[Show abstract][Hide abstract] ABSTRACT: Objective:
The optimal treatment of intervertebral disk lesions accompanying thoracolumbar fractures remains controversial. To evaluate short- and medium-term progression of intervertebral disk lesions accompanying vertebral fractures, MRI scans obtained after trauma were compared with scans obtained at an average follow-up of 1 year, by means of our clinically useful classification of traumatic intervertebral disk lesions.
Materials and methods:
MRI scans of 54 disks in patients with trauma-induced single-level thoracolumbar fractures were analyzed retrospectively. All patients underwent posterior stabilization using a titanium internal fixator. Exclusion criteria were malignant vertebral collapse, spondylodiskitis, osteoporotic fractures, and degenerative disk disease in the uninjured disks. Morphologic changes and signal alterations of the adjacent disks were compared using routine MRI scans obtained after trauma and at an average follow-up of 1 year. Disks were divided according to their signals into four categories, from grade 0 to grade 3.
Of the disks studied after trauma (n = 54), 27.8% were determined to be grade 0, 31.5% were grade 2, and 40.7% were grade 3. In the follow-up examination, MRI detected grade 0 in 13% of disks. Hence, more than 50% of the disks with grade 0 after trauma changed into grade 2 lesions, resulting in 46.3% grade 2 lesions. Grade 3 disk lesions (40.7%) remained the same without any sign of recovery.
In the current study, we found progressive disk degradation and creeping in instrumented and nonfused segments in thoracolumbar fractures. For further validation, randomized controlled long-term outcome investigations seem mandatory as the next step in future clinical research.
American Journal of Roentgenology 07/2014; 203(1):140-5. DOI:10.2214/AJR.13.11590 · 2.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sprunggelenkverletzungen gehören zu den häufigsten Verletzungen im Kindesalter. Dennoch sind Untersuchungen zur Epidemiologie und Langzeitfolgen an großen Fallzahlen selten. In der gesetzlichen Unfallversicherung werden große Patientenkollektive mittels eines standardisierten Dokumentationssystems erfasst. Mit Hilfe dieser Datenbank wurden retrospektiv Daten der Unfallkasse Hessen zur Epidemiologie, Therapie, Komplikationen und zum langfristigen Outcome von Sprunggelenkverletzungen bei Schülern (Am häufigsten lagen den Sprunggelenkverletzungen Unfälle im Sport (33 %), in der Pause (24 %) und im Treppenhaus (18 %) der Schule zugrunde. In 21 % der Fälle lag eine Bandverletzung vor, in 79 % eine Fraktur. Die durchschnittliche Behandlungszeit (Median) betrug 45 Tage. Bei 11 Patienten wurde ein Rentengutachten erstellt, bei 4 Patienten verblieb eine dauerhafte Minderung der Erwerbsfähigkeit von 10 %. Relevante Langzeitfolgen von kindlichen Sprunggelenksverletzungen werden somit im berufsgenossenschaftlichen Heilverfahren selten festgestellt.
Trauma und Berufskrankheit 03/2014; 16(1). DOI:10.1007/s10039-013-2051-5
[Show abstract][Hide abstract] ABSTRACT: Fractures of the distal humerus belong to the most common injuries of the upper arm in childhood. Most frequently occurring is the supracondylar fracture of the distal humerus. In these cases and in the second most common epicondylar fractures, the metaphysis is affected and these fractures are therefore extra-articular. They have to be distinguished from articular fractures regarding therapy and prognosis. The growth potential of the distal epiphysis is very limited as is the possibility of spontaneous correction so that major dislocations should not be left uncorrected. Unstable and especially dislocated articular fractures must be anatomically reconstructed employing various osteosynthetic techniques, mostly combined with immobilization. Insufficient reconstruction, growth disturbance and non-union can result in axial deformities, such as cubitus valgus and varus, restriction of motion, pain and nerve palsy.
