Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Tscherne Festschrift 24 articles

Articles

Acute Complications of Patients With Pelvic Fractures After Pelvic Angiographic Embolization

Amir Matityahu MD, Meir Marmor MD, Joshua Knute Elson MPH, Corey Lieber MD, Gregory Rogalski MD, Cindy Lin MPH, Tigist Belaye MS, Theodore Miclau MD, Utku Kandemir MD

Hemodynamically unstable patients with a pelvic fracture and arterial pelvic bleeding frequently are treated with pelvic angiographic embolization (PAE). PAE is reported to be a safe and effective method of controlling hemorrhage. However, the loss of blood supply and subsequent ischemia from embolization may lead to adverse consequences.

Severity of Injury Predicts Subsequent Function in Surgically Treated Displaced Intraarticular Calcaneal Fractures

Stefan Rammelt MD, PhD, Hans Zwipp MD, PhD, Wolfgang Schneiders MD, PhD, Constanze Dürr MD

The treatment of displaced, intraarticular calcaneal fractures (DIACFs) remains challenging and the best treatment choices remain controversial. The majority of patients will have some lasting functional restrictions. However, it is unclear which patient- or surgeon-related factors predict long-term function.

Trauma Care in India and Germany

Hans-Joerg Oestern MD, Bhavuk Garg MD, Prakash Kotwal MD

Road traffic accidents are among the leading causes of death worldwide in individuals younger than 45 years. In both India and Germany, there has been an increase in registered motor vehicles over the last decades. However, while the number of traffic accident victims steadily dropped in Germany, there has been a sustained increase in India. We analyze this considering the sustained differences in rescue and trauma system status.

Does Additional Head Trauma Affect the Long-term Outcome After Upper Extremity Trauma in Multiple Traumatized Patients: Is There an Additional Effect of Traumatic Brain Injury?

Hagen Andruszkow MD, Christian Probst MD, Orna Grün MD, Christian Krettek MD, Frank Hildebrand MD

Musculoskeletal injuries are common in patients with multiple trauma resulting in pain, functional deficits, and disability. Traumatic brain injuries (TBIs) are common in severely injured patients potentially resulting in neurological impairment and permanent disability that would add to that from the musculoskeletal injuries. However, it is unclear to what degree the combination affects impairment.

Can a Modified Anterior External Fixator Provide Posterior Compression of AP Compression Type III Pelvic Injuries?

Richard Martin Sellei MD, Peter Schandelmaier MD, Philipp Kobbe MD, Matthias Knobe MD, Hans-Christoph Pape MD, FACS

Current anterior fixators can close a disrupted anterior pelvic ring. However, these anterior constructs cannot create posterior compressive forces across the sacroiliac joint. We explored whether a modified fixator could create such forces.

Trauma Care in Germany: An Inclusive System

Johannes A. Sturm MD, Hans-Christoph Pape MD, Thomas Dienstknecht MD

Development of trauma systems is a demanding process. The United States and Germany both have sophisticated trauma systems. This manuscript is a summary of political, economic, and medical changes that have led to the development of both trauma systems and the current high-quality standards.

Surgical Technique: Tscherne-Johnson Extensile Approach for Tibial Plateau Fractures

Eric E. Johnson MD, Stephen Timon MD, Chukwunenye Osuji MD

The standard approach to lateral tibial plateau fractures involves elevation of the iliotibial band (IT) and anterior tibialis origin in continuity from Gerdy’s tubercle and metaphyseal flare. We describe an alternative approach to increase lateral plateau joint exposure and maintain iliotibial band insertion to Gerdy’s tubercle.

Is the Transplant Quality at the Time of Surgery Adequate for Matrix-guided Autologous Cartilage Transplantation? A Pilot Study

Johannes Zellner MD, Peter Angele MD, Florian Zeman PhD, Richard Kujat PhD, Michael Nerlich MD

Matrix-guided autologous chondrocyte transplantation (MACT) has been proposed as an option for treating large full-thickness cartilage defects. However, little is known about the chondrogenic potential of transplants for MACT at the time of implantation, although cell quality and chondrogenic differentiation of the implants are crucial for restoration of function after MACT.

Which Implant Is Better for Treating Reverse Obliquity Fractures of the Proximal Femur: A Standard or Long Nail?

Güvenir Okcu MD, Nadir Ozkayin MD, Cemil Okta MD, Ismet Topcu MD, Kemal Aktuglu MD

Reverse obliquity fractures of the proximal femur have biomechanical characteristics distinct from other intertrochanteric fractures and high implant failure rate when treated with sliding hip screws. Intramedullary hip nailing for these fractures reportedly has less potential for cut-out of the lag screw because of their loadbearing capacity when compared with extramedullary implants. However, it is unclear whether nail length influences healing.

Submuscular Bridge Plating for Complex Pediatric Femur Fractures Is Reliable

Amr A. Abdelgawad MD, Ryan N. Sieg MD, Matthew D. Laughlin DO, Juan Shunia MD, Enes M. Kanlic MD

Complex, high-energy pediatric femur diaphyseal fractures cannot be treated reliably by conventional methods: casting is not suitable for polytrauma and large children, external fixation is associated with a high rate of malalignment and refractures, elastic nails are unsuitable for unstable fractures and metaphyseal areas, and lateral trochanteric entry rigid nails cannot address proximal and distal fragments and need relatively large medullary canals. A few centers have reported that submuscular bridge plating (SBP) is associated with minimal complications, but these findings require confirmation.

