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Introducción. Los pacientes con Covid-19 tienen el riesgo de presentar síndrome de dificultad respiratoria aguda, por lo que pueden requerir ventilación mecánica y traqueostomía. De este modo, la decanulación es un proceso importante que está a cargo del equipo rehabilitador. Objetivos. Describir y caracterizar el proceso de decanulación en pacientes traqueostomizados con COVID-19 para identificar posibles factores que influyen en su realización exitosa. Métodos. Estudio descriptivo transversal realizado en los pacientes que fueron sometidos a traqueostomía entre junio de 2020 y julio del 2021 en la Clínica de Alta Complejidad Santa Bárbara de Palmira, Colombia. Las variables categóricas se presentaron con porcentajes y para las cuantitativas se contrastó la hipótesis de normalidad a través de la prueba de Kolmogorov-Smirnov. Resultados. Los pacientes, al momento de ingreso, tenían características de severidad, con un promedio de PaO2/FiO2 de 99,7 mmhg y bloqueo neuromuscular hasta por 20 días; el tiempo promedio de ventilación mecánica fue 17,3 días. A todos los pacientes el equipo de rehabilitación les realizó intervención; de los 15 pacientes incluidos, tres no fueron decanulados. Se realizó un análisis descriptivo de los objetivos y de la interven- ción realizada por cada disciplina; para los tres pacientes no decanulados se analizaron las principales barreras y los predictores del fracaso de una decanulación. Conclusión. Gracias a la instauración de un plan constante y activo de rehabilitación multidisciplinario en el que los pacientes reciben intervención desde su ingreso hasta su egreso se logró decanular de manera exitosa al 80% de los pacientes traqueostomizados.

Introducción: El COVID-19 ha generado retos por la alta demanda de servicios, haciendo necesario buscar alternativas de soporte ventilatorio que permitan responder a las necesidades de la población.Es importante disponer de herramientas que permitan detectar precozmente el fracaso de estrategias ventilatorias no invasivas e identificar tempranamente la necesidad de intubación. Objetivo: identificar las variables asociadas a fracaso en el tratamiento con cánula de alto flujo (CNAF) en pacientes con COVID-19. Materiales y Métodos: estudio observacional analítico, corte transversal con 68 pacientes de la unidad de cuidados intensivos con COVID-19, que recibieron tratamiento con CNAF. Las variables de estudio se evaluaron en tres momentos, a las 24, 48 y 72 horas, llevando a cabo un análisis bivariado y multivariado entre los que fracasaron y los que tuvieron éxito. Resultados: en el análisis bivariado las variables que presentaron una relación estadísticamente significativa a las 24h fueron el no presentar un aumento del trabajo respiratorio (Wresp) (p=0.000) y saturación de oxígeno (SatO2) normal (p=0.006). A las 48h: no aumento en Wresp (p=0.014), SatO2 normal (p=0.005), presión arterial de oxígeno/fracción inspirada de oxígeno (PAFI) leve o moderado (p=0.039). A las 72h fracasaron: PAFI severa (p=0.000), aumento de Wresp (p=0.001) y el índice de ROX menor a 4.88 (p=0.023). De acuerdo con el análisis multivariado las variables predictoras de fracaso a las 24h fueron: FIO2, SatO2, Wresp y a las 48h FIO2 y SatO2. Conclusiones: el aumento de FIO2>70 %, presentar incremento del Wresp y SpO2 menor de 88 % son variables asociadas a fracaso de la CNAF y facilitan tomar decisiones clínicas sobre avanzar o no hacia un soporte ventilatorio invasivo.

Nutrition status is health relating to the use of eating pattern by body. Belawan Public Health center ranked4 with malnutrition status with the total of 196 (3.1%) below Medan Labuhan, Medan Helvetia, and MedanTuntungan. Malnutrition mostly occured at environment 15 that is, 8 babies suffering from malnutrition outof 2.047 babies, and 2 babies having bad nutrition. The research aims at finding out the relationshipbetween dependent and independent variables at environment 15, families of Pekan Labuhan, PekanLabuhan regency of Medan Labuhan in 2015. The research method is Cross sectional using total samplingtechniqe that 40 familes were taken as samples having babies. The research data were taken byperforming home visits from house to house, visiting to integrated post service (Posyandu) with interviewguide and questionnaires. The result of the study showed that 2 respondents (5%) experiencedmalnutrition, 8 respondents (20%) suffered from less nutrition and 30 respondents (75%) experiencedgood nutrition. Based on bivariate analysis, it was found that there was a dependent variable not having asignificant relationship with baby nutrition status; that is, variable of family income ( ρ-value = 0.108) and 4independent variables have a significant relationship with baby nutrition status; that is, variable of mother’s(ρ-value = 0.000), and the number of family member (ρ-value = 0.027). The research concludes that thereis a significant relationship between mother knowledge, mother attitude, mother education and the numberof family members on the baby nutrition status. Public Health Center is suggested to provide counseling tomothers having babies continually Mothers are suggested to visit Public Health Center routinely to checkup their baby nutrition

Governor is a turbine speed regulator where the governor is the one who regulates the amount of water that enters the turbine as the initial driver. This arrangement is done by the governor unit that works with its functions in case of frequency changes in the system. Therefore the frequency raised is the same as that used by consumers, and the frequency will decrease if the power needs used by consumers are greater than those raised. Then the governor serves as a rotation guard on the generator to be in the frequency of 50 Hz. The change of a load will affect the output voltage of the generator, if the load rises then the generator output voltage drops and if the load drops then the generator output voltage rises. In order for the output voltage of the generator still needed a generator output voltage regulator.

The COVID-19 pandemic has necessitated adaptation of cancer patient care. Oncology patients who contract COVID-19 have poor outcomes. Telemedicine clinics (teleclinics) have been introduced for cancer patients to reduce the risk of horizontal transmission at St. Bartholomew’s Hospital and The Royal Free Hospital in London. Teleclinics have become routine in many specialities; however, inclusion in oncology care was not standard prior to the pandemic. A mixed-methods survey was designed and delivered to cancer patients (n = 106) at St. Bartholomew’s Hospital and The Royal Free Hospital who had transitioned to teleclinics in March 2020. The survey explored patients’ perceptions of this format. In total, 96 (90.5%) patients consented to take part, across a range of tumour types. Overall, respondents reacted favourably to the format of the teleclinics, with 90.6% of respondents (87/96) stating they would utilise teleclinics beyond the pandemic. Additionally, a survey was distributed to clinicians delivering these teleclinics (n = 16) to explore previous training in, perceptions of, and lessons learned from the introduction of telemedicine. Results suggest patients are accepting of teleclinic use for most clinical purposes. Teleclinic implementation affords benefits to cancer patient care both during and after COVID-19, but there is an urgent need for telemedicine education in oncology specialty training. Supplementary Information The online version contains supplementary material available at 10.1007/s13187-021-02053-8.

