G Tosounidis

Universität des Saarlandes, Saarbrücken, Saarland, Germany

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Publications (26)24.84 Total impact

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    ABSTRACT: The purpose of this study was to describe the so-called posterior two-portal approach to the scapula in detail and to investigate the clinical outcome of patients with displaced glenoid and scapular neck fractures who were surgically treated using this approach. From February 1992 to August 2008, 39 patients (30 men and nine women; mean age: 53 years) with scapular fractures underwent surgical fixation at our institution. Thirty-three patients had glenoid fractures and six had unstable scapular neck fractures. All patients were treated via the two-portal approach. The reduction was evaluated radiographically, and the clinical results were analysed using the Constant score. The mean follow-up period was 78 months (range: 6-168). In 24 of the 33 glenoid fractures, the reduction was anatomical. The mean Constant score was 82.3 (range: 35-100) points. In one case, an early postoperative wound infection was cured by local revision, and one patient developed posttraumatic osteoarthritis of the acromioclavicular joint after 2 years. Only one patient developed specific glenohumeral degeneration after non-anatomical reduction. The posterior two-portal approach allows for a good visualisation of the posterior scapular neck and the glenoid area, facilitating the reduction and safe internal fixation of dislocated scapular neck and glenoid fractures.
    Injury 08/2013; · 2.46 Impact Factor
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    ABSTRACT: The aim of this study was to analyze the clinical outcome and incidence of hip arthritis in elderly patients with acetabular fractures. Because of poor bone quality in the elderly, even a low-energy trauma may lead to an acetabular fracture. An anatomical reconstruction of the acetabulum is necessary to achieve sufficient stability also for a potential hip arthroplasty. So far, there is very limited information on the outcome of acetabular fractures in the elderly. During a period of 6 years (2001-2006), 48 patients older than 60 years were admitted to our department with an acetabular fracture. Thirty-nine patients were treated operatively and nine patients non-operatively. Twenty-nine operatively treated patients were followed up. Nineteen of them were assessed using EQ-5D, SF-12 and Merle d'Aubigné questionnaires in addition to their clinical examination. Ten other surgical patients were only examined using the questionnaires. Of the 29 patients that were followed up, 5 underwent total hip arthroplasty due to secondary post-traumatic hip arthritis after open reduction and internal fixation (ORIF). The range of motion of the operated hip was comparable to that of the non-operated contralateral side. However, the internal rotation was found to be slightly decreased at the operated side when compared to the non-operated contralateral side. Merle d'Aubigné score and physical and mental SF-12 score components as well as quality of life were better in patients treated with ORIF compared to those patients that were treated by secondary hip arthroplasty. Regarding the different treatment strategies (ORIF vs primary hip arthroplasty vs non-operative treatment) of acetabular fractures in the elderly, data from the literature are conflicting. Our results indicate that ORIF represents a good treatment option for acetabular fractures in the elderly. In patients that did not develop secondary hip arthritis, a good clinical outcome and quality of life was documented.
    Der Unfallchirurg 08/2011; 114(8):655-62. · 0.64 Impact Factor
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    ABSTRACT: To determine longitudinal trends in mortality, and the contribution of specific injury characteristics and treatment modalities to the risk of a fatal outcome after severe and complex pelvic trauma. We studied 5048 patients with pelvic ring fractures enrolled in the German Pelvic Trauma Registry Initiative between 1991 and 1993, 1998 and 2000, and 2004 and 2006. Complete datasets were available for 5014 cases, including 508 complex injuries, defined as unstable fractures with severe peri-pelvic soft tissue and organ laceration. Multivariable mixed-effects logistic regression analysis was employed to evaluate the impact of demographic, injury- and treatment-associated variables on all-cause in-hospital mortality. All-cause in-hospital mortality declined from 8% (39/466) in 1991 to 5% (33/638) in 2006. Controlling for age, Injury Severity Score, pelvic vessel injury, the need for emergency laparotomy, and application of a pelvic clamp, the odds ratio (OR) per annum was 0.94 (95% confidence interval [CI] 0.91-0.96). However, the risk of death did not decrease significantly in patients with complex injuries (OR 0.98, 95% CI 0.93-1.03). Raw mortality associated with this type of injury was 18% (95% CI 9-32%) in 2006. In contrast to an overall decline in trauma mortality, complex pelvic ring injuries remain associated with a significant risk of death. Awareness of this potentially life-threatening condition should be increased amongst trauma care professionals, and early management protocols need to be implemented to improve the survival prognosis.
