Search

Der Einfluss der Unfallkinematik auf die Verletzungen der Halswirbelsaule (HWS) findet in den gangigen Klassifikationssystemen neben dem Kraftvektor aktuell keine Berucksichtigung. Inwieweit die Unfallstarke einen zusatzlichen Einfluss auf Zahl und Komplexitat der Verletzungen hat und ob sich dies klassifizieren lasst, ist noch nicht abschliesend untersucht. Inwieweit hat neben der Kraftrichtung auch die Kraftstarke Einfluss auf Verletzungen der HWS? Anhand der AOSpine-Klassifikationen fur die obere und subaxiale HWS erfolgte eine retrospektive Fallauswertung von 134 Traumapatienten. Analog der S3-Polytrauma-Leitlinie erfolgten eine Zuordnung in 6 Unfallgruppen und die Einteilung der Verletzungsmorphologie anhand der CT-Schnittbildgebung. Eine hohere Unfallenergie hat einen signifikanten Einfluss auf die Anzahl an Verletzungen (p = 0,005). Bei Niedrigrasanzunfallen ist C2 der am haufigsten verletzte Wirbelkorper (WK) (51 %; p = 0,022), bei Hochrasanzunfallen C7 (37 %; p = 0,017). Auserdem lies sich zeigen, dass die obere HWS bei steigendem Alter und niedriger Unfallenergie vermehrt bei weiblichen (z. B. Sturz aus dem Stand) und die untere HWS bei Hochrasanzunfallen bei jungeren mannlichen Patienten verletzt ist (p = 0,012). Eine genaue Kenntnis des Unfallmechanismus ist bei der Traumaversorgung hilfreich. Verletzungsmuster konnen besser abgeschatzt und die angemessene Diagnostik eingeleitet werden. Die Ergebnisse unterstreichen erneut die Wichtigkeit einer konsequenten HWS-Immobilisation auch bei Bagatelltraumata. Bei Hochrasanzunfallen ist die untere HWS haufiger verletzt, insbesondere C7. Aufgrund der Haufung mehrsegmentaler Verletzungen ist die radiologische Abklarung der gesamten WS nach Hochrasanztrauma zu empfehlen.

Soft tissue sarcomas are a heterogeneous group of neoplasias that due to their often clinically silent appearance often remain undetected or experience delayed treatment. Especially soft tissue swelling is often misinterpreted by patients and doctors and trivialized or verified with an incorrect biopsy technique. The hereby evoked complications for the patients are serious and may be reduced by simply following the available guidelines. The treatment of soft tissue sarcomas requires a close interdisciplinary coordination between specialists in tumor orthopedics, oncology, radiology, pathology and radiotherapy. On the basis of a selective literature review, the following article points out the current evidence on the treatment and illustrates a treatment algorithm.Weichteilsarkome sind eine heterogene Gruppe von seltenen Neoplasien, die aufgrund ihrer anatomischen Lage und ihres oft inapparenten klinischen Erscheinungsbildes eine häufig zu spät diagnostizierte Tumorentität darstellen. Gerade weichteilige Schwellungen werden initial oft fehlinterpretiert und im Gegensatz zu den gängigen Behandlungsleitlinien bagatellisiert oder inkorrekt biopsiert. Die daraus resultierenden Komplikationen sind für den Patienten gravierend und können durch Befolgen gewisser Behandlungsgrundsätze minimiert werden. Die Behandlung der Weichteilsarkome kann nur im interdisziplinären Kontext unter Einbeziehung von chirurgischen Fächern, Onkologie, Pathologie und Strahlentherapie gelingen und sollte beginnend mit der Biopsie an Tumorzentren durchgeführt werden. Dieser Übersichtsartikel versucht, anhand einer selektiven Literaturrecherche eine Übersicht über die aktuelle Evidenzlage zur Behandlung dieser Tumorentität aufzuzeigen und einen Behandlungsalgorithmus darzustellen.

