Ingo Marzi

University Hospital Frankfurt, Frankfurt, Hesse, Germany

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Publications (446)757.18 Total impact

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    ABSTRACT: Objective: This review aims to summarize current knowledge regarding the underlying patho-mechanisms of delayed fracture healing in polytraumatized patients. Data sourcesand study selection: The following search terms were used: 'fracture', 'hemorrhage', 'chest trauma', 'inflammation', 'inflammatory response', 'fracture healing', 'delayed healing', 'non-union', 'fracture stabilisation', 'intramedullary nailing', 'external fixation', 'Early Total Care' and 'Damage Control'. Medline, Embase and Cochrane Library were searched for studies published between 1.1.1990through 3.30.2014. Of 1,322 publications, 68 were included in the current summary. Conclusion: Concomitant injuries and the strategy for fracture stabilization seem to affect bone metabolism and fracture healing. Among the relevant patho-mechanisms, interactions between the local and systemic inflammatory response appear to play a role. However, the consequences of fracture fixation strategies in case of severe concomitant injuries on local inflammation and bone healing remain unknown. Level of evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
    Journal of orthopaedic trauma 11/2015; DOI:10.1097/BOT.0000000000000489 · 1.80 Impact Factor

  • Experimental and therapeutic medicine 11/2015; DOI:10.3892/etm.2015.2850 · 1.27 Impact Factor
  • S Wicker · H F Rabenau · B Scheller · I Marzi · S Wutzler ·
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    ABSTRACT: Background: Previous studies have indicated that the prevalence of human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV) virus infections among trauma patients seems to be higher compared to the general population. Objective: This study investigated the seroprevalence of blood-borne pathogens among patients with suspected severe multiple trauma in a German university hospital (level I trauma center). Methods: Routine blood samples taken from trauma patients at the university hospital Frankfurt were tested for HBV, HCV and HIV (from 1 February 2014 to 31 January 2015). Results: Overall, 275 patients with a median injury severity score (ISS) of 9 points (range 0-54) were included in the study representing 84.4 % of all trauma room admissions during this time period. Altogether 3.3 % (n = 9) of the patients were infected with blood-borne pathogens, where 7 patients were infected with HCV and 2 patients had an active HBV infection. None of the patients were tested HIV positive and only one initial diagnosis for HCV was made. A further six samples (five HCV and one HIV) showed a weak reaction in the screening assay that could not be verified by the confirmatory assay. Conclusion: To the best of our knowledge this study is the first report on the prevalence of blood-borne infections among trauma patients at a level I trauma center in an urban area in Germany. Compared to the general population the prevalence of blood-borne infections was higher but considerably lower than indicated in previous international studies. Considering the broad implications of occupationally transmitted blood-borne infections occupational safety is of paramount importance.
    Der Unfallchirurg 11/2015; DOI:10.1007/s00113-015-0110-z · 0.65 Impact Factor

  • Injury 11/2015; DOI:10.1016/j.injury.2015.10.079 · 2.14 Impact Factor
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    ABSTRACT: Introduction: The surgical treatment of large bone defects continues to pose a major challenge in modern trauma and orthopaedic surgery. In this study we test the effectiveness of a tissue engineering approach, using 3D β-TCP scaffolding plus bone marrow-derived mononuclear cells (BM-MNCs), combined with a vascularized periosteal flap, in a rat femur critical size defect model. Methods: Eighty rats were randomly allocated into 4 equal groups. Under general anesthetized, critical size defects were created on their femurs and were treated with: 1) Vascularized periosteal flap alone, 2) Vascularized periosteal flap + β-TCP scaffolding, 3) Vascularized periosteal flap + β-TCP scaffolding + ligated vascular pedicle, and 4) Vascularized periosteal flap + β-TCP scaffolding + BM-MNCs. After 4 and 8 weeks animals were euthanized and the bone defects were harvested for analysis of new bone formation, vascularization and strength using histology, immunohistology, micro-CT and biomechanical testing respectively. Results: Group 1: (P. flap) Increase in new bone formation and vascularization. Group 2: (P. flap + Scaffold) Increase in new bone formation and vascularization. Group 3: (P. flap + Scaffold + ligated vascular pedicle) No new bone formation and no vascularization. Group 4: (P. flap + Scaffold + BM-MNCs). A significant (p<0.05) increase was seen in new bone formation, vascularization, and strength in bones treated with flaps, scaffold and BM-MNCs, when compared to the other treatment groups. Conclusion: Combining a vascularized periosteal flap with tissue engineering approach (β-TCP scaffolding and BM-MNC) results in significantly improved bone healing in our rat femur critical size bone defect model.