    Injury 04/2011; 42(10):997-1002. · 2.46 Impact Factor
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    ABSTRACT: Zusammenfassung Acetabulumfrakturen im Alter sind selten. Bei osteoporotisch veränderter Knochenstruktur und einer erhöhten Komorbidität bei diesen Patienten ist bisher keine einheitliche Strategie in der Versorgung gegeben. Konservative Therapieansätze, offene Reposition und Osteosynthese allein, augmentierende Osteosynthese zur sekundären Frühimplantation einer Totalendoprothese (TEP) oder primäre Hüft- (H-)TEP stehen sich häufig alternativ und konkurrierend gegenüber. Ziel dieser Untersuchung war es, die klinischen und radiologischen Ergebnisse nach operativer Versorgung von Acetabulumfrakturen zu evaluieren und eine entsprechende Strategie zur Versorgung dieser Gelenkfrakturen des älteren Patienten darzustellen. In einem Zeitraum von 6 Jahren (2001–2006) wurden 48 Patienten nach Acetabulumfrakturen behandelt, die >60 Jahre waren. Durch eine offene Reposition und Platten-/Schraubenosteosynthese (ORIF) wurden 39 dieser Patienten operativ versorgt. Bei 9 Patienten wurde eine konservative Therapie eingeleitet. Sieben der 39 operativ versorgten Patienten erhielten sekundär einen endoprothetischen Hüftgelenkersatz (H-TEP). In der konservativ behandelten Gruppe mussten 2 Patienten sekundär mit einer H-TEP versorgt werden. Insgesamt konnten 29 Patienten nachuntersucht werden. Eine klinische Untersuchung und Nachkontrolle mit Fragebögen [Merle d’Aubigné, EuroQol- (EQ-)5D und SF-12] wurde bei 19 operierten Patienten (ORIF-Gruppe) durchgeführt. Eine ausschließliche Nachkontrolle mit Fragebögen erfolgte bei weiteren 10 Patienten. Von den Patienten welche zur klinischen Nachuntersuchung herangezogen wurden, erhielten insgesamt 5 eine sekundäre H-TEP. Für die Patienten, die offen reponiert und mit einer Plattenosteosynthese stabilisiert worden waren und sekundär keine H-TEP implantiert bekamen konnten sehr gute funktionelle und klinische Ergebnisse nach Auswertung des Merle d’Aubigné-, EQ-5D- und SF-12-Fragebogens gezeigt werden. Die radiologische Auswertung zeigte keine wesentliche Verschlechterung der Gelenkstellung im Sinne einer posttraumatischen Arthrose im Vergleich zur unverletzten Seite. Die Ergebnisse zeigen, dass auch im höheren Lebensalter eine operative Stabilisierung zu guten funktionellen Ergebnissen führt.
    Der Unfallchirurg 01/2011; · 0.64 Impact Factor
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    ABSTRACT: Whereas pelvic injuries in patients in their 20s and 30s are typically caused by high energy trauma, another group suffering this injury are elderly patients between the seventh and eighth decades of life. Due to osteoporosis and co-morbidities females are particularly affected by low energy trauma. After examining the medical history a physical examination of the pelvis is performed. This is followed by imaging with X-ray and CT scanning with 3D reconstruction if necessary. If there are concomitant injuries additional diagnostics are essential (e.g. sonography, MRI, retrograde ureterography, cystography and excretion urogram). The standard AO/ATO classification (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association) has been well proven and does not depend on the age of the patient. Three different fracture types are differentiated, types A, B and C. This classification in combination with the description of the affected anatomical region (e.g. transsymphysis, transpubic, etc.) is sufficient in the daily clinical practice to decide on the necessary treatment. Often there are diagnostic difficulties in elderly patients (so-called differentiation of the A-B problem). In these patients a type A fracture is initially diagnosed and treated conservatively but due to persistent pain the imaging is repeated and an additional (insufficiency) fracture is found. With this new information the therapeutic regime has to be changed. The reconstruction of the pelvic ring is of major importance especially for elderly patients. This reduces the pain and the primary objective, an earliest possible rehabilitation without prolonged immobilization, can be achieved. In elderly patients external fixation with supra-acetabular screw positioning is an effective procedure and secondary insufficiency-instability (mostly dorsal) can be avoided. Whereas type A fractures can almost exclusively be treated non-surgically, types B and C fractures usually need surgery. As in young patients type B fractures are stabilized ventrally and C fractures dorsoventrally. In an emergency supra-acetabular external fixation and when required extraperitoneal tamponade has been established as the standard treatment for elderly patients in Germany. For the definitive surgical management standard procedures are used, but they often have to be modified depending on the bone structure.