An electric motor is an electro-magnetic device that converts electrical energy into mechanical energy. This mechanical energy is used to, for example, rotate a pump impeller, fan or blower, drive a compressor, lift materials, etc. Electric motors are also used at home (mixers, electric drills, wind fans) and in industry. Electric motors are sometimes called the "workhorse" of industry because it is estimated that they use about 70% of the industry's total electrical load. And at this time the power from the power source, namely PLN (State Electricity Company) often changes in voltage. Therefore, it is necessary to know by calculating the rotation and input power which is influenced by changes in the load of an induction motor as an illustration of induction motors in society which generally use single-phase induction motors. In this article, a 4 HP cage rotor 3-phase induction motor with a voltage of 380/220 volts is used in the electrical energy conversion laboratory of FT-UHN.

Aseptic prosthetic loosening and periprosthetic joint infections (PJI) are among the most frequent complications after total knee/hip joint arthroplasty (TJA). Current research efforts focus on understanding the involvement of the immune system in these frequent complications. Different immune cell types have already been implicated in aseptic prosthetic loosening and PJI. The aim of this study was to systematically analyze aspirates from knee and hip joints, evaluating the qualitative and quantitative composition of soluble immunoregulatory markers, with a focus on co-inhibitory and co-stimulatory markers. It has been shown that these molecules play important roles in immune regulation in cancer and chronic infectious diseases, but they have not been investigated in the context of joint replacement. For this purpose, aspirates from control joints (i.e., native joints without implanted prostheses), joints with TJA (no signs of infection or aseptic loosening), joints with aseptic implant failure (AIF; i.e., aseptic loosening), and joints with PJI were collected. Fourteen soluble immunoregulatory markers were assessed using bead-based multiplex assays. In this study, it could be shown that the concentrations of the analyzed immunoregulatory molecules vary between control, TJA, AIF, and PJI joints. Comparing TJA patients to CO patients, sCD80 was significantly elevated. The marker sBTLA was significantly elevated in AIF joints compared to TJA joints. In addition, a significant difference for eight markers could be shown when comparing the AIF and CO groups (sCD27, sCTLA-4, sCD137, sCD80, sCD28, sTIM-3, sPD-1, sBTLA). A significant difference was also reached for nine soluble markers when the PJI and CO groups were compared (sLAG-3, sCTLA-4, sCD27, sCD80, sCD28, sTIM-3, sPD-1, IDO, sBTLA). In summary, the analyzed immunoregulatory markers could be useful for diagnostic purposes as well as to develop new therapeutic approaches for AIF and PJI.

Background: Clavicular shortening often occurs after midclavicular fractures and its impact on functional outcomes has thus far been evaluated solely by radiographic and surgeon-based measures, with divergent findings.

Key Points Question Do individuals with autism show atypical duration of brain functional connections? Findings In this cohort study of 52 individuals with autism and 38 typically developing participants and a replication study of 1402 participants in a brain imaging database, increased durations of functional connections in autism were found in both distributed networks and individual brain regions, which were associated with metrics of disease severity. Meaning Persistence of brain connectivity in autism may limit the ability to rapidly shift from one brain state to another and contribute to the pathophysiology of autism., Importance Despite reports of widespread but heterogeneous atypicality of functional connectivity in individuals with autism, little is known regarding the temporal dynamics of functional brain connections and how they relate to autistic traits. Objective To investigate differences in temporal synchrony between brain regions in individuals with autism and those with typical development. Design, Setting, and Participants This cohort study, conducted at the University of Utah, included 90 adolescent and adult male participants. A larger sample from the multisite Autism Brain Imaging Data Exchange (ABIDE) was also used as a replication sample. The study includes data acquired between December 2016 and April 2018. Aggregate data included in the replication sample were released to the public in August 2012 (ABIDE I) and June 2016 (ABIDE II). Data analysis were conducted between January 2018 and April 2018. Exposures Male individuals diagnosed as having autism (n = 52) and typically developing male individuals (n = 38). Main Outcomes and Measures Long duration (30 minutes/individual) of multiband, multiecho functional magnetic resonance imaging was acquired to estimate functional connectivity between brain regions. Sustained connectivity, a measure of functional connectivity duration, as well as lagged temporal dynamics related to functional connectivity, were compared between groups for 361 gray matter regions of interest and a 17-network parcellation. Lagged findings were replicated in the larger ABIDE sample (n = 1402). Sustained connectivity findings were also associated with behavioral and cognitive variables. Results In 52 males with autism (mean [SD] age, 27.73 [8.66] years) and 38 control males with typical development (mean [SD] age, 27.09 [7.49] years), increases in both sustained and functional connectivity at several lags were found in individuals with autism compared with the control group. Group differences in functional connectivity were replicated in the larger ABIDE data set at a 6-second lag. Measures of symptom severity in individuals with autism were positively associated with sustained connectivity values. In the control group, sustained connectivity was negatively associated with cognitive processing. A replication sample (n = 1402) composed of 579 individuals with autism (80 female and 499 male; mean [SD] age, 15.08 [6.89] years) and 823 in the control group (211 female and 612 male; mean [SD] age, 15.06 [6.79] years) from the ABIDE data set was also analyzed. Conclusions and Relevance Whereas the magnitude of functional connectivity in autism is variable across brain regions, participant samples, and development, prolonged temporal synchrony of functional connections is reproducibly observed in autism, suggesting a potential mechanism for core symptoms., This cohort study investigates the differences in temporal synchrony between brain regions in individuals with autism and those with typical development.

