New intramedullary locking nail for olecranon fracture fixation--an in vitro biomechanical comparison with tension band wiring.

The aim of this study was to determine the difference in displacement of a newly designed intramedullary olecranon fracture fixation device compared with multifilament tension band wiring after 4 cycles and 300 cycles of dynamic continuous loading.In eight pairs of fresh-frozen cadaver ulnae, oblique olecranon fractures were created and stabilized using either newly designed intramedullary olecranon nail or multifilament tension band wiring. The specimens were then subjected to continuous dynamic loading (from 25 N to 200 N) using matched pairs of cadaveric upper extremities. The Wilcoxon test was used to determine statistical differences of the displacement in the fracture gap.After 4 cycl…

Clinical performance of a new medullary humeral nail: antegrade versus retrograde insertion.

Objective A new intramedullary nail system for humeral shaft fractures is evaluated to determine whether retrograde nailing is as reliable as antegrade nailing. Study design Prospective multicenter nonrandomized clinical study. Patients Eighty-four patients with acute humeral shaft fractures were nailed with the new unreamed humeral nail (UHN) system. Fifty-seven nails were introduced retrogradely, and twenty-seven antegradely. Bone healing and functional outcome were the follow-up parameters. Results The ratio of perioperative complications was equivalent for both groups, but one shaft fracture and three fractures or fissures at the entry point occurred in the group with retrograde nail in…

Der HEPFIEx-Simulator, eine Apparatur zur Bestimmung der Reibzahlen zwischen Hüftkopf-Prothesen und Knorpel / The HEPFlEx Simulator, a Device for Measuring the Friction between Femoral Head Prostheses and Cartilage

We describe a device designed to investigate friction between various femoral head prostheses and human acetabula. It enables not only the determination of friction and the relevance of the play between the femoral head and acetabulum, but also the evaluation of the kinematic behaviour of bipolar prostheses. In the simulator, the various femoral head prostheses are placed on a special cone and tested against a human cadaveric acetabulum. The swiveling range of the device is uniaxial, and the swiveling angle is +/- 35 degrees. The maximum force produced pneumatically is 5kN. Testing of the simulator with a TEP was successful and friction-coefficients of < 0.1 were measured, as are reported i…

The European trauma course – trauma teaching goes European

The World Health Organization (WHO) has identified trauma as the major health care challenge of our century, claiming more productive life years worldwide than any other disease [1]. In the European Union (EU), injury accounts for 15 % of all deaths before the age of 60 years and is the fourth most common cause of death, with more than 235,000 deaths each year from injuries, equating to 600 injury fatalities per day [2]. In children, adolescents and young adults, accident and injury rates are even higher, being the leading cause of death in these age groups. Mortality from trauma in the EU has fallen 20 % in the past 20 years, to a rate of 63.7 per 100,000 in 2010 [3]. This reduction is par…

Progress of Phototherapy Applications in the Treatment of Bone Cancer

Bone cancer including primary bone cancer and metastatic bone cancer, remains a challenge claiming millions of lives and affecting the life quality of survivors. Conventional treatments of bone cancer include wide surgical resection, radiotherapy, and chemotherapy. However, some bone cancer cells may remain or recur in the local area after resection, some are highly resistant to chemotherapy, and some are insensitive to radiotherapy. Phototherapy (PT) including photodynamic therapy (PDT) and photothermal therapy (PTT), is a clinically approved, minimally invasive, and highly selective treatment, and has been widely reported for cancer therapy. Under the irradiation of light of a specific wa…

Dynamische Analyse von Osteosynthesen am Olecranon: ein in-vitro Vergleich zweier Osteosynthesesysteme / Dynamic analysis of olecranon osteosyntheses – an in vitro comparison of two osteosynthesis systems

INTRODUCTION The aim of the present study was to develop a test setup with continuous angle alteration to imitate elbow joint motion for the mechanical evaluation of tension band wiring and a newly designed intramedullary nail. MATERIALS AND METHODS The servo-pneumatical test stand worked with a rotational angle-adjusted and a linear force-adjusted engine. The fracture model was dynamically tested under cyclic loading imitating elbow joint motion. In total, 14 fresh cadaver upper extremities underwent olecranon fracture by means of transverse osteotomy and were assigned to two groups: tension band wiring and intramedullary nailing. There was a continuous angle alteration between 0 and 1000 …

Verfahrenswechsel in der operativen Knochenbruchbehandlung der oberen Extremität, geplant und erzwungen

Prinzipiell werden in der operativen Knochenbruchbehandlung der oberen Extremitat definitive Verfahren angestrebt. Als ¶geplant ist der Verfahrenswechsel bei zweit- und drittgradig offenen Frakturen, insbesondere am Unterarm, akzeptiert, um nach Beherrschung der Weichteilsituation zum definitiven Verfahren, meist Plattenosteosynthese oder Marknagelung, zu wechseln. Am Oberarm kann die Indikation zum definitiven Verfahren insbesondere durch Titanmarknagel auch bei offenen Frakturen weiter gestellt werden, der Fixateur externe tritt mehr in den Hintergrund. Infekte nach Osteosynthesen, aber auch Knochenheilungsstorungen, erzwingen in der Regel den Verfahrenswechsel auch an der oberen Extremit…

Calf Blood Compound (CFC) and Homeopathic Drug Induce Differentiation of Primary Human Skeletal Muscle Cells.

AbstractThe use of injections to treat structural muscle injuries is controversially discussed. In our controlled in vitro study, we investigated the biological impact of Actovegin and Traumeel alone and in combination on primary human skeletal muscle cells. Cells were characterized by immunofluorescence staining for myogenic factor 5 (Myf5) and MyoD, and cultured with or without Actovegin and / or Traumeel. The effects of these agents were assayed by cell viability and gene expression of the specific markers MyoD, Myf5, neural adhesion molecule (NCAM), and CD31. Myotube formation was determined by myosin staining. Neither Actovegin nor Traumeel showed toxic effects or influenced cell viabi…

Medial buttressing of the quadrilateral surface in acetabular and periprosthetic acetabular fractures

Background In geriatric acetabular fractures, the quadrilateral plate is often involved in the fracture pattern and medially displaced. Open reduction and internal fixation (ORIF) includes reduction of the quadrilateral plate and securing its position. In this study, the concept of medial buttressing in acute and periprosthetic acetabular fractures is evaluated. Materials and methods Patients, who sustained an acetabular fracture between 2012 and 2018, in whom ORIF with a specific implant for medial buttressing was performed, were included in the study. Patients were divided in two groups; acute acetabular fractures (group 1) and periprosthetic acetabular fractures (group 2). Demographics,…

Olecranon fractures in adults: factors influencing outcome.

In a retrospective, non-randomized study, we reviewed our experience with the operative treatment of olecranon fractures to find out which factors correlate with subjective complaints and functional outcome. A total of 95 consecutive olecranon fractures were operatively treated in our level I trauma institution between 1 March 1992 and 1 March 2000. Medical records and X-rays of all patients were evaluated. Three patients died, 23 were lost to follow-up. Fifty-eight of 69 available patients (84.0%) were reviewed clinically and/or radiologically after a mean time of 36 months. Fracture type, fracture classification, associated lesions, technical correctness of osteosynthesis, age and comorbi…

Intramedullary nailing vs. palmar locked plating for unstable dorsally comminuted distal radius fractures: A biomechanical study

Abstract Background The purpose of this study was to compare the stability of a 2.4 mm palmar locking compression plate and a new intramedullary nail-plate-hybrid Targon DR for dorsally comminuted distal radius fractures. Methods An extraarticular 10 mm dorsally open wedge osteotomy was created in 8 pairs of fresh frozen human radii to simulate an AO–A3-fracture. The fractures were stabilized using one of the fixation methods. The specimens were loaded axially with 200 N and dorsal-excentrically with 80 N. 2000 cycles of dynamic loading and axial loading-to-failure were performed. Findings Axial loading revealed that intramedullary osteosynthesis (Targon DR: 369 N/mm) was significantly ( p …

Cytokine Interferon-γ suppresses the function of capsule myofibroblasts and induces cell apoptosis

Myofibroblasts (MFs), a contractile subset of fibroblasts, play a pivotal role in physiological wound healing and in the development of many fibroconnective disorders. The complex cytokine network regulating the function of MFs in joint stiffness is still poorly understood. In this in vitro study, we investigated the effect of the cytokine Interferon-gamma (IFN-γ) on MFs isolated from human joint capsules. MFs were cultivated either in the presence of increasing concentrations of IFN-γ alone or in combination with IFN-γ neutralizing antibodies. Cell viability, cytotoxicity, apoptosis, and mRNA gene expression of the MF markers alpha-smooth muscle actin (α-SMA) and collagen type I were analy…

Mid- to long-term results after bipolar radial head arthroplasty.