Background Conventional radiography (CR) is the imaging method of choice in monitoring bone remodelling and other stability parameters after total hip arthroplasty (THA). Quantitative roentgen- or computed-tomography-based methods to determine bone density are prone to metal artifacts and often very costly, which is why they are not used as standard in a clinical setting. Since subjective assessment of bone remodelling in CR also has a certain susceptibility to errors, semi-quantitative methods have been developed to help approximate periprosthetic bone density development via CR to open up an additional tool for documentation of radiographic THA follow-up. Objective Proof-of-principle of a newly designed imaging-software-aided method to measure relative bone density around the femoral stem in a series of conventional radiographs following THA. Methods Eighty-six patients with hip modular tapered, fluted titanium stems were selected from the clinical database and series of baseline and postoperative follow-up radiographs were obtained after 24 and 48 weeks. Relative bone densities were measured per Gruen zones G1-7 with the use of an open-source image analysis package (ImageJ) by means of greyscale histograms. In addition, subjective evaluation of selected cases was performed by three independent, blinded orthopedic surgeons. Besides descriptive and nonparametric analyses, intra-class correlation (ICC) was performed and objective and subjective results were compared by linear regression analysis. Results Two individual cases are presented as a proof-of-principle. Increase or decrease of bone density could be measured correctly over time in each case. In a collective analysis there were no significant differences in mean relative bone densities between groups after 24 and 48 weeks, although a positive tendency was visible towards increased bone formation over time. Individual analyses by Gruen zones revealed that some zones, namely the proximal ones (e.g. G6), exhibit a broader scattering than others over time. This could be explained by the design of the evaluated tapered revision stem that achieves distal fixation and allows for proximal micromotion. Correlation analysis with subjective ratings (inter-rater reliability ICC = 0.71) showed a positive correlation with objective results, suggesting a feasibility of the method for clinical use. Conclusions In conclusion the presented method is an easy and accessible tool to quantify relative bone density changes during THA follow-up. It shows a positive correlation to established subjective assessment of bone remodelling and may therefore serve as a quantitative supplement in clinical documentation.

The second part of this review deals with the several options for the surgical therapy of bone metastases according to their anatomical site and the patient's individual prognosis. Although metastases to the bone - with few exceptions - are normally given palliative therapy, patients nowadays reach survival times of several months to years, depending on the underlying tumour entity. Scoring systems are suitable to estimate the patient's prognosis and fracture risk. The indication for operation has to be adapted to these parameters. In order to preserve a high quality of life, a limb saving procedure has to be aimed at. The options include the resection of the metastasis with stabilisation, the sole stabilisation of the affected bone, and wide resection with limb reconstruction using a modular tumor endoprosthesis. With today's anaesthesiological peri- and intraoperative care, a vast number of surgical implants and bone augmentations are available. However, what is important is not the practicability of the procedure, but the oncological justification and patient-adapted selection of surgical therapy.Der vorliegende 2. Teil dieser Übersichtsarbeit befasst sich mit den unterschiedlichen operativen Therapiemöglichkeiten von Skelettmetastasen in Abhängigkeit von deren Lokalisation und der individuellen Prognose des Patienten. Obwohl im Falle der ossären Metastasierung mit wenigen Ausnahmen von einem palliativen Therapieschema ausgegangen wird, erreichen die Patienten dennoch Überlebensraten von mehreren Monaten bis Jahren in Abhängigkeit von der zugrunde liegenden Tumorentität. Zur Abschätzung der Prognose und Frakturgefährdung stehen verschiedene Scores zur Verfügung. Die Operationsindikation ist immer im Zusammenhang mit der Prognose und patientenindividuell zu stellen. Im Sinne des Erhaltens einer hohen Lebensqualität ist prinzipiell eine extremitätenerhaltende Therapie anzustreben. Diese lässt sich unterteilen in eine Resektion der Metastase mit Stabilisierung der Extremität, der alleinigen Stabilisierung sowie der weiten Resektion mit ossärer und funktioneller Defektrekonstruktion mittels einer Tumorendoprothese. Mit den heutigen Möglichkeiten der intra- und perioperativen Patientenversorgung ist eine Vielzahl von Implantaten und Möglichkeiten der Augmentation von metastatischen Knochendefekten verfügbar. Im Vordergrund steht jedoch nicht die chirurgische Durchführbarkeit, sondern die onkologisch sinnvolle und patientengerechte Wahl der Therapie und des operativen Vorgehens.

Intervertebral vacuum phenomenon (IVP) is mainly seen as a sign of degenerative disc diseases. Although studies have shown that IVP also occurs after traumatic injuries to the spine, its clinical relevance in spinal fractures remains unknown. Therefore, the aim of this study was to analyse the prevalence, demographic parameters and fracture morphology in patients with fracture-associated IVP (FAVP) of the thoracolumbar spine. In this retrospective cohort study, patients with traumatic fractures of the thoracolumbar spine who were admitted between January 2014 and December 2015 were included. CT scans were assessed for the presence of intervertebral areas of gaseous radiolucency, which were defined as IVP. Fractures were classified according to the AOSpine Thoracolumbar Spine Injury Classification System. Demographic and anamnestic data, including age, sex and trauma mechanism, were documented. A total of 201 patients with 305 fractures were included. Seventy-three patients with 98 fractures had follow-up CTs. Sixty-eight patients had IVP, of whom 46 patients had FAVP. On the follow-up CT, a significant correlation was found between A3 fractures and FAVP, while initial FAVP was significantly correlated with age and low-velocity trauma mechanisms. Initial degenerative IVP also showed a significant correlation with age. FAVP occurred significantly more often in burst fractures and therefore may lead to disc degeneration due to nutritional supply disturbances via the vertebral endplate. As surgical management strategies for burst fractures are intensively discussed, the appearance of FAVP should be taken in consideration.

