Biomedical subjects

Christian Krettek

Publications and source records attributed to Christian Krettek.

At least 37 records · Page 2Linked to original sources

PubMed2006

Overdistraction of the fracture eases reduction in delayed femoral nailing: results of intraoperative force measurements.

BACKGROUND: (Initial) primary external fixation of femoral shaft fractures followed by secondary intramedullary nailing is a concept of damage control orthopedics. We hypothesized that external fixation with overdistraction of the fracture might reduce reduction forces and shorten reduction time during the secondary nailing. METHODS: An experimental study on seven patients with eight fractures of the femoral shaft was conducted. Intraoperative reduction forces were determined in all patients using a load cell. The amount of distraction was measured on the latest radiographs before nailing. The reduction time was recorded as an indirect indicator of the intricacy of reposition. Reduction forces and reduction times were compared between those fractures fixed with shortening (Group A) and those fixed in distraction (Group B). RESULTS: Three femurs showed some shortening and five femurs showed some distraction within the fracture. The maximum measured distraction force along the shaft axis was 396 N. On average the maximal force was 336 N (+/- 51.9 N) in Group A and 200 N (+/- 43.1 N) in Group B. This difference is statistically significant (p = 0.007). The average reduction time was 28.3 minutes (+/- 21.8 minutes) in Group A and 5.8 minutes (+/- 4.0 minutes) in Group B. This difference shows a trend toward significance (p = 0.056). CONCLUSION: Fracture shortening leads to higher restraining forces and consequently prolonged reduction time in delayed nailing. Overdistraction should be performed as soon as possible under careful soft-tissue monitoring.

Adult↗

PubMed2006

Long-term results after functional nonoperative treatment of achilles tendon rupture.

BACKGROUND: Nonoperative treatment of complete Achilles tendon ruptures generally involves a long period of cast immobilization and is associated with frequent reruptures. Functional nonoperative treatment of complete Achilles tendon ruptures involves the use of a high-shaft boot with a 3-cm hindfoot elevation, in which physical therapy is begun after 3 weeks of wear. We reviewed our long-term results with this treatment protocol to determine its effectiveness. METHODS: The indications for nonoperative treatment, defined by ultrasound, were a distance of 10 mm or less between the tendon ends with the ankle in neutral position and complete apposition of the tendon ends in 20 degrees of plantarflexion. From 1990 to 1996, 168 patients were treated; 125 (74%) were available for followup at a mean of 5.5 (2 to 12.7) years after the injury. RESULTS: Good or excellent results were achieved in 92 (73.5%) with complete rehabilitation and return to sports activity at their pre-injury levels. Satisfactory (9%) and poor results (17.5%) were due to pain in the Achilles tendon region, a lengthened Achilles tendon, markedly reduced strength, or a marked reduction of calf size in 25 patients (76%). Eight patients (6.4%) sustained a rerupture. CONCLUSIONS: Functional nonoperative treatment achieved good results in patients who had precise sonographic evaluation and who were compliant. As a result of our study, we modified our protocol: (1) a repeat ultrasound examination is done by an experienced sonographer 2 to 5 days after the first to confirm the indications for nonoperative treatment, (2) the use of the 3-cm hindfoot elevation is extended from 6 to 8 weeks to provide a longer protection of the tendon, and (3) patients then wear shoes with 1-cm hindfoot elevation for another 3 months.

Achilles Tendon↗

PubMed2006

Intraoperative pedography: a validated method for static intraoperative biomechanical assessment.

