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H C Pape

Publications and source records attributed to H C Pape.

At least 19 recordsLinked to original sources
PubMed2006

Accelerated bone healing and excessive callus formation in patients with femoral fracture and head injury.

The effect of head injury on systemic physiology, including bone healing is still a topic of vivid discussion. Whether the observed changes genuinely represent accelerated fracture healing or are a form of local heterotopic ossification remains unclear. We aimed to investigate whether in patients with long bone fractures the presence of head injury is associated with accelerated bone healing and excessive callus formation. In total 67 patients were studied 17 with head injury and 50 without head injury (25 treated with reamed and the other 25 with the unreamed nailing technique). Both groups were comparable in terms of age, sex, ISS. All underwent stabilisation of their femoral fracture with intramedullary nailing. The quantification of fracture healing response was estimated by taking the radiological ratio of the largest diameter of callus formed into two planes and the adjacent normal diameter of femoral canal. The minimum follow up of the patients was 12 months. In patients with head injury, the mean time to fracture union was significantly shorter than either the reamed or unreamed group (10.5 weeks compared with 20.5 and 26.9 weeks, p<0.001). The difference between the mean callus to diaphyseal ratio was statistically significant for both the AP and Lateral projections (AP: mean difference 0.462, 95% CI 0.312 to 0.602, p<0.0001, LAT: mean difference 0.289, 95% CI 0.142 to 0.436, p<0.001) with the head injured patients having more florid callus compared to the control group.

Adolescent↗
PubMed2005

Open pelvic fractures: epidemiology, current concepts of management and outcome.

Open pelvic fractures constitute one of the most devastating injuries in musculo-skeletal trauma and must be treated aggressively, incorporating a multidisciplinary approach. Early treatment, focusing on prevention of haemorrhage and sepsis, is essential. The management of associated soft tissue injuries must also be aggressive, including early administration of broad-spectrum antibiotics and repeated, meticulous wound debridement and irrigation. Selective faecal diversion, based on wound location, is compulsory and safe, minimising the risk of sepsis and reducing mortality rates.

Algorithms↗
PubMed2005

The impact of injuries below the knee joint on the long-term functional outcome following polytrauma.

Previous studies have suggested that the lower-extremities are among the most frequently injured body regions in polytrauma patients and have a major impact on the functional recovery following polytrauma. In particular, injuries to the distal part of the lower-extremity appear to be associated with a poor functional outcome. Therefore, the goal of this study was to evaluate the impact of injuries below the knee joint on the long-term functional outcome following polytrauma. Three hundred eighty-nine polytrauma patients with associated lower-extremity fractures and a minimum follow-up of 10 years were included in this study. All patients were examined by a doctor, using a patient questionnaire and a standardised physical examination. Significantly, inferior outcomes were seen in patients with fractures below the knee joint as measured by the modified Karlström-Olerud score, Lysholm score, range of motion, weight bearing status, Hannover score for polytrauma outcome (HASPOC), SF-12, Tegner activity score, and inability to work (P < 0.05). Fractures below the knee joint have a significant impact on the functional recovery following polytrauma. We suggest that delayed treatment, thin soft tissue envelope below the knee joint, high-energy trauma, unfavorable blood supply, and complex fracture patterns contribute to these unfavorable outcomes.

Adult↗
PubMed2004

[DRG reimbursement for multiple trauma patients -- a comparison with the comprehensive hospital costs using the German trauma registry].

UNLABELLED: The introduction of diagnosis related groups (DRG) will radically change the payment system for German hospitals. In 2002 the values for most DRG's were published for the german system (G-DRG). The polytrauma working group of the German Trauma Society developed a calculating algorithm to estimate the comprehensive hospital costs for every patient in the German trauma registry. The aim of this study was to compare these costs with the reimbursement according the the G-DRG's for a standardized population of polytrauma patients. MATERIAL AND METHODS: For polytrauma patients treated at Hannover Medical School in 2000 and 2001 the reimbursement according to the G-DRG's was calculated using a base value of 2900 euro. In the same patients the total cost of inpatient treatment was calculated according to the algorithm developed by the polytrauma working group of the German Trauma Society. The difference between these values represents the economic result. This was calculated as an overall result, but also for specific subgroups of patients (injury severity, mortality, G-DRG grouping). RESULTS: Datasets of 103 polytrauma patients were included. The following G-DRG's were most frequently occuring: A06Z (n=41), A07Z (n=16), W01Z (n=13). All other G-DRG's were documented less than 3 times. The mean reimbursement according to the G-DRG was 21.380+/-12.300 euro for a polytrauma patient. However, the mean hospital cost accounted to 34.274+/-22.501 euro, which resulted in a mean deficit of 12.893+/-15.534 euro. Analysis of subgroups revealed, that an ISS of more than 35 points, patients with a prolonged hospital stay and patients of the G-DRG group A06Z show a particularly negative result. CONCLUSION: The comprehensive hospital costs for treating polytrauma patients are on average 12.893 euro higher than the reimbursement according the G-DRG's. For hospitals to be fully reimbursed G-DRG values have to be reconfigured according to the German health care system. Thus, inclusion criteria to specific G-DRG have to be changed and a specific G-DRG group for very severely injured patients needs to be established.