Background Radial head arthroplasty is considered the treatment of choice for unreconstructable radial head fractures in the acute fracture situation. Although short-term results in the current literature are promising, replacement of the radial head remains controversial as long-term results are still missing. We report our 8.8-year results after treatment with a bipolar radial head prosthesis by Judet. Materials and methods In our department, 19 patients were treated with bipolar radial head arthroplasty between 1997 and 2001. Seventeen of these patients—14 men and 3 women—were examined retrospectively after 106 months (range, 78-139). Of these, 9 patients were treated primarily, 7 patien…

Misdiagnosis of Thoracolumbar Posterior Ligamentous Complex Injuries and Use of Radiographic Parameter Correlations to Improve Detection Accuracy

Study Design Retrospective study. Purpose To evaluate radiological parameters as indicators for posterior ligamentous complex (PLC) injuries in the case of limited availability of magnetic resonance imaging. Overview of Literature Traumatic thoracolumbar spinal fractures with PLC injuries can be misdiagnosed on X-rays or computed tomography scans. This study aimed to retrospectively assess unrecognized PLC injuries and evaluate radiographic parameters as indicators of PLC injuries requiring surgery. Methods In total, 314 patients with type A and type B2 fractures who underwent surgical treatment between 2001 and 2010 were included. The frequency of misdiagnosis was reassessed, and radiograp…

Transsacral Bar Osteosynthesis

Uni- or bilateral sacral ala fractures in elderly persons may cause significant disability and result in non-union, if treated non-surgically. Transsacral positioning bar osteosynthesis provides the advantages of a minimally invasive approach yet reducing the risk of implant loosening. A threaded 6 mm bar is inserted through the posterior part of the ilium and the SI-joint, and advanced through the center of the S1 vertebral body towards the opposite posterior ilium. Washers and nuts are placed and tightened on both ends of the bar providing moderate compression of the vertical fracture planes in the sacrum. The stability of fixation does not depend on the bone mineral density of the sacrum…

Influence of different calcium phosphate ceramics on growth and differentiation of cells in osteoblast-endothelial co-cultures

Strategies for improvement of angiogenesis and vasculogenesis using different cells and materials are paramount aims in the field of bone tissue engineering. Thereby, the interaction between different cell types and scaffold materials is crucial for growth, differentiation, and long-term outcomes of tissue-engineered constructs. In this study, we evaluated the interaction of osteoblasts and endothelial cells in three-dimensional tissue-engineered constructs using beta tricalciumphosphate (β-TCP, [s-Ca3 (PO4 )2 ]) and calcium-deficient hydroxyapatite (CDHA, [Ca9 (PO4 )5 (HPO4 )OH]) ceramics as scaffolds. We focused on initial cell organization, cell proliferation, and differential expression…

Radial Head Fractures

Radial head fractures are the most common elbow fractures, accounting for 20–30 %. Typically, the fractures evolve from a fall on the outstretched hand with the elbow extended and the forearm in pronation. The role of the radial head as an important stabilizer of the elbow joint has been recognized in the last decade. Sixty percent of the axial load transmitted through the elbow is conducted through the radial head. Furthermore, the radial head is an important stabilizer against valgus stresses. While the medial collateral ligament (MCL) is the primary stabilizer against valgus stress, the role of the radial head emerges when the MCL is torn. These findings have led to a change in treatment…

Exposure to radial extracorporeal shockwaves induces muscle regeneration after muscle injury in a surgical rat model

The leading cause of training interruption in sport is a muscle injury, for which the standard treatment is nonsteroidal anti-inflammatory drugs (NSAIDs). To find alternative treatments, we investigated whether the radial extracorporeal shockwave application (rESWT) could stimulate muscle regeneration. A lesion with complete rupture (grade III muscle tear) was set in the musculus rectus femoris of 12-week-old Wistar rats, and the NSAID diclofenac, rESWT, or a combined therapy were applied on day 0, 3, and 5 directly following the surgery. Rats were euthanized at 2, 4, and 7 days after surgery and the area of muscle lesion was excised for histological and gene expression analysis to determin…

Humeral Shaft Fractures

Humeral shaft fractures account for approximately 7 % of all fractures in adults. They occur after direct trauma such as traffic accidents or after indirect, rotational trauma in sports accidents or falls at home. There are two peaks of incidence in the adult population: the young male and the older female. The first patient typically is the victim of high-energy trauma with multiple lesions, a more severe humeral fracture type and concomitant soft tissue damage. The latter patient suffers a solitary lesion and is the victim of a low-energy accident such as a fall from a standing or sitting position. The fracture type is then simple and there is no or minimal soft tissue damage. As pain is …

Komprimierte Marknagelung bei Oberarmschaftfrakturen

Aufgrund geringer Fragmentverzahnung neigen Quer- und kurze Schragfrakturen des Humerus zur Entwicklung einer Pseudarthrose. Da der menschliche Humerus durch das Korpergewicht kaum axial druckbelastet ist und bei den taglichen Verrichtungen eher Zug- und Rotationskraften ausgesetzt ist, erfordern Humerusfrakturen eine hohe Stabilisierungspotenz. Diese lasst sich durch die Verriegelungsmarknagelung u. U. mit zusatzlicher interfragmentarer Kompression erreichen. Eine spezielle Kompressionsvorrichtung verlagert den dynamischen Bolzen an der Nagelbasis zusammen mit dem Knochenfragment in Richtung Bruchspalt und bewirkt nach Fragmentadaption eine Fragmentpressung und die Bolzenverklemmung. Das E…

Internal Fixation in Postpartum Symphysis Pubis Rupture: Report of Three Cases

We present three patients with postpartum symphysis pubis rupture whose severe complaints persisted after conservative treatment. All three ruptures were stabilized with open reduction and internal fixation. There were no postoperative problems, and implants were removed after a mean period of six months. Patients were free of complaints after implant removal. In select cases, operative treatment of postpartum symphysiolysis may be indicated.

Die Kleinfragment-Doppelplattenosteosynthese bei C1- bis C3-Frakturen des Pilon tibiale

Intra-articular fractures of the tibial pilon always have been a challenge for the surgeon and his operative technique. With conservative or operative management, we have to take care of destroyed articular surfaces and traumatised soft tissues. Therefore, tibial pilon fractures are known in the literature as complicated lesions with a high rate of complications. Between 1993 and 2001 twenty-one patients who were between 18 and 65 years old and suffered a monotrauma of the tibial pilon of the type C1 to C3 of the AO classification, were treated with a staged reconstruction. Stabilisation was done by small-fragment double plate osteosynthesis. In this retrospective study, we could review 17 …

(i) Comminuted patellar fractures

Summary Purpose of review This article reviews current best practice for the diagnosis and treatment of comminuted patellar fractures. Recent findings Patellar fractures make up about 1% of all fractures. As a rule, fractures of the patella are caused by direct trauma to the knee. A transverse fracture is the most common fracture type. Open reduction and internal fixation is the treatment of choice for the majority of displaced patellar fractures. Treatment must achieve anatomic reduction of the articular surface and reestablish the continuity of the extensor mechanism. Tension-band wiring, interfragmentary screw fixation and a combination of cerclage wiring and screw fixation are the most …

The role of muscular trauma in the development of heterotopic ossification after hip surgery: An animal-model study in rats.

Abstract Background Heterotopic ossification (HO), the formation of bone in soft tissues, is a frequent complication after surgery of the hip and the pelvis. Although the pathophysiological entities responsible for the formation of HO remain largely unclear, muscle trauma is alleged to play a central role in the pathogenic mechanisms underlying HO. However, for this observation, made by many surgeons for decades, no objective evidence has been provided yet. Methods Fifty male Wistar rats were subjected to surgery of the right hip. The femoral canal was reamed in three steps up to 2 mm. Animals formed 2 groups: in group 1 (25 animals) every effort was taken not to injure the muscles. In cont…

Clinical pathways for fragility fractures of the pelvic ring: personal experience and review of the literature

AbstractFragility fractures of the pelvic ring (FFP) are increasing in frequency and require challenging treatment. A new comprehensive classification considers both fracture morphology and degree of instability. The classification system also provides recommendations for type and invasiveness of treatment. In this article, a literature review of treatment alternatives is presented and compared with our own experiences. Whereas FFP Type I lesions can be treated conservatively, FFP Types III and IV require surgical treatment. For FFP Type II lessions, percutaneous fixation techniques should be considered after a trial of conservative treatment. FFP Type III lesions need open reduction and in…

Soft Tissue Management and Postoperative Care

The acute compartment syndrome is a limb-threatening complication. Although the diagnosis is primarily based on clinical evaluation, intracompartmental pressure monitoring may be required in specific situations. Surgical decompression is the only adequate treatment. Any delay in surgical management increases the risk of late sequellae.

