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Behrendt P, Robinson JR, Herbst E, Gellhaus F, Raschke MJ, Seekamp A, Herbort M, Kurz B, Kittl C. Isometry of anteromedial reconstructions mimicking the deep medial collateral ligament depends on the femoral insertion. Knee Surg Sports Traumatol Arthrosc 2024; 32:978-986. [PMID: 38431913 DOI: 10.1002/ksa.12111] [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: 11/01/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE This study aimed to investigate the length change patterns of the native deep medial collateral ligament (dMCL) and potential anteromedial reconstructions (AMs) that might be added to a reconstruction of the superficial MCL (sMCL) to better understand the control of anteromedial rotatory instability (AMRI). METHODS Insertion points of the dMCL and potential AM reconstructions were marked with pins (tibial) and eyelets (femoral) in 11 cadaveric knee specimens. Length changes between the pins and eyelets were then tested using threads in a validated kinematics rig with muscle loading of the quadriceps and iliotibial tract. Between 0° and 100° knee flexion, length change pattern of the anterior, middle and posterior part of the dMCL and simulated AM reconstructions were analysed using a rotary encoder. Isometry was tested using the total strain range (TSR). RESULTS The tibiofemoral distance of the anterior dMCL part lengthened with flexion (+12.7% at 100°), whereas the posterior part slackened with flexion (-12.9% at 100°). The middle part behaved almost isometrically (maximum length: +2.8% at 100°). Depending on the femoral position within the sMCL footprint, AM reconstructions resulted in an increase in length as the knee flexed when a more centred position was used, irrespective of the tibial attachment position. Femoral positioning in the posterior aspect of the sMCL footprint exhibited <4% length change and was slightly less tight in flexion (min TSR = 3.6 ± 1.5%), irrespective of the tibial attachment position. CONCLUSION The length change behaviour of potential AM reconstructions in a functionally intact knee is mainly influenced by the position of the femoral attachment, with different tibial attachments having a minimal effect on length change. Surgeons performing AM reconstructions to control AMRI would be advised to choose a femoral graft position in the posterior part of the native sMCL attachment to optimise graft length change behaviour. Given the high frequency of MCL injuries, sufficient restoration of AMRI is essential in isolated and combined ligamentous knee injuries. LEVEL OF EVIDENCE There is no level of evidence as this study was an experimental laboratory study.
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Affiliation(s)
- Peter Behrendt
- Department of Orthopedic and Trauma Surgery, Asklepios St. Georg, Hamburg, Germany
- Department of Anatomy, Christian-Albrechts-University, Kiel, Germany
- Department of Trauma and Orthopedic Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | | | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University of Muenster, Muenster, Germany
| | - Florian Gellhaus
- Department of Anatomy, Christian-Albrechts-University, Kiel, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University of Muenster, Muenster, Germany
| | - Andreas Seekamp
- Department of Trauma and Orthopedic Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Mirco Herbort
- OCM Orthopedic Surgery Munich Clinic, Munich, Germany
| | - Bodo Kurz
- Department of Anatomy, Christian-Albrechts-University, Kiel, Germany
| | - Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, University of Muenster, Muenster, Germany
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Fitschen-Oestern S, Franke GM, Kirsten N, Lefering R, Lippross S, Schröder O, Klüter T, Müller M, Seekamp A. Does tranexamic acid have a positive effect on the outcome of older multiple trauma patients on antithrombotic drugs? An analysis using the TraumaRegister DGU ®. Front Med (Lausanne) 2024; 11:1324073. [PMID: 38444412 PMCID: PMC10912612 DOI: 10.3389/fmed.2024.1324073] [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: 10/18/2023] [Accepted: 01/22/2024] [Indexed: 03/07/2024] Open
Abstract
BackgroundAcute hemorrhage is one of the most common causes of death in multiple trauma patients. Due to physiological changes, pre-existing conditions, and medication, older trauma patients are more prone to poor prognosis. Tranexamic acid (TXA) has been shown to be beneficial in multiple trauma patients with acute hemorrhage in general. The relation of tranexamic acid administration on survival in elderly trauma patients with pre-existing anticoagulation is the objective of this study. Therefore, we used the database of the TraumaRegister DGU® (TR-DGU), which documents data on severely injured trauma patients.MethodsIn this retrospective analysis, we evaluated the TR-DGU data from 16,713 primary admitted patients with multiple trauma and age > =50 years from 2015 to 2019. Patients with pre-existing anticoagulation and TXA administration (996 patients, 6%), pre-existing anticoagulation without TXA administration (4,807 patients, 28.8%), without anticoagulation as premedication but TXA administration (1,957 patients, 11.7%), and without anticoagulation and TXA administration (8,953 patients, 53.6%) were identified. A regression analysis was performed to investigate the influence of pre-existing antithrombotic drugs and TXA on mortality. A propensity score was created in patients with pre-existing anticoagulation, and matching was performed for better comparability of patients with and without TXA administration.ResultsRetrospective trauma patients who underwent tranexamic acid administration were older and had a higher ISS than patients without tranexamic acid donation. Predicted mortality (according to the RISC II Score) and observed mortality were higher in the group with tranexamic acid administration. The regression analysis showed that TXA administration was associated with lower mortality rates within the first 24 h in older patients with anticoagulation as premedication. The propensity score analysis referred to higher fluid requirement, higher requirement of blood transfusion, and longer hospital stay in the group with tranexamic acid administration. There was no increase in complications. Despite higher transfusion volumes, the tranexamic acid group had a comparable all-cause mortality rate.ConclusionTXA administration in older trauma patients is associated with a reduced 24-h mortality rate after trauma, without increased risk of thromboembolic events. There is no relationship between tranexamic acid and overall mortality in patients with anticoagulation as premedication. Considering pre-existing anticoagulation, tranexamic acid may be recommended in elderly trauma patients with acute bleeding.
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Affiliation(s)
| | - Georg Maximilian Franke
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - Nora Kirsten
- Department of Trauma Surgery, Hannover Medical School, Hannover, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Germany
| | - Sebastian Lippross
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - Ove Schröder
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - Tim Klüter
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - Michael Müller
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - Andreas Seekamp
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Kiel, Germany
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Behrens A, Behrendt P, Heintzen MJ, Finn J, Seekamp A, Mader K, Lippross S, Klatte TO. Mid-term clinical and sonographic outcomes of minimally invasive acromioclavicular joint reconstruction: mini-open versus arthroscopically assisted. Arch Orthop Trauma Surg 2024; 144:807-814. [PMID: 37940713 PMCID: PMC10822806 DOI: 10.1007/s00402-023-05110-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 10/12/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION The current literature describes various operative stabilization strategies which achieve good clinical outcomes after acute acromioclavicular joint (ACJ) dislocation. The aim of this study was to compare the mid-term clinical and sonographic treatment outcomes after minimally invasive mini-open and arthroscopic reconstruction. MATERIALS AND METHODS We conducted a retrospective two-center study of patients with acute ACJ dislocation. Surgical treatment was performed using either a mini-open approach (MIOP) or an arthroscopic technique (AR). The primary outcome parameters of this study were the sonographically measured acromioclavicular (ACD) and coracoclavicular distances (CCD). Secondary outcome parameters included the Constant-Murley score (CS), range of motion (ROM), postoperative pain scale (VAS), return to daily routine, return to sports, complications, as well as operative revisions. RESULTS After a mean follow-up of 29 months, 30 patients were included in this study with an average age of 41.3 ± 14.8 years (MIOP) and 41.2 ± 15.4 years (AR). The sonographic ACD (MIOP 9.11 mm vs. AR 8.93 mm, p = 0.41) and CCD (MIOP 25.08 mm vs. AR 24.36 mm, p = 0.29) distances showed no statistically significant differences. Furthermore, there was no statistically significant difference when compared to the contralateral side (p = 0.42). With both techniques, patients achieved excellent clinical outcome parameters without statistically significant differences in CS (MIOP 95 vs. AR 97, p = 0.11) and VAS (MIOP 1.76 vs. AR 1.14, p = 0.18). The return to daily activity and return to sport rates did not differ. There were neither complications nor revisions in both groups. CONCLUSION Both minimally invasive techniques for acute ACJ stabilization achieved excellent clinical and sonographic outcomes without one technique being statistically superior to the other.
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Affiliation(s)
- A Behrens
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany.
| | - P Behrendt
- Asklepios Hospital St. Georg, Hamburg, Germany
- Department of Anatomy, Kiel University, Kiel, Germany
- Department of Trauma and Orthopedic Surgery, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - M J Heintzen
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - J Finn
- Orthopraxis Kiel, Kiel, Germany
- Department of Trauma and Orthopedic Surgery, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - A Seekamp
- Department of Trauma and Orthopedic Surgery, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - K Mader
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - S Lippross
- Department of Trauma and Orthopedic Surgery, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - T O Klatte
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
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Wegner M, Backhauß JC, Michalsky Y, Seesko H, Hensler J, Klueter T, Jansen O, Seekamp A, Lippross S. Prevalence of degenerative vertebral disc changes in elite female Crossfit athletes - a cross-sectional study. BMC Musculoskelet Disord 2023; 24:963. [PMID: 38082262 PMCID: PMC10712126 DOI: 10.1186/s12891-023-07071-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Crossfit athletes consistently recruit or transfer high levels of repetitive forces through the spine, and MRI has documented a higher rate of intervertebral disc degeneration in athletes compared with matched controls. The aim of this study was to evaluate early degenerative spinal disc changes in elite female CrossFit athletes quantified by 3.0 Tesla magnetic resonance imaging (MRI) matched with female none-athletes. METHODS In a cross-sectional single-center study 19 asymptomatic adult participants, nine German female elite Crossfit athletes and ten female participants underwent spinal MRI (3.0T). Demographic data, spinal clinical examination results and sport-specific performance parameters were collected prior to the MRI. The primary outcome was the prevalence of degenerative spinal disc changes. The secondary outcome was the grade of degeneration using Pfirrmann grading. RESULTS A total of 437 discs underwent spinal MRI (3.0T). The prevalence of early degenerative disc disease was not increased. Pfirrmann degenerative grade did not show significant differences among groups. CONCLUSION Asymptomatic female elite Crossfit athletes do not show an increased prevalence of degenerative disc disease. Compared to a sex-matched control group, high training volume in Crossfit does not correlate to a higher incidence of degenerative disc changes in young females.
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Affiliation(s)
- Mathis Wegner
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany.
| | - Jan-Christoph Backhauß
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Yannik Michalsky
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Henrik Seesko
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Johannes Hensler
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Tim Klueter
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Andreas Seekamp
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Sebastian Lippross
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
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Scarone P, Chatterjea A, Jenniskens I, Klüter T, Weuster M, Lippross S, Presilla S, Distefano D, Chianca V, Sedaghat S, Nelson M, Lampe F, Seekamp A. Correction: Percutaneous thoraco‑lumbar‑sacral pedicle screw placement accuracy results from a multi‑center, prospective clinical study using a skin marker‑based optical navigation system. Eur Spine J 2023; 32:4470. [PMID: 37861725 DOI: 10.1007/s00586-023-07989-7] [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: 10/21/2023]
Affiliation(s)
- Pietro Scarone
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Ospedale Regionale Di Lugano Civico E Italiano, Lugano, Switzerland
| | - Anindita Chatterjea
- Image Guided Therapy Systems, Philips Healthcare, Veenpluis 6, 5684 PC, Best, The Netherlands.
| | - Inge Jenniskens
- Image Guided Therapy Systems, Philips Healthcare, Veenpluis 6, 5684 PC, Best, The Netherlands
| | - Tim Klüter
- Klinik Für Orthopädie Und Unfallchirurgie, UKSH, Campus Kiel, Kiel, Germany
| | - Matthias Weuster
- Klinik Für Orthopädie Und Unfallchirurgie, UKSH, Campus Kiel, Kiel, Germany
| | - Sebastian Lippross
- Klinik Für Orthopädie Und Unfallchirurgie, UKSH, Campus Kiel, Kiel, Germany
| | - Stefano Presilla
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Ospedale Regionale Di Lugano Civico E Italiano, Lugano, Switzerland
| | - Daniela Distefano
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale Di Lugano Civico E Italiano, Lugano, Switzerland
| | - Vito Chianca
- Clinica di Radiologia EOC IIMSI, Lugano, Switzerland
- Ospedale Evangelico Betania, Naples, Italy
| | - Sam Sedaghat
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Ospedale Regionale Di Lugano Civico E Italiano, Lugano, Switzerland
| | - Melissa Nelson
- Image Guided Therapy Systems, Philips Healthcare, Veenpluis 6, 5684 PC, Best, The Netherlands
| | - Finn Lampe
- Klinik Für Orthopädie Und Unfallchirurgie, UKSH, Campus Kiel, Kiel, Germany
| | - Andreas Seekamp
- Klinik Für Orthopädie Und Unfallchirurgie, UKSH, Campus Kiel, Kiel, Germany
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Kühl J, Gorb S, Kern M, Klüter T, Kühl S, Seekamp A, Fuchs S. Extrusion-based 3D printing of osteoinductive scaffolds with a spongiosa-inspired structure. Front Bioeng Biotechnol 2023; 11:1268049. [PMID: 37790253 PMCID: PMC10544914 DOI: 10.3389/fbioe.2023.1268049] [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: 07/27/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023] Open
Abstract
Critical-sized bone defects resulting from trauma, inflammation, and tumor resections are individual in their size and shape. Implants for the treatment of such defects have to consider biomechanical and biomedical factors, as well as the individual conditions within the implantation site. In this context, 3D printing technologies offer new possibilities to design and produce patient-specific implants reflecting the outer shape and internal structure of the replaced bone tissue. The selection or modification of materials used in 3D printing enables the adaption of the implant, by enhancing the osteoinductive or biomechanical properties. In this study, scaffolds with bone spongiosa-inspired structure for extrusion-based 3D printing were generated. The computer aided design process resulted in an up scaled and simplified version of the bone spongiosa. To enhance the osteoinductive properties of the 3D printed construct, polycaprolactone (PCL) was combined with 20% (wt) calcium phosphate nano powder (CaP). The implants were designed in form of a ring structure and revealed an irregular and interconnected porous structure with a calculated porosity of 35.2% and a compression strength within the range of the natural cancellous bone. The implants were assessed in terms of biocompatibility and osteoinductivity using the osteosarcoma cell line MG63 and patient-derived mesenchymal stem cells in selected experiments. Cell growth and differentiation over 14 days were monitored using confocal laser scanning microscopy, scanning electron microscopy, deoxyribonucleic acid (DNA) quantification, gene expression analysis, and quantitative assessment of calcification. MG63 cells and human mesenchymal stem cells (hMSC) adhered to the printed implants and revealed a typical elongated morphology as indicated by microscopy. Using DNA quantification, no differences for PCL or PCL-CaP in the initial adhesion of MG63 cells were observed, while the PCL-based scaffolds favored cell proliferation in the early phases of culture up to 7 days. In contrast, on PCL-CaP, cell proliferation for MG63 cells was not evident, while data from PCR and the levels of calcification, or alkaline phosphatase activity, indicated osteogenic differentiation within the PCL-CaP constructs over time. For hMSC, the highest levels in the total calcium content were observed for the PCL-CaP constructs, thus underlining the osteoinductive properties.
