A Badke

Publications (18)23.43 Total impact

• Article: [Hardware removal after spinal instrumentation].

  H C Baron, B G Ochs, F M Stuby, U Stöckle, A Badke
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  ABSTRACT: Because of the increasing number of patients with surgically treated injuries of the spine we more often have to answer the question of indication for hardware removal. In the cervical spine and after anterior instrumentations of the thoracic and lumbar spine hardware removal is only indicated as part of the management of postoperative complications. After dorsal instrumentation for fractures of the thoracic and lumbar spine, implant-associated discomfort is possible. In addition, in non-fusion procedures there is the risk of implant failure. In these cases the hardware should be removed. If the consolidation of the fracture is in doubt, a preoperative CT scan is useful.
  Der Unfallchirurg 04/2012; 115(4):339-42. · 0.61 Impact Factor
• Article: [Refracture of long bones after implant removal. An avoidable complication?].

  B G Ochs, C E Gonser, H C Baron, U Stöckle, A Badke, F M Stuby
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  ABSTRACT: Refractures of long bones after implant removal are a rare but serious complication, which in most cases make a reoperation necessary. We analysed our own cases and reviewed the scarce literature on this subject. As a result we found that it is possible to reduce this complication by performing thorough preoperative preparation, observing an adequate interim time between initial osteosynthesis and hardware removal, cautiously exposing the weakened bone to force for a certain time period after implant removal and taking the character of the fracture healing into consideration. It is not possible to entirely eradicate this complication because a lot of patients demand the implant removal even though it is known that demineralisation and residual screw holes both induce a reduction of energy-absorbing capacity and therefore predispose the patient to refracture. In some cases the surgeon should recommend that the implants remain in situ.
  Der Unfallchirurg 04/2012; 115(4):323-9. · 0.61 Impact Factor
• Article: [Hardware removal after pelvic ring injury].

  F M Stuby, C E Gonser, H C Baron, U Stöckle, A Badke, B G Ochs
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  ABSTRACT: Pelvic ring fractures are considered as rare injuries. Minimally invasive sacroiliac screw fixation has been used increasingly in recent years as an operative strategy for the treatment of these injuries, if the dorsal pelvic ring needed to be addressed. Treatment options for the anterior pelvic ring comprise plates, screws or external fixation. Based on the limited number of publications on this subject and our own experience with 80 patients who suffered pelvic ring B- or C-type injuries during a period of 8 years we are able to show that the indication for hardware removal in the pelvic ring should be strictly defined. In some cases like external fixation, implant-associated infection, malpositioning, allergic implant reaction, critical soft tissue covering, palpable hardware and consolidated juvenile fractures implant removal is certainly indicated. In patients without symptoms and in patients with trauma-associated symptoms which are not definitely associated with the hardware, the removal should be only indicated after thorough consideration of the risks versus the benefits and additionally by taking the initial injury pattern into account. If despite all these objections the hardware removal has been indicated it should always be considered that hardware removal may be challenging with several possible severe complications.
  Der Unfallchirurg 04/2012; 115(4):330-8. · 0.61 Impact Factor
• Article: [Evaluation of image quality of two different three-dimensional cone-beam-scanners used for orthopedic surgery in the bony structures of the pelvis in comparison with standard CT scans].

