, but still better than at t0. At t1 and t2, linguistic analysis showed a change in the team leaders communication behaviour, which can be interpreted as a surrogate parameter for reduced stress. CONCLUSION The PERFECT checklist has a good validity and high reliability for assessing trauma procedures and teamwork.
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Affiliation(s)
- David Häske
- Faculty of Medicine, Eberhard Karls University Tübingen, Tübingen, Germany
- DRK Rettungsdienst Reutlingen, Reutlingen, Germany
| | - Stefan K. Beckers
- Department of Anaesthesiology, Faculty of Medicine, University Hospital RWTH, Aachen, Aachen, Germany
- Emergency Medical Service, Fire Department, City of Aachen, Aachen, Germany
| | | | - Rolf Lefering
- Institute for Research in Operative Medicine, University of Witten/Herdecke, Cologne, Germany
| | - Christine Preiser
- Coordination Centre for Health Services Research, University Hospital Tübingen, Tübingen, Germany
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Tübingen, Germany
| | | | - Paul Alfred Grützner
- Department of Trauma and Orthopaedic Surgery, BG Hospital Ludwigshafen, Ludwigshafen, Germany
| | - Ulrich Stöckle
- Department of Traumatology and Reconstructive Surgery, BG Hospital Tübingen, Tübingen, Germany
| | - Matthias Münzberg
- Department of Trauma and Orthopaedic Surgery, BG Hospital Ludwigshafen, Ludwigshafen, Germany
- Centre of interdisciplinary Rescue- and Emergency Medicine, BG Hospital Ludwigshafen, Ludwigshafen, Germany
- * E-mail:
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Vetter SY, Magaraggia J, Beisemann N, Schnetzke M, Keil H, Franke J, Grützner PA, Swartman B. Virtual guidance versus virtual implant planning system in the treatment of distal radius fractures. Int J Med Robot 2018; 14:e1945. [PMID: 30084164 DOI: 10.1002/rcs.1945] [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: 01/29/2018] [Revised: 05/18/2018] [Accepted: 07/04/2018] [Indexed: 11/05/2022]
Abstract
BACKGROUND A virtual guidance framework is used to assist the conventional method of virtual implant planning system (VIPS). The study null hypothesis was that its screw placement accuracy is equal to that of conventional VIPS. METHODS In 34 distal radius sawbone models, 3D implant planning was performed. A camera attached to the surgical drill was used to support screw positioning. Differences of angles/tip distances between planned and placed screws were identified in intraoperative cone beam Computer tomography (CT) and compared with already existing data from 22 patients treated by conventional VIPS. RESULTS The virtual guidance group showed tip distances of 1.02 ± 0.56 mm, azimuth of 3.69° ± 4.34°, and inclination of 1.75° ± 1.37°, whereas the VIPS group showed tip distances of 2.23 ± 0.99 mm (P < 0.001), azimuth of 23.17° ± 33.50° (P < 0.001), and inclination angle of 4.18° ± 6.29° (P = 0.001). CONCLUSIONS The results reveal that using a guidance framework leads to a higher accuracy in screw placement compared with the conventional VIPS itself.
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Affiliation(s)
- Sven Yves Vetter
- BG-Klinik Ludwigshafen, MINTOS Research Group, Department of Orthopaedics and Orthopaedic Trauma, Trauma Clinic at Heidelberg University, Heidelberg, Germany
| | - Jessica Magaraggia
- Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nils Beisemann
- BG-Klinik Ludwigshafen, MINTOS Research Group, Department of Orthopaedics and Orthopaedic Trauma, Trauma Clinic at Heidelberg University, Heidelberg, Germany
| | - Marc Schnetzke
- BG-Klinik Ludwigshafen, MINTOS Research Group, Department of Orthopaedics and Orthopaedic Trauma, Trauma Clinic at Heidelberg University, Heidelberg, Germany
| | - Holger Keil
- BG-Klinik Ludwigshafen, MINTOS Research Group, Department of Orthopaedics and Orthopaedic Trauma, Trauma Clinic at Heidelberg University, Heidelberg, Germany
| | - Jochen Franke
- BG-Klinik Ludwigshafen, MINTOS Research Group, Department of Orthopaedics and Orthopaedic Trauma, Trauma Clinic at Heidelberg University, Heidelberg, Germany
| | - Paul Alfred Grützner
- BG-Klinik Ludwigshafen, MINTOS Research Group, Department of Orthopaedics and Orthopaedic Trauma, Trauma Clinic at Heidelberg University, Heidelberg, Germany
| | - Benedict Swartman
- BG-Klinik Ludwigshafen, MINTOS Research Group, Department of Orthopaedics and Orthopaedic Trauma, Trauma Clinic at Heidelberg University, Heidelberg, Germany