Osteosynthese am proximalen Humerus mittels winkelstabiler Platte oder Doppelplatte: eine vergleichende biomechanische Untersuchung / Angle-fixed plate fixation or double-plate osteosynthesis in fractures of the proximal humerus: a biomechanical study

Internal fixation of fractures of the proximal humerus needs a high stability of fixation to avoid secondary loss of fixation. This is especially important in osteoporotic bone. In an experimental study, the biomechanical properties of the angle-fixed Philos plate (internal fixator) and a double-plate osteosynthesis using two one-third tubular plates were assessed. The fracture model was an unstable three-part fracture (AO type B2). Eight pairs of human cadaveric humeri were submitted to axial load and torque. In the first part of the study, it was assessed to which degree the original stiffness of the humeri could be restored after the osteotomy by the osteosynthesis procedure. Subsequentl…

Mechanical characterization of rose bengal and green light crosslinked collagen scaffolds for regenerative medicine

Abstract Collagen is one of the most important biomaterials for tissue engineering approaches. Despite its excellent biocompatibility, it shows the non-negligible disadvantage of poor mechanical stability. Photochemical crosslinking with rose bengal and green light (RGX) is an appropriate method to improve this property. The development of collagen laminates is helpful for further adjustment of the mechanical properties as well as the controlled release of incorporated substances. In this study, we investigate the impact of crosslinking and layering of two different collagen scaffolds on the swelling behavior and mechanical behavior in micro tensile tests to obtain information on its wearin…

Influence of formalin fixation on the biomechanical properties of human diaphyseal bone.

Owing to the lack of fresh human bones, formalin-fixed specimens are frequently used in biomechanical testing. However, formalin fixation is assumed to affect the biomechanical properties of bone. The aim of this study was to compare axial and torsional stiffness and bone mineral density in fresh and embalmed human bones. The subtrochanteric regions of 12 pairs of fresh human femora were randomised into two groups for paired comparison. After bone mineral density measurement, one group was preserved in 4% formalin. After 6 weeks, bone mineral density was remeasured and each specimen underwent axial and torsional loading. The formalin group showed significant higher stiffness values for tors…

Retrograde Transpubic Screw Fixation

In the vast majority of fragility fractures of the pelvis, fractures of the posterior and anterior pelvic ring occur combined. Fractures of the pubic rami above and below the obturator foramen are much more frequent than fractures of the pubic bone and fractures at the anterior lip of the acetabulum. Retrograde transpubic screw fixation is a minimally invasive technique for stabilization of pubic rami fractures. The anterior column corridor is a straight corridor between the anterior cortex of the superior pubic ramus near to the pubic tubercle and the external cortex of the ilium above the acetabulum. The minimal canal diameter, measured in 160 Japanese, was on average 13.5 mm for men and …

Are there any differences in various polyaxial locking systems? A mechanical study of different locking screws in multidirectional angular stable distal radius plates.

Numerous angular stable plates for the distal radius exist, and technically based comparisons of the polyaxial locking interfaces are lacking. The aim of this mechanical study was to investigate three different locking interfaces of angular stable volar plates by cantilever bending: VA-LCP Two-Column Distal Radius Plates 2.4 mm (Synthes® GmbH, Oberdorf, Switzerland), IXOS® P4 (Martin, Tuttlingen, Germany) and VariAX™ (Stryker®, Duisburg, Germany). We assessed the strength of 0°, 5°, 10° and 15° screw locking angles and tested the bending strength from 10° to 5° angles by cyclic loading until breakage. The final setup repeated the above assessments by inclusion of four locking screws. The si…

Hypothenar Hammer Syndrome in a Golf Player: A Case Report

A Locked Intraosseous Nail for Transverse Patellar Fractures: A Biomechanical Comparison with Tension Band Wiring Through Cannulated Screws.

Background Displaced transverse patellar fractures require open reduction and internal fixation. State-of-the-art stabilization techniques are tension band wiring (TBW) using Kirschner wires or cannulated screws. These techniques are associated with high rates of secondary fracture displacement, implant migration, implant prominence, wound-healing disturbances, and the need for implant removal. Recently, a locked intraosseous patellar nail prototype was developed. The aim of the present study was to investigate the biomechanical performance of this nail compared with TBW using cannulated screws. Methods Seven paired fresh-frozen human cadaveric knees were stripped of all soft tissues except…

Isolated fractures of the greater tuberosity of the proximal humerus

Background and purpose The diagnosis and treatment of isolated greater tuberosity fractures of the proximal humerus is not clear-cut. We retrospectively assessed the clinical and radiographic outcome of isolated greater tuberosity fractures. Patients and methods 30 patients (mean age 58 (26–85) years, 19 women) with 30 closed isolated greater tuberosity fractures were reassessed after an average follow-up time of 3 years with DASH score and Constant score. Radiographic outcome was assessed on standard plain radiographs. Results 14 of 17 patients with undisplaced or slightly displaced fractures (≤ 5 mm) were treated nonoperatively and had good clinical outcome (mean DASH score of 13, mean Co…

The Surgery of Neglected Distal Humerus Fractures in Children and Adults

The restoration of function after a neglected distal humerus fracture presents a formidable challenge to the surgeon because of both the complexity of the regional anatomy and the proximity of numerous neurovascular structures. Inadequate or unstable fixation, a failure to reposition the articular fragments anatomically, prolonged post-operative immobilization, or the development of soft-tissue complications will result in substantial disability for the patient. Complications after injuries affecting a child’s elbow are common due to understimating the severity of the injury on the native X-rays where the growth plates and cartilage structures can not be seen.

Radiation exposure to the hands and the thyroid of the surgeon during intramedullary nailing.

Abstract During 41 procedures of intramedullary nailing of femoral and tibial fractures, the primary surgeon and the first assistant wore ring dosimeters on their dominant index fingers. While the average fluoroscopy time per procedure was 4.6 min, the average dose of radiation to the dominant hand of the primary surgeon was 1.27 mSv and 1.19 mSv to the first assistant. The dose limit for the extremities is 500 mSv per year, as recommended by the International Commission on Radiological Protection. Extrapolation of the mean dose of the primary surgeon and first assistent per procedure of 1.23 mSv leads to the result that the recommended dose limit of 500 mSv would only be exceeded if more t…

Distal Humerus Fractures

Distal humerus fractures display seldom but severe injuries because of the complex distal humerus anatomy and often comminuted fracture types. They account for approximately 2–3 % of all fractures and for 17–30 % of fractures around the elbow. In younger patients, there is a predominance among males. The mechanism of accident is mostly a high-energy trauma in this population. In contrast, among elderly patients, distal humerus fractures concern mostly women with osteoporotic bone. Fractures are caused by a low-energy trauma such as a fall from standing height onto the outstretched or slightly flexed arm. These fractures are often severely comminuted. Because of the thin soft tissue envelope…

&lt;p&gt;Effects of losartan and atorvastatin on the development of early posttraumatic joint stiffness in a rat model&lt;/p&gt;

Background After a trauma, exuberant tissue healing with fibrosis of the joint capsule can lead to posttraumatic joint stiffness (PTJS). Losartan and atorvastatin have both shown their antifibrotic effects in different organ systems. Objective The purpose of this study was the evaluation of the influence of losartan and atorvastatin on the early development of joint contracture. In addition to joint angles, the change in myofibroblast numbers and the distribution of bone sialoprotein (BSP) were assessed. Study design and methods In this randomized and blinded experimental study with 24 rats, losartan and atorvastatin were compared to a placebo. After an initial joint injury, rat knees were …

Rommens PM, Kuechle R, Bord T et al. Humeral nailing revisited [Injury 2008;39:1319–28]

Screw fixation of radial head fractures: Compression screw versus lag screw—A biomechanical comparison

Abstract Introduction Secondary loss of reduction and pseudarthrosis due to unstable fixation methods remain challenging problems of surgical stabilisation of radial head fractures. The purpose of our study was to determine whether the 3.0 mm Headless Compression Screw (HCS) provides superior stability to the standard 2.0 mm cortical screw (COS). Materials and methods Eight pairs of fresh frozen human cadaveric proximal radii were used for this paired comparison. A standardised Mason II-Fracture was created with a fragment size of 1/3 of the radial head's articular surface that was then stabilised either with two 3.0 mm HCS (Synthes) or two 2.0 mm COS (Synthes) according to a randomisation …

Two-year results of vertebral body stenting for the treatment of traumatic incomplete burst fractures.

