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1.
Emerg Radiol ; 2024 Jun 17.
Article in English | MEDLINE | ID: mdl-38880828

ABSTRACT

PURPOSE: Controversy exists about whole-body computed tomography (CT) as a primary screening modality for suspected multiple trauma patients. Therefore, the aim of this study was to analyze time trends of CT examinations for trauma patients in relation to the Injury Severity Score (ISS). METHODS: We retrospectively analyzed 561 adult trauma patients (mean age = 54 years) who were admitted to the trauma room of our hospital, immediately followed by a CT examination, in 2009, 2013 und 2017. Review of electronic patient charts was performed to determine the cause of injury. ISS was either calculated upon hospital charts and CT imaging reports or documented in the TraumaRegister DGU® for trauma patients with ICU treatment or ISS ≥ 16. RESULTS: An increasing number of CT examinations of acute trauma patients were performed at our hospital with 117 patients in 2009 compared to 192 in 2013 and 252 in 2017. Their mean age increased (50 years in 2009, 54 in 2013 and 55 in 2017;p = 0.046), whereas their mean ISS decreased over time (15.2 in 2009 compared to 12.1 in 2013 and 10.6 in 2017;p = 0.001), especially in women (15.1 in 2009, 11.8 in 2013 and 7.4 in 2017;p = 0.001 both), younger age groups (18 to 24 years:15.6 in 2009, 6.5 in 2013 and 8.9 in 2017; p = 0.033 and 25 to 49 years:15.0 in 2009, 11.2 in 2013 and 8.3 in 2017;p = 0.001) as well as motor vehicle collision (MVC) victims (16.2 in 2009, 11.8 in 2013 and 6.1 in 2017; p < 0.001). Trauma patients with a high ISS were especially more likely of older age (OR 1.02,p < 0.001) and with the type of incident being a fall (< 3 m: OR3.84,p < 0.001;>3 m: OR6.22,p < 0.001) compared to MVC. CONCLUSION: Previous studies suggesting a benefit of primary whole-body CT for trauma patients might not reflect the current patient population with decreasing ISS. Especially females, younger age groups and MVC patients might benefit from stricter selection criteria for receiving whole-body CT. Our results also emphasize the importance of prevention of fall or tumble for elderly people.

2.
Eur J Trauma Emerg Surg ; 49(6): 2373-2379, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37978059

ABSTRACT

PURPOSE: Patients with tibial plateau fractures (TPF) are at risk of long-term hampered bipedal locomotion. A retrospective single-center study using patient-related outcome measures and a sophisticated assessment of walking abilities was conducted. METHODS: Adults receiving surgical treatment of an isolated TPF between January 2012 and December 2016 received the KOOS questionnaire together with the invitation for an extensive follow-up examination on the clinical outcome including standardized assessment of the walking abilities (loadsol® system). Outcome was assessed relative to the severity of the injury or time to follow-up. Fractures were classified according to AO/OTA and Luo, respectively. RESULTS: 58 out of 132 eligible patients filled in the questionnaire and participated at a median follow-up of 3.05 years after injury. For the categories "pain", "mobility", and "daily life activities", all patients were rather satisfied and this was virtually not related to the time between fracture and assessment. Relevant limitations were reported for "sports and recreational activities" and "quality of life". Loading of the previously fractured leg was most evidently changed on stairs and outdoor walking. Outcome was not related to either fracture type severity or time from injury. CONCLUSION: Outcome after an isolated TPF is neither related to fracture type, severity of the fracture nor time from injury. Simple gait analysis techniques relying on different tasks appear to yield a more sophisticated image on functional deficits after TPF than classical exam of ground-level walking and correlate quite well with validated patient-related outcome measures as the KOOS.


Subject(s)
Tibial Fractures , Tibial Plateau Fractures , Adult , Humans , Fracture Fixation, Internal/methods , Retrospective Studies , Tibial Fractures/surgery , Quality of Life , Treatment Outcome
3.
Biomedicines ; 11(5)2023 May 05.
Article in English | MEDLINE | ID: mdl-37239040