Der Orthopäde 11/2013; 42(11):977-87. · 0.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Frakturen des distalen Humerus sind die häufigste Verletzung des kindlichen Oberarms. Überwiegend kommt es zur suprakondylären Humerusfraktur. Sie betrifft den metaphysären Bereich und ist damit ebenso wie die zweithäufigste epikondyläre Verletzung extraartikulär. Daher können beide prognostisch und therapeutisch von Gelenkfrakturen, den kondylären Frakturen, abgegrenzt werden. Die Wachstumspotenz und damit das Korrekturpotenzial sind ellenbogennah sehr gering, sodass keine größeren Fehlstellungen belassen werden dürfen. Instabile und dislozierte Frakturen bedürfen einer anatomischen Reposition und stabilen Osteosynthese, meist kombiniert mit einer entsprechenden Ruhigstellung. Eine konsequente Therapie führt zu guten funktionellen Resultaten. Durch unzureichend reponierte Frakturen, Wachstumsstörungen oder Pseudarthrosenbildungen können ein v. a. kosmetisch beeinträchtigender Cubitus valgus oder varus, Bewegungseinschränkungen, Schmerzen und Nervenirritationen resultieren.
Der Orthopäde 11/2013; 42(11). DOI:10.1007/s00132-013-2203-0 · 0.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Indications for surgical intervention in the geriatric spine has been expanded over the last several decades, better meeting the needs of a growing elderly community with increased life expectations and activity level. In contrast to younger patients, injury in this age group is often caused by minor trauma facilitated from osteoporotic bone quality—one of the main factors responsible for increasing costs in any health system. Cement augmentation techniques have gained widespread use as the sole method to treat osteoporotic fractures, although important studies have opened up a broad discussion about indications and especially benefit for the patient. To that end, the paper from Benneker and Hoppe  gives a fresh update on this major tool in geriatric spine surgery.Besides treating spontaneous fractures induced from poor bone quality with cement augmentation, this technique has been established more recently as a supportive tool in the treatment of trauma-induced spine fractures in t ...
European Journal of Trauma and Emergency Surgery 10/2013; 39(5):443-444. DOI:10.1007/s00068-013-0320-4 · 0.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose
Although there are currently many different strategies and recommendations in the therapy of cervical spine fractures in elderly patients, there are still no generally accepted treatment algorithms. The aim of the present study was to analyze the morbidity, mortality, and outcome of operated cervical spine injuries in the elderly.
This study presents a retrospective review of 69 patients aged 65 years or older admitted to our level I trauma center with cervical spine injury, who had undergone surgical treatment. The data were acquired by analysis of the hospital inpatient enquiry system and radiological review.
The ratio between male and female patients was 37:32. The average age of the patients was 76 years (ranging from 65 to 96 years) for males and 80 years (ranging from 66 to 93 years) for females. Injury to the cervical spine was caused by low-energy trauma in 71 % and high-energy trauma in 29 %, respectively. 55.1 % sustained isolated cervical spine injuries, 39.1 % injuries to two adjacent vertebrae, 2.9 % injuries to three adjacent vertebrae, and 2.9 % an odontoid fracture combined with associated fracture(s) in non-contiguous vertebra(e). Isolated spine injury level was dominated by C2 (47.8 %). The most common site for injuries to two adjacent vertebrae was observed at C6/C7 (14.5 %). The morbidity included cerebral complications, respiratory complications, Clostridium difficile-associated disease, heart failure, and acute renal failure. Operative complications included dislocation/malposition, neurovascular lesions, wound infection, and transient swallowing difficulty. The mortality rate at 3 months was 26.1 %, with an in-hospital mortality of 21.7 %. Age was associated with mortality at 3 months. A cervical fracture-induced neurological deficit was documented in 26.1 %, resulting in a mortality of 44.4 % (8/18). Twenty-seven of 33 patients living at home/nursing home at the time of injury returned to their home/nursing home after their hospitalization. The overall outcome was predominantly related to age and the severity of neurological deficit.
In elderly patients with cervical spine fractures, the hospital course is complicated by medical issues and early mortality rates are significant. Therefore, treatment strategies should be carefully individualized to the patients and their comorbidities.