    Tissue Engineering Part A 10/2015; DOI:10.1089/ten.TEA.2015.0030 · 4.64 Impact Factor

  • Injury 10/2015; 46:S33-S38. DOI:10.1016/S0020-1383(15)30016-4 · 2.14 Impact Factor
  • J Menke · N Wagner · M Lehnert · I Marzi · B Relja ·
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    ABSTRACT: Introduction: Alcohols' influence on trauma patients (TP) remains controversial. Alcohol was associated with neuroprotective effects in TBI, while others reported negative or no effects on survival and/or in-hospital stay in TP. Here, the relationship of alcohol with injury characteristics and outcome and its possible anti-inflammatory effects in major TP were analyzed. Methods: 184 severely injured TP (ISS≥16) were enrolled. Blood alcohol concentration (BAC) and systemic interleukin (IL)-6 were determined. Patients were grouped according to their positive BAC (>0.5‰, BAC) vs. <0.5‰ alcohol (no-BAC) upon admission (ED). Injury characteristics, physiologic parameters and outcome (organ/MOF, SIRS, sepsis, pneumonia, ARDS or mortality) were assessed. Results: 49 TP had positive BAC without chronic alcohol abuse history (1.61 ± 0.1‰) and 135 patients had BAC levels below 0.5‰ (0.03 ± 0.02‰). Injury severity (ISS BAC: 23.7 ± 1.5 vs. ISS no-BAC: 27.3 ± 0.6) and age (BAC: 43.4 ± 2.3 vs. no-BAC: 43.1 ± 1.5) were comparable between groups. No-BAC TP received significantly higher amount of packed red blood cells and fresh frozen plasma compared to BAC TP. Organ failure, MOF, SIRS, sepsis, pneumonia, ARDS and in-hospital mortality were not markedly different. BAC TP had significantly decreased leukocyte cell numbers and IL-6 levels compared to no-BAC group (leukocytes: 10.8 ± 0.74 vs. 13.2 ± 0.5U/nL; IL-6: 97.2 ± 19.3 vs. 252.9 ± 65.7pg/mL, both p < 0.05). Conclusion: Positive BAC appears not to markedly influence the outcome after trauma. Alcohols' immune-suppressive effects have been observed in reduced leukocyte cell numbers and systemic IL-6 levels. The relevance of this immune-suppression for the clinical outcome remains to be elucidated in larger prospective clinical studies.