Supplementary Information results. (PDF 8812Â kb)

Item does not contain fulltext PURPOSE: Stable fixation of distal humerus fracture fragments is necessary for adequate healing and maintenance of reduction. The purpose of this study was to measure the reliability and accuracy of interpretation of postoperative radiographs to predict which implants will loosen or break after operative treatment of bicolumnar distal humerus fractures. We also addressed agreement among surgeons regarding which fracture fixation will loosen or break and the influence of years in independent practice, location of practice, and so forth. METHODS: A total of 232 orthopedic residents and surgeons from around the world evaluated 24 anteroposterior and lateral radiographs of distal humerus fractures on a Web-based platform to predict which implants would loosen or break. Agreement among observers was measured using the multi-rater kappa measure. RESULTS: The sensitivity of prediction of failure of fixation of distal humerus fracture on radiographs was 63%, specificity was 53%, positive predictive value was 36%, the negative predictive value was 78%, and accuracy was 56%. There was fair interobserver agreement (kappa = 0.27) regarding predictions of failure of fixation of distal humerus fracture on radiographs. Interobserver variability did not change when assessed for the various subgroups. CONCLUSIONS: When experienced and skilled surgeons perform fixation of type C distal humerus fracture, the immediate postoperative radiograph is not predictive of fixation failure. Reoperation based on the probability of failure might not be advisable. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic III.

Hintergrund: Komplexe Sprunggelenksfrakturen sind haufige Verletzungen des alten Menschen. In der eigenen Klinik wurde in diesem Patientengut in Einzelfallen eine Diskrepanz zwischen den praoperativ erhobenen Befunden der konventionellen Rontgenaufnahmen und den intraoperativen Befunden hinsichtlich der Frakturmorphologie beobachtet. Es wurde deshalb die Hypothese formuliert, dass bei alteren Patienten viele therapierelevante Verletzungen im Rontgenbild nicht erkannt werden. Die Dokumentation einer mehrfragmentaren Fraktursituation am oberen Sprunggelenk ist erlosrelevant. Material und Methoden: Fur die Untersuchung konnten die kompletten Daten und praoperativen Rontgenbilder von 84 Patienten mit Sprunggelenksfrakturen in einem Alter von uber 60 Jahren retrospektiv ausgewertet werden. Hierbei handelte es sich um 59 Frauen und 25 Manner im mittleren Alter von 69,9 Jahren (Range 60–90 Jahre). Die OP-Berichte und die praoperativen konventionellen Rontgenbilder wurden hinsichtlich folgender Kriterien analysiert: mehrfragmentare Ausenknochelfraktur, Innenknochelfraktur, posteriores Kantenfragment, knocherner Ausriss der vorderen Syndesmose. Es wurden die Sensitivitat, die Spezifitat, der positiv pradiktive Wert, der negativ pradiktive Wert, die Pravalenz sowie die Genauigkeit berechnet. Ergebnisse: Die Pravalenz der einzelnen Lasionen betrug in dem hier analysierten Kollektiv fur eine mehrfragmentare Ausenknochelfraktur 24 %, fur eine Innenknochelfraktur 38 %, fur eine Beteiligung des hinteren Volkmann-Dreiecks 25 % und fur einen knochernen Ausriss der vorderen Syndesmose 22,6 %. Mehrfragmentare Ausenknochelfrakturen (Sensitivitat 0 %) und knocherne Ausrisse der vorderen Syndesmose (Sensitivitat 5 %) wurden im konventionellen praoperativen Rontgenbild kaum erkannt. Innenknochelfrakturen und Frakturen des hinteren Volkmann-Dreiecks wurden im konventionellen Rontgenbild mit einer ausreichenden Sensitivitat (96,8 %/76,2 %) und Spezifitat (jeweils 100 %) erkannt. Schlussfolgerungen: Die hier vorliegende Untersuchung hat gezeigt, dass bei alteren Patienten in einem Viertel der Falle mit komplexen Sprunggelenksfrakturen zu rechnen ist. Mehrfragmentare Ausenknochelfrakturen entziehen sich dem Nachweis auf dem konventionellen Rontgenbild. Die Indikation zur praoperativen CT-Untersuchung sollte groszugig gestellt werden, um intraoperativ nicht von einer mehrfragmentaren Situation uberrascht zu werden. Der MDK sollte bei Fallprufungen auf den intraoperativ dokumentierten Befund und nicht auf den praoperativen Rontgenbefund zuruckgreifen, wenn es darum geht zu entscheiden, ob eine mehrfragmentare Sprunggelenksfraktur vorliegt.

Antecedentes: La infección con la varicela zoster es mundial. La incidencia varía por grupos de edad, localización geográfica. En Colombia la transmisibilidad el virus se favorece por la multiplicidad de climas, aspectos geográficos y atmosféricos. En el año 2016 se notificaron 112.400 casos, 34.037 en población adulta, 744 fueron población privada de la libertad (PPL). La definición de brote en establecimientos carcelarios se da a partir de un caso. Condiciones de hacinamiento y el contexto social hacen interesante conocer el estudio de brote y las medidas de implementación realizadas.Objetivo: Describir los factores de riesgo, características demográficas y evaluar medidas de control de la varicela en el Centro de Prisiones y Prisiones de Seguridad Moderada(EPMSC) de Cali de 2017 a 2018Métodos: Se realizó un estudio observacional descriptivo de corte transversal entre el 2017 al 2018 en PPL, mediante registros, entrevistas y fichas de notificación se analizaron variables de tiempo, lugar y persona, se realizaron distribuciones de frecuencias, se calcularon medidas de tendencia central, tasas de ataque y proporciones por pabellón.Resultados: Fue un brote de fuente propagada, se registraron 146 casos. La tasa de ataque del brote (2017) fue de 2.2% y en 2018 fue de 0.4%. El pabellon con mayor tasa de ataque (2017) fue el 5 (4.9%) y en 2018 el 1A (2.5%). El hacinamiento en el 2017 fue de 264% y en el 2018 de 192%.Conclusiones: El hacinamiento y las condiciones de salud en los centros penitenciarios dificultan el control oportuno de las epidemias.