  F Stuby, A C Seethaler, T Shiozawa, K Weise, A Mroue, A Badke, M Buchgeister, B G Ochs
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  ABSTRACT: This study evaluated the image quality of two different cone beam CT scanners used in the operation theatre in pelvic trauma surgery in relation to their radiation dosage. Furthermore, the assumption that a higher dosage would result in better image quality was analysed by using the different acquisition scanner modes. We scanned the acetabulum (n=4) and iliosacral joints (n=4) of two human cadavers with a conventional CT and with two mobile cone beam CT scanners (Siemens Arcadis Orbic 3D and Ziehm Vision Vario 3D). With the two cone beam CT scanners (3D-BV), we used 6 different acquisition modes with different radiation dosages. The axial views of all scans were exported and blinded. Subsequently, the images were evaluated by 7 medical doctors with regard to identifiability of cortical structures (acetabular joint, fovea capitis femoris, cortical bone of the femur head, iliosacral joint, and sacral foramina), and the quality of the cancellous structure of the femur head. The evaluation was performed on axial views by using a defined five-point score. The interrater quality was statistically analysed according to Cohen with the kappa coefficient. In addition, the Wilcoxon test was used to identify significances between the 21 paired results of the evaluators. For determination of the signal-to-noise ratio, a Catphan 600 reference block with two different test elements (Teflon, PMP) was used. Overall, the image quality of the conventional CT scans received the best score. Comparing the two 3D cone beams, the image quality of the Siemens Arcadis Orbic 3D in high-dosage mode received the best score (median: 2.40), the Ziehm Vision Vario 3D in low-dose mode without large patient key received the lowest score (median: 3.16). The differences in the 21 paired results of the two different acquisition modes were significant in 17 cases (p < 0.05) but the size of difference when comparing the different acquisition modes was almost always small. The interobserver agreement in one acquisition mode was low (kappa 0.008-0.134). The overall evaluation results of the same acquisition mode diverged by up to 2 score points. We noted a higher signal-to-noise ratio in the high dosage mode than in the low dosage mode. When using intraoperative 3D imaging with the cone beam CT technique for pelvic injury, image acquisition in low-dose mode is adequate in terms of signal-to-noise ratio and image quality. The image quality does not correlate linearly with a higher radiation dosage. Therefore, the pelvic trauma surgeon using this technique is encouraged to gather his own experience with low dose modes thereby reducing patient radiation exposure.
  Zeitschrift fur Orthopadie und Unfallchirurgie 05/2011; 149(6):659-67. · 0.52 Impact Factor
• Article: [Postarthroscopic glenohumeral chondrolysis--are there any causal factors? Case report].

  S Schröter, O Lutz, C E Gonser, A Ateschrang, A Badke, D Albrecht
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  ABSTRACT: Postarthroscopic glenohumeral chondrolysis (PAGCL) is a rare complication of shoulder arthroscopy. PAGCL describes a chondrolysis in the shoulder joint after arthroscopy mostly affecting younger patients. The process leading to chondrolysis is not known yet. The case report describes a patient with rapid progress of the PAGCL. A literature review with key words: PAGCL, postarthroscopic glenohumeral chondrolysis, shoulder arthroscopy AND chondrolysis, chondronecrosis AND arthroscopy was carried out. 16 Publications involving case reports with 96 cases were found. The mean age at operation was 28 ± 10 years (range: 13 to 61 years). The majority of patients (62%) were male. 8 diagnoses at index operation were found. 63% received intraarticular local anaesthetics (62% bupivacain, 21% bupivacain and epinephrin, 2% lidocain) through a pain pump. PAGCL is a rare and disturbing complication after shoulder arthroscopy. The majority of the patients are young and male. A relevant causal factor is an intraarticular pain pump with bupivacain. Other factors have not yet been verified. A multifactorial aetiology is likely. No specific and effective treatment regimen is described.
  Zeitschrift fur Orthopadie und Unfallchirurgie 04/2011; 149(6):688-93. · 0.52 Impact Factor
• Article: Early sacral neuromodulation prevents urinary incontinence after complete spinal cord injury.

  Karl-Dietrich Sievert, Bastian Amend, G Gakis, P Toomey, A Badke, H P Kaps, Arnulf Stenzl
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  ABSTRACT: The study aim was to investigate potential influences on human nerves and pelvic organs through early implantation of bilateral sacral nerve modulators (SNMs) in complete spinal cord injury (SCI) patients during the acute bladder-areflexia phase. Ten patients with neurologically-confirmed complete spinal cord lesions (SCLs) were provided with bilateral SNMs during the phase of atonic-detrusor muscle. Modulation was achieved by two electrodes implanted into each S(3)-foramen. Six patients declined and served as controls. The mean follow-up was 26.2 months. Videourodynamics (VU) confirmed detrusor acontractility, resulting in urinary continence as well as significant reductions in urinary tract infections (UTIs). Bowel movements did not require oral laxatives; additional preprogrammed parameters achieved erections for intercourse. Early SNM implantation in SCI patients may revolutionize neurogenic lower urinary tract (LUT) dysfunction management; it prevented detrusor overactivity and urinary incontinence, ensured normal bladder capacity, reduced UTI rates, and improved bowel and erectile functionality without nerve damage. Future SCI investigations will be conducted to evaluate the potential benefits of even earlier SNM placement to progressively enhance pelvic organ functionality. This new approach may provide important clues required for assessing whether neuronal information is passed through the sympathetic trunk ganglion to the brain after complete SCI. Further investigations are needed to determine if functional magnetic resonance imaging (fMRI) might be helpful for analyzing changes in brain function in patients with SNMs and those taking antimuscarinics.
  Annals of Neurology 08/2009; 67(1):74-84. · 11.09 Impact Factor
• Article: Traumatic dislocation of the fibula head in childhood and adolescence: operative therapy and outcome of a rare injury.

