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Nousiainen M.T.,Holland Orthopaedic and Arthritic Center | Omoto D.M.,Holland Orthopaedic and Arthritic Center | Zingg P.O.,Uniklinik Balgrist | Weil Y.A.,Hadassah University Hospital | And 2 more authors.
Journal of Orthopaedic Trauma | Year: 2013

BACKGROUND: Femoral neck fractures are among the most common orthopaedic injuries impacting the health care system. Surgical management of such fractures with cannulated screws is a commonly performed procedure. The acquisition of surgical skills necessary to perform this procedure typically involves learning on real patients with fluoroscopic guidance. This study attempts to determine if a novel computer-navigated training model improves the learning of this basic surgical skill. METHODS: A multicenter, prospective, randomized, and controlled study was conducted using surgical trainees with no prior experience in surgically managing femoral neck fractures. After a training session, participants underwent a pretest by performing the surgical task (screw placement) on a simulated hip fracture using fluoroscopic guidance. Immediately after, participants were randomized into either undergoing a training session using conventional fluoroscopy or computer-based navigation. Immediate posttest, retention (4 weeks later), and transfer tests were performed. Performance during the tests was determined by radiographic analysis of hardware placement. RESULTS: Screw placement by trainees was ultimately equal to the level of an expert surgeon with either training technique. Participants who trained with computer navigation took fewer attempts to position hardware and used less fluoroscopy time than those trained with fluoroscopy. When those trained with fluoroscopy used computer navigation at the transfer test, less fluoroscopy time and dosage was used. The concurrent augmented feedback provided by computer navigation did not affect the learning of this basic surgical skill in surgical novices. No compromise in learning occurred if the surgical novice trained with one type of technology and transferred to using the other. CONCLUSIONS: The findings of this study suggest that computer navigation may be safely used to train surgical novices in a basic procedure. This model avoids using both live patients and harmful radiation without a compromise in the acquisition of a 3-dimensional technical skill. Copyright © 2013 by Lippincott Williams &Wilkins.


Ciurea A.,University of Zürich | Scherer A.,Swiss Clinical Quality Management Foundation | Weber U.,King Christian 10th Hospital for Rheumatic Diseases | Exer P.,Private Practice | And 9 more authors.
Annals of the Rheumatic Diseases | Year: 2015

Objectives To investigate the impact of smoking on the response to treatment with a first tumour necrosis factor inhibitor (TNFi) in patients with axial spondyloarthritis (axSpA) in a real-life cohort. Methods Patients fulfilling the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axSpA in the Swiss Clinical Quality Management Cohort were included in this study. The potential association between smoking status and differential response to TNFi in terms of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS) was analysed using multiple adjusted longitudinal mixed effect models. Binary response rates at 1 year were assessed with multiple adjusted logistic analyses. Results A first TNFi was initiated in 698 patients with axSpA with available smoking status and a baseline or follow-up BASDAI assessment, of which 490 (70%) had complete covariate data. In comparison to non-smokers, current smokers demonstrated significantly smaller reductions in BASDAI and ASDAS scores upon treatment with TNFi (0.75 BASDAI units and 0.69 ASDAS units less, p=0.005 and 0.001, respectively) for patients with elevated baseline C-reactive protein (CRP) level. This effect was numerically smaller in patients with normal CRP. The odds for reaching a 50% improvement in BASDAI response or the ASAS criteria for 40% improvement after 1 year were significantly lower in current smokers than in non-smokers (0.54, 95% CI 0.31 to 0.95, p=0.03 and 0.43, 95% CI 0.24 to 0.76, p=0.004, respectively). Conclusions Current smoking is associated with an impaired response to TNFi in axSpA. © 2015 BMJ Publishing Group Ltd & European League Against Rheumatism.


