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ABSTRACT: HintergrundIm Rahmen moderner Versorgungsstrategien von hüftgelenknahen Oberschenkelbrüchen erfolgt meist im Anschluss an die belastungsstabile
Versorgung der Fraktur im Akutkrankenhaus eine stationäre interdisziplinär-geriatrische Frührehabilitation. Ob diese Versorgungssysteme
einen effektiven Beitrag zur nachhaltigen Versorgungsqualität darstellen oder lediglich zu einer Kostenverschiebung mit Verkürzung
der Verweildauer im operierenden Krankenhaus führen, wird kontrovers diskutiert.
Patienten und MethodikIm Rahmen einer prospektiven Studie wurden 282Patienten mit einer hüftgelenknahen Fraktur und einem Lebensalter von durchschnittlich
86±7,9Jahren (Range 65–110) eingeschlossen. Alle Patienten wurden operativ versorgt und anschließend nach durchschnittlich
12±9Tagen (4–103) in eine stationäre geriatrische Rehabilitation verlegt. Die mittlere Rehabilitationsdauer dort betrug 27±13Tage.
Zielparameter der Studie waren die Alltagsaktivität gemessen am Barthel-Index (BI) und die Wohnsituation der Patienten zum
Zeitpunkt der Entlassung aus dem Akutkrankenhaus, unmittelbar nach der Rehabilitation und 1Jahr nach dem Unfallereignis.
Des Weiteren wurde der Einfluss definierter patientenbezogener Variablen auf das langfristige Aktivitätsniveau untersucht.
ErgebnisseBei Entlassung aus dem Akutkrankenhaus lag der BI bei 42±20Punkten und erhöhte sich auf 65±26Punkte nach Abschluss der Rehabilitation.
Ein Jahr später lag er bei 67±28Punkten. Während der Rehabilitation verbesserten sich 90% aller Patienten im BI. Innerhalb
eines Jahres kam es bei 40% der Patienten wieder zu einer Verschlechterung der Alltagsaktivität. 51% der Patienten konnten
in ihr gewohntes Umfeld reintegriert werden. Ein Jahr nach dem Unfallereignis war der BI von Patienten, die nach der Rehabilitation
in ihr häusliches Umfeld reintegriert wurden (BI 75±24) signifikant höher als bei Patienten, die bereits vor dem Unfall institutionalisiert
waren (BI 52±27). Die Parameter Alter, kognitive Leistungsfähigkeit und Verletzungsart hatten keinen Einfluss auf das langfristige
Aktivitätsniveau.
SchlussfolgerungDie geriatrische Frührehabilitation nach einer hüftgelenknahen Fraktur führt kurzfristig bei nahezu allen Patienten zu einer
Verbesserung der Versorgungsqualität. Langfristig profitieren vor allem Patienten, die vor dem Unfall zu Hause lebten und
auch im Anschluss an die Rehabilitation auf Dauer in ihr häusliches Umfeld reintegriert werden können. Ob jedoch die soziofunktionelle
Effektivität stationärer Rehabilitationen die mit steigender Gesamtverweildauer erhöhten Gesamtkosten rechtfertigen, bleibt
Gegenstand weiterer gesundheitsökonomischer Untersuchungen.
BackgroundModern strategies for postoperative care of patients with hip fractures include early discharge from the acute care hospital
to inpatient interdisciplinary rehabilitation facilities. Whether these programs are effective for the patients and improve
their long-term outcomes or if they simply transfer costs, with a reduction of the inpatient days in the acute care hospital,
is currently under discussion.
Patients and methodsThis prospective study included 282patients with hip fracture admitted to our trauma center were included into the prospective
study. The mean patient age was 86±8 (65–110) years. All patients were treated operatively. After a mean of 12±9 days, the
patients underwent inpatient interdisciplinary geriatric rehabilitation for a mean of 27±13 (4–103) days. The primary outcome
measure was their activities of daily living (Barthel index) before, at the end of rehabilitation, and 1year after trauma.
In addition, patient-related variables were correlated with the Barthel index.
ResultsWith discharge from the acute care hospital, the Barthel index was 42±20points and it increased during rehabilitation to
65±26points. One year later the Barthel index was 67±28points. Ninety percent of patients improved their Barthel index during
rehabilitation. Within 1year, 40% of patients deteriorated in their activities of daily living. Fifty one percent of patients
were reintegrated back to their homes. Patients who lived at home before trauma and were reintegrated back to their homes
had a significant higher Barthel index (75±24) 1year after trauma than patients who were living in a nursing care facility
before the trauma (Barthel index 52±27). The variables of age, level of cognition, and type of fracture had no influence on
the long-term outcome. An extension of rehabilitation above the mean time period did not improve the sustainable clinical
outcome.