The problem of the level of influence of soil carrying capacity is one of the things needed to be considered in a planning and work of a civil construction. This is because the soil serves as a medium that withstands the load or action of the construction built on it. Stabilization using sand materials is one way to meet the necessary power requirements. Weather and temperature changes in the field are factors making the ground unstable. Type of stabilized soil is silt originating from jl.Pancasila Batangkuis Regency Deliserdang. This research was conducted using mixed sand with mixed variations of 25%, 40%, 55% and 65%. Then, DST testing and Index properties were done for each sample. Based on the results of this test the soil obtained classification According to AASHTO criteria that is that this land including silt land or with a general assessment as the soil very well up to very well. This is because the plasticity (PI) of the soil sample is 8.69

Introduction Stoma closure is one of the most frequently performed surgeries. The common complications are surgical site infection (SSI) and poor scar cosmesis. Purse-string sutures are expected to have less incidence of SSI due to the free drainage of secretions from the wound and possibly the early detection of a wound infection. Compared to the conventional linear closure, the purse-string closure technique is expected to have less wound infection, improved scar cosmesis, and good patient satisfaction because of a smaller size scar. Hence, a well-structured study is required to substantiate the advantage of this technique. Methodology This randomized control trial was carried out for two years in a tertiary care centre in Southern India. Patients with various stoma reversals, including colostomy, as well as ileostomy reversal, were included in the study. Patients were divided into Group I - conventional linear skin suturing (n = 40) and Group II - purse-string closure (n = 40). After the closure of rectus muscle, the skin is closed using the purse-string method (subcuticular) in the experimental group. Results Both the groups were comparable with respect to age, gender, body mass index (BMI), the presence of co-morbidities, and indication for surgery. Stomal procedures were done (26.3%) for malignant cases. The difference in mean hospital days for both groups were statistically insignificant (11.95 vs. 9.9; p = 0.927). The incidence of SSI between the groups were statistically significant (17 vs. 3; p = 0.003). The mean Patient and Observer Scar Assessment Scoring (POSAS) scores between the groups (65.30 vs. 83.40; p = 0.012) were statistically significant. This proved significant improvement in scar cosmesis in purse-string skin closure. At one month postoperative, the purse-string group had better patient satisfaction (3.08 vs. 4.48; p = 0.001), which was evidenced by a mean Likert 3 scale score. The mean visual analogue scale (VAS) score did not show any significant difference in pain between the groups. Conclusion Purse-string skin closure for stoma reversal had significantly less incidence of SSI. The duration of antibiotic therapy was also less in purse-string skin closure patients as compared to linear skin closure patients. Purse-string skin closures significantly improved the scar outcome and patient satisfaction.

Background: Clavicular shortening often occurs after midclavicular fractures and its impact on functional outcomes has thus far been evaluated solely by radiographic and surgeon-based measures, with divergent findings.

Das Ziel der hier vorliegenden Untersuchung bestand in einer patientenorientierten Erfassung der Schulterfunktion und der verbliebenen Beschwerden nach diaphysaren Klavikulafrakturen in Bezug auf eine Verkurzungsfehlstellung. Grundlage der hier vorgestellten Analyse sind die Daten eines Kollektivs von 172 erwachsenen Patienten (Alter 39 ± 14 Jahre) mit verheilten Klavikulafrakturen, die operativ (n = 108) oder konservativ (n = 64) behandelt wurden. Als Vergleichskollektiv dienten 35 schultergesunde Erwachsene und 25 Patienten mit Pseudarthrosen nach konservativer Behandlung. Erfasst wurden die subjektive Einschatzung der Schmerzstarke auf einer visuellen Analogskala (VAS 0–100 Punkte), der relative Constant-Score, der Kolner Klavikulascore, der DASH-Score (Disabilities of the Arm, Shoulder and Hand) sowie die Langendifferenz der Klavikula im Seitenvergleich. Patienten mit einer Klavikulalangendifferenz ≥ 2 cm beklagten signifikant (p

The purpose of this study was to investigate comorbid psychiatric disorders and psychotropic medication use among adults with autism spectrum disorder (ASD) ascertained as children during a 1980's statewide Utah autism prevalence study (n = 129). Seventy-three individuals (56.6 %) met criteria for a current psychiatric disorder; 89 participants (69.0 %) met lifetime criteria for a psychiatric disorder. Caregivers reported a psychiatric diagnosis in 44 participants (34.1 %). Anxiety disorder had the highest current and lifetime prevalence (39.5 and 52.7 %, respectively). Participants with intellectual disability (n = 94, 72.8 %) were significantly less likely to have community-based diagnoses of anxiety (χ(2) = 5.37, p = 0.02) or depression (χ(2) = 13.18, p 0.001) reported by caregivers. Seventy-six participants (58.9 %) were taking ≥1 psychotropic medication. Comorbid psychiatric disorders occur frequently in adults with ASD, though identifying these disorders poses a challenge in community settings. A greater understanding of the presentation of these conditions within this population will increase assessment validity and the potential for efficacious intervention.

Klavikulaschaftfrakturen gehoren mit einer Inzidenz von 64/100.000 zu den haufigen Frakturen. Ende der 1990er Jahre wurde die elastisch-stabile intramedullare Schienung mit Prevot-Nageln beschrieben, die eine minimalinvasive Stabilisierung der Fraktur und damit eine sofortige Ubungsstabilitat und schnelle Belastbarkeit ermoglicht. Heute erfreut sich diese Technik wegen der fur die Patienten geringen Belastung und schneller Rekonvaleszenz groser Beliebtheit. Wurden fruher fast alle Frakturen konservativ therapiert, wird heute eine deutlich grosere Anzahl operativ behandelt. Bei groben Dislokationen und/oder Verkurzungen von uber 1,75 cm sollte bei 2- und 3-Fragment-Frakturen eine intramedullare Schienung erfolgen, da sie funktionell zu besseren Ergebnissen fuhrt, als die konservative Therapie. Wenn eine geschlossene Reposition nicht moglich ist, kann offen reponiert werden. Bei dislozierten mehrfragmentaren Frakturen und bei Pseudarthrosen ist die Plattenosteosynthese die Therapie der ersten Wahl.