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Oppelt K, Hähnlein D, Boschert J, Küffer M, Grützner PA, Münzberg M, Kreinest M. Influence of demographic factors and clinical status parameters on long-term neurological, psychological and vegetative outcome following traumatic brain injury. Brain Inj 2018; 32:1500-1509. [PMID: 30024773 DOI: 10.1080/02699052.2018.1499963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PRIMARY OBJECTIVE We evaluated the neurologic, psychological and vegetative outcome, the health status and changes of the personal and occupational status of patients after traumatic brain injuries (TBIs). Correlations between outcome parameters and basic demographic factors and initial clinical status parameters of the patients were assessed. RESEARCH DESIGN Monocentric, retrospective follow-up analysis. METHODS AND PROCEDURES We evaluated the neurologic, psychological and vegetative outcome and health status of patients, who survived TBI with a mean follow-up time of 54 months. Glasgow Outcome Scale (GOS), Disability Rating Scale (DRS) and a questionnaire on Quality of Life were used for outcome measurement. The personal and occupational status, trauma-derived changes to that status and medical and demographic factors that have an impact on the health condition of patients after TBI were assessed. MAIN OUTCOMES AND RESULTS With a median GOS of 5.0 and median DRS of 3.0, our patients showed just moderate disabilities. Fifty-six per cent of the patients felt 'very good' or 'good'. Age, gender, the preclinical Glasgow Coma Scale (GCS), state of pupil reaction and surgical treatment did not seem to affect the GOS or DRS. Correlations between body mass index, age and gender and distinct neurologic, psychological and vegetative symptoms were found. The personal status did not change significantly after TBI. Changes to occupational and socioeconomic status were evident. CONCLUSIONS One-third of the patients are heavily affected by neurological, psychological and vegetative symptoms after surviving TBI. Some demographic factors affected this integrity.
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Affiliation(s)
- Konrad Oppelt
- a Klinik für Unfallchirurgie und Orthopädie , BG Klinik Ludwigshafen , Ludwigshafen , Germany
| | - Doreen Hähnlein
- a Klinik für Unfallchirurgie und Orthopädie , BG Klinik Ludwigshafen , Ludwigshafen , Germany.,b Abteilung für Anästhesie und Intensivmedizin , GRN-Klinik Sinsheim , Sinsheim , Germany
| | - Jürgen Boschert
- c Abteilung für Neurochirurgie , BG Klinik Ludwigshafen , Ludwigshafen , Germany
| | | | - Paul Alfred Grützner
- a Klinik für Unfallchirurgie und Orthopädie , BG Klinik Ludwigshafen , Ludwigshafen , Germany
| | - Matthias Münzberg
- a Klinik für Unfallchirurgie und Orthopädie , BG Klinik Ludwigshafen , Ludwigshafen , Germany
| | - Michael Kreinest
- a Klinik für Unfallchirurgie und Orthopädie , BG Klinik Ludwigshafen , Ludwigshafen , Germany
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Fischer C, Reiner C, Schmidmaier G, Doll J, Child C, Grützner PA, Biglari B, Boxriker S, Moghaddam A. Safety study: is there a pathologic IGF-1, PDGF and TGF-β cytokine expression caused by adjunct BMP-7 in tibial and femoral non-union therapy? Ther Clin Risk Manag 2018; 14:691-697. [PMID: 29713178 PMCID: PMC5907889 DOI: 10.2147/tcrm.s160064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background In this prospective safety study, we investigated if the characteristic cytokine expression during bone regeneration is manipulated by the local application of bone morphogenetic protein-7 (BMP-7) in non-union surgery. Therefore, the levels of insulin like growth factor 1 (IGF-1), platelet-derived growth factor AB (PDGF-AB) and transforming growth factor beta (TGF-β) were compared between patients with the gold standard use of autologous bone graft (ABG) and those with additional application of BMP-7 as part of the diamond concept. Patients and methods Between 2009 and 2014, of the 153 patients with tibial and femoral non-unions, a matched pair analysis was performed to compare the serological cytokine expressions. Blood samples were collected preoperatively, 1, 2 and 6 weeks as well as 3 and 6 months after non-union surgery. Matching criteria were smoking status, fracture location, gender, age and body mass index (BMI). Patients in G1 (n=10) were treated with ABG and local BMP-7 while their matching partners in G2 (n=10) received ABG only. The routine clinical and radiologic follow-up was 1 year. Results Although the IGF-1 quantification in G2 showed higher pre- and postoperative values compared to G1 (p<0.05), the courses of both groups were similar. Likewise, PDGF-AB and TGF-β expressions appeared similar in G1 and G2 with peaks in both groups at 2 weeks follow-up. Osseous consolidation was assessed in all operated non-unions. The adjunct application of BMP-7 did not cause any pathologic cytokine expression. Conclusion Similar expressions of the serum cytokines IGF-1, PDGF-AB and TGF-β were demonstrated in non-union patients treated with ABG and additional application of BMP-7 according to the diamond concept. Our findings indicate that the local application of BMP-7, which imitates the physiologic secretion of growth factors during bone regeneration, is safe and without the risk of abnormal systemic cytokine expression. Studies with higher patient numbers will have to validate these assumptions.