Adult↗
PubMed2004

[Fracture of the medial femoral condyle as a complication of retrograde femoral nail removal].

A 26-year-old female patient with a femoral shaft fracture underwent retrograde femoral nailing. Nail removal was performed 2 years later, after fracture healing. An intraoperative fracture of the medial condyle of the femur occurred. This complication has not been previously described in the literature. Screw osteosynthesis of the fracture was performed and articular congruence reestablished. After 6 weeks of fractional weight bearing, the patient proceeded up to full weight bearing without complication. The case demonstrates that the removal of retrograde femoral nails is not without complications. The decision to undertake implant removal should be made carefully.

Adult↗
PubMed2004

[Evaluation of costs incurred for patients with multiple trauma particularly from the perspective of the hospital].

The aim of this study was to evaluate the costs involved in treating severely injured patients at the clinic differentiated by several characteristics (injury, age), sectors (emergency room, surgery, intensive and normal care), and kinds of costs (fixed costs, variable costs) and to determine influencing factors regarding costs based on the register of the DGU (Deutsche Gesellschaft für Unfallchirurgie). All patients were taken into account who had an injury severity score (ISS) of at least 16. On this basis costs of 3702 patients were analyzed. They were compared by using analysis of variance for different groups of patients classified according to kind of injury, severity of injury, and age. Moreover, multiple regression was performed to control the common influence of demographic factors and the type of injury on costs. The average ISS of the analyzed patients was 30.6 (+/-11.6) points. The average costs of the clinic were 32,166 (+/-25,404) EUR per patient. More than half of the costs was incurred by intensive care and about one-fourth by surgery. On average 30.6% were variable costs and 69.4% were fixed costs. The analysis of variance revealed that costs increased with advancing age and severity of injury (ISS). Multiple regression confirmed these interrelations indicating that extremities are very cost intensive. Due to the high portion of fixed costs, the overall costs strongly depend on the capacity utilization and less on hospital stay. That is why it may be necessary in the future to create centers for trauma care to maintain economic efficiency for treatment of these patients. Besides large differences of costs within closely defined groups of patients, hospitals carry a high economic risk so that a more complex reimbursement system should be discussed than implemented by the German DRGs.

Adult↗
PubMed2004

[Decision making and and priorities for surgical treatment during and after shock trauma room treatment].

OBJECTIVE: Concepts for optimal surgical treatment of the patient with blunt multiple injuries are being evaluated on the basis of the current literature. METHODS: Clinical trials were systematically collected (Medline, Cochrane and hand searches) and classified into evidence levels (1 to 5 according to the Oxford system). RESULTS: The posttraumatic clinical course is divided into four different periods: acute-, primary-, secondary- und tertiary period. The first and second period are important for life saving surgery and the stabilization of major fractures. After the cardiorespiratory systems have been stabilized, the following priorities have been formulated: head, face, spine, abdomen, extremities. To restrict the degree of operative burden on the patient it appears to be necessary to limit the duration of initial surgery to less than 6 hours. In patients at high risk to develop posttraumatic complications-"borderline patients"-it appears safer to perform only temporary fixation of major fractures. CONCLUSIONS: Three different factors determine the clinical course after polytrauma: Trauma represents the first hit, followed by the therapy-induced burden (second hit). In addition, the third hit is represented by the individual response. An evaluation of the clinical status by immunologic monitoring can be performed in order to assess the patient's status.

Clinical Trials as Topic↗
PubMed2004

[Knee para-articular focal dome osteotomy].

Focal dome osteotomy (FDO) is a cylindrically shaped osteotomy, with corresponding bone cuts rotating around the central axis of the deformity. Thus, complete correction can be achieved without secondary translation. FDO provides high adjustability of the bone ends, optimal bone contact, and high primary stability. As with straight cut closing, neutral, and opening-wedge osteotomies, FDO allows closing, neutral, and opening corrections. Opening FDO allows preservation of bone contact, whereas closing FDO does not require removal of bone stock. The osteotomy can be modified to tighten the medial collateral ligament. A FDO below the tuberosity does not compromise patellofemoral function and reduces the risk of intra-articular fractures. Sufficient bone stock of the proximal tibial or distal femoral fragment allows intramedullary stabilization. FDO is of high value in the treatment of sagittal plane and frontal plane corrections of the knee even in severe deformities.

Bone Malalignment↗
PubMed2004

Damage control orthopaedics in unstable pelvic ring injuries.

Pelvic ring injuries are often associated with other system injuries and require a multidisciplinary approach for their treatment. Early mortality is usually secondary to uncontrolled haemorrhage whereas late mortality is due to associated injuries and sepsis-induced multiple organ failure. The management of the pelvic fracture should be conceived as part of the resuscitative effort as errors in early management may lead to significant increases in mortality. In severely multiple injured patients who are in an 'unstable' or 'in extremis' clinical condition damage control orthopedics is the current treatment of choice. By performing limited surgical interventions the subsequent reduction in blood loss and transfusion requirements can only be beneficial in these critically ill patients, reducing the risk of developing systemic complications and early mortality.