The rising number of medical publications makes it difficult to keep up-to-date on scientific knowledge. In recent years, reviews in the form of narrative or systematic publications and meta-analyses have increased. These can only be interpreted and evaluated if the reader understands the techniques used. This review article describes the differences between narrative and systematic reviews, together with the characteristics of meta-analysis, and discusses their interpretation. The concept of systematic reviews and meta-analysis includes a systematic literature search and summary, together with an appraisal of the quality of the publications. Systematic reviews are often considered to be original studies due to their structure and ability to reduce bias.

Durch Storung des Wachstums, z. B. im Rahmen einer kongenitalen Huftluxation, eines Morbus Perthes oder einer bakteriellen Coxitis, kann bei Kindern und Jugendlichen durch Fehlwachstum eine typische Deformitat des proximalen Femur mit verkurztem Schenkelhals und hochstehendem Trochanter major entstehen. Von Morscher und Buess wurde bereits 1988 eine Schenkelhalsverlangerungsosteotomie zur Therapie Erwachsener beschriebenen. Wir zeigen erstmalig die Modifikation der „Morscher-Osteotomie“ bei Kindern und Jugendlichen mit einem winkelstabilen Osteosynthesesystem. Ziel der schenkelhalsverlangernden Osteotomie ist die bestmogliche Wiederherstellung der normalen Anatomie mit anatomischer Schenkelhalslange und einer weitgehend artikulotrochantaren Distanz bei Kindern und Jugendlichen. Alle klinisch relevanten Deformierungen des proximalen Femur mit kurzem Schenkelhals und konsekutivem Trochanterhochstand. Eitrige Koxitis innerhalb der letzten zwei Jahre; erhohte Infektparameter. Unzureichende Zentrierung des Femurkopfs im Azetabulum. Zwei Osteotomieschnitte. Erste Osteotomie im Bereich des Trochanter major. Distalisierung des Trochanterfragments, anschliesende intertrochantare Femurosteotomie. Stabilisierung mittels winkelstabiler Platte (130°-Padiatrie-Huftplatte, Fa. Synthes, Oberdorf, Schweiz). Bis 55 kg Korpergewicht schmerzadaptierte Vollbelastung; >55 kg Korpergewicht Teilbelastung fur 6 Wochen postoperativ. Bei 5 weiblichen Patienten (mittleres Alter 11,67 Jahre) traten intra- und postoperativ keine Komplikationen auf; nach 6–12 Wochen negatives Trendelenburg-Zeichen; nach 3–6 Monaten nahezu freier Bewegungsumfang.

Patellar resurfacing (PR) in total knee arthroplasty (TKA) is still one of the major controversies in orthopaedic surgery today. The aim of the present retrospective case-control study was to identify predictors for secondary patellar resurfacing (SPR) after initial TKA to create a rationale for surgeons to decide which patients to resurface primarily. It was hypothesized that proper TKA implantation and component positioning as well as a maintained physiological patellar geometry will lead to a reduced risk of SPR. Overmore, it was hypothesized that intrinsic factors like overweight might also have an influence on the need for SPR. After identification of suitable patients and age/sex matching in a 1:2 fashion, 29 cases (TKA/SPR) and 58 controls (TKA) were included and screened for available clinical and epidemiological data as well as for radiographic data after primary TKA. Pearson’s correlation analysis as well as logistic regression modeling was performed to identify possible predictors for SPR following TKA. Binary logistic regression was able to correctly classify 88.5% of patients into case or control groups. It indicated that patella tilt, patella height, and thickness as well as the delta angle were significant predictors of a need for SPR following primary TKA. An increase in patellar width by 1 mm will increase the risk of SPR, while an increase in patellar thickness by 1 mm will reduce it. An increase in patellar tilt by 1° will also increase the risk of SPR. Finally, an increase in delta angle by 1° will again reduce the risk of SPR. Easy and accessible radiographic measurements have been identified as possible predictors of SPR following primary TKA. Although indication for primary PR may still remain a controversial topic, a rationale has been proposed in this study to support surgeons in objectively estimating an individual patient’s risk for SPR prior to primary TKA measuring the patella tilt, width, and thickness. Overmore, regarding surgical aspects of TKA, tibial component positioning has also been shown to be of importance to reduce the risk of SPR.

Surgical equipment, and especially the so-called ‘splash basins’ that are used intraoperatively, are a potential source of bacterial contamination in primary total hip arthroplasty (THA). With this risk in mind, many commercially available draping kits include plastic bags that can be used to collect fluid or to temporarily store instruments. Following this rationale, we hypothesised that first: the fluid collection bags are a potential reservoir of bacteria and second: there is a time dependency for bacterial contamination. After ethics approval, we investigated in a prospective, internally controlled, non-blinded trial 43 patients who received primary THA. At the beginning of the surgery, we took deep, representative, intracapsular tissue samples, which served as negative controls. At the end of surgery, tissue samples were taken from the bottom of the ‘fluid collection bag’ for microbiological analysis. All 86 control samples were negative. Out of the samples taken from the bags, a pathogen could be detected in four patients (9.3%). All pathogens were detected after a surgery time lasting longer than 90 min. We were able to show that fluid collection bags are a potential reservoir for bacteria in THA when surgery time was greater than a 90-min threshold. Our data suggest that the risks from fluid collection bags outweigh the advantages of using them. Therefore, we recommend against the use of fluid collection bags intraoperatively in primary THA.