    Shock (Augusta, Ga.) 09/2015; 44 Suppl 2:12. DOI:10.1097/01.shk.0000472041.07631.4b · 3.05 Impact Factor
  • D Heftrig · R Sturm · I Marzi · B Relja ·
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    ABSTRACT: Introduction: Trauma patients (TP) often develop an imbalanced immune response, frequently leading to infectious post-injury complications. Monocytes, part of innate immune system, show diminished HLA-DR-expression and impaired pro-inflammatory cytokine-release upon stimulation after trauma. Monocytes recognize lipopolysaccharide (LPS) via TLR4 and CD14. Data on TLR4-expression in TP's monocytes are conflicting. Moreover, there are no studies describing TLR4-expression after secondary stimulation or TLR4- and HLA-DR-co-expression after trauma. Methods: 20 TP [ISS≥16] and ten healthy volunteers (HV) were included. Ex vivo in vitro LPS-stimulation (10 μg/mL, 24 h) of whole blood was performed daily until day 10. IL-1β-release was determined by ELISA. TLR4-expression on HLA-DR-positive and -negative monocytes prior and after their stimulation with the leukocyte-activation-cocktail (LAC) was determined by flow cytometry. Results: LPS-induced IL-1β-release was significantly diminished in TP showing a recovery after day 5 compared to HV (p < 0.05). TLR4-expression in unstimulated samples from TP was significantly reduced at ED compared to HV. LAC-stimulated monocytes from TP had continuously reduced TLR4-expression compared to HV during the whole time course. HLA-DR-expression was lowered after trauma, and even more profound after stimulation. Co-expression analysis indicated that HLA-DR- monocytes may be responsible for impaired TLR4-expression after stimulation in TP. Ratio of CD14+ monocytes to leukocytes was significantly increased in the later post-injury phase. Conclusion: Next to reduced monocyte function, TP show diminished TLR4-expression after stimulation. Here, a possible mechanism for endotoxin tolerance in monocytes after major trauma is shown. Additionally, impaired TLR4-expression on naive HLA-DR- monocytes may contribute to functional suppression of monocytes after trauma.
    Shock (Augusta, Ga.) 09/2015; 44 Suppl 2:8. DOI:10.1097/01.shk.0000472026.48427.7b · 3.05 Impact Factor
  • N Wagner · B Relja · J Menke · M Lehnert · I Marzi ·
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    ABSTRACT: Introduction: The influence of alcohol consumption on inflammatory state and outcome in patients suffering from traumatic brain injury (TBI) remains controversial. We analyzed effects of positive blood alcohol concentration (BAC) on inflammatory changes, in-hospital complications, and mortality in TBI-patients. Methods: Patients with an Injury Severity Score (ISS)≥16 and Abbreviated Injury Scale of head (AIS-head)≥3 were enrolled upon arrival in the emergency room. Injury severity, vital signs, complications, mortality and systemic interleukin (IL)-6 levels were prospectively taken, blood alcohol concentration was measured. Patients were grouped according to positive BAC (>0.5‰, BAC) vs. <0.5‰ alcohol (no BAC). Matched-pair analysis according to ISS, AIS-head, age and gender was conducted. Results: 101 TBI-patients were included. 74 patients were grouped to no BAC group, 27 to BAC-group. ISS was significantly higher in the no BAC-group. Positive BAC-group received significantly less packed red blood cells and fresh frozen plasma (p < 0.05). BAC-patients had shorter ICU-stay. In-hospital complications, including single/multiple-organ failure, SIRS, sepsis, pneumonia, ARDS showed no significant changes. BAC- positive patients showed significantly lower systemic IL-6 levels and leukocyte counts (IL-6: 65.0 ± 8.0 vs. 151.8 ± 22.3, leukocytes: 10.2 ± 0.9 vs. 13.2 ± 0.8, both p < 0.05). Matched-pair analysis was performed with 27 pairs. No significant differences in transfusions were observed after matching. However, lowered systemic IL-6 levels and leukocyte counts in the BAC- group were detected after matching also, indicating that this effect is ISS-independent. Conclusion: This study indicates that positive BAC influences systemic IL-6 levels and leukocyte numbers in TBI-patients, and may deliver further insights into the understanding of possible anti- inflammatory effects of alcohol.