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Affiliation(s)
- Julie Kühl
- Experimental Trauma Surgery, Department of Orthopedics and Trauma Surgery, University Medical Center, Kiel, Germany
| | - Stanislav Gorb
- Department of Functional Morphology and Biomechanics, Kiel University, Kiel, Germany
| | - Matthias Kern
- Department of Prosthodontics, Propaedeutics and Dental Material, University Medical Center, Kiel, Germany
| | - Tim Klüter
- Experimental Trauma Surgery, Department of Orthopedics and Trauma Surgery, University Medical Center, Kiel, Germany
| | - Sebastian Kühl
- Department of Electrical and Information Engineering, Kiel University, Kiel, Germany
| | - Andreas Seekamp
- Experimental Trauma Surgery, Department of Orthopedics and Trauma Surgery, University Medical Center, Kiel, Germany
| | - Sabine Fuchs
- Experimental Trauma Surgery, Department of Orthopedics and Trauma Surgery, University Medical Center, Kiel, Germany
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Lippross S, Wehrenpfennig C, Wedel T, Seekamp A, Osmonov D, Moradi B, Fitschen-Oestern S, Finn J, Klueter T, Kurz B, Alkatout I. The anterior transmuscular intrapelvic approach for the treatment of acetabular fractures-a new anterior surgical strategy. BMC Musculoskelet Disord 2023; 24:638. [PMID: 37559078 PMCID: PMC10411011 DOI: 10.1186/s12891-023-06775-2] [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: 04/01/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023] Open
Abstract
The anterior ilioinguinal and the posterior Kocher-Langenbeck approach have long been the standard surgical approaches to the acetabulum. The last decade has witnessed the development of so-called intrapelvic approaches for anterior pathologies because they provide better exposure of the quadrilateral plate. Currently, the modified Stoppa approach and the pararectus approach are frequently used by surgeons for the treatment of acetabular fractures. We investigated an even more direct access to the entire anterior column and the quadrilateral plate via the abdominal wall muscles, between the incisions for the ilioinguinal and the pararectus approach.After intensive study of anatomic specimens, a cadaver dissection was performed prior to clinical application. The approach was then used in 20 patients who were assessed retrospectively.Postoperative CT scans showed that, according to the Matta scoring system, the quality of fracture reduction was "anatomical" (≤ 1 mm) in 12 (60%), "imperfect" (2-3 mm) in four (20%), and "poor" (> 3 mm) in four (20%) patients. Numerous minor complications were observed; the majority of these had resolved at the time of discharge.In conclusion, the anterior transmuscular intrapelvic approach (ATI) is a safe and effective alternative to the ilioinguinal and pararectal approaches, and may be regarded as an evolutionary advancement of traditional procedures.
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Affiliation(s)
- Sebastian Lippross
- Department of Trauma and Orthopaedic Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - Clara Wehrenpfennig
- Department of Trauma and Orthopaedic Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thilo Wedel
- Institute of Anatomy, Christian-Albrecht University, Kiel, Germany
| | - Andreas Seekamp
- Department of Trauma and Orthopaedic Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Daniar Osmonov
- Department of Urology, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Babak Moradi
- Department of Trauma and Orthopaedic Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Stefanie Fitschen-Oestern
- Department of Trauma and Orthopaedic Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Joerg Finn
- Department of Trauma and Orthopaedic Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Tim Klueter
- Department of Trauma and Orthopaedic Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Bodo Kurz
- Institute of Anatomy, Christian-Albrecht University, Kiel, Germany
| | - Ibrahim Alkatout
- Department of Gynaecology, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Hagel S, Liedtke KR, Bax S, Wailke S, Klüter T, Behrendt P, Franke GM, Seekamp A, Langguth P, Balandin A, Grünewald M, Schunk D. [Patient safety in differentiated (in-hospital) activation of the resuscitation room for severely injured patients]. Unfallchirurgie (Heidelb) 2023; 126:441-448. [PMID: 36622382 PMCID: PMC9827437 DOI: 10.1007/s00113-022-01279-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Providing trauma services demands high personnel resources and structural costs. The goal of this study was to show if the assignment of trauma patients to a defined A or B resuscitation room treatment as a modified management concept is safe and feasible. MATERIAL AND METHODS Between May 2020 and January 2021, all resuscitation room trauma patients were included in this single center prospective observational study. All patients admitted to the resuscitation room underwent a classification according to the German S3 guidelines grade of recommendation GoR A and GoR B in polytrauma and the status of the ABCDE sequence to an A and B resuscitation room. The classification was performed by the senior consultant on call via telephone after consultation and discussion of clinical findings. RESULTS All 135 resuscitation room patients were included in the study of whom 42 trauma patients were assigned to the A resuscitation room (A-SR) and 93 were assigned to the B resuscitation room (B-SR). The comparison of the two groups showed that patients in the A‑SR group are more likely to be accompanied by a prehospital emergency physician (80.5%) than patients in the B‑SR group (55.5%). Patients in the B‑SR group showed a significantly higher Glasgow coma scale (GCS). Using the eFAST emergency ultrasound protocol, 2.4% of the A‑SR and 4.3% of the B‑SR patients had trauma-associated pathologies, 26% of the A‑SR and only 3.2% of the B‑SR patients had to be admitted to the ICU, 21.4% of the A‑SR and 1% of the B‑SR patients died within 30 days after trauma. The injury severity scores (ISS) of the A‑SR patients were significantly higher than in the B‑SR group (ISS 28.3 vs. 6.8). CONCLUSION The study confirmed that the assignment by the emergency department consultant according to the German S3 guideline in combination with the ABCDE sequence into resuscitation room A or B treatment is feasible, does not compromise the quality of care and is efficient in the use of the personnel resources.
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Affiliation(s)
- S Hagel
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - K R Liedtke
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - S Bax
- Zentrale Einrichtung Interdisziplinäre Notaufnahme, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - S Wailke
- Zentrale Einrichtung Interdisziplinäre Notaufnahme, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - T Klüter
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - P Behrendt
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - G M Franke
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - A Seekamp
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - P Langguth
- Klinik für Radiologie und Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - A Balandin
- Klinik für Anästhesiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - M Grünewald
- Klinik für Anästhesiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - D Schunk
- Zentrale Einrichtung Interdisziplinäre Notaufnahme, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland.
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Kirsten N, Ohmes J, Mikkelsen MD, Nguyen TT, Blümel M, Wang F, Tasdemir D, Seekamp A, Meyer AS, Fuchs S. Impact of Enzymatically Extracted High Molecular Weight Fucoidan on Lipopolysaccharide-Induced Endothelial Activation and Leukocyte Adhesion. Mar Drugs 2023; 21:339. [PMID: 37367664 DOI: 10.3390/md21060339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/24/2023] [Accepted: 05/28/2023] [Indexed: 06/28/2023] Open
Abstract
The endothelial cell lining creates an interface between circulating blood and adjoining tissue and forms one of the most critical barriers and targets for therapeutical intervention. Recent studies suggest that fucoidans, sulfated and fucose-rich polysaccharides from brown seaweed, show multiple promising biological effects, including anti-inflammatory properties. However, their biological activity is determined by chemical characteristics such as molecular weight, sulfation degree, and molecular structure, which vary depending on the source, species, and harvesting and isolation method. In this study, we investigated the impact of high molecular weight (HMW) fucoidan extract on endothelial cell activation and interaction with primary monocytes (MNCs) in lipopolysaccharide (LPS)-induced inflammation. Gentle enzyme-assisted extraction combined with fractionation by ion exchange chromatography resulted in well-defined and pure fucoidan fractions. FE_F3, with a molecular weight ranging from 110 to 800 kDa and a sulfate content of 39%, was chosen for further investigation of its anti-inflammatory potential. We observed that along with higher purity of fucoidan fractions, the inflammatory response in endothelial mono- and co-cultures with MNCs was reduced in a dose-dependent manner when testing two different concentrations. This was demonstrated by a decrease in IL-6 and ICAM-1 on gene and protein levels and a reduced gene expression of TLR-4, GSK3β and NF-kB. Expression of selectins and, consequently, the adhesion of monocytes to the endothelial monolayer was reduced after fucoidan treatment. These data indicate that the anti-inflammatory effect of fucoidans increases with their purity and suggest that fucoidans might be useful in limiting the inflammatory response of endothelial cells in cases of LPS-induced bacterial infection.
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Affiliation(s)
- Nora Kirsten
- Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Julia Ohmes
- Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Maria Dalgaard Mikkelsen
- Protein Chemistry and Enzyme Technology Section, DTU Bioengineering, Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800 Kongens Lyngby, Denmark
| | - Thuan Thi Nguyen
- Protein Chemistry and Enzyme Technology Section, DTU Bioengineering, Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800 Kongens Lyngby, Denmark
| | - Martina Blümel
- GEOMAR Centre for Marine Biotechnology (GEOMAR-Biotech), Research Unit Marine Natural Products Chemistry, GEOMAR Helmholtz Centre for Ocean Research Kiel, 24106 Kiel, Germany
| | - Fanlu Wang
- Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Deniz Tasdemir
- GEOMAR Centre for Marine Biotechnology (GEOMAR-Biotech), Research Unit Marine Natural Products Chemistry, GEOMAR Helmholtz Centre for Ocean Research Kiel, 24106 Kiel, Germany
- Faculty of Mathematics and Natural Science, Kiel University, 24118 Kiel, Germany
| | - Andreas Seekamp
- Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Anne S Meyer
- Protein Chemistry and Enzyme Technology Section, DTU Bioengineering, Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800 Kongens Lyngby, Denmark
| | - Sabine Fuchs
- Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
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10
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Xiong J, Kaleja P, Ückert L, Nezaratizadeh N, Krantz S, Krause MF, Fitschen-Oestern S, Seekamp A, Cassidy L, Tholey A, Fuchs S. Alveolar-Capillary Barrier Protection In Vitro: Lung Cell Type-Specific Effects and Molecular Mechanisms Induced by 1α, 25-Dihydroxyvitamin D3. Int J Mol Sci 2023; 24:ijms24087298. [PMID: 37108455 PMCID: PMC10138495 DOI: 10.3390/ijms24087298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
Low serum levels of 1α, 25-dihydroxyvitamin D3 (VD3) are associated with a higher mortality in trauma patients with sepsis or ARDS. However, the molecular mechanisms behind this observation are not yet understood. VD3 is known to stimulate lung maturity, alveolar type II cell differentiation, or pulmonary surfactant synthesis and guides epithelial defense during infection. In this study, we investigated the impact of VD3 on the alveolar-capillary barrier in a co-culture model of alveolar epithelial cells and microvascular endothelial cells respectively in the individual cell types. After stimulation with bacterial LPS (lipopolysaccharide), gene expression of inflammatory cytokines, surfactant proteins, transport proteins, antimicrobial peptide, and doublecortin-like kinase 1 (DCLK1) were analyzed by real-time PCR, while corresponding proteins were evaluated by ELISA, immune-fluorescence, or Western blot. The effect of VD3 on the intracellular protein composition in H441 cells was analyzed by quantitative liquid chromatography-mass spectrometry-based proteomics. VD3 effectively protected the alveolar-capillary barrier against LPS treatment, as indicated by TEER measurement and morphological assessment. VD3 did not inhibit the IL-6 secretion by H441 and OEC but restricted the diffusion of IL-6 to the epithelial compartment. Further, VD3 could significantly suppress the surfactant protein A expression induced in the co-culture system by LPS treatment. VD3 induced high levels of the antimicrobial peptide LL-37, which counteracted effects by LPS and strengthened the barrier. Quantitative proteomics identified VD3-dependent protein abundance changes ranging from constitutional extracellular matrix components and surfactant-associated proteins to immune-regulatory molecules. DCLK1, as a newly described target molecule for VD3, was prominently stimulated by VD3 (10 nM) and seems to influence the alveolar-epithelial cell barrier and regeneration.
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Affiliation(s)
- Junyu Xiong
- Experimental Trauma Surgery, Department of Trauma Surgery and Orthopedics, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Patrick Kaleja
- Systematic Proteomics & Bioanalytics, Institute for Experimental Medicine, Christian-Albrechts-Universität zu Kiel, 24015 Kiel, Germany
| | - Larissa Ückert
- Experimental Trauma Surgery, Department of Trauma Surgery and Orthopedics, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Niloufar Nezaratizadeh
- Experimental Trauma Surgery, Department of Trauma Surgery and Orthopedics, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Stefanie Krantz
- Experimental Trauma Surgery, Department of Trauma Surgery and Orthopedics, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Martin Friedrich Krause
- Department of Pediatrics, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Stefanie Fitschen-Oestern
- Experimental Trauma Surgery, Department of Trauma Surgery and Orthopedics, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Andreas Seekamp
- Experimental Trauma Surgery, Department of Trauma Surgery and Orthopedics, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Liam Cassidy
- Systematic Proteomics & Bioanalytics, Institute for Experimental Medicine, Christian-Albrechts-Universität zu Kiel, 24015 Kiel, Germany
| | - Andreas Tholey
- Systematic Proteomics & Bioanalytics, Institute for Experimental Medicine, Christian-Albrechts-Universität zu Kiel, 24015 Kiel, Germany
| | - Sabine Fuchs
- Experimental Trauma Surgery, Department of Trauma Surgery and Orthopedics, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
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11
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Wegner M, Seekamp A, Lippross S. [Camera-based navigation in the hybrid operating room]. Chirurgie (Heidelb) 2023; 94:307-311. [PMID: 36494452 PMCID: PMC10042925 DOI: 10.1007/s00104-022-01777-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/14/2022]
Abstract
Camera-based navigation in the hybrid operating room represents a possibility for precise, low-complication and efficient pedicle screw insertion in spinal surgery. In addition to increasing patient safety, the use of camera-based navigation as an orientation aid for the surgeon reduces radiation exposure. Camera-based navigation focuses on the surgeon's anatomical knowledge of landmarks, preoperative image acquisition, and subsequent information integration by the navigation software. The information provided from volume tomography (cone beam computed tomography, CBCT) and surface referencing through the video input from four optical cameras and the associated surface markers is collected, processed, optimized and customized by the software used. The result is the creation of a trajectory that allows the surgeon to analyze and evaluate complex anatomical structures more easily and facilitates the performance of the planned procedure. Minimally invasive insertion of pedicle screws using surface-reference navigation (augmented reality surgical navigation; ARSN) provides comparable accuracy to conventional fluoroscopic insertion of pedicle screws while reducing radiation by eliminating the need for postoperative computed tomographic imaging.