ABSTRACT

Testosterone deficiency in males is linked to various pathological conditions, including muscle and bone loss. This study evaluated the potential of different training modalities to counteract these losses in hypogonadal male rats. A total of 54 male Wistar rats underwent either castration (ORX, n = 18) or sham castration (n = 18), with 18 castrated rats engaging in uphill, level, or downhill interval treadmill training. Analyses were conducted at 4, 8, and 12 weeks postsurgery. Muscle force of the soleus muscle, muscle tissue samples, and bone characteristics were analyzed. No significant differences were observed in cortical bone characteristics. Castrated rats experienced decreased trabecular bone mineral density compared to sham-operated rats. However, 12 weeks of training increased trabecular bone mineral density, with no significant differences among groups. Muscle force measurements revealed decreased tetanic force in castrated rats at week 12, while uphill and downhill interval training restored force to sham group levels and led to muscle hypertrophy compared to ORX animals. Linear regression analyses showed a positive correlation between bone biomechanical characteristics and muscle force. The findings suggest that running exercise can prevent bone loss in osteoporosis, with similar bone restoration effects observed across different training modalities.

4.
Eur J Trauma Emerg Surg ; 48(5): 3635-3641, 2022 Oct.
Article in English | MEDLINE | ID: mdl-32415366

ABSTRACT

PURPOSE: The role of classification systems for the choice of surgical approach and the management of tibial plateau fractures remains unclear. The purpose of this study was to investigate the potential of classification systems to choose the appropriate operative approach. Current surgical management strategies were investigated in a large multicenter assessment. METHODS: In this study, we retrospectively analyzed all patients with tibial plateau fractures that have received surgical treatment in one of the five Level I trauma facilities between 2012 and 2015. Fractures were classified in each center by a senior orthopedic surgeon using the AO/OTA and the Luo classification. Demographics, trauma mechanism, as well as the surgical approach were recorded. RESULTS: 538 patients (46.1% male, 53.9% female) were included. The anterolateral approach was used most frequently with 54.8% of all single approaches; 76.2% of all combined approaches used anterolateral as part of the approach. Combined approaches were used in 22.5% of the cases; a combination of the anterolateral and medial (10%), anterolateral, and posteromedial approach (5.8%) were used most frequently. The lowest number was found for the posterolateral (1.3%) and the combined approaches dorsal/anterolateral and medial/dorsal (1.7%, 1.1%). The AO/OTA classification showed a peak for 41.B2 (21.9%) and B3 (35.5%) fractures. Regarding the Luo classification, the dorsal column was involved in 45.7%. In contrast, only 14.7% of the surgical approaches used were able to address the dorsal tibial plateau potentially. CONCLUSION: The use of dorsal approach seems to be of minor importance than expected in daily clinical practice in this multicenter study. It was not possible to specify whether the AO/OTA or the Luo classification can reliably predict the choice of surgical approach. The operative treatment strategy of tibial plateau fractures seems to rather rely on the surgeons' experience, education, and preferences.


Subject(s)
Fracture Fixation, Internal , Tibial Fractures , Female , Humans , Male , Retrospective Studies , Tibia/surgery , Tibial Fractures/surgery
6.
Radiologe ; 60(7): 581-590, 2020 Jul.
Article in German | MEDLINE | ID: mdl-32382829

ABSTRACT

The complex anatomy of the elbow joint enables a wide range of movement and complex functions in everyday and professional life. Typical injuries of this joint include a variety of different pathologies. Due to overlaying structures in plain radiographs, diagnosis of injuries to the elbow joint places high demands on the treating physicians and often needs further diagnostic imaging. The following article will give an overview of the most common of these injuries and their diagnosis.


Subject(s)
Arm Injuries , Elbow Injuries , Radius Fractures , Arm , Arm Injuries/diagnosis , Humans , Radius Fractures/diagnosis , Treatment Outcome
7.
Am J Infect Control ; 48(2): 167-172, 2020 02.
Article in English | MEDLINE | ID: mdl-31604621

ABSTRACT

BACKGROUND: For the prevention of surgical wound infections (SSIs), local microorganism counts can be lowered by skin antisepsis prior to surgical incisions. Until now, it has been unclear which antiseptic is the most effective. METHODS: This prospective randomized trial analyzed the efficacy of 2 frequently used agents in the reduction of postoperative wound complication rates after aseptic trauma surgery on the lower leg and foot. In the study, 279 consecutive participants were randomized; 112 received surgical skin preparations using chlorhexidine (CHX) (ChloraPrep; Becton Dickinson, Franklin Lakes, NJ) and 167 received preparations with povidone-iodine (PVP-I) (Braunoderm; B. Braun Melsungen AG, Melsungen, Germany). Primary clinical endpoints were SSIs and wound healing disorders (WHDs) within 6 months after surgery. Secondary outcome variables included demographic and perioperative risk factors for SSIs. RESULTS: Rates of WHDs and SSIs were significantly higher in the PVP-I treatment group, which experienced 9 SSIs and 12 WHDs (n = 21; 12.6%), compared to the CHX treatment group, which had 2 SSIs and 3 WHDs (n = 5; 4.5%) (P = .022). Perioperative risk factors for WHDs were obesity and longer surgery time, whereas SSIs were increased in participants with cardiovascular diseases and suction drainage. Logistic regression analysis showed that the odds of complications of wound healing were 3.5 times higher for PVP-I than for CHX (odds ratio = 3.5; 95% confidence interval, 1.1-11.2; P = .032). CONCLUSIONS: Preoperative skin antisepsis for trauma surgery of the lower leg and foot using CHX led to significantly fewer complications of wound healing when compared to PVP-I.


