Search

In the volar plating of distal radius fractures, intraoperative three-dimensional (3D) imaging is designed to allow better judgment regarding screw and implant positioning compared with conventional intraoperative two-dimensional (2D) imaging. We evaluated the impact of these two imaging modalities on the rates of intraoperative revision and secondary surgery, as well as the need for implant removal during follow-up. A retrospective analysis of consecutive patients who underwent volar plate osteosynthesis for isolated distal radius fractures between January 2008 and April 2016 was performed. Patient files were evaluated for intraoperative imaging findings, intraoperative and postoperative revision rates, and implant removal during follow-up. Additional analyses of radiation exposure, operation time, and hospitalization time were performed. A total of 314 patients were analyzed (mean age: 54 ± 19 years; 210 females). For 246 patients, only 2D imaging was performed, while the remaining 68 patients underwent both 2D and 3D imaging (O-Arm, Medtronic). The intraoperative revision rate was significantly (p

To find ways to reduce the rate of over-triage without drastically increasing the rate of under-triage, we applied a current guideline and identified relevant pre-hospital triage predictors that indicate the need for immediate evaluation and treatment of severely injured patients in the resuscitation area. Data for adult trauma patients admitted to our level-1 trauma centre in a one year period were collected. Outpatients were excluded. Correct triage for trauma team activation was identified for patients with an ISS or NISS ≥ 16 or the need for ICU treatment due to trauma sequelae. In this retrospective analysis, patients were assigned to trauma team activation according to the S3 guideline of the German Trauma Society. This assignment was compared to the actual need for activation as defined above. 13 potential predictors were retained. The relevance of the predictors was assessed and 14 models of interest were considered. The performance of these potential triage models to predict the need for trauma team activation was evaluated with leave-one-out cross-validated Brier and logarithmic scores. A total of 1934 inpatients ≥ 16 years were admitted to our trauma department (mean age 48 ± 22 years, 38% female). Sixty-nine per cent (n = 1341) were allocated to the emergency department and 31% (n = 593) were treated in the resuscitation room. The median ISS was 4 (IQR 7) points and the median NISS 4 (IQR 6) points. The mortality rate was 3.5% (n = 67) corresponding to a standardized mortality ratio of 0.73. Under-triage occurred in 1.3% (26/1934) and over-triage in 18% (349/1934). A model with eight predictors was finally selected with under-triage rate of 3.3% (63/1934) and over-triage rate of 10.8% (204/1934). The trauma team activation criteria could be reduced to eight predictors without losing its predictive performance. Non-relevant parameters such as EMS provider judgement, endotracheal intubation, suspected paralysis, the presence of burned body surface of > 20% and suspected fractures of two proximal long bones could be excluded for full trauma team activation. The fact that the emergency physicians did a better job in reducing under-triage compared to our final triage model suggests that other variables not present in the S3 guideline may be relevant for prediction.

Asymmetry in odontoid-lateral mass interspace in trauma patients is a common finding that regularly leads to additional diagnostic work-up, since its dignity is not entirely clear. There is little evidence in the literature that atlantoaxial asymmetry is associated with C1–C2 instability or (sub) luxation. Asymmetry in odontoid-lateral mass interspace seems to occur occasionally in healthy individuals and patients suffering a cervical spine injury. Congenital abnormalities in odontoid-lateral mass asymmetry may mimic an atlantoaxial asymmetry. The center of C1–C2 rotation is based in the peg of dens axis; therefore, a C1–C2 rotational influence seems unlikely. So far, no study examined the influence of C0–C1–C2 tilt to an asymmetry in odontoid-lateral mass interspace. In order to determine if rotation or tilt influences the lateral atlantodental interval (LADI) and to estimate physiologic values, we examined 300 CT scans of the cervical spine. The mean LADI was 3.57 mm and the mean odontoid-lateral mass asymmetry was 1.0 mm. Head position during CT examination was found to be rotated in 39 % of the cases in more than 5°. Subsequent mean C0/C2 rotation was 4.6°. There was no significant correlation between atlantoaxial asymmetry and head rotation (p = 0.437). The average tilt of C0–C1–C2 was found to be 2°. We found a significant correlation between tilt of C0–C1–C2 and asymmetry in odontoid-lateral mass interspace (p = 0.000). We conclude that an atlantoaxial asymmetry revealed in CT scans of the cervical spine occurs occasionally. Since head tilt correlates with an atlantoaxial asymmetry, it is crucial to perform cervical spine CT scans in a precise straight head position.

