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Dienstknecht T.,University of Regensburg | Dienstknecht T.,Aachen University Medical Center | Luring C.,University of Regensburg | Luring C.,Aachen University Medical Center | And 4 more authors.
International Orthopaedics | Year: 2013

Purpose: The benefits of minimally invasive surgical techniques in total hip arthroplasty (THA) are well known, but concerns about applying those techniques in obese patients are controversial. We prospectively compared patients with increased body mass index (BMI ≥30) undergoing THA with normal weight patients. Methods: A total of 134 patients admitted for unilateral THA were randomised to have surgery through either a transgluteal or a minimally invasive approach (MicroHip). In each group a BMI ≥30 was used to define obese patients. Pre- and early post-operative demographics, intraoperative data, baseline haematological values, hip function (Harris Hip Score, Oxford Hip Score) and quality of life (EQ-5D) were assessed with follow-up at three months. Results: Duration of surgery, blood loss, C-reactive protein levels, radiographic measurements and complication rates were comparable in all groups. There was a tendency for lower serum creatine kinase levels in the MicroHip group. Intraoperative fluoroscopic time and dose area products were significantly elevated in patients with a BMI exceeding 30 regardless of the approach used. Time points of mobilisation, length of hospital stay and functional outcome measurements were similar in the different weight groups. Conclusions: Our data suggest that obese patients gain similar benefit from MicroHip THA as do non-obese patients. The results of this study should be further investigated to assess long-term survivorship. © 2013 Springer-Verlag Berlin Heidelberg.


Pape H.-C.,Harald Tscherne Laboratory for Orthopaedic Trauma | Lefering R.,Witten/Herdecke University | Butcher N.,University of Newcastle | Peitzman A.,University of Pittsburgh | And 10 more authors.
Journal of Trauma and Acute Care Surgery | Year: 2014

Background: The nomenclature for patients with multiple injuries with high mortality rates is highly variable, and there is a lack of a uniform definition of the term polytrauma. A consensus process was therefore initiated by a panel of international experts with the goal of assessing an improved, database-supported definition for the polytraumatized patient. Methods: The consensus process involved the following: 1. Expert panel. Multiple meetings and consensus discussions (members: European Society for Trauma and Emergency Surgery [ESTES], American Association for the Surgery of Trauma [AAST], German Trauma Society [DGU], and British Trauma Society [BTS]). 2. Literature review (original articles before June 8, 2014). 3. A priori assumptions by the expert panel. The basis for a new definition should include the Injury Severity Score (ISS) based on the Abbreviated Injury Scale (AIS); ''A patient classified as polytraumatized should have a mortality rate of approximately 30%, twice above the established mortality of ISS > 15.'' 4. Database-derived resources. Deductive calculation of parameters based on a nationwide trauma registry (TraumaRegister DGU) with the following inclusion criteria: multiple injuries and need for intensive care therapy. RESULTS: A total of 28,211 patients in the trauma registry met the inclusion criteria. The mean (SD) age of the study cohort was 42.9 (20.2) years (72% males, 28% females). The mean (SD) ISS was 30.5 (12.2), with an overall mortality rate of 18.7% (n = 5,277) and an incidence of 3% of penetrating injuries (n = 886). Five independent physiologic variables were identified, and their individual cutoff values were calculated based on a set mortality rate of 30%: hypotension (systolic blood pressure ≤ 90 mm Hg), level of consciousness (Glasgow Coma Scale [GCS] score ≤ 8), acidosis (base excesse≤ 6.0), coagulopathy (international normalized ratio ≥ 1.4/partial thromboplastin time ≥ 40 seconds), and age (≥ 70 years). Conclusion: Based on several consensus meetings and a database analysis, the expert panel proposes the following parameters for a definition of ''polytrauma'': significant injuries of three or more points in two or more different anatomic AIS regions in conjunction with one or more additional variables from the five physiologic parameters. Further validation of this proposal should occur, favorably by mutivariate analyses of these parameters in a separate data set. Copyright © 2014 by Lippincott Williams & Wilkins).


Voo S.,Maastricht University | Bucerius J.,Maastricht University | Mottaghy F.M.,Maastricht University | Mottaghy F.M.,Aachen University Medical Center
Methods | Year: 2011

Metaiodobenzylguanidine (MIBG) is a tracer that selectively targets neuroendocrine cells. On this basis, radiolabeled iodinated-MIBG (I-131-MIBG) has been introduced as a molecular nuclear therapy in the management of neuroendocrine tumors, including neuroblastoma, pheochromocytoma, paraganglioma, neuroendocrine carcinomas, and other rare neuroendocrine tumors. Extensive work has been addressed to develop I-131-MIBG therapy: doses, therapeutic schemes, and efficiency. In this paper, we present an overview on I-131-MIBG therapy, with main focus on different aspects how to perform this treatment. © 2011 Elsevier Inc.


