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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 213 - 213
1 Sep 2012
Knobe M Sellei R Kobbe P Lichte P Pfeifer R Mooij S Aliyev R Muenker R Pape HC
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Introduction

Unstable intertrochanteric hip fractures (AO 31A2) continue to be a challenge, as non-locking implants have shown a considerable rate of loss of reduction. Intramedullary fixation has been recommended, although screw cut-out has been identified as problematic. This study was performed to ascertain whether treatments with the established proximal femoral nail (PFN) and the newer PFNA with blade design (proximal femoral nail antirotation) have advantages over the use of the Percutaneous Compression Plate (PCCP, developed by Gotfried).

Methods

Cohort study. Between March 2003 and March 2008, 134 patients with unstable fractures were treated with a PCCP, (n=44, 78.3 yrs, ASA 2.8), a PFN (n=50, 77.2 yrs, ASA 2.8), or a PFNA (n=40, 75.8 yrs, ASA 2.6). The patients (31 PCCP, 33 PFN, 30 PFNA) were then reexamined clinically and radiologically after approximately 21 months.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 437 - 437
1 Sep 2012
Kobbe P Hockertz I Sellei R Reilmann H Hockertz T
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Sacroiliac screw fixation is the method of choice for the definitive treatment of unstable posterior pelvic ring injuries; however this technique is demanding and associated with a high risk of iatrogenic neurovascular damage. We therefore evaluated the outcome, complications, surgical and fluoroscopy time for unstable posterior pelvic ring injuries managed with a transiliac locked compression plate.

23 patients were managed with a transiliac locked compression plate for unstable posterior pelvic injuries at a Level I Trauma Center. 21 patients were available for follow up after an average of 30 months and outcome evaluation was performed with the Pelvic Outcome Score, which is composed of a clinical, radiological, and social integration part.

The overall outcome for the pelvic outcome score was excellent in 47.6% (10 patients), good in 19% (4 patients), fair in 28.6% (6 patients) and poor in 4.8% (1 patient). 15 out of 21 patients (71.4%) returned to their normal life, 3 patients (14.3%) were limited at work, and 3 patients (14.3%) were not able to return to work due to their disabilities. The social status was unchanged to the preinjury status in 19 patients (90.5%). 13 patients (62%) stated no changes in spare time and sports activities; 4 patients (19%) had minor and another 4 patients (19%) had major restrictions. The average operation time was 101 min and intraoperative fluoroscopic time averaged 74.2 sec. No iatrogenic neurovascular injuries were observed.

Posterior percutaneous plate osteosynthesis may be a good alternative to sacral screw fixation because it is quick, safe, and associated with a good functional outcome.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 308 - 308
1 Sep 2012
Lichte P Kobbe P Sellei R Knobe M Pape H
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Aim of the study

Aim of this study was to find out which factors influence the outcome after both column fractures of the acetabulum.

Methods

We performed a retrospective analyse of 115 patients with both column acetabular fractures. The period between the injury and follow-up ranges between 2 and 19 years, 5,7 years on average. The initial displacement, the presence of a dislocation of the hip and fractures of the femoral head were analyzed on the initial radiographs. Postoperative displacement was classified according the classification of Matta. The common classifications of Helfet (posttraumatic arthrosis), Ficat/Arlet (femur head necrosis) and Brooker (periarticular calcification) were used to radiologically classify the long term results. Statistics were performed by the Chi-square-test.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 377 - 377
1 Sep 2012
Sellei R Kobbe P Knobe M Lichte P Pfeifer R Schmidt M Turner J Grice J Pape H
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Objectives

The additive use of an external modular device may improve dorsal compression forces in pelvic external fixation. This would improve the efficiency of indirect reduction and stabilization with an anterior pelvic external fixator. The purpose of this study was to determine the forces of the posterior pelvis achieved by a new device improving the application of a supraacetabular anterior external fixator compared with other constructs.

Material and Method

Synthetic pelvic models were used. Complete pelvic ring instability was created by symphyseal and unilateral sacroiliac joint disruption. Four different constructs of fixation were tested. A pressure-sensitive film was placed in the sacroiliac joint. The constructs were applied in a standardized way. The maximum sacroiliacal compression loads (N) of each trial was recorded. Statistics was performed with the student t-test.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 521 - 521
1 Sep 2012
Sellei R Hingmann S Knobe M Kobbe P Lichte P De La Fuente M Schmidt F Linke S Grice J Turner J Pape H
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Background

Overlooked compartment syndrome represents a devastating complication for the patient. Invasive compartment pressure measurement continues to be the gold standard. However, repeated measurements in uncertain cases may be difficult to achieve. We developed a new, noninvasive method to assess tissue firmness by pressure related ultrasound.