This study investigates the biomechanical stability of a novel technique for symphyseal internal rod fixation (SYMFIX) using a multiaxial spinal screw-rod implant that allows for direct reduction and can be performed percutaneously and compares it to standard internal plate fixation of the symphysis. Standard plate fixation (PLATE, n = 6) and the SYMFIX (n = 6) were tested on pelvic composite models with a simulated open book injury using a universal testing machine. On a previously described testing setup, 500 consecutive cyclic loadings were applied with sinusoidal resulting forces of 200 N. Displacement under loading was measured using an optoelectronic camera system and construct rigidity was calculated as a function of load and displacement. The rigidity of the PLATE construct was 122.8 N/mm (95 % CI: 110.7–134.8), rigidity of the SYMFIX construct 119.3 N/mm (95 % CI: 105.8–132.7). Displacement in the symphyseal area was mean 0.007 mm (95 % CI: 0.003–0.012) in the PLATE group and 0.021 mm (95 % CI: 0.011–0.031) in the SYMFIX group. Displacement in the sacroiliac joint area was mean 0.156 mm (95 % CI: 0.051–0.261) in the PLATE group and 0.120 mm (95 % CI: 0.039–0.201) in the SYMFIX group. In comparison to standard internal plate fixation for the stabilization of open book pelvic ring injuries, symphyseal internal rod fixation using a multiaxial spinal screw-rod implant in vitro shows a similar rigidity and comparable low degrees of displacement.

Zusammenfassung: Der Einfluss des Transportmittels auf die Mortalität polytraumatisierter Patienten wird nach wie vor kontrovers diskutiert. In der vorliegenden Arbeit wurde an 333 erwachsenen schwerverletzten Patienten, die innerhalb eines Jahres in ein Zentrumsspital in der Schweiz eingewiesen wurden, der Einfluss des Transportmittels auf ihre Überlebenswahrscheinlichkeit untersucht. Der relativ neu etablierte RISC-Score (Revised Injury Severity Classification Score) fand als Zielgröße dabei Anwendung. Es konnte ein geringer, wenn auch nicht statistisch signifikanter Überlebensvorteil für Patienten, welche mit dem Rettungshubschrauber eingewiesen wurden im Vergleich zu den bodengebunden transportierten Patienten nachgewiesen werden ("standardized mortality ratio" 1,06 vs. 1,29). Faktoren, welche die Überlebenswahrscheinlichkeit in der vorliegenden Untersuchung verbessern, sind kurze präklinische Rettungszeiten und der Transport mit dem Notarzt.

Metastasen der Wirbelsäule sind eine häufige Begleiterscheinung in fortgeschrittenen Stadien von Malignom-Erkrankungen und stellen neben der Lunge und Leber die dritthäufigste Lokalisation dar. Neben den chronischen, stetig zunehmenden Schmerzen führen sie durch Destruktion des Wirbelkörpers und die folgende epidurale Ausbreitung zu einer Wirbelkörperinstabilität und zu neurologischen Ausfällen. Ziel einer chirurgischen Intervention ist der Erhalt der neurologischen Funktion und der Stabilität der Wirbelsäule gemeinsam mit der Reduktion von Schmerzen. Die Indikation zur Operation sollte dabei für jeden Patienten, individuell, in interdisziplinärer Absprache festgelegt werden. Ziel der vorliegenden Arbeit ist es, einen Überblick über Diagnostik und Behandlung von Wirbelkörpermetastasen aus der Sicht des Chirurgen zu geben.

Zusammenfassung: Aufgrund der häufig insuffizienten Weichteilsituation im Rahmen von Tibiaplateaufrakturen und der damit assoziierten höheren Rate an postoperativen Wundheilungsstörungen und Weichteilinfektionen ist ihre operative Behandlung nicht selten eine herausfordernde Aufgabe. Die klassische offene Reposition und Plattenosteosynthese beinhaltet eine ausgiebige Weichteilpräparation und partielle Periostablösung, um so die abgesunkenen Fragmente zu bergen und aufzurichten. Die Wiederherstellung der Gelenkfläche gestaltet sich dabei häufig als schwierig. In der vorliegenden Arbeit beschreiben wir eine neuartige operative Technik, in der das eingesunkene Tibiaplateau durch einen perkutan eingebrachten Ballon in Kombination mit einer minimal-invasiven Plattenosteosynthese versorgt wird. Darüber hinaus berichten wir über 5Fälle, welche mit diesem Verfahren bislang behandelt wurden