Wiese A.,Aachen University Medical Center | Wiese A.,University of Aachen Medical Center | Pape H.C.,University of Pittsburgh
Orthopedic Clinics of North America | Year: 2010

Bone defects represent a difficult problem for the clinician. They entail a sustained increase in hospitalization, risk of complications, and associated increase in expenses. This article discusses bone defects caused by high-energy injuries, bone loss, infected nonunions, and nonunions. © 2010 Elsevier Inc. All rights reserved.


Gradl G.,University of Rostock | Gradl G.,Aachen University Medical Center | Mielsch N.,University of Rostock | Wendt M.,University of Rostock | And 3 more authors.
Injury | Year: 2014

Background: Intramedullary techniques for stabilization of displaced distal radius fractures are now available. Purported benefits include limited soft tissue dissection while affording sufficient stability to allow early wrist motion. The primary null hypothesis of this randomized trial is that there is no significant difference with respect to functional outcome, pain and disability between patients treated with either 2.4-mm volar locking plate fixation or intramedullary nail fixation of unstable dorsally displaced extra-articular fractures of the distal radius. Methods: We conducted a single-centre, parallel-group trial, with unrestricted randomization. Patients with dorsally displaced extra-articular distal radius fractures were randomized to receive volar locking plate (n = 72) fixation or intramedullary nailing (n = 80). The outcome was measured on the basis of the Gartland and Werley and Castaing score; the pain level; the range of wrist motion; the rate of complications; and radiographic measurements including volar tilt and ulnar variance. Clinical and radiographic assessment was performed at 8 weeks, 6 months, 1 year and 2 years after the operation. Results: There were no significant differences between groups in terms of range of motion, grip strength or the level of pain during the entire follow-up period (p > 0.05). There was no significant difference between treatment groups with respect to volar tilt or ulnar variance (p > 0.05). There was no significant difference in the complication rate between groups (p > 0.05). Conclusions: The present study supports the view that intramedullary nail fixation and volar plate fixation for the treatment of displaced extra-articular distal radius fractures have equivalent radiographic and functional outcomes. Level of evidence: Level I therapeutic study. © 2013 Elsevier Ltd. All rights reserved.


Pfeifer R.,Aachen University Medical Center | Lichte P.,Aachen University Medical Center | Schreiber H.,Aachen University Medical Center | Sellei R.M.,Aachen University Medical Center | And 4 more authors.
Cytokine | Year: 2013

Introduction: The hemorrhagic shock (HS) model is commonly used to initiate a systemic post-traumatic inflammatory response. Numerous experimental protocols exist and it is unclear how differences in these models affect the immune response making it difficult to compare results between studies. The aim of this study was to compare the inflammatory response of different established protocols for volume-controlled shock in a murine model. Methods: Male C57/BL6 mice 6-10. weeks and weighing 20-25. g were subjected to volume-controlled or pressure-controlled hemorrhagic shock. In the volume-controlled group 300 μl, 500 μl, or 700 μl blood was collected over 15. min and mean arterial pressure was continuously monitored during the period of shock. In the pressure-controlled hemorrhagic shock group, blood volume was depleted with a goal mean arterial pressure of 35. mmHg for 90. min. Following hemorrhage, mice from all groups were resuscitated with the extracted blood and an equal volume of lactated ringer solution. Six hours from the initiation of hemorrhagic shock, serum IL-6, KC, MCP-1 and MPO activity within the lung and liver tissue were assessed. Results: In the volume-controlled group, the mice were able to compensate the initial blood loss within 30. min. Approximately 800 μl of blood volume was removed to achieve a MAP of 35. mmHg (p< 0.001). No difference in the pro-inflammatory cytokine (IL-6 and KC) profile was measured between the volume-controlled groups (300 μl, 500 μl, or 700 μl). The pressure-controlled group demonstrated significantly higher cytokine levels (IL-6 and KC) than all volume-controlled groups. Pulmonary MPO activity increased with the severity of the HS (p< 0.05). This relationship could not be observed in the liver. Conclusion: Volume-controlled hemorrhagic shock performed following current literature recommendations may be insufficient to produce a profound post-traumatic inflammatory response. A decrease in the MAP following blood withdrawal (300 μl, 500 μl or 700 μl) was usually compensated within 30. min. Pressure-controlled hemorrhagic shock is a more reliable for induction of a systemic inflammatory response. © 2012 Elsevier Ltd.