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Affiliation(s)
- Mathis Wegner
- Orthopädie und Unfallchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland.
| | - Andreas Seekamp
- Orthopädie und Unfallchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland
| | - Sebastian Lippross
- Orthopädie und Unfallchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland
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12
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Seekamp A. [Robotics and computer-assisted surgery]. Chirurgie (Heidelb) 2023; 94:289-291. [PMID: 36971811 PMCID: PMC10042745 DOI: 10.1007/s00104-023-01822-z] [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] [Accepted: 01/19/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Andreas Seekamp
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller Straße 3, Haus C, 24105, Kiel, Deutschland.
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13
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Scarone P, Chatterjea A, Jenniskens I, Klüter T, Weuster M, Lippross S, Presilla S, Distefano D, Chianca V, Sedaghat S, Nelson M, Lampe F, Seekamp A. Percutaneous thoraco-lumbar-sacral pedicle screw placement accuracy results from a multi-center, prospective clinical study using a skin marker-based optical navigation system. Eur Spine J 2022; 31:3098-3108. [PMID: 36149493 DOI: 10.1007/s00586-022-07387-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/05/2022] [Accepted: 09/11/2022] [Indexed: 06/16/2023]
Abstract
STUDY DESIGN Prospective multi-center study. OBJECTIVE The study aimed to evaluate the accuracy of pedicle screw placement using a skin marker-based optical surgical navigation system for minimal invasive thoraco-lumbar-sacral pedicle screw placement. METHODS The study was performed in a hybrid Operating Room with a video camera-based navigation system integrated in the imaging hardware. The patient was tracked with non-invasive skin markers while the instrument tracking was via an on-shaft optical marker pattern. The screw placement accuracy assessment was performed by three independent reviewers, using the Gertzbein grading. The screw placement time as well as the staff and patient radiation doses was also measured. RESULTS In total, 211 screws in 39 patients were analyzed for screw placement accuracy. Of these 32.7% were in the thoracic region, 59.7% were in the lumbar region, and 7.6% were in the sacral region. An overall accuracy of 98.1% was achieved. No screws were deemed severely misplaced (Gertzbein grading 3). The average time for screw placement was 6 min and 25 secs (± 3 min 33 secs). The average operator radiation dose per subject was 40.3 µSv. The mean patient effective dose (ED) was 11.94 mSv. CONCLUSION Skin marker-based ON can be used to achieve very accurate thoracolumbarsacral pedicle screw placements.
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Affiliation(s)
- Pietro Scarone
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Ospedale Regionale Di Lugano Civico E Italiano, Lugano, Switzerland
| | - Anindita Chatterjea
- Image Guided Therapy Systems, Philips Healthcare, Veenpluis 6, 5684 PC, Best, The Netherlands.
| | - Inge Jenniskens
- Image Guided Therapy Systems, Philips Healthcare, Veenpluis 6, 5684 PC, Best, The Netherlands
| | - Tim Klüter
- Klinik Für Orthopädie Und Unfallchirurgie, UKSH, Campus Kiel, Kiel, Germany
| | - Matthias Weuster
- Klinik Für Orthopädie Und Unfallchirurgie, UKSH, Campus Kiel, Kiel, Germany
| | - Sebastian Lippross
- Klinik Für Orthopädie Und Unfallchirurgie, UKSH, Campus Kiel, Kiel, Germany
| | - Stefano Presilla
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Ospedale Regionale Di Lugano Civico E Italiano, Lugano, Switzerland
| | - Daniela Distefano
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale Di Lugano Civico E Italiano, Lugano, Switzerland
| | - Vito Chianca
- Clinica di Radiologia EOC IIMSI, Lugano, Switzerland
- Ospedale Evangelico Betania, Naples, Italy
| | - Sam Sedaghat
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Ospedale Regionale Di Lugano Civico E Italiano, Lugano, Switzerland
| | - Melissa Nelson
- Image Guided Therapy Systems, Philips Healthcare, Veenpluis 6, 5684 PC, Best, The Netherlands
| | - Finn Lampe
- Klinik Für Orthopädie Und Unfallchirurgie, UKSH, Campus Kiel, Kiel, Germany
| | - Andreas Seekamp
- Klinik Für Orthopädie Und Unfallchirurgie, UKSH, Campus Kiel, Kiel, Germany
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14
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Gutwerk A, Behrendt P, Vetter S, Menzdorf L, Oates E, Jazra S, Lippross S, Klüter T, Seekamp A, Weuster M. Retrospective Mid-Term Follow-Up of Posttraumatic and Iatrogenic Neurovascular Complications in Surgically Treated Paediatric Patients with Distal Humerus Fracture. Children (Basel) 2022; 9:1349. [PMID: 36138658 PMCID: PMC9497747 DOI: 10.3390/children9091349] [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] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The purpose of the study was to investigate and describe neurovascular complications and mid-term clinical outcomes of operatively managed fractures of the distal humerus in a paediatric population. Neurovascular injuries are common in these fractures, but reports about their implications for mid-term clinical outcomes is sparse. METHODS A single-centre retrospective study was conducted at a university teaching hospital investigating paediatric patients who underwent operative management of a distal humerus fracture between 2014 and 2018. Patient demographics, fracture classification, pre-, peri- and postoperative neurovascular complications were investigated. Mid-term follow up clinical examination and functional scoring using QuickDASH, the Broberg and Morrey Score (BMS), the Mayo Elbow Performance Score (MEPS) and the Numeric Rating Scale were performed. RESULTS A total of 84 patients were identified, of which 34 met the inclusion criteria and were available for follow-up clinical examination. The average time to follow-up was 150 weeks (1049.44 days ± 448.54). Ten primary traumatic neurovascular complications were identified, the majority of which involved the median nerve. Primary traumatic dissection of the brachial artery was recorded in three patients. Secondary iatrogenic nerve injury was documented in five patients after previously normal clinical examination. At follow-up, the average QuickDASH score was 3.0 ± 4.3, BMS was 98.6 ± 3.4 and MEPS was 97.1 ± 3.3 points. CONCLUSIONS The mid-term clinical outcome following surgical management of distal humerus fractures is excellent. There is, however, a considerable frequency of both primary and secondary neurovascular complications, which must be considered when opting to treat these injuries surgically.
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Affiliation(s)
- Alexander Gutwerk
- Department of Orthopedic, Trauma, Hand and Reconstructive Surgery, DIAKO Clinic, 24939 Flensburg, Germany
| | - Peter Behrendt
- Department of Trauma Surgery, Orthopedics and Sportsorthopedics, Asklepios St. Georg, 20099 Hamburg, Germany
- Department of Anatomy, Christian-Albrechts-University, 24118 Kiel, Germany
- Department of Orthopedics and Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Svenja Vetter
- Department of Orthopedics and Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Leif Menzdorf
- Department of Orthopedic, Trauma, Hand and Reconstructive Surgery, DIAKO Clinic, 24939 Flensburg, Germany
| | - Edward Oates
- Department of Orthopedic, Trauma, Hand and Reconstructive Surgery, DIAKO Clinic, 24939 Flensburg, Germany
| | - Sebastian Jazra
- Department of Orthopedic, Trauma, Hand and Reconstructive Surgery, DIAKO Clinic, 24939 Flensburg, Germany
| | - Sebastian Lippross
- Department of Orthopedics and Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Tim Klüter
- Department of Orthopedics and Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Andreas Seekamp
- Department of Orthopedics and Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Matthias Weuster
- Department of Orthopedic, Trauma, Hand and Reconstructive Surgery, DIAKO Clinic, 24939 Flensburg, Germany
- Department of Orthopedics and Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
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15
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Ohmes J, Mikkelsen MD, Nguyen TT, Tran VHN, Meier S, Nielsen MS, Ding M, Seekamp A, Meyer AS, Fuchs S. Depolymerization of fucoidan with endo-fucoidanase changes bioactivity in processes relevant for bone regeneration. Carbohydr Polym 2022; 286:119286. [PMID: 35337530 DOI: 10.1016/j.carbpol.2022.119286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Received: 12/15/2021] [Revised: 02/01/2022] [Accepted: 02/21/2022] [Indexed: 12/24/2022]
Abstract
Fucoidans are polysaccharides from brown macroalgae, showing multiple bioactivities important for bone regeneration and bone health. However, the use of fucoidans in medical applications remains sparse due to the heterogeneity in their chemical properties and unclear structure-function relationships. Innovations in extraction techniques and post processing steps are needed to produce homogeneous fucoidan molecules with tailorable bioactivities. Here, we applied enzyme-assisted extraction coupled with enzymatic hydrolysis by Fhf1 fucoidanase to generate low (LMW) and medium molecular weight (MMW) fucoidans from Fucus evanescens. In contrast to the anti-angiogenic properties of the high molecular weight fucoidan, LMW and MMW no longer suppressed the production of pro-angiogenic molecules by bone stem cells, nor impaired the formation of prevascular structures in vitro. In contrast to LMW, a pro-inflammatory response of OEC was observed after treatment with high concentrations of MMW. Thus, fucoidanase hydrolysis could be a useful tool to tailor the bioactivity of fucoidans.
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Affiliation(s)
- Julia Ohmes
- Experimental Trauma Surgery, Department of Orthopedics and Trauma Surgery, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany.
| | - Maria Dalgaard Mikkelsen
- Protein Chemistry and Enzyme Technology Section, DTU Bioengineering, Department of Biotechnology and Biomedicine, Technical University of Denmark, Building 221, 2800 Kongens Lyngby, Denmark.
| | - Thuan Thi Nguyen
- Protein Chemistry and Enzyme Technology Section, DTU Bioengineering, Department of Biotechnology and Biomedicine, Technical University of Denmark, Building 221, 2800 Kongens Lyngby, Denmark; Nha Trang Institute of Technology Research and Application, Vietnam Academy of Science and Technology, 02 Hung Vuong Street, Nhatrang 650000, Viet Nam.
| | - Vy Ha Nguyen Tran
- Protein Chemistry and Enzyme Technology Section, DTU Bioengineering, Department of Biotechnology and Biomedicine, Technical University of Denmark, Building 221, 2800 Kongens Lyngby, Denmark; Nha Trang Institute of Technology Research and Application, Vietnam Academy of Science and Technology, 02 Hung Vuong Street, Nhatrang 650000, Viet Nam.
| | - Sebastian Meier
- Department of Chemistry, Technical University of Denmark, Building 207, 2800 Kongens Lyngby, Denmark.
| | - Mads Suhr Nielsen
- Orthopedic Research Laboratory, Department of Orthopedic Surgery and Traumatology, Odense University Hospital & Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark.
| | - Ming Ding
- Orthopedic Research Laboratory, Department of Orthopedic Surgery and Traumatology, Odense University Hospital & Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark.
| | - Andreas Seekamp
- Experimental Trauma Surgery, Department of Orthopedics and Trauma Surgery, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany.
| | - Anne S Meyer
- Protein Chemistry and Enzyme Technology Section, DTU Bioengineering, Department of Biotechnology and Biomedicine, Technical University of Denmark, Building 221, 2800 Kongens Lyngby, Denmark.
| | - Sabine Fuchs
- Experimental Trauma Surgery, Department of Orthopedics and Trauma Surgery, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany.
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16
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Schroeder O, Schroeder J, Fitschen‐Oestern S, Besch L, Seekamp A. Effectiveness of autonomous home hazard reduction on fear of falling in community‐dwelling older women. J Am Geriatr Soc 2022; 70:1754-1763. [DOI: 10.1111/jgs.17725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/10/2022] [Accepted: 01/29/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Ove Schroeder
- University Medical Department Center Schleswig‐Holstein, Department of Orthopedic and Trauma Surgery Kiel Germany
| | - Julia Schroeder
- Christian‐Albrechts‐University, Medical faculty Kiel Germany
| | - Stefanie Fitschen‐Oestern
- University Medical Department Center Schleswig‐Holstein, Department of Orthopedic and Trauma Surgery Kiel Germany
| | - Lutz Besch
- University Medical Department Center Schleswig‐Holstein, Department of Orthopedic and Trauma Surgery Kiel Germany
| | - Andreas Seekamp
- University Medical Department Center Schleswig‐Holstein, Department of Orthopedic and Trauma Surgery Kiel Germany
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17
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Seuthe R, Seekamp A, Kurz B, Pfarr J, Schaefer JP, Peh S, Lippross S. Comparison of a ceiling-mounted 3D flat panel detector vs. conventional intraoperative 2D fluoroscopy in plate osteosynthesis of distal radius fractures with volar locking plate systems. BMC Musculoskelet Disord 2021; 22:924. [PMID: 34727909 PMCID: PMC8564984 DOI: 10.1186/s12891-021-04784-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/08/2021] [Indexed: 11/10/2022] Open
Abstract
Objectives To compare intraoperative 3D fluoroscopy with a ceiling-mounted flat panel detector in plate osteosynthesis of distal radius fractures (AO/OTA 2R3C1.2) with volar locking plate systems to conventional 2D fluoroscopy for detection of insufficient fracture reduction, plate misplacement and protruding screws. Methods Using a common volar approach on 12 cadaver forearms, total intraarticular distal radius fractures were induced, manually reduced and internally fixated with a 2.4 distal radius locking compression plate. 2D (anterior-posterior and lateral) and 3D (rotational) fluoroscopic images were taken as well as computed tomographies. Fluoroscopic images, Cone Beam CT (CBCT), 360° rotating sequences (so called “Movies”) and CT scans were co-evaluated by a specialist orthopedic surgeon and a specialist radiologist regarding quality of fracture reduction, position of plate, position of the three distal locking screws and position of the three diaphyseal screws. In reference to gold standard CT, sensitivity and specifity were analyzed. Results “Movie” showed highest sensitivity for detection of insufficient fracture reduction (88%). Sensitivity for detection of incorrect position of plate was 100% for CBCT and 90% for “Movie.” For intraarticular position of screws, 2D fluoroscopy and CBCT showed highest sensitivity and specifity (100 and 91%, respectively). Regarding detection of only marginal intraarticular position of screws, sensitivity and specifity of 2D fluoroscopy reached 100% (CBCT: 100 and 83%). “Movie” showed highest sensitivity for detection of overlapping position of screws (100%). When it comes to specifity, CBCT achieved 100%. Regarding detection of only marginal overlapping position of screws, 2D fluoroscopy and “Movie” showed highest sensitivity (100%). CBCT achieved highest specifity (100%). Conclusion As for assessment of quality of fracture reduction and detection of incorrect position of plate as well as overlapping position of the three diaphyseal screws CBCT and “Movie” are comparable to CT – especially when combined. Particularly sensitivity is high compared to standard 2D fluoroscopy.