    Shock (Augusta, Ga.) 09/2015; 44 Suppl 2:25. DOI:10.1097/01.shk.0000472080.77136.41 · 3.05 Impact Factor
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    ABSTRACT: Background: Chronic ethanol (EtOH) abuse worsens pathophysiological derangements after hemorrhagic shock and resuscitation (H/R) that induce hepatic injury and strong inflammatory changes via JNK and NF-κB activation. Inhibiting JNK with a cell-penetrating, protease-resistant peptide D-JNKI-1 after H/R in mice with healthy livers ameliorated these effects. Here, we studied if JNK inhibition by D-JNKI-1 in chronically EtOH-fed mice after hemorrhagic shock prior to the onset of resuscitation also confers protection. Methods: Male mice were fed a Lieber-DeCarli diet containing EtOH or an isocaloric control (ctrl) diet for 4 weeks. Animals were hemorrhaged for 90 min (32 ± 2 mm Hg) and randomly received either D-JNKI-1 (11 mg/kg, intraperitoneally, i. p.) or sterile saline as vehicle (veh) immediately before the onset of resuscitation. Sham animals underwent surgical procedures without H/R and were either D-JNKI-1 or veh treated. Two hours after resuscitation, blood samples and liver tissue were harvested. Results: H/R induced hepatic injury with increased systemic interleukin (IL)-6 levels, and enhanced local gene expression of NF-κB-controlled genes such as intercellular adhesion molecule (ICAM)-1 and matrix metallopeptidase (MMP)9. c-Jun and NF-κB phosphorylation were increased after H/R. These effects were further increased in EtOH-fed mice after H/R. D-JNKI-1 application inhibited the proinflammatory changes and reduced significantly hepatic injury after H/R in ctrl-fed mice. Moreover, D-JNKI-1 reduces in ctrl-fed mice the H/R-induced c-Jun and NF-κB phosphorylation. However, in chronically EtOH-fed mice, JNK inhibition did not prevent the H/R-induced hepatic damage and proinflammatory changes nor c-Jun and NF-κB phosphorylation after H/R. Conclusions: These results indicate, that JNK inhibition is protective only in not pre-harmed liver after H/R. In contrast, the pronounced H/R-induced liver damage in mice being chronically fed with ethanol cannot be prevented by JNK inhibition after H/R and seems to be under the control of NF-κB.
    PLoS ONE 09/2015; 10(9):e0137875. DOI:10.1371/journal.pone.0137875 · 3.23 Impact Factor
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    ABSTRACT: After a major trauma, IL-1β-producing capacity of monocytes is reduced. Generation of IL-1β is important for appropriate immune response after trauma and requires not only synthesis and transcription of inflammasome components but also their activation. Altered IL-1β-processing due to deregulated NLRP inflammasomes assembly is associated with several inflammatory diseases. However, the precise role of NLRP1 inflammasome in monocytes after trauma is unknown. Here, we investigated if NLRP1 inflammasome components are responsible for depressed monocyte function after trauma. We found in ex vivo in vitro assays that LPS-stimulation of CD14(+)-isolated monocytes from healthy volunteers (HV) results in remarkably higher capacity of the IL-1β-release compared to trauma patients (TP). During the 10-day time course, this monocyte depression was highest immediately after admission. Inflammasome activation correlating with this inflammatory response was demonstrated by enhanced protein production of cleaved IL-1β and caspase-1. Furthermore, we found that the gene expression of IL-1β, caspase-1, and ASC was comparable in TP and HV after LPS-stimulation during the 10-day course, while NLRP1 was markedly reduced in TP. We demonstrated that transfected monocytes from TP, which expressed the lacking components, were recovered in their LPS-induced IL-1β-release and that lacking of NLRP1 is responsible for the suppressed monocyte activity after trauma. The restoration of NLRP1 inflammasome suggests new mechanistic target for the recovery of dysbalanced immune reaction after trauma. Suppression in monocyte function occurs early after a major trauma or surgery. Reduced gene expression abrogates NLRP1 inflammasome assembly after trauma. Limited availability of inflammasome components may cause reduced host defense. Restoring NLRP1 in immune-suppressed monocytes recovers NLPR1 activity after trauma. Recovered inflammasome activity may improve the immune response to PAMPs/DAMPs.
