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Greiner S.,Center for Musculoskeletal Surgery
Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca

Due to rapidly increasing numbers of arthroplasty surgeries of the upper extremity, periprosthetic humeral fractures after shoulder and elbow arthroplasty, formerly described as rare, may hence increase in the near future. Therefore the aim of the present work was to give an overview of the existing literature including possible classifications as well as an update on treatment concepts and experiences with own cases. After a literature research have been done, existing prevalence, classifications and treatment options, mostly described in case series, were processed to create an overview of the existing state of knowledge. Additionally 7 own cases are described in detail to show the different treatment options used at the authors department. The currently used classification systems take fracture location, angulation and rotation and fixation of the implant into account. Possible solutions for periposthetic fractures of the humerus include conservative management, open reduction and internal fixation for stable prosthesis and long stemmed implants for lose implants as well as the use of additional allo- or autogeneous bone grafting and reverse shoulder arthroplasty in revision cases with rotator cuff dysfunction. After all treatment of periprosthetic humeral fractures after shoulder and elbow arthroplasty remain a challenging problem. Source

Reinhold M.,Innsbruck Medical University | Knop C.,Katharinen Hospital | Beisse R.,Trauma Center Murnau | Audige L.,AO Clinical Investigation and Documentation AOCID | And 9 more authors.
European Spine Journal

The second, internet-based multicenter study (MCSII) of the Spine Study Group of the German Association of Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie) is a representative patient collection of acute traumatic thoracolumbar (T1-L5) injuries. The MCSII results are an update of those obtained with the first multicenter study (MCSI) more than a decade ago. The aim of the study was to assess and bring into focus: the (1) epidemiologic data, (2) surgical and radiological outcome, and (3) 2-year follow-up (FU) results of these injuries. According to the Magerl/AO classification, there were 424 (57.8%) compression fractures (A type), 178 (24.3%) distractions injuries (B type), and 131 (17.9%) rotational injuries (C type). B and C type injuries carried a higher risk for neurological deficits, concomitant injuries, and multiple vertebral fractures. The level of injury was located at the thoracolumbar junction (T11-L2) in 67.0% of the case. 380 (51.8%) patients were operated on by posterior stabilization and instrumentation alone (POSTERIOR), 34 (4.6%) had an anterior procedure (ANTERIOR), and 319 (43.5%) patients were treated with combined posteroanterior surgery (COMBINED). 65% of patients with thoracic (T1-T10) and 57% with lumbar spinal (L3-L5) injuries were treated with a single posterior approach (POSTERIOR). 47% of the patients with thoracolumbar junction (T11-L2) injuries were either operated from posterior or with a combined posterior-anterior surgery (COMBINED) each. Short angular stable implant systems have replaced conventional non-angular stable instrumentation systems to a large extent. The posttraumatic deformity was restored best with COMBINED surgery. T-spine injuries were accompanied by a higher number and more severe neurologic deficits than TL junction or L-spine injuries. At the same time T-spine injuries showed less potential for neurologic recovery especially in paraplegic (Frankel/AISA A) patients. 5% of all patients required revision surgery for perioperative complications. Follow-up data of 558 (76.1%) patients were available and collected during a 30-month period from 1 January 2004 until 31 May 2006. On average, a posterior implant removal was carried out in a total of 382 COMBINED and POSTERIOR patients 12 months after the initial surgery. On average, the rehabilitation process required 3-4 weeks of inpatient treatment, followed by another 4 months of outpatient therapy and was significantly shorter when compared with MCSI in the mid-1990s. From the time of injury until FU, 80 (60.6%) of 132 patients with initial neurological deficits improved at least one grade on the Frankel/ASIA Scale; 8 (1.3%) patients deteriorated. A higher recovery rate was observed for incomplete neurological injuries (73%) than complete neurological injuries (44%). Different surgical approaches did not have a significant influence on the neurologic recovery until FU. Nevertheless, neurological deficits are the most important factors for the functional outcome and prognosis of TL spinal injuries. POSTERIOR patients had a better functional and subjective outcome at FU than COMBINED patients. However, the posttraumatic radiological deformity was best corrected in COMBINED patients and showed significantly less residual kyphotic deformity (biseg GDW -3.8° COMBINED vs. -6.1° POSTERIOR) at FU (p = 0.005). The sagittal spinal alignment was better maintained when using vertebral body replacement implants (cages) in comparison to iliac strut grafts. Additional anterior plate systems did not have a significant influence on the radiological FU results. In conclusion, comprehensive data of a large patient population with acute thoracolumbar spinal injuries has been obtained and analyzed with this prospective internet-based multicenter study. Thus, updated results and the clinical outcome of the current operative treatment strategies in participating German and Austrian trauma centers have been presented. Nevertheless, it was not possible to answer all remaining questions to contradictory findings of the subjective, clinical outcome and corresponding radiological findings between different surgical subgroups. Randomized-controlled long-term investigations seem mandatory and the next step in future clinical research of Spine Study Group of the German Trauma Society. © 2010 Springer-Verlag. Source