  T Vogel, M Baumann, J Rether, F Stuby, K Weise, A Badke
  European Journal of Pediatric Surgery 05/2009; 19(6):413-6. · 0.81 Impact Factor
• Article: Immune depression syndrome following human spinal cord injury (SCI): a pilot study.

  T Riegger, S Conrad, H J Schluesener, H-P Kaps, A Badke, C Baron, J Gerstein, K Dietz, M Abdizahdeh, J M Schwab
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  ABSTRACT: Experimental spinal cord injury (SCI) has been identified to trigger a systemic, neurogenic immune depression syndrome. Here, we have analyzed fluctuations of immune cell populations following human SCI by FACS analysis. In humans, a rapid and drastic decrease of CD14+ monocytes (<50% of control level), CD3+ T-lymphocytes (<20%, P<0.0001) and CD19+ B-lymphocytes (<30%, P=0.0009) and MHC class II (HLA-DR)+ cells (<30%, P<0.0001) is evident within 24 h after spinal cord injury reaching minimum levels within the first week. CD15+ granulocytes were the only leukocyte subpopulation not decreasing after SCI. A contributing, worsening effect of high dose methylprednisolone cannot be excluded with this pilot study. We demonstrate that spinal cord injury is associated with an early onset of immune suppression and secondary immune deficiency syndrome (SCI-IDS). Identification of patients suffering spinal cord injury as immune compromised is a clinically relevant, yet widely underappreciated finding.
  Neuroscience 09/2008; 158(3):1194-9. · 3.38 Impact Factor
• Article: [CT-based assessment score after ventral spondylodesis for thoracolumbar spine fracture].

  A Badke, P Jedrusik, M Feiler, F Dammann, C D Claussen, H P Kaps, K Weise
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  ABSTRACT: Dorsoventral stabilization is a common procedure to treat thoracolumbar spine fractures. Especially in respect of the evaluation of alternative procedures to autogenous bone graft, a standardized evaluation score for ventral spondylodesis is necessary. In a group of 44 patients a follow-up CT scan was evaluated with a standardized scoring system by four different independent evaluators (a trauma surgeon, an orthopedic surgeon, and two radiologists). The score is based on the morphologic classification of the region between graft and vertebral body. It allows a classification of the spondylodesis as sufficient, partial, and not sufficient. The statistical evaluation of the classification of the different evaluators shows very good interobserver agreement in monosegmental fusion and good agreement in bisegmental fusion. The demonstrated score is easy to handle, does not need special equipment for CT scans, and shows good interobserver agreement in the classification of spinal fusion after ventral spondylodesis for thoracolumbar spine fracture.
  Der Unfallchirurg 03/2006; 109(2):119-24. · 0.61 Impact Factor
• Article: [Development of the spine after traumatic spinal cord injury in children and adolescents].

  H-P Kaps, A Badke
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  ABSTRACT: In the 1970s, there was growing concern about the risk of secondary deformations of the spine as these seemed to endanger the otherwise improving prognosis for the life of paraplegic subjects, especially of paralyzed children and adolescents. According to the literature, the level and extent of the spinal cord injury and the age at the time of injury are determinants of the development of scoliosis, hyperlordosis or global kyphosis. Correction of the deformity by brace orthosis is not indicated except for children. The indications for surgical intervention in terms of the extent of the scoliosis and technical performance corresponds to the well known situation for idiopathic scoliosis except for the length of fusion. A special form of scoliosis, the so called "collapsing spine", allows good surgical correction because it is usually not rigid. Early, substantial degenerative processes such as segmental intervertebral instability at the level of the paraplegia, as well as distinct uncarthrosis proximally distant from the innervated zones with secondary radicular damage, are observed. By means of modern surgical procedures, the appearance of the patient's body, as well as the quality of life, can be favorably influenced.
  Der Orthopäde 03/2005; 34(2):128-30, 132-6. · 0.51 Impact Factor
• Article: Erfahrungen mit winkelstabilen Implantaten an Brust- und Lendenwirbelsäule