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Affiliation(s)
- Raphael Seuthe
- Department of Trauma and Orthopedic Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Andreas Seekamp
- Department of Trauma and Orthopedic Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Bodo Kurz
- Department of Anatomy, Christian-Albrechts-University, Kiel, Germany
| | - Julian Pfarr
- Department of Radiology and Neuroradiology, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jost Philipp Schaefer
- Department of Radiology and Neuroradiology, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Simon Peh
- Department of Trauma and Orthopedic Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Sebastian Lippross
- Department of Trauma and Orthopedic Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
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18
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Wang F, Xiao Y, Neupane S, Ptak SH, Römer R, Xiong J, Ohmes J, Seekamp A, Fretté X, Alban S, Fuchs S. Influence of Fucoidan Extracts from Different Fucus Species on Adult Stem Cells and Molecular Mediators in In Vitro Models for Bone Formation and Vascularization. Mar Drugs 2021; 19:194. [PMID: 33805470 PMCID: PMC8066524 DOI: 10.3390/md19040194] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 01/03/2023] Open
Abstract
Fucoidans, sulfated polysaccharides extracted from brown algae, are marine products with the potential to modulate bone formation and vascularization processes. The bioactivity and safety of fucoidans are highly associated with their chemical structure, which may vary with algae species and extraction method. Thus, in depth evaluation of fucoidan extracts in terms of endotoxin content, cytotoxicity, and their detailed molecular biological impact on the individual cell types in bone is needed. In this study, we characterized fucoidan extracts from three different Fucus species including Fucus vesiculosus (Fv), Fucus serratus (Fs), and Fucus distichus subsp. evanescens (Fe) for their chemical features, endotoxin content, cytotoxicity, and bioactive effects on human outgrowth endothelial cells (OEC) and human mesenchymal stem cells (MSC) as in vitro models for bone function and vascularization. Extracts contained mainly high molecular weight (HMW) fucoidans and were free of endotoxins that may cause inflammation or influence vascularization. OEC tolerated fucoidan concentrations up to 200 µg/mL, and no indication of cytotoxicity was observed. The inflammatory response, however, investigated by real-time PCR (RT-PCR) and enzyme-linked immunosorbent assay (ELISA) and endothelial barrier assessed by impedance measurement differed for the individual extracts. MSC in comparison with endothelial cells were more sensitive to fucoidans and showed partly reduced metabolic activity and proliferation at higher doses of fucoidans. Further results for MSC indicated impaired osteogenic functions in alkaline phosphatase and calcification assays. All tested extracts consistently lowered important molecular mediators involved in angiogenesis, such a VEGF (vascular endothelial growth factor), ANG-1 (angiopoietin 1), and ANG-2 (angiopoietin 2), as indicated by RT-PCR and ELISA. This was associated with antiangiogenic effects at the functional level using selected extracts in co-culture models to mimic bone vascularization processes during bone regeneration or osteosarcoma.
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Affiliation(s)
- Fanlu Wang
- Experimental Trauma Surgery, Department of Orthopedics and Trauma Surgery, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany; (F.W.); (Y.X.); (R.R.); (J.X.); (J.O.); (A.S.)
| | - Yuejun Xiao
- Experimental Trauma Surgery, Department of Orthopedics and Trauma Surgery, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany; (F.W.); (Y.X.); (R.R.); (J.X.); (J.O.); (A.S.)
| | - Sandesh Neupane
- Department of Pharmaceutical Biology, Pharmaceutical Institute, Kiel University, 24148 Kiel, Germany; (S.N.); (S.A.)
| | - Signe Helle Ptak
- SDU Chemical Engineering, University of Southern Denmark, 5230 Odense, Denmark; (S.H.P.); (X.F.)
| | - Ramona Römer
- Experimental Trauma Surgery, Department of Orthopedics and Trauma Surgery, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany; (F.W.); (Y.X.); (R.R.); (J.X.); (J.O.); (A.S.)
| | - Junyu Xiong
- Experimental Trauma Surgery, Department of Orthopedics and Trauma Surgery, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany; (F.W.); (Y.X.); (R.R.); (J.X.); (J.O.); (A.S.)
| | - Julia Ohmes
- Experimental Trauma Surgery, Department of Orthopedics and Trauma Surgery, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany; (F.W.); (Y.X.); (R.R.); (J.X.); (J.O.); (A.S.)
| | - Andreas Seekamp
- Experimental Trauma Surgery, Department of Orthopedics and Trauma Surgery, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany; (F.W.); (Y.X.); (R.R.); (J.X.); (J.O.); (A.S.)
| | - Xavier Fretté
- SDU Chemical Engineering, University of Southern Denmark, 5230 Odense, Denmark; (S.H.P.); (X.F.)
| | - Susanne Alban
- Department of Pharmaceutical Biology, Pharmaceutical Institute, Kiel University, 24148 Kiel, Germany; (S.N.); (S.A.)
| | - Sabine Fuchs
- Experimental Trauma Surgery, Department of Orthopedics and Trauma Surgery, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany; (F.W.); (Y.X.); (R.R.); (J.X.); (J.O.); (A.S.)
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19
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Ohmes J, Xiao Y, Wang F, Mikkelsen MD, Nguyen TT, Schmidt H, Seekamp A, Meyer AS, Fuchs S. Effect of Enzymatically Extracted Fucoidans on Angiogenesis and Osteogenesis in Primary Cell Culture Systems Mimicking Bone Tissue Environment. Mar Drugs 2020; 18:E481. [PMID: 32967359 PMCID: PMC7550999 DOI: 10.3390/md18090481] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/02/2020] [Accepted: 09/18/2020] [Indexed: 01/17/2023] Open
Abstract
Angiogenesis, the formation of new blood vessels from existing ones, is an essential process for successful bone regeneration. Further, angiogenesis is a key factor for the development of bone-related disorders like osteosarcoma or arthritis. Fucoidans, sulfated polysaccharides from brown algae, have been shown to affect angiogenesis as well as a series of other physiological processes including inflammation or infection. However, the chemical properties of fucoidan which define the biological activity vary tremendously, making a prediction of the bioactivity or the corresponding therapeutic effect difficult. In this study, we compare the effect of four chemically characterized high molecular weight fucoidan extracts from Fucus distichus subsp. evanescens (FE_crude and fractions F1, F2, F3) on angiogenic and osteogenic processes in bone-related primary mono- and co-culture cell systems. By determining the gene expression and protein levels of the regulatory molecules vascular endothelial growth factor (VEGF), angiopoietin-1 (ANG-1), ANG-2 and stromal-derived factor 1 (SDF-1), we show that the extracted fucoidans negatively influence angiogenic and osteogenic processes in both the mono- and co-culture systems. We demonstrate that purer fucoidan extracts with a high fucose and sulfate content show stronger effects on these processes. Immunocytochemistry of the co-culture system revealed that treatment with FE_F3, containing the highest fucose and sulfate content, impaired the formation of angiogenic tube-like structures, indicating the anti-angiogenic properties of the tested fucoidans. This study highlights how chemical properties of fucoidan influence its bioactivity in a bone-related context and discusses how the observed phenotypes can be explained on a molecular level-knowledge that is indispensable for future therapies based on fucoidans.
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Affiliation(s)
- Julia Ohmes
- Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany; (J.O.); (Y.X.); (F.W.); (A.S.)
| | - Yuejun Xiao
- Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany; (J.O.); (Y.X.); (F.W.); (A.S.)
| | - Fanlu Wang
- Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany; (J.O.); (Y.X.); (F.W.); (A.S.)
| | - Maria Dalgaard Mikkelsen
- Protein Chemistry and Enzyme Technology Section, DTU Bioengineering, Department of Biotechnology and Biomedicine, Technical University of Denmark, Building 221, 2800 Kongens Lyngby, Denmark; (M.D.M.); (T.T.N.); (A.S.M.)
| | - Thuan Thi Nguyen
- Protein Chemistry and Enzyme Technology Section, DTU Bioengineering, Department of Biotechnology and Biomedicine, Technical University of Denmark, Building 221, 2800 Kongens Lyngby, Denmark; (M.D.M.); (T.T.N.); (A.S.M.)
| | | | - Andreas Seekamp
- Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany; (J.O.); (Y.X.); (F.W.); (A.S.)
| | - Anne S. Meyer
- Protein Chemistry and Enzyme Technology Section, DTU Bioengineering, Department of Biotechnology and Biomedicine, Technical University of Denmark, Building 221, 2800 Kongens Lyngby, Denmark; (M.D.M.); (T.T.N.); (A.S.M.)
| | - Sabine Fuchs
- Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany; (J.O.); (Y.X.); (F.W.); (A.S.)
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20
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Fitschen-Oestern S, Lippross S, Lefering R, Klüter T, Behrendt P, Weuster M, Seekamp A, Dgu T. Missed hand and forearm injuries in multiple trauma patients: An analysis from the TraumaRegister DGU®. Injury 2020; 51:1608-1617. [PMID: 32434714 DOI: 10.1016/j.injury.2020.04.022] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/13/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Multiple trauma patients have a high risk of missed injuries. The main point of our study was to provide new epidemiological data on hand and forearm injuries in multiple trauma with a focus on those that were missed. Therefore, we used the database of the TraumaRegister DGU®. METHODS In this study, we evaluated anonymous data from 139931 patients aged 1-100 years with multiple trauma in the TraumaRegister DGU® of the German Society for Trauma Surgery from 2007 to 2017. Patients with hand and forearm injuries documented during hospital stay were identified and analyzed. We included fractures, dislocations, tendon injuries, nerve injuries and vessel injuries. Patients with missed hand and forearm injuries were compared with patients with primary diagnosed injuries in view of gender, age, ISS, Abbreviated Injury Score (AIS), Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS), trauma mechanism type of injury, hospital stay, RISC II and mortality rate. Missed injuries were defined as injuries that were recently diagnosed and documented in the intensive care unit (ICU). RESULTS A total of 50459 multiple trauma patients (36.1%) had hand or forearm injuries, and 89472 patients (63.9%) had neither. Patients with hand injuries were younger and were more often involved in car and motorcycle accidents. Severe head trauma was evaluated less frequently, and severe thorax trauma was evaluated more often in patients with hand injuries. The times of diagnosis of hand injuries were documented in 10971 cases. A total of 727 patients (6.6%) with missed hand injuries were registered. The most commonly missed injuries in multiple trauma were 104 carpal fractures/dislocations (11.2%), 195 nerve injuries (25.4%) and 54 tendon injuries (11.4%). Predisposing factors for missing injuries were multiple diagnoses, primary care in the first hospital and direct from emergency room transfer to the ICU. CONCLUSION In contrast to previous findings, severely injured patients, especially those with head injuries and GCS of ≤8, were not predisposed to have missed hand injuries compared to patients without severe head trauma. Special attention should be paid to younger patients after traffic accidents with multiple diagnoses and direct transfer to the ICU.
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Affiliation(s)
- Stefanie Fitschen-Oestern
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany.
| | - Sebastian Lippross
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Germany
| | - Tim Klüter
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany
| | - Peter Behrendt
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany
| | - Matthias Weuster
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany
| | - Andreas Seekamp
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany
| | - TraumaRegister Dgu
- Committee on Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU), Germany
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21
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Peh S, Chatterjea A, Pfarr J, Schäfer JP, Weuster M, Klüter T, Seekamp A, Lippross S. Accuracy of augmented reality surgical navigation for minimally invasive pedicle screw insertion in the thoracic and lumbar spine with a new tracking device. Spine J 2020; 20:629-637. [PMID: 31863933 DOI: 10.1016/j.spinee.2019.12.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [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: 05/28/2019] [Revised: 12/11/2019] [Accepted: 12/13/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Minimally invasive approaches are increasingly used in spine surgery. The purpose of navigation systems is to guide the surgeon and to reduce intraoperative x-ray exposure. PURPOSE This study aimed to determine the feasibility and clinical accuracy of a navigation technology based on augmented reality surgical navigation (ARSN) for minimally invasive thoracic and lumbar pedicle screw instrumentation compared with standard fluoroscopy-guided minimally invasive technique. STUDY DESIGN/SETTING Cadaveric laboratory study. METHODS ARSN was installed in a hybrid operating room, consisting of a flat panel detector c-arm with two dimensional/three dimensional imaging capabilities and four integrated cameras in its frame. The surface-referenced navigation device does not require a bony reference but uses video cameras and optical markers applied to the patient's skin for tracking. In four cadavers, a total of 136 pedicle screws were inserted in thoracic and lumbar vertebrae. The accuracy was assessed by three independent raters in postoperative conventional computed tomography. RESULTS The overall accuracy of ARSN was 94% compared with an accuracy of 88% for fluoroscopy. The difference was not statistically significant. In the thoracic region, accuracy with ARSN was 92% compared with 83% with fluoroscopy. With fluoroscopy, unsafe screws were observed in three normal cadavers and one with scoliosis. Using ARSN, unsafe screws were only observed in the scoliotic spine. No significant difference in the median of time for K-wire placement was recorded. As no intraoperative fluoroscopy was necessary in ARSN, the performing surgeon was not exposed to radiation. CONCLUSIONS In this limited cadaveric study minimally invasive screw placement using ARSN was demonstrated to be feasible and as accurate as fluoroscopy. It did not require any additional navigation time or use of any intraoperative x-ray imaging, thereby potentially permitting surgery in a protective lead garment-free environment. A well-powered clinical study is needed to demonstrate a significant difference in the accuracy between the two methods. CLINICAL SIGNIFICANCE ARSN offers real-time imaging of planned insertion paths, instrument tracking, and overlay of three dimensional bony anatomy and surface topography. The referencing procedure, by optical recognition of several skin markers is easy and does not require a solid bony reference as necessary for conventional navigation which saves time. Additionally, ARSN may foster the reduction of intraoperative x-ray exposure to spinal surgeons.
