Objectives Osteoporotic fractures of the pelvis (OFP) are an increasing issue in orthopedics. Cur... more Objectives Osteoporotic fractures of the pelvis (OFP) are an increasing issue in orthopedics. Current classification systems (CS) are mostly CT-based and complex and offer only moderate to substantial inter-rater reliability (interRR) and intra-rater reliability (intraRR). MRI is thus gaining importance as a complement. This study aimed to develop a simple and reliable CT- and MRI-based CS for OFP. Methods A structured iterative procedure was conducted to reach a consensus among German-speaking spinal and pelvic trauma experts over 5 years. As a result, the proposed OF-Pelvis CS was developed. To assess its reliability, 28 experienced trauma and orthopedic surgeons categorized 25 anonymized cases using X-ray, CT, and MRI scans twice via online surveys. A period of 4 weeks separated the completion of the first from the second survey, and the cases were presented in an altered order. While 13 of the raters were also involved in developing the CS (developing raters (DR)), 15 user rater...
Zeitschrift für Orthopädie und Unfallchirurgie, 2019
ZusammenfassungIm Jahr 2017 erstellten die Mitglieder der AG „obere HWS“ der Sektion „Wirbelsäule... more ZusammenfassungIm Jahr 2017 erstellten die Mitglieder der AG „obere HWS“ der Sektion „Wirbelsäule“ der DGOU in einem Konsensusprozess mit 4 Sitzungen Empfehlungen zur Diagnostik und Therapie oberer Halswirbelsäulenverletzungen unter Berücksichtigung der aktuellen Literatur. Der folgende Artikel beschreibt die Empfehlung für Frakturen des Atlasrings. Etwa 10% aller HWS-Verletzungen betreffen den Atlas. Die Diagnostik zielt im Wesentlichen auf die Detektion der Verletzung sowie die Beurteilung der Gelenkflächen hinsichtlich einer Lateralisationstendenz der Atlasmassive. Zur Klassifikation haben sich die Gehweiler-Klassifikation und ergänzend die Dickman-Klassifikation bewährt. Zum primären klinischen Screening hat sich die Canadian C-Spine Rule bewährt. Bildgebendes Verfahren der Wahl bei klinischem Verdacht auf eine Atlasverletzung ist die CT. Die MRT dient der Beurteilung der Integrität des Lig. transversum atlantis bei vorderer und hinterer Bogenfraktur. Die Indikation zur Gefäßdar...
Retrospective study. To evaluate radiological parameters as indicators for posterior ligamentous ... more Retrospective study. To evaluate radiological parameters as indicators for posterior ligamentous complex (PLC) injuries in the case of limited availability of magnetic resonance imaging. Traumatic thoracolumbar spinal fractures with PLC injuries can be misdiagnosed on X-rays or computed tomography scans. This study aimed to retrospectively assess unrecognized PLC injuries and evaluate radiographic parameters as indicators of PLC injuries requiring surgery. In total, 314 patients with type A and type B2 fractures who underwent surgical treatment between 2001 and 2010 were included. The frequency of misdiagnosis was reassessed, and radiographic parameters were evaluated and correlated. The average age of the patients was 51.8 years. There were 225 type A3/A4 and 89 type B2 fractures; 39 of the type B2 fractures (43.8%) had been misdiagnosed as type A fractures. Type B fractures presented with a significantly higher kyphotic wedge angle and Cobb angle and a lower sagittal index (SI) th...
Expert consensus. To establish treatment recommendations for subaxial cervical spine injuries bas... more Expert consensus. To establish treatment recommendations for subaxial cervical spine injuries based on current literature and the knowledge of the Spine Section of the German Society for Orthopaedics and Trauma. This recommendation summarizes the knowledge of the Spine Section of the German Society for Orthopaedics and Trauma. Therapeutic goals are a stable, painless cervical spine and protection against secondary neurologic damage while retaining maximum possible motion and spinal profile. The AOSpine classification for subaxial cervical injuries is recommended. The Canadian C-Spine Rule is recommended to decide on the need for imaging. Computed tomography is the favoured modality. Conventional x-ray is preserved for cases lacking a "dangerous mechanism of injury." Magnetic resonance imaging is recommended in case of unexplained neurologic deficit, prior to closed reduction and to exclude disco-ligamentous injuries. Computed tomography angiography is recommended in high-g...