Background The critical shoulder angle combines the acromion index and glenoid inclination and has potential to discriminate between shoulders at risk for rotator cuff tear or osteoarthritis and those that are asymptomatic. However, its biomechanics, and particularly the role of the glenoid inclination, are not yet fully understood. Methods A shoulder simulator was used to analyze the independent influence of glenoid inclination during abduction from 0 to 60°. Spindle motors transferred tension forces by a cable-pulley on human cadaveric humeri. A six-degree-of-freedom force transducer was mounted directly behind the polyethylene glenoid to measure shear and compressive joint reaction force and calculate the instability ratio (ratio of shear and compressive joint reaction force) with the different force ratios of the deltoid and supraspinatus muscles (2:1 and 1:1). A stepwise change in the inclination by 5° increments allowed simulation of a critical shoulder angle range of 20° to 45°. Findings Tilting the glenoid to cranial (increasing the critical shoulder angle) increases the shear joint reaction force and therefore the instability ratio. A balanced force ratio (1:1) between the deltoid and the supraspinatus allowed larger critical shoulder angles before cranial subluxation occurred than did the deltoid-dominant ratio (2:1). Interpretation Glenoid inclination-dependent changes of the critical shoulder angle have a significant impact on superior glenohumeral joint stability. The increased compensatory activity of the rotator cuff to keep the humeral head centered may lead to mechanical overload and could explain the clinically observed association between large angles and degenerative rotator cuff tears.

Minimal invasive screw fixation is common for treating posterior pelvic ring pathologies, but lack of bone quality may cause anchorage problems. The aim of this study was to report in detail a new technique combining iliosacral screw fixation with in-screw cement augmentation (ISFICA). The patient was put under general anesthesia and placed in the supine position. A K-wire was inserted under inlet–outlet view to guide the fully threaded screw. The screw placement followed in adequate position. Cement was applied through a bone filler device, inserted at the screwdriver. The immediate control of cement distribution, accurate screw placement and potential leakage were obtained via intraoperative CT scan. Twenty consecutive patients treated with ISFICA were included in this study. The mean age was 74.4 years (range 48–98). Screw placement, possible cement leakage and screw positioning were evaluated via intraoperative CT scan. Postoperative neurologic deficits, pain reduction and immediate postoperative mobilization were clinically evaluated. Twenty-six screws were implanted. All patients were postoperatively, instantly mobilized with reduced pain. No neurologic deficits were apparent postoperatively. No cement leakage occurred. One breach of the iliac cortical bone was noted due to severe osteoporosis. One screw migration was seen after 1 year and two patients showed iliosacral joint arthropathy, which led to screw removal. ISFICA is a very promising technique in terms of safety, precision and initial postoperative outcome. Long-term outcomes such as lasting mechanical stability or pain reduction and screw loosening despite cement augmentation should be investigated in further studies with larger patient numbers.

We report the case of a patient who experienced post-traumatic static anterosuperior subluxation of the shoulder. The displacement worsened after surgical treatment associating a preglenoid bone block and pectoralis major transfer. We studied the lines of action of the conjoint tendon on an anatomic model. The biomechanical study demonstrated that alone, the coracoid bone block did not provoke the anterior glenohumeral subluxation. On the contrary, the compression components of the humeral head into the glenoid cavity increased and could not explain the worsening dislocation. Inversely, the tendon of the pectoralis major passed in front of the conjoint tendon because of the absence of the subscapularis and could have been the cause of the aggravated anterior subluxation.

Zusammenfassung: Zweizeitige Milzrupturen sind seltene, gleichwohl bekannte und potentiell sehr gefährliche Komplikationen nach stumpfen abdominalen Traumata. Ihre Inzidenz ist zwischen dem 4. und 8. posttraumatischen Tag am höchsten, wobei in der Literatur auch Fälle mit einer Latenz von Wochen beschrieben werden. Wir berichten im Folgenden über eine zweizeitige Milzruptur am 13. posttraumatischen Tag, wobei die dem Ereignis vorangegangenen computertomographischen Befunde sich in der überwiegenden Zahl als unauffällig präsentierten und geben einen Überblick über die pathophysiologischen Mechanismen, die Diagnostik sowie Therapie

Einleitung: Das Krankheitsbild der Sepsis ist trotz intensiver Forschung mit einer hohen Letalitätsrate behaftet und stellt ein grosses Problem der modernen Chirurgie dar. Die unkontrollierte Aktivierung des Complementsystems während Sepsis führt zur überschüssigen Bildung des[for full text, please go to the a.m. URL], 127. Kongress der Deutschen Gesellschaft für Chirurgie

Secondary hydrocephalus communicans after traumatic upper cervical spine injuries with leakage of cerebrospinal fluid is a rare and hardly described complication. A case of a 75-year-old woman sustained a type II dens axis without other injuries, especially without evidence of a hydrocephalus in the primary CT scan. Dorsal atlanto-axial fusion was performed. Postoperative drainage was prolonged and positive for β2-transferrin. Wound revision with an attempt to seal the leakage was not successful. Secondary CT scans of the brain were performed due to neurological deterioration and showed a hydrocephalus with typical EEG findings. No anatomical reason for a circulative obstruction was found in the CT scan. After application of a ventriculo-peritoneal shunt the neurological status improved and the patient could be discharged to neurological rehabilitation.