    Journal of Molecular Medicine 08/2015; DOI:10.1007/s00109-015-1320-0 · 5.11 Impact Factor
  • A L Sander · F Ebert · I Marzi · J Frank ·
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    ABSTRACT: Background: To date, the Aptis distal radioulnar joint (DRUJ) prosthesis by Scheker is the only total, bipolar prosthesis available. In the literature, only few data exist concerning the prosthesis and its surgical technique. Aim of the present study was the evaluation of the medium-term clinical and radiological outcome following implantation of the Aptis DRUJ prosthesis. Methods and Patients: 5 patients (4 women and 1 man) with mean age of 40.2 (30-65) years underwent secondary implantation of the Aptisprosthesis between February 2006 and May 2013. The average date of the follow-up was after 36 (24-48) months. Besides the complications, the wrist range of motion (ROM) and the strength in grip were measured. The quality of pain was determined using a visual analogue pain scale from 0-10. In follow-up X-ray controls, bone resorption and bony abnormalities were evaluated. The DASH score as well as the postoperative subjective satisfaction of the patients were recorded. Results: No patient required removal of the prosthesis. Only 1 patient underwent secondary surgery in which debridement of the screw tip over the radius was required. The postoperative range of motion in pronation and supination was measured with 78 (70-90)° and 82 (70-90)°. The average grip strength amounted to 29 (24-32) kg. This represented 85 (76-100)% of the value of the contralateral side. Postoperative pain symptoms on the visual analogue pain scale were measured with 0 points at rest and with 1.2 (0-2) points under strain. Radiological evaluation showed bone resorption at the radial peg in 2 patients, but without evidence of implant loosening. The DASH score was recorded with 37 (13-75) points. All patients were satisfied or very satisfied after the surgical treatment. Conclusion: The Aptis prosthesis is a safe and efficient treatment option for previously failed surgery of the DRUJ. © Georg Thieme Verlag KG Stuttgart · New York.
    Handchirurgie · Mikrochirurgie · Plastische Chirurgie 06/2015; 47(5). DOI:10.1055/s-0035-1550035 · 0.65 Impact Factor
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    ABSTRACT: Increased local and systemic levels of interleukin (IL)‑6 are associated with inflammatory processes, including neutrophil infiltration of the alveolar space, resulting in lung injury. Our previous study demonstrated the beneficial anti‑inflammatory effects of acute exposure to ethanol (EtOH) in an acute in vivo model of inflammation. However, due to its side‑effects, EtOH is not used clinically. In the present study, the effects of EtOH and ethyl pyruvate (EtP) as an alternative anti‑inflammatory drug prior to and following application of an IL‑6 stimulus on cultured A549 lung epithelial cells were compared, and it was hypothesized that treatment with EtOH and EtP reduces the inflammatory potential of the A549 cells. Time‑ and dose‑dependent release of IL‑8 from the A549 cells was observed following stimulation with IL‑6. The release of IL‑8 from the A549 cells was assessed following treatment with EtP (2.5‑10 mM), sodium pyruvate (NaP; 10 mM) or EtOH (85‑170 mM) for 1, 24 or 72 h, prior to and following IL‑6 stimulation. The adhesion capacities of neutrophils to the treated A549 cells, and the expression levels of cluster of differentiation (CD)54 by the epithelial cells were measured. Treatment of the A549 cells with either EtOH or EtP significantly reduced the IL‑6‑induced release of IL‑8. This effect was observed in the pre‑ and post‑stimulatory conditions, which is of therapeutic importance. Similar data was revealed regarding the IL‑6‑induced neutrophil adhesion to the treated A549 cells, in which pre‑ and post‑treatment with EtOH or EtP decreased the adhesion capacity, however, the results were dependent on the duration of incubation. Incubation durations of 1 and 24 h decreased the adhesion rates of neutrophils to the stimulated A549 cells, however, the reduction was only significant at 72 h post‑treatment. The expression of CD54 was reduced only following treatment for 24 h with either EtOH or EtP, prior to IL‑6 stimulation. Therefore, EtOH and EtP reduced the inflammatory response of lung epithelial cells, and the potential of EtP to mimic EtOH was observed in the pre‑ and post‑treatment conditions.