    Der Unfallchirurg 04/2010; 113(4):258-71. · 0.64 Impact Factor
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    ABSTRACT: The tremendous increase of acetabular fractures in the elderly provides new challenges for their surgical treatment. The aim of this study was to evaluate the biomechanical properties of conventional and newly developed implants for the stabilisation of an anterior column combined with posterior hemitransverse fracture (ACPHTF), which represents the typical acetabular fracture in the elderly. Using a single-leg stance model we analysed four different implant systems for the stabilisation of ACPHTFs in synthetic and cadaveric pelvises. Applying an increasing axial load, fracture dislocation was analysed with a new multidirectional ultrasonic measuring system. Results of the different implant systems were compared by Scheffé post hoc test and one-way ANOVA. In synthetic pelvises, the standard reconstruction plate fixed by 3 periarticular long screws and a new titanium fixator with multidirectional interlocking screws were associated with significantly less dislocation of the fractured quadrilateral plate of the acetabulum when compared to a standard reconstruction plate fixed by only one periarticular long screw and a locking reconstruction plate. No significant differences between the different osteosynthesis techniques could be observed in cadaver pelvises, probably due to a heterogeneous bone quality. We conclude that the plate fixation by positioning of periarticular long screws as well as the multidirectional positioning of interlocking screws account for the most sufficient fracture stabilisation of ACPHTFs under experimental conditions.
    Injury 04/2010; 41(4):405-10. · 2.46 Impact Factor
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    ABSTRACT: The definition of complex pelvic trauma has allowed a selection of those pelvic fracture patients with the highest mortality rate. The term complex pelvic trauma is used as a definition for pelvic fractures which are associated with serious soft tissue lesions in the pelvic region. These may include visceral and neurovascular, as well as extensive skin and muscle injuries. Haemodynamic instability particularly related to vascular injuries raises the mortality dramatically. Traumatic hemipelvectomy, which represents the worst case of a complex pelvic trauma, is associated with mortality rates of up to 60%. The pelvic study groups 1-3 of the German trauma association (DGU) and the Association for Osteosynthesis (AO) provide the worldwide largest database on pelvic injuries (group 1, 1991-1993: 1,722 patients from 10 hospitals; group 2, 1998-2002: 2,569 patients from 22 hospitals; and group 3, 2005-2007: 2,704 patients from 23 hospitals). Using this database this article reviews epidemiological data, therapy concepts, associated injuries as well as the incidence and mortality rates related to complex pelvic trauma over a 16-year time period. Special attention has been paid to complex trauma in the elderly (patients >60 years of age). An additional aim of this article is to analyze the correlation between different treatment modalities and the mortality rate of complex pelvic trauma and to investigate whether changes in the treatment of complex pelvic trauma have improved the outcome of these injuries. Taken together an increase in measures for an initial mechanical stabilization of the pelvic ring, such as the use of the pelvic C clamp, the external fixator or primary osteosynthesis was found over the 16-year observation period. In addition to stabilization of the pelvic ring, pelvic tamponade for mechanical haemostasis has been proven to be one of the most effective measures to control haemorrhaging. These treatment regimes did not differ between young patients and patients >60 years of age. Regarding the outcome of these treatment strategies only slight decreases in the mortality rate were found (pelvic study group 1: 21%; pelvic study group 2: 22%; pelvic study group 3: 18%). In all pelvic study groups the mortality rate in patients >60 years of age was found to be significantly higher than in individuals <60 years of age (pelvic study group 1: 57% versus 29.6%, pelvic study group 2: 33% versus 22.6%, pelvic study group 3: 41% versus 10.4%, p <0.05, respectively).
    Der Unfallchirurg 03/2010; 113(4):281-6. · 0.64 Impact Factor
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    ABSTRACT: The diagnosis and treatment of pelvic ring injuries is demanding. Therefore, standardized classifications characterizing the stability and severity of pelvic ring fractures are essential to define clear algorithms for the treatment of these injuries. The first part of this article provides an overview of the etiology and classification of pelvic ring injuries. We recommend the AO classification to assess the stability of pelvic ring fractures. This classification includes 3 types of pelvic ring fractures: stable fractures (type A), fractures with only rotational instability (type B), and fractures with complete (rotational and translational) instability. To describe the severity of the injury, pelvic ring fractures can be classified as plain pelvic fractures, which include fractures with osteoligamentous instability, but without significant concomitant injuries to the soft tissue, versus complex pelvic fractures, which are combined with severe peripelvic soft tissue lesions.While plain pelvic fractures allow thorough clinical and radiological diagnostics, complex pelvic traumata represent a life threatening situation for the patient, which needs immediate emergency measures. In the second part of the this review we present current data of the German Pelvic Multicenter Study III (DGU/AO) on the epidemiology and treatment of pelvic ring injuries deriving from a study population of more than 3000 patients. In addition, we compare the present data with those of the German Pelvic Multicenter Study I and highlight changes in the epidemiology and treatment of pelvic ring fractures during the past decades. Taken together, we could observe an increasing number of elderly patients sustaining pelvic ring fractures.Regarding the treatment of pelvic ring fractures we found a rising use of external fixators and SI screws, while the number of laparotomies has markedly decreased.
    Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca 01/2010; 77(6):450-6. · 1.63 Impact Factor
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    ABSTRACT: Durch die Definition des Komplextraumas bei Beckenverletzungen ist es gelungen, die bzgl. der Überlebensrate kritischen Patienten klar zu selektieren. Komplexe Beckenfrakturen sind Verletzungen des Beckenrings, die mit zusätzlich begleitenden peripelvinen Verletzungen assoziiert sind. Diese umfassen Verletzungen der Weichteile (Haut-Muskel), des Urogenital- und Darmtrakts, der großen Nervenbahnen und Verletzungen von Arterien, Venen und Venengeflechten im kleinen Becken. Komplexverletzungen des Beckens sind trotz Verbesserung der klinischen Erstversorgung weiterhin mit einer hohen Letalität vergesellschaftet. Insbesondere bei einer begleitenden Gefäßverletzung und dadurch bedingter hämodynamischer Instabilität steigt die Letalität deutlich an. Die maximale Ausprägung des komplexen Beckentraumas ist die Hemipelvektomie, die mit einer Letalität bis 60% assoziiert ist. Aus der weltweit größten Datensammlung für Beckenverletzungen mit Daten der Arbeitsgruppe (AG) BeckenI (1991–1993, 1722Patienten, 10 Kliniken), der Arbeitsgruppe BeckenII (1998–2002, 2569Patienten, 22 Kliniken) und der Arbeitsgruppe BeckenIII (2005–2007, 2704Patienten, 23 Kliniken) der Deutschen Gesellschaft für Unfallchirurgie (DGU) und der Deutschen Sektion der Arbeitsgemeinschaft für Osteosynthesefragen (AO) International werden die epidemiologischen Grunddaten, Inzidenz, Veränderung der Therapiekonzepte, Letalität und Verletzungsmuster im Beobachtungszeitraum von 16Jahren analysiert und beschrieben. Im Fokus der vorliegenden Untersuchung lagen komplexe Beckenverletzungen bei Patienten über 60Jahre. Im Beobachtungszeitraum von 16Jahren erkennt man eine weiterhin hohe Letalität bei komplexen Beckentraumen (AGI 21%, AGII 22%, AGIII 18%). In der Gruppe der über 60-jährigen Patienten ist die Letalität dabei im Vergleich zu den Patienten unter 60Jahren signifikant erhöht (AGI 57 vs. 29,6%, AGII 33 vs. 22,6%, AGIII 41 vs. 10,4%, jeweils p <0,05). Als Notfallmaßnahmen zur Behandlung von Patienten mit komplexem Beckentrauma wurde für die Stabilisierung zunehmend die Beckenzwinge, der Fixateur externe und primäre interne Osteosyntheseverfahren angewendet. Begleitend zu diesen Maßnahmen wurde die Beckentamponade vermehrt eingesetzt. Diese Beobachtung ist auch in der Gruppe der über 60-jährigen Patienten nachzuvollziehen. Ziel der vorliegenden Untersuchung war es zu evaluieren, in wie weit sich die primären Behandlungsmaßnahmen, die Begleitverletzungen, der Frakturtyp und die Letalität bei komplexen Beckenverletzungen im Beobachtungszeitraum bezogen auf das Lebensalter der Patienten verändert haben. The definition of complex pelvic trauma has allowed a selection of those pelvic fracture patients with the highest mortality rate. The term complex pelvic trauma is used as a definition for pelvic fractures which are associated with serious soft tissue lesions in the pelvic region. These may include visceral and neurovascular, as well as extensive skin and muscle injuries. Haemodynamic instability particularly related to vascular injuries raises the mortality dramatically. Traumatic hemipelvectomy, which represents the worst case of a complex pelvic trauma, is associated with mortality rates of up to 60%. The pelvic study groups1–3 of the German trauma association (DGU) and the Association for Osteosynthesis (AO) provide the worldwide largest database on pelvic injuries (group1, 1991–1993: 1,722patients from 10 hospitals; group2, 1998–2002: 2,569patients from 22 hospitals; and group3, 2005–2007: 2,704patients from 23 hospitals). Using this database this article reviews epidemiological data, therapy concepts, associated injuries as well as the incidence and mortality rates related to complex pelvic trauma over a 16-year time period. Special attention has been paid to complex trauma in the elderly (patients >60years of age). An additional aim of this article is to analyze the correlation between different treatment modalities and the mortality rate of complex pelvic trauma and to investigate whether changes in the treatment of complex pelvic trauma have improved the outcome of these injuries. Taken together an increase in measures for an initial mechanical stabilization of the pelvic ring, such as the use of the pelvic C clamp, the external fixator or primary osteosynthesis was found over the 16-year observation period. In addition to stabilization of the pelvic ring, pelvic tamponade for mechanical haemostasis has been proven to be one of the most effective measures to control haemorrhaging. These treatment regimes did not differ between young patients and patients >60years of age. Regarding the outcome of these treatment strategies only slight decreases in the mortality rate were found (pelvic study group1: 21%; pelvic study group2: 22%; pelvic study group3: 18%). In all pelvic study groups the mortality rate in patients >60years of age was found to be significantly higher than in individuals <60 years of age (pelvic study group 1: 57% versus 29.6%, pelvic study group2: 33% versus 22.6%, pelvic study group3: 41% versus 10.4%, p <0.05, respectively). SchlüsselwörterKomplextrauma-Begleitverletzungen-Letalität-Frakturtyp-Behandlungsmaßnahmen KeywordsComplex trauma-Concomitant injuries-Mortality-Fracture type-Treatment regimes