Gabriel M.,Sidra Medical and Research Center | Niederer K.,Johannes Gutenberg University Mainz | Becker M.,Center for Musculoskeletal Surgery | Raynaud C.M.,Sidra Medical and Research Center | And 2 more authors.
Bioconjugate Chemistry

Many biomaterials used for tissue engineering applications lack cell-adhesiveness and, in addition, are prone to nonspecific adsorption of proteins. This is especially important for blood-contacting devices such as vascular grafts and valves where appropriate surface properties should inhibit the initial attachment of platelets and promote endothelial cell colonization. As a consequence, the long-term outcome of the implants would be improved and the need for anticoagulation therapy could be reduced or even abolished. Polytetrafluoroethylene (PTFE), a frequently used polymer for various medical applications, was wet-chemically activated and subsequently modified by grafting the endothelial cell (EC) specific peptide arginine-glutamic acid-aspartic acid-valine (REDV) using a bifunctional polyethylene glycol (PEG)-spacer (known to reduce platelet and nonspecific protein adhesion). Modified and control surfaces were both evaluated in terms of EC adhesion, colonization, and the attachment of platelets. In addition, samples underwent bacterial challenges. The results strongly suggested that PEG-mediated peptide immobilization renders PTFE an excellent substrate for cellular growth while simultaneously endowing the material with antifouling properties. © 2016 American Chemical Society. Source

Navigation of the cup in total hip arthroplasty is well analyzed and shows accurate results, reducing cup outliers of Lewinnek's "safe zone." With regard to the combined anteversion of cup and stem, however, a "new" safe zone with a range of 25° to 50° has been published. The aim of this study was to analyze total anteversion (cup and stem) by postoperative 3D computed tomography in isolated cup navigation cases. In 46 patients, the mean combined anteversion was 34.4° (range, 16.3°-57.3°, SD ± 9.3°) with 10 outliers. The mean cup anteversion was 19.5° (range, 11°-27°, SD ± 3.7°). Regarding Lewinnek's "safe zone" (cup only), we observed 5 outliers. An improvement of technique of stem implantation or navigation may reduce outliers of combined anteversion. Copyright 2010, SLACK Incorporated. Source

Wolke J.,Center for Musculoskeletal Surgery | Herrmann D.A.,Center for Musculoskeletal Surgery | Krannich A.,Charite - Medical University of Berlin | Scheibel M.,Center for Musculoskeletal Surgery
American Journal of Sports Medicine

Background: Recurrent anteroinferior shoulder dislocations are often associated with bony glenoid and humeral defects. The influence of those bony lesions on the postoperative outcomes after arthroscopic shoulder stabilization procedures has been the subject of many studies. Little is known about the influence of those lesions on preoperative function. Purpose: To evaluate the influence of glenoid and humeral bony defects on preoperative shoulder function in recurrent anteroinferior shoulder instability. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included in the study were 90 patients (70 men, 20 women; mean age, 27.1 years; 24 patients with prior failed stabilization) with posttraumatic recurrent anteroinferior shoulder instability who underwent preoperative computed tomography (CT) of both shoulders. The glenoid index was used to measure glenoid defect on a 3-dimensional CT. Humeral head defect was measured on a 2-dimensional CT with evaluation of the Hill-Sachs quotient, product, sum, and difference. Preoperative evaluation also included the Rowe score, Constant score, Walch-Duplay score, Melbourne Instability Shoulder Score (MISS), Western Ontario Shoulder Instability Index (WOSI), and Subjective Shoulder Value (SSV). Results: There was a weak but significant correlation of the Hill-Sachs quotient and the glenoid index with the Rowe score (P =.03, r = '0.22 and P =.03, r = 0.23, respectively). Furthermore, the Hill-Sachs product significantly correlated with the WOSI (P =.02); in particular, the physical symptoms subscore showed a significant correlation (P =.04). The glenoid index showed a significant correlation with the SSV (P <.01). No significant correlation was found between the Walch-Duplay score, Constant score, or MISS and bony defects. Conclusion: The results of this study show that objective and subjective scoring systems correlate significantly with the clinical condition of patients with recurrent shoulder instability and associated bony defects. It is recommended that clinicians use the Rowe score, WOSI, and SSV for the clinical evaluation of patients with recurrent anteroinferior shoulder instability and associated bony defects. These evaluation systems may provide an early clinical indication of bony defects. Furthermore, very poor results on these evaluations could underline the necessity of a CT scan for the diagnosis of bony defects in recurrent shoulder instability and might be helpful for decision making concerning the indication of a CT. © 2016 American Orthopaedic Society for Sports Medicine. Source

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