Ciurea A.,University of Zürich | Scherer A.,Swiss Clinical Quality Management Foundation | Weber U.,King Christian 10th Hospital for Rheumatic Diseases | Exer P.,Private Practice | And 9 more authors.
Annals of the Rheumatic Diseases | Year: 2016

Objectives: To investigate the impact of smoking on the response to treatment with a first tumour necrosis factor inhibitor (TNFi) in patients with axial spondyloarthritis (axSpA) in a real-life cohort. Methods: Patients fulfilling the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axSpA in the Swiss Clinical Quality Management Cohort were included in this study. The potential association between smoking status and differential response to TNFi in terms of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS) was analysed using multiple adjusted longitudinal mixed effect models. Binary response rates at 1 year were assessed with multiple adjusted logistic analyses. Results: A first TNFi was initiated in 698 patients with axSpA with available smoking status and a baseline or follow-up BASDAI assessment, of which 490 (70%) had complete covariate data. In comparison to non-smokers, current smokers demonstrated significantly smaller reductions in BASDAI and ASDAS scores upon treatment with TNFi (0.75 BASDAI units and 0.69 ASDAS units less, p=0.005 and 0.001, respectively) for patients with elevated baseline C-reactive protein (CRP) level. This effect was numerically smaller in patients with normal CRP. The odds for reaching a 50% improvement in BASDAI response or the ASAS criteria for 40% improvement after 1 year were significantly lower in current smokers than in nonsmokers (0.54, 95% CI 0.31 to 0.95, p=0.03 and 0.43, 95% CI 0.24 to 0.76, p=0.004, respectively). Conclusions: Current smoking is associated with an impaired response to TNFi in axSpA.


PubMed | Private Practice, Bethesda Hospital, King Christian 10th Hospital for Rheumatic Diseases, University of Zürich and 5 more.
Type: Journal Article | Journal: Annals of the rheumatic diseases | Year: 2016

To investigate the impact of smoking on the response to treatment with a first tumour necrosis factor inhibitor (TNFi) in patients with axial spondyloarthritis (axSpA) in a real-life cohort.Patients fulfilling the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axSpA in the Swiss Clinical Quality Management Cohort were included in this study. The potential association between smoking status and differential response to TNFi in terms of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS) was analysed using multiple adjusted longitudinal mixed effect models. Binary response rates at 1year were assessed with multiple adjusted logistic analyses.A first TNFi was initiated in 698 patients with axSpA with available smoking status and a baseline or follow-up BASDAI assessment, of which 490 (70%) had complete covariate data. In comparison to non-smokers, current smokers demonstrated significantly smaller reductions in BASDAI and ASDAS scores upon treatment with TNFi (0.75 BASDAI units and 0.69 ASDAS units less, p=0.005 and 0.001, respectively) for patients with elevated baseline C-reactive protein (CRP) level. This effect was numerically smaller in patients with normal CRP. The odds for reaching a 50% improvement in BASDAI response or the ASAS criteria for 40% improvement after 1year were significantly lower in current smokers than in non-smokers (0.54, 95% CI 0.31 to 0.95, p=0.03 and 0.43, 95% CI 0.24 to 0.76, p=0.004, respectively).Current smoking is associated with an impaired response to TNFi in axSpA.


Baertschi E.,Uniklinik Balgrist | Baertschi E.,ZHAW Zurich University of Applied Sciences | Swanenburg J.,Uniklinik Balgrist | Brunner F.,Uniklinik Balgrist | Kool J.,ZHAW Zurich University of Applied Sciences
BMC Musculoskeletal Disorders | Year: 2013

Background: Decreased scapulothoracic motion has been associated with various pathologies of the shoulder. Reliable and simple assessment methods of scapular mobility are, however lacking. The aim of this study was to evaluate the interrater reliability of four clinical tests to assess scapulothoracic motion in patients with a slightly restricted shoulder flexion. Methods. A total of nineteen patients with a symptomatic slight restriction of shoulder flexion and twenty asymptomatic subjects were evaluated. The investigation consisted of four palpatory tests to assess scapulothoracic motion. A two-level rating scale (positive, negative) was utilised. Interrater reliability was evaluated using kappa coefficients. Results: We found substantial to almost perfect (Kappa = 0.63-0.4) interrater reliability for the four tests. Conclusion: Our study demonstrates that the four mobility tests of the shoulder are a reliable and simple instrument to assess patients with a slightly restricted shoulder flexion. Future studies should be conducted to evaluate the validity of these tests and to establish their clinical usefulness. © 2013 Baertschi et al.; licensee BioMed Central Ltd.