    Der Unfallchirurg 01/2010; 113(4):281-286. · 0.64 Impact Factor
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    ABSTRACT: Während Beckenringverletzungen bei jüngeren Patienten zwischen dem 2. und 3. Lebensjahrzehnt typischerweise infolge eines Hochrasanztraumas auftreten, zeigt sich ein zweiter deutlicher Gipfel im höheren Lebensalter zwischen dem 7. und 8. Lebensjahrzehnt. Hier ist insbesondere das weibliche Geschlecht betroffen, die notwendige einwirkende Verletzungsenergie ist bei häufig gestörter Knochenstruktur (Osteoporose, Komorbidität) dabei wesentlich geringer. Nach der Anamneseerhebung zum Unfallhergang schließt sich eine klinische Untersuchung des Beckens an. Anschließend kommen bildgebende Verfahren mit konventionellen Röntgenuntersuchungen und CT mit ggf. 3D-Rekonstruktionen zum Einsatz. Bei Begleitverletzungen werden zusätzlich weitere diagnostische Maßnahmen erforderlich (Sonographie, „nuclear magnetic resonance“ – NMR, retrograde Uretrographie, Zystogramm, Ausscheidungsurogramm). Für die Einteilung der Beckenringfrakturen hat sich die standardisierte Klassifikation nach AO/OTA (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association) lebensaltersunabhängig bewährt. Es werden 3 Frakturtypen (A, B und C) unterschieden. Für den klinischen Alltag und die Entscheidung zur konservativen oder operativen Therapie reicht dies in Verbindung mit der Beschreibung der betroffenen anatomischen Region im Beckenring aus (transsymphysär, transpubisch u.a.). Probleme bereiten bei älteren Patienten die diagnostischen Grauzonen (sog. A-B-Problematik), bei denen eine diagnostizierte Typ-A-Fraktur zunächst konservativ behandelt wird und sich bei der erneuten Kontrolle aufgrund fortgesetzter Schmerzsymptomatik eine zusätzliche (Insuffizienz-)Fraktur im hinteren Beckenringbereich mit konsekutiver Änderungsnotwendigkeit der Therapie ergibt. Die Wiederherstellung der Ringkontinuität ist bei der operativen Versorgung insbesondere für den älteren Patienten von entscheidender Bedeutung. Die Wiederherstellung hilft auf der einen Seite, Schmerzen zu reduzieren und damit dem Primärziel der frühestmöglichen Rehabilitation ohne lange Immobilisationszeiten näher zu kommen. Bei alten Patienten ist hier der Fixateur externe mit supraazetabulärer Schraubenlage ein probates Verfahren. Auf der anderen Seite werden sekundär auftretende zusätzliche Insuffizienzinstabilitäten (zumeist dorsal) vermieden. Während Typ-A-Verletzungen fast ausschließlich konservativ therapiert werden können, werden Typ-B- und -C-Frakturen in der Regel operativ behandelt. Dabei gilt wie auch bei jüngeren Patienten, dass B-Verletzungen ventral und C-Verletzungen dorsoventral stabilisiert werden. In der Notfallsituation haben sich in Deutschland beim älteren Patienten der supraazetabuläre Fixateur externe und ggf. die pelvine extraperitoneale Tamponade als Behandlungsverfahren durchgesetzt. Bei der definitiven Versorgung werden die Standardtechniken verwendet, allerdings müssen sie häufig modifiziert und an die Knochenverhältnisse adaptiert werden. Whereas pelvic injuries in patients in their 20s and 30s are typically caused by high energy trauma, another group suffering this injury are elderly patients between the seventh and eighth decades of life. Due to osteoporosis and co-morbidities females are particularly affected by low energy trauma. After examining the medical history a physical examination of the pelvis is performed. This is followed by imaging with X-ray and CT scanning with 3D reconstruction if necessary. If there are concomitant injuries additional diagnostics are essential (e.g. sonography, MRI, retrograde ureterography, cystography and excretion urogram). The standard AO/ATO classification (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association) has been well proven and does not depend on the age of the patient. Three different fracture types are differentiated, types A, B and C. This classification in combination with the description of the affected anatomical region (e.g. transsymphysis, transpubic, etc.) is sufficient in the daily clinical practice to decide on the necessary treatment. Often there are diagnostic difficulties in elderly patients (so-called differentiation of the A-B problem). In these patients a type A fracture is initially diagnosed and treated conservatively but due to persistent