BACKGROUND: A new device was developed to perform intraoperative static pedography. The purpose of this study was to validate the introduced method by a comparison with the standard method for dynamic and static pedography. METHODS: A device known as Kraftsimulator Intraoperative Pedographie (KIOP) was developed for intraoperative placement of standardized forces to the sole of the foot. Pedographic measurements were done with a custom-made mat that was inserted into the KIOP (Pliance, Novel Inc., St. Paul, MN, USA). Validation was done in two steps: (1) comparison of standard dynamic pedography walking on a platform, standard static pedography in standing on a platform, and pedography with KIOP in supine position in 30 healthy volunteers, and (2) comparison of static pedography in standing position, pedography with KIOP supine awake, and pedography with KIOP supine with 30 patients under anesthesia. Individuals who had operative procedures at the knee or distal to the knee were excluded. The different measurements were compared (one-way ANOVA, t-test; significance level 0.05). RESULTS: No significant differences were found among all measurements for the hindfoot compared to midfoot-forefoot force distribution. For the medial compared to lateral force distribution and the 10-region-mapping, significant differences were found when comparing all measurements (steps 1 and 2) and when comparing the measurements of step 1 only. No differences were found for these distributions when comparing the measurements of step 2 alone or when comparing the measurements of step 1 and 2 without the platform measurements of step 1 (dynamic walking pedography and static standing pedography). No significant differences in the force distributions were found in step 2 when comparing subjects without anesthesia, with general anesthesia, and with spinal anesthesia. CONCLUSIONS: The KIOP device allows a valid static intraoperative pedography measurement. No statistically significant force distribution differences were found between standing subjects and anesthetized subjects in the supine position.

Adult↗

PubMed2006

Differences in the mechanical properties of calcaneal artificial specimens, fresh frozen specimens, and embalmed specimens in experimental testing.

BACKGROUND: Artificial calcanei, fresh-frozen cadaver specimens, and embalmed cadaver specimens were compared in experimental testing under biocompatible loading to clarify the biocompatibility of artificial calcaneal specimens for implant testing. METHODS: Two different artificial calcaneal bone models (Sawbone, Pacific Research Laboratories, Vashon, WA, and Synbone, Synbone Inc., Davos, Switzerland), embalmed cadaver calcaneal specimens (bone density, 313.1 +/- 40.9 g/cm2; age, 43.8 +/- 7.9 years), and fresh-frozen cadaver calcanei (bone density, 238.5 +/- 30.0 g/cm2; age, 44.4 +/- 8.2 years) were used for testing. Seven specimens of each model or cadaver type were tested. A mechanical testing machine (Zwick Inc., Ulm, Germany) was used for loading and measurements. Cyclic loading (preload 20 N, load was increased every 100 cycles by 100 N from 1,000 to 2,500 N, 0.5 mm/s) and load to failure (0.5 mm/s) were performed. The loads were applied through an artificial talus in a physiological loading direction. The displacement of the posterior facet in the primary loading direction was measured. RESULTS: The four different specimen groups showed different stability and different displacement in the primary loading direction during cyclic loading. The variation of the maximal displacement in the primary loading direction for the entire cyclic loading was higher in artificial specimens than in the cadaver specimens. CONCLUSIONS: Artificial calcanei (Sawbone, Synbone) showed different biomechanical characteristics than cadaver bones (embalmed and fresh-frozen) in this experimental setup with biocompatible cyclic loading. These results do not support the use of artificial calcanei for biomechanical implant testing. Fresh-frozen and embalmed specimens seem to be equally adequate for mechanical testing. The low variation of mechanical strength in the unpaired cadaver specimens suggests that the use of PAIRED specimens is not necessary.

Adult↗

PubMed2006

Dehydroepiandrosterone administration modulates endothelial and neutrophil adhesion molecule expression in vitro.

INTRODUCTION: The steroid hormone dehydroepiandrosterone (DHEA) exerts protecting effects in the treatment of traumatic and septic complications in several animal models. This effect goes along with reduced amounts of infiltrating immune cells in organs such as lung and liver. However, the underlying mechanisms of DHEA action are still not known. Adhesion molecules are important for the extravasation of neutrophils into organs where they may exhibit detrimental effects. Therefore, we investigated the in vitro effect of DHEA on the expression pattern of adhesion molecules of human endothelial cells and neutrophils. METHODS: Endothelial cells derived from human umbilical cord were subjected to an lipopolysaccharide (LPS) challenge. DHEA was administered in two different concentrations, 10(-5) M and 10(-8) M, as a single stimulus or in combination with LPS challenge. After two, four and 24 hours, fluorescence activated cell sorter (FACS) analysis for vascular cell adhesion molecule-1, intercellular adhesion molecule-1 and E-selectin was performed. Neutrophils were freshly isolated from blood of 10 male healthy volunteers, stimulated the same way as endothelial cells and analyzed for surface expression of L-selectin, CD11b and CD18. RESULTS: In the present study, we were able to demonstrate effects of DHEA on the expression of every adhesion molecule investigated. DHEA exhibits opposite effects to those seen upon LPS exposure. Furthermore, these effects are both time and concentration dependent as most DHEA specific effects could be detected in the physiological concentration of 10(-8) M. CONCLUSION: Thus, we conclude that one mechanism by which DHEA may exert its protection in animal models is via the differential regulation of adhesion molecule expression.