Subject(s)
Anti-Infective Agents, Local/pharmacology , Antisepsis/methods , Chlorhexidine/pharmacology , Povidone-Iodine/pharmacology , Adult , Aged , Aged, 80 and over , Female , Humans , Lower Extremity , Male , Middle Aged , Odds Ratio , Preoperative Care , Prospective Studies , Risk Factors , Surgical Wound Infection/prevention & control , Young Adult
8.
Arch Orthop Trauma Surg ; 140(10): 1359-1366, 2020 Oct.
Article in English | MEDLINE | ID: mdl-31858219

ABSTRACT

BACKGROUND: In the elderly, osteoporotic fractures of the femur are associated with high morbidity and mortality. At the time of hospitalization and during pre-operative care identification of patients at risk for poor outcome despite an otherwise good clinical condition is challenging. We hypothesized that the serum concentration of fetuin-A during post-operative recovery might serve as a biomarker. METHODS: During a 15 months period patients admitted to our hospital for treatment of a femur fracture were registered on a voluntary basis and irrespective of age, underlying diseases and therapy. For all patients enrolled in this registry, blood was sampled for additional laboratory analysis. Patients with osteoporotic fractures were invited for follow-up examination about 2 years later. At this time, the functional outcome and clinical performance together with the handgrip strength as a surrogate measure of overall strength were assessed and the occurrence of additional fractures was recorded. Results from these assessments and the absence or presence of subsequent fractures were combined as summary score of outcome (SSO) and overall physical performance (oPP), a score derived by principal component analysis and relying on normally distributed data, only. RESULTS: 39 of 96 eligible patients were deceased during the follow-up period, while 45 consented to participate in the study. Patients with a SSO ≥ 17 pts were younger and had higher fetuin-A serum concentrations (each p < 0.05) during hospitalization compared to those with a SSO below 8 pts. Age at follow-up together with total serum protein and fetuin-A levels during post-operative recovery had significant influence on SSO and oPP. Fetuin-A at time of follow-up examination was not associated with outcome. CONCLUSIONS: Our results are in favor of fetuin-A as an important factor for fracture healing but do not support an association between fetuin-A at time of follow-up examination and either SSO or oPP.


Subject(s)
Femoral Fractures , Osteoporotic Fractures , alpha-2-HS-Glycoprotein/analysis , Aged , Aged, 80 and over , Femoral Fractures/epidemiology , Femoral Fractures/mortality , Femoral Fractures/surgery , Hospitalization , Humans , Middle Aged , Osteoporotic Fractures/epidemiology , Osteoporotic Fractures/mortality , Osteoporotic Fractures/surgery , Treatment Outcome
9.
J Orthop Surg Res ; 14(1): 297, 2019 Sep 05.
Article in English | MEDLINE | ID: mdl-31488155