pain the imaging is repeated and an additional (insufficiency) fracture is found. With this new information the therapeutic regime has to be changed. The reconstruction of the pelvic ring is of major importance especially for elderly patients. This reduces the pain and the primary objective, an earliest possible rehabilitation without prolonged immobilization, can be achieved. In elderly patients external fixation with supra-acetabular screw positioning is an effective procedure and secondary insufficiency-instability (mostly dorsal) can be avoided. Whereas type A fractures can almost exclusively be treated non-surgically, types B and C fractures usually need surgery. As in young patients type B fractures are stabilized ventrally and C fractures dorsoventrally. In an emergency supra-acetabular external fixation and when required extraperitoneal tamponade has been established as the standard treatment for elderly patients in Germany. For the definitive surgical management standard procedures are used, but they often have to be modified depending on the bone structure. SchlüsselwörterBeckenring-Komplextrauma-Altersfraktur-Versorgungskonzepte am Becken-Blutung bei Beckenfrakturen KeywordsPelvic ring-Complex trauma-Fractures in the elderly-Management of pelvic fractures-Pelvic bleeding
    Der Unfallchirurg 01/2010; 113(4):258-271. · 0.64 Impact Factor
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    ABSTRACT: Case report and clinical discussion. A rare case of air passage into multiple body compartments after thoracoscopic minimally invasive spine surgery is described. In recent years, there is growing interest in thoracoscopic minimally invasive spine surgery for the treatment of thoracic and lumbar spine fractures. Severe complications due to the operative procedure are rare. We present a case of a 73-year-old woman who developed bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema after thoracoscopic anterior stabilization of a Th12 fracture. The operative procedure was completed without any obvious intraoperative complications. Routine made postoperative radiograph of the chest revealed a pneumothorax on the right side, bilateral subphrenic free air, and bilateral supraclavicular air. Subsequently, a CT scan showed bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum and a supraclavicular subcutaneous emphysema. Bronchoscopy, esophagogastroduodenoscopy, and laryngoscopy showed no hollow organ injury or any other pathologic changes. Intraabdominal free air and pneumothoraces could not be detected on thoracic radiographs after 2 days. The patient remained cardiopulmonary stable throughout the hospital course. This report documents a rare case of air passage into multiple body compartments after thoracoscopic-assisted treatment of a spinal fracture, which has not yet been described previously. After exclusion of a tracheo-bronchial and hollow organ injury the process was self-limiting. To avoid this complication, special care should be taken to evacuate all intrathoracal air at the end of the endoscopic procedure.
    Spine 06/2009; 34(10):E371-5. · 2.16 Impact Factor
  • U. Culemann, G. Tosounidis, T. Pohlemann
    01/2009;
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    ABSTRACT: In recent years, the closed reduction and percutaneous fixation of posterior pelvic ring fractures by sacroiliac screws has become a well established treatment option for stabilization of posterior pelvic ring disruptions. Stable percutaneous pelvic ring fixation also implies a very low complication rate, e.g., in operative blood loss, wound healing, and operative time. To avoid malpositioning of the screws, sufficient reduction and radiologic visualization are essential. The surgical technique has been described in several studies; however, great importance is attached to the personal experience of the surgeon. Therefore, this study was conducted to establish a standard procedure that allows different surgeons a safe positioning of sacroiliac screws. A total of 41 injuries of the posterior pelvic ring were stabilized with 73 sacroiliac lag screws inserted by 7 different surgeons using a standardized technique. In all cases adequate reduction of the fracture and radiologic visualization were achieved. No wound infections, no relevant bleedings, and no spiral fractures of screws were observed. In two cases malpositioning led to revision of the screws. Of interest, one case of S1 paresthesia resulting from a malpositioned screw could be revised. In contrast, two cases of screw loosening and one case of screw bending did not require further intervention. We conclude that safe positioning of the sacroiliac screws was accomplished by all surgeons given a standardized technique. For safe insertion preparation of the patients, accurate visualization of the fracture zone, and potential closed reduction is always required.