ConclusionPostoperative inpatient rehabilitation programs enhance short-term activities of daily living. In particular, patients who
lived at home before the trauma and were reintegrated back home benefited in perpetuity from geriatric rehabilitation. A policy
for early discharge to geriatric rehabilitation is associated with extension of overall hospital stay. This association along
with the related increased health care costs should be weighed against the sociofunctional effectiveness of these programs.
Der Unfallchirurg 04/2012; 111(9):719-726. · 0.61 Impact Factor
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Der Unfallchirurg 04/2012; 113(1):65-68. · 0.61 Impact Factor
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Der Unfallchirurg 01/2010; 113(1):65-8. · 0.61 Impact Factor
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ABSTRACT: Sacral insufficiency fractures can cause severe, debilitating pain to patients concerned. The incidence of this fracture type correlates with the appearance of osteoporosis in the elderly population. A polymethylmethacrylate (PMMA) cement injection procedure called sacroplasty has been recently described as an optional method for the treatment of this fracture type. However, the correct cement placement in the complex anatomical structure of the sacrum is a surgical challenge. The aim of the study is to compare the precision, safety, and radiation exposure of standard multiplanar fluoroscopy and computed tomography (CT) guidance for PMMA application to the sacrum using both balloon-assisted sacroplasty and conventional sacroplasty. A controlled experimental investigation in a human cadaver trial has been performed. Two imaging and two application modalities to monitor percutaneous PMMA injection to the sacrum were examined. The application forms were randomized from side to side of the pelvis. We found less cement extravasation in the CT-guided groups, but also a significant higher radiation exposure (P < 0.05) by using CT guidance. The conventional fluoroscopy-guided sacroplasty revealed the shortest procedure time (incision to closure time) of all treatment groups (P < 0.01). These findings show no difference regarding cement extravasation between ballon-assisted and conventional sacroplasty. Further, in comparison to fluoroscopy-assisted technique, the CT-guided cement injection seems to decrease the risk of cement extravasation, irrespective of the use of an additional balloon assistance. However, we have to consider a greater radiation exposure using CT guidance. Further investigations will proof the suitability in the normal course of clinical life.
European Spine Journal 05/2009; 18(8):1226-33. · 1.97 Impact Factor
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ABSTRACT: Modern strategies for postoperative care of patients with hip fractures include early discharge from the acute care hospital to inpatient interdisciplinary rehabilitation facilities. Whether these programs are effective for the patients and improve their long-term outcomes or if they simply transfer costs, with a reduction of the inpatient days in the acute care hospital, is currently under discussion.
This prospective study included 282 patients with hip fracture admitted to our trauma center were included into the prospective study. The mean patient age was 86+/-8 (65-110) years. All patients were treated operatively. After a mean of 12+/-9 days, the patients underwent inpatient interdisciplinary geriatric rehabilitation for a mean of 27+/-13 (4-103) days. The primary outcome measure was their activities of daily living (Barthel index) before, at the end of rehabilitation, and 1 year after trauma. In addition, patient-related variables were correlated with the Barthel index.
With discharge from the acute care hospital, the Barthel index was 42+/-20 points and it increased during rehabilitation to 65+/-26 points. One year later the Barthel index was 67+/-28 points. Ninety percent of patients improved their Barthel index during rehabilitation. Within 1 year, 40% of patients deteriorated in their activities of daily living. Fifty one percent of patients were reintegrated back to their homes. Patients who lived at home before trauma and were reintegrated back to their homes had a significant higher Barthel index (75+/-24) 1 year after trauma than patients who were living in a nursing care facility before the trauma (Barthel index 52+/-27). The variables of age, level of cognition, and type of fracture had no influence on the long-term outcome. An extension of rehabilitation above the mean time period did not improve the sustainable clinical outcome.
Postoperative inpatient rehabilitation programs enhance short-term activities of daily living. In particular, patients who lived at home before the trauma and were reintegrated back home benefited in perpetuity from geriatric rehabilitation. A policy for early discharge to geriatric rehabilitation is associated with extension of overall hospital stay. This association along with the related increased health care costs should be weighed against the sociofunctional effectiveness of these programs.
Der Unfallchirurg 07/2008; 111(9):719-26. · 0.61 Impact Factor
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ABSTRACT: The treatment of unstable cervical spine injuries with the halo vest represents an established procedure. So far no data reflecting the quality of life of patients following a halo vest treatment are available. Elderly people make up a large part of the inpatients in our hospital. Therefore special attention is payed to this group of patients in this study.