Methods

Decreased tissue elasticity by means of rising compartment pressures was mimicked by infusion of saline directly into the anterior tibial compartment of 6 human specimens post mortem. A pressure transducer (Codman) monitored the pressure of the anterior tibial compartment. A second transducer was located in a saline filled ultrasound probe head to allow a simultaneous recording of the probe pressure provoked by the user. The ultrasound images were generated at 5 and 100mmHg probe pressures to detect the tissue deformity by B-mode ultrasound. The fascial displacement was measured before and after compression (d). Subsequently, increments of 5mmHg pressure increases were used to generate a standard curve (0–80mmHg), thus mimicking rising compartment pressures. The intra-observer reliability was tested using 10 subsequent measurements. A correlation was determined between d and the simulated intacompartmental pressure (ICP) in the compartment. The Pearson correlation coefficient (r) was calculated. The reliability determined by the kappa value and a regression analysis was performed.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 215 - 216
1 May 2011
Lichte P Kobbe P Pardini D Giannoudis P Pape H
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Background: Polytrauma patients with bilateral femur shaft fractures are known to have a higher rate of complications when compared with those who have sustained unilateral fractures. The current study tests the hypothesis that the high incidence of posttraumatic complications in patients who have no severe head or chest injury is caused by accompanying injuries rather than by the additional femur fracture.

Methods: Prospective cohort study. Inclusion criteria: Injury severity score > 16 points; No AIS score value of the head or chest > 3 points. Two study groups: a unilateral (group USF) (n=146) and a bilateral femur shaft fracture (group BSF) (n=29). A further differentiation was made according to the patient’s status. All patients underwent early (< 24 hours after injury) fixation of their extremity fractures. Endpoints monitored were: Pneumonia, Acute lung injury (ALI), Systemic inflammatory response syndrome (SIRS), Sepsis. Statistics: Pearson chi-square test for binary indicators of injury severity, regression analyses regarding clinical complications.

Results: Patients with bilateral femur fractures exhibited a longer ICU stay (p< 0.01), a higher incidence of pneumonia (p< 0.02) and SIRS (p=0.04) than those with unilateral fractures. Following corrective analyses for injury severity, no differences in blood transfusion rates, length of ICU stay, or complications was observed. Patients in borderline condition spend significantly more time in the ICU in comparison to those in stable condition. For analyses predicting presence of systemic inflammatory response syndrome, only the variable indicating receipt of a blood transfusion upon admission to the hospital emerged as a significant predictor. Bilateral fracture patients who were in uncertain condition preoperatively, developed significantly more complications postoperatively(p=0.02).

Conclusions: Polytrauma patients with bilateral femur shaft fractures have a similar clinical course as those with unilateral fractures when no significant head or chest injury is present.

An increased incidence of systemic inflammatory response syndrome was associated with three variables: presence of borderline condition, hemothorax and requirement of blood transfusion. This may have important treatment implications, including the management of major fractures.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 179 - 179
1 May 2011
Kobbe P Lichte P Pfeifer R Pape HC
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Patients with bilateral femur fractures are known to be at a high risk for the Systemic Inflammatory Response Syndrome; however the impact of fracture-associated soft tissue injury in the induction of systemic inflammation following bilateral femur fracture is poorly understood. To address this, the systemic inflammatory response and remote organ dysfunction following bilateral femur fracture with various degrees of soft tissue injuries were investigated in this study.

6–8 weeks old male C57/BL6 mice (n = 4–8 animals per group) were grouped as follows: Control-group (no anaesthesia, no femoral catheterisation); Sham-group (6 hour anaesthesia, femoral catheterisation); Fx-group (6 hour anaesthesia, femoral catheterisation, bilateral femur fracture with minor soft tissue injury); Fx+STI-group (6 hour anaesthesia, femoral catheterisation, bilateral femur fracture with severe soft tissue injury). Six hours after bilateral femur fracture serum levels of IL-2, IL-4, IL-6, IL-10, IL-12, TNF-α, KC and MCP-1 were measured. Furthermore, IL-6 levels of homogenized liver tissue were assessed. Neutrophil accumulation in liver and lung was determined with a myeloperoxidase (MPO) assay. Changes in liver permeability were assessed by measuring the wet-dry-ratio.

The Fx+STI-group showed significantly increased serum cytokine levels as compared to the Fx- or Sham-group. The homogenized liver tissue of the Fx+STI-group showed significantly increased IL-6 levels as compared to the Sham-group. The MPO activity in lung and liver in the Fx+STI-group was significantly increased in comparison to the Fx- or Sham-group and in the Fx-group in comparison to the Sham-group. The wet-dry-ratio of the liver was significantly increased in the Fx+STI-group as compared to the Sham-group.

The degree of fracture-associated soft tissue injury appears to modify systemic inflammation following bilateral femur fracture and is able to induce remote organ dysfunction. These results may have implications that have been underestimated, thus warranting clinical follow-up studies.