Expert opinion. Osteoporotic vertebral fractures are of increasing medical importance. For an ade... more Expert opinion. Osteoporotic vertebral fractures are of increasing medical importance. For an adequate treatment strategy, an easy and reliable classification is needed. The working group "Osteoporotic Fractures" of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU) has developed a classification system (OF classification) for osteoporotic thoracolumbar fractures. The consensus decision followed an established pathway including review of the current literature. The OF classification consists of 5 groups: OF 1, no vertebral deformation (vertebral edema); OF 2, deformation with no or minor (<1/5) involvement of the posterior wall; OF 3, deformation with distinct involvement (>1/5) of the posterior wall; OF 4, loss of integrity of the vertebral frame or vertebral body collapse or pincer-type fracture; OF 5, injuries with distraction or rotation. The interobserver reliability was substantial (κ = .63). The proposed OF classification is easy to use...
Prospective clinical cohort study (data collection); expert opinion (recommendation development).... more Prospective clinical cohort study (data collection); expert opinion (recommendation development). Treatment options for nonsurgical and surgical management of osteoporotic vertebral body fractures are widely differing. Based on current literature, the knowledge of the experts, and their classification for osteoporotic fractures (OF classification) the Spine Section of the German Society for Orthopaedics and Trauma has now introduced general treatment recommendations. a total of 707 clinical cases from 16 hospitals were evaluated. An OF classification-based score was developed to guide in the option of nonsurgical versus surgical management. For every classification type, differentiated treatment recommendations were deduced. Diagnostic prerequisites for reproducible treatment recommendations were defined: conventional X-rays with consecutive follow-up images (standing position whenever possible), magnetic resonance imaging, and computed tomography scan. OF classification allows for ...
Zusammenfassung Der endoprothetische Ersatz des Humeruskopfes bei nicht rekonstruierbaren Fraktu... more Zusammenfassung Der endoprothetische Ersatz des Humeruskopfes bei nicht rekonstruierbaren Frakturen des proximalen Humerus wurde bereits in den 1970er Jahren von Neer mit guten Ergebnissen publiziert. Seither gelang es keiner Arbeitsgruppe, ähnlich gute Ergebnisse zu reproduzieren. Alle Studien der vergangenen 20 Jahre zeigen, dass für die Patienten ein akzeptables Schmerzniveau erreicht werden kann. Die Funktion des Schultergelenkes ist in der Regel jedoch schlecht.
Minimally Invasive Therapy & Allied Technologies, 2014
Abstract Purpose: Vertebral body stenting (VBS) was developed to prevent loss of reduction after ... more Abstract Purpose: Vertebral body stenting (VBS) was developed to prevent loss of reduction after balloon deflation during kyphoplasty. The aim of this study is the radiological and clinical mid-term evaluation of traumatic incomplete burst fractures treated by vertebral body stenting. Material and methods: This retrospective study included patients with traumatic thoracolumbar incomplete burst fractures treated with VBS between 2009 and 2010. The outcome was evaluated with the visual analogue pain scale (VAS), the Oswestry Disability Score (ODI), the SF-36 Health Survey and radiologically assessed. Results: Eighteen patients with an average age of 74.8 years were treated with VBS. Twelve were female and six were male. Two years after the operation the ODI and SF-36 showed a moderate limitation of daily activities and quality of life without neurological deficits. VBS restored the vertebral kyphosis by 3.2° and segmental kyphosis by 5°. A minor sintering was observed at follow-up losing 0.8° vertebral kyphosis and 2.1° segmental kyphosis correction. Two asymptomatic cement leakages were detected. Conclusion: VBS provides clinical outcomes comparable with BKP. The stent allows a reconstruction of the anterior column with reduced subsequent loss of correction.