Vertebral body stenting (VBS) was developed to prevent loss of reduction after balloon deflation during kyphoplasty. The aim of this study is the radiological and clinical mid-term evaluation of traumatic incomplete burst fractures treated by vertebral body stenting.This retrospective study included patients with traumatic thoracolumbar incomplete burst fractures treated with VBS between 2009 and 2010. The outcome was evaluated with the visual analogue pain scale (VAS), the Oswestry Disability Score (ODI), the SF-36 Health Survey and radiologically assessed.Eighteen patients with an average age of 74.8 years were treated with VBS. Twelve were female and six were male. Two years after the op…

Dexamethasone Inhibits the Pro-Angiogenic Potential of Primary Human Myoblasts

Tissue regeneration depends on the complex processes of angiogenesis, inflammation and wound healing. Regarding muscle tissue, glucocorticoids (GCs) inhibit pro-inflammatory signalling and angiogenesis and lead to muscle atrophy. Our hypothesis is that the synthetic GC dexamethasone (dex) impairs angiogenesis leading to muscle atrophy or inhibited muscle regeneration. Therefore, this study aims to elucidate the effect of dexamethasone on HUVECs under different conditions in mono- and co-culture with myoblasts to evaluate growth behavior and dex impact with regard to muscle atrophy and muscle regeneration. Viability assays, qPCR, immunofluorescence as well as ELISAs were performed on HUVECs,…

Photocrosslinkable polysaccharide hydrogel composites based on dextran or pullulan-amylose blends with cytokines for a human co-culture model of human osteoblasts and endothelial cells

Although a large body of research has been devoted to biomaterial development for bone tissue engineering and related medical disciplines in the last few years, novel and optimized materials especially for bone fractures of critical sizes demand continued development. In this respect, polysaccharide-based hydrogels demonstrate beneficial properties and fulfill the main requirements for a bone tissue scaffold as they are hydrophilic, biocompatible, and biodegradable. The aim of the present study was the development of a natural polysaccharide-based scaffold material that can integrate with the host tissue and support bone regeneration. For this purpose, we prepared and investigated two polym…

Der enge Spinalkanal aus traumatologischer Sicht

Verletzungen der Wirbelsaule sind auch heute noch eine grose Herausforderung fur die behandelnden Unfallchirurgen.Vom Konzept der uberwiegend konservativen Behandlung ist man im letzten Jahrhundert infolge einer differenzierteren Diagnostik gerade bei den sog. instabilen Verletzungen abgekommen. Diskrepanzen bestehen nach wie vor in der Stabilitatsbeurteilung. In den letzten Jahren haben sich sowohl dorsale als auch ventrale oder kombinierte Versorgungen etabliert. Verengte Spinalkanale und neurologische Defizite sind dabei wichtige Faktoren. Anhand der Literatur werden die verschiedenen Vorgehensweisen und Beurteilungen diskutiert und abschliesend unserer eigenes Konzept vorgestellt.

Internal Fixation of Proximal Humeral Fractures: Current Concepts

Fractures of the proximal humerus are an increasingly common type of injury. Mainly elderly patients with osteoporotic bone are affected. Whereas non-displaced and stable fractures are managed successfully with conservative treatment, there is no general agreement on the surgical strategy for displaced and unstable two- to four-part fractures. The clinical outcome is influenced by the fracture type and concomitant injury to the rotator cuff. Extensive surgical manipulation of the soft tissues, non-anatomic and/or unstable fixation as well as technical errors are important contributing factors to poor clinical results. Goals of surgical treatment are to restore anatomy, to achieve fixation t…

CD34+cells seeded in collagen scaffolds promote bone formation in a mouse calvarial defect model

Bone tissue engineering (BTE) holds promise for managing the clinical problem of large bone defects. However, clinical adoption of BTE is limited due to limited vascularization of constructs, which could be circumvented by pre-cultivation of osteogenic and endothelial derived cells in natural-based polymer scaffolds. However, until now not many studies compared the effect of mono- and cocultures pre-seeded in collagen before implantation. We utilized a mouse calvarial defect model and compared five groups of collagen scaffolds: a negative control of a collagen scaffold alone, a positive control treated with BMP-7, monocultures of either human osteoblasts (hOBs) or CD34+ cells, and a cocultu…

Symptoms of adjustment disorder and smoking predict long-term functional outcome after ankle and lower leg fracture

Objective To examine the psychological, social, behavioural and injury-related factors impacting functional outcome in patients with ankle or lower limb fracture one year post-operation. Methods In this prospective study 66 patients with ankle or lower leg fracture were recruited and followed up one year post-operation. Possible associations between predictors and functional outcome were explored by regression analyses. Functional outcome was assessed with the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score. Results Linear regression models revealed that smoking and elevated symptoms of adjustment disorder were associated with lower functional outcome one year post-operation…

Thromboembolische komplikationen bei patienten mit becken- und azetabulumfrakturen Diagnostik, therapie, prevention

Patienten mit Becken- und Azetabulumfrakturen unterliegem einem sehr hohen Risiko, eine tiefe Bein- oder Beckenvenenthrombose mit Folgekomplikationen zu entwickeln. Die Thromboseinzidenz liegt bei 10% bis 60%. Proximale Thrombosen mit dem hochsten Embolisationsrisiko treten in 25% his 35% auf, ungefahr die Halfte in den Beckenvenen. Eine symptomatische Lungenembolie entsteht bei einer Population mit Beckenverletzungen bei 2% bis 10%, klinisch inapparente Embolien sind wesentlich haufiger. Emboliegefahrdete proximale Thrombosen werden im Oberschenkelbereich am besten mit der farbkodierten Duplexsonographie diagnostiziert, fur die Beckenetage kristallisiert sich die MRT als Diagnosemittel der…

Screw‐in‐screw fixation of fragility sacrum fractures provides high stability without loosening—biomechanical evaluation of a new concept

Surgical treatment of fragility sacrum fractures with percutaneous sacroiliac (SI) screw fixation is associated with high failure rates. Turn-out is detected in up to 20% of the patients. The aim of this study was to evaluate a new screw-in-screw implant prototype for fragility sacrum fracture fixation. Twenty-seven artificial hemipelvises were assigned to three groups (n = 9) for instrumentation of an SI screw, the new screw-in-screw implant prototype, ora transsacral screw. Before implantation, a vertical osteotomy was set in zone 1 after Denis. All specimens were biomechanically tested to failure in upright position. Validated setup and test protocol were used for complex axial and torsi…

Toxic Effect of Vancomycin on Viability and Functionality of Different Cells Involved in Tissue Regeneration

To prevent infections local delivery of antibiotics is a useful tool. Especially in bone fractures, vancomycin impregnated bone cements are often used allowing high concentrations of antibiotics at the infection side without high serum concentrations. However, besides potential pathogens, cells involved in tissue regeneration may also be affected by the drug. We investigated the effect of vancomycin on the viability and functionality on osteoblasts, endothelial cells, fibroblasts and skeletal muscle cells. Our results show that the viability of all cells analyzed was reduced by vancomycin and that the observed effects were time and concentration dependent. The most pronounced toxic effect w…

Der ilioinguinale Zugang bei Azetabulumfrakturen

Operationsziel Darstellung des gesamten vorderen Pfeilers des Azetabulums und der Inenseite des hinteren Pfeilers. Indikationen Offene Reposition und innere Fixation der vorderen Azetabulumwand und des vorderen Pfeilers sowie von Frakturen, die den vorderen und hinteren Pfeiler in Mitleidenschaft ziehen, wobei der hintere Pfeiler indirekt gut reponiert werden kann. Kontraindikationen Frakturen der hinteren Azetabulumwand. Frakturen des hinteren Pfeilers. Frakturen beider Pfeiler, wobei der hintere Pfeiler oder die hintere Wand direkt reponiert werden muss. Frakturen, die einen direkten Zugang zum Huftgelenk erfordern, z. B. bei intraartikularen Frakturfragmenten. Operationstechnik Darstellu…

Xenograft models for undifferentiated pleomorphic sarcoma not otherwise specified are essential for preclinical testing of therapeutic agents

Undifferentiated pleomorphic sarcoma not otherwise specified belongs to the heterogeneous group of soft tissue tumors. It is preferentially located in the upper and lower extremities of the body, and surgical resection remains the only curative treatment. Preclinical animal models are crucial to improve the development of novel chemotherapeutic agents for the treatment of undifferentiated pleomorphic sarcoma. However, this approach has been hampered by the lack of reproducible animal models. The present study established two xenograft animal models generated from stable non-clonal cell cultures, and investigated the difference in chemotherapeutic effects on tumor growth between undifferenti…

Dynamic biomechanical analysis of different olecranon fracture fixation devices--tension band wiring versus two intramedullary nail systems: an in-vitro cadaveric study.

Abstract Background. The aim of this study was to develop a test-setup with continuous angle alteration to imitate joint motion for the evaluation of 3 different olecranon fracture fixation devices. Methods. Twenty-one fresh cadaver upper extremities underwent olecranon fracture by the means of transverse osteotomy and received 3 different fixation systems. Group 1: Tension band wiring according to Weber. Group 2: XS-nail with 9 holes, all locked with 2 mm threaded K-wires. Group 3: Olecranon Nailing System with 90 mm length, locked with 2.7 mm screws, a variable angle locking hole for the proximal fragment and a proximal locking end cap. The servo-pneumatical test stand worked with a rotat…

Do We Need a Separate Classification for Fragility Fractures of the Pelvis?