ABSTRACT

BACKGROUND: Due to our aging population, an increase in proximal femur fractures can be expected, which is associated with impaired activities of daily living and a high risk of mortality. These patients are also at a high risk to suffer a secondary osteoporosis-related fracture on the contralateral hip. In this context, growth factors could open the field for regenerative approaches, as it is known that, i.e., the growth factor BMP-7 (bone morphogenetic protein 7) is a potent stimulator of osteogenesis. Local prophylactic augmentation of the proximal femur with a BMP-7 loaded thermoresponsive hydrogel during index surgery of an osteoporotic fracture could be suitable to reduce the risk of further osteoporosis-associated secondary fractures. The present study therefore aims to test the hypothesis if a BMP-7 augmented hydrogel is an applicable carrier for the augmentation of non-fractured proximal femurs. Furthermore, it needs to be shown that the minimally invasive injection of a hydrogel into the mouse femur is technically feasible. METHODS: In this study, male C57BL/6 mice (n = 36) received a unilateral femoral intramedullary injection of either 100 µl saline, 100 µl 1,4 Butan-Diisocyanat (BDI)-hydrogel, or 100 µl hydrogel loaded with 1 µg of bone morphogenetic protein 7. Mice were sacrificed 4 and 12 weeks later. The femora were submitted to high-resolution X-ray tomography and subsequent histological examination. RESULTS: Analysis of normalized CtBMD (Cortical bone mineral density) as obtained by X-ray micro-computed tomography analysis revealed significant differences depending on the duration of treatment (4 vs 12 weeks; p < 0.05). Furthermore, within different anatomically defined regions of interest, significant associations between normalized TbN (trabecular number) and BV/TV (percent bone volume) were noted. Histology indicated no signs of inflammation and no signs of necrosis and there were no cartilage damages, no new bone formations, or new cartilage tissues, while BMP-7 was readily detectable in all of the samples. CONCLUSIONS: In conclusion, the murine femoral intramedullary injection model appears to be feasible and worth to be used in subsequent studies that are directed to examine the therapeutic potential of BMP-7 loaded BDI-hydrogel. Although we were unable to detect any significant osseous effects arising from the mode or duration of treatment in the present trial, the effect of different concentrations and duration of treatment in an osteoporotic model appears of interest for further experiments to reach translation into clinic and open new strategies of growth factor-mediated augmentation.


Subject(s)
Bone Morphogenetic Protein 7/administration & dosage , Femoral Fractures/prevention & control , Femur/drug effects , Hydrogels/administration & dosage , Animals , Bone Morphogenetic Protein 7/analysis , Drug Evaluation, Preclinical/methods , Femoral Fractures/pathology , Femur/chemistry , Femur/pathology , Fracture Fixation, Intramedullary/methods , Hydrogels/analysis , Male , Mice , Mice, Inbred C57BL
10.
Injury ; 50 Suppl 3: 63-68, 2019 Aug.
Article in English | MEDLINE | ID: mdl-31378540

ABSTRACT

INTRODUCTION: Surgical treatment of displaced intra-articular calcaneal fractures using a standard extended lateral approach for plate fixation is frequently associated with substantial wound healing complications and infections. This matched pairs analysis compares the new minimally-invasive calcaneal interlocking nailing technique to standard locking plate fixation in terms of reduction capacity, complication rates, and functional outcomes. METHODS: Forty feet in 38 patients (mean patient age 52.5 years, range 27-78) were treated with calcaneal locking nail (LN)(n=20) or locking plate (LP)(n=20) and followed clinically and radiologically for 20 months. Follow-up included radiological assessments and functional evaluations including the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and the Foot Function Index (R-FFI). RESULTS: Times for surgery were similar for both techniques (LN 93min, range 34 to 175 vs. LP 101min, range 53 to 305). Length of hospital stay was significantly lower in the LN group (7.6 days, range 3 to 14 vs. LP 11 days, range 6 to 37). Time away from work was shorter by 3.5 days in LN group. LP group had superior range of motion in plantarflexion, eversion, and inversion at follow-up, while LP patients were superior in demonstrating a secure heelstrike (79% vs. LN 58%) and fewer needed permanent walking aids. AOFAS and FFI scores revealed no differences for both groups. Radiographs indicated an adequate reconstruction in both groups, followed by a slight loss of reduction at follow-up (LP 4.7° postoperative vs. follow-up; LN 5.1°). The overall complication rate between groups was significant with 5% complications in the LN group vs. 50% in the LP group (5% deep infection, 35% impaired wound healing, 5% hardware breakage, 5% superficial wound infection; LN: 5% superficial wound infection). CONCLUSIONS: The new calcaneal interlocking nail shows promising results in terms of reduction capacity and safety. Use of the minimally invasive locking nail technique minimized the risk of postoperative wound complications and achieved superior functional outcomes compared with standard locking plate fixation via the extended lateral approach.


