0000000000297660
AUTHOR
M. H. Hessmann
Cell viability, osteoblast differentiation, and gene expression are altered in human osteoblasts from hypertrophic fracture non-unions
Recent studies have provided evidence that the number and proliferation capacity of bone marrow-derived mesenchymal stem cells, as well as the number of osteoprogenitor cells are reduced in patients with fracture non-unions. For fracture non-unions that do not heal after appropriate surgical intervention, the question arises as to what extent systemic cellular dysfunctions should be considered as being pathogenetic factors. For this purpose, we have examined the hypothesis that the cell function of osteoblasts isolated from patients with fracture non-unions may differ from those of normal control individuals in an identical and controlled in vitro situation. We analyzed the osteoblast cell …
The influence of bone allograft processing on osteoblast attachment and function
In order to assess the influence of eight different sterilisation and disinfection methods for bone allografts on adhesion, proliferation, and differentiation of human bone marrow stromal cells (BMSC), cells were grown in culture and then plated onto pieces of human bone allografts. Following processing methods were tested: autoclavation (AUT), low-temperature-plasma sterilisation of demineralised allografts (D-LTP), ethylene oxide sterilisation (EtO), fresh frozen bone (FFB), 80 degrees C-thermodisinfection (80 degrees C), gamma-irradiation (Gamma), chemical solvent disinfection (CSD), and Barrycidal-disinfection (BAR). The seeding efficiency was determined after one hour to detect the num…
Dissatisfaction with post-operative pain management—A prospective analysis of 1071 patients
Summary A total number of 1071 patients was investigated using a modified questionnaire of the American Pain Society to evaluate the pain profile and satisfaction/dissatisfaction on the second post-operative day after different types of surgery (abdominal, traumatic, orthopaedic, urologic, gynaecologic, ENT). Patients were either treated with non-standardized pain management (no measurement of pain intensities, no regular administration of analgesics) (non-APS; n = 575) under responsibility of surgical specialties or with standardized pain management (regular assessment of pain and dose adaptation with i.v. PCA or epidurals) (APS; n = 496) by an anaesthesiology-based acute pain service. Pat…
Transverse fracture-dislocation of the sacrum: a diagnostic pitfall and a surgical challenge.
Transverse fracture-dislocations of the sacrum are rare. Associated lesions of the lumbosacral spine as well as neurological injuries are common. Conventional radiographs of the pelvis often fail to clearly visualize the fracture. Delayed diagnosis increases the risk of progressive neurological disfunction. True lateral sacral views and CT-scans with 3-dimensional reconstructions are very helpful in establishing the full extent of the injury. These examinations should be considered in all patients with a history of high energy trauma and clinical signs indicating lumbosacral injury, such as severe low back pain and neurological disturbances of the lower extremities. The management of transv…
Callus distraction of the femur and tibia. Experience with the Monofixator - indications for reosteosynthesis
In a 4-year period, 18 patients underwent callus distraction of the femur or tibia with the use of a unilateral external fixator. Twelve patients had post-traumatic bone loss resulting from complex lower-limb fractures. The bony defect was located in the tibia in 11 cases and in the femur in one case. All patients had major associated soft-tissue lesions. The length of the bony defect averaged 6.25 cm. Eight fractures were infected at the beginning of treatment. Six other patients underwent callus distraction for reasons of limb shortening. Five femora and one tibia were lengthened. The average increase in length was 6.5 cm. There were no fixator-related complications during distraction. Th…
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…
Osteosynthesetechniken bei proximalen Humerusfrakturen
Proximale Humerusfrakturen sind haufige Verletzungen. Die Frage der optimalen osteosynthetischen Behandlung instabiler und dislozierter 2- bis 4-Segmentfrakturen ist nach wie vor nicht einhellig geklart. Die operative Therapie befindet sich in der Konfliktsituation zwischen der Forderung einer anatomischen Reposition und stabilen Frakturretention auf der einen Seite und der Notwendigkeit einer maximalen intraoperativen Schonung der periglenohumeralen Weichteilstrukturen und Blutversorgung des Oberarmkopfs, mit dem Ziel das iatrogene Risiko der avascularen Kopfnekrose zu minimieren, andererseits. Wahrend Minimalosteosynthesen, bei denen die Reposition indirekt oder percutan erfolgt, Vorteile…
Primäre Ellenbogenprothese bei distalen Humerustrümmerfrakturen
The use of hip- and shoulder arthroplasty in elderly patients for grossly displaced intraarticular fractures is being more and more accepted. Total elbow replacement (TER) has not been considered as an option for the treatment of extensively comminuted fractures of the distal humerus because surgeons feel the outcome is not predictable after TER generally. On the basis of a Medline literature research of this issue and the documented results based on the improvement of the designs of the implants, operative technique and the selection of patients, TER has a definite role in the treatment of some fractures of the distal humerus. We retrospectively reviewed forty-nine acute distal humeral fra…
Mortalit�t, Morbidit�t und funktionelles Endergebnis nach "Open-book-Verletzungen" und lateralen Kompressionsverletzungen des Beckenringes
In einer retrospektiven Studie wurden die Begleitverletzungen, Behandlungsmerkmale, Morbiditat, Mortalitat und das radiologische und funktionelle Endergebnis von 222 Patienten mit einer Beckenringverletzung vom Typ B oder vom Typ C nach der Klassifikation von M.Tile eruiert. 52 Patienten wiesen eine "Open-book-Verletzung" auf (Typ B1), 48 Patienten eine laterale Kompressionsverletzung (Typ B2/B3), 122 Patienten wiesen eine C-Verletzung auf. Die Zahl der neurologischen bzw.urologischen Begleitverletzungen lag bei den B1-Patienten mit 21% bzw. 9,6% deutlich hoher als bei den B2/B3 Patienten mit 12% bzw.2,1%.66% der Patienten mit einer B-Verletzung wurden mit einem Fixateur externe entversorgt…
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…
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…
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…
Traumatic damage to the cartilage influences outcome of anatomically reduced acetabular fractures: A medium-term retrospective analysis
We reviewed 77 patients with an acetabular fracture, treated operatively through a non-extensile approach after an average time of 45 months. The ilioinguinal approach was chosen in 41, the Kocher-Langenbeck approach in 36 patients. Following the Letournel classification, the most frequent lesions were posterior wall (26%), two-column (22.1%) and anterior column (14.3%) fractures. Subchondral impaction, intra-articular fracture fragments and fracture comminution, called modifiers, could be identified in the preoperative CT-data of 38 patients (49.4%). Patients were operated after an average of 4 days. Average hospital stay was 19 days. Sciatic nerve and peroneal nerve palsy were registered …
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/…