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Affiliation(s)
- Simon Peh
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, 24105 Kiel, Germany.
| | - Anindita Chatterjea
- Image Guided Therapy Systems, Philips Healthcare, Veenpluis 4-6, 5684 PC, Best, the Netherlands
| | - Julian Pfarr
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, 24105 Kiel, Germany
| | - Jost Philipp Schäfer
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, 24105 Kiel, Germany
| | - Matthias Weuster
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, 24105 Kiel, Germany
| | - Tim Klüter
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, 24105 Kiel, Germany
| | - Andreas Seekamp
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, 24105 Kiel, Germany
| | - Sebastian Lippross
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, 24105 Kiel, Germany
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22
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Klüter T, Hassan R, Rasch A, Naujokat H, Wang F, Behrendt P, Lippross S, Gerdesmeyer L, Eglin D, Seekamp A, Fuchs S. An Ex Vivo Bone Defect Model to Evaluate Bone Substitutes and Associated Bone Regeneration Processes. Tissue Eng Part C Methods 2020; 26:56-65. [DOI: 10.1089/ten.tec.2019.0274] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Tim Klüter
- Department of Trauma and Orthopedic Surgery, Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Rywan Hassan
- Department of Trauma and Orthopedic Surgery, Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Alexander Rasch
- Department of Trauma and Orthopedic Surgery, Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Hendrik Naujokat
- Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Fanlu Wang
- Department of Trauma and Orthopedic Surgery, Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Peter Behrendt
- Department of Trauma and Orthopedic Surgery, Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Sebastian Lippross
- Department of Trauma and Orthopedic Surgery, Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Ludger Gerdesmeyer
- Department of Trauma and Orthopedic Surgery, Section for Oncological and Rheumatological Orthopedics, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - David Eglin
- AO Research Institute Davos, Davos, Switzerland
| | - Andreas Seekamp
- Department of Trauma and Orthopedic Surgery, Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Sabine Fuchs
- Department of Trauma and Orthopedic Surgery, Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
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Gries A, Seekamp A, Wrede C, Dodt C. [Training in clinical acute and emergency medicine - Supraspeciality in Germany : A concept for nationwide implementation!]. Anaesthesist 2019; 67:895-900. [PMID: 30511109 DOI: 10.1007/s00101-018-0515-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
At the 121st German Physicians Conference 2018 in Erfurt a resolution to accept the full amendment of the (draft) further training regulations (MWBO) was adopted and the State Medical Councils were requested to include them in their respective areas of responsibility. Therefore, the nationwide implementation of the supraspeciality (ZWB) for clinical acute and emergency medicine has been officially finalized. After consultation with the German Medical Council (BÄK) concerning the format, both the new MWBO 2018 and now the content of the ZWB are available as of 15 November 2018.The Physicians Conference resolution and anchoring of the new ZWB clinical acute and emergency medicine in the MWBO were preceded by a process lasting approximately 10 years. The concept of the ZWB clinical acute and emergency medicine, which was scrutinized by the Standing Committee on "medical further training" and the board of the BÄK and presented for approval, was essentially developed by representatives of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) and the German Society for Interdisciplinary Emergency and Acute Medicine (DGINA) in consultation with the BÄK. A consensus was finally reached in September 2017 in cooperation with those German specialist societies with a high proportion of emergency patients.In addition to the title, definition, and minimum requirements for applying the ZWB, the content was processed according to the European curriculum for emergency medicine. The structural prerequisites have now been approved, the Standing Committee has configured the content, and the complete MWBO 2018 has been successfully presented, such that the ZWB clinical acute and emergency medicine is expected to be implemented in the individual Federal States within the next 1-2 years.This article describes the history and development of ZWB clinical acute and emergency medicine in Germany and outlines future perspectives.
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Affiliation(s)
- A Gries
- Zentrale Notaufnahme, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland.
| | - A Seekamp
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Schleswig Holstein, Kiel, Deutschland
| | - C Wrede
- Interdisziplinäres Notfallzentrum, HELIOS Klinikum Berlin-Buch, Berlin, Deutschland
| | - C Dodt
- Notfallzentrum, Städtisches Klinikum München Bogenhausen, München, Deutschland
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24
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Lippross S, Jünemann KP, Osmonov D, Peh S, Alkatout I, Finn J, Egberts JH, Seekamp A. Robot assisted spinal surgery- A technical report on the use of DaVinci in orthopaedics. J Orthop 2019; 19:50-53. [PMID: 32021036 DOI: 10.1016/j.jor.2019.11.045] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/24/2019] [Indexed: 10/25/2022] Open
Abstract
Background Robot assisted procedures have evolved during the last years, today many surgical, units perform laparoscopic procedures with DaVinci on a regular Basis. The major advantages of Robot assisted procedures comprise technical factors and improved visualization. In Spinal surgery endoscopic stabilization of fractures has become a Standard for many. Purpose We have employed DaVinci as an access tool for a retroperitoneal lumbar approach followed by a DaVinci assisted corpectomy and cage implantation to treat a fracture of L3. Study design A single operation as proof of concept and demonstration of the method was performed. Methods The whole procedure was video recorded. Time factors and clinical outcome were documented. Results The procedure was performed safely with no complications. The operating time was longer than usual but within reasonable limits. The postoperatrive outcome did not differ from the usual procedure. The visualization of critical structure during preparation of the vertebral body was superior along with superior soft tissue management with DaVinci. Conclusion An endoscopic robotic instrument can be used for endoscopic access surgery. Despite major advantages in visualization and handling of the endoscopic instruments all bone and cartilage preparation must be performed in a traditional endoscpic way because no appropriate instruments are available at present. In order to perform full robotic assisted procedures, new instruments need to be developed.
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Affiliation(s)
- Sebastian Lippross
- Department of Trauma and Orthopaedics, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Klaus-Peter Jünemann
- Department of Urology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Daniar Osmonov
- Department of Urology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Simon Peh
- Department of Trauma and Orthopaedics, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ibrahim Alkatout
- Department of Gynaecology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jörg Finn
- Department of Trauma and Orthopaedics, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jan-Hendrik Egberts
- Department of General Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Andreas Seekamp
- Department of Trauma and Orthopaedics, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
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25
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Fitschen-Oestern S, Behrendt P, Martens E, Finn J, Schiegnitz J, Borzikowsky C, Seekamp A, Weuster M, Lippross S. Reversed shoulder arthroplasty for the treatment of proximal humerus fracture in the elderly. J Orthop 2019; 17:180-186. [PMID: 31879501 DOI: 10.1016/j.jor.2019.08.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/03/2019] [Accepted: 08/13/2019] [Indexed: 01/18/2023] Open
Affiliation(s)
- S Fitschen-Oestern
- Department of Orthopedics and Trauma Surgery, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - P Behrendt
- Department of Orthopedics and Trauma Surgery, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - E Martens
- Department of Orthopedics and Trauma Surgery, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - J Finn
- Department of Orthopedics and Trauma Surgery, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - J Schiegnitz
- Department of Orthopedics and Trauma Surgery, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - C Borzikowsky
- Institute of Medical Informatics and Statistics, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - A Seekamp
- Department of Orthopedics and Trauma Surgery, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - M Weuster
- Department of Orthopedics and Trauma Surgery, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - S Lippross
- Department of Orthopedics and Trauma Surgery, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany
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26
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Rasch A, Naujokat H, Wang F, Seekamp A, Fuchs S, Klüter T. Evaluation of bone allograft processing methods: Impact on decellularization efficacy, biocompatibility and mesenchymal stem cell functionality. PLoS One 2019; 14:e0218404. [PMID: 31220118 PMCID: PMC6586299 DOI: 10.1371/journal.pone.0218404] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 02/22/2019] [Accepted: 05/31/2019] [Indexed: 12/19/2022] Open
Abstract
In an ever-aging society the demand for bone-defect filling grafts continues to gain in importance. While autologous grafting still prevails as the gold standard, allografts and xenografts present viable alternatives with promising results. Physiochemical properties of a graft strongly depend on the processing method such as the decellularization protocol. In addition, the physiochemical characteristics are critical factors for a successful integration of the graft after the implantation and might influence mesenchymal stem cell function in therapeutic approaches combining grafts and autologous mesenchymal stem cells (MSCs). Several decellularization methods have been proposed, however it still remains unclear which method results in favorable physiochemical properties or might be preferred in stem cell applications. In the first part of this study we compared two decellularization approaches resulting in chemically processed allografts (CPAs) or sonication-based processed allografts (SPAs). Each decellularization approach was compared for its decellularization efficacy and its influence on the grafts' surface texture and composition. In the second part of this study biocompatibility of grafts was assessed by testing the effect of extraction medium on MSC viability and comparing them to commercially available allografts and xenografts. Additionally, grafts' performance in terms of MSC functionality was assessed by reseeding with MSCs pre-differentiated in osteogenic medium and determining cell adhesion, proliferation, as well as alkaline phosphatase (ALP) activity and the degree of mineralization. In summary, results indicate a more effective decellularization for the SPA approach in comparison to the CPA approach. Even though SPA extracts induced a decrease in MSC viability, MSC performance after reseeding was comparable to commercially available grafts based on DNA quantification, alkaline phosphatase activity and quantification of mineralization. Commercial Tutoplast allografts showed overall the best effects on MSC functionality as indicated by extraction biocompatibility testing as well as by comparing proliferation and osteogenic differentiation.
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Affiliation(s)
- Alexander Rasch
- Experimental Trauma Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Hendrik Naujokat
- Experimental Trauma Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Fanlu Wang
- Experimental Trauma Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Andreas Seekamp
- Experimental Trauma Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sabine Fuchs
- Experimental Trauma Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
- * E-mail:
| | - Tim Klüter
- Experimental Trauma Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Fitschen-Oestern S, Lippross S, Lefering R, Besch L, Klüter T, Schenzer-Hoffmann E, Seekamp A, TraumaRegister Dgu. Missed foot fractures in multiple trauma patients. BMC Musculoskelet Disord 2019; 20:121. [PMID: 30909889 PMCID: PMC6434880 DOI: 10.1186/s12891-019-2501-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/13/2019] [Indexed: 11/22/2022] Open
Abstract
Background Missed or underestimated injuries are one of the central problems in trauma care. Foot injuries can easily be missed because they lay beyond the regularly screened field of a trauma computer tomography scan (CT scan). During primary and secondary survey a careful examination of the extremities often becomes of secondary interest in the severely injured patient. Methods Thirty-four thousand ninety-one multiple trauma patients of the TraumaRegister DGU® were evaluated from 2002 to 2014. We differentiated between patients with foot injuries, patients with missed foot injuries and patients without foot injuries. Included were ankle fractures, calcaneus fractures, talus fractures, metatarsal fractures, toe fractures, amputation, soft tissue injuries and/or ligamentous injuries. Results Summarized evaluation of 34,091 trauma patients showed a share of 2532 patients with foot injuries. Time of diagnosis was documented in 2199 cases. 2055 patients had early diagnosed foot injuries and 144 patients had initially missed foot injuries. Missed foot injuries were especially found in patients with car accidents or fall from ≥3 m. Patients with higher Abbreviated Injury Scale (AIS) or lower Glasgow Coma Scale (GCS) were not significantly more affected by missed foot injuries. Missing foot injuries was also not caused by injury severity or higher age. Conclusions Our data highlights the need of careful evaluation of the feet during primary and secondary survey particularly when a tibia or femur fracture is diagnosed. Special attention should be turned to patients after car accidents or fall from great height. Suicide victims also need major attention. Patients with early operations also need careful examination and tertiary survey is highly recommended.
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Affiliation(s)
- Stefanie Fitschen-Oestern
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Arnold-Heller Straße 7, 24105, Kiel, Germany.
| | - Sebastian Lippross
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Arnold-Heller Straße 7, 24105, Kiel, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Germany
| | - Lutz Besch
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Arnold-Heller Straße 7, 24105, Kiel, Germany
| | - Tim Klüter
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Arnold-Heller Straße 7, 24105, Kiel, Germany
| | - Elke Schenzer-Hoffmann
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Arnold-Heller Straße 7, 24105, Kiel, Germany
| | - Andreas Seekamp
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Arnold-Heller Straße 7, 24105, Kiel, Germany
| | - TraumaRegister Dgu
- Committee on Emergency Medicine, Intensive Care and Trauma Management, (Sektion NIS) of the German Trauma Society (DGU), Cologne, Germany
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Wutzler S, Bläsius FM, Störmann P, Lustenberger T, Frink M, Maegele M, Weuster M, Bayer J, Caspers M, Seekamp A, Marzi I, Andruszkow H, Hildebrand F. Pneumonia in severely injured patients with thoracic trauma: results of a retrospective observational multi-centre study. Scand J Trauma Resusc Emerg Med 2019; 27:31. [PMID: 30871601 PMCID: PMC6419484 DOI: 10.1186/s13049-019-0608-4] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/28/2019] [Indexed: 01/03/2023] Open
Abstract
Background While the incidence and aspects of pneumonia in ICU patients has been extensively discussed in the literature, studies on the occurrence of pneumonia in severely injured patients are rare. The aim of the present study is to elucidate factors associated with the occurrence of pneumonia in severely injured patients with thoracic trauma. Setting Level-I University Trauma Centres associated with the TraumaRegister DGU®. Methods A total of 1162 severely injured adult patients with thoracic trauma documented in the TraumaRegister DGU® (TR-DGU) were included in this study. Demographic data, injury severity, duration of mechanical ventilation (MV), duration of ICU stay, occurrence of pneumonia, bronchoalveolar lavage, aspiration, pathogen details, and incidences of mortality were evaluated. Statistical evaluation was performed using SPSS (Version 25.0, SPSS, Inc.) software. Results The overall incidence of pneumonia was 27.5%. Compared to patients without pneumonia, patients with pneumonia had sustained more severe injuries (mean ISS: 32.6 vs. 25.4), were older (mean age: 51.3 vs. 47.5) and spent longer periods under MV (mean: 368.9 h vs. 114.9 h). Age, sex (male), aspiration, and duration of MV were all independent predictors for pneumonia occurrence in a multivariate analysis. The cut-off point for duration of MV that best discriminated between patients who would and would not develop pneumonia during their hospital stay was 102 h. The extent of thoracic trauma (AISthorax), ISS, and presence of pulmonary comorbidities did not show significant associations to pneumonia incidence in our multivariate analysis. No significant difference in mortality between patients with and without pneumonia was observed. Conclusions Likelihood of pneumonia increases with age, aspiration, and duration of MV. These parameters were not found to be associated with differences in outcomes between patients with and without pneumonia. Future studies should focus on independent parameters to more clearly identify severely injured subgroups with a high risk of developing pneumonia. Level of evidence Level II - Retrospective medical record review.