The association of dural arteriovenous fistulas (DAVF) in children with Vein of Galen malformation (VGM) has recently been reported for the first time. In a larger series of cases treated with transarterial NBCA embolization, 30% had DAVF. We wanted to analyze the development of DAVF in our cohort of children with VGM and to evaluate whether their occurrence depends on different treatment timing and embolic materials. We analyzed 43 VGM cases treated with a combined transarterial and transvenous approach between 2003 and 2016. In our early series until 2011, we used coils solely in 21 children. Since 2012, 22 children were treated with the combination of coils and Onyx. In the early series treated with coils solely, no case presented initially with or developed DAVF over time on follow-up angiograms. In our recent series we found four cases (9%) with DAVF. In two patients (5%), DAVF were found on the initial angiogram. Both patients presented at our department at age >2 years and were not treated elsewhere before. One patient (2%) presented at our department with too proximal occlusion of arterial feeders performed at another institution before. Only one patient (2%) developed DAVF in our department after the transarterial use of Onyx. Interestingly, this child did not develop DAVF as long as we used coils solely and his DAVF was localized exactly where an Onyx cast was identified. In conclusion, delayed and incomplete treatment may have a considerable impact on the occurrence of DAVF in VGM.

Wirbelkorperfrakturen (WKF) konnen durch verschiedene Unfallmechanismen entstehen. Nach dem Grad der Instabilitat erfolgt bei der AOSpine-Klassifikation die Einteilung in 3 Hauptfrakturtypen. Inwieweit neben der Kraftrichtung auch die Kraftstarke einen Einfluss auf die Zahl und Komplexitat der Frakturen hat, ist bisher noch nicht abschliesend untersucht worden. Welchen Einfluss haben Unfallereignisse unterschiedlicher Kinematik auf die Lokalisation, Komplexitat und Anzahl an WKF der Brust(BWS)- und der Lendenwirbelsaule (LWS)? In einer retrospektiven Studie wurden Daten von Patienten mit frischen traumatischen WKF analysiert. Je nach Unfallmechanismus wurden die Patienten in 6 Unfallgruppen (UFG) eingeteilt und die WKF anhand der CT-Bildgebung nach der AOSpine-Klassifikation beurteilt. Es wurde 2‑seitig getestet und ein Signifikanzniveau von 5 % zugrunde gelegt. Fur die Durchfuhrung der statistischen Berechnungen wurde IBM SPSS Statistics eingesetzt. Bei den Hochrasanztraumata (UFG III und V) konnte eine signifikante Zunahme der Frakturschwere nach der AOSpine-Klassifikation festgestellt werden. Zudem stieg die Haufigkeit thorakaler (TH) WKF fur TH7 (p = 0,011) und TH10 (p = 0,001) signifikant an. Im Vergleich zu den anderen UFG war das Risiko einer TH7-Fraktur bei Hochrasanzunfallen 7‑fach erhoht („odds ratio“ [OR]: 7,0; 95 %-Konfidenzintervall [95 %-KI]: 1,4–35,2). Die UFG III (Sturz > 3 m) bot mit 2,5 WKF im Median (SD ± 1,84) die hochste Frakturanzahl. Eine exakte Wiedergabe des Unfallhergangs ermoglicht die Einteilung in hoch- bzw. niedrigenergetische UFG. Bei vorherigen Untersuchungen wurden Verkehrsunfalle (VU) als eine Gruppe erfasst; ein Einfluss der zunehmenden kinematischen Energie konnte daher nicht beurteilt werden. Durch Berucksichtigung von Hoch- und Niedrigrasanztrauma kann der Unfallkinematik Rechnung getragen werden. Als „Risikowirbel“ bei Hochrasanzunfallen stellten sich TH7 und TH10 heraus. Neben der Kraftrichtung hat somit auch die Kraftstarke einen masgeblichen Einfluss auf das Verteilungsmuster von WKF.

