Stuttgart, Germany
Stuttgart, Germany

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Schmeling H.,University of Calgary | Minden K.,Childrens University Hospital Charite | Foeldvari I.,Hamburg Center for Paediatrics and Adolescence Rheumatology | Ganser G.,North Western German Center for Rheumatology and Orthopaedics | And 2 more authors.
Arthritis and Rheumatology | Year: 2014

Objective. To evaluate the efficacy and safety of adalimumab in patients with juvenile idiopathic arthritis (JIA). Methods. Baseline demographic and clinical characteristics and disease activity parameters were prospectively documented in the German Biologics JIA Registry. Efficacy was determined using the American College of Rheumatology (ACR) Pediatric (Pedi) response criteria and the Juvenile Arthritis Disease Activity Score based on a 10-joint count (JADAS-10). Safety assessments were based on adverse event reports from the responsible physician. Results. Two hundred eighty-nine patients with a total of 1,046 visits were identified (435.7 patient-years). A high proportion of patients demonstrated a significant response to treatment, with a marked decrease in the JADAS-10 score in both the biologics-naive group (which consisted of patients who had not received therapy with a biologic agent prior to initiation of adalimumab) and the biologic-switcher group (which consisted of patients who had been treated with a different biologic agent prior to initiation of adalimumab). The median JADAS-10 score at treatment start was significantly higher in the biologics-naive group than in the biologic-switcher group (12.9 versus 8.5; P = 0.00044), although the score in the biologics-naive group was lower over the course of adalimumab treatment. ACR Pedi 30, 50, 70, and 90 scores were achieved in 63.4%, 61.0%, 48.8%, and 34.2% of biologics-naive patients, respectively, at 6 months of treatment, while ACR Pedi 30, 50, 70, and 90 scores were achieved in 47.6%, 38.1%, 21.9%, and 15.2% of biologic-switcher patients, respectively. Forty-eight patients experienced 222 adverse events (50.9 per 100 patient-years). Eleven were reported as serious (2.5 per 100 patient-years). No malignancies were observed during adalimumab exposure. There were 16 uveitis flares in 11 patients. Treatment was discontinued in 58 patients for the following reasons: inefficacy 11.1%, adverse events 5.2%, remission 4.5%, patient request 11.8%, and other reasons 7.9%. Conclusion. Adalimumab appears to be highly effective in children and adolescents with JIA who have been previously treated with biologic agents and in children and adolescents who switched biologic agents. The treatment is safe and its efficacy is similar to that of other biologic agents used to treat JIA. Few patients discontinued therapy due to intolerance or inefficacy. © 2014, American College of Rheumatology.


Fernandez F.F.,Olgahospital
Trauma und Berufskrankheit | Year: 2015

Background: Elbow injuries are common lesions with an incidence of approximately 8 % of all injuries. In childhood, the elbow region tends to show high complication rates and it is noteworthy that the majority of complications are of iatrogenic origin. Treatment of fractures of the growing elbow requires knowledge of the characteristic features. Attributable to the low growing potential of the distal humerus in children older than 7 years, malposition in the sagittal plane should not be acceptable.Therapy: The fracture treatment has to be adapted to age and fracture dislocation. Supracondylar fractures should be treated according to the type of fracture and malpositions should be corrected in all three planes. In fractures of the lateral condyle, a differentiation between types I and II is crucial. Fractures of the radial neck have a good prognosis if treated by repositioning and subsequent stabilization with intramedullary wire. It is recommended that the procedure be performed in a closed way as far as possible. © 2015, Springer-Verlag Berlin Heidelberg.


Wirth T.,Olgahospital
Orthopade | Year: 2012

Fibrous dysplasia is a benign intraosseous tumor disease which can be found in a monostotic or polyostotic form. In combination with dermatological and endocrine features it is known as McCune-Albright disease. Fibrous dysplasia originates from a genetic defect that has been identified as a postzygotic mutation of the GNAS gene leading to a malregulation of osteogenesis of the affected part of the bone. The weakening of the bone may result in isolated local pain, pathological fractures or severe deformation of the bones, which in the latter case results in loss of walking ability. Orthopedic treatment offers suitable methods to set and stabilize fractures, to strengthen weak areas of bone and to straighten out and stabilize deformed long bones. The treatment can help many patients to return to a high level of pain-free mobility or help the most affected patients lead a better life with a restricted but individual mobility. © 2012 Springer-Verlag Berlin Heidelberg.