Subject(s)
Calcaneus/surgery , Foot Injuries/surgery , Fracture Fixation, Internal/methods , Intra-Articular Fractures/surgery , Postoperative Complications/surgery , Adult , Aged , Bone Plates , Female , Foot Injuries/diagnostic imaging , Foot Injuries/physiopathology , Humans , Intra-Articular Fractures/diagnostic imaging , Intra-Articular Fractures/physiopathology , Male , Middle Aged , Postoperative Complications/diagnostic imaging , Postoperative Complications/physiopathology , Radiography , Range of Motion, Articular , Treatment Outcome
11.
Unfallchirurg ; 121(10): 825-838, 2018 Oct.
Article in German | MEDLINE | ID: mdl-30218165

ABSTRACT

Complex regional pain syndrome (CRPS) is not a very common yet typical complication of extremity trauma in the daily practice of a trauma surgeon. The pathophysiology of this puzzling disease is still not completely understood and its impact on the patient cannot be overestimated. However, advantages have been made in diagnostics and therapy. While a multitude of different diagnostic systems has led to confusion in the past, we now have an internationally accepted, validated and easy to reproduce diagnostic algorithm in the form of the Budapest criteria. The adequate therapy is still a field for debate, but there is now a broad choice of conservative and interventional treatments for the out- and inpatient setting.


Subject(s)
Complex Regional Pain Syndromes/diagnosis , Extremities/injuries , Extremities/surgery , Algorithms , Complex Regional Pain Syndromes/etiology , Complex Regional Pain Syndromes/physiopathology , Complex Regional Pain Syndromes/therapy , Humans
12.
Arch Orthop Trauma Surg ; 137(2): 195-207, 2017 Feb.
Article in English | MEDLINE | ID: mdl-27987182

ABSTRACT

BACKGROUND: Training programs directed to improve neuromuscular and musculoskeletal function of the legs are scarce with respect to older osteoporotic patients. We hypothesized that a modified step aerobics training program might be suitable for this purpose and performed a randomized controlled pilot study to assess the feasibility of conducting a large study. Here we report on the training-related effects on neuromuscular function of the plantar flexors. PATIENTS AND METHODS: Twenty-seven patients with an age of at least 65 years were enrolled and randomized into control and intervention group. The latter received supervised modified step aerobics training (twice weekly, 1 h per session) over a period of 6 months. At baseline, and after 3 and 6 months neuromuscular function of the plantar flexors, i.e., isometric maximum voluntary torque, rate of torque development and twitch torque parameters were determined in detail in all patients of both groups. RESULTS: Twenty-seven patients (median age 75 years; range 66-84 years) were randomized (control group n = 14; intervention group n = 13). After 3 and 6 months of training, maximum voluntary contraction strength in the intervention group was significantly higher by 7.7 Nm (9.1%; 95% CI 3.3-12.2 Nm, P < 0.01) and 12.4 Nm (14.8%; 95% CI 6.4-18.5 Nm, P < 0.01) compared to controls. These changes were most probably due to neural and muscular adaptations. CONCLUSION: It is worthwhile to investigate efficacy of this training program in a large randomized trial. However, a detailed neuromuscular assessment appears feasible only in a subset of participants.


Subject(s)
Exercise Therapy/methods , Isometric Contraction/physiology , Muscle Strength/physiology , Muscle, Skeletal/physiopathology , Osteoporosis/rehabilitation , Adult , Aged , Aged, 80 and over , Electromyography , Female , Humans , Leg , Male , Osteoporosis/physiopathology , Pilot Projects
13.
Joint Bone Spine ; 84(1): 71-77, 2017 Jan.
Article in English | MEDLINE | ID: mdl-27236261

ABSTRACT

OBJECTIVES: Osteoarthritis (OA) is increasingly considered a disease of the whole joint, yet the interplay between the articular cartilage and the subchondral bone remains obscure. We here set out to investigate the impact of bone mass on the progression of surgically induced knee OA in the mouse. METHODS: OA was induced in the right knees of female C57BL/6 (low bone mass) and STR/ort (high bone mass) mice via anterior cruciate ligament transection and destabilization of the medial meniscus. At 36 weeks of age, left and right knee joints were histologically compared for cartilage degeneration and via microCT analysis for subchondral bone plate thickness. In addition, femora were analyzed for bone mass at diaphysis and distal meta- and epiphysis. RESULTS: The severity of cartilage deterioration did not differ under high and low bone mass conditions. However, the extent of bone sclerosis differed and was proportional to the baseline subchondral bone plate thickness. Moreover, the cancellous bone loss following OA progression was inversely related to the bone mass: high bone mass restricted the loss to the epiphysis, whereas low bone mass allowed for a more widespread loss extending into the metaphysis. CONCLUSIONS: Our results suggest that cartilage degeneration is independent of the underlying bone mass. In contrast, subchondral bone remodeling associated with OA progression seem to correlate with the initial bone mass and suggest an enhanced crosstalk between the deteriorating cartilage and the subchondral bone under low bone mass conditions.