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Affiliation(s)
- Sebastian Wutzler
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590, Frankfurt, Germany
| | - Felix M Bläsius
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074, Aachen, Germany.
| | - Philipp Störmann
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590, Frankfurt, Germany
| | - Thomas Lustenberger
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590, Frankfurt, Germany
| | - Michael Frink
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Marburg, Baldingerstraße, D-35043, Marburg, Germany
| | - Marc Maegele
- Department of Trauma and Orthopaedic Surgery, Cologne-Merheim, Medical Centre (CMMC), Ostmerheimer Str. 200, D-51109, Köln, Germany
| | - Matthias Weuster
- Department of Trauma Surgery, University Hospital Schleswig-Holstein, Campus Kiel, 24105, Kiel, Germany
| | - Jörg Bayer
- Department of Orthopaedics and Trauma Surgery, Medical Centre Albert-Ludwings-University of Freiburg, Sir-Hans-A.-Krebs-Straße, D-79106, Freiburg, Germany
| | - Michael Caspers
- Department of Trauma and Orthopaedic Surgery, Cologne-Merheim, Medical Centre (CMMC), Ostmerheimer Str. 200, D-51109, Köln, Germany
| | - Andreas Seekamp
- Department of Trauma Surgery, University Hospital Schleswig-Holstein, Campus Kiel, 24105, Kiel, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590, Frankfurt, Germany
| | - Hagen Andruszkow
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074, Aachen, Germany
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Fitschen-Oestern S, Lippross S, Klueter T, Weuster M, Varoga D, Tohidnezhad M, Pufe T, Rose-John S, Andruszkow H, Hildebrand F, Steubesand N, Seekamp A, Neunaber C. Correction to: A new multiple trauma model of the mouse. BMC Musculoskelet Disord 2019; 20:72. [PMID: 30744619 PMCID: PMC6371601 DOI: 10.1186/s12891-018-2330-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 10/30/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Stefanie Fitschen-Oestern
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - Sebastian Lippross
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Tim Klueter
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Matthias Weuster
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Deike Varoga
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Mersedeh Tohidnezhad
- Department of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany
| | - Thomas Pufe
- Department of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany
| | - Stefan Rose-John
- Department of Biochemistry, Medical Faculty, Olshausenstr. 40, 24098, Kiel, Germany
| | - Hagen Andruszkow
- Department of Trauma Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Trauma Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nadine Steubesand
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Andreas Seekamp
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Claudia Neunaber
- Department of Trauma Surgery, Hannover Medical School, Hannover, Germany
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Janga H, Cassidy L, Wang F, Spengler D, Oestern-Fitschen S, Krause MF, Seekamp A, Tholey A, Fuchs S. Site-specific and endothelial-mediated dysfunction of the alveolar-capillary barrier in response to lipopolysaccharides. J Cell Mol Med 2017; 22:982-998. [PMID: 29210175 PMCID: PMC5783864 DOI: 10.1111/jcmm.13421] [Citation(s) in RCA: 21] [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] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 09/12/2017] [Indexed: 12/16/2022] Open
Abstract
Infectious agents such as lipopolysaccharides (LPS) challenge the functional properties of the alveolar‐capillary barrier (ACB) in the lung. In this study, we analyse the site‐specific effects of LPS on the ACB and reveal the effects on the individual cell types and the ACB as a functional unit. Monocultures of H441 epithelial cells and co‐cultures of H441 with endothelial cells cultured on Transwells® were treated with LPS from the apical or basolateral compartment. Barrier properties were analysed by the transepithelial electrical resistance (TEER), by transport assays, and immunostaining and assessment of tight junctional molecules at protein level. Furthermore, pro‐inflammatory cytokines and immune‐modulatory molecules were evaluated by ELISA and semiquantitative real‐time PCR. Liquid chromatography–mass spectrometry‐based proteomics (LS‐MS) was used to identify proteins and effector molecules secreted by endothelial cells in response to LPS. In co‐cultures treated with LPS from the basolateral compartment, we noticed a significant reduction of TEER, increased permeability and induction of pro‐inflammatory cytokines. Conversely, apical treatment did not affect the barrier. No changes were noticed in H441 monoculture upon LPS treatment. However, LPS resulted in an increased expression of pro‐inflammatory cytokines such as IL‐6 in OEC and in turn induced the reduction of TEER and an increase in SP‐A expression in H441 monoculture, and H441/OEC co‐cultures after LPS treatment from basolateral compartment. LS‐MS‐based proteomics revealed factors associated with LPS‐mediated lung injury such as ICAM‐1, VCAM‐1, Angiopoietin 2, complement factors and cathepsin S, emphasizing the role of epithelial–endothelial crosstalk in the ACB in ALI/ARDS.
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Affiliation(s)
- Harshavardhan Janga
- Department of Trauma Surgery and Orthopedics, Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Liam Cassidy
- Systematic Proteomics & Bioanalytics, Institut für Experimentelle Medizin, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Fanlu Wang
- Department of Trauma Surgery and Orthopedics, Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Dietmar Spengler
- Department of Pediatrics, University Medical Center Schleswig- Holstein, Kiel, Germany
| | - Stefanie Oestern-Fitschen
- Department of Trauma Surgery and Orthopedics, Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Martin F Krause
- Department of Pediatrics, University Medical Center Schleswig- Holstein, Kiel, Germany
| | - Andreas Seekamp
- Department of Trauma Surgery and Orthopedics, Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Andreas Tholey
- Systematic Proteomics & Bioanalytics, Institut für Experimentelle Medizin, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Sabine Fuchs
- Department of Trauma Surgery and Orthopedics, Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
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Fitschen-Oestern S, Lippross S, Klueter T, Weuster M, Varoga D, Tohidnezhad M, Pufe T, Rose-John S, Andruszkow H, Hildebrand F, Steubesand N, Seekamp A, Neunaber C. A new multiple trauma model of the mouse. BMC Musculoskelet Disord 2017; 18:468. [PMID: 29157219 PMCID: PMC5697084 DOI: 10.1186/s12891-017-1813-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 11/06/2017] [Indexed: 01/07/2023] Open
Abstract
Background Blunt trauma is the most frequent mechanism of injury in multiple trauma, commonly resulting from road traffic collisions or falls. Two of the most frequent injuries in patients with multiple trauma are chest trauma and extremity fracture. Several trauma mouse models combine chest trauma and head injury, but no trauma mouse model to date includes the combination of long bone fractures and chest trauma. Outcome is essentially determined by the combination of these injuries. In this study, we attempted to establish a reproducible novel multiple trauma model in mice that combines blunt trauma, major injuries and simple practicability. Methods Ninety-six male C57BL/6 N mice (n = 8/group) were subjected to trauma for isolated femur fracture and a combination of femur fracture and chest injury. Serum samples of mice were obtained by heart puncture at defined time points of 0 h (hour), 6 h, 12 h, 24 h, 3 d (days), and 7 d. Results A tendency toward reduced weight and temperature was observed at 24 h after chest trauma and femur fracture. Blood analyses revealed a decrease in hemoglobin during the first 24 h after trauma. Some animals were killed by heart puncture immediately after chest contusion; these animals showed the most severe lung contusion and hemorrhage. The extent of structural lung injury varied in different mice but was evident in all animals. Representative H&E-stained (Haematoxylin and Eosin-stained) paraffin lung sections of mice with multiple trauma revealed hemorrhage and an inflammatory immune response. Plasma samples of mice with chest trauma and femur fracture showed an up-regulation of IL-1β (Interleukin-1β), IL-6, IL-10, IL-12p70 and TNF-α (Tumor necrosis factor- α) compared with the control group. Mice with femur fracture and chest trauma showed a significant up-regulation of IL-6 compared to group with isolated femur fracture. Conclusions The multiple trauma mouse model comprising chest trauma and femur fracture enables many analogies to clinical cases of multiple trauma in humans and demonstrates associated characteristic clinical and pathophysiological changes. This model is easy to perform, is economical and can be used for further research examining specific immunological questions.
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Affiliation(s)
- Stefanie Fitschen-Oestern
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Arnold-Heller Straße 7, 24105, Campus Kiel, Kiel, Germany.
| | - Sebastian Lippross
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Arnold-Heller Straße 7, 24105, Campus Kiel, Kiel, Germany
| | - Tim Klueter
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Arnold-Heller Straße 7, 24105, Campus Kiel, Kiel, Germany
| | - Matthias Weuster
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Arnold-Heller Straße 7, 24105, Campus Kiel, Kiel, Germany
| | - Deike Varoga
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Arnold-Heller Straße 7, 24105, Campus Kiel, Kiel, Germany
| | - Mersedeh Tohidnezhad
- Department of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, D-52074, Aachen, Germany
| | - Thomas Pufe
- Department of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, D-52074, Aachen, Germany
| | - Stefan Rose-John
- Department of Biochemistry, Medical Faculty, Olshausenstr. 40, 24098, Kiel, Germany
| | - Hagen Andruszkow
- Department of Trauma Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Trauma Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nadine Steubesand
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Arnold-Heller Straße 7, 24105, Campus Kiel, Kiel, Germany
| | - Andreas Seekamp
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Arnold-Heller Straße 7, 24105, Campus Kiel, Kiel, Germany
| | - Claudia Neunaber
- Department of Trauma Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
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Behrendt P, Kruse E, Klüter T, Fitschen-Oestern S, Weuster M, Menzdorf L, Finn J, Varoga D, Seekamp A, Müller M, Lippross S. [Fixed angle carbon fiber reinforced polymer composite plate for treatment of distal radius fractures : Pilot study on clinical applications]. Unfallchirurg 2017; 120:139-146. [PMID: 26507986 DOI: 10.1007/s00113-015-0088-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The clinical implementation of a new carbon-fiber-reinforced polyetheretherketon (PEEK) plate for distal radius fractures might offer advantageous properties over the conventional metallic devices. This includes similar elastic modulus to cortical bone, radiolucency, low artifacts on MRI scans and the lack of metal allergies. OBJECTIVE The aim of this study was to evaluate the clinical results at 6-week and 12-month follow-up using either a new fixed angle (monoaxial) PEEK plate system or a fixed angle (polyaxial) titanium plate. METHODES We included 26 patients (mean age 59.3) with displaced fractures of the distal radius (all AO types). Radiological and functional outcomes were measured prospectively at a 6-week and 12 month follow-up. RESULTS We documented no cases of hardware breakage or significant loss of the surgically achieved fracture reduction with the usage oft the new PEEK device. Operating time was 101.0 min using PEEK versus 109.3 min in titanium plates, recorded times were including preparation, draping, and postoperative processing (ns, p 0.156). At the 6-week follow up the PEEK plate showed a trend for better range of motion and functional results (DASH-score, Mayo-wrist score, VAS) with no statistical significance. Results of 12 month follow up with PEEK showed comparable results with corresponding studies examining titanium plate after this period. CONCLUSION First experience with PEEK plate osteosynthesis demonstrate quick clinical implementation with good clinical outcome and the advantage of excellent postoperative radiological assessment. At early follow-up PEEK even showed a trend for improved functional results.
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Affiliation(s)
- P Behrendt
- Klinik für Orthopädie und Unfallchirurgie, UNIVERSITÄTSKLINIKUM Schleswig-Holstein, Campus Kiel, Haus 18, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland.
| | - E Kruse
- Klinik für Orthopädie und Unfallchirurgie, UNIVERSITÄTSKLINIKUM Schleswig-Holstein, Campus Kiel, Haus 18, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - T Klüter
- Klinik für Orthopädie und Unfallchirurgie, UNIVERSITÄTSKLINIKUM Schleswig-Holstein, Campus Kiel, Haus 18, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - S Fitschen-Oestern
- Klinik für Orthopädie und Unfallchirurgie, UNIVERSITÄTSKLINIKUM Schleswig-Holstein, Campus Kiel, Haus 18, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - M Weuster
- Klinik für Orthopädie und Unfallchirurgie, UNIVERSITÄTSKLINIKUM Schleswig-Holstein, Campus Kiel, Haus 18, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - L Menzdorf
- Klinik für Orthopädie und Unfallchirurgie, UNIVERSITÄTSKLINIKUM Schleswig-Holstein, Campus Kiel, Haus 18, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - J Finn
- Klinik für Orthopädie und Unfallchirurgie, UNIVERSITÄTSKLINIKUM Schleswig-Holstein, Campus Kiel, Haus 18, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - D Varoga
- Klinik für Orthopädie und Unfallchirurgie, UNIVERSITÄTSKLINIKUM Schleswig-Holstein, Campus Kiel, Haus 18, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - A Seekamp
- Klinik für Orthopädie und Unfallchirurgie, UNIVERSITÄTSKLINIKUM Schleswig-Holstein, Campus Kiel, Haus 18, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - M Müller
- Klinik für Orthopädie und Unfallchirurgie, UNIVERSITÄTSKLINIKUM Schleswig-Holstein, Campus Kiel, Haus 18, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - S Lippross
- Klinik für Orthopädie und Unfallchirurgie, UNIVERSITÄTSKLINIKUM Schleswig-Holstein, Campus Kiel, Haus 18, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
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Behrendt P, Häfelein K, Preusse-Prange A, Bayer A, Seekamp A, Kurz B. IL-10 ameliorates TNF-α induced meniscus degeneration in mature meniscal tissue in vitro. BMC Musculoskelet Disord 2017; 18:197. [PMID: 28511649 PMCID: PMC5434535 DOI: 10.1186/s12891-017-1561-x] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/09/2017] [Indexed: 12/19/2022] Open
Abstract
Background Joint inflammation causes meniscus degeneration and can exacerbate post-traumatic meniscus injuries by extracellular matrix degradation, cellular de-differentiation and cell death. The aim of this study was to examine whether anti-inflammatory interleukin-10 exerts protective effects in an in vitro model of TNF-α-induced meniscus degeneration. Methods Meniscus tissue was harvested from the knees of adult cows. After 24 h of equilibrium explants were simultaneously treated with bovine TNF-α and IL-10. After an incubation time of 72 h cell death was measured histomorphometrically (nuclear blebbing, NB) and release of glycosaminoglycans (GAG, DMMB assay) and nitric oxide (NO, Griess-reagent) were analysed. Transcription levels (mRNA) of matrix degrading enzymes, collagen type X (COL10A1) and nitric oxide synthetase 2 (NOS2) were measured by quantitative real time PCR. TNF-α-dependent formation of the aggrecanase-specific aggrecan neoepitope NITEGE was visualised by immunostaining. Differences between groups were calculated using a one-way ANOVA with a Bonferroni post hoc test. Results Administration of IL-10 significantly prevented the TNF-α-related cell death (P .001), release of NO (P .003) and NOS2 expression (P .04). Release of GAG fragments (P .001), NITEGE formation and expression of MMP3 (P .007), -13 (P .02) and ADAMTS4 (P .001) were significantly reduced. The TNF-α-dependent increase in COL10A1 expression was also antagonized by IL-10 (P .02). Conclusion IL-10 prevented crucial mechanisms of meniscal degeneration induced by a key cytokine of OA, TNF-α. Administration of IL-10 might improve the biological regeneration and provide a treatment approach in degenerative meniscus injuries and in conditions of post-traumatic sports injuries.