Item does not contain fulltext OBJECTIVES: There is substantial variation in the classification and management of scapula fractures. The first purpose of this study was to analyze the interobserver reliability of the OTA/AO classification and the New International Classification for Scapula Fractures. The second purpose was to assess the proportion of agreement among orthopaedic surgeons on operative or nonoperative treatment. DESIGN: Web-based reliability study. SETTING: Independent orthopaedic surgeons from several countries were invited to classify scapular fractures in an online survey. PARTICIPANTS: One hundred three orthopaedic surgeons evaluated 35 movies of three-dimensional computerized tomography reconstruction of selected scapular fractures, representing a full spectrum of fracture patterns. MAIN OUTCOME MEASUREMENTS: Fleiss kappa (kappa) was used to assess the reliability of agreement between the surgeons. RESULTS: The overall agreement on the OTA/AO classification was moderate for the types (A, B, and C, kappa = 0.54) with a 71% proportion of rater agreement (PA) and for the 9 groups (A1 to C3, kappa = 0.47) with a 57% PA. For the New International Classification, the agreement about the intraarticular extension of the fracture (Fossa (F), kappa = 0.79) was substantial and the agreement about a fractured body (Body (B), kappa = 0.57) or process was moderate (Process (P), kappa = 0.53); however, PAs were more than 81%. The agreement on the treatment recommendation was moderate (kappa = 0.57) with a 73% PA. CONCLUSIONS: The New International Classification was more reliable. Body and process fractures generated more disagreement than intraarticular fractures and need further clear definitions. 01 maart 2014

Tourette's syndrome (TS) is a developmental disorder that has one of the highest familial recurrence rates among neuropsychiatric diseases with complex inheritance. However, the identification of definitive TS susceptibility genes remains elusive. Here, we report the first genome-wide association study (GWAS) of TS in 1285 cases and 4964 ancestry-matched controls of European ancestry, including two European-derived population isolates, Ashkenazi Jews from North America and Israel and French Canadians from Quebec, Canada. In a primary meta-analysis of GWAS data from these European ancestry samples, no markers achieved a genome-wide threshold of significance (P

Das Ziel dieser Arbeit bestand in der Erstellung eines Scores zur Beurteilung der Behandlungsergebnisse von Frakturen des mittleren Klavikuladrittels. Hierzu wurden 172 Patienten im Mittel 15 Monate nach dem Unfallereignis untersucht. Als Kontrollgruppe dienten 45 gesunde Probanden. Der sog. „Klavikulascore“ basiert auf einem System aus 3 Partneritems plus der Beurteilung des Rontgenbildes. Als Partneritems wurden die Elemente mit den signifikantesten Mittelwertveranderungen bezogen auf die Einteilung der objektiven Partner ermittelt. Scorewertbeurteilungsgrenzen (sehr gut, gut, masig, schlecht) wurden festgelegt. Zur Validierung des Bewertungssystems wurde eine lineare Regressionsanalyse bezogen auf 2 etablierte Bewertungssysteme (Constant-Score/DASH-Score) durchgefuhrt. Mit einem Korrelationskoeffizienten R=0,756 (Constant) und R=0,687 (DASH) wurde gezeigt, dass die Aussagen valide sind. Zur Prufung der Reliabilitat wurde der Reliabilitatskoeffizient Cronbach’s α gebildet, der mit einem Wert von 0,8241 eine hohe Reliabilitat zeigt. Der Klavikulascore ist ein wenig aufwendiges, valides und reliables Instrument zur Beurteilung der Behandlungsergebnisse nach Frakturen des mittleren Klavikuladrittels.

Die elastisch stabile intramedullare Nagelung bei Klavikulafrakturen des mittleren Drittels ist ein sicheres Operationsverfahren bei Frakturen der Typen A und B nach der Orthopaedic-trauma-association- (OTA-)Klassifikation. Im vorliegenden Fall fuhrten die Verwendung eines Kirschner-Drahts sowie die nicht korrekte Durchfuhrung der Operationstechnik zu einer Pseudarthrose. Nach Revision und Anwendung eines elastischen Titannagels kam es zur knochernen Ausheilung.

Nonoperative treatment has long been the norm for clavicle fractures. However, more recent evidence indicates that shortening or poorly healed fractures lead to considerable loss of arm function. A logical treatment algorithm for clavicle fractures based on up-to-date scientific data was developed, and the operative technique of intramedullary nailing of the clavicle is here described and demonstrated with instructive diagrams. Along with surgical indications, the preoperative, perioperative, and postoperative management is detailed. Operative hints and tricks are explained, the known complications and pitfalls of the procedure are analyzed, and avoidance strategies are offered.

Recent MRI studies have indicated that regions of the temporal lobe including the superior temporal gyrus (STG) and the temporal stem (TS) appear to be abnormal in autism. In this study, diffusion tensor imaging (DTI) measurements of white matter in the STG and the TS were compared in 43 autism and 34 control subjects. DTI measures of mean diffusivity, fractional anisotropy, axial diffusivity, and radial diffusivity were compared between groups. In all regions, fractional anisotropy was significantly decreased and both mean diffusivity and radial diffusivity were significantly increased in the autism group. These results suggest that white matter microstructure in autism is abnormal in these temporal lobe regions, which is consistent with theories of aberrant brain connectivity in autism.

Background: Although the anatomy and physiology of the venous circulation of the ankle and midfoot are well documented, the physiologic importance of forefoot mobility has not been reported in the literature. The question of this study was whether the first metatarsophalangeal (MTP) joint may operate, like the ankle, as a “pump” to encourage venous return. Methods: Forty-nine cadaver foot specimens were examined using dissection, plastination, vessel infiltration, and maceration, and radiographic (including venography, MRI, and magnetic resonance angiography) techniques. The anatomy and physiology were described and compared to the ankle joint. Forty patients had biphasic Doppler flow studies. Results: The major finding was the medial drainage of the plantar venous sinus, which is fibrotically bound to the joint capsule. Functional venous valves were evident distally and within fibrous vascular lumens. Mobilization of the first MTP joint led to compression and emptying of the veins. Passive mobilization of the first MTP joint led to an average flow increase of 55% ± 7 ( p < 0.0001), while active movement led to an average increase of 78% ± 7 ( p < 0.0001). Conclusions: Our described connection between the joint capsule and veins indicates a “toe-ankle pump” with a significant increase of venous blood flow during motion of the MTP joint. Possible clinical applications for an external MTP pump include anti-edema or thromboprophylactic therapy, especially in patients with foot or ankle injuries. A new toe-pump has been designed based on these results.

Trotz der gunstigen Prognose weisen 10–30% der konservativ behandelten Patienten mit Klavikulafraktur unbefriedigende Ergebnisse auf. Die vorgestellte Technik der intramedullaren Osteosynthese beruht auf einer langstreckigen intramedullaren Stabilisierung durch die elastische Verspannung eines geraden Titannagels in der S-formig gebogenen Klavikula nach dem Prinzip der „elastisch stabilen intramedullaren Nagelung“. Bei mit dieser Methode versorgten 132 Patienten (136 Klavikulafrakturen) zeigte sich, dass die Reposition der Fraktur und die Herstellung einer elastischen Stabilitat am Frakturspalt Voraussetzung fur eine rasche postoperative Schmerzfreiheit und Beweglichkeit der verletzten Schulter sind. In einer prospektiv vergleichenden Untersuchung konnten 53 Patienten mit Klavikulafraktur frei zwischen konservativer und operativer Behandlung wahlen (27 konservativ/26 operativ). Hinsichtlich Schmerzen, subjektiver Zufriedenheit, asthetischem und funktionellem Ergebnis, Arbeitsunfahigkeit, Langendifferenz, Constant- und DASH-Score waren die Resultate nach Operation signifikant besser als nach konservativer Behandlung. Die vorgestellte Methode ist somit bei Klavikulafrakturen des mittleren Drittels der Typen A und B der OTA-Klassifikation am ausgewachsenen Skelett indiziert.