PubMed | Aachen University Medical Center, University of Rostock and Munich Municipal Hospital Group
Type: | Journal: Injury | Year: 2017

Proposed benefits of intramedullary techniques include limited soft tissue dissection while affording sufficient stability to allow early wrist motion. The primary null hypothesis of this randomized trial was that there is no significant difference with respect to functional outcome, pain and disability between patients treated with either 2.4-mm volar locking plate fixation or intramedullary nail fixation of intra-articular fractures of the distal radius.We conducted a single-centre, prospective randomized matched-pairs trial. Patients with intraarticular distal radius fractures with metaphyseal comminution and a sagittal fracture line (AO 23 C2.1) were randomized to receive volar locking plate fixation (n = 14) or intramedullary nailing (n = 14). The outcome was measured on the basis of the Gartland and Werley and Castaing score; the pain level; the range of wrist motion; the rate of complications; and radiographic measurements including volar tilt and ulnar variance. Clinical and radiographic assessment was performed at 8 weeks and 2 years after the operation.There were no significant differences between groups in terms of range of motion, grip strength or the level of pain at eight weeks. At the final follow up, patients in the nail group had regained more extension than in the plate group (98% of the unaffected side vs. 94%, this however, did not reach significance). Reduction was maintained in both groups; however volar tilt and ulnar variance were significantly better in the plate group. There was no significant difference in the complication rate between groups.The present study suggests that intramedullary nail fixation is a reasonable alternative to volar plate fixation for the treatment of intra-articular distal radius fractures and both techniques can yield reliably good results.


PubMed | Aachen University Medical Center and St Nicolaus Hospital
Type: Journal Article | Journal: European journal of trauma and emergency surgery : official publication of the European Trauma Society | Year: 2016

Interleukin-6 is a mainly proinflammatory interleukin and an indicator for the magnitude of surgery. The IL-6 serum concentration correlates with injury severity, the extent of tissue trauma and has negative impact on prognosis. To date it is unclear whether the immunologic changes assessed are age dependent. The aim of this study is to compare the surgical inflammatory response in different age groups.Data were collected at a level-1 university trauma center in a prospective, consecutive cohort study. IL-6 levels were analyzed via ELISA from venous blood samples of cohorts of injuries with typical peak incidence: patients with unstable fractures of the spine (SP) for a middle-aged group and patients with fractures of the proximal femur (PF) for a geriatric group. Surgical treatment was performed using minimal-invasive instrumentation.25 patients in group SP (age: 51 years20) and 16 patients in the group PF (age: 73 years16) were analysed. Group PF showed higher baseline IL-6 concentrations. Surgical treatment was followed by a significant increase of IL-6 levels in both groups 4 and 24h postoperatively. Concentration profiles were similar, but increase was significantly higher in the PF group 4h after surgery.Both the operative treatment of fractures in a middle-aged (SP) and a geriatric group (PF) lead to significant increasing of IL-6 levels. In view of a comparative surgical burden, these data suggest that age may be a confounding factor for a surgery induced pro-inflammatory response in the early postoperative stage.


PubMed | Aachen University Medical Center and University of Rostock
Type: | Journal: Injury | Year: 2014

Intramedullary techniques for stabilization of displaced distal radius fractures are now available. Purported benefits include limited soft tissue dissection while affording sufficient stability to allow early wrist motion. The primary null hypothesis of this randomized trial is that there is no significant difference with respect to functional outcome, pain and disability between patients treated with either 2.4-mm volar locking plate fixation or intramedullary nail fixation of unstable dorsally displaced extra-articular fractures of the distal radius.We conducted a single-centre, parallel-group trial, with unrestricted randomization. Patients with dorsally displaced extra-articular distal radius fractures were randomized to receive volar locking plate (n=72) fixation or intramedullary nailing (n=80). The outcome was measured on the basis of the Gartland and Werley and Castaing score; the pain level; the range of wrist motion; the rate of complications; and radiographic measurements including volar tilt and ulnar variance. Clinical and radiographic assessment was performed at 8 weeks, 6 months, 1 year and 2 years after the operation.There were no significant differences between groups in terms of range of motion, grip strength or the level of pain during the entire follow-up period (p>0.05). There was no significant difference between treatment groups with respect to volar tilt or ulnar variance (p>0.05). There was no significant difference in the complication rate between groups (p>0.05).The present study supports the view that intramedullary nail fixation and volar plate fixation for the treatment of displaced extra-articular distal radius fractures have equivalent radiographic and functional outcomes.Level I therapeutic study.


PubMed | Aachen University Medical Center and NHS England
Type: Journal Article | Journal: PloS one | Year: 2016

A high percentage (50%-60%) of trauma patients die due to their injuries prior to arrival at the hospital. Studies on preclinical mortality including post-mortem examinations are rare. In this review, we summarized the literature focusing on clinical and preclinical mortality and studies included post-mortem examinations.A literature search was conducted using PubMed/Medline database for relevant medical literature in English or German language published within the last four decades (1980-2015). The following MeSH search terms were used in different combinations: multiple trauma, epidemiology, mortality , cause of death, and autopsy. References from available studies were searched as well.Marked differences in demographic parameters and injury severity between studies were identified. Moreover, the incidence of penetrating injuries has shown a wide range (between 4% and 38%). Both unimodal and bimodal concepts of trauma mortality have been favored. Studies have shown a wide variation in time intervals used to analyze the distribution of death. Thus, it is difficult to say which distribution is correct.We have identified variable results indicating bimodal or unimodal death distribution. Further more stundardized studies in this field are needed. We would like to encourage investigators to choose the inclusion criteria more critically and to consider factors affecting the pattern of mortality.

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