Subject(s)
Bone Resorption/pathology , Osteoarthritis, Knee/pathology , Osteoarthritis, Knee/physiopathology , Animals , Biopsy, Needle , Bone Density , Cartilage, Articular/pathology , Disease Models, Animal , Epiphyses/pathology , Female , Immunohistochemistry , Mice , Mice, Inbred C57BL , Normal Distribution , Osteoarthritis, Knee/genetics , Phenotype , Random Allocation , Sclerosis/pathology , Sensitivity and Specificity , Statistics, Nonparametric
14.
Physiol Meas ; 37(9): 1528-40, 2016 09.
Article in English | MEDLINE | ID: mdl-27511629

ABSTRACT

The Bindex(®) quantitative ultrasound (QUS) device is currently available and this study analyzed (I) its relative and absolute intra- and inter-session reliability and (II) the relationship between the data provided by Bindex(®)-QUS and the bone mineral density (BMD) measured by dual-energy x-ray absorptiometry at corresponding skeletal sites in young and healthy subjects (age: 25.0 ± 3.6 years). Bindex(®)-QUS calculates a density index on the basis of the thickness of cortical bone measured at the distal radius and the distal plus proximal tibia. The data show a very good relative and absolute intra- (ICC = 0.977, CV = 1.5%) and inter-session reliability (ICC = 0.978, CV = 1.4%) for the density index. The highest positive correlations were found between cortical thickness and BMD for the distal radius and distal tibia (r ⩾ 0.71, p < 0.001). The data indicate that the Bindex(®)-QUS parameters are repeatable within and between measurement sessions. Furthermore, the measurements reflect the BMD at specific skeletal sites. Bindex(®)-QUS might be a useful tool for the measurement of skeletal adaptations.


Subject(s)
Absorptiometry, Photon , Bone Density , Cortical Bone/anatomy & histology , Cortical Bone/diagnostic imaging , Ultrasonography/instrumentation , Adult , Cortical Bone/physiology , Female , Humans , Male , Reproducibility of Results
15.
Z Orthop Unfall ; 154(1): 16, 2016 Feb.
Article in German | MEDLINE | ID: mdl-27340710
16.
Biomed Res Int ; 2016: 4094161, 2016.
Article in English | MEDLINE | ID: mdl-27019848

ABSTRACT

INTRODUCTION: Current treatment strategies for osteoporotic vertebral compression fractures (VCFs) focus on cement-associated solutions. Complications associated with cement application are leakage, embolism, adjacent fractures, and compromise in bony healing. This study comprises a validated VCF model in osteoporotic sheep in order to (1) evaluate a new cementless fracture fixation technique using titanium mesh implants (TMIs) and (2) demonstrate the healing capabilities in osteoporotic VCFs. METHODS: Twelve 5-year-old Merino sheep received ovariectomy, corticosteroid injections, and a calcium/phosphorus/vitamin D-deficient diet for osteoporosis induction. Standardized VCFs (type AO A3.1) were created, reduced, and fixed using intravertebral TMIs. Randomly additional autologous spongiosa grafting (G1) or no augmentation was performed (G2, n = 6 each). Two months postoperatively, macroscopic, micro-CT and biomechanical evaluation assessed bony consolidation. RESULTS: Fracture reduction succeeded in all cases without intraoperative complications. Bony consolidation was proven for all cases with increased amounts of callus development for G2 (58.3%). Micro-CT revealed cage integration. Neither group showed improved results with biomechanical testing. CONCLUSIONS: Fracture reduction/fixation using TMIs without cement in osteoporotic sheep lumbar VCF resulted in bony fracture healing. Intravertebral application of autologous spongiosa showed no beneficial effects. The technique is now available for clinical use; thus, it offers an opportunity to abandon cement-associated complications.