Avascular necrosis is a well-known, severe complication postfracture or subluxation of the talus. Type and localization of injury often permit conclusions regarding the probability of bone necrosis. In the following case, talar neovascularization was demonstrated after severe trauma, resulting in an open pilon fracture of the right tibia and complete talar dislocation with consequent destruction of the most relevant blood supply. This example shows that even after apparently irreversible injury to the arterial circulation, immediate bony reconstruction with comprehensive soft tissue management is indicated and can lead to bony healing. The anatomy of intraosseus vascularization is reviewed and discussed.

Depression among methamphetamine users is more prevalent in females than males, but gender-specific treatment options for this comorbidity have not been described. Reduced brain phosphocreatine levels have been shown to be lower in female methamphetamine users compared to males, and, of relevance, studies have demonstrated an association between treatment-resistant depression and reduced brain phosphocreatine concentrations. The nutritional supplement creatine monohydrate has been reported to reduce symptoms of depression in female adolescents and adults taking antidepressants, as well as to increase brain phosphocreatine in healthy volunteers. Therefore, the purpose of this pilot study was to investigate creatine monohydrate as a treatment for depression in female methamphetamine users.Fourteen females with depression and comorbid methamphetamine dependence were enrolled in an 8-week open label trial of 5 g of daily creatine monohydrate and of these 14, 11 females completed the study. Depression was measured using the Hamilton Depression Rating Scale (HAMD) and brain phosphocreatine levels were measured using phosphorus magnetic resonance spectroscopy pre- and post-creatine treatment. Secondary outcome measures included anxiety symptoms, measured with the Beck Anxiety Inventory (BAI), as well as methamphetamine use, monitored by twice weekly urine drug screens and self-reported use.The results of a linear mixed effects repeated measures model showed significantly reduced HAMD and BAI scores as early as week 2 when compared to baseline scores. This improvement was maintained through study completion. Brain phosphocreatine concentrations were higher at the second phosphorus magnetic resonance spectroscopy scan compared to the baseline scan; Mbaseline = 0.223 (SD = 0.013) vs. Mpost-treatment = 0.233 (SD = 0.009), t (9) = 2.905, p.01, suggesting that creatine increased phosphocreatine levels. Also, a reduction in methamphetamine positive urine drug screens of greater than 50% was observed by week 6. Finally, creatine was well tolerated and adverse events that were related to gastrointestinal symptoms and muscle cramping were determined as possibly related to creatine.The current study suggests that creatine treatment may be a promising therapeutic approach for females with depression and comorbid methamphetamine dependence. This study is registered on clinicaltrials.gov (NCT01514630).

Objective: Obsessive-compulsive disorder (OCD) and Tourette's syndrome are highly heritable neurodevelopmental disorders that are thought to share genetic risk factors. However, the identification of definitive susceptibility genes for these etiologically complex disorders remains elusive. The authors report a combined genome-wide association study (GWAS) of Tourette's syndrome and OCD.Method: The authors conducted a GWAS in 2,723 cases (1,310 with OCD, 834 with Tourette's syndrome, 579 with OCD plus Tourette's syndrome/chronic tics), 5,667 ancestry-matched controls, and 290 OCD parent-child trios. GWAS summary statistics were examined for enrichment of functional variants associated with gene expression levels in brain regions. Polygenic score analyses were conducted to investigate the genetic architecture within and across the two disorders.Results: Although no individual single-nucleotide polymorphisms (SNPs) achieved genome-wide significance, the GWAS signals were enriched for SNPs strongly associated with variations in brain gene expression levels (expression quantitative loci, or eQTLs), suggesting the presence of true functional variants that contribute to risk of these disorders Polygenic score analyses identified a significant polygenic component for OCD (p=2x10(-4)), predicting 3.2% of the phenotypic variance in an independent data set. In contrast, Tourette's syndrome had a smaller, nonsignificant polygenic component, predicting only 0.6% of the phenotypic variance (p=0.06). No significant polygenic signal was detected across the two disorders, although the sample is likely underpowered to detect a modest shared signal. Furthermore, the OCD polygenic signal was significantly attenuated when cases with both OCD and co-occurring Tourette's syndrome/chronic tics were included in the analysis (p=0.01).Conclusions: Previous work has shown that Tourette's syndrome and OCD have some degree of shared genetic variation. However, the data from this study suggest that there are also distinct components to the genetic architectures of these two disorders. Furthermore, OCD with co-occurring burette's syndrome/chronic tics may have different underlying genetic susceptibility compared with OCD alone.

ObjectiveObsessive-compulsive disorder (OCD) and Tourette's syndrome are highly heritable neurodevelopmental disorders that are thought to share genetic risk factors. However, the identification of definitive susceptibility genes for these etiologically complex disorders remains elusive. The authors report a combined genome-wide association study (GWAS) of Tourette's syndrome and OCD.MethodThe authors conducted a GWAS in 2,723 cases (1,310 with OCD, 834 with Tourette's syndrome, 579 with OCD plus Tourette's syndrome/chronic tics), 5,667 ancestry-matched controls, and 290 OCD parent-child trios. GWAS summary statistics were examined for enrichment of functional variants associated with gene expression levels in brain regions. Polygenic score analyses were conducted to investigate the genetic architecture within and across the two disorders.ResultsAlthough no individual single-nucleotide polymorphisms (SNPs) achieved genome-wide significance, the GWAS signals were enriched for SNPs strongly associated with variations in brain gene expression levels (expression quantitative loci, or eQTLs), suggesting the presence of true functional variants that contribute to risk of these disorders. Polygenic score analyses identified a significant polygenic component for OCD (p=2×10(-4)), predicting 3.2% of the phenotypic variance in an independent data set. In contrast, Tourette's syndrome had a smaller, nonsignificant polygenic component, predicting only 0.6% of the phenotypic variance (p=0.06). No significant polygenic signal was detected across the two disorders, although the sample is likely underpowered to detect a modest shared signal. Furthermore, the OCD polygenic signal was significantly attenuated when cases with both OCD and co-occurring Tourette's syndrome/chronic tics were included in the analysis (p=0.01).ConclusionsPrevious work has shown that Tourette's syndrome and OCD have some degree of shared genetic variation. However, the data from this study suggest that there are also distinct components to the genetic architectures of these two disorders. Furthermore, OCD with co-occurring Tourette's syndrome/chronic tics may have different underlying genetic susceptibility compared with OCD alone.