Adult↗

PubMed2005

Navigated intraoperative analysis of lower limb alignment.

INTRODUCTION: Accurate intraoperative assessment of lower limb alignment is crucial for the treatment of long bone fractures, implantation of knee arthroplasties and correction of deformities. During orthopaedic surgery, exact real time control of the mechanical axis is strongly desirable. The aim of this study was to compare conventional intraoperative analysis of the mechanical axis by the cable method with continuous, 3-dimensional imaging with a navigation system. MATERIALS AND METHODS: Twenty legs of fresh human cadaver were randomly assigned to conventional analysis with the cable method (n = 10) or navigated analysis with a fluoroscopy based navigation system (n = 10). The intersection of the mechanical axis with the tibia plateau was presented as percentage of the tibia plateau (beginning with 0% at the medial border and ending with 100% laterally). CT-scans were performed for all legs and the CT-values of the mechanical axis were compared to the measurements after cable method and navigation. Furthermore, the radiation time and dose area product of both groups for single analysis of the mechanical axis was compared. RESULTS: Conventional evaluation of the mechanical axis by the cable method showed 6.0+/-3.1% difference compared to the analysis by CT. In the navigated group the difference was 2.6+/-1.8% (P = 0.008). Radiation time and dose area product were highly significantly lower after conventional measurement. CONCLUSIONS: Navigated intraoperative evaluation of the mechanical axis offers increased accuracy compared to conventional intraoperative analysis. Furthermore, navigation provides continuous control not only of the mechanical axis, but also of the sagittal and transverse plane. Using the cable method, radiation exposure depends on the number of measurements and is lower compared to the navigation system for single intraoperative analysis of the mechanical axis, but may be higher in case of repeated intraoperative measurements.

Arthroplasty, Replacement, Knee↗

PubMed2005

Achilles tendon and paratendon microcirculation in midportion and insertional tendinopathy in athletes.

BACKGROUND: Neovascularisation can be detected qualitatively by Power Doppler in Achilles tendinopathy. Quantitative data regarding tendon microcirculation have not been established and may be substantial. PURPOSE: To assess the microcirculation of the Achilles tendon and the paratendon in healthy volunteers as well as in athletes with either midportion or insertional tendinopathy. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: In 66 physically active volunteers, parameters of Achilles tendon and paratendon microcirculation, such as tissue oxygen saturation, relative postcapillary venous filling pressures, and microcirculatory blood flow, were determined at rest at 2-mm and 8-mm tissue depths. Forty-one patients never had Achilles pain (25 men, 27 +/- 8 years), 14 patients had insertional pain (7 men, 29 +/- 8 years), and 11 patients had midportion tendinopathy (7 men, 38 +/- 13 years, not significant). RESULTS: Achilles tendon diameter 2 cm and 6 cm proximal to the insertion was increased in symptomatic tendons. Compared with the uninvolved opposite tendon, deep microcirculatory blood flow was significantly elevated at insertional (160 +/- 79 vs 132 +/- 42, P < .05) as well as in midportion tendinopathy (150 +/- 74 vs 119 +/- 34, P < .05). The microcirculation in the uninvolved opposite tendon and the normal athlete controls were not significantly different from each other (132 +/- 42 insertional asymptomatic vs 119 +/- 34 mid-portion vs 120 +/- 48 healthy tendon). Insertional paratendon deep microcirculatory flow was elevated in all groups, whereas tissue oxygen saturation and relative postcapillary venous filling pressures were not significantly different. CONCLUSION: Microcirculatory blood flow is significantly elevated at the point of pain in insertional and midportion tendinopathy. Postcapillary venous filling pressures are increased at both the midportion Achilles tendon and the midportion paratendon, whereas tissue oxygen saturation is not different among the studied groups. We found no evidence of an abnormal microcirculation of the asymptomatic limb in Achilles tendinopathy.