Reconstruction of the extensor apparatus of the knee joint. Open reduction and stable internal fi... more Reconstruction of the extensor apparatus of the knee joint. Open reduction and stable internal fixation of patella fractures. Exact reconstruction of the articular surface of the patellofemoral joint. Open and closed fractures. Fractures with an intraarticular incongruity (&gt; 2 mm). Incapability of extension of the knee also in nondisplaced fractures of the patella. In the context of internal fixations of additional periarticular fractures of the knee joint. Compromised general health status or associated injuries. Compromised local soft-tissue situation (contamination, poor soft-tissue cover). Relative: nondisplaced transverse fractures (no displacement in 40 degrees of flexion). Relative: nondisplaced longitudinal fractures(3). Relative: nondisplaced radiating fractures(3). Relative: nondisplaced fractures of the distal pole without involvement of the joint surface and intact extensor apparatus(3). Longitudinal parapatellar incision. Tension band wiring. Lag screw osteosynthesis. Combination of tension band wiring and lag screws. Patellectomy (partial/complete). Thrombosis prophylaxis. Early physiotherapy. Knee brace. 70% good to excellent results. 30% chronic pain and posttraumatic arthritis. Loss of motion (limited extension).
In den letzten fünf Jahren wurden 16 extraartikuläre Frakturen der proximalen Tibia in der Unfall... more In den letzten fünf Jahren wurden 16 extraartikuläre Frakturen der proximalen Tibia in der Unfallchirurgischen Universitätsklinik Mainz operativ versorgt. Es handelte sich dabei um proximale metaphysäre und meta-/diaphysäre Verletzungen ohne Beteiligung des Kniegelenkes. Eine begleitende Fraktur der Fibula lag bei 13 Patienten vor. Die Frakturen wurden nach dem AO-System klassifiziert. Es handelte sich um vier offene und zwölf geschlossene Frakturen. Abhängig von der Weichteilsituation wurde der Zeitpunkt der operativen Versorgung (im Mittel drei Tage posttraumatisch) gewählt. Sechs Frakturen wurden mit einer intramedullären Osteosynthese und zehn Frakturen mittels Plattenosteosynthese nach offener Reposition stabilisiert. Die mittlere postoperative Beobachtungsdauer betrug 14 Monate, die durchschnittliche Heilungszeit 14 Wochen. Es kam zu zwei verzögerten Bowie einer ausbleibenden Knochenheilung. In insgesamt neun Fällen traten Fehlstellungen im Bereich der Fraktur auf, hiervon sechs mit einer Abweichung von &gt; 5° in mindestens einer Ebene. Die operativen Ergebnisse sind somit bezüglich der Achsgenauigkeit in einem Drittel der hier dokumentierten Fälle als nicht optimal zu werten, wobei keine der angewandten Operationstechniken wesentliche Vorteile geboten hat.
Traumatic thoracolumbar spine fractures are frequently classified as burst fractures Magerl type ... more Traumatic thoracolumbar spine fractures are frequently classified as burst fractures Magerl type A3. There still are many controversies regarding the treatment of this fracture. The therapeutic spectrum ranges from conservative to invasive operative methods with attendant morbidities. The minimal-invasive technique of kyphoplasty has established itself as a common treatment of osteoporotic vertebral compression fractures and is associated with a low complication rate. The aim of this study is to evaluate the functional and radiological results after kyphoplasty of traumatic thoracolumbar burst fractures. Patients with traumatic thoracolumbar fractures type A3.1, A3.2 and A3.3, who were treated with kyphoplasty, were included in this study. The clinical outcome was measured at follow up with a neurological assessment, the visual analogue pain scale (VAS), the Oswestry Disability Score (ODI) and the SF-36 Health Survey. The radiological measurements, performed on preoperative, postoperative and follow up radiographs, included the sagittal index, the wedge angle and the modified Cobb angle of Daniaux. 26 patients with 23 A3.1, one A3.2 and five A3.3 fractures were treated between 2004 and 2007, including five patients with multiple vertebral fractures. At follow up the Oswestry Disability Score (26.2%) and the SF-36 score (60.1%) assessed a moderately limitation of functional outcome and quality of life without any neurological deficits. Radiological measurements showed a postoperative height restoration and reduction of kyphosis, but at follow up a secondary loss of correction except in five cases. Six minor ventrocranial cement leakages without further clinical consequence were observed. The present study showed that kyphoplasty is a safe and feasible method for the treatment of burst fractures. It allowed the correction of the kyphosis, stabilisation of the facture, pain reduction and early mobilisation.