Fragility fractures of the pelvis are occurring with increasing frequency. These fractures, occurring in the geriatric patient population, are low-energy injuries and are dissimilar in many ways from those caused by high-energy trauma. For example, the mechanism of injury is different and emergency treatment is usually not necessary. Having diminished bone strength, fragility fracture lines follow areas of low bone mineral density and loss of pelvic stability may increase over time. Based on our clinical experience, we propose a comprehensive classification of pelvic fragility fractures separate from the existing pelvic ring injury classification to provide a framework for distinguishing th…

Die retrograde Verriegelungsmarknagelung von Humerusschaftfrakturen mit dem unaufgebohrten Humerusnagel

Operationsziel Ubungsstabile Osteosynthese des Humerus mit solidem, intramedullaren Verriegelungsmarknagel in nichtaufgebohrter Technik. Rasche Wiederherstellung von Form und Funktion der betroffenen Gliedmase.

Posterior Wall Fractures of the Acetabulum: Characteristics, Management, Prognosis

A consecutive series of 60 fractures of the posterior wall of the acetabulum, treated operatively in a Level I Trauma center, is reviewed retrospectively. Characteristics of the lesion, type of treatment, early and late postoperative complications and two-year functional results were recorded. In 27 patients (45%), additional damage to the cartilage of the acetabular cavity such as subchondral impaction, free articular fragments or separation of the posterior wall into several pieces was present. Seven patients (11.6%) showed preoperative neurological deficit. All fractures were treated with open reduction and internal fixation through a Kocher-Langenbeck approach. Secondary nerve damage wa…

Complex radial head and neck fractures treated with modern locking plate fixation

Background Internal fixation of complex radial head and neck (CRHN) fractures is difficult, and postoperative complications are common. This study evaluated elbow function and patient clinical status after internal fixation of CRHN fractures with modern locking plates. Methods We included 40 patients with 41 fractures (1 bilateral lesion). In 25 patients (61%), a concomitant injury was found. Patients were an average age of 46 years (range, 22-70 years). The mean follow-up time was 36 months (range, 2-70 months). Postoperative assessments included evaluation of range of motion, functional scores, and radiologic findings. We assessed fracture healing, surgical complications, revision surgery…

Principles of Damage Control in the Elderly

A steadily increase of severely injured elderly patients may be expected. Comorbidities are present in the majority of these patients and negatively influence outcome. Blunt trauma is the leading cause of high-energy injuries in the elderly. Motor vehicle accidents, either as driver or as pedestrian hit by a car, and falls from height are the most important mechanisms of polytrauma. The principles of advanced trauma life support (ATLS) should also apply for elderly persons. Underestimation of the severity of injury is a common problem leading to undertriage. A basic rule of primary care is to avoid the lethal triad of hypothermia, coagulopathy and acidosis. Emergent invasive monitoring redu…

Stability of radial head and neck fractures: a biomechanical study of six fixation constructs with consideration of three locking plates.

Open reduction and internal fixation of radial neck fractures can lead to secondary loss of reduction and nonunion due to insufficient stability. Nevertheless, there are only a few biomechanical studies about the stability achieved by different osteosynthesis constructs.Forty-eight formalin-fixed, human proximal radii were divided into 6 groups according to their bone density (measured by dual-energy x-ray absorptiometry). A 2.7-mm gap osteotomy was performed to simulate an unstable radial neck fracture, which was fixed with 3 nonlocking implants: a 2.4-mm T plate, a 2.4-mm blade plate, and 2.0-mm crossed screws, and 3 locking plates: a 2.0-mm LCP T plate, a 2.0-mm 6x2 grid plate, and a 2.0…

Number and Locations of Screw Fixation for Volar Fixed-Angle Plating of Distal Radius Fractures: Biomechanical Study

Purpose To compare the biomechanical properties of different numbers and locations of screws in a multidirectional volar fixed-angle plate in a distal radius osteotomy cadaver model. Methods We created an extra-articular fracture in 16 pairs of fresh-frozen human cadaver radiuses. The 32 specimens were randomized into 4 groups. All fractures were fixated with a multidirectional volar fixed-angle plate. We tested 4 different screw-placement options in the distal fragment. The distal fragment was fixed with 4 locking screws in the distal row of the plate in group a, and with 4 locking screws alternately in the distal and proximal rows in group b. In group c, 3 locking screws were used in the …

Osteoporotische Frakturen des Beckenrings

Durch die Alterung der Bevölkerung sind wir mit einer Zunahme an osteoporotischen und Ermüdungsfrakturen des Beckenrings konfrontiert. Sie werden durch niedrigenergetische Traumen verursacht. Die konventionelle Diagnostik ist weniger aufschlussreich als bei Jugendlichen und Erwachsenen, eine CT- oder MRT-Diagnostik ist erforderlich. Die Erscheinungsformen sind multipel und bieten ein ganzes Spektrum von Instabilitäten. Die konventionelle Klassifikation trifft nicht auf alle Erscheinungsformen dieser Frakturen zu. Die Behandlung umfasst sowohl konservative als auch operative Verfahren. Entscheidend dabei sind der Grad und die Lokalisation der Instabilität. Die Osteosyntheseformen unterscheid…

Dose-Adjusted Thrombosis Prophylaxis in Trauma Surgery According to Levels of D-Dimer

In 234 trauma surgery patients, thrombosis prophylaxis with Nadroparin-Calcium low-molecular-weight heparin (LMWH) was adjusted according to levels of D-Dimer. Basic prophylaxis was 2,850 IU per day. If D-Dimer concentrations rose above 2 mg/L after the fourth postoperative (p.o.) day, LMWH was administered twice a day. Color Doppler ultrasound was performed between the fifth and seventh p.o. days. Patients were divided into a high-risk (group 1: hip, femur, or knee replacement surgery, n=102) and a moderate-risk group (group 2: other surgery of the knee, tibia, fibula, or foot, n=132). Group 1 showed significantly higher D-Dimer levels than group 2 (p0.001). Measurement of D-Dimer on days …

Retrograde locked nailing of humeral shaft fractures using the unreamed humeral nail (UHN)

Objectives Bony consolidation of humeral fractures in anatomical reduction. Rapid rehabilitation. Restoration of normal function.

Symptome einer Anpassungsstörung nach einer Unfallverletzung: Risiko- und Schutzfaktoren

Symptoms of Adjustment Disorder after an accidental injury: risk and protective factors Objectives: The identification of protective and risk factors for symptoms of adjustment disorder (AD) after an accident injury. Methods: In this prospective long-term study, data from 73 patients with ankle and lower leg fractures were analyzed. Symptoms of AD were assessed at enrollment (T0), 1 month (T1) and 12 months (T2) after injury. In addition, questionnaires regarding adverse childhood experiences, coping strategies and the number of stressors during the last year were obtained. The Structured Clinical Interview for DSM-IV (SCID) was conducted at T1 and T2. Results: 4.1 % of patients met the cri…

Bone Mass Distribution in the Sacrum

The trabecular architecture and bone mass distribution of each bone follows biomechanical principles and is an adaption to the stress exhibited during lifetime. In patients with osteoporosis, the bone mass decreases and the bone microarchitecture changes. A distinct bone mass distribution in non-osteoporotic and osteoporotic individuals is demonstrated using statistical modelling in the sacrum. The authors studied the sacral bone mass distribution using a 3D statistical model based on clinical CT scans of 92 Europeans. In the group with worse general bone mass (less than 100 Houndsfeld Units (HU) measured in the body of L5), there were large areas of negative HU in the sacral alae. These “a…

Osteoporotic Pelvic Fractures

Background The estimated incidence of osteoporotic pelvic fractures among persons over age 60 in Germany is 224 per 100 000 persons per year, and rising. A number of surgical treatment options are available, but clinical long-term data are lacking. Methods This review is based on pertinent publications and guidelines retrieved by a selective literature search, and on the authors' clinical experience. Results Patients often report one or more relatively trivial traumatic incidents leading up to the fracture. They complain of pain in the hip, groin, or lower lumbar region, or of low back pain and sciatica. A new classification scheme entitled Fragility Fractures of the Pelvis (FFP) takes the …

Impingement of the Sciatic Nerve due to a Protruding Acetabular Cage Rim

Abstract Sciatic nerve damage is a well-known complication that occurs in 1.5% of patients after primary total hip arthroplasty and in 8% after revision total hip arthroplasty. Yet when considering re-revision arthroplasty and acetabular cage implantation, incidence and management remain unclear. This case report describes a young female patient with sciatic nerve impingement after acetabular cage implantation. Her primary complaint was shooting sciatic left leg pain, worsening on ambulation and when seated. A complete workup was negative for spinal impingement or infection, and axonal nerve damage was confirmed through nerve conduction studies. The intraoperative findings showed that it wa…

3D Bioprinting for Vascularized Tissue-Engineered Bone Fabrication

Vascularization in bone tissues is essential for the distribution of nutrients and oxygen, as well as the removal of waste products. Fabrication of tissue-engineered bone constructs with functional vascular networks has great potential for biomimicking nature bone tissue in vitro and enhancing bone regeneration in vivo. Over the past decades, many approaches have been applied to fabricate biomimetic vascularized tissue-engineered bone constructs. However, traditional tissue-engineered methods based on seeding cells into scaffolds are unable to control the spatial architecture and the encapsulated cell distribution precisely, which posed a significant challenge in constructing complex vascul…

Total Elbow Replacement as Primary Treatment for Complex Fractures of the Distal Osteopenic Humerus

Background: The use of hip and shoulder arthroplasty in elderly patients for grossly displaced intraarticular fractures is becoming more and more accepted. Total elbow replacement (TER) has not been considered an option for the treatment of extensively comminuted fractures of the distal humerus because surgeons feel the outcome is generally not predictable after TER. Evaluation of TER: On the basis of a MEDLINE literature search of this issue and the documented results based on the improvement of implant designs, operative technique and patient selection, TER has a definite role in the treatment of some fractures of the distal humerus.