PubMed | University of Zürich, Uniklinik Balgrist and ETH Zurich
Type: Journal Article | Journal: Biology open | Year: 2016

After tendon rupture repair, two main problems may occur: re-rupture and adhesion formation. Suitable non-murine animal models are needed to study the healing tendon in terms of biomechanical properties and extent of adhesion formation. In this study 24 New Zealand White rabbits received a full transection of the Achilles tendon 2cm above the calcaneus, sutured with a 4-strand Becker suture. Post-surgical analysis was performed at 3, 6 and 12weeks. In the 6-week group, animals received a cast either in a 180 deg stretched position during 6weeks (adhesion provoking immobilization), or were re-casted with a 150 deg position after 3weeks (adhesion inhibiting immobilization), while in the other groups (3 and 12weeks) a 180 deg position cast was applied for 3weeks. Adhesion extent was analyzed by histology and ultrasound. Histopathological scoring was performed according to a method by Stoll et al. (2011), and the main biomechanical properties were assessed. Histopathological scores increased as a function of time, but did not reach values of healthy tendons after 12weeks (only around 15 out of 20 points). Adhesion provoking immobilization led to an adhesion extent of 82.79.7%, while adhesion inhibiting immobilization led to 31.99.8% after 6weeks. Biomechanical properties increased over time, however, they did not reach full strength nor elastic modulus at 12weeks post-operation. Furthermore, the rabbit Achilles tendon model can be modulated in terms of adhesion formation to the surrounding tissue. It clearly shows the different healing stages in terms of histopathology and offers a suitable model regarding biomechanics because it exhibits similar biomechanics as the human flexor tendons of the hand.


Krause F.G.,University of Bern | Klammer G.,Uniklinik Balgrist | Benneker L.M.,University of Bern | Werlen S.,Klinik Sonnenhof | And 2 more authors.
Journal of Orthopaedic Research | Year: 2010

Pes cavovarus affects the ankle biomechanics and may lead to ankle arthrosis. Quantitative T2 STAR (T2) magnetic resonance (MR) mapping allows high resolution of thin cartilage layers and quantitative grading of cartilage degeneration. Detection of ankle arthrosis using T2* mapping in cavovarus feet was evaluated. Eleven cavovarus patients with symptomatic ankle arthrosis (13 feet, mean age 55.6 years, group 1), 10 cavovarus patients with no or asymptomatic, mild ankle arthrosis (12 feet, mean age 41.8 years, group 2), and 11 controls without foot deformity (18 feet, mean age 29.8 years, group 3) had quantitative T2* MR mapping. Additional assessment included plain radiographs and the American Orthopaedic Foot and Ankle Society (AOFAS) score (groups 1 and 2 only). Mean global T2* relaxation time was significantly different between groups 1 and 2 (p = 0.001) and groups 1 and 3 (p = 0.017), but there was no significance for decreased global T2* values in group 2 compared to group 3 (p = 0.345). Compared to the medial compartment T2* values of the lateral compartment were significantly (p = 0.025) higher within group 1. T2* values in the medial ankle joint compartment of group 2 were significantly lower than those of group 1 (p = 0.019). Ankle arthrosis on plain radiographs and the AOFAS score correlated significantly with T2* values in the medial compartment of group 1 (p = 0.04 and 0.039, respectively). Biochemical, quantitative T2* MR mapping is likely effective to evaluate ankle arthrosis in cavovarus feet but further studies are required. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.