There is increasing evidence that inflammation and biomechanical loading can influence the effects of bisphosphonates (BP). The aim of this study was to investigate the influence of tensile strain application combined with IL-1s and clodronate or zoledronate on human periodontal ligament fibroblasts (HPdLF) in vitro. HPdLF were cultured with 10 nM IL-1s and 5 μM clodronate or zoledronate for 48 h. Cells were applied to cyclic tensile strain (CTS; 3% elongation) for 12 h in vitro. Cell number was analyzed directly after CTS by MTT assay. Gene expression of receptor activator of cyclooxygenase-2 (COX-2) was investigated using real-time PCR. MMP-8, TIMP-1, and PGE2 were measured by ELISA. Statistics were performed with SPSS (ANOVA, p

Variations in the temperature of body and skin are symptoms of many pathological changes. Although joint replacement surgery of hip and knee has been very successful in recent decades, periprosthetic infection is a growing problem and the number one reason for revision. While many studies have investigated changes in blood levels, investigation of temperature has not been performed on a regular basis. The objective of this work is to determine whether reference literature exists for the infrared thermographic examination in knee and hip arthroplasty and if reference values can be derived for the methodology or if there is a peri- and postoperative benefit.By means of a systematic online database search and based on the Cochrane, PICOT and PRISMA guidelines, this systematic review retrieved 254 studies. All publications with thermographic examination in arthroplasty of the hip and knee were imbedded. 249 studies were excluded due to the defined inclusion and exclusion criteria and five studies with 251 patients have finally been included in the evaluation process. This was followed by an analysis and discussion of the methodology.Infrared thermography is a useful tool in the perioperative care of patients after arthroplasty of the knee and hip joint. The technology is portable, easy to use and non-invasive. Based only on these few publications, values can be derived, which provide a guidance for the thermographic aftercare in arthroplasty surgery.Veränderungen der Körper- und Hauttemperatur sind Symptom vieler pathologischer Veränderungen des Körpers. Obwohl der künstliche Gelenkersatz von Hüft- und Kniegelenk in den letzten Dekaden große Erfolge feiern konnte, ist die periprothetische Infektion ein zunehmendes Problem und Revisionsgrund Nummer 1. Während viele Arbeiten laborchemische Veränderungen untersuchten, ist die Temperaturdiagnostik bisher nicht in die Routine eingegangen. Diese Arbeit beschäftigt sich mit der Frage, ob in der Literatur für die infratrothermografische Untersuchung von Knie- und Hüftgelenkendoprothetik Referenzbereiche existieren, sich Richtwerte für die Methodik ableiten lassen und ob diese Technik einen peri- und postoperativen Nutzen zeigt.Mittels einer systematischen Onlinerecherche und basierend auf den Cochrane-, PICOT- und PRISMA-Richtlinien, erfasst dieses systematische Review 254 Publikationen, von denen 5 mit 251 Patienten in die Auswertung eingegangen sind. Erfasst wurden alle Publikationen der Thematik einer thermografischen Untersuchung bei endoprothetischen Primäroperationen an Hüfte und Knie.Die Infrarotthermografie zeigt sich als nützliches Verfahren in der perioperativen Begleitung von Patienten nach endoprothetischem Ersatz von Knie- und Hüftgelenk. Die Technik ist mobil, einfach in der Anwendung und nicht invasiv. Bereits aus den wenigen zur Verfügung stehenden Arbeiten lassen sich Werte ableiten, welche für die eigenständige thermografische Nachsorge einer endoprothetisch tätigen Klinik oder Praxis eine Orientierung bieten.

Recent studies focused on angiogenesis in the pathophysiology of bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) and identified geranylgeraniol (GGOH) as a feasible option for BP-ONJ therapy. This study investigated the influence of GGOH on microvessel sprouting after BP-incubation in vitro. Ten experimental set-ups were randomly designed in an in vitro 3D-angiogenesis assay. Two groups included HUVEC cell spheroids with and without (±) GGOH substitution as controls and eight groups pairwise contained either clodronate or the nitrogen-containing bisphosphonates (N-BP) ibandronate, pamidronate, and zoledronate ± GGOH. The size of the cell spheroids including the outbranching sprouts (SpS) as well as the density (SpD) and length of the sprouts (SpL) were analyzed by a grid system after 0, 24, 48, and 72 h. For controls and NN-BP clodronate, no significant differences at any tested parameter and any point of measurement could be detected within the experimental set-ups ± GGOH (p each ≥0.05). For N-BP ibandronate, the experimental set-ups +GGOH showed a significantly increased SpS, SpD, and SpL after 48 and 72 h (p each ≤0.002) compared to the experimental set-ups −GGOH. For N-BPs pamidronate and zoledronate, the experimental set-ups + GGOH demonstrated a significantly increased SpS, SpD, and SpL after 24, 48, and 72 h (p each ≤0.001) compared to the experimental set-ups −GGOH. The strong negative influence of N-BPs on microvessel sprouting could be significantly reversed by GGOH. Since supportive therapeutic options for BP-ONJ are lacking, GGOH might be a promising substitute for BP-ONJ prevention and therapy.

Microcirculatory integrity and proper function are the cornerstones to tissue nourishment and viability. In the clinical environment extended immobility, injuries, and inflammatory reactions demand local microcirculatory adaption to provide adequate supply. Assessment of endothelial adjustment capability and microcirculatory perfusion status, as direct or surrogate markers of disease, are therefore of uttermost interest to the treating physician. Given the simple, noninvasive, nonradiating nature of laser-based techniques for bedside or intraoperative microcirculatory perfusion assessment, this article's objective is to present a comprehensive overview of available techniques, their technological aspects, and current application. Advantages of individual methods are pointed out and compared with each other. The areas of medical utilization relevant to orthopedics and trauma surgery are exemplified and their available evidence elaborated. A particular focus is put on laser speckle contrast imaging, with its current and future influence on medical practice.