Fragility Fractures of the Pelvis.

Fragility fractures of the pelvic ring (FFP) show an increasing frequency. Trauma mechanism, fracture morphology and degree of instability are different from those in high-energy pelvic ring lesions. Little is known about the optimal treatment strategy. A new comprehensive classification system with four categories of increasing instability is presented. It is connected with recommendations for type and invasiveness of treatment. FFP Type I are anterior instabilities only and can be treated conservatively. FFP Type II are non-displaced posterior lesions which can be treated conservatively or with percutaneous fixation. FFP Type III lesions are unilateral displaced posterior lesions which re…

Iliosacral Screw Osteosynthesis

Fragility fractures of the anterior pelvic ring are very often combined with fractures of the posterior pelvic ring. The large majority of the posterior fractures is situated in the sacral ala. Non-operative therapy may be cumbersome in patients with a combination of an anterior with a posterior pelvic ring fracture. Any surgical therapy should be as less invasive as possible. Iliosacral screw fixation is a minimal invasive technique. Variations of the upper sacral anatomy make optimal iliosacral screw placement challenging. The vestibule or isthmus is the narrowest part of the bony corridor from the lateral ilium to the S1 sacral body. It always points towards anterior and superior. The wh…

Is there a role for percutaneous pelvic and acetabular reconstruction?

The primary goal in the treatment of pelvic fractures is the restoration of haemodynamic stability. The secondary goal is the reconstruction of stability and symmetry of the pelvic ring. Percutaneous reconstruction can only be accepted if these goals are met. The type of definitive surgery is dependent of the degree of instability of the anterior and posterior pelvic ring. Retrograde transpubic screw fixation of pubic rami fractures is a good alternative to external fixation or plate and screw osteosynthesis. The technique of screw placement and image intensifier control is explained. Internal fixation of pure sacroiliac dislocations, fracture-dislocations of the sacroiliac joint and sacral…

Humeral nailing revisited.

Unreamed interlocked humeral nailing for stabilisation of acute humeral fractures was introduced a decade ago. Antegrade and retrograde nail insertion are equally popular. The role of nailing as opposed to plating of humeral fractures is the subject of continuous debate. Between 1997 and 2005, 99 acute fractures of the humeral shaft were treated operatively with the unreamed humeral nail (UHN, Synthes) in our Level I Trauma Centre. The mean age of the patients was 63 years. Only eight patients (8.1%) were polytraumatised, nine patients had an open fracture (9.1%), five had a primary radial nerve palsy (5.1%). There were 54 antegrade and 45 retrograde nailings. The procedures were performed …

A Bibliometric Analysis of Fragility Fractures: Top 50.

Background and Objectives: The population is aging and fragility fractures are a research topic of steadily growing importance. Therefore, a systematic bibliometric review was performed to identify the 50 most cited articles in the field of fragility fractures analyzing their qualities and characteristics. Materials and Methods: From the Core Collection database in the Thomson Reuters Web of Knowledge, the most influential original articles with reference to fragility fractures were identified in February 2021 using a multistep approach. Year of publication, total number of citations, average number of citations per year since year of publication, affiliation of first and senior author, geo…

Der Kocher-Langenbeck-Zugang zur Behandlung von Azetabulumfrakturen

Darstellung der dorsalen Seite des hinteren Azetabulumpfeilers. Offene Reposition und innere Fixation der hinteren Azetabulumwand und des hinteren Pfeilers. Offene Reposition und innere Fixation von juxta- und infratektalen Querfrakturen. Offene Reposition und innere Fixation von Frakturen, die den vorderen und hinteren Pfeiler oder die Wand in Mitleidenschaft ziehen und bei denen der hintere Pfeiler oder die Wand direkt reponiert werden muss. Frakturen der vorderen Azetabulumwand. Frakturen des vorderen Pfeilers. Frakturen beider Pfeiler, bei denen nur der vordere Pfeiler oder die vordere Wand direkt reponiert werden muss. Darstellung des hinteren Azetabulumpfeilers durch Langsspaltung des…

Functional results after operative treatment of olecranon fractures.

In a retrospective, nonrandomized study, we reviewed our experience with the operative treatment of olecranon fractures to find out which factors correlate with subjective complaints and functional outcome. A total of 95 consecutive olecranon fractures were operatively treated in our level I trauma institution between March 1, 1992 and March 1, 2000. Medical charts and radiographs of all patients were evaluated. Three patients died, 23 were lost to follow-up. Fifty-eight of 69 available patients (84.0%) were reviewed clinically and/or radiologically after a mean time interval of 36 months. Fracture type, fracture classification, associated lesions, technical correctness of osteosynthesis, a…

Photocrosslinked Dextran-Based Hydrogels as Carrier System for the Cells and Cytokines Induce Bone Regeneration in Critical Size Defects in Mice

Modified biomaterials have for years been the focus of research into establishing new bone substitutes. In our preceding in vitro study employing different cell cultures, we developed chemically and mechanically characterized hydrogels based on photocrosslinkable dextran derivatives and demonstrated their cytocompatibility and their beneficial effects on the proliferation of osteoblasts and endothelial cells. In the present in vivo study, we investigate photocrosslinked dextran-based hydrogels in critical size defects in mice to evaluate their potential as carrier systems for cells or for a specific angiogenesis enhancing cytokine to induce bone formation. We could demonstrate that, with op…

Progress of instability in fragility fractures of the pelvis: An observational study.

Abstract Fragility fractures of the pelvis (FFP) are an increasing entity among elderly persons. Characteristics are different from high-energy pelvic trauma. Little is known about the natural course of FFP in conservative and after operative treatment. Materials and methods Medical charts and radiologic data of 148 patients with an FFP, who were admitted in a 3-year period, were analysed retrospectively. Incidence and characteristics of fracture progression (FP) were noted. Results Patients presenting early after a traumatic event had more often non-displaced fractures, fractures with lower FFP Type classification and were more frequently treated conservatively. FP was observed in 21 cases…

The Retrograde Tibial Nail: presentation and biomechanical evaluation of a new concept in the treatment of distal tibia fractures.

Displaced distal tibia fractures require stable fixation while minimizing secondary damage to the soft tissues by the surgical approach and implants. Antegrade intramedullary nailing has become an alternative to plate osteosynthesis for the treatment of distal metaphyseal fractures over the past two decades. While retrograde intramedullary nailing is a standard procedure in other long bone fractures, only few attempts have been made on retrograde nailing of tibial fractures. The main reasons are difficulties of finding an ideal entry portal and the lack of an ideal implant for retrograde insertion. The Retrograde Tibial Nail (RTN) is a prototype intramedullary implant developed by our group…

Sind winkelstabile Plattensysteme mit elastischen Eigenschaften für die Stabilisierung der Oberarmkopffraktur vorteilhaft? / Eine in-vitro biomechanische Untersuchung

AbstractWinkelstabile Platten werden mit zunehmender Häufigkeit zur Stabilisierung von Oberarmkopfbrüchen verwendet. Rigide Implantate führen bei osteoporotischen Knochenverhältnissen u. U. aber häufiger zum Versagen. Um den Effekt der Implantatelastizität zu beurteilen wurden in einer in-vitro Studie die biomechanischen Eigenschaften eines rigiden und eines elastischen winkelstabilen Plattensystems vergleichend analysiert. An 8 Humeruspaaren wurde eine instabile subkapitale Fraktur simuliert. Die Proben wurden axial- und torsions-belastet. Analysiert wurden die Steifigkeit, das Setzverhalten unter Dauerlast und die Versagensbelastung.Das elastische Plattensystem kennzeichnete sich durch ei…

Is the Posterior Wall Avulsion the Simplest Acetabular Fracture?

The posterior wall fracture – the most frequent acetabular lesion – is often regarded as the simplest acetabular fracture. In fact, a large variety of complex articular lesions is subsumed under this fracture type. A consecutive series of 60 posterior wall fractures is reviewed retrospectively. Lesions characteristics, treatment method, early and late postoperative complications a 2-year functional results were recorded. In 27 patients (45%), additional damage to the cartilage of the acetabular cavitiy such as subchondral impaction, free articular fragments of separation of the posterior wall into several pieces was present. Seven patients (11.6%) showed preoperative neurologic deficit. Sec…

Transverse sacral fracture with intrapelvic intrusion of the lumbosacral spine: case report and review of the literature.