Achilles Tendon↗

PubMed2005

Effects of hypothermia and re-warming on the inflammatory response in a murine multiple hit model of trauma.

INTRODUCTION: Although, hypothermia is a frequent event after trauma, it is unclear whether its beneficial or detrimental effects are more important. This study aims to quantify the effects of hypothermia and re-warming on the inflammatory response after fracture/hemorrhage and subsequent fracture stabilization with resuscitation. MATERIALS AND METHODS: Eighty-one male C57Bl/6 mice (aged 8-10 weeks, weighing 22.0+/-3.0 g) underwent femoral fracture and hemorrhage followed by resuscitation and splint fixation of the fracture. Animals were sacrificed 3h after induction of hemorrhage and fracture. Besides a sham group (n=6), four experimental groups were created: A: normothermia (n=12), B: hypothermia after trauma (n=21), C: re-warming after resuscitation and before stabilization (n=21), and D: hypothermia before trauma (n=21). Groups B-D were further subdivided into three subgroups according to the degree of hypothermia (subgroup 1: 35-33 degrees C, subgroup 2: 32.9-30.0 degrees C, and subgroup 3: 29.9-27.0 degrees C). Plasma cytokine (TNF-alpha, IL-6, and IL-10) and chemokine (MCP-1) concentrations were determined by ELISA, pulmonary permeability changes were quantified, and histological analysis of lung and liver tissues was performed. RESULTS: Normothermia resulted in a significantly increased early mortality rate. A significantly increased pro-inflammatory and decreased anti-inflammatory responses were also observed in normothermia as compared to hypothermia. The extent of these changes was most pronounced in the severe hypothermic group. Re-warming after mild hypothermia resulted in a pro-inflammatory response comparable to normothermia. CONCLUSION: Hypothermia has a beneficial effect on early survival after trauma, which appears to be independent of the level of hypothermia and re-warming. Re-warming, however, enhanced the pro-inflammatory response. Further studies with a longer posttraumatic observation period are required to investigate the long term effects of the hypothermia and re-warming-induced changes on the pro- and anti-inflammatory responses.

Animals↗

PubMed2005

Complete osteolysis of the dens with atlantoaxial luxation caused by infection with Staphylococcus aureus: a case report and review of the literature.

STUDY DESIGN: Case report. OBJECTIVES: To present a case of complete osteolysis of the dens and accompanying luxation of the atlantoaxial joint, on the basis of a Staphylococcus aureus infection. SUMMARY OF BACKGROUND DATA: To date, complete osteolysis of the dens followed by atlantoaxial dislocation has only been reported as a rare complication in patients with tuberculosis but not as secondary to a Staphylococcus aureus infection. METHODS: Because of emerging neurological complications in both upper extremities, we chose closed reduction and temporary Halo-fixation together with appropriate antibiotic coverage as primary treatment followed by an operative stabilization with Magerl fusion (Galli fusion combined with transarticular screw fixation of C1 and C2). RESULTS: After the operative procedure (Magerl fusion), immediate pain relief was achieved as well as almost complete resolution of neurological deficits. CONCLUSIONS: To our knowledge, this presents the first reported case of a complete destruction of the dens, as a result of a purulent bacterial infection leading to atlantoaxial luxation. Our case demonstrates that infections of the atlantoaxial region are difficult to diagnose and are seen mostly in immunocompromised patients, such as patients with diabetes. Furthermore, it proves that other infections besides tuberculosis can lead to complete osteolytic destruction of the atlantoaxial joint.