The aim of this study was to investigate in vitro the effect of clodronate on interleukin-1s (IL-1s)–stimulated human periodontal ligament fibroblasts (HPdLFs) with the focus on inflammatory factors of orthodontic tooth movement with and without compressive force. HPdLFs were incubated with 5 μM clodronate and 10 ng/mL IL-1s. After 48 h, cells were exposed to 3 h of compressive force using a centrifuge. The gene expression of cyclooxygenase-2 (COX-2), interleukin-6 (IL-6), matrix metalloproteinase 8 (MMP-8), and the tissue inhibitor of MMP (TIMP-1) was analyzed using RT-PCR. Prostaglandin E2 (PGE-2), IL-6, and TIMP-1 protein syntheses were quantified via ELISA. Compressive force and IL-1s induced an overexpression of COX-2 gene expression (61.8-fold; p

Spondylodiscitis is an infection of the intervertebral disc with subsequent infection of the adjacent vertebral bodies. The main causes are 3 pathogen groups: bacteria, particularly tuberculosis pathogens, fungi and parasites. In pyogenic spondylodiscitis, infections with Staphylococcus aureus are the most common, with an incidence of up to 80%. Mortality is around 2 - 3%. Infections with tuberculosis are often associated with psoas and paravertebral abscesses. Neurological deficits are registered in up to 50% of patients. For microbiological diagnostic testing, blood cultures are used for aerobic and anaerobic bacteria. However, histological examination leads significantly more frequently to positive pathogen detection. In tissue samples, results with 16S rRNA PCR results are clearly superior to results from microbiological examination. The MRI exhibits high sensitivity and specificity and is therefore superior to other radiological methods. Elimination of the infection, pain reduction and stabilisation of the spine are the main objectives of any treatment. A standardised antibiotic therapy for spondylodiscitis has not been clearly defined. Pathogen detection is important, with focused antibiotic therapy. Antibiotic therapy should initially be administered intravenously for 2 - 4 weeks. This should be followed by oral administration for 6 - 12 weeks. In the case of antibiotic-resistant infections with neurological deficiencies, it is recommended to perform a surgical procedure, with careful debridement and instrumentation as well as i. v. administered antibiotics for 3 weeks followed by three month oral antibiotic treatment. Surgical procedures are indicated with neurological deficits, progressive increase in spinal deformities, failure of conservative therapy with insufficient pain relief and unreliable pathogen identification. The selection of the surgical procedure should mainly be based on the extent and localisation of bone destruction and the individual circumstances of the patients. The prognosis is good if there is a clear reduction in CRP and ESR in the first few weeks.Die Spondylodiszitis ist eine Infektion der Bandscheiben mit einer nachfolgenden Infektion der benachbarten Wirbelkörper. Hauptursache sind 3 Erregergruppen: Bakterien (pyogene Infektion), Tuberkuloseerreger und Pilze (granulomatöse Infektion) und Parasiten. Bei der pyogenen Spondylodiszitis dominieren meist Monoinfektionen mit Staphylococcus aureus bei einer Häufigkeit bis zu 80%. Die Letalität liegt bei der Spondylodiszitis bei 2 – 3%. Tuberkulöse Infektionen sind häufig mit Psoas- und paravertebralen Abszessen assoziiert. In bis zu 50% der Patienten werden neurologische Ausfälle registriert. Zur mikrobiologischen Diagnostik werden Blutkulturen für aerobe und anaerobe Keime eingesetzt. Die histologische Untersuchung führt jedoch signifikant häufiger zu einem positiven Erregernachweis. Hinsichtlich Genauigkeit ergibt sich eine deutliche Überlegenheit der 16S-rRNA-PCR im Vergleich zur mikrobiologischen Untersuchung von Gewebeproben. Das MRT zeigt eine hohe Sensitivität und Spezifität und ist daher den anderen radiologischen Methoden überlegen. Die Beseitigung der Infektion, die Verminderung der schmerzhaften Beschwerden sowie die Wiederherstellung und Bewahrung von Struktur bzw. Funktion der Wirbelsäule gelten als Hauptziele jeder Behandlungsmaßnahme. Eine standardisierte Antibiotikatherapie der Spondylodiszitis ist bisher nicht eindeutig definiert. Entscheidend sind der Erregernachweis und eine entsprechende gezielte Antibiotikatherapie. Die antibiotische Therapie sollte zunächst 2 – 4 Wochen intravenös verabreicht werden. Anschließend ist eine Umstellung auf eine orale Gabe für 6 – 12 Wochen vorzusehen. Beim Nachweis antibiotikaresistenter Infektionen mit neurologischen Ausfällen wird empfohlen, ein chirurgisches Vorgehen mit sorgfältigem Débridement und Instrumentation vorzunehmen sowie eine Nachbehandlung mit intravenös verabreichten Antibiotika über 3 Wochen mit anschließend 3-monatiger oraler Antibiotikabehandlung zu verordnen. Chirurgische Eingriffe sind indiziert bei neurologischen Defiziten, progressiver Zunahme spinaler Deformierungen, Versagen der konservativen Therapie mit unzureichender Schmerzlinderung und unsicherer Keimidentifizierung. Die Auswahl des Operationsverfahrens sollte hauptsächlich nach dem Ausmaß der Knochendestruktion, der Lokalisation und den individuellen Gegebenheiten bei den Patienten richten. Eine gute Prognose kann gestellt werden, wenn CRP und BSG in den ersten Wochen deutlich abfallen.