    Der Unfallchirurg 09/2007; 110(8):669-74. · 0.64 Impact Factor
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    ABSTRACT: Reliable osteosynthesis for fractures in the different regions of the human pelvis are described in the literature while there is no common and satisfying treatment for unstable sacral fractures. Because of the posterior pelvic rings special anatomic conditions a local plate osteosynthesis seems to be advantageous. In many fields of modern fracture treatment locking implants show superior results. The prototype of a local locking plate osteosynthesis was compared to a common local plate and two sacroiliac screws. The implants were tested using six plastic models of the pelvis and three embalmed human specimens. A Tile C1 fracture was created by disruption of the pubic symphysis and a transforaminal osteotomy. The specimens were exposed to axial loading in an upright single-leg stance with a maximum of 800 N for the plastic models and 200 N for the human specimens. An ultrasonic-based measuring system recorded translations (X, Y, Z) and rotations (alpha, beta, gamma). Parameters such as pattern of motion, translation/rotation, load to failure and remaining dislocation were evaluated. Concerning most of the evaluated parameters the local plate osteosynthesis was inferior compared with two sacroiliac screws. There were no significant differences between the locking implant and the local plate osteosynthesis. Compared with the two sacroiliac screws the locking implant shows biomechanically equal results but allows greater anterior rotation and remaining dislocation. Because of the lower bone quality, the results from the anatomic specimen tested were not utilisable. The locking implant is biomechanically an alternative compared with two sacroiliac screws. Problems occurred due to the preset direction of the locking head screws.
    Der Unfallchirurg 07/2007; 110(6):528-36. · 0.64 Impact Factor
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    ABSTRACT: The range of severity of pelvic injuries is wide and can include simple, undisplaced pelvic fractures, which may limit the activity of the individual patient for only a short period of time, and severe, complex or even open pelvic fractures, causing immediate life threatening situations. Even with continuous progress in development of techniques and treatment protocols, primary treatment and definitive reconstruction of pelvic ring injuries and acetabular fractures there is still an ongoing debate about specific problems in the evaluation of injuries and fractures. Because of the low incidence of pelvic fractures (37/100,000) the individual experience, which can be acquired by the surgical team, even in major Trauma Centres, is limited and can only be acquired over a longer period of time. The German Multicentre Pelvic Study Group started with reporting of pelvic fractures in 1991 and included 10 University- and Major Trauma Hospitals. The intense work on definitions and classification during the first years generated a universal "language" of understanding, which also helped in unifying indications and even procedures in pelvic and acetabular fractures. With several modifications and expansion of the number of participating hospitals the Group has been active until now and is just entering a "third phase" converting into the "German Multicentre Pelvic and Acetabular Registry" being technologically modified to an Internet based data registry. As this registry is already designed as an open platform, not limited in capacity and regions, it provides a platform, which may easily be expanded to the European level allowing for international multicentre studies and case sampling. Therefore this type of pelvic registry could act as a basis for further scientific evaluation of specific topics in the field of pelvic and acetabular surgery and could be a template for a European Expert Network. Driven by the differences of healthcare systems and organisation of trauma care within Europe and the challenge that pelvic fractures not only can lead to permanent disability, but also play an important role in posttraumatic fatalities, a clear need can be shown for detailed analysis of the present situation within the different European nations.
    Injury 04/2007; 38(4):416-23. · 2.46 Impact Factor
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    ABSTRACT: Die transiliosakrale Verschraubung des hinteren Beckenrings gewinnt zunehmend an Bedeutung, da diese Methode zur Stabilisierung des hinteren Beckenrings bei geschlossener Reposition perkutan durchgeführt werden kann. Voraussetzung für eine perkutane Schraubenosteosynthese sind jedoch eine ausreichende Repositionsgüte und Visualisierung der Fraktur, um beschriebene Implantatfehllagen zu vermeiden. Die vorliegenden Publikationen zur Technik bieten hierbei wenig Hilfestellung bezüglich der detaillierten Operationsplanung und Durchführung, sodass der persönlichen Erfahrung des einzelnen Operateurs eine hohe Bedeutung zukommt. Ziel der vorliegenden Untersuchung war es daher, durch eine methodische Standardisierung des Verfahrens, eine Erhöhung der Implantationssicherheit zu erhöhen.Durch 7 verschiedene Operteure wurden bei 41 posterioren Beckenringverletzungen insgesamt 73 transiliosakrale Zugschrauben in vorgeschriebener, konventioneller Standardtechnik implantiert. In allen Fällen konnte eine ausreichende Repositionsgüte und Visualisierung zur Implantation der Schrauben erreicht werden. Es traten keine Infektionen und keine relevanten Blutungen auf. Schraubenbrüche waren ebenfalls nicht zu verzeichnen. In 2 Fällen trat eine Schraubenfehllage auf, in einem Fall mit sensibler S1-Symptomatik, die sich nach sofortiger Schraubenkorrektur komplett erholte. In 2 Fällen traten im Heilungsverlauf sekundäre Schraubenlockerungen ohne Revisionspflichtigkeit auf. In einem weiteren Fall zeigte sich nach Mobilisation mit Vollbelastung eine Schraubenverbiegung ohne weitere Interventionspflichtigkeit.Mit der hier vorgestellten, standardisierten Methode kann bei Einhaltung einer genauen Patientenselektion, einer möglichen geschlossenen Reposition und Visualisierung der Fraktur eine ausreichende Sicherheit bei der Schraubenplatzierung durch verschiedene Operateure gezeigt werden.