Das Ziel der hier vorliegenden Untersuchung besteht in einer vergleichenden Analyse des Regeneratgewebes in einem chondralen Knorpeldefekt der Schafsfemurkondyle nach autologer De-novo-Knorpeltransplantation. Bei 48 Schafen wurde an der medialen Femurkondyle ein chondraler Knorpeldefekt mit einem Durchmesser von 4 mm platziert. 12 Defekte wurden der spontanen Heilung uberlassen, 16 Defekte mit einem Periostlappen bedeckt, und 20 Defekte wurden mit einem autologen De-novo-Knorpeltransplantat gefullt. Im Vergleich zu den Kontrollgruppen wurde die Transplantatgruppe sowohl nach 26 Wochen als auch nach 52 Wochen signifikant (p

An experimental cadaver model was used to assess the effects of a malunited fracture of the middle third of the clavicle on the functional anatomy of the shoulder joint. Anatomic samples were prepared with simulated shortening and axial malposition of the clavicle. From these, alterations in glenoid fossa position were measured and depicted graphically. Healing of clavicle fractures with bony shortening leads to a ventromedialcaudal shift in glenoid fossa position. The following malpositions of the clavicle lead to the respective glenoid fossa positional changes: caudal deviation leads to a mediocaudal shift, cranial deviation leads to a dorsolateral shift of the glenoid fossa, ventral deviation causes a ventrolateral shift, dorsal deviation leads to mediocaudal shift of the fossa, cranial rotation leads to ventrolateral shift in fossa position, and caudal rotation leads to a dorsomedial shift in glenoid fossa position. Clinical implication of these data is that bony shortening in combination with caudal displacement leads to distinct functional deficits in abduction, particularly overhead motion. Using the above data, a vector model was created to calculate position of the glenoid fossa dependent on clavicle position/malposition. The model is a valuable tool to be used for planning open reduction and fixation of clavicular fractures or malunions.

The Kiddie Schedule for Affective Disorders and Schizophrenia was modified for use in children and adolescents with autism by developing additional screening questions and coding options that reflect the presentation of psychiatric disorders in autism spectrum disorders. The modified instrument, the Autism Comorbidity Interview-Present and Lifetime Version (ACI-PL), was piloted and frequently diagnosed disorders, depression, ADHD, and OCD, were tested for reliability and validity. The ACI-PL provides reliable DSM diagnoses that are valid based on clinical psychiatric diagnosis and treatment history. The sample demonstrated a high prevalence of specific phobia, obsessive compulsive disorder, and ADHD. The rates of psychiatric disorder in autism are high and are associated with functional impairment.

Fractures of the distal end of the radius are common injuries and are the commonest bony injury around the wrist. Management of these fractures has remained controversial as far as modality of treatment is concerned. There are aggressive concepts with open reduction and internal fixation with plates and minimally invasive pinning after closed reduction. The latter treatment concept is evaluated using own data and results from the literature. Percutaneous pinning is used as treatment alternativ in ASIF A2 and A3 fractures. In C3 type fracture they can play an important part as supplementary adjunct in combination with external fixation or plates. Furthermore percutaneous pinning techniques can be used in distal radius fractures in children with dislocation. Elderly patients with type C fractures do gain superior results in functional outcome using this technique than with reduction and casting alone. Percutaneous pinning is very cost-effective in comparison to plating. When using correct indications this technique can provide excellent functional results.

Intramedullary fixation is used increasingly to treat clavicular fractures. Anatomical variations in the clavicle of relevance to this procedure are analyzed. The length, diameters and curvature of the clavicle were measured in 196 specimens from the dissecting room. The calcium bone density was analyzed in 300 cross-sectional samples of 100 specimens. The thickness of cortical and medullary bone of 70 slices was analyzed from freshly plastinated clavicles with implants in place. The female clavicle was shorter, less curved, and had a lower concentration of calcium than the male clavicle. Measurement of cortical thickness showed a mean value of 1.05 +/- 0.23 mm at the most sternal measuring point, 2.05 +/- 0.29 mm at the midpoint of the clavicle, and 0.95 +/- 0.35 mm at the acromial end. The thinnest regions were the medial ventral cortex and the dorsal acromial cortex. These measurements explain clinical observations on nail perforation. The diameter of the medullary canal measured 6.7 +/- 2.6 mm at its narrowest part, so that reaming (i.e., predrilling the medullary canal) prior to 3.5 mm titanium nail insertion is not necessary. The main difficulties encountered when placing a nail are secondary to the S-curvature of the clavicle. In 80% of fractures, the break is located at the narrowest diameter of the medullary canal. Thus, the clavicle displays definite gender- and side-specific anatomical features in terms of length, diameter, curvature, and calcium concentration. These should be considered when performing intramedullary fixation.

Eighteen patients with intraarticular calcaneal fractures treated with open reduction and internal fixation and augmentation with an injectable carbonated apatite cement. Functional follow-up studies using the Zwipp Foot Score and densitometry were performed at 6-month intervals postoperatively. Histological samples of biopsies obtained at the time of hardware removal (6 months postoperatively) were also analyzed. The use of bone cement led to intermediate-term functional outcomes that were no better than those reported with conventional surgical procedures using bone graft. Patients demonstrated postoperative difficulties similar to those seen in other studies of this fracture, including pain, subtalar motion restrictions, peroneal impingement, and difficulties on uneven terrain and with toe- and heel-walking. However, compared to patients treated surgically without injectable carbonated apatite cement, full weight bearing on the affected extremity was regained at an average 4 weeks postoperatively. In addition, autogenous bone graft was not required to fill the osseous defect using this technique, minimizing morbidity and discomfort. During the present observation period of 3 years, only a slight decrease in the density of the peripheral zones of the cement block was observed. Histological examination revealed fibrous bone formation resulting from remodelling processes. Complete resorption and remodeling of the bone cement were not complete at 3 years. One patient developed a postoperative wound infection. Another displayed cement loosening secondary to failure of bony ingrowth.