Adult↗

PubMed2005

Use of the less invasive stabilization system (LISS) in patients with distal femoral (AO33) fractures: a prospective multicenter study.

INTRODUCTION: The Less Invasive Stabilization System (LISS) is an internal fixator that can be inserted percutaneously by means of a minimally invasive surgical approach. This paper presents the use of this system exclusively in patients with AO33 distal femoral fractures, a group in which fracture management is often complicated by multiple trauma and soft-tissue damage. MATERIALS AND METHODS: A series of 62 patients (mean age 52 years) with 66 AO33A or C fractures received the LISS implant and were followed prospectively for 12 months. Assessments included the radiographic evaluation of implant placement and healing, measurement of valgus/varus and sagittal joint malalignment, and the assessment of weight-bearing capacity and range of motion. RESULTS: The mean duration of surgery was 85 min (range 40-135 min) for 33A fractures and 149 min (range 50-300 min) for 33C fractures. Postoperative radiographic assessments showed that the LISS implant was positioned correctly in 59 cases (89%). Assessment of valgus/varus alignment showed correct axial alignment in 49 cases (74%), a deviation of 5-10 degrees in 13 cases, and a 10-20 degrees deviation in 1 case. Correct sagittal alignment was observed in 56 cases (85%), 5-10 degrees malalignment in 5 cases, and 10-20 degrees in 2 cases. During the course of the 1-year follow-up, 8 patients (9 fractures) died; 2 other patients were not available for follow-up. Complete fracture healing was achieved in 85% of the followed-up patients. Forty-eight patients were capable of full weight-bearing. After fracture healing, maximum flexion of the injured limb was on average 80% of the range of the uninjured limb. An extension deficit of more than 5 degrees was measured in 3 cases. Of the 62 patients, 14 underwent further operations during the course of follow-up. Of these, 6 required bone grafting and 3 refixation of the implant due to implant loosening. Deep infections requiring several debridements occurred in 2 patients. No complications relating solely to the implant were observed. CONCLUSION: The LISS showed good overall results in the treatment of these difficult fractures. It is a good alternative to conventional extramedullary and intramedullary stabilizing techniques, especially in more complex fracture situations.

Adult↗

PubMed2005

Secondary effects of femoral instrumentation on pulmonary physiology in a standardised sheep model: what is the effect of lung contusion and reaming?

Intramedullary nailing is the treatment of choice for patients with femoral shaft fractures. However, there is an ongoing debate in multiple trauma patients with associated lung contusion when primary or secondary definitive stabilisation of the long bone fracture should be performed, as nailing is thought to play an important role in the pathogenesis of adult respiratory distress syndrome (ARDS). In a standardised sheep model, this study aimed to quantify the development of acute pulmonary endothelial changes, to assess the activation of polymorphonuclear leucocytes (PMNL) and to observe the effects on the coagulation system associated with the reamed nailing procedure. Furthermore, the effect of coexisting lung contusion in an experimental model was evaluated. The animals were randomly assigned to one of four different groups (6 animals/group). In control groups, only a sham operation (thoracotomy) was performed, whereas in study groups, lung contusion was induced prior to femoral stabilisation either by external fixation or reamed femoral nailing. Using bronchoalveolar lavage (BAL) pulmonary permeability changes were quantified and PMNL activation was assessed by chemiluminescence. Additionally PMNL diapedesis and interstitial lung oedema were determined by histological analysis. All animals were sacrificed 4 h after the start of the femoral instrumentation. Without an associated lung injury, instrumentation of the femoral canal with the reamed nailing technique induced a transient increase in pulmonary permeability. In the face of an induced lung contusion, reamed femoral nailing resulted in significant increases in PMNL activation, pulmonary permeability and interstitial lung oedema, compared with external fixation. Without pulmonary contusion, reaming of the femoral canal was associated with a transient increase in pulmonary permeability. This was exacerbated in the presence of lung contusion along with increased PMNL activation. External fixation did not provoke similar changes. The findings of this study support the view that reaming of the femoral canal should be avoided in polytrauma patients with severe chest trauma as it could act as an additional stimulus for adverse outcome. Temporary external fixation appears to be a safe method for fracture stabilisation until inflammatory and coagulatory disturbances after trauma have been normalized.