Subject(s)
Fracture Healing , Internal Fixators , Lumbar Vertebrae/surgery , Spinal Fractures/surgery , Surgical Mesh , Titanium , Animals , Disease Models, Animal , Sheep
17.
J Bone Miner Res ; 31(4): 852-63, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26572927

ABSTRACT

Caloric restriction (CR) is a well-described dietary intervention that delays the onset of aging-associated biochemical and physiological changes, thereby extending the life span of rodents. The influence of CR on metabolism, strength, and morphology of bone has been controversially discussed in literature. Thus, the present study evaluated whether lifelong CR versus short-term late-onset dietary intervention differentially affects the development of senile osteoporosis in C57BL/6 mice. Two different dietary regimens with 40% food restriction were performed: lifelong CR starting in 4-week-old mice was maintained for 4, 20, or 74 weeks. In contrast, short-term late-onset CR lasting a period of 12 weeks was commenced at 48 or 68 weeks of age. Control mice were fed ad libitum (AL). Bone specimens were assessed using microcomputed tomography (µCT, femur and lumbar vertebral body) and biomechanical testing (femur). Adverse effects of CR, including reduced cortical bone mineral density (Ct.BMD) and thickness (Ct.Th), were detected to some extent in senile mice (68+12w) but in particular in cortical bone of young growing mice (4+4w), associated with reduced femoral failure force (F). However, we observed a profound capacity of bone to compensate these deleterious changes of minor nutrition with increasing age presumably via reorganization of trabecular bone. Especially in lumbar vertebrae, lifelong CR lasting 20 or 74 weeks had beneficial effects on trabecular bone mineral density (Tb.BMD), bone volume fraction (BV/TV), and trabecular number (Tb.N). In parallel, lifelong CR groups showed reduced structure model index values compared to age-matched controls indicating a transformation of vertebral trabecular bone microarchitecture toward a platelike geometry. This effect was not visible in senile mice after short-term 12-week CR. In summary, CR has differential effects on cortical and trabecular bone dependent on bone localization and starting age. Our study underlines that bone compartments possess a lifelong capability to cope with changing nutritional influences.


Subject(s)
Caloric Restriction , Femur/metabolism , Lumbar Vertebrae/metabolism , Animals , Female , Mice , Time Factors
18.
J Clin Densitom ; 19(2): 192-201, 2016.
Article in English | MEDLINE | ID: mdl-25439456

ABSTRACT

This cross-sectional observational cohort study was designed to simultaneously investigate bone microarchitecture and serum markers of bone metabolism in elderly osteoporotic patients experiencing a trochanteric or femoral neck fracture. Special emphasis was put on renal function, sclerostin and fibroblast growth factor-23 (FGF-23). Eighty-two patients (median age: 84 years; 49 trochanteric fractures) scheduled for emergency surgery due to an osteoporotic fracture participated. Bone specimens for ex vivo microcomputed X-ray tomography were sampled during surgery. Blood samples for laboratory workup were collected before surgery (t0) and 1 day afterward (t1). Fifty-eight patients consented to dual-energy X-ray absorptiometry scanning of the lumbar spine and/or contralateral femoral neck after recovery during the in-patient stay. Samples were grouped according to the site of fracture. Regression coefficients were controlled for age and/or estimated glomerular filtration rate (eGFR), if appropriate. Patients experiencing a femoral neck fracture presented with better preserved renal function (eGFR) and lower C-terminal fragment of fibroblast growth factor-23 (cFGF-23) concentrations compared to those with trochanteric fractures. By contrast, serum sclerostin was similar at both time points and did not differ between groups. Age-adjusted correlation analysis revealed negative associations between eGFR and cFGF-23 determined at t1 (R=-0.34; p<0.05) as well as between eGFR and sclerostin levels at t0 (R=-0.45; p<0.05) in patients with trochanteric and femoral neck fractures, respectively. Our study provides evidence that not only an age-related decline of renal function but also the type of skeletal injury may contribute to the circulating concentrations of cFGF-23.


Subject(s)
Bone Density , Femoral Neck Fractures , Fibroblast Growth Factors/blood , Osteoporotic Fractures , Absorptiometry, Photon/methods , Adaptor Proteins, Signal Transducing , Aged , Aged, 80 and over , Bone Morphogenetic Proteins/blood , Cohort Studies , Cross-Sectional Studies , Female , Femoral Neck Fractures/metabolism , Femoral Neck Fractures/pathology , Femur Neck/diagnostic imaging , Fibroblast Growth Factor-23 , Genetic Markers , Germany , Glomerular Filtration Rate , Humans , Lumbar Vertebrae/diagnostic imaging , Male , Osteoporotic Fractures/metabolism , Osteoporotic Fractures/pathology , Risk Factors , Statistics as Topic
19.
J Sci Med Sport ; 19(2): 170-6, 2016 Feb.
Article in English | MEDLINE | ID: mdl-25766509