Objectives Osteoporotic fractures of the pelvis (OFP) are an increasing issue in orthopedics. Cur... more Objectives Osteoporotic fractures of the pelvis (OFP) are an increasing issue in orthopedics. Current classification systems (CS) are mostly CT-based and complex and offer only moderate to substantial inter-rater reliability (interRR) and intra-rater reliability (intraRR). MRI is thus gaining importance as a complement. This study aimed to develop a simple and reliable CT- and MRI-based CS for OFP. Methods A structured iterative procedure was conducted to reach a consensus among German-speaking spinal and pelvic trauma experts over 5 years. As a result, the proposed OF-Pelvis CS was developed. To assess its reliability, 28 experienced trauma and orthopedic surgeons categorized 25 anonymized cases using X-ray, CT, and MRI scans twice via online surveys. A period of 4 weeks separated the completion of the first from the second survey, and the cases were presented in an altered order. While 13 of the raters were also involved in developing the CS (developing raters (DR)), 15 user rater...
Zeitschrift für Orthopädie und Unfallchirurgie, 2019
ZusammenfassungIm Jahr 2017 erstellten die Mitglieder der AG „obere HWS“ der Sektion „Wirbelsäule... more ZusammenfassungIm Jahr 2017 erstellten die Mitglieder der AG „obere HWS“ der Sektion „Wirbelsäule“ der DGOU in einem Konsensusprozess mit 4 Sitzungen Empfehlungen zur Diagnostik und Therapie oberer Halswirbelsäulenverletzungen unter Berücksichtigung der aktuellen Literatur. Der folgende Artikel beschreibt die Empfehlung für Frakturen des Atlasrings. Etwa 10% aller HWS-Verletzungen betreffen den Atlas. Die Diagnostik zielt im Wesentlichen auf die Detektion der Verletzung sowie die Beurteilung der Gelenkflächen hinsichtlich einer Lateralisationstendenz der Atlasmassive. Zur Klassifikation haben sich die Gehweiler-Klassifikation und ergänzend die Dickman-Klassifikation bewährt. Zum primären klinischen Screening hat sich die Canadian C-Spine Rule bewährt. Bildgebendes Verfahren der Wahl bei klinischem Verdacht auf eine Atlasverletzung ist die CT. Die MRT dient der Beurteilung der Integrität des Lig. transversum atlantis bei vorderer und hinterer Bogenfraktur. Die Indikation zur Gefäßdar...
Retrospective study. To evaluate radiological parameters as indicators for posterior ligamentous ... more Retrospective study. To evaluate radiological parameters as indicators for posterior ligamentous complex (PLC) injuries in the case of limited availability of magnetic resonance imaging. Traumatic thoracolumbar spinal fractures with PLC injuries can be misdiagnosed on X-rays or computed tomography scans. This study aimed to retrospectively assess unrecognized PLC injuries and evaluate radiographic parameters as indicators of PLC injuries requiring surgery. In total, 314 patients with type A and type B2 fractures who underwent surgical treatment between 2001 and 2010 were included. The frequency of misdiagnosis was reassessed, and radiographic parameters were evaluated and correlated. The average age of the patients was 51.8 years. There were 225 type A3/A4 and 89 type B2 fractures; 39 of the type B2 fractures (43.8%) had been misdiagnosed as type A fractures. Type B fractures presented with a significantly higher kyphotic wedge angle and Cobb angle and a lower sagittal index (SI) th...
Expert consensus. To establish treatment recommendations for subaxial cervical spine injuries bas... more Expert consensus. To establish treatment recommendations for subaxial cervical spine injuries based on current literature and the knowledge of the Spine Section of the German Society for Orthopaedics and Trauma. This recommendation summarizes the knowledge of the Spine Section of the German Society for Orthopaedics and Trauma. Therapeutic goals are a stable, painless cervical spine and protection against secondary neurologic damage while retaining maximum possible motion and spinal profile. The AOSpine classification for subaxial cervical injuries is recommended. The Canadian C-Spine Rule is recommended to decide on the need for imaging. Computed tomography is the favoured modality. Conventional x-ray is preserved for cases lacking a "dangerous mechanism of injury." Magnetic resonance imaging is recommended in case of unexplained neurologic deficit, prior to closed reduction and to exclude disco-ligamentous injuries. Computed tomography angiography is recommended in high-g...