Animals↗

PubMed2005

Improvements in passive car safety led to decreased injury severity--a comparison between the 1970s and 1990s.

PURPOSE: The purpose of this study was to characterize changes in the mechanism and pattern of injury for vehicular trauma victims with modern vehicle design. Crash and injury severity were specifically investigated to isolate the influence of these improvements in vehicle design. METHODS: Since 1972, a local, prospective, assessment of vehicular trauma victims on-scene and at medical institutions providing care has been performed including the following parameters: delta-v, collision speed, type of road using, abbreviated injury scale (AIS), injury severity score (ISS), incidence of polytrauma or death. Victims (for restrained car occupants, bicyclists, pedestrians) injured between 1973 and 1978, and between 1994 and 1999 were compared. RESULTS: Lower crash severity (delta-v, collision speed) and injury severity (AIS, ISS, incidence of polytrauma or death) were measured for restrained car occupants, bicyclists and pedestrians during the later period. The correlation coefficient between delta-v or vehicle collision speed and ISS was higher in the earlier period for car occupants, cyclists and pedestrians. CONCLUSIONS: This study suggests that the observed reduction in injury severity in restrained car occupants, bicyclists and pedestrians is not only linked to the reduction of crash severity, but also related to improvements in vehicle design beyond seat-belt use. Passive car safety led to decreased injury severity--a comparison.

Accidents, Traffic↗

PubMed2005

Limb lengthening with the Intramedullary Skeletal Kinetic Distractor (ISKD).

OBJECTIVE: Callus distraction of the femur or tibia with an intramedullary distractor, which lengthens mechanically through alternating rotations of at least 3 degrees. INDICATIONS: Femoral or tibial shortening between 20 and 80 mm. Angular and rotational deformities can be corrected at the osteotomy site. CONTRAINDICATIONS: Open epiphyses. Small medullary canal (after intramedullary reaming femoral diameter < 14.5 mm, tibial diameter < 12.5 mm). Severe deformities. Insufficient compliance. Osteitis. Soft-tissue infections. SURGICAL TECHNIQUE: Supine position. Femoral shaft osteotomy at the proximal or middle third by multiple drill holes completed with a chisel. For lengthening of the tibia, osteotomy with a Gigli saw is preferred. Control of the rotation by two parallel 3.0-mm Kirschner wires. Correction of angular or rotational deformities. Via stab incision reaming of the medullary canal with a flexible reamer. The femur is overreamed 2.0 mm and the tibia 1.5 mm above the desired implant diameter. Insertion of the Intramedullary Skeletal Kinetic Distractor (ISKD) into the medullary canal and distal locking in freehand technique. Control of the rotation and of the osteotomy gap. Proximal locking with an aiming device. For femoral lengthening 3 days and for tibial lengthening 5 days postoperatively the distraction is begun by increasing mobilization with partial weight bearing, to achieve daily distraction of 1 mm. In case of insufficient distraction, additional rotations are performed by the patient while checking the external monitor that displays the daily and total distraction length. RESULTS: Intramedullary lengthening with the ISKD was performed in four patients having an average age of 29 years (18-36 years). Two femoral shortenings were combined with complex rotational and angular deformities. The average lengthening of three femora and one tibia was 31 mm (26-40 mm). The average intraoperative blood loss was 230 ml (110-320 ml), the mean surgical time 108 min (90-145 min). The average daily distraction amounted to 1.2 mm (0.9-1.8 mm). Full weight bearing was permitted after 10 weeks (7-14 weeks), return to regular work after 11 weeks (7-16 weeks). At follow-up examination of an average of 2.3 years postoperatively the knee range of motion was full. Consolidation was noted 80 days (51-111 days) postoperatively with an average consolidation index of 2.9 days/mm (1.8-4.1 days/mm). No complications were observed. According to the Paley Score all patients had an excellent outcome.