    Molecular Medicine Reports 05/2015; 12(2). DOI:10.3892/mmr.2015.3764 · 1.55 Impact Factor
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    ABSTRACT: Unlabelled: Purpose. Elderly patients are susceptible to wound healing problems due to impaired neovascularisation in tissue repair. We investigated influence of surgical wound fluid (WF) obtained from both young and aged patients after musculoskeletal surgery on in-vitro recruitment and differentiation of endothelial progenitor cells (EPCs). Further, VEGF and TGF-b1 in WF were measured and blockade experiments were performed to analyze the role of both cytokines in EPC recruitment. Methods: WF was obtained from young (28 ± 5 years, n = 14) and elderly (74 ± 8 years, n = 15) patients at 3, 8, and 24 hours after surgery. EPCs were isolated from healthy donors and incubated (72 hours) in medium substituted by WF. EPC number/differentiation was determined by fluorescence-microscopy and flow-cytometry after staining for DiLDL and lectin. CBF or ELISA was used to measure VEGF and TGF-b1 in WF. For blockade experiments, WF was mixed with antibodies against VEGF/TGF-b1 before incubation. Results: A significantly higher number and increased differentiation of EPC can be observed after incubation with WF from young compared to elderly individuals. VEGF and TGF-b1 were higher in young patients' WF, and blockade of both cytokines reduced EPC numbers significantly. Conclusion: Impaired wound healing in the elderly could be a result of dampened recruitment of EPC to site of affliction, possibly due to low VEGF/TGF-b1 levels.  .
    Wounds: a compendium of clinical research and practice 04/2015; 22(8):204-11. · 0.54 Impact Factor
  • S Fischer · T Vogl · M Kresing · I Marzi · S Zangos · M Mack · K Eichler ·

    RöFo - Fortschritte auf dem Gebiet der R 04/2015; 187(S 01). DOI:10.1055/s-0035-1551043 · 1.40 Impact Factor
  • Daniela Ulrich · Maika Voth · Johannes Frank · Ingo Marzi ·
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    ABSTRACT: Hintergrund Die traumatische Ellenbogenluxation im Kindesalter ist eine relativ seltene, aber schwerwiegende Verletzung und geht häufig mit einer Begleitfraktur oder einer begleitenden Instabilität einher, die zu dauerhaften Spätschäden führen kann. Diagnostik und Therapie Zur Vermeidung von Wachstumsstörungen durch Bewegungseinschränkungen ist die erfolgreiche Wiederherstellung der Anatomie und Beweglichkeit im Ellenbogengelenk sehr wichtig. In diesem Beitrag werden die wichtigen Verletzungsmuster im Kindesalter, wie die Ellenbogenluxation, der Epicondylus-ulnaris-Abriss, die Condylus-radialis- und Olekranonfrakturen sowie Monteggia-Verletzungen, im Hinblick auf die Diagnostik und Therapie dargelegt.
    Trauma und Berufskrankheit 03/2015; DOI:10.1007/s10039-015-0007-7
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    ABSTRACT: Klinische Situation Bei Verletzungen der Handwurzel finden sich im Wesentlichen zwei klinische Situationen: zum einen der Patient nach einem schweren Trauma, z. B. Absturz, Motorradsturz bzw. schwere Quetschverletzung, zum anderen der Patient, der sich im Extremfall gar nicht genau an den Unfallhergang erinnert. Diagnostik Im ersten Fall ist die Wahrscheinlichkeit einer Luxation und damit Bandruptur deutlich höher. Hier ist die Diagnostik und entsprechend die Behandlung der Bandrupturen wesentlich einfacher. Im zweiten Fall ist, nach genauer Ursachenevaluation in der Vorgeschichte, eine differenzierte klinische und apparative Diagnostik erforderlich, bevor überhaupt ein konservatives oder operatives Konzept angeboten werden kann. Die Kenntnis der typischen Verletzungsmechanismen und Läsionsmuster ist wesentlich für die Klärung unklarer Befunde. Therapie Neben der konservativen Therapie stehen je nach Lokalisation, Schweregrad und degenerativen Begleitsituationen zahlreiche operative Methoden zur Verfügung. Unter diesen muss entsprechend der persönlichen Erfahrung, unter Berücksichtigung der Ergebnisse aus der Literatur, ausgewählt werden. Schlussfolgerung Das Ausbleiben einer adäquaten Versorgung, z. B. mittels Bandstabilisierung, hat nicht selten einen zunehmenden Kollaps der Handwurzel mit Schmerzhaftigkeit, Belastungs- und Bewegungsstörungen zur Folge. Das Erkennen und Wiederherstellen der Bandstrukturen hat somit eine erhebliche Bedeutung.