European Journal of Trauma and Emergency Surgery 10/2013; 39(5):1-8. DOI:10.1007/s00068-013-0311-5 · 0.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Therapy of vertebral fractures in the elderly is a growing challenge for surgeons. Within the last two decades, the use of polymethylmethacrylate (PMMA) in the treatment of osteoporotic vertebral fractures has been widely established. Besides vertebroplasty and kyphoplasty, the augmentation of pedicle screws with PMMA found widespread use to strengthen the implant–bone interface. Several studies showed an enhanced pullout strength of augmented screws compared to standard pedicle screws in osteoporotic bone models. To validate the clinical relevance, we analyzed postoperative radiologic follow-up data in regard to secondary loss of correction and loosening of pedicle screws in elderly patients.
Materials and methods
In this retrospective comparative study, 24 patients admitted to our level I trauma center were analyzed concerning screw loosening and secondary loss of correction following vertebral fracture and posterior instrumentation. Loss of correction was determined by the bisegmental Cobb angle and kyphosis angle of the fractured vertebra. Follow-up computed tomography (CT) scans were used to analyze the prevalence of clear zones around the pedicle screws as a sign of loosening.
In 15 patients (mean age 76 ± 9.3 years) with 117 PMMA-augmented pedicle screws, 4.3 % of screws showed signs of loosening, whereas in nine patients (mean age 75 ± 8.2 years) with 86 uncemented screws, the loosening rate was 62.8 %. Thus, PMMA-augmented pedicle screws showed a significantly lower loosening rate compared to regular pedicle screws. Loss of correction was minimal, despite poor bone quality. There was significantly less loss of correction in patients with augmented pedicle screws (1.1° ± 0.8°) as compared to patients without augmentation (5° ± 3.8°).
The reinforcement of pedicle screws using PMMA augmentation may be a viable option in the surgical treatment of spinal fractures in the elderly.
European Journal of Trauma and Emergency Surgery 10/2013; 39(5):1-6. DOI:10.1007/s00068-013-0310-6 · 0.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Within the last two decades the use of polymethylmethacrylate (PMMA) in the treatment of osteoporotic vertebral fractures has been established widely. Several techniques of cement application in spinal surgery have been described. Besides classical vertebroplasty, kyphoplasty and related techniques that reinforce stability of the fractured vertebral body itself, augmentation of pedicle screws became an issue in the past 10 years. Aim of this technique is strengthening of the implant-bone-interface and the prevention of loosening and failure of posterior instrumentation in limited bone quality due to osteoporosis. PMMA use in spinal surgery always bears the risk of cement leakage and cement embolism. There are only few publications dealing with cement leakage in pedicle screw augmentation. We examined our cohort concerning incidence and type of leakage in comparison to the literature. In particular, we evaluated a possible role of intrathoracic pressure during cementation procedure. In this retrospective study 42 patients were included. Mean age was 74 (57-89) years. 311 fenestrated, augmented screws were analyzed postoperatively concerning leakage and subsequent pulmonary embolism of cement particles. Overall, there was a leakage rate of 38.3 %, and 28.6 % of patients showed pulmonary embolism of PMMA. During surgery, patients were in part ventilated with a positive end-expiratory pressure (PEEP) of 15 cmH(2)O during cement injection. These individuals showed significantly less leakage locally as well as less PMMA-emboli in the pulmonary circulation in contrast to patients ventilated without increased PEEP. PEEP elevation during administration of PMMA via fenestrated pedicle screws is reducing the leakage rate in spinal surgery. These beneficial effects warrant further evaluation in prospective studies.
European Journal of Trauma and Emergency Surgery 10/2013; 39(5):1-8. DOI:10.1007/s00068-013-0319-x · 0.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
There are a variety of surgical strategies for the treatment of traumatic thoracolumbar vertebral fractures. There is still no proof for the superiority of any strategy concerning clinical or radiological outcomes. The aim of this study was the evaluation of residual complaints and correlation with radiological findings.