PubMed | University of Nimes, Emergency Care and the Multidisciplinary Pain Center, Uniklinik Balgrist, Pfizer and Free University of Brussels
Type: Journal Article | Journal: Acta anaesthesiologica Scandinavica | Year: 2016

This study assessed non-inferiority of parecoxib vs. combination parecoxib+propacetamol and compared the opioid-sparing effects of parecoxib, propacetamol, and parecoxib+propacetamol vs. placebo after total hip arthroplasty.In this randomized, placebo-controlled, parallel-group, non-inferiority study, patients received one of four IV treatments after surgery: parecoxib 40 mg bid (n = 72); propacetamol 2 g qid (n = 71); parecoxib 40 mg bid plus propacetamol 2 g qid (n = 72); or placebo (n = 38) with supplemental IV patient-controlled analgesia (morphine). Patients and investigators were blinded to treatment. Pain intensity at rest and with movement was assessed regularly, together with functional recovery (modified Brief Pain Inventory-Short Form) and opioid-related side effects (Opioid-Related Symptom Distress Scale) questionnaires up to 48 h.After 24 h, cumulative morphine consumption was reduced by 59.8% (P < 0.001), 38.9% (P < 0.001), and 26.8% (P = 0.005) in the parecoxib+propacetamol, parecoxib, and propacetamol groups, respectively, compared with placebo. Parecoxib did not meet criteria for non-inferiority to parecoxib+propacetamol. Parecoxib+propacetamol and parecoxib significantly reduced least-squares mean pain intensity scores at rest and with movement compared with propacetamol (P < 0.05). One day after surgery, parecoxib+propacetamol significantly reduced opioid-related symptom distress and decreased pain interference with function compared with propacetamol or placebo.Parecoxib and parecoxib+propacetamol provided significant opioid-sparing efficacy compared with placebo; non-inferiority of parecoxib to parecoxib+propacetamol was not demonstrated. Opioid-sparing efficacy was accompanied by significant reductions in pain intensity on movement, improved functional outcome, and less opioid-related symptom distress. Study medications were well tolerated.


Scemama C.,University of Paris Descartes | Dora C.,Uniklinik Balgrist | Langlois J.,University of Paris Descartes | Hamadouche M.,University of Paris Descartes
International Orthopaedics | Year: 2015

Purpose: Highly cross-linked polyethylenes (PE) have been developed with encouraging results in terms of wear. Another body of the literature has indicated potential catastrophic failures related to reduced fatigue properties and oxidation. Each PE available on the market has its own processing characteristics. The aim of this retrospective study was to evaluate the minimum five-year wear properties of an original highly cross-linked PE in a consecutive series of primary THAs. Methods: Between August 2005 and December 2007, 80 patients with a mean age of 62.7 years were included. All patients had a 28-mm CoCr femoral head articulating with a highly cross-linked insert (Highcross®, Medacta SA) that was 100 Mrads gamma radiated, remelted at 150 °C, and ethylene oxide sterilized. The primary criterion for evaluation was the femoral head penetration, as measured by Hip Analysis Suite software. The steady state wear was also calculated. Functional results were evaluated according to the WOMAC score. Results: Complete data were available for analysis in 67 patients at a mean follow-up of 5.5 years. The mean femoral head penetration was 0.128 ± 0.62 mm and the steady state wear was−0.025 ± 0.22 mm/year. The WOMAC score significantly decreased from 16.5 ± 5.93 pre-operatively to 4.12 ± 5.5 at the latest follow-up (p <0.001). Conclusions: The minimal five-year results of this retrospective study indicate that this particular highly cross-linked and remelted polyethylene had a low wear rate. Longer-term results are needed to warrant that these mid-term data will generate less osteolysis and resultant aseptic loosening. © 2014, SICOT aisbl.


Schweizer A.,Uniklinik Balgrist
Swiss Medical Weekly | Year: 2012

Rock climbing, sport climbing and bouldering are highly popular new sport disciplines. An increasing number of indoor climbing gyms throughout the country offer the possibility to perform the sport regularly independently from the weather. As a result a variety of new pathologies like the closed flexor tendon pulley rupture of the finger and syndromes caused by overuse mainly in the upper extremity have appeared and should be familiar to physicians and therapists working in the field of sports medicine. An overview of the most common and most specific climbing related injuries as well as their diagnosis and treatment options with a focus on the upper extremity are presented.

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