    Trauma und Berufskrankheit 03/2015; DOI:10.1007/s10039-015-0003-y
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    D. Schneidmueller · I. Marzi · V. Bühren ·
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    ABSTRACT: Hintergrund Die Diagnostik von Ellenbogenverletzungen stellt eine besondere Herausforderung dar. Nicht selten werden hier relevante Verletzungen mit Langzeitfolgen übersehen. Diagnostik Grundlage der Diagnostik ist die Kenntnis der möglichen Verletzungsmuster sowie der alterstypischen Verteilung der einzelnen Verletzungen. Ziel ist es, in der Akutdiagnostik eine aktiv behandlungsbedürftige Verletzung zu erkennen bzw. auszuschließen. Dabei bildet das konventionelle Röntgenbild in 2 Ebenen nach wie vor die Basis der bildgebenden Diagnostik. Die Magnetresonanztomographie spielt häufig bei prolongierten Heilverläufen zum Ausschluss z. B. einer okkulten Fraktur oder von Knorpelläsionen eine Rolle. Aufgrund der geringen Ossifikation beim Kind wird die Computertomographie i.d.R. erst beim Adoleszenten zur Beurteilung der seltenen Gelenkfraktur des distalen Humerus eingesetzt. Die Sonographie ermöglicht die Darstellung nichtossifizierter Anteile und von Frakturen, die im Röntgen nicht sichtbar sind.
    Trauma und Berufskrankheit 03/2015; 17(S1):74-77. DOI:10.1007/s10039-014-2118-y
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    ABSTRACT: Outcome after traumatic brain injury (TBI) in the elderly has not been fully elucidated. The present retrospective observational study investigates the age-dependent outcome of patients suffering from severe isolated TBI with regard to operative and non-operative treatment. Data were prospectively collected in the TraumaRegister DGU(®). Anonymous datasets of 8629 patients with isolated severe blunt TBI (AISHead≥3, AISBody≤1) documented from 2002 to 2011 were analysed. Patients were grouped according to age: 1-17, 18-59, 60-69, 70-79 and ≥80 years. Cranial fractures (44.8%) and subdural haematomas (42.6%) were the most common TBIs. Independent from the type of TBI the group of patients with operative treatment declined with rising age. Subgroup analysis of patients with critical TBI (AISHead=5) revealed standardised mortality ratios (SMRs) of 0.81 (95% CI 0.75-0.87) in case of operative treatment (n=1201) and 1.13 (95% CI 1.09-1.18) in case of non-operative treatment (n=1096). All age groups ≥60 years showed significantly reduced SMRs in case of operative treatment. Across all age groups the group of patients with low/moderate disability according to the GOS (4 or 5 points) was higher in case of operative treatment. Results of this retrospective observational study have to be interpreted cautiously. However, good outcome after TBI with severe space-occupying haemorrhage is more frequent in patients with operative treatment across all age groups. Age alone should not be the reason for limited care or denial of operative intervention. Copyright © 2015. Published by Elsevier Ltd.