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Affiliation(s)
- Christian Fischer
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG - Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Reiner
- Department of Trauma and Orthopedic Surgery, Paracelsus Medical University, Nuremberg Hospital South, Nuremberg, Germany
| | - Gerhard Schmidmaier
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG - Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany
| | - Julian Doll
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG - Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany
| | - Christopher Child
- Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Bahram Biglari
- Trauma and Orthopedics, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | - Sonja Boxriker
- Center of Orthopedics, Trauma Surgery and Sport Medicine, ATORG Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Arash Moghaddam
- Center of Orthopedics, Trauma Surgery and Sport Medicine, ATORG Aschaffenburg-Alzenau, Aschaffenburg, Germany
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Keil H, Beisemann N, Schnetzke M, Vetter SY, Swartman B, Grützner PA, Franke J. Intraoperative assessment of reduction and implant placement in acetabular fractures-limitations of 3D-imaging compared to computed tomography. J Orthop Surg Res 2018; 13:78. [PMID: 29636062 PMCID: PMC5894195 DOI: 10.1186/s13018-018-0780-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 03/23/2018] [Indexed: 01/24/2023] Open
Abstract
Background In acetabular fractures, the assessment of reduction and implant placement has limitations in conventional 2D intraoperative imaging. 3D imaging offers the opportunity to acquire CT-like images and thus to improve the results. However, clinical experience shows that even 3D imaging has limitations, especially regarding artifacts when implants are placed. The purpose of this study was to assess the difference between intraoperative 3D imaging and postoperative CT regarding reduction and implant placement. Methods Twenty consecutive cases of acetabular fractures were selected with a complete set of intraoperative 3D imaging and postoperative CT data. The largest detectable step and the largest detectable gap were measured in all three standard planes. These values were compared between the 3D data sets and CT data sets. Additionally, possible correlations between the possible confounders age and BMI and the difference between 3D and CT values were tested. Results The mean difference of largest visible step between the 3D imaging and CT scan was 2.0 ± 1.8 mm (0.0–5.8, p = 0.02) in the axial, 1.3 ± 1.4 mm (0.0–3.7, p = 0.15) in the sagittal and 1.9 ± 2.4 mm (0.0–7.4, p = 0.22) in the coronal views. The mean difference of largest visible gap between the 3D imaging and CT scan was 3.1 ± 3.6 mm (0.0–14.1, p = 0.03) in the axial, 4.6 ± 2.7 mm (1.2–8.7, p = 0.001) in the sagittal and 3.5 ± 4.0 mm (0.0–15.4, p = 0.06) in the coronal views. A positive correlation between the age and the difference in gap measurements in the sagittal view was shown (rho = 0.556, p = 0.011). Conclusions Intraoperative 3D imaging is a valuable adjunct in assessing reduction and implant placement in acetabular fractures but has limitations due to artifacts caused by implant material. This can lead to missed malreduction and impairment of clinical outcome, so postoperative CT should be considered in these cases.
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Affiliation(s)
- Holger Keil
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Nils Beisemann
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Marc Schnetzke
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Sven Yves Vetter
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Benedict Swartman
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Paul Alfred Grützner
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Jochen Franke
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.