Ludwig-Seibold C.U.,Oberschwabenklinik GmbH | Holder M.,Olgahospital | Rami B.,Medical University of Vienna | Raile K.,Charité - Medical University of Berlin | And 2 more authors.
Pediatric Diabetes | Year: 2012

Objective: To determine frequency, duration, and relationship of continuous glucose monitoring (CGM) to glycemic control and rate of hypoglycemia in children and adults in Germany and Austria. Research design and methods: From 59 920 patients documented in the DPV (Diabetessoftware zur prospektiven Verlaufsdokumentation) database, 144 385 sensor days of 2874 patients using CGM between January 2008 and September 2010 were analyzed. Results: Overall, 4.8% of patients used CGM. In pediatric patients, study period (p = 0.0309), age (p = 0.0140), insulin dose (p < 0.0001), and use of insulin analogs (p < 0.0001) significantly influenced hemoglobin A1c (HbA1c), but duration of diabetes, sex, and CGM use did not. In contrast, adults with longer CGM use (>30 d) had significantly lower HbA1c (p < 0.0016). Severe hypoglycemia was not reduced in patients using CGM for <30 d. Conclusions: CGM is still rarely used in Germany and Austria. CGM use is associated with a significant reduction of HbA1c in adults but not in children. Hypoglycemic events were not reduced, irrespective of age. © 2011 John Wiley & Sons A/S.


Slongo T.,University of Bern | Fernandez F.F.,Olgahospital
Unfallchirurg | Year: 2011

Although the so-called Monteggia-injury, defined as an isolated fracture of the Ulna accompanying a sub- or complete dislocation of the radial head - is already known more than one hundred years - this injury is anyway often assessed completely wrong! Not the overlooked ulna fracture there is the problem but the not realized dislocation of the radial head. The prognosis of such an overlooked Monteggia-lesion is depending of different factors: age of the patient, duration of the dislocation, the amount of the morphological alteration in the elbow joint. The presented article describes the essential criteria with which is necessary for a correct assessment. Due to these criteria the individual therapies are described. This in relation to the existing time of the dislocation of the radial head. The results depend on the surgeon's experience, the accuracy of the planning and the technique chosen. An intensive postoperative physiotherapy is mandatory, frequently with initial application of CPM (continuous passive motion). Loss of correction and residual malalignments are well known and not rare. They occur mostly in instances of insufficient stability and centralization of the radial head, respectively. There are no evident numbers but this is confirmed by clinical experience. © 2011 Springer-Verlag.


Fracture geometry, frequency, the accident mechanism and soft tissue damage in isolated tibial shaft fractures and fractures of the lower leg of the growing skeleton are essentially age-dependent. For a long time the treatment of shaft fractures was the domain of conservative therapy. With the development of elastic stable intramedullary nailing (ESIN) a minimally invasive technique is now available, which can be employed as an alternative in many situations. For the lower leg strict age-dependent correction limitations must be taken into consideration for treatment. Isolated tibial shaft fractures have a high risk of a secondary varus malposition. Fractures of the lower leg have a tendency towards a valgus malposition. All fractures which are not dislocated can be conservatively treated with an above knee plaster cast. Unstable fractures should be repositioned with the patient under general anesthesia. If there is evidence of instability after repositioning with an increased risk of secondary dislocation, treatment with ESIN in the sense of a primary definitive treatment should be strived for in children over 9 years old. The extent of soft tissue damage has a decisive influence on the decision for treatment. © 2016, Springer-Verlag Berlin Heidelberg.


Background: In daily practice apophyseal avulsions of sportive adolescents are frequently being diagnosed with a time delay and treated heterogeneously. Goal: Using the most actual literature and the own experience the current diagnostic and therapeutic strategies are put into perspective with regards of the needs of the adolescent athlete. Material and Methods: The apophyseal lesions of the hip area in adolescence are separated in those at the pelvis and those at the proximal femur. They are reviewed according to its frequency and relevance using the most updated literature. The treatment methods reported focus on the degree of dislocation and level of sports activity. Results: The most frequent apophyseal avulsion of the pelvis is the avulsion of the tuber ischiadicum, followed by the inferior anterior iliac spine the superior anterior iliac spine and the apophysis of the ilium. The most affected structure at the proximal femur is the lesser trochanter, lesions of the greater trochanter are rare. The cause of injury is a specific acute contracture of the muscle inserting at the affected apophysis during different sporting activities. The treatment of pelvic apophyseal injuries is surgical only in cases with considerable fragment dislocation and in high level athletes. At the femoral side the patients are treated almost always conservatively. Discussion: Despite of modern and efficient osteosynthetic techniques the treatment of avulsion lesions of the hip region is mainly conservative, even in athletes. By applying consequent diagnostic and therapeutic principles the development of pseudarthroses and heteropic ossifications can be minimised. © 2016, Springer-Verlag Berlin Heidelberg.