    Injury 03/2015; 1(9). DOI:10.1016/j.injury.2015.02.013 · 2.14 Impact Factor
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    ABSTRACT: Unlabelled: QUESTION/AIM: Cell-based therapy by cultivated stem cells (mesenchymal stem cells [MSC] and endothelial progenitor cells [EPC]) in a large-sized bone defect has already shown improved vascularization and new bone formation. However, these methods are clinically afflicted with disadvantages. Another heterogeneous bone marrow cell population, the so-called human bone marrow-derived mononuclear cells (BMC), has nevertheless been used clinically and showed improved vascularization in ischemic limbs or in the myocardium. For clinical use, a certified process has been established; thus, BMC were isolated from bone marrow aspirate by density gradient centrifugation, washed, cleaned, and given back to patients within several hours. This investigation tested the ability of human BMC seeded on beta-tricalcium phosphate (β-TCP) and placed into a large bone defect in rats to improve the bone healing process in vivo. Methods: Human EPC were isolated from buffy coat, and MSC or BMC, respectively, were isolated from bone marrow aspirate by density gradient centrifugation. 1.0×10(6) cells were loaded onto 750 μL β-TCP (0.7-1.4 mm). Large femoral defects (6 mm) in athymic rats were created surgically and stabilized with an internal fixateur. The remaining defects were filled with β-TCP granules alone (group 1), β-TCP+EPC/MSC (group 2), or β-TCP+BMC (group 3). After 8 weeks, histomorphometric analysis (new bone formation), radiological microcomputer tomography analysis (bony bridging), and biomechanical testing (three-point bending) were achieved. Moreover, a tumorigenicity study was performed to evaluate the safety of BMC implantation after 26 weeks. For statistical analysis, the Kruskal-Wallis test was used. Results: Eight weeks after implantation of EPC/MSC or BMC, respectively, we detected a more significant new bone formation compared to control. In group 2 and 3, bony bridging of the defect was seen. In the control group, more chondrocytes and osteoid were detected. In the BMC and EPC/MSC group, respectively, less chondrocytes and a significantly more advanced bone formation were observed. The biomechanical stability of the bone regenerate was significantly enhanced if BMC and EPC/MSC, respectively, were implanted compared to control. Moreover, no tumor formation was detected either macroscopically or histologically after 26 weeks of BMC implantation. Discussion: Implanted BMC suggest that a heterogeneous cell population may provide a powerful cellular therapeutic strategy for bone healing in a large bone defect in humans.
    Tissue Engineering Part A 02/2015; 21(9-10). DOI:10.1089/ten.TEA.2014.0410 · 4.70 Impact Factor

Publication Stats

4k Citations
757.18 Total Impact Points


  • 2006-2015
    • University Hospital Frankfurt
      Frankfurt, Hesse, Germany
  • 2002-2015
    • Goethe-Universität Frankfurt am Main
      • • Klinik für Unfall-, Hand-, und Wiederherstellungschirurgie
      • • Center of Surgery
      • • Institut für Diagnostische und Interventionelle Radiologie
      Frankfurt, Hesse, Germany
  • 2013
    • Berufsgenossenschaftliche Unfallklinik Murnau
      Murnau, Bavaria, Germany
  • 2010-2013
    • Hospital Frankfurt Hoechst
      Frankfurt, Hesse, Germany
  • 2007-2009
    • Orthopädische Universitätsklinik Friedrichsheim
      Frankfurt, Hesse, Germany
  • 1989-2006
    • University of North Carolina at Chapel Hill
      • • Department of Surgery
      • • Department of Pharmacology
      North Carolina, United States
  • 2004
    • Krankenhaus Barmherzige Brüder Regensburg
      Ratisbon, Bavaria, Germany
  • 1990-2004
    • Universität des Saarlandes
      Saarbrücken, Saarland, Germany
  • 2000
    • University of Cologne
      Köln, North Rhine-Westphalia, Germany
    • University Children's Hospital Basel
      Bâle, Basel-City, Switzerland
    • University of Amsterdam
      Amsterdamo, North Holland, Netherlands
  • 1993
    • Ludwig Boltzmann Institute for Experimental and Clinical Traumatology
      Wien, Vienna, Austria
  • 1991
    • Ludwig-Maximilians-University of Munich
      München, Bavaria, Germany