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Swartman B, Frere D, Wei W, Schnetzke M, Grechenig S, Matityahu A, Beisemann N, Keil H, Franke J, Grützner PA, Vetter SY. Wire Placement in the Sustentaculum Tali Using a 2D Projection-Based Software Application for Mobile C-Arms: Cadaveric Study. Foot Ankle Int 2018; 39:485-492. [PMID: 29347832 DOI: 10.1177/1071100717746618] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Indirect screw fixation of the sustentaculum tali in the lateral-medial direction can be challenging due to the complex calcaneal anatomy. A novel 2-dimensional (2D) projection-based software application detects Kirschner wires (K-wires) and visualizes their intended direction as a colored trajectory. The aim of this prospectively randomized cadaver study was to investigate whether the software would facilitate the indirect K-wire placement in the sustentaculum tali. METHODS In 20 cadaver foot specimens, K-wires were placed indirectly in the sustentaculum tali by an experienced and an inexperienced surgeon, with and without using the application. Number of placement attempts, duration of procedure, fluoroscopy time, and number of individual fluoroscopy images were recorded. Each wire's position was analyzed in a 3-dimensional (3D) C-arm scan by an experienced blinded investigator. RESULTS Use of the software by the inexperienced surgeon significantly reduced the number of placement attempts from 3.2 to 1.2 ( P = .006). The application also reduced operating time, from 273 s to 199 s ( P = .15), and fluoroscopy time, from 41 s to 29 s ( P = .15). Using the software, the experienced surgeon had a longer operating time (139 s to 183 s; P = .30), longer fluoroscopy time (5.6 s to 9.2 s; P = .17), and more individual fluoroscopy images (11.6 to 14.8; P = .30). Wire position did not show significant differences in both cases. CONCLUSION During indirect K-wire placement in the sustentaculum tali, the software appeared to be a useful tool for the inexperienced surgeon. In our chosen study setting, the experienced surgeon did not benefit from the software. CLINICAL RELEVANCE Possible indications for the software would be fractures of the proximal femur, sacrum, sacroiliac instabilities, vertebral bodies, scaphoid, Lisfranc joint, talus and calcaneus.
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Affiliation(s)
- Benedict Swartman
- 1 BG-Klinik Ludwigshafen, Clinic for Trauma Surgery and Orthopaedics, Trauma Surgery Clinic at Heidelberg University, Ludwigshafen, Germany
| | - Dirk Frere
- 1 BG-Klinik Ludwigshafen, Clinic for Trauma Surgery and Orthopaedics, Trauma Surgery Clinic at Heidelberg University, Ludwigshafen, Germany
| | - Wei Wei
- 2 Siemens Healthcare, Erlangen, Germany
| | - Marc Schnetzke
- 1 BG-Klinik Ludwigshafen, Clinic for Trauma Surgery and Orthopaedics, Trauma Surgery Clinic at Heidelberg University, Ludwigshafen, Germany
| | - Stephan Grechenig
- 3 Department of Trauma Surgery, Regensburg University, Regensburg, Germany
| | - Amir Matityahu
- 4 Department of Orthopaedic Surgery, University of California, San Francisco, san Francisco, USA
| | - Nils Beisemann
- 1 BG-Klinik Ludwigshafen, Clinic for Trauma Surgery and Orthopaedics, Trauma Surgery Clinic at Heidelberg University, Ludwigshafen, Germany
| | - Holger Keil
- 1 BG-Klinik Ludwigshafen, Clinic for Trauma Surgery and Orthopaedics, Trauma Surgery Clinic at Heidelberg University, Ludwigshafen, Germany
| | - Jochen Franke
- 1 BG-Klinik Ludwigshafen, Clinic for Trauma Surgery and Orthopaedics, Trauma Surgery Clinic at Heidelberg University, Ludwigshafen, Germany
| | - Paul Alfred Grützner
- 1 BG-Klinik Ludwigshafen, Clinic for Trauma Surgery and Orthopaedics, Trauma Surgery Clinic at Heidelberg University, Ludwigshafen, Germany
| | - Sven Yves Vetter
- 1 BG-Klinik Ludwigshafen, Clinic for Trauma Surgery and Orthopaedics, Trauma Surgery Clinic at Heidelberg University, Ludwigshafen, Germany
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Vetter SY, Schüler S, Hackbusch M, Müller M, Swartman B, Schnetzke M, Grützner PA, Franke J. Tablets for Image Review and Communication in Daily Routine of Orthopedic Surgeons-An Evaluation Study. J Digit Imaging 2018; 31:74-83. [PMID: 28799133 PMCID: PMC5788817 DOI: 10.1007/s10278-017-0011-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Medical images are essential in modern traumatology and orthopedic surgery. Access to images is often cumbersome due to a limited number of workstations. Moreover, due to the tremendous increase of data, the time to review or to communicate images has also become limited. One approach to overcome these problems is to make use of modern mobile devices, like tablet computers, to facilitate image access and associated workflows. Ten orthopedic surgeons were equipped with an Apple iPad mini 2 and specialized viewing software for medical images. The surgeons were able to send images from a workstation onto the tablets or to search for patient images directly. The software enabled the physicians to share images, annotated key slices, and messages instantly with their colleagues. The surgeons carried the tablets within or in the periphery of the hospital. The participants evaluated the software by means of daily questionnaires. Data was collected for a period of 9 months. Nearly 25 images were viewed in total by the surgeons per day. The tablet viewer was used for accessing approximately 30% of these images. On average, the surgeons were asked 1.7 times per day by a colleague for a second opinion. They used the tablets in approximately 29% of these cases. Furthermore, the mean time for accessing images was significantly lower using mobile software compared to conventional methods. Tablet computers can play a vital role for image access and communication in the daily routine of an orthopedic surgeon. Mobile image access is an important aspect for surgeons, especially in larger facilities, to facilitate and accelerate the clinical workflows.