The Benefit of Multislice CT in the Emergency Room Management of Polytraumatized Patients

The early treatment of polytraumatized patients needs an effective and standardized approach. Reducing time requirements for the primary diagnostic evaluation is a major concern in the early phase of polytrauma management. Multislice-CT (MSCT) is a quick and reliable method for the initial diagnostic evaluation. Computed tomography provides more detailed and more consistent information than conventional radiography. It has the great advantage of allowing rapid examination of the head, vertebral column, chest, abdomen and pelvis during one single examination. The CT-suite needs to be adequately equipped for resuscitation and reanimation, which is done parallel to the radiological investigati…

Osteosynthetische versorgung proximaler extraartikul�rer tibiafrakturen Indikationen, komplikationen, ergebnisse

In den letzten funf Jahren wurden 16 extraartikulare Frakturen der proximalen Tibia in der Unfallchirurgischen Universitatsklinik Mainz operativ versorgt. Es handelte sich dabei um proximale metaphysare und meta-/diaphysare Verletzungen ohne Beteiligung des Kniegelenkes. Eine begleitende Fraktur der Fibula lag bei 13 Patienten vor. Die Frakturen wurden nach dem AO-System klassifiziert. Es handelte sich um vier offene und zwolf geschlossene Frakturen. Abhangig von der Weichteilsituation wurde der Zeitpunkt der operativen Versorgung (im Mittel drei Tage posttraumatisch) gewahlt. Sechs Frakturen wurden mit einer intramedullaren Osteosynthese und zehn Frakturen mittels Plattenosteosynthese nach…

Biomechanical evaluation of a new treatment method for distal tibia fractures

Distal tibial fractures are often the result of high-energy impacts combined with excessive soft tissue injury. Treatment options include either open reduction and internal fixation usually as a mi...

Radiological analysis, operative management and functional outcome of open book pelvic lesions: a 13-year cohort study.

Abstract We present the clinical and radiological outcome of a 13-year cohort study of 38 open book pelvic lesions. All patients were treated in one Level I Trauma centre. In the posterior pelvis, sacro-iliac diastasis was seen in 31 patients, sacral fracture in 7. In all patients with sacro-iliac diastasis, the pubic bone was inferiorly displaced on the primary ap pelvic overview on the side of injury. All but one patient was treated with open reduction and internal fixation of the symphysis pubis. Additional stabilization of the posterior pelvis was done in 9 patients. 32 patients were seen after a median follow up of 84 months. Majeed score and SF-36 questionnaire were used. Functional o…

Biomechanical testing of different posterior fusion devices on lumbar spinal range of motion.

Abstract Background Recent minimal-invasive posterior fusion devices are supposed to provide stability and obtain fusion in combination with interbody cages in the instrumented segment. The aim of the present study is to evaluate the primary stability of two minimal-invasive posterior prototypes compared to an established spinous process plate and standard pedicle screw instrumentation. Methods Seven fresh frozen human cadaver lumbar spines (L2–L5) were tested in a spinal testing device with a moment of 7.5 Nm. Spinal stability was determined as mean range of motion (RoM) in the segment L3/L4 during extension-flexion, lateral bending and axial rotation. The RoM was measured during five cond…

Staged Reconstruction of Pelvic Ring Disruption: Differences in Morbidity, Mortality, Radiologic Results, and Functional Outcomes Between B1, B2/B3, and C-Type Lesions

To analyze injury pattern, surgical therapy, radiologic results, and functional outcome in unstable B-type and C-type pelvic ring fractures.Retrospective study.Level I University Trauma Center.Two-hundred-twenty-two consecutive patients, admitted during a nine-year period with unstable B-type (n = 100) and C-type (n = 122) pelvic ring injuries, of whom 122 (61.3 percent of surviving patients) were eligible for evaluation with a minimum follow-up of one year.Staged reconstruction dependent upon injury pattern. Emergency external compression of the pelvic ring in case of hemodynamic instability. Management of associated lesions. Secondary open reduction and internal fracture fixation.Assessme…

Stabilization of fatigue fractures of the dorsal pelvis with a trans-sacral bar. Operative technique and outcome.

Abstract Introduction Due to ageing of our population the number of fatigue fractures of the pelvic ring is steadily growing. These fractures are often treated with bed rest but may result in a disabling immobility with severe pain. An operative treatment is an option in these cases. The aim of operative treatment is bony healing obtained by stable fixation giving back to the patient's previous mobility. Optimal surgical treatment is currently under debate. Sacroiliac screw fixation and sacroplasty are used for stabilization of the dorsal pelvis. Due to the technique and the low density of spongious sacral bone, no or only low compression in the fracture site is obtained, which may inhibit …

Effect of bone sialoprotein coated three-dimensional printed calcium phosphate scaffolds on primary human osteoblasts

The combination of the two techniques of rapid prototyping 3D-plotting and bioactive surface functionalization is presented, with emphasis on the in vitro effect of Bone Sialoprotein (BSP) on primary human osteoblasts (hOBs). Our primary objective was to demonstrate the BSP influence on the expression of distinctive osteoblast markers in hOBs. Secondary objectives included examinations of the scaffolds' surface and the stability of BSP-coating as well as investigations of cell viability and proliferation. 3D-plotted calcium phosphate cement (CPC) scaffolds were coated with BSP via physisorption. hOBs were seeded on the coated scaffolds, followed by cell viability measurements, gene expressi…

In vivo ultrasound real-time motion of the cervical spine during intubation under manual in-line stabilization: a comparison of intubation methods

Background and objectiveIn emergency trauma situations, manual in-line stabilization of the cervical spine is recommended to reduce cervical spine movement during intubation. The aim of this study was to compare the effect of manual in-line stabilization during different intubation techniques on three-dimensional cervical spine movements and times to intubation.MethodsForty-eight subjects without any history of trauma, inflammatory or degenerative disorder of the cervical spine were randomly grouped, regardless of gender or age. All underwent elective surgery under general anaesthesia. Under manual in-line stabilization, laryngeal intubation with Macintosh laryngoscope, intubating laryngeal…

The effect of the pro-inflammatory cytokine tumor necrosis factor-alpha on human joint capsule myofibroblasts.

Introduction Previous studies have shown that the number of myoblastically differentiated fibroblasts known as myofibroblasts (MFs) is significantly increased in stiff joint capsules, indicating their crucial role in the pathogenesis of post-traumatic joint stiffness. Although the mode of MFs' function has been well defined for different diseases associated with tissue fibrosis, the underlying mechanisms of their regulation in the pathogenesis of post-traumatic joint capsule contracture are largely unknown. Methods In this study, we examined the impact of the pro-inflammatory cytokine tumor necrosis factor-alpha (TNF-α) on cellular functions of human joint capsule MFs. MFs were challenged w…

Dynamic angular three-dimensional measurement of multisegmental thoracolumbar motion in vivo.

Study design Method validation and in vivo motion segment study. Objective To determine in healthy subjects in vivo intervertebral segmental kinematics and coupled motion behavior in all 3 planes simultaneously for 3 segments and to evaluate whether these results differ from those in the normal population according to the literature. Summary of background data Few studies have provided a direct invasive approach to investigate segmental kinematics in vivo. Dynamic recordings of 3-dimensional segmental motion patterns of adjacent segments have rarely been reported. To date, no studies have examined the 3-dimensional segmental movements of the thoracolumbar junction in vivo in detail. Methods…

The effect of human osteoblasts on proliferation and neo-vessel formation of human umbilical vein endothelial cells in a long-term 3D co-culture on polyurethane scaffolds

Angiogenesis is a key element in early wound healing and is considered important for tissue regeneration and for directing inflammatory cells to the wound site. The improvement of vascularization by implementation of endothelial cells or angiogenic growth factors may represent a key solution for engineering bone constructs of large size. In this study, we describe a long-term culture environment that supports the survival, proliferation, and in vitro vasculogenesis of human umbilical vein endothelial cells (HUVEC). This condition can be achieved in a co-culture model of HUVEC and primary human osteoblasts (hOB) employing polyurethane scaffolds and platelet-rich plasma in a static microenvir…

Does the Intrapelvic Compartment Syndrome Exist?

Pelvic compartment syndrome is a rare condition. As in other musculoskeletal localizations, the intra-compartmental pressure raises above a critical level. In the pelvic compartment syndromes, the gluteal compartments are mainly concerned. We report on three patients with bilateral ureteral obstruction, due to compression by a massive retroperitoneal haematoma as a complication of an unstable pelvic ring or acetabular fracture. Anuria with renal organ failure, due to compression of the ureters in the small true pelvis represents an intrapelvic compartment syndrome. Anuria, due to ureteral compression, mostly developing 24 to 48 hours after injury, has to be differentiated from anuria due to…

Ilioinguinal Approach for Acetabular Fractures

Objective Exposure of the entire anterior column of the acetabulum and of the inner part of the posterior column.

The anatomy of the proximal radius: implications on fracture implant design.