  A. Badke, H.-P. Kaps
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  ABSTRACT: Winkelstabile Implantate in Form des Fixateur interne werden bei der dorsalen Instrumentierung von Verletzungen des thorakolumbalen bergangs seit vielen Jahren eingesetzt. Der bereits bei liegendem Implantat, jedoch insbesondere nach Materialentfernung zu beobachtende Korrekturverlust fhrte dazu, dass im Rahmen der Frakturversorgung an der BWS und LWS in zunehmender Zahl dorsoventrale Spondylodesen durchgefhrt wurden. Auch hier haben sich winkelstabile Implantate als sinnvoll erwiesen. Die auch fr minimalinvasive Zugnge geeigneten Implantate werden kontinuierlich weiterentwickelt, sodass insbesondere der Schraubenhalt im Knochen verbessert werden kann. Ob und bei welchen Frakturen die winkelstabile ventrale Instrumentierung in der Lage ist, eine ausreichende Stabilitt zu gewhrleisten, werden zuknftige Studien mit greren Zahlen zeigen mssen.Internal fixators have long been used as fixed-angle implants for dorsal intrumentation of fractures of the thoracolumbar transition in the spine. After such dorsal intrumentation, even while the implants were still in place but even more after their removal, loss of correction has frequently been observed. Dorso-ventral spondylodesis provides a higher stability and is now increasingly frequently applied in the treatment of fractures of the thoracic and lumbar spine. Few data are available on the fusion rate of bone grafts. Early experience with fixed-angle implants that can be inserted in minimally invasive procedures are convincing. Further studies are needed to test whether these implants provide enough stability for ventrale spondylodesis without dorsal tension band instrumentation.
  Trauma und Berufskrankheit 01/2004; 6:S41-S43.
• Article: Distalization of the patella during tibial callus distraction.

  C Eingartner, C Bretschneider, A Badke, K Weise
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  ABSTRACT: Consecutive distalization of the patella is described in two patients undergoing segmental transportation after high tibial corticotomy. Revision surgery with loosening and proximal reattachment of a portion of the patellar ligament bridging the callus distraction zone could re-establish the correct patellar position. Despite excellent callus formation after tibial corticotomy just below the tibial tuberositas, this procedure should be performed more distally as the fibers of the patellar tendon spread laterally and distally.
  Archives of Orthopaedic and Trauma Surgery 02/1998; 117(6-7):397-8. · 1.37 Impact Factor
• Article: [Treatment and rehabilitation of post-traumatic tetraplegia in advanced age. A report of experiences].

  A Badke, H Bilow
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  ABSTRACT: We report about the results of the treatment of patients older than 70 years with posttraumatic tetraplegia. In 7 out of 11 patients treatment in a specialised department lasting for many months makes it possible to live a subjective satisfactory life at home in spite of being severely handicapped. The goals and limits of rehabilitation of patients with posttraumatic tetraplegia cannot only be derived from the age but from the individual capability of the injured patient.
  Unfallchirurgie 07/1997; 23(3):100-4.
• Article: [Traumatic damage to the lower cervical spine--a diagnostic problem?].

  R Volkmann, A Badke, E Winter, D Höntzsch
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  ABSTRACT: Even today fractures and dislocations of the lower cervical spine are usually not recognized, or the interpretation of the results of the diagnostic procedures is not correct. These diagnostic failures are often caused by an incomplete representation of the cervical spine in the conventional radiograms, particularly in the lateral projection. Beyond that, the interpretation of the results of the neurological examination of patients with motoric or sensoric deficits after spine injury can be incorrect. Ignorance of the distribution of the segmental innervation of the upper extremities could lead to the wrong diagnosis of paraplegia in a tetraplegic patient. Two patients with injuries of the lower cervical spine are reported, in whom these problems led to an incorrect diagnosis. With regard to these cases we propose a standard diagnostic procedure for the clinical and radiological emergency examination of patients with neurological deficits after spine injury. The technical possibilities of obtaining correct radiographs of the lower cervical spine are described in detail.
  Der Unfallchirurg 08/1996; 99(7):466-9. · 0.61 Impact Factor
• Article: [Unilateral, paramedian spinal contusion after athletic injury with complete recovery].