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Affiliation(s)
- Sven Y Vetter
- BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Svenja Schüler
- Medical Biometry, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Matthes Hackbusch
- Medical Biometry, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Michael Müller
- Department Computer Assisted Medical Interventions, German Cancer Research Center, Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany
- mbits imaging GmbH, Bergheimer Str. 147, D-69115, Heidelberg, Germany
| | - Benedict Swartman
- BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Marc Schnetzke
- BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Paul Alfred Grützner
- BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Jochen Franke
- BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.
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Wölfl C, Schuster L, Höner B, Englert S, Klein R, Hirche C, Münzberg M, Grützner PA, Kneser U, Harhaus L. Influence of extracorporeal shock wave therapy (ESWT) on bone turnover markers in organisms with normal and low bone mineral density during fracture healing: a randomized clinical trial. GMS Interdiscip Plast Reconstr Surg DGPW 2018; 6:Doc17. [PMID: 29308349 PMCID: PMC5738494 DOI: 10.3205/iprs000119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Low bone mineral density (BMD) leads to metaphyseal fractures, which are considered of delayed, qualitatively reduced healing resulting in prolonged care phases and increased socioeconomic costs. Extracorporeal shockwave therapy (ESWT) is already approved to support bone healing of pseudarthrosis and delayed unions. With this study, we examined its influence on bone turnover markers (BTM) during fracture healing in patients with low and normal BMD. Methods: Within a period of 2 years, patients with a metaphyseal fracture of the distal radius or the proximal humerus, requiring surgical osteosynthesis were included into the study. Patients were randomized within their fracture groups whether they received ESWT after surgery or not. ESWT was applied once after surgery with an energy flux density (EFD) of 0.55 mJ/mm² à 3000 shockwaves. In addition, serum levels of vitamin D3, parathyroid hormone (iPTH), bone alkaline phosphatase (BAP), c-telopeptide of type-I-collagen (β-CTX) and serum band 5 tartrate-resistant acid phosphate (TRAP5b) were determined before surgery and post-operatively in week 1, 4, 8, 52. T-score levels as an indicator of the BMD were measured with dual-energy X-ray absorptiometry (DXA). Results: 49 patients (40 females, 9 males; mean age 62 years) with fractures of the metaphyseal distal radius (n=25) or the proximal humerus (n=24) were included in the study. The follow-up time was one year. 24 of them were diagnosed of having low BMD, whereas 25 had a normal BMD. During follow-up time serum levels of bone turnover markers, as well as vitamin D3 and iPTH, showed no significant changes; however, ESWT approaches the decreased serum levels of patients with low BMD to the level of healthy organisms. Conclusions: ESWT as treatment option of fractures in patients with low BMD can lead to an equilibration of levels of bone turnover markers to the levels of patients with normal BMD.