Patients and methods:
87 patients, who underwent different types of surgery for vertebral fractures of the thoracolumbar region were included. Patients were treated by posterior stabilisation with internal fixation alone, by a combined approach using posterior internal fixation and anterior fusion by bone graft from the iliac crest with or without additional anterior plating or with a combined approach using posterior stabilisation and anterior implantation of an expandable titanium cage. Data were collected using results of physical examination, standardised testing of several established quality of life scores (SF-36, VAS, LBOS and Oswestry score) as well as radiological findings (post-traumatic kyphosis, loss of correction).
There was no difference in the overall results of quality of life in the different subgroups. Analysis of the subgroups revealed differences in the complaints according to the surgical strategy used (a high rate of non-fusion where bone grafts, especially without additional anterior plating were used, combined with a high rate of bone graft morbidity, intercostal neuralgia in cage implantation). Loss of correction as documented in the radiological course showed a maximum in patients who underwent posterior stabilisation without an additional anterior approach. There was no correlation of loss of correction and quality of life.
Overall outcomes of the four surgical strategies were comparable in our study concerning loss of correction and quality of life, respectively. The use of bone grafts, however, results in a high rate of non-fusion with a remarkable number of patients complaining about bone graft morbidity. Therefore we prefer the use of expandable titanium cages for anterior stabilisation if additional anterior stabilisation is necessary due to type of fracture or damage of adjacent discs. In any other cases, a limited approach by posterior instrumentation alone should be considered.
[Show abstract][Hide abstract] ABSTRACT: Background
The incidence of pulmonary failure in trauma patients is considered to be influenced by several factors such as liver injury. We intended to assess the association of various potential predictors of pulmonary failure following thoracic trauma and liver injury.
Records of 12,585 trauma patients documented in the TraumaRegister DGU® of the German Trauma Society were analyzed regarding the potential impact of concomitant liver injury on the incidence of pulmonary failure using uni- and multivariate analyses. Pulmonary failure was defined as pulmonary failure of ≥ 3 SOFA-score points for at least two days. Patients were subdivided according to their injury pattern into four groups: group 1: AIS thorax < 3; AIS liver < 3; group 2: AIS thorax ≥ 3; AIS liver < 3; group 3: AIS thorax < 3; AIS liver ≥ 3 and group 4: AIS thorax ≥ 3; AIS liver ≥ 3.
Overall, 2643 (21%) developed pulmonary failure, 12% (n= 642) in group 1, 26% (n= 697) in group 2, 16% (n= 30) in group 3, and 36% (n= 188) in group 4. Factors independently associated with pulmonary failure included relevant lung injury, pre-existing medical conditions (PMC), sex, transfusion of more than 10 units of packed red blood cells (PRBC), Glasgow Coma Scale (GCS) ≤ 8, and the ISS. However, liver injury was not associated with an increased risk of pulmonary failure following severe trauma in our setting.
Specific factors, but not liver injury, were associated with an increased risk of pulmonary failure following trauma. Trauma surgeons should be aware of these factors for optimized intensive care treatment.
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 04/2013; 21(1):34. DOI:10.1186/1757-7241-21-34 · 2.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Lesions of the intervertebral disk accompanying vertebral fractures are the subject of controversy regarding the extent of surgical intervention, in part due to the lack of a comprehensive classification. The purpose of this study is to present a novel and clinically useful classification system for traumatic disk lesions after vertebral fractures.
MRI of 204 disks in 102 patients with trauma-induced single-level thoracolumbar fractures referred to our trauma center between 2007 and 2011 were analyzed retrospectively. Exclusion criteria were malignant vertebral collapse, spondylodiskitis, osteoporotic fractures, and degenerative disk disease in the uninjured disks. Morphologic changes and signal alterations of the adjacent disks were determined using routine MRI of these patients and a grading system was developed. Disks were divided according to their signals into four categories from grade 0 to grade 3. Intra- and interobserver reliabilities were measured by calculating the Cohen kappa coefficient.
Of the 204 disks studied, 28.9% (59/204) were determined to be grade 0 (uninjured), 4.9% (10/204) grade 1 (disk edema), 25.5% (52/204) grade 2 (bleeding/rupture), and 40.7% (83/204) grade 3 (displacement). The kappa value for the intra- and interobserver agreement was 0.96.