Three-dimensional (3-D) endoscopic optics use 2 cameras to simulate the different perspectives of the right and left eye, creating the illusion of spatial depth. Optimised orientation as well as improved hand-eye coordination compared to 2-D-optics could be proven in standardised test setups (black box) and in laparoscopic use. This retrospective study examines whether these results can also be applied to thoracoscopic vertebral body replacement at the thoracolumbar junction.1. Ventral vertebral body replacement using 3-D-thoracoscopy results in a shorter operation time than with 2-D-thoracoscopy. 2. Perioperative blood loss is less, due to better spatial orientation (faster haemostasis) and reduced tissue laceration.29 patients met the inclusion criteria of this retrospective study. Between 08 - 2012 and 08 - 2017, all of these received ventral thoracoscopic vertebral replacement at the thoracolumbar junction (Th11 to L2). Patients with additional anterior procedures (e.g. anterolateral plate) were excluded. Perioperative data such as blood loss, duration of surgery and length of hospital stay were analysed. Conventional 2-D-optics were used in n = 14 patients and 3-D-optics in 15 patients. Aesculap EinsteinVisionThe most common diagnosis was a L1 fracture (n = 18, 62%). Mean OR time was 24 minutes shorter in the 3-D group (149 ± 29, 107 - 198 min) than in the 2-D group (173 ± 39, 125 - 260 min), but this difference was not significant. Total perioperative blood loss in the 3-D group was significantly lower than in the 2-D group (**p = 0.043). Proportional intraoperative blood loss in the 3-D group was also lower (mean around 115 ml), but not significantly so. Significantly lower values were found for the delivery rate of the thoracic drainage in the 3-D group (248 vs. 560 ml, *p = 0.195). Inpatient stay with the 3-D group was on average 1.5 days (d) shorter (8.7 d for the 3-D group, 10.2 d for the 2-D group) but this difference was not significant (p = 0.27).Thoracoscopic-assisted vertebral body replacement at the thoracolumbar junction is a safe and reliable surgical procedure using conventional 2-D-optics or the new 3-D-optics. Both methods allow thoracoscopic vertebral body replacement in comparable operation times but in our study the 3-D group presented with significantly lower postoperative blood loss. Due to the small number of cases and because of the retrospective design, the present study is considered to be a pilot study only.Dreidimensionale (3-D) endoskopische Optiken können durch 2 Kameras die unterschiedliche Perspektive des rechten und linken Auges simulieren und somit die Illusion einer räumlichen Tiefe erzeugen. Im laparoskopischen Einsatz konnte eine optimierte Orientierung und ein exakteres Handling gegenüber 2-D-Optiken nachgewiesen werden. Ob sich diese Ergebnisse auch auf den thorakoskopischen Wirbelkörperersatz im thorakolumbalen Übergang übertragen lassen, wird anhand der retrospektiven Studie untersucht. Hypothesen: 1. Der ventrale Wirbelkörperersatz unter Einsatz der 3-D-Thorakoskopie führt zu einer kürzeren OP-Zeit. 2. Der perioperative Blutverlust sinkt durch die bessere Raumorientierung (zügigere Blutstillung) und verminderte Gewebeschädigung.In der retrospektiven Studie wurden 29 Patienten mit ventralem thorakoskopischem Wirbelkörpersatz eingeschlossen. Bei n = 14 Patienten wurde die konventionelle 2-D-Optik angewendet, bei n = 15 Patienten die 3-D-Optik. Es wurden perioperative Daten wie Blutverlust, OP-Dauer und Aufenthaltsdauer analysiert. Statistische Signifikanz wurde mittels Studentʼs t-Test berechnet.Die häufigste Diagnose war eine LWK-1-Fraktur (n = 18, 62%). Die mittlere OP-Zeit war in der 3-D-Gruppe (149 ± 29, 107 – 198 min) um 24 min kürzer als in der 2-D-Gruppe (173 ± 39, 125 – 260 min), jedoch nicht signifikant. Der gesamte perioperative Blutverlust der 3-D-Gruppe war signifikant niedriger als in der 2-D-Gruppe (**p = 0,043). Der anteilige intraoperative Blutverlust der 3-D-Gruppe war ebenfalls niedriger (im Mittel um 115 ml), jedoch nicht signifikant. Signifikant geringer war die Fördermenge der Thoraxdrainage bei der 3-D-Gruppe (248 vs. 560 ml, *p = 0,0195). Der stationäre Aufenthalt bei der 3-D-Gruppe war im Mittel 1,5 Tage (d) kürzer, jedoch nicht signifikant.Sowohl mit der konventionellen 2-D-Optik als auch mit der 3-D-Optik ist der thorakoskopisch assistierte Wirbelkörperersatz im thorakolumbalen Übergang ein sicheres und zuverlässiges Operationsverfahren. Beide Verfahren ermöglichen vergleichbare OP-Zeiten, aber in unserer Studie bei der 3-D-Optik mit signifikant reduziertem Blutverlust postoperativ. Die vorliegende Studie ist hinsichtlich der geringen Fallzahl und aufgrund des retrospektiven Charakters lediglich als orientierende Pilotstudie zu werten.