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Affiliation(s)
- P Behrendt
- Department of Orthopaedics and Trauma Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - K Häfelein
- Institute of Anatomy, Christian Albrechts-University, Kiel, Germany
| | - A Preusse-Prange
- Institute of Anatomy, Christian Albrechts-University, Kiel, Germany
| | - A Bayer
- Department of Cardiovascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A Seekamp
- Department of Orthopaedics and Trauma Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - B Kurz
- Institute of Anatomy, Christian Albrechts-University, Kiel, Germany
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Fitschen-Oestern S, Weuster M, Lippross S, Behrendt P, Fuchs S, Pufe T, Tohidnezhad M, Bayer A, Seekamp A, Varoga D, Klüter T. Hepatocytes express the antimicrobial peptide HBD-2 after multiple trauma: an experimental study in human and mice. BMC Musculoskelet Disord 2017; 18:100. [PMID: 28270138 PMCID: PMC5341361 DOI: 10.1186/s12891-017-1458-8] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 02/21/2017] [Indexed: 11/23/2022] Open
Abstract
Background Human-beta defensins (HBD) belong to the family of acute phase peptides and hold a broad antimicrobial spectrum that includes gram-positive and gram-negative bacteria. HBD are up-regulated after severe injuries but the source of posttraumatic HBD expression has not been focused on before. In the current study we analysed the role of liver tissue in expression of HBD after multiple trauma in human and mice. Methods HBD-2 expression has been detected in plasma samples of 32 multiple trauma patients (ISS > 16) over 14 days after trauma by ELISA. To investigate major sources of HBD-2, its expression and regulation in plasma samples, polymorphonuclear neutrophils (PMN) and human tissue samples of liver and skin were analysed by ELISA. As liver samples of trauma patients are hard to obtain we tried to review findings in an established trauma model. Plasma samples and liver samples of 56 male C57BL/6 N-mice with a thorax trauma and a femur fracture were analysed by ELISA, real-time PCR and immunohistochemistry for murine beta defensin 4 (MBD-4) and compared with the expression of control group without trauma. The induction of HBD-2 expression in cultured hepatocytes (Hep G2) was analysed after incubation with IL-6, supernatant of Staphylococcus aureus (SA) and Lipopolysaccharides (LPS). One possible signalling pathway was tested by blocking toll-like receptor 2 (TLR2) in hepatocytes. Results Compared to healthy control group, plasma of multiple traumatized patients and mice showed significantly higher defensin levels after trauma. Compared to skin cells, which are known for high beta defensin expression, liver tissue showed less HBD-2 expression, but higher HBD-2 expression compared to PMN. Immunhistochemical staining demonstrated upregulated MBD-4 in hepatocytes of traumatised mice. In HepG2 cells HBD-2 expression could be increased by stimulation with IL-6 and SA. Neutralization of HepG2 cells with αTLR2 showed reduced HBD-2 expression after stimulation with SA. Conclusion Plasma samples of multiple traumatized patients showed high expression of HBD-2, which may protect the severely injured patient from overwhelming bacterial infection. Our data support the hypothesis that liver is one possible source for HBD-2 in plasma while posttraumatic inflammatory response.
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Affiliation(s)
- Stefanie Fitschen-Oestern
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Matthias Weuster
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Sebastian Lippross
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Peter Behrendt
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Sabine Fuchs
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Thomas Pufe
- Department of Trauma Surgery, University of Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Mersedeh Tohidnezhad
- Department of Trauma Surgery, University of Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Andreas Bayer
- Department of Cardiovascular Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Andreas Seekamp
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Deike Varoga
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Tim Klüter
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
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Behrendt P, Klüter T, Seekamp A. [Injuries of major tendons : Review of current diagnostic and surgical standards]. Chirurg 2017; 88:175-186. [PMID: 28108771 DOI: 10.1007/s00104-016-0367-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Chronic degenerative tendon injuries as well as injuries due to acute high-energy trauma and incisional injuries are a significant aspect in the emergency surgery department. As a result of anatomical characteristics and exposure certain tendons are particularly vulnerable to injury. These include the biceps brachialis, quadriceps femoris, patella, achilles and tibialis anterior tendons. Besides the broad spectrum of non-surgical treatment, surgeons should have knowledge of the various surgical techniques including suturing, anchor refixation and reconstruction techniques. The indications for surgery are of particular importance for the clinical outcome of tendon injuries. The therapeutic approach should consider the patients biological age, functional requirements and pre-existing comorbid pathologies. Finally, adequate aftercare has been shown to significantly determine the surgical outcome.
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Affiliation(s)
- P Behrendt
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland
| | - T Klüter
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland.
| | - A Seekamp
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland
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Shi Y, Wang F, Tiwari S, Yesilbas M, Steubesand N, Weitkamp JT, Klüter T, Lippross S, Eglin D, Seekamp A, Fuchs S. Role of myeloid early endothelial progenitor cells in bone formation and osteoclast differentiation in tissue construct based on hydroxyapatite poly(ester-urethane) scaffolds. J Orthop Res 2016; 34:1922-1932. [PMID: 26945676 DOI: 10.1002/jor.23222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 02/23/2016] [Indexed: 02/04/2023]
Abstract
Engineering of a vascularized bone construct is a highly challenging task which needs to take into account the impact of different components on the bone regeneration process. Bone repair influencing factors in such constructs range from the material properties and scaffold design, to the interaction of different cell types contributing to bone formation and remodeling or neovascularization, respectively. In this context, early endothelial progenitor cells (EPC), mononuclear cells isolated from the peripheral blood, express the endothelial marker CD31 but also a series of myeloid markers and have been shown to support the formation of vessel-like structures. These cells are also characterized by a highly adaptable phenotype influenced by other cells creating an instructive niche. The present study was designed to investigate the impact of EPC on bone formation or remodeling using a co-culture system of outgrowth endothelial cells, mature endothelial cells isolated from the peripheral blood cell cultures, and mesenchymal stem cells grown on hydroxyapatite poly(ester-urethane) scaffolds. The formation of vessel-like structures in these constructs was shown by CLSM and immunohistochemistry and further evaluated by real time RT-PCR. Osteogenic differentiation in these constructs was investigated by von Kossa, Alizarin Red, and real time PCR. Data indicated that osteogenic differentiation occurred within the constructs after 14 days of culture but without a direct influence by EPC in this process. Finally, although we observed a series of osteoclast related makers in the constructs when EPC were included, no indications for an increased osteoclast-like activity, which might lead to increased bone resorption, were observed. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1922-1932, 2016.
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Affiliation(s)
- Yang Shi
- Experimental Trauma Surgery, Arnold-Heller-Straße 3, University Medical Center Schleswig-Holstein, UKSH, 24105, Kiel, Germany
| | - Fanlu Wang
- Experimental Trauma Surgery, Arnold-Heller-Straße 3, University Medical Center Schleswig-Holstein, UKSH, 24105, Kiel, Germany
| | - Sanjay Tiwari
- Molecular Imaging North Competence Center (MOINCC), Kiel, Germany
| | - Meran Yesilbas
- Experimental Trauma Surgery, Arnold-Heller-Straße 3, University Medical Center Schleswig-Holstein, UKSH, 24105, Kiel, Germany
| | - Nadine Steubesand
- Experimental Trauma Surgery, Arnold-Heller-Straße 3, University Medical Center Schleswig-Holstein, UKSH, 24105, Kiel, Germany
| | - Jan-Tobias Weitkamp
- Experimental Trauma Surgery, Arnold-Heller-Straße 3, University Medical Center Schleswig-Holstein, UKSH, 24105, Kiel, Germany
| | - Tim Klüter
- Experimental Trauma Surgery, Arnold-Heller-Straße 3, University Medical Center Schleswig-Holstein, UKSH, 24105, Kiel, Germany
| | - Sebastian Lippross
- Experimental Trauma Surgery, Arnold-Heller-Straße 3, University Medical Center Schleswig-Holstein, UKSH, 24105, Kiel, Germany
| | - David Eglin
- AO Research Institute Davos, Davos, Switzerland
| | - Andreas Seekamp
- Experimental Trauma Surgery, Arnold-Heller-Straße 3, University Medical Center Schleswig-Holstein, UKSH, 24105, Kiel, Germany
| | - Sabine Fuchs
- Experimental Trauma Surgery, Arnold-Heller-Straße 3, University Medical Center Schleswig-Holstein, UKSH, 24105, Kiel, Germany
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Dick WF, Baskett PJF, Grande C, Delooz H, Kloeck W, Lackner C, Lipp M, Mauritz W, Nerlich M, Nicholl J, Nolan J, Oakley P, Parr M, Seekamp A, Soreide E, Steen PA, van Camp L, Wolcke B, Yates D. Recommendations for uniform reporting of data following major trauma - the Utstein style. Trauma 2016. [DOI: 10.1177/146040860000200105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Menzdorf L, Weuster M, Klüter T, Brüggemann S, Behrendt P, Fitchen-Oestern S, Varoga D, Seekamp A, Purcz N, Glueer CC, Pufe T, Lippross S. Local pamidronate influences fracture healing in a rodent femur fracture model: an experimental study. BMC Musculoskelet Disord 2016; 17:255. [PMID: 27283180 PMCID: PMC4899908 DOI: 10.1186/s12891-016-1113-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 06/02/2016] [Indexed: 11/17/2022] Open
Abstract
Background Bisphosphonates are a main component in the therapy of osteoporosis and other bone resorptive diseases. Previous studies have shown a positive effect of systemically applied bisphosphonates on fracture healing. Nevertheless high doses are related to side effects like osteonecrosis of the jaw, nephrotoxis and gastrointestinal symptoms. In this study we investigated the effect of locally applied pamidronate on fracture healing. Methods In a rodent model a simple femur fracture was set in female Wistar rats. We performed intramedullary fixation of the fracture and placed a collagen matrix around the fracture area. One group was treated with pamidronate, the other group with placebo via the matrix. To investigate the volume and quality of the callus we used micro-CT (μCT) and histology after 14 and 28 days. Results Our results show a positive influence of local applied pamidronate on callus volume. After 14 days an insignificant increase of callus volume in the treated animals was seen. 28 days after trauma the increase of callus volume in the treatment group was significantly higher in comparison to the control group. Osteonecrosis was not seen. Conclusions Locally applied bisphosphonates increase the callus volume in fracture healing.
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Affiliation(s)
- Leif Menzdorf
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - Matthias Weuster
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Tim Klüter
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Stefan Brüggemann
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Peter Behrendt
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Stefanie Fitchen-Oestern
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Deike Varoga
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Andreas Seekamp
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Nicolai Purcz
- Department of Oral and Maxillofacial Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Claus C Glueer
- Section of Biomedical Imaging, Department of Radiology and Neuroradiology, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thomas Pufe
- Department of Anatomy and Cell Biology, RWTH Aachen University, Aachen, Germany
| | - Sebastian Lippross
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Sun W, Motta A, Shi Y, Seekamp A, Schmidt H, Gorb SN, Migliaresi C, Fuchs S. Co-culture of outgrowth endothelial cells with human mesenchymal stem cells in silk fibroin hydrogels promotes angiogenesis. ACTA ACUST UNITED AC 2016; 11:035009. [PMID: 27271291 DOI: 10.1088/1748-6041/11/3/035009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sufficient vascularization of the implant construct is required for tissue regeneration to ensure the supply of oxygen and nutrients. In our previous work, we established sonication-induced silk fibroin hydrogel to load neural stem cells for brain tissue engineering applications. In this study, we explored the application of silk fibroin as an injectable hydrogel for vascularization of soft tissues. We investigated the ability of outgrowth endothelial cells (OECs) in mono-culture or in co-culture with human bone marrow-derived mesenchymal stem cells (BM-MSCs) to form capillary networks in silk fibroin hydrogels. Furthermore, the silk fibroin hydrogel was modified with IKVAV peptide revealing a sequence derived from the extracellular matrix component laminin-1 to test its effects on angiogenesis, using unmodified and VVIAK modified silk fibroin hydrogel as controls. In monocultures of OECs, no angiogenic structures were observed in silk fibroin hydrogels. In contrast, vascular structures were abundant and increased in co-culture, as confirmed by immunocytochemistry and scanning electron microscopy (SEM) over 10 d of culture in silk fibroin-based hydrogels. Although no significant differences in angiogenic activity seem to be caused by the IKVAV peptide in our experimental settings, these results indicate that sonication-induced silk fibroin-based hydrogels support the formation of functional endothelial tubes and vascularization networks in the presence of mesenchymal cells supporting the vascular sprouting of endothelial cells.
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Affiliation(s)
- Wei Sun
- Department of Industrial Engineering and Biotech Research Center, University of Trento, via Mesiano 77, 38123 Trento, Italy. European Institute of Excellence on Tissue Engineering and Regenerative medicine, Trento, Italy
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Koziolek M, Schneider F, Grimm M, Modeβ C, Seekamp A, Roustom T, Siegmund W, Weitschies W. Intragastric pH and pressure profiles after intake of the high-caloric, high-fat meal as used for food effect studies. J Control Release 2015; 220:71-78. [DOI: 10.1016/j.jconrel.2015.10.022] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 10/22/2022]
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Borggrefe J, Bolte H, Worms W, Mahlke L, Seekamp A, Menzdorf L, Varoga D, Müller M, Weuster M, Zorenkov D, Wedel T, Lippross S. Comparison of intraoperative flat panel imaging and postoperative plain radiography for the detection of intraarticular screw displacement in volar distal radius plate ostheosynthesis. Orthop Traumatol Surg Res 2015; 101:913-7. [PMID: 26522382 DOI: 10.1016/j.otsr.2015.07.023] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 05/03/2015] [Accepted: 07/24/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate if intraoperative 3D flat panel imaging improves the detection of radiocarpal intraarticular screw misplacement (RCSM) in comparison to standard postoperative x-ray. METHODS In a study on cadaver specimens, we evaluated the sensitivity and specificity to detect RCSM using X-ray, intraoperative 3D-fluoroscopy as well as the digital volume tomography. The gold standard reference was computed tomography. RESULTS Sensitivity for the detection of RCSM for X-ray was 58% and specificity 88%. For DVT, the sensitivity to detect RCSM was 88% and the specificity 53%. For 3D-fluoroscopy, the sensitivity for RCSM was 68% and specificity 95%. When combining the methods, the best performance was found, when combining the two intraoperative imaging methods, with a resulting sensitivity of 88% and a specificity of 73%. CONCLUSIONS Intraoperative 3D fluoroscopy and digital volume tomography appear to be at least as sensitive and specific to detect RCSM than the regular postoperative radiography in two planes. However, especially discrete screw misplacements can be missed with either method. LEVEL OF EVIDENCE Level IV. Diagnostic device study.