This novel classification may improve communication between spine surgeons and radiologists as well as facilitate clinical decision making in spine surgery. Further studies need to be conducted to verify clinical relevance.
American Journal of Roentgenology 03/2013; 200(3):618-23. DOI:10.2214/AJR.12.8748 · 2.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction Diagnosis of Triplane fractures remains difficult in common practice. Aim of the study was the evaluation of the fracture pattern and the benefit of cross-sectional imaging in classification of Triplane-fractures. Material and Methods A total of 27 pediatric patients treated for ankle fractures were identified from patient charts. Radiographic images of epiphyseal fractures (X-rays and additional cross-sectional imaging) were blinded evaluated by 13 observers to answer a specific questionnaire regarding type or fracture and treatment suggestion. Results There were seven Triplane-I and eight Triplane-II fractures. The other physeal ankle fracture group consisted of four patients with a Twoplane-fracture, five Salter-and-Harris (SH) II, one SH-III, and two SH-IV fracture. Accuracy of classification improved considerably depending on the experience of the observer in pediatric trauma care. Surgeons specialized in pediatric trauma care classified correctly with conventional X-rays in 48.1 % of all cases presented versus 31.5 % appropriate diagnosis by younger fellows. Accuracy in exact specification of Triplane-fractures was comparable lesser in younger fellows (31.1 vs. 22 %). Cross-sectional imaging improved classification of all fractures in both groups (75.6 % specialized vs. 47.3 % non specialized). Whereas availability of cross-sectional imaging improved treatment recommendation in specialized surgeons this benefit was not detectable for the doctors without specialization. Evaluation of fracture pattern showed a relatively stereotypical fracture pattern in Triplane-II fractures, whereas Triplane-I fractures were more variable. Conclusion The additional information of cross-sectional imaging seems helpful for any physician in finding the right classification of a pediatric ankle fracture. However, the additive information appears especially viable for experienced surgeons to suggest the appropriate treatment.
European Journal of Trauma and Emergency Surgery 02/2013; 40(1):37-43. DOI:10.1007/s00068-013-0338-7 · 0.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Kindertraumatologie stellt nicht die Behandlung kleiner Menschen nach Maßstäben der Erwachsenentraumatologie dar. Am Beispiel der Sprunggelenkfrakturen soll die Qualität der Frakturdiagnostik der durchgangsärztlichen Behandlung hinsichtlich der Notwendigkeit einer Zusatzspezialisierung erfasst und beurteilt werden.Im Rahmen einer retrospektiven Datenanalyse der Unfallkasse Hessen wurden 621 Sprunggelenkverletzungen von Kindern (bis einschließlich dem 13. Lebensjahr) in 10 Jahren erfasst. Anhand der Unfallanzeigen und Folgeberichte konnten 433 Fälle ausgewertet werden. In 57,6% lag eine nachvollziehbare kinderspezifische Diagnose vor. In 42,4% entsprach die Frakturbeschreibung nicht den Kriterien der Kindertraumatologie oder es wurde lediglich das Vorhandensein einer Fraktur ohne ausreichend genaue Beschreibung dokumentiert.Die Daten zeigen, dass bisher nicht in allen Fällen eine Diagnosestellung im Sinne einer kindertraumatologischen Klassifikation erfolgte. Zugangsvoraussetzungen zur Teilhabe an der Behandlung verletzter Kinder und/oder entsprechende Weiterbildungsangebote sollten helfen, die Qualität kinderspezifischer Diagnostik zu verbessern.