Do Parameters Used to Clear Noncritically Injured Polytrauma Patients for Extremity Surgery Predict Complications?

Thomas Dienstknecht MD, Dieter Rixen MD, Peter Giannoudis MD, Hans-Christoph Pape MD

In multiply injured patients, definitive stabilization of major fractures is performed whenever feasible, depending on the clinical condition.

Are Pentraxin 3 and Transsignaling Early Markers for Immunologic Injury Severity in Polytrauma? A Pilot Study

Christian Kleber MD, Christopher A. Becker MD, Katharina Schmidt-Bleek DVM, PhD, Klaus D. Schaser MD, Norbert P. Haas MD

Inflammatory-related conditions and organ failure (OF) lead to late trauma mortality. Cytokine profiles can predict adverse events and mortality, potentially guiding treatment strategies (damage control surgery versus early total care). However, the specific cytokines to predict the clinical course in polytraumatized patients are not fully identified.

Cumulative Effects of Bone and Soft Tissue Injury on Systemic Inflammation: A Pilot Study

Roman Pfeifer MD, Sophie Darwiche MD, Lauryn Kohut MA, Timothy R. Billiar MD, FACS, Hans-Christoph Pape MD, FACS

In multiply injured patients, bilateral femur fractures invoke a substantial systemic inflammatory impact and remote organ dysfunction. However, it is unclear whether isolated bone or soft tissue injury contributes to the systemic inflammatory response and organ injury after fracture.

Is There a Difference in Timing and Cause of Death After Fractures in the Elderly?

Inge S. Liem MD, Christian Kammerlander MD, Christoph Raas MD, Markus Gosch MD, Michael Blauth MD

Patients who sustain osteoporotic fractures have excessive mortality compared to age-matched controls, which is most pronounced within the first 6 months postfracture. However, the timing and cause of death in the first 3 months after sustaining a fracture are unclear.

Heterotopic Ossification Rates After Acetabular Fracture Surgery Are Unchanged Without Indomethacin Prophylaxis

Sean M. Griffin MD, Stephen H. Sims MD, Madhav A. Karunakar MD, Rachel Seymour PhD, Nikkole Haines MD

We previously found no reduction in heterotopic ossification (HO) rates after acetabular surgery with indomethacin compared with a placebo. We subsequently abandoned routine indomethacin therapy after acetabular surgery but questioned whether the incidence had changed using a posterior approach.

Implant Material and Design Alter Construct Stiffness in Distal Femur Locking Plate Fixation: A Pilot Study

Ulf Schmidt MD, Rainer Penzkofer PhD, Samuel Bachmaier MSc, Peter Augat PhD

Construct stiffness affects healing of bones fixed with locking plates. However, variable construct stiffness reported in the literature may be attributable to differing test configurations and direct comparisons may clarify these differences.

Minimally Invasive Percutaneous Plate Fixation of Tibia Fractures: Results in 80 Patients

Alexandre A. Sitnik MD, PhD, Alexander V. Beletsky MD

Minimally invasive percutaneous plate fixation (MIPPF) has gained wide acceptance for treating periarticular fractures of the tibia. Despite the theoretical biological advantages of MIPPF, it is unclear whether these are offset by wound complications, union rate, and malalignment.

What Are Predictors for Patients’ Quality of Life After Pelvic Ring Fractures?

Joerg H. Holstein MD, Antonius Pizanis MD, Daniel Köhler MD, Tim Pohlemann MD

Data from literature on predictors for patients’ quality of life after pelvic ring fractures are conflicting and based on small study populations.

Unstable Intertrochanteric Femur Fractures: Is There a Consensus on Definition and Treatment in Germany?

Matthias Knobe MD, Gertraud Gradl MD, Andreas Ladenburger MD, Ivan S. Tarkin MD, Hans-Christoph Pape MD

Extramedullary and intramedullary implants have improved in recent years, although consensus is lacking concerning the definition and classification of unstable intertrochanteric fractures, with uncertainties regarding treatment.

Can Joint Contact Dynamics Be Restored by Anterior Cruciate Ligament Reconstruction?

Yuichi Hoshino MD, PhD, Freddie H. Fu MD, DSc, James J. Irrgang PT, PhD, ATC, FAPTA, Scott Tashman PhD

Rotational kinematics has become an important consideration after ACL reconstruction because of its possible influence on knee degeneration. However, it remains unknown whether ACL reconstruction can restore both rotational kinematics and normal joint contact patterns, especially during functional activities.

Segmental Tibial Fractures: An Infrequent but Demanding Injury

Martin Teraa MD, Taco J. Blokhuis MD, PhD, Lisa Tang MS, Loek P. H. Leenen MD, PhD

Segmental tibial fractures are considered to be a special injury type associated with high complication rates. However, it is unclear whether healing of these fractures truly differs from that of nonsegmental fractures.