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Affiliation(s)
- Christoph Wölfl
- Department of Orthopedic and Trauma Surgery, Marienhaus Klinikum Hetzelstift, Neustadt/Weinstrasse, Germany
| | - Laura Schuster
- Departement of Surgery, Evangelisches Krankenhaus Karlsruhe Rüpprurr, Karlsruhe, Germany
| | - Bernd Höner
- SRH University Heidelberg, Department of Social Sciences and Law, Heidelberg, Germany
| | - Sarah Englert
- Department of Orthopedic and Trauma Surgery, Marienhaus Klinikum Hetzelstift, Neustadt/Weinstrasse, Germany
| | - Roman Klein
- Department of Orthopedic and Trauma Surgery, Marienhaus Klinikum Hetzelstift, Neustadt/Weinstrasse, Germany
| | - Christoph Hirche
- Department of Plastic-, Reconstructive and Handsurgery, Burn Care Centre, Department of Plastic Surgery of Heidelberg University, BG Traumacenter Ludwigshafen, Ludwigshafen, Germany
| | - Matthias Münzberg
- Department of Orthopedic and Trauma Surgery, BG Traumacenter Ludwigshafen, Ludwigshafen, Germany
| | - Paul Alfred Grützner
- Department of Orthopedic and Trauma Surgery, BG Traumacenter Ludwigshafen, Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Plastic-, Reconstructive and Handsurgery, Burn Care Centre, Department of Plastic Surgery of Heidelberg University, BG Traumacenter Ludwigshafen, Ludwigshafen, Germany
| | - Leila Harhaus
- Department of Plastic-, Reconstructive and Handsurgery, Burn Care Centre, Department of Plastic Surgery of Heidelberg University, BG Traumacenter Ludwigshafen, Ludwigshafen, Germany
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Klein R, Armbruster W, Grotz M, Höner B, Münzberg M, Grützner PA, Wölfl CG. Pay for performance - motivation to succeed in Advanced Trauma Life Support courses - a question of background or funding? GMS Interdiscip Plast Reconstr Surg DGPW 2017; 6:Doc16. [PMID: 29214123 PMCID: PMC5717918 DOI: 10.3205/iprs000118] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Objective: To correlate students’ performance with their professional background and motivation to take part in Advanced Trauma Life Support (ATLS) courses. We base our analysis on the self-determination theory that differentiates intrinsic (ambition to perform by individual itself) from extrinsic motivation (incentive by external stimuli). Design: We present a non-blinded, monocentric, non-randomized descriptive study of 376 students taking part in an ATLS course at one course site in Germany. Part of a two-day ATLS course are two written tests; we correlate test scores with background information provided by the students in a questionnaire of 13 items (age, sex, adress, board certification, specialty, subspecialty, position, hospital level of care, hospital operator and hospital participation in trauma network, motivation, funding source, condition of funding). Setting: The students were recuited at the BG Trauma Center Ludwigshafen (Germany), a large 528-bed trauma center and one of 13 ATLS course sites in Germany. Participants: 449 ATLS course students taking part in ATLS courses at the above-mentioned course site from February 2009 to May 2010 were sent a questionnaire asking for their background. All 449 course students were eligible to participate. 376 (83.7%) questionnaires were returned, pre- and post-test results of all students aquired and included into our calculations. 312 (83%) were male and 64 (17%) female. The majority (59.3%) of recruited students came from trauma surgery, 21.8% from anesthesiology, 8% from general surgery, 4% from abdominal surgery, 0.5% from vascular or thoracic surgery each and 5.9% from other specialties. Results: Neither age, sex, subspecialty, hospital level of care, hospital operator, or hospital participation in trauma network played a role with respect to motivation or test results. The high degree of intrinsic motivation of consultants (92.3%) had no impact on their test results. Anesthesiologists were higher motivated (75.6% intrinsically motivated) in contrast to all surgical colleagues (63.6%), which showed significant differences in the pre- (89.8% vs. 85.3%, p=0.03) but not the post-test. Of all 13.6% students who were self-payers, 94.1% were intrinsically motivated; the 86.2% whose course fee was accounted for were less likely to be intrinsically motivated (63.9%). Sponsoring however did not have a negative impact on test results. Conditional funding (sponsored only on passing both tests) was detrimental to motivation: 0% of these individuals were intrinsically motivated and they scored significantly lower (82.5%) than all other students in the post-test (86.9%, p=0.002). Overall, intrinsically motivated students overtopped extrinsically motivated students in the post-test (88.0% vs. 83.4%, p<0.001). Conclusions: ATLS course participation is not compulsory for medical doctors in Germany. Intrinsic motivation to take part in these courses is a key prerequisite to increase performance, irrespective of the background of the students. Intrinsically motivated students are ready to invest into their education and vice versa. Conditional funding (course fee only sponsored on passing the course) evokes no intrinsic motivation at all and causes worse results.