Expert opinion. Osteoporotic vertebral fractures are of increasing medical importance. For an ade... more Expert opinion. Osteoporotic vertebral fractures are of increasing medical importance. For an adequate treatment strategy, an easy and reliable classification is needed. The working group "Osteoporotic Fractures" of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU) has developed a classification system (OF classification) for osteoporotic thoracolumbar fractures. The consensus decision followed an established pathway including review of the current literature. The OF classification consists of 5 groups: OF 1, no vertebral deformation (vertebral edema); OF 2, deformation with no or minor (<1/5) involvement of the posterior wall; OF 3, deformation with distinct involvement (>1/5) of the posterior wall; OF 4, loss of integrity of the vertebral frame or vertebral body collapse or pincer-type fracture; OF 5, injuries with distraction or rotation. The interobserver reliability was substantial (κ = .63). The proposed OF classification is easy to use...
Prospective clinical cohort study (data collection); expert opinion (recommendation development).... more Prospective clinical cohort study (data collection); expert opinion (recommendation development). Treatment options for nonsurgical and surgical management of osteoporotic vertebral body fractures are widely differing. Based on current literature, the knowledge of the experts, and their classification for osteoporotic fractures (OF classification) the Spine Section of the German Society for Orthopaedics and Trauma has now introduced general treatment recommendations. a total of 707 clinical cases from 16 hospitals were evaluated. An OF classification-based score was developed to guide in the option of nonsurgical versus surgical management. For every classification type, differentiated treatment recommendations were deduced. Diagnostic prerequisites for reproducible treatment recommendations were defined: conventional X-rays with consecutive follow-up images (standing position whenever possible), magnetic resonance imaging, and computed tomography scan. OF classification allows for ...
Zusammenfassung Der endoprothetische Ersatz des Humeruskopfes bei nicht rekonstruierbaren Fraktu... more Zusammenfassung Der endoprothetische Ersatz des Humeruskopfes bei nicht rekonstruierbaren Frakturen des proximalen Humerus wurde bereits in den 1970er Jahren von Neer mit guten Ergebnissen publiziert. Seither gelang es keiner Arbeitsgruppe, ähnlich gute Ergebnisse zu reproduzieren. Alle Studien der vergangenen 20 Jahre zeigen, dass für die Patienten ein akzeptables Schmerzniveau erreicht werden kann. Die Funktion des Schultergelenkes ist in der Regel jedoch schlecht.
Minimally Invasive Therapy & Allied Technologies, 2014
Abstract Purpose: Vertebral body stenting (VBS) was developed to prevent loss of reduction after ... more Abstract Purpose: Vertebral body stenting (VBS) was developed to prevent loss of reduction after balloon deflation during kyphoplasty. The aim of this study is the radiological and clinical mid-term evaluation of traumatic incomplete burst fractures treated by vertebral body stenting. Material and methods: This retrospective study included patients with traumatic thoracolumbar incomplete burst fractures treated with VBS between 2009 and 2010. The outcome was evaluated with the visual analogue pain scale (VAS), the Oswestry Disability Score (ODI), the SF-36 Health Survey and radiologically assessed. Results: Eighteen patients with an average age of 74.8 years were treated with VBS. Twelve were female and six were male. Two years after the operation the ODI and SF-36 showed a moderate limitation of daily activities and quality of life without neurological deficits. VBS restored the vertebral kyphosis by 3.2° and segmental kyphosis by 5°. A minor sintering was observed at follow-up losing 0.8° vertebral kyphosis and 2.1° segmental kyphosis correction. Two asymptomatic cement leakages were detected. Conclusion: VBS provides clinical outcomes comparable with BKP. The stent allows a reconstruction of the anterior column with reduced subsequent loss of correction.