    Der Unfallchirurg 01/2007; 110(8). · 0.64 Impact Factor
  • G Tosounidis, R Wirbel, U Culemann, T Pohlemann
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    ABSTRACT: Clinical outcome following pelvic ring fractures of AO/OTA type-A in the elderly is often unsatisfying because the posterior pelvic ring fracture is underdiagnosed and patients with type B fractures were conservatively treated like patients with type A fractures. This so-called "A-B" problem was systematically analyzed in our patients with pelvic ring fractures. 183 patients were treated with pelvic ring fractures. Primarily, the injuries were classified as follows: 81 type A, 38 type B, and 64 type C. The diagnosis was changed from type A to type B injury in seven patients. Parameters of investigation included fracture type, duration of symptoms, treatment, and outcome score according to the German Multicenter Study Group Pelvis. Persistent pain in the sacral area over an average of 2 (1-6) weeks was found in all patients. The CT scan revealed in all patients a transalar sacral impression fracture in the sense of an internal rotationally unstable injury of type AO/OTA B 2.1. The treatment consisted in a supra-acetabular external fixator for an average of 3 weeks. After 4 weeks the mean pelvis outcome score was 9 (7-10) points. In cases of persistent pain for more than 2 weeks after transpubic pelvic ring fractures in the elderly further investigation by CT scan should be recommended to exclude a concomitant sacral fracture, which then could be safely treated by a supra-acetabular external fixator.
    Der Unfallchirurg 09/2006; 109(8):678-80. · 0.64 Impact Factor
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    ABSTRACT: Zusammenfassung Die klinischen Ergebnisse nach Typ-A-Beckenfrakturen im Alter sind oft wegen persistierender Schmerzen unbefriedigend. Vielfach werden Beckenringverletzungen im hinteren Beckenring bei älteren Patienten nicht diagnostiziert. Patienten mit einer Beckenringfraktur Typ B werden als A-Frakturen behandelt. DieseA-B-Problematikwurde bei den von uns behandelten Patienten mit Beckenringfrakturen systematisch analysiert.183 Patienten mit Beckenringverletzungen wurden behandelt, von denen primär 81 als Typ-A-, 38 als Typ-B- und 64 als Typ-C-Verletzungen eingestuft wurden. Bei 7 Patienten erfolgte eine Diagnoseänderung von Typ-A- zur Typ-B-Verletzung. Untersuchungskriterien waren Frakturtyp, Beschwerdedauer, Therapie und Outcomescore nach derAG Beckender AO.Bei allen Patienten persistierten Schmerzen im Sakralbereich über durchschnittlich 2 (1–6) Wochen. In der CT fand sich bei allen Patienten eine transalare Sakrumimpressionsfraktur im Sinne einer Innenrotationsverletzung (Typ AO B 2.1). Die Therapie bestand in einer supraazetabulären Fixateur externe Anlage für durchschnittlich 3 Wochen. Der mittlere Becken-Outcomescore betrug nach 4 Wochen im Durchschnitt 9 (7–10) Punkte.Bei Beschwerdepersistenz über 2 Wochen bei Patienten mit transpubischen Beckenfrakturen im Alter sollte eine CT-Untersuchung zum Ausschluss einer begleitenden Sakrumfraktur erfolgen, die dann mit einem supraazetabulären Fixateur externe für 3 Wochen sicher behandelt wird.
    Der Unfallchirurg 01/2006; 109(8):678-680. · 0.64 Impact Factor
  • U Culemann, G Tosounidis, T Pohlemann
    Zentralblatt für Chirurgie 11/2005; 130(5):W58-71; quiz W72-3. · 0.69 Impact Factor
  • T Pohlemann, U Culemann, G Tosounidis, A Kristen
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    ABSTRACT: Unstable pelvic girdle injury combined with severe pelvis related haemorrhage has a high mortality rate. This prognosis can be improved by using the C-clamp according to Ganz. This can be applied while the life saving measures are in progress, and should, if necessary, be combined with a pelvic tamponade. Due to the limited number of patients, trauma centres have the most experience with this technique. In this contribution, we present our standardised application technique, which allows the use of the procedure through well defined clinically recognisable orientation points in the emergency room.
    Der Unfallchirurg 01/2005; 107(12):1185-91. · 0.64 Impact Factor