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Affiliation(s)
- Roman Klein
- Clinic of orthopedic surgery, trauma surgery and sports traumatology, Krankenhaus Hetzelstift, Neustadt an der Weinstrasse, Germany
| | - Wolfgang Armbruster
- Clinic of orthopedic surgery and trauma surgery, Kreiskrankenhaus Bergstraße, Heppenheim, Germany
| | - Martin Grotz
- MDKN - Geschäftsbereich Behandlungsfehler, Hannover, Germany
| | - Bernd Höner
- SRH-Hochschule Heidelberg, Department for social studies and law, Heidelberg, Germany
| | - Matthias Münzberg
- BG Trauma Center Ludwigshafen, Department of trauma surgery and orthopedics, Ludwigshafen, Germany
| | - Paul Alfred Grützner
- BG Trauma Center Ludwigshafen, Department of trauma surgery and orthopedics, Ludwigshafen, Germany
| | - Christoph Georg Wölfl
- Clinic of orthopedic surgery, trauma surgery and sports traumatology, Krankenhaus Hetzelstift, Neustadt an der Weinstrasse, Germany
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Swartman B, Frere D, Wei W, Schnetzke M, Beisemann N, Keil H, Franke J, Grützner PA, Vetter SY. 2D projection-based software application for mobile C-arms optimises wire placement in the proximal femur - An experimental study. Injury 2017; 48:2068-2073. [PMID: 28774707 DOI: 10.1016/j.injury.2017.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/18/2017] [Accepted: 07/17/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE A new software application can be used without fixed reference markers or a registration process in wire placement. The aim was to compare placement of Kirschner wires (K-wires) into the proximal femur with the software application versus the conventional method without guiding. As study hypothesis, we assumed less placement attempts, shorter procedure time and shorter fluoroscopy time using the software. The same precision inside a proximal femur bone model using the software application was premised. METHODS The software detects a K-wire within the 2D fluoroscopic image. By evaluating its direction and tip location, it superimposes a trajectory on the image, visualizing the intended direction of the K-wire. The K-wire was positioned in 20 artificial bones with the use of software by one surgeon; 20 bones served as conventional controls. A brass thumb tack was placed into the femoral head and its tip targeted with the wire. Number of placement attempts, duration of the procedure, duration of fluoroscopy time and distance to the target in a postoperative 3D scan were recorded. RESULTS Compared with the conventional method, use of the application showed fewer attempts for optimal wire placement (p=0.026), shorter duration of surgery (p=0.004), shorter fluoroscopy time (p=0.024) and higher precision (p=0.018). Final wire position was achieved in the first attempt in 17 out of 20 cases with the software and in 9 out of 20 cases with the conventional method. CONCLUSIONS The study hypothesis was confirmed. The new application optimised the process of K-wire placement in the proximal femur in an artificial bone model while also improving precision. Benefits lie especially in the reduction of placement attempts and reduction of fluoroscopy time under the aspect of radiation protection. The software runs on a conventional image intensifier and can therefore be easily integrated into the daily surgical routine.
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Affiliation(s)
- B Swartman
- BG-Klinik Ludwigshafen, MINTOS Research Group, Clinic for Trauma Surgery and Orthopaedics, Trauma Surgery Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | - D Frere
- BG-Klinik Ludwigshafen, MINTOS Research Group, Clinic for Trauma Surgery and Orthopaedics, Trauma Surgery Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | - W Wei
- Siemens Healthcare GmbH, Advanced Therapies, Surgery, Research & Development, HC AT SU R&D NT MCA, Siemensstr. 1, 91301 Forchheim, Germany
| | - M Schnetzke
- BG-Klinik Ludwigshafen, MINTOS Research Group, Clinic for Trauma Surgery and Orthopaedics, Trauma Surgery Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | - N Beisemann
- BG-Klinik Ludwigshafen, MINTOS Research Group, Clinic for Trauma Surgery and Orthopaedics, Trauma Surgery Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | - H Keil
- BG-Klinik Ludwigshafen, MINTOS Research Group, Clinic for Trauma Surgery and Orthopaedics, Trauma Surgery Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | - J Franke
- BG-Klinik Ludwigshafen, MINTOS Research Group, Clinic for Trauma Surgery and Orthopaedics, Trauma Surgery Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | - P A Grützner
- BG-Klinik Ludwigshafen, MINTOS Research Group, Clinic for Trauma Surgery and Orthopaedics, Trauma Surgery Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | - S Y Vetter
- BG-Klinik Ludwigshafen, MINTOS Research Group, Clinic for Trauma Surgery and Orthopaedics, Trauma Surgery Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany.
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Schmitt FCF, Brenner T, Hofer S, Weigand MA, Grützner PA, Kneser U, Kremer T, Franke J, Müller U. [Morel-Lavallée lesion : Severely injured 13 year old after being run over]. Anaesthesist 2017; 66:672-678. [PMID: 28474244 DOI: 10.1007/s00101-017-0318-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 02/25/2017] [Accepted: 04/14/2017] [Indexed: 10/19/2022]
Abstract
Accidents in which a person is run over are often associated with multiple serious injuries. Immediate bleeding control is crucial. Pressure and shear stress at the borders of subcutaneous tissue to the muscle fascia can cause hypoperfusion and the emergence of blood-filled cavities that are associated with a high risk of infection and necrosis, a so-called Morel-Lavallée lesion. Insufficient therapy can lead to local complications and furthermore to live-threatening sepsis.