Reconstruction of the extensor apparatus of the knee joint. Open reduction and stable internal fi... more Reconstruction of the extensor apparatus of the knee joint. Open reduction and stable internal fixation of patella fractures. Exact reconstruction of the articular surface of the patellofemoral joint. Open and closed fractures. Fractures with an intraarticular incongruity (&gt; 2 mm). Incapability of extension of the knee also in nondisplaced fractures of the patella. In the context of internal fixations of additional periarticular fractures of the knee joint. Compromised general health status or associated injuries. Compromised local soft-tissue situation (contamination, poor soft-tissue cover). Relative: nondisplaced transverse fractures (no displacement in 40 degrees of flexion). Relative: nondisplaced longitudinal fractures(3). Relative: nondisplaced radiating fractures(3). Relative: nondisplaced fractures of the distal pole without involvement of the joint surface and intact extensor apparatus(3). Longitudinal parapatellar incision. Tension band wiring. Lag screw osteosynthesis. Combination of tension band wiring and lag screws. Patellectomy (partial/complete). Thrombosis prophylaxis. Early physiotherapy. Knee brace. 70% good to excellent results. 30% chronic pain and posttraumatic arthritis. Loss of motion (limited extension).
In den letzten fünf Jahren wurden 16 extraartikuläre Frakturen der proximalen Tibia in der Unfall... more In den letzten fünf Jahren wurden 16 extraartikuläre Frakturen der proximalen Tibia in der Unfallchirurgischen Universitätsklinik Mainz operativ versorgt. Es handelte sich dabei um proximale metaphysäre und meta-/diaphysäre Verletzungen ohne Beteiligung des Kniegelenkes. Eine begleitende Fraktur der Fibula lag bei 13 Patienten vor. Die Frakturen wurden nach dem AO-System klassifiziert. Es handelte sich um vier offene und zwölf geschlossene Frakturen. Abhängig von der Weichteilsituation wurde der Zeitpunkt der operativen Versorgung (im Mittel drei Tage posttraumatisch) gewählt. Sechs Frakturen wurden mit einer intramedullären Osteosynthese und zehn Frakturen mittels Plattenosteosynthese nach offener Reposition stabilisiert. Die mittlere postoperative Beobachtungsdauer betrug 14 Monate, die durchschnittliche Heilungszeit 14 Wochen. Es kam zu zwei verzögerten Bowie einer ausbleibenden Knochenheilung. In insgesamt neun Fällen traten Fehlstellungen im Bereich der Fraktur auf, hiervon sechs mit einer Abweichung von &gt; 5° in mindestens einer Ebene. Die operativen Ergebnisse sind somit bezüglich der Achsgenauigkeit in einem Drittel der hier dokumentierten Fälle als nicht optimal zu werten, wobei keine der angewandten Operationstechniken wesentliche Vorteile geboten hat.
Traumatic thoracolumbar spine fractures are frequently classified as burst fractures Magerl type ... more Traumatic thoracolumbar spine fractures are frequently classified as burst fractures Magerl type A3. There still are many controversies regarding the treatment of this fracture. The therapeutic spectrum ranges from conservative to invasive operative methods with attendant morbidities. The minimal-invasive technique of kyphoplasty has established itself as a common treatment of osteoporotic vertebral compression fractures and is associated with a low complication rate. The aim of this study is to evaluate the functional and radiological results after kyphoplasty of traumatic thoracolumbar burst fractures. Patients with traumatic thoracolumbar fractures type A3.1, A3.2 and A3.3, who were treated with kyphoplasty, were included in this study. The clinical outcome was measured at follow up with a neurological assessment, the visual analogue pain scale (VAS), the Oswestry Disability Score (ODI) and the SF-36 Health Survey. The radiological measurements, performed on preoperative, postoperative and follow up radiographs, included the sagittal index, the wedge angle and the modified Cobb angle of Daniaux. 26 patients with 23 A3.1, one A3.2 and five A3.3 fractures were treated between 2004 and 2007, including five patients with multiple vertebral fractures. At follow up the Oswestry Disability Score (26.2%) and the SF-36 score (60.1%) assessed a moderately limitation of functional outcome and quality of life without any neurological deficits. Radiological measurements showed a postoperative height restoration and reduction of kyphosis, but at follow up a secondary loss of correction except in five cases. Six minor ventrocranial cement leakages without further clinical consequence were observed. The present study showed that kyphoplasty is a safe and feasible method for the treatment of burst fractures. It allowed the correction of the kyphosis, stabilisation of the facture, pain reduction and early mobilisation.
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