Trauma und Berufskrankheit 01/2013; 15(2). DOI:10.1007/s10039-012-1925-2
[Show abstract][Hide abstract] ABSTRACT: Komplexe Eingriffe am Kniegelenk, wie die Ersatzplastik des vorderen Kreuzbandes (VKB) in Zweibündeltechnik, werden bisher nicht explizit im DRG-System (,,diagnosis related groups“) berücksichtigt. Ziel der vorliegenden Arbeit war es, eine Kostenträgerrechnung zu erstellen und zu evaluieren, wie hoch der Deckungsbeitrag der VKB-Ersatzplastik in Ein- bzw. Zweibündeltechnik ist.In der Einbündeltechnik (Gruppe A) wurden 30 Fälle und 21 Patienten in der Zweibündeltechnik (Gruppe B) versorgt. Ermittelt wurden die Personal-, Material- und Implantatkosten. Berücksichtigt wurden ferner die Gemeinkosten für den nichtmedizinischen Bereich und die medizinische Infrastruktur.Alle Fälle mündeten in die DRG I30Z ,,komplexe Eingriffe am Kniegelenk“. Für 2008 ergab sich ein Erlös von 2996,65 EUR und für 2009 von 3120,35 EUR. Unter Berücksichtigung der Kosten lag der Deckungsbeitrag 2008 und 2009 in Gruppe A bei 592,42 EUR bzw. 716,12 EUR. In der Gruppe B ergab sich ein weitaus geringer Erlös von 314,68 EUR respektive 438,38 EUR.Die VKB-Ersatzplastik in Doppelbündeltechnik kann im stationären Bereich nur durch eine drastische Einsparungen (Reduktion der Liegedauer, Einsparungen bei den Implantatkosten und Optimierung der Schnitt-Naht-Zeit) kostendeckend durchgeführt werden. Zudem ist eine Überarbeitung des Relativgewichts erforderlich.
Der Unfallchirurg 01/2013; 116(6). · 0.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Traumatic hemipelvectomy is a severe, however rare injury associated with high lethality. Up to now, immediate surgical completion of the amputation has been recommended as a lifesaving therapy. We present a case of near complete hemipelvectomy with open fracture of the ileosacral joint, wide open symphysis and severe soft tissue trauma including a decollement around the pelvis. Successful complete replantation was performed by primary internal stabilisation and revascularisation using vascular grafts. In the further hospital course, numerous revisions of the soft tissue injury and reconstructive surgery were needed. Thirty months later, the patient's condition is physically and psychologically stable and he is able to walk using crutches. The key point of successful management was skilled emergency damage control surgery followed by dedicated surgical care to avoid septic complications.
[Show abstract][Hide abstract] ABSTRACT: Clara cell protein 16 (CC16) has recently gained acceptance as a blood biomarker for detecting direct and indirect lung injury. Although the early elevation of CC16 serum levels has been shown to correlate with pulmonary damage in patients with multiple injuries, the subsequent time course of CC16 serum levels has not been investigated in these patients.
Fifty-eight patients with multiple injuries, 32 with severe thoracic injury, and 12 healthy volunteers were enrolled in this study. CC16 serum levels were measured at the time they were admitted to the trauma ward "time 0" and subsequently until day 14 using the enzyme-linked immunosorbent assay technique. The correlation between CC16 serum levels and severe lung injury, onset of nosocomial pneumonia, acute respiratory distress syndrome or acute lung injury, and organ failure was measured. In addition, areas under the receiver operating characteristic curve were calculated (p < 0.05 = significant).
In patients with lung injury, initial "time 0" median CC16 values were significantly elevated (11.2 ng/mL) compared with patients without severe thoracic injury (6.9 ng/mL) and controls (6.3 ng/mL). The observed elevation in serum CC16 declined to control values within 12 to 24 hours after trauma unless patients secondarily developed pneumonia. In the latter patients, median CC16 serum levels were significantly elevated (14.5 ng/mL) at the onset of pneumonia compared with their levels (7.3 ng/mL) 1 day before. In contrast, no secondary elevation in CC16 serum levels was observed in patients without severe lung injury within the same 24-hour period. The area under the receiver operating characteristic curve for serum CC16 and pneumonia was 0.79 (0.62-0.97; p = 0.0011).
Our results confirm the previously described association between initial elevation in CC16 serum levels and severe thoracic injury in patients with multiple injuries. In addition, we found that the initial elevation in CC16 serum levels declines to control values within the first day after trauma and that a secondary elevation indicates respiratory complications.
Diagnostic study, level II.
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Liver cirrhosis has been shown to be associated with impaired outcome in patients who underwent elective surgery. We therefore investigated the impact of alcohol abuse and subsequent liver cirrhosis on outcome in multiple trauma patients.