In this study 41 patients (average age of 51.8 +/- 23.5 years) with an unstable injury of the upper cervical spine were investigated. All of them underwent a halo vest therapy in our hospital during 1988-2003. The health-related quality of life was assessed in the mean 8.0 years after the trauma by using the SF-36 Health Survey. Additionally, the incidence of complications and the union rate over time were observed.
The evaluation of the data obtained from the SF-36 revealed a reduced quality of life in the patient group in comparison to the reference population. This was particularly apparent in patients older than 60 years. The fracture healing under halo vest treatment was comparably slow. In 17% of the cases no fracture union was obtained after 12 weeks. This was only seen for patients older than 60 years. The complication rate associated to the halo vest amounted to 43% and was independent of age.
The treatment of unstable fractures of the upper cervical spine with a halo vest results in a prolongated fracture healing for elderly people. Furthermore a halo vest therapy reduces the health related quality of life. Therefore, even for elderly patients an internal osteosynthetic stabilization of an unstable injury of the upper cervical spine should be considered if indicated.
Der Unfallchirurg 05/2006; 109(4):306-12. · 0.61 Impact Factor
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ABSTRACT: Im nachfolgenden Artikel wird über zwei weitere Fälle eines Lipofibroms des Nervus medianus berichtet. Es handelt sich dabei
um einen sehr seltenen, benignen Tumor dieses peripheren Nervs. In der bisher erschienenen Literatur finden sich etwa 30 Fälle,
auf die ebenfalls zurückgegriffen wird, um eine Einordnung der beiden neuen Fälle vorzunehmen. Neben der operativen Behandlung,
die eine neuropathologische Befundung erst ermöglicht, ist die präoperative Diagnostik erstmals um die NMR-Untersuchung des
betroffenen Nervenabschnittes erweitert worden. Der nichtinfiltrative Charakter des Tumors ist auf diesen Aufnahmen gut erkennbar,
Signalverhalten und anatomische Nähe zum Nervus medianus können die Verdachtsdiagnose eines Lipofibroms erhärten. Durch die
postoperative histologische Aufarbeitung wurde die Diagnose klassisch bestätigt, dabei konnte bei der immunologischen Markierung
gegen das S-100-Protein eine auffällige Verminderung dieses Proteins festgestellt werden. Die von uns dargestellten Fälle
rekapitulieren in typischer Weise Anamnese, Klinik und therapeutisches Vorgehen beim Lipofibrom des Nervus medianus.
The following article presents two new cases of a lipofibroma of the median nerve. This formation is a very rare benign tumor
of peripheral nerve tissue. Up to now 30 cases have been reported in the literature and are reviewed in this article and are
compared with the two cases reported. Besides the operative treatment, which made the neuropathological diagnosis possible,
preoperative diagnosis has been extended by MNT-scans of the involved parts of the nerve. The noninfiltrating character of
the tumor could be well recognized on these scans. The signal quality and the anatomical proximity to the median nerve made
the diagnosis of a lipofibroma likely. By the postoperative histological reviews the diagnosis was confirmed in classic manner.
The immunological marking of the S-100 protein showed a remarkable reduction of this protein in these peripheral nerve tumors.
The two cases reported by us recapitulate the clinical history typically and describe symptoms and our treatment for the lipofibroma
of the median nerve.
European Journal of Trauma 04/1994; 20(1):42-48.
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ABSTRACT: The following article presents two new cases of a lipofibroma of the median nerve. This formation is a very rare benign tumor of peripheral nerve tissue. Up to now 30 cases have been reported in the literature and are reviewed in this article and are compared with the two cases reported. Besides the operative treatment, which made the neuropathological diagnosis possible, preoperative diagnosis has been extended by MNT-scans of the involved parts of the nerve. The noninfiltrating character of the tumor could be well recognized on these scans. The signal quality and the anatomical proximity to the median nerve made the diagnosis of a lipofibroma likely. By the postoperative histological reviews the diagnosis was confirmed in classic manner. The immunological marking of the S-100 protein showed a remarkable reduction of this protein in these peripheral nerve tumors. The two cases reported by us recapitulate the clinical history typically and describe symptoms and our treatment for the lipofibroma of the median nerve.
Unfallchirurgie 03/1994; 20(1):42-8.
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Biomedizinische Technik 02/1990; 35 Suppl 3:10-1. · 0.86 Impact Factor