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Affiliation(s)
- F C F Schmitt
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
| | - T Brenner
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - S Hofer
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - M A Weigand
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - P A Grützner
- Klinik für Unfallchirurgie und Orthopädie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen, Deutschland
| | - U Kneser
- Klinik für Hand-, Plastische- und Rekonstruktive Chirurgie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen, Deutschland
| | - T Kremer
- Klinik für Hand-, Plastische- und Rekonstruktive Chirurgie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen, Deutschland
| | - J Franke
- Klinik für Unfallchirurgie und Orthopädie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen, Deutschland
| | - U Müller
- Klinik für Unfallchirurgie und Orthopädie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen, Deutschland
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Schnetzke M, Aytac S, Herrmann P, Wölfl C, Grützner PA, Heppert V, Guehring T. [Postoperative implant-associated osteomyelitis of the shoulder: Hardware-retaining revision concept using temporary drainage]. Unfallchirurg 2016; 118:520-6. [PMID: 24127077 DOI: 10.1007/s00113-013-2520-0] [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: 01/04/2023]
Abstract
BACKGROUND Posttraumatic and postoperative osteomyelitis (PPO) is a subgroup of bone infections with increasing importance. However, to date no standardized reoperation concept exists particularly for patients with PPO of the shoulder region. Therefore the purpose of this study was to evaluate a revision concept including débridement, irrigation, and insertion of temporary drainage with hardware retention until healing. PATIENTS AND METHODS A total of 31 patients with PPO were included with a proximal humerus fracture (n = 14), clavicle fracture (n = 10), or AC-joint separation (n = 7). In all, 27 of these patients could be followed for > 1 year. RESULTS Hardware retention until fracture or ligament healing could be achieved in > 83%. Six patients required follow-up débridement due to recurrent infections, but then were unremarkable. Clinical outcome showed excellent Constant scores (91.6 ± 2.8). CONCLUSION A cost-efficient, simple, and successful revision concept for patients with PPO of the shoulder region is described.
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Affiliation(s)
- M Schnetzke
- Klinik für Unfallchirurgie und Orthopädie, BG Unfallklinik Ludwigshafen, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Deutschland
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Ziegler B, Hirche C, Horter J, Kiefer J, Grützner PA, Kremer T, Kneser U, Münzberg M. In view of standardization Part 2: Management of challenges in the initial treatment of burn patients in Burn Centers in Germany, Austria and Switzerland. Burns 2016; 43:318-325. [PMID: 27665246 DOI: 10.1016/j.burns.2016.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/03/2016] [Accepted: 08/05/2016] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Initial therapy of severe burns in specialized burn trauma centers is a challenging task faced by the treating multi-professional and interdisciplinary team. A lack of consistent operating procedures and varying structural conditions was recently demonstrated in preliminary data of our group. These results raised the question on how specific treatment measures in acute burn care are met in the absence of standardized guidelines. MATERIAL AND METHODS A specific questionnaire containing 57 multiple-choice questions was sent to all 22 major burn centers in Germany, Austria and Switzerland. The survey included standards of airway management and ventilation, fluid management and circulation, body temperature monitoring and management, topical burn wound treatment and a microbiological surveillance. Additionally, the distribution of standardized course systems was covered. RESULTS 17 out of 22 questionnaires (77%) were returned completed. Regarding volume resuscitation, results showed a similar approach in estimating initial fluid while discrepancies persisted in the use of colloidal fluid and human albumin. Elective tracheostomy and the need for bronchoscopy with suspected inhalation injury were the most controversial issues revealed by the survey. Topical treatment of burned body surface also followed different principles regarding the use of synthetic epidermal skin substitutes or enzymatic wound debridement. Less discrepancy was found in basic diagnostic measures, body temperature management, estimation of the extent of burns and microbiological surveillance. CONCLUSION While many burn-related issues are clearly not questionable and managed in a similar way in most participating facilities, we were able to show that the most contentious issues in burn trauma management involve initial volume resuscitation, management of inhalation trauma and topical burn wound treatment. Further research is required to address these topics and evaluate a potential superiority of a regime in order to increase the level of evidence.
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Affiliation(s)
- Benjamin Ziegler
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Christoph Hirche
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Johannes Horter
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Jurij Kiefer
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Paul Alfred Grützner
- Department of Trauma and Orthopedic Surgery, Air Rescue Center, BG Trauma Center Ludwigshafen/Rhine, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Thomas Kremer
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Matthias Münzberg
- Department of Trauma and Orthopedic Surgery, Air Rescue Center, BG Trauma Center Ludwigshafen/Rhine, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany.
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Grützner PA, Gebhard F. [Imaging in orthopaedics and trauma surgery]. Unfallchirurg 2016; 119:788-9. [PMID: 27638549 DOI: 10.1007/s00113-016-0239-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- P A Grützner
- Unfallchirurgie und Orthopädie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
| | - F Gebhard
- Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
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