  B Ebert, A Badke
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  ABSTRACT: The acute injury of the spinal column and the spinal cord asks for immediate diagnostic techniques and adequate therapeutical intensive care in order to secure the possibility of a maximum of neurologic recovery. An impact trauma of the spinal cord in sports accidents can cause an incomplete paraplegia. In some cases, morphologic lesions of the myelon cannot be detected. We present an exceptional and striking case of a 15-year old young woman who suffered from a contusio spinalis after high jump with the clinical signs of an incomplete, sensomotoric paraplegia which showed a strictly unilateral and paramedian border at the right side of her body for about two weeks. Additionally, the diagnostic possibilities of physical examination, magnetic resonance imaging, computed tomography and neurophysiologic diagnostic techniques in detecting spinal cord injuries are demonstrated.
  Sportverletzung · Sportschaden 04/1995; 9(1):26-9. · 0.61 Impact Factor
• Article: [Pharyngo-vertebral fistula with transspinous course to the neck skin due to a cervical spondylodesis - case report and review of the literature].

  B Ulmar, C Baron, H-P Kaps, K Weise, A Badke
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  ABSTRACT: Pharyngo-vertebral fistulas - especially with delayed diagnosis - are a rare but grave reported complication in cervical spine surgery. We present a patient, sent postoperatively from Italy after cervical spine surgery to our department. The patient has developed a pharyngo-vertebral fistula with transspinous course to the dorsal neck skin due to infected spondylodesis. In the presented patient, the successful closure of the pharyngo-vertebral fistula with transspinous course was made after diverse revisions at the anterior side with a platysma flap, at the posterior one with a drain. Aetiology, diagnostic work-up and treatment opinions are discussed in a detailed literature review. To the best of the authors' knowledge the presented pharyngo-vertebral fistula with transspinous course to the dorsal neck skin as a complication after anterior cervical spine surgery has not been reported in the literature before.
  Zeitschrift fur Orthopadie und Unfallchirurgie 147(2):215-9. · 0.52 Impact Factor
• Article: [Traumatic lumbosacral dislocation - an underrated injury].

  S Schroeter, K Weise, A Badke
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  ABSTRACT: Traumatic lumbosacral dislocations are rare. We report two cases with initially missed posttraumatic lumbosacral dislocations. The reported cases and the review of the literature show that, especially, accident victims with multiple fractures of the lumbar transverses processes may require a CT scan to confirm fractures or dislocations of L5/S1. Follow-up examinations due to persisting pain after physiotherapy should include lateral X-rays of the lumbar spine of the patient standing. According to the literature and our experience, the treatment of traumatic lumbosacral dislocation usually consists of open reduction and postero-lateral or dorso-ventral fusion of the unstable segments.
  Zeitschrift fur Orthopadie und Unfallchirurgie 147(2):231-5. · 0.52 Impact Factor
• Article: [Traumatic thoracic spine fractures: inter- and intraobserver reliability of vertebral, local and segmental kyphosis in lateral X-rays].

  B Ulmar, M Gühring, F Stuby, A Brunner, T Schmälzle, K Weise, A Badke
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  ABSTRACT: The evaluation of the vertebral, local and segmental kyphosis according to Cobb is usual practice in the determination of traumatic, idiopathic and degenerative spinal deformities. The present study compares the inter- and intraobserver reliability of these 3 angles in the lateral X-rays of thoracic spine fractures with spinal kyphosis. From 1999 till 2007 all patients with adequate X-rays, age < 50 years, traumatic, thoracic spine fracture, kyphotic deformity and surgical intervention were included. The vertebral, local and segmental kyphosis were assessed by 3 observers at 2 time-points in the preoperative lateral X-rays. 63 patients, 11 women and 52 men, with a mean age of 34 years could be evaluated. In all cases an adequate trauma had led to the fracture. The most common trauma was an injury with a motorcycle; the 12th thoracic vertebra was most commonly affected. The segmental kyphosis showed 'excellent' results for inter- and intraobserver reliability (Ø-ICC: 0.8189 and Ø-ICC:0.8003). 'Good' results for inter- and intraobserver reliability could be evaluated for the vertebral (Ø-ICC: 0.7797 and Ø-ICC: 0.7797) and local (Ø-ICC: 0.7532 and Ø-ICC: 0.7296) kyphosis. Due to excellent and good results for inter- and intraobserver reliability of the segmental,vertebral and local kyphosis in the lateral X-rays of the thoracic spine, these angles could be a helpful tool, indicating a surgical procedure in traumatic thoracic fractures with kyphosis. Further possible interesting applications in the usage of these 3 angles could be the observation of the vertebral sintering in surgically or conservatively treated vertebral fractures. Appropriate studies should be performed before general recommendations can be given.
  Zeitschrift fur Orthopadie und Unfallchirurgie 147(4):481-6. · 0.52 Impact Factor