Hirschfeld G.,Childrens Hospital Datteln | Von Glischinski M.,Childrens Hospital Datteln | Blankenburg M.,Olgahospital | Zernikow B.,Childrens Hospital Datteln
Pediatrics | Year: 2014

BACKGROUND AND OBJECTIVE: Although guidelines for the management of children with type 1 diabetes include recommendations to screen for diabetic peripheral neuropathies (DPN), the research into the diagnostic utility of screening methods has not been systematically reviewed. The goal of this study was to summarize the findings with regard to the diagnostic accuracy of the Semmes-Weinstein monofilament and the Rydel-Seiffer tuning fork in detecting DPN in children and adolescents compared with the gold standard nerve conduction studies. METHODS: Based on a PubMed search (conducted on April 26, 2013) and secondary searching, we identified 72 articles for review. We included studies that: (1) assessed DPN with the gold standard nerve conduction studies; (2) used noninvasive screening for DPN (monofilament, tuning fork, or biothesiometer); and (3) were performed in the relevant population (children with diabetes). Five articles met these criteria. Study quality was assessed by using the revised Quality Assessment of Diagnostic Accuracy Studies criteria. Heterogeneous methods precluded a formal meta-analysis of effects. RESULTS: Diagnostic accuracies were heterogeneous for the different screening methods. Sensitivities ranged from 1% to 19% for the tuning fork (3 studies); from 61% to 80% for the biothesiometer (2 studies); and from 19% to 73% for the monofilament (2 studies). CONCLUSIONS: Data show extremely low diagnostic utility for standard screening methods (tuning fork and 10-g monofilament) but acceptable utilities for biothesiometry and finer (1 g) monofilaments. Data on the diagnostic utility should be used to inform national and international guidelines on diabetes management. Copyright © 2014 by the American Academy of Pediatrics.


Wirth T.,Olgahospital
Unfallchirurg | Year: 2011

Dislocation of the patella represents a frequent knee problem in childhood and adolescence. There are traumatic, recurrent, habitual and chronic forms. Many anatomical variations, which promote patellar dislocation, are known. The first traumatic dislocation is primarily treated conservatively with the exception of concomitant osteochondral fragments or very large soft tissue damage which justify surgical interventions. Recurrent, habitual and chronic dislocations are best cured surgically by vastus medialis advancement, reconstruction of the medial patellofemoral ligament, strengthening of the medial retinaculum together with a lateral release and by fixation of the patella using tendon grafts or medialisation of the insertion of the patellar ligament. To improve the femoropatellar groove by trochleaplasty is a different surgical concept. The long-term results following medialisation of the patellar ligament insertion or trochleaplasty are good with regards to patellar stability but mediocre in terms of avoiding degenerative changes in the patellofemoral joint. © 2011 Springer-Verlag.


Wirth T.,Olgahospital
Zeitschrift fur Orthopadie und Unfallchirurgie | Year: 2011

A slipped upper femoral epiphysis (SUFE) is the most common disease of the hip among adolescents. In the light of our current knowledge on the development of coxarthrosis, it represents a first line model case that has led to a series of novel ideas in the therapy for SUFE. The development of coxarthrosis from a cam impingement, i.e., the loss of offset of the neck of the femur and degenerative damage to the acetabular lip as its early form, is seen again in the clinical picture of slipped upper femoral epiphysis. Depending on the degree of slippage, we see a varying severity of the loss of offset and thus also different extents of the potential damage to the hip joint. This knowledge is by no means new. The questions of reorientation of the epiphysis of the humeral head and thus restoration of the anatomy of the coxal end of the femur have been addressed by renowned surgeons and answered with the development of widely varying procedures for surgical correction. However, within the framework of the surgical techniques introduced for treatment of impingement syndromes of the hip, these therapeutic options have been supplemented and broadened. The current discussion about the best therapeutic strategies emphasizes the fascination of the clinical entity of upper femoral epiphysis and constitutes a central component of this article. © Georg Thieme Verlag KG Stuttgart - New York.

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