Medial patellofemoral ligament reconstruction (MPFL-R) is the gold standard in patella soft tissue surgery for patellofemoral instability. Although claimed, recent reports indicate that MPFL-R may fail to distalize the patella in mild cases of patella alta. The present study is a retrospective case-control study to compare radiographic patella height between MPFL-R and historical Insall’s proximal realignment (IPR) pre- and post-operatively with respect to distalization and assess redislocation rates at a mid-term follow-up. Sixty-four patients were age/sex matched (1:1), yielding 32 patients for group 1 MPFL-R (cases) and 32 patients for group 2 IPR (controls). Insall-Salvati, Blackburne-Peel and Caton-Deschamps indices were analyzed for differences pre- and post-operatively. An additional inter-rater reliability analysis was performed by means of intra-class correlation (ICC). Redislocation rates were considered as treatment failures in this study. ICC was excellent for all three patella indices. MPFL-R failed to show significant differences if compared to IPR with respect to distalization in mild stages of patella alta. Moreover, redislocation rates significantly favored MPFL-R (3.1%) over IPR (12.5%; p

Periprosthetic joint infections (PJIs) are a major complication in total joint arthroplasty. Staphylococcus aureus and coagulase-negative staphylococci are known to cause the majority of all PJIs. This study aimed to analyze the eradication rates of S. aureus and S. epidermidis with methicillin susceptibility and methicillin resistance in a 2-stage therapy algorithm. Seventy-four patients with PJI caused by methicillin-resistant S. aureus (MRSA), methicillin-resistant coagulase-negative staphylococci (MRSE), methicillin-susceptible S. aureus (MSSA), and methicillin-susceptible coagulase-negative staphylococci (MSSE) were included, and the outcome was analyzed retrospectively. After a minimal follow-up of 2 years, n = 56 patients (75.7%) were definitively free of infection. The analysis revealed significant differences between the groups, with eradication rates as follows: MSSA (92.6%), MSSE (95.2%), MRSA (80%), and MRSE (54.2%). MRSE showed a significantly lower rate of patients graded as “definitively free of infection” as compared to patients with infections caused by MSSA, MSSE, and MRSA.

The stabilization of an atlantoaxial (C1-C2) instability is demanding due to a complex atlantoaxial anatomy with proximity to the spinal cord, a variable run of the vertebral artery (VA) and narrow C2 pedicles. We perfomed the GoelHarms fusion in combination with an intraoperative 3D imaging to ensure correct screw placement in the C2 pedicle. We hypothesized, that narrow C2 pedicles lead to a higher malposition rate of screws by perforation of the pedicle wall. The purpose of this study was to describe a certain pedicle size, under which the perforation rate rises.In this retrospective study, all patients (n=30) were operated in the GoelHarms technique. The isthmus height and pedicle diameter of C2 were measured. The achieved screw position in C2 was evaluated according to GertzbeinRobbin classification (GRGr).A statistically significant correlation was found between the pedicles size (isthmus height/pedicle diameter) and the achieved GRGr for the right (p=0.002/p=0.03) and left side (p=0.018/p=0.008). The ROC analysis yielded a Cut Off value for the pedicle size to distinguish between an intact or perforated pedicle wall (GRGr 1 or ≥2). The Cut-Off value was identified for the isthmus height (right 6.1mm, left 5.4mm) and for the pedicle diameter (6.6mm both sides).The hypothesis, that narrow pedicles lead to a higher perforation rate of the pedicle wall, can be accepted. Pedicles of6.6mm turned out to be a risk factor for a perforation of the pedicle wall (GRGr 2 or higher). Intraoperative 3D imaging is a feasible tool to confirm optimal screw position, which becomes even more important in cases with thin pedicles. The rising risk of VA injury in these cases support the additional use of navigation.