Critical Care↗
PubMed2004

Traumatic brain injury and stabilisation of long bone fractures: an update.

In the era of "damage control orthopaedics", the timing and type of stabilisation of long bone fractures in patients with associated severe traumatic brain injury has been a topic of lively debate. This review summarises the current evidence available regarding the management of these patients. There appear to be no clear treatment guidelines. Irrespective of the treatment protocol followed, if secondary brain damage is to be avoided at all times, ICP monitoring should be used, both in the intensive care unit and in the operating theatre during surgical procedures, since aggressive ICP management appears to be related to improved outcomes. Treatment protocols should be based on the individual clinical assessment, rather than mandatory time policies for fixation of long bone fractures.

Arm Injuries↗
PubMed2004

Predicting outcome after multiple trauma: which scoring system?

We have undertaken a review of the commonly used scoring systems to identify advantages and possible pitfalls involved in their use. Currently, there is a variety of systems available for scoring trauma severity. Some of them are based on the anatomical description of the injuries, whilst others are based on physiological parameters. The most widely used systems for the purpose of predicting outcome after trauma are based on combined anatomical and physiological parameters. Systems such as the Injury Severity Score (ISS) and the Trauma Injury Severity Score (TRISS) have served some useful purposes and have proved popular over time, but it now seems that there is no ideal scoring system available. The task of incorporating various factors such as pre-existing morbidity, age, immunological differences and different genetic predispositions has made the prospect of creating a universally acceptable and applicable trauma-scoring system extremely arduous, if not impossible. Therefore caution should be exercised when using any of the existing scoring systems until an ideal one becomes available.

APACHE↗
PubMed2003

Trauma care in Germany.

Trauma Care in Germany fulfils all requirements to deal with injured young and mobile individuals as well as with an increasing number of injured elderly patient. Furthermore, it is prepared to cope with mass casualties of injured. As a public task the Trauma System in Germany is well organized and follows clear cut demands. To perform technical and medical therapy at highest available level as soon as possible, a ground system of physician staffed ambulances is supported by a network of physician-staffed HEMS all over Germany. Therefore, enormous efforts in financing, basic research and quality management have been undertaken during recent years to create such a sophisticated rescue system.

Accidents, Traffic↗
PubMed2003

[Open reduction and internal fixation of unstable sacral fractures].

Sacral fractures are frequently misdiagnosed or overlooked, as the majority of the patients are suffering from polytrauma situations. Obvious clinical signs both of the fracture and the associated neurological complications are missing. A poor longterm outcome with pain and urogenital disorders is frequent. Based on clinical and biomechanical studies a new concept for internal fixation of transsacral pelvic instabilities combined with decompression of the central canal is applied. To approach the sacrum, a posterior longitudinal incision is carried out and can be modified according to the fracture pattern. Decompression and anatomic reduction is performed and the fracture stabilized with minimized small fragment implants which are solely fixed in the sacrum. 32 patients were treated according to this protocol between 1989 and 1996. Bony healing occurred in all but one case. A complete anatomical sacral reconstruction was achieved in 80 % of the cases, another 16 % had close to anatomic (< 5 mm) reconstruction. In eight cases a primary neurologic deficit was present, with five complete or partial recoveries directly postoperative. Complications occurred in seven patients with two secondary displacements.

Adolescent↗
PubMed2002

Review: systemic effects of femoral nailing: from Küntscher to the immune reactivity era.

Intramedullary nailing is the preferred treatment for stabilizing femoral diaphyseal fractures. Despite the superior biomechanical advantages over other implants, its use especially in some selected groups of patients, has been questioned because of possible harmful systemic effects of intramedullary reaming. The lung seems to be the primary target for fat embolization and for mediated effects by inflammatory reactions. The latter are initiated in the immediate aftermath after injury, and femoral nailing can amplify these responses. The role of reaming in the context of early femoral fracture fixation in the patient experiencing trauma is debatable. This review article focuses on the evidence that has emerged during the past century regarding the systemic effects of femoral nailing.

Animals↗
PubMed2001

Axonal connections of thalamic posterior paralaminar nuclei with amygdaloid projection neurons to the cholinergic basal forebrain in the rat.

Stimulation of the amygdala elicits cortical activation mediated by the corticopetal basal forebrain. An unresolved question is whether the involved amygdala neurons that project to the basal forebrain receive direct thalamic input. Using combined retrograde and anterograde tracing techniques, we demonstrate a monosynaptic contact between thalamic posterior paralaminar nuclei axons and neurons in the central amygdala that project to corticopetal cholinergic basal forebrain regions. These contacts may constitute the morphological substrate for the induction of fast cortical arousal and attention triggered by emotional events.

Amygdala↗