Materials and methods:
Using the multi-centre population-based Trauma Registry of the German Society for Trauma Surgery, we retrospectively compared outcome in patients (ISS ≥ 9, ≥ 18) with pre-existing alcohol abuse and liver cirrhosis with healthy trauma victims in univariate and matched-pair analysis. Means were compared using Student's t-test and analysis of variance (ANOVA) and categorical variables using χ(2) (p<0.05=significant).
Overall 13,527 patients met the inclusion criteria and were, thus, analyzed. 713 (5.3%) patients had a documented alcohol abuse and 91 (0.7%) suffered from liver cirrhosis. Patients abusing alcohol and suffering from cirrhosis differed from controls regarding injury pattern, age and outcome. More specific, liver cirrhotic patients showed significantly higher in-hospital mortality than predicted (35% vs. predicted 19%) and increased single- and multi-organ failure rates. While alcohol abuse increased organ failure rates as well this did not affect in-hospital mortality.
Patients suffering from liver cirrhosis presented impaired outcome after multiple injuries. Pre-existing condition such as cirrhosis should be implemented in trauma scores to assess the individual mortality risk profile.
[Show abstract][Hide abstract] ABSTRACT: This study investigates the outcome after traumatic brain injury (TBI) in mice lacking the essential DNA repair gene xeroderma pigmentosum group A (XPA). As damage to DNA has been implicated in neuronal cell death in various models, the authors sought to elucidate whether the absence of an essential DNA repair factor would affect the outcome of TBI in an experimental setting.
Thirty-seven adult mice of either wild-type (n = 18) or XPA-deficient ("knock-out" [n = 19]) genotype were subjected to controlled cortical impact experimental brain trauma, which produced a focal brain injury. Sham-injured mice of both genotypes were used as controls (9 in each group). The mice were subjected to neurobehavoral tests evaluating learning/acquisition (Morris water maze) and motor dysfunction (Rotarod and composite neuroscore test), pre- and postinjury up to 4 weeks. The mice were killed after 1 or 4 weeks, and cortical lesion volume, as well as hippocampal and thalamic cell loss, was evaluated. Hippocampal staining with doublecortin antibody was used to evaluate neurogenesis after the insult.
Brain-injured XPA(-/-) mice exhibited delayed recovery from impairment in neurological motor function, as well as pronounced cognitive dysfunction in a spatial learning task (Morris water maze), compared with injured XPA(+/+) mice (p < 0.05). No differences in cortical lesion volume, hippocampal damage, or thalamic cell loss were detected between XPA(+/+) and XPA(-/-) mice after brain injury. Also, no difference in the number of cells stained with doublecortin in the hippocampus was detected.
The authors' results suggest that lack of the DNA repair factor XPA may delay neurobehavioral recovery after TBI, although they do not support the notion that this DNA repair deficiency results in increased cell or tissue death in the posttraumatic brain.
Journal of Neurosurgery 03/2012; 116(6):1368-78. DOI:10.3171/2012.2.JNS11888 · 3.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Zusammenfassung Bei einer schwangeren 24-jährigen Patientin (32. SSW) wurde im Rahmen der Abklärung einer unklaren, nicht heilenden Wunde
im Bereich des distalen Radius eine ossäre Tuberkulose diagnostiziert und erfolgreich mittels medikamentös-chirurgischer Kombinationstherapie
behandelt. Ein Jahr nach der operativen Versorgung war die Mutter klinisch beschwerdefrei und das Kind entwickelte sich unauffällig.
Die operative Versorgung der ossären Tuberkulose in Kombination mit einer tuberkulostatischen Therapie in der Schwangerschaft
und Stillzeit stellt bei bestehender Indikation, insbesondere bei drohender Gelenkdestruktion oder vertebraler Tuberkulose
die Methode der Wahl dar, da sie für das Kind mit einem vertretbaren Risiko und für die Mutter mit einem guten Outcome einhergeht.
Der Unfallchirurg 01/2012; DOI:10.1007/s00113-011-1957-2 · 0.65 Impact Factor