Adolescent↗

PubMed2005

[Internal fixation of sacroiliac joint disruption].

OBJECTIVE: Stabilization of the completely disrupted sacroiliac (SI) joint with two three-hole DC plates. INDICATIONS: Definitive treatment of the posterior pelvic ring in type C injuries (AO classification) with complete SI joint disruption, transiliac or transsacral fracture-dislocation of the SI joint with an insignificant, small fragment. Emergency stabilization of the SI joint following a laparotomy. CONTRAINDICATIONS: Poor general health of patient. Local soft-tissue damage. Rotationally unstable type B pelvic injuries. SURGICAL TECHNIQUE: Supine. Anterolateral approach to the iliac crest. Subperiosteal detachment of the iliac muscle. Debridement of the SI joint and reduction under direct vision. Stabilization of the SI joint with two three-hole DC plates inserted at an angle of 70-90 degrees. POSTOPERATIVE MANAGEMENT: Partial weight bearing on the injured side at 15 kg for 8-12 weeks with two forearm crutches. Implant removal 6-12 months after injury provided ankylosis has not occurred. RESULTS: In 27 patients with disruption of the SI joint consistent with a type C injury, the average displacement of the affected SI joint was 16 mm (8-30 mm). Complications relating to the osteosynthesis occurred as a deep infection in one patient, originating from a concomitant acetabular osteosynthesis. Iatrogenic nerve damage (lateral femoral cutaneous nerve) was present in two patients. 16 patients were followed up using radiologic techniques (pelvic, possibly inlet and outlet views, computed tomography). 13 SI joints healed in anatomic position. The malalignments observed were relatively slight (2-4 mm). There was no secondary implant failure. Almost all patients (n = 14) showed posttraumatic changes of the SI joint (osteophytes, arthrosis, ankylosis).

Adolescent↗

PubMed2005

[A simple supraacetabular external fixation for pelvic ring fractures].

OBJECTIVE: Closed reduction and maintenance of pelvic ring injuries by external stabilization. INDICATIONS: Emergency management of unstable type B and type C pelvic ring fractures. Definitive treatment of type B injuries. Definitive treatment of the anterior pelvic ring in type C injuries with transpubic instability after posterior internal stabilization. Adjunct stabilization of internal fixation. Stabilization of pelvic ring fractures in children. CONTRAINDICATIONS: Poor general condition. Local soft-tissue damage. Local infection. SURGICAL TECHNIQUE: Bilateral percutaneous insertion of Schanz screws into the supraacetabular area of iliac bone. Closed reduction and stabilization of the pelvic ring by compression and application of a connecting rod under image intensification. POSTOPERATIVE MANAGEMENT: Depending on the patient's condition and the degree of pelvic instability, a change to an open procedure may become necessary. Mobilization of the patient with partial weight bearing (one fifth of body weight) on the side of the injured posterior pelvic ring using forearm crutches, irrespective of the degree of stability of the pelvis. RESULTS: Retrospective analysis of 64 supraacetabular external fixator applications to stabilize the anterior pelvic ring in 20 type B and 44 type C injuries. Iatrogenic lesions of the lateral femoral cutaneous nerve: 4.5%; all sensory disturbances completely reversed within 1 year. No pin site infection. In two patients (3%) primary perforation of the Schanz screw into the small pelvis not necessitating any treatment. No secondary displacements of the anterior or posterior pelvic ring in type B injuries nor for type C injuries, sacral fractures associated with fractures of the pubic ramus. One pseudarthrosis of the pubic and ischial rami requiring surgical treatment.

Acetabulum↗

PubMed2005

Influence of workers' compensation eligibility upon functional recovery 10 to 28 years after polytrauma.