Background The proximal radius features a complex anatomy. Several studies have been published on the anatomy using different technical approaches; however, most of these studies were conducted with a special focus on parameters relevant to radial prosthetic design. The purpose of our study was to explore the complex geometry of the proximal radius with regard to fracture implant design. Methods Our computed tomography-based measurements of 78 multiplanar reformatted radii allow for exact assessment of its geometry and offer a scientific rationale towards the design of fracture implants. We conducted measurements on the radial head, the radial neck, the radial tuberosity, the radial head-to…

Biomechanische Untersuchungen verschiedener Osteosynthesen an der proximalen Tibia - Vorstellung einer neuartigen meßgeometrischen Anordnung. Biomechanical Investigations of Various Osteosynthesis Procedures on the Proximal Tibia - Introduction of a New Measuring System

In this article a new measuring system for biomechanical studies of various osteosynthesis procedures on the tibia is described. The paired tibias are osteotomized and embedded in PMMA in accordance with a randomization protocol. Testing is then carried out under nonaxial loading at 350 N, 600 N and 900 N, uniaxial bending applying a force of 12 Nm, and torsion at a force of 5 Nm in a universal pneumatic testing machine. Ultrasonic sensors pick up movement at the fracture gap under external loading. Testing of the measuring setup has been successful, and relevant results were obtained.

Treatment of distal intraarticular tibial fractures: A biomechanical evaluation of intramedullary nailing vs. angle-stable plate osteosynthesis

In factures of the distal tibia with simple articular extension, the optimal surgical treatment remains debatable. In clinical practice, minimally invasive plate osteosynthesis and intramedullary nailing are both routinely performed. Comparative biomechanical studies of different types of osteosynthesis of intraarticular distal tibial fractures are missing due to the lack of an established model. The goal of this study was first to establish a biomechanical model and second to investigate, which are the biomechanical advantages of angle-stable plate osteosynthesis and intramedullary nailing of distal intraarticular tibial fractures. Seven 4(th) generation biomechanical composite tibiae feat…

Locking Reconstruction Double Plating of Distal Humeral Fractures: How Many Screws in the Distal Ulnar Column Segment in A3 Fracture Provide Superior Stability? A Comparative Biomechanical In Vitro Study

Objectives: Two 90-degree configurations of locking reconstruction plates with different numbers of screws in the distal ulnar column segment of distal extra-articular humeral fractures with metaphyseal comminution (A3) were biomechanically investigated. Methods: Eight pairs of fresh-frozen human humeri were used. For paired comparison, the humeri were divided into 2 randomized groups. In both groups, double-plate osteosyntheses with locking reconstruction plates were performed in 90-degree configurations. In group 1, the posteriorly placed radial column plate exceeded the capitellum and the ulnar column plate extended into the ulnar sulcus. The ulnar plate was molded around the medial epic…

Retrograde nailing versus locking plate osteosynthesis of proximal humeral fractures: a biomechanical study

Background In locking plate osteosynthesis of proximal humeral fractures, secondary varus malalignment is a specific complication. Retron nails (Tantum AG, Neumunster, Germany), among others, have been designed to improve medial support of the calcar humeri. The aim of our biomechanical study was to examine whether Retron nails provide increased stiffness for axial loads and adequate stiffness for torsional loads when compared with Philos plates (Synthes AG, Umkirch, Germany). Materials and methods Twenty-two fresh-frozen paired humeri were collected. After potting the specimens, intact bones were exposed to sinusoidal axial (10-120 N) and torsional (±2.5 Nm) loading for 8 cycles to calcula…

Retrograde Nailing of Humeral Shaft Fractures

The use of intramedullary nailing in the upper extremity is still controversial. Those who have experience with antegrade nailing have either great enthusiasm or strong criticism for the procedure. Criticism of the procedure is because of the trauma that can occur to the rotator cuff and possible impingement syndrome, which can occur after antegrade nail insertion. The technique of retrograde nail insertion with the unreamed humeral nail is described in detail. In a series of 190 retrograde nailings performed in a prospective multicenter study, the most frequent intraoperative problems were fissure or avulsion at the entry portal (n = 8; 4.2%) and secondary radial nerve palsy (n = 8; 4.2%).…

Classification of Fragility Fractures of the Pelvis

The characteristics of fragility fractures of the pelvis are different from pelvic fractures in adolescents and adults. There are specific fracture morphologies such as U- or H-shaped fractures of the sacrum and bilateral fractures. The classification systems of AO/ASIF and Young-Burgess reflect the trauma mechanism and the type of instability in high-energy pelvic injuries. Not all types of fragility fractures of the pelvic ring fit into these classification systems. A new, comprehensive classification (FFP classification) includes all morphologies of fragility fractures of the pelvis, whether acute or chronic. It provides a framework for how to look at these lesions. The first criterion o…

Survival trends and predictors of mortality in severe pelvic trauma: estimates from the German Pelvic Trauma Registry Initiative.

Abstract Study objective To determine longitudinal trends in mortality, and the contribution of specific injury characteristics and treatment modalities to the risk of a fatal outcome after severe and complex pelvic trauma. Methods We studied 5048 patients with pelvic ring fractures enrolled in the German Pelvic Trauma Registry Initiative between 1991 and 1993, 1998 and 2000, and 2004 and 2006. Complete datasets were available for 5014 cases, including 508 complex injuries, defined as unstable fractures with severe peri-pelvic soft tissue and organ laceration. Multivariable mixed-effects logistic regression analysis was employed to evaluate the impact of demographic, injury- and treatment-a…

Personality of Fragility Fractures of the Pelvis

The personality of pelvic fractures in the elderly differs in many ways from pelvic ring lesions in adults. Only high-energy trauma leads to pelvic ring disruptions. Concomitant lesions of the soft tissues occur frequently. In the elderly, low-energy falls are the rule. The most important symptom is pain, which restricts mobility. Hemodynamic instability in fragility fractures of the pelvis is rare. Emergency stabilization with pelvic binders or sheets, C-clamping or emergency external fixation are not needed. Arteriography and selective embolization is only recommended in the rare patients, who develop an active arterial bleeding due to the pelvic fracture. Especially patients, who are tre…

Influence of the anti-inflammatory cytokine interleukin-4 on human joint capsule myofibroblasts

Post-traumatic joint contracture was reported to be associated with elevated numbers of contractile myofibroblasts (MFs) in the healing capsule. During the physiological healing process, the number of MFs declines; however, in fibroconnective disorders, MFs persist. The manifold interaction of the cytokines regulating the appearance and persistence of MFs in the pathogenesis of joint contracture remains to be elucidated. The objective of our current study was to analyze the impact of the anti-inflammatory cytokine interleukin (IL)-4 on functional behavior of MFs. Cells were isolated from human joint capsule specimens and challenged with three different concentrations of IL-4 with or without…

Locked Plate Fixation and Intramedullary Nailing for Proximal Humerus Fractures: A Biomechanical Evaluation

Background Internal fixation of proximal humeral fractures is associated with a considerable secondary malalignment rate. Fixed-angle implants have been suggested to increase the stability of fixation. Methods The biomechanical properties of four different implants were tested. These included an internal fixator with semi-elastic properties (reference), the Synthes T-plate, a locked plate with rigid properties and a spiral blade locked intramedullary nail (PHN). These implants were assessed in twenty-four osteotomized pairs of human cadaveric humeri. Specimens were subjected to two-hundred cycles of axial loading and torque followed by load to failure. Results The PHN had greater axial stif…

Extracorporeal shock wave-mediated changes in proliferation, differentiation, and gene expression of human osteoblasts.

The goal of this study was to determine whether cell proliferation, differentiation, and gene expression of primary human osteoblasts (hOB) are influenced by shock wave application (SWA).Osteoblast cultures were isolated from cancellous bone fragments and treated with 500 impulses of energy flux densities of 0.06 mJ/mm, 0.18 mJ/mm, 0.36 mJ/mm, and 0.50 mJ/mm. Twenty-four hours and 96 hours after SWA cell proliferation, alkaline phosphatase activity, and mineralization were analyzed. The global gene expression profiling was determined 96 hours after SWA employing Affymetrix HG-U133A microarrays.After 24 hours, hOB showed a dose-dependent increase in cell proliferation from 68.7% (at 0.06 mJ/…

Volar Fixed-Angle Plating of Distal Radius Fractures

The purpose of this biomechanical study was to determine whether a multidirectional fixed-angle plate with locking screws or with locking pegs in the distal fragment would optimize fixation of Orthopaedic Trauma Association (OTA) type A3 distal radius fractures.Eight pairs of fresh-frozen human distal radii were used. Extra-articular distal radius fractures were created and stabilized with a multidirectional volar fixed-angle plate. The radii were randomized into 2 matched-paired groups. The distal fragment in Group I was stabilized with 7 locking screws. The distal fragment in Group II was fixed with 7 locking pegs. The proximal fragment in both groups was fixed with 3 screws. The specimen…

Hypothenar Hammer Syndrome in a Golf Player.