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Affiliation(s)
- J Borggrefe
- University medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of radiology, Uniklinik Köln, Köln, Germany.
| | - H Bolte
- University medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of nuclear medicine, university-Clinics Münster, Münster, Germany
| | - W Worms
- Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - L Mahlke
- Saint-Vincenz hospital, Paderborn, Germany
| | - A Seekamp
- Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - L Menzdorf
- Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - D Varoga
- Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - M Müller
- Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - M Weuster
- Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - D Zorenkov
- Department of neurology, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - T Wedel
- Department of anatomy, Christian-Albrecht-aniversity, Kiel, Germany
| | - S Lippross
- Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Fitschen-Oestern S, Scheuerlein F, Weuster M, Klueter T, Menzdorf L, Varoga D, Kopetsch C, Mueller M, van der Horst A, Seekamp A, Behrendt P, Lippross S. Reduction and retention of thoracolumbar fractures by minimally invasive stabilisation versus open posterior instrumentation. Injury 2015; 46 Suppl 4:S63-70. [PMID: 26542868 DOI: 10.1016/s0020-1383(15)30020-6] [Citation(s) in RCA: 16] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was in thoracolumbar fractures to assess the effectiveness of minimal invasive stabilisation compared to the open technique with regards to the change in kyphosis angle, the loss of reduction and length of hospital stay. METHODS The retrospective study consisted of 104 patients who received minimally invasive stabilisation or open stabilisation. Patients were between 15 and 86 years of age, had a thoracolumbar fracture and no neurological deficits. Kyphotic angle (Cobb angle) and loss of reduction was compared after minimal invasive and open stabilisation. The Cobb angle was evaluated directly post operatively, at 6 weeks, 3 months, 6 months and 12 months after surgery. RESULTS Evaluated patients who received the minimally invasive technique had a shorter surgical intervention time and a shorter hospital stay compared to patients who received the open technique. Kyphosis angle and loss of reduction showed no significant difference compared to open technique. There was also no significant difference between minimally invasive poly-axial and mono-axial stabilisation. CONCLUSION In this study we provide evidence that MIS instrumentation in selected thoracolumbar fractures can effectively be used without significant differences in loss of reduction compared to open stabilisation. MIS can also sufficiently retain reduction as compared to traditional open techniques. The main advantages are reduced operation time and shorter hospital stay.
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Affiliation(s)
| | - Florian Scheuerlein
- Department of Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel Campus, Germany
| | - Matthias Weuster
- Department of Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel Campus, Germany
| | - Tim Klueter
- Department of Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel Campus, Germany
| | - Leif Menzdorf
- Department of Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel Campus, Germany
| | - Deike Varoga
- Department of Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel Campus, Germany
| | - Christoph Kopetsch
- Department of Radiology, University Medical Center Schleswig-Holstein, Kiel Campus, Germany
| | - Michael Mueller
- Department of Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel Campus, Germany
| | - Alex van der Horst
- Department of Spinal Surgery, Division of Orthopaedic Spine Surgery, University of Namibia, Windhoek, Namibia
| | - Andreas Seekamp
- Department of Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel Campus, Germany
| | - Peter Behrendt
- Department of Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel Campus, Germany
| | - Sebastian Lippross
- Department of Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel Campus, Germany
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Beckmann R, Lippross S, Hartz C, Tohidnezhad M, Ferreira MSV, Neuss-Stein S, Seekamp A, Nebelung S, Kweider N, Rath B, Jahr H, Pufe T, Varoga DJ. Abrasion arthroplasty increases mesenchymal stem cell content of postoperative joint effusions. BMC Musculoskelet Disord 2015; 16:250. [PMID: 26364138 PMCID: PMC4567829 DOI: 10.1186/s12891-015-0705-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 09/02/2015] [Indexed: 01/15/2023] Open
Abstract
Background Abrasion arthroplasty (AAP) is a procedure by which intrinsic cartilage healing is believed to be stimulated. Although clinically accepted for degenerative and traumatic cartilage lesions scientific evidence at a molecular level that proves the effect of AAP is scarce. Method Mononuclear cells were extracted from postoperative joint effusions 21.5 h post AAP and simple debridement of cartilage lesions. Luminex, ELISA and FACS experiments were performed. Immunohistochemical stainings of cell cultures for cartilage markers were used to confirm the findings. Results Postoperative joint effusions after AAP showed increased contents of Mononuclear cells compared to Arthroscopic Chondroplasty (ACP). BMP-4 and IGF were increased in AAP as complared to ACP. Mononuclear cells isolated after AAP express the MSC markers CD 73, CD 105, CD 90, CD 44 and are CD34 negative. Chondrogenic differentiation was demonstrated by positive staining for Sox9, collagen II, proteoglycan, chondroitin-4-sulfate. Conclusion Our results support the clinical application of AAP as a procedure that enhances cartilage repair as an alternative to far more complex procedures that have gained popularity. Furthermore the data presented supports clinical investigations that recommend not to use suction drainage as by this procedure a considerable amount of the regeneratory potential of postoperative joint effusions might be extracted.
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Affiliation(s)
- Rainer Beckmann
- Department of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany.
| | | | - Claudia Hartz
- Department of Trauma and Orthopaedics, University Hospital Heidelberg, Bergheim, Germany.
| | - Mersedeh Tohidnezhad
- Department of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany.
| | - Mónica S Ventura Ferreira
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen, Aachen, Germany.
| | - Sabine Neuss-Stein
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen, Aachen, Germany.
| | - Andreas Seekamp
- Department of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany.
| | - Sven Nebelung
- Department of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany. .,Department of Orthopaedic Surgery, RWTH Aachen University, Aachen, Germany.
| | - Nisreen Kweider
- Department of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany.
| | - Björn Rath
- Department of Orthopaedic Surgery, RWTH Aachen University, Aachen, Germany.
| | - Holger Jahr
- Department of Orthopaedic Surgery, RWTH Aachen University, Aachen, Germany.
| | - Thomas Pufe
- Department of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany.
| | - Deike J Varoga
- Department of Trauma, University Hospital of Kiel, Kiel, Germany.
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Riessen R, Gries A, Seekamp A, Dodt C, Kumle B, Busch HJ. Positionspapier für eine Reform der medizinischen Notfallversorgung in deutschen Notaufnahmen. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0013-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hess T, Inden P, Seekamp A, Knacke PG, Kerner T. [Invasive emergency techniques - In-field-amputation]. Anasthesiol Intensivmed Notfallmed Schmerzther 2015; 50:186-95. [PMID: 25850645 DOI: 10.1055/s-0041-100874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
On-scene invasive emergency procedures, such as Cricothyroidotomy, chest drain, intraosseous puncture or even in-field-amputation, are often unavoidable, when indicated, and present a major challenge for the emergency physician. Personal, temporal or local conditions are often unsuitable. Even with regular intervention by the Emergency Medical Service, "last resort" measures occur very infrequently, particularly in relation to paediatric emergencies. As well as theoretical training, practice-oriented course concepts are essential in order to achieve high quality in these procedures. This article presents the use of in-field-amputation, with reference to indication, implementation, problems and risks. It is part of a series of four articles on the subject of invasive emergency techniques.
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Klüter T, Weuster M, Brüggemann S, Menzdorf L, Fitschen-Oestern S, Steubesand N, Acil Y, Pufe T, Varoga D, Seekamp A, Lippross S. Rivaroxaban does not impair fracture healing in a rat femur fracture model: an experimental study. BMC Musculoskelet Disord 2015; 16:79. [PMID: 25886252 PMCID: PMC4404693 DOI: 10.1186/s12891-015-0502-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 02/13/2015] [Indexed: 11/11/2022] Open
Abstract
Background The prescription of the oral anticoagulant rivaroxaban to prevent thromboembolic episodes associated with orthopaedic surgery has dramatically increased since it was introduced. Rivaroxaban is beeing prescribed although recent in-vitro studies revealed that it impaired osteoblast metabolism. In this study we analysed the effect of rivaroxaban on fracture healing in a rat femur fracture model. Methods Femur fractures were created by a 3-point-bending device in 48 Wistar rats and subsequently stabilized by intramedullary nailing. After the surgical procedure animals were randomised into four groups. Two groups were fed with 3 mg rivaroxaban per kg body weight per day and two control groups were fed with chow only. Animals were euthanized 28 or 49 days after surgical procedure. Femurs underwent undecalcified histologic staining micro CT scanning and biomechanical testing. The statistical significance was evaluated using one-way Anova with Bonferroni correction. Results Micro CT-scans revealed significantly increased volume of bone tissue in the fracture zone between day 28 and 49. During the same time callus volume decreased significantly. Comparing the fracture zone of the rivaroxaban group to the control group the treated group revealed a larger callus and a marginal increase of the tissue mineral density. The torsional rigidity was not influenced by the treatment of rivaroxaban. Conclusion In the present study we were able to demonstrate that rivaroxaban does not impair fracture healing in a rat femur fracture model. Considering the fact that low molecular weight heparins delay fracture healing significantly, rivaroxaban might be an improved alternative.
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Affiliation(s)
- Tim Klüter
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany.
| | - Matthias Weuster
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany.
| | - Stefan Brüggemann
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany.
| | - Leif Menzdorf
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany.
| | - Stefanie Fitschen-Oestern
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany.
| | - Nadine Steubesand
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany.
| | - Yahya Acil
- Department of Maxillo-Facialy, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany.
| | - Thomas Pufe
- Department of Anatomy and Cell Biology, RWTH Aachen University, Aachen, Germany.
| | - Deike Varoga
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany.
| | - Andreas Seekamp
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany.
| | - Sebastian Lippross
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany.
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Klüter T, Fitschen-Oestern S, Weuster M, Fickenscher H, Seekamp A, Lippross S. Toxic-shock-Syndrom nach offener Sprunggelenkverletzung. Unfallchirurg 2014; 118:643-6. [DOI: 10.1007/s00113-014-2659-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zachos C, Steubesand N, Seekamp A, Fuchs S, Lippross S. Co-cultures of programmable cells of monocytic origin and mesenchymal stem cells do increase osteogenic differentiation. J Orthop Res 2014; 32:1264-70. [PMID: 24961926 DOI: 10.1002/jor.22663] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 05/14/2014] [Indexed: 02/04/2023]
Abstract
Impaired bone healing can occur with numerous pathologic conditions like trauma, osteoporosis, and infection. Therefore tissue-engineering strategies that aim to enhance osteogenic differentiation of stem cells in order to accelerate bone healing are a major goal of contemporary regenerative research. In this study we cultivated mesenchymal stem cells (MSC) together with the recently patented programmable cells of monocytic origin (PCMO) to test whether co-cultures promote an osteogenic differentiation process. PCMO have recently been shown to have pluripotent characteristics and do support the regeneration processes of liver and heart diseases. Quantitative real time PCR expression profiles of osteogenic marker genes such as alkaline phosphatase in co-cultures of PCMO and MSC showed that MSC differentiated into osteoblast-like cells more rapidly as compared to mono-cultures. Alkaline phosphatase expression and enzyme activity levels were highly increased in co-cultures compared to mono-cultures of MSC. Tests for mineralized matrix formation also indicated that PCMO have a positive effect on co-cultured MSC under osteogenic culture conditions. However, analysis of collagen 1A did not show enhanced expression. In summary, PCMO obviously have the ability to promote osteogenic differentiation of MSC in vitro while their own pluripotent potential is not sufficient to develop osteoblast-like characteristics themselves.
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Affiliation(s)
- Christina Zachos
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Arnold-Heller Strasse 3, 24105, Kiel, Germany
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Hildebrand F, Radermacher P, Ruchholtz S, Huber-Lang M, Seekamp A, Flohé S, van Griensven M, Andruszkow H, Pape HC. Relevance of induced and accidental hypothermia after trauma-haemorrhage-what do we know from experimental models in pigs? Intensive Care Med Exp 2014; 2:16. [PMID: 26266916 PMCID: PMC4512998 DOI: 10.1186/2197-425x-2-16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 04/06/2014] [Indexed: 12/17/2022] Open
Abstract
Recent experimental research has either focused on the role of accidental hypothermia as part of the lethal triad after trauma or tried to elucidate the effects of therapeutically induced hypothermia on the posttraumatic course. Induced hypothermia seems to reduce the mortality in experimental models of trauma-haemorrhage. As potential mechanisms, a decrease of cellular metabolism, beneficial effects on haemodynamic function and an attenuation of the inflammatory response have been described. However, negative side effects of hypothermia have to be considered, such as impairment of the coagulatory function and immunosuppressive effects. Furthermore, the optimal strategy for the induction of hypothermia (magnitude, duration, timing, cooling rate, etc.) and subsequent rewarming remains unclear. Nevertheless, this piece of information is essential before considering hypothermia as a treatment strategy for severely injured patients. This review aims to elaborate the differences between accidental and induced hypothermia and to summarize the current knowledge of the potential therapeutic use of induced hypothermia suggested in porcine models of trauma-haemorrhage.
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Affiliation(s)
- Frank Hildebrand
- Department of Orthopedic Trauma and Reconstructive Surgery and Harald Tscherne Laboratory, University of Aachen, Pauwelsstraße 30, Aachen, 52074, Germany,
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Shi Y, Kramer G, Schröder A, Kirkpatrick CJ, Seekamp A, Schmidt H, Fuchs S. Early endothelial progenitor cells as a source of myeloid cells to improve the pre-vascularisation of bone constructs. Eur Cell Mater 2014; 27:64-79; discussion 79-80. [PMID: 24464729 DOI: 10.22203/ecm.v027a06] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
According to present knowledge, blood derived endothelial progenitor cells (EPC) might act as proangiogenic myeloid cells, which play a fundamental role in the regulation of angiogenesis and blood vessel reorganisation. In this context, we have evaluated the contribution of endogenous myeloid cells in co-cultures of blood derived outgrowth endothelial cells (OEC) and osteogenic cells. In addition, we investigated the role of EPC as a potential source of myeloid cells in the formation of vascular structures in an in vitro model consisting of mesenchymal stem cells (MSC) and OEC. For this purpose, we added EPCs to co-cultures of MSC and OECs. Vascular structures and the co-localisation of myeloid cells were analysed by confocal laser microscopy (CLSM) for endothelial and myeloid markers and quantitative image analysis. The molecular effects of myeloid cells were evaluated by quantitative real time PCR, ELISA and protein arrays from cell culture supernatants and lysates. Endogenous myeloid cells were significantly co-localised with angiogenic structures in co-cultures of OEC and osteogenic cells. The active addition of EPC to co-cultures of OEC and MSC resulted in a statistically approved increase in the formation of prevascular structures at early stages of the co-culture process. In addition, we observed an increase of endothelial markers, indicating beneficial effects of EPC or myeloid cells on endothelial cell growth. Furthermore, real time PCR indicated high expression levels of CD68, CD11b and CD163 in co-cultures of EPC and MSC indicating that EPC act at least partly as macrophage like-cells.
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Affiliation(s)
- Y Shi
- Experimental Trauma Surgery, University Medical Centre Schleswig-Holstein, Kiel,
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