BACKGROUND: Previous studies have shown that work-related injuries are often associated with inferior outcomes. The aim of the current study was to compare the long-term functional outcome after polytrauma between work-related and non-work-related injuries at a minimum follow-up of 10 years. METHODS: Six hundred thirty-seven polytrauma patients were evaluated using a patient questionnaire and a physical examination. The average follow-up was 17.5 years (range 10-28 years); the average Injury Severity Score (ISS) was 20.7 (range 4 to 54). RESULTS: A multivariate analysis, with adjustments for age, sex, injury severity, and injury pattern, demonstrated that work-related injuries resulted in significantly inferior outcomes measured by the Hannove Score for Polytrauma Outcome (HASPOC), 12-Item Short-Form Health Survey (SF-12), requirement for medical aids and devices, length of rehabilitation, and retirement status (P < .05). CONCLUSIONS: Polytrauma patients receiving workers' compensation achieve significantly inferior long-term outcomes than other patients. The obtained results demonstrate that psychosocial variables such as insurance status have a significant impact on the functional recovery following polytrauma.

Accidents, Occupational↗

PubMed2005

Role of adhesion molecule ICAM in the pathogenesis of polymicrobial sepsis.

INTRODUCTION: Intercellular adhesion molecule-1 (ICAM-1) is thought to be involved in polymorphonuclear leukocytes (PMNL) recruitment and secondary organ damage in response to infection and inflammation. The precise role of ICAM-1 in disease progression is unknown and remains a topic of controversy. The aim of this study was to investigate the effect of ICAM-1 on histological changes and cytokine synthesis in a murine model of polymicrobial sepsis. METHODS: Polymicrobial sepsis was induced in experimental animals by caecal ligation and puncture (CLP). A control group was formed using sham laparotomy without CLP. In order to ascertain the role of ICAM-1 in the response, procedures were performed in both ICAM-1 knockout animals (ICAM-1-/-) and in C57BL/6 mice that were not genetically modified (wild type, WT). Clinical response was observed daily, morphological changes occurring in the lung and liver were studied using light microscopy and quantified using a scoring system. Plasma concentrations of various cytokines (TNF-alpha, IL-6, IL-10) were measured via ELISA. RESULTS: In ICAM-1-/- mice a less severe clinical response to induced sepsis was observed with significantly less weight loss and hypothermia. A significantly lower mortality rate was observed in ICAM-1-/- mice (12.5% vs. WT: 45.5%) and no significant histological changes were apparent in pulmonary or hepatic tissue on light microscopy following CLP. In WT animals however, significant evidence of leukocyte infiltration and interstitial thickening in pulmonary tissue was observed. Similarly, hepatic tissue sinusoidal widening and hydropic degeneration was present. In addition, pro- and anti-inflammatory cytokine synthesis in ICAM-1-/- animals was significantly attenuated when compared to WT mice. (ICAM-1-/-: TNF-alpha: 67.7+/-12.1pg/microl; IL-6: 208.9+/-26.7pg/microl; IL-10: 34.6+/-5.8pg/microl; WT: TNF-alpha: 840.7+/-150.2pg/microl; IL-6: 3100.2+/-1052.3 pg/microl; IL-10: 1550.1+/-495.7 pg/microl). DISCUSSION: This study suggests that ICAM-1 has an important pathophysiological role in the response to polymicrobial sepsis. It would appear that absence of this molecule impairs the ability of PMNL to migrate into organ tissues and reduces consequent secondary organ damage resulting in improved clinical status and overall survival. Further investigation into the effectiveness of ICAM-1 modulation in the treatment of sepsis is warranted.

Animals↗

PubMed2005

L-selectin: adhesion, signalling and its importance in pathologic posttraumatic endotoxemia and non-septic inflammation.

The leucocyte expressed surface-bound L-selectin belongs to the selectin family of adhesion molecules. It exhibits adhesive as well as signalling functions. Mainly, it is of importance in lymphocyte homing and in the extravasation of leucocytes into the surrounding tissue during inflammation. Acting in the initial step of the cell adhesion cascade, L-selectin is responsible for the rolling of leucocytes on endothelial layers. Therefore, L-selectin is thought to be an adequate target for pharmacological interventions. Beneath the discussion of the molecules' general features like molecule structure and its regulation, the review focuses firstly on L-selectin in the context of posttraumatic inflammatory disorders, and secondly on the importance of L-selectin specific signalling events.

Animals↗