Reduction and intramedullary fixation of midclavicular fractures with an elastic titanium nail with the goal to reduce pain and to quickly resume activities of daily living postoperatively. Midclavicular fractures types A and B according to the OTA (Orthopaedic Trauma Association) classification of fractures. Surgery > 3 weeks after trauma. Fractures type C according to the OTA classification. Osteoporosis. Skin incision just above the sternal end of the clavicle. Approximately 1 cm lateral to the sternoclavicular joint, a hole is drilled into the anterior cortex. A titanium nail varying in diameter between 2.5 to 3.5 mm is mounted on a universal chuck with a T-handle. With oscillating movements the titanium nail is advanced until it reaches the fracture site. If closed reduction maneuvers are unsuccessful, an additional skin incision has to be made at the level of the fracture site enabling direct manipulation of the fragments. Postoperatively, no immobilization is performed. Patients are encouraged to move the arm as much as tolerated and to use it in daily activities. Intramedullary fixation was applied to 136 clavicle fractures in 132 patients (89 men, 43 women, mean age 32.9 years). In 78 fractures closed reduction was successful. Average subjective pain assessment using a visual analog scale decreased from 72.4 points preoperatively to 18.9 points 3 days postoperatively. Average shoulder abduction increased significantly. The average Constant-Murley clinical outcomes score 1 year after implant removal was 97.1 points.

Das Ziel der hier vorliegenden Untersuchung bestand in der prospektiven Erhebung der Ergebnisse nach der elastisch stabilen intramedullaren Nagelung von Klavikulapseudarthrosen. In einem Zeitraum von 2,5 Jahren konnten 14 Patienten in die Untersuchung einbezogen werden. Ausschlusskriterien waren Pseudarthrosen bei pathologischen Frakturen, Infektpseudarthrosen, atrophe Pseudarthrosen, knocherne Defekte, vorausgegangene operative Masnahmen, ein Patientenalter 70 Jahre. Die Ergebnisse wurden nach 3, 6, 12 und 18 Monaten evaluiert. Die subjektive Schmerzempfindung, die Zufriedenheit der Patienten, der Constant- und DASH-Score waren ab dem 3. postoperativen Monat signifikant (p

vor als eine Beteiligung der Brust- (n=10) oder Halswirbelsaule (n=1). In 15 Fallen wurde aus Blutkulturen oder intraoperativen Gewebebiopsien Staphylococcus aureus (davon in 6 Fallen MRSA) nachgewiesen. Methodik. Bei Destruktion eines einzelnen Bewegungssegments (n=7) wurde nach ventralem Debridement, Biopsiegewinnung und Applikation von PMMA-Ketten zweizeitig die ventrale Fusion mit einem eingefalzten Beckenkammspan ausgefuhrt. Bei 29 Patienten mit einer Beteiligung von 2 (n=27) oder 3 (n=3) Bewegungssegmenten erfolgte primar die gegebenenfalls erforderliche Laminektomie (n=4), die dorsale Instrumentierung und die ventrale Sanierung. Nach Stabilisierung des Allgemeinzustandes und bei makroskopisch unzweifelhaftem Implantatlager wurde die ventrale Fusion mit trikortikalem Span oder Cage in Verbindung mit einem Platten- oder Fixateur-interne-System mehrzeitig abgeschlossen.

The objective of this retrospective study was to compare the results of two operative techniques used for the treatment of distal radius fractures classified as AO type A3. Patients were treated with either fixed-angle volar plates or intrafocal Kirschner wires (K-wires) using a Kapandji-like technique. The functional results were determined with the Gartland & Werley Score as well as the DASH Score after an average follow-up of 28 months. 55 patients were included in the study. Of these, 33 were female and 22 male, with an average age of 59 years. In patients < 60 years, the Gartland Score was 1.4 points in the fixed-angle volar plate group, and 4.6 points in the Kapandji group. In patients ≥ 60 years, no significant difference between the therapy groups could be ascertained. The DASH Score measured 17 points in each group. In all cases, a satisfactory reduction was obtained. The Kapandji group experienced significantly more loss of reduction position at follow-up in terms of volar tilt and radioulnar inclination than the fixed-angle volar plate group. These results show that intrafocal K-wire fixation in older patients is a suitable method to attain and hold sufficient bony reduction. However, younger patients achieve better radiologic and functional results when treated with open reduction using the 3.5-mm LCP fixed-angle volar plate.

With an incidence of 64/100,000, clavicular shaft fractures are one of the most common fractures. Intramedullary fixation with Prevot nails was initially reported in the late 1990s. This procedure offers minimally invasive stabilization of the fracture, thus enabling immediate mobilization and rapid loading capacity. Using a case study, the positioning and procedure are demonstrated on video. The intramedullary implant accommodates the varying tension loading of the clavicle. This treatment is ideal for clavicular fractures with 2-3 fragments. Compared to patients treated conservatively, operated patients achieve more rapid and improved mobility. Employment disability is shorter, and malunion occurs less frequently.

Biodegradierbare Implantate ermoglichen eine Fixierung osteochondraler Frakturen ohne spatere Metallentfernung. Je nach Implantatzusammensetzung und -abbaugeschwindigkeit werden Fremdkorper- und Weichteilreaktionen unter der Degradation beschrieben. Einem Polyl-L/DL-Laktid-Stift (Polypin) wurden 10% Trikalziumphosphat beigesetzt, um die Degradationseigenschaften zu verbessern. Im Tierversuch uber 3 Jahre konnten ein vollstandiger Abbau der Implantate und Ersatz des Lagers mit Knochen oder Narbe belegt werden. Anschliesend wurden 78 Patienten operiert und im Mittel nach 39 Monaten (1,5–85 Monaten) klinisch und konventionell radiologisch nachuntersucht. An der Schulter wurden 5, am Ellenbogen 42, an der Hufte 12, am Knie 7 und am Fus 12 Patienten mit biodegradierbaren Implantaten versorgt. Alle Frakturen heilten ohne Dislokation mit guten funktionellen Ergebnissen aus. Fremdkorper- oder Weichteilreaktionen aufgrund der Implantate wurden nicht beobachtet. Verglichen mit den Literaturwerten waren die klinischen Ergebnisse gleichwertig oder besser.