ABSTRACT

OBJECTIVES: This study investigated effects of plyometric training (6 weeks, 3 sessions/week) on maximum voluntary contraction (MVC) strength and neural activation of the knee extensors during isometric, concentric and eccentric contractions. DESIGN: Twenty-seven participants were randomly assigned to the intervention or control group. METHODS: Maximum voluntary torques (MVT) during the different types of contraction were measured at 110° knee flexion (180°=full extension). The interpolated twitch technique was applied at the same knee joint angle during isometric, concentric and eccentric contractions to measure voluntary activation. In addition, normalized root mean square of the EMG signal at MVT was calculated. The twitch torque signal induced by electrical nerve stimulation at rest was used to evaluate training-related changes at the muscle level. In addition, jump height in countermovement jump was measured. RESULTS: After training, MVT increased by 20Nm (95% CI: 5-36Nm, P=0.012), 24Nm (95% CI: 9-40Nm, P=0.004) and 27Nm (95% CI: 7-48Nm, P=0.013) for isometric, concentric and eccentric MVCs compared to controls, respectively. The strength enhancements were associated with increases in voluntary activation during isometric, concentric and eccentric MVCs by 7.8% (95% CI: 1.8-13.9%, P=0.013), 7.0% (95% CI: 0.4-13.5%, P=0.039) and 8.6% (95% CI: 3.0-14.2%, P=0.005), respectively. Changes in the twitch torque signal of the resting muscle, induced by supramaximal electrical stimulation of the femoral nerve, were not observed, indicating no alterations at the muscle level, whereas jump height was increased. CONCLUSIONS: Given the fact that the training exercises consisted of eccentric muscle actions followed by concentric contractions, it is in particular relevant that the plyometric training increased MVC strength and neural activation of the quadriceps muscle regardless of the contraction mode.


Subject(s)
Knee/physiology , Muscle Contraction/physiology , Muscle Strength/physiology , Plyometric Exercise , Adult , Electromyography , Female , Humans , Male , Quadriceps Muscle/physiology , Torque
20.
Injury ; 46 Suppl 4: S17-23, 2015 Oct.
Article in English | MEDLINE | ID: mdl-26542861

ABSTRACT

INTRODUCTION: Vertebral compression fractures (VCFs) are one of the most common injuries in the aging population presenting with an annual incidence of 1.4 million new cases in Europe. Current treatment strategies focus on cement-associated solutions (kyphoplasty/vertebroplasty techniques). Specific cement-associated problems as leakage, embolism and the adjacent fracture disease are reported adding to open questions like general fracture healing properties of the osteoporotic spine. In order to analyze those queries animal models are of great interest; however, both technical difficulties in the induction of experimental osteoporosis in animal as well as the lack of a standardized fracture model impede current and future in vivo studies. This study introduces a standardized animal model of an osteoporotic VCF type A3.1 that may enable further in-depth analysis of the afore mentioned topics. MATERIAL AND METHODS: Twenty-four 5-year-old female Merino sheep (mean body weight: 67 kg; range 57-79) were ovariectomized (OP1) and underwent 5.5 months of weekly corticosteroid injections (dexamethasone and dexamethasone-sodium-phosphate), adding to a calcium/phosphorus/vitamin D-deficient diet. Osteoporosis induction was documented by pQCT and micro-CT BMD (bone mineral density) as well as 3D histomorphometric analysis postoperatively of the sheep distal radius and spine. Non osteoporotic sheep served as controls. Induction of a VCF of the second lumbar vertebra was performed via a mini-lumbotomy surgical approach with a standardized manual compression mode (OP2). RESULTS: PQCT analysis revealed osteoporosis of the distal radius with significantly reduced BMD values (0.19 g/cm(3), range 0.13-0.22 vs. 0.27 g/cm(3), range 0.23-0.32). Micro-CT documented significant lowering of BMD values for the second lumbar vertebrae (0.11 g/cm(3), range 0.10-0.12) in comparison to the control group (0.14 g/cm(3), range 0.12-0.17). An incomplete burst fracture type A3.1 was achieved in all cases and resulted in a significant decrease in body angle and vertebral height (KA 4.9°, range: 2-12; SI 4.5%, range: 2-12). With OP1, one minor complication (lesion of small bowel) occurred, while no complications occurred with OP2. CONCLUSIONS: A suitable spinal fracture model for creation of VCFs in osteoporotic sheep was developed. The technique may promote the development of improved surgical solutions for VCF treatment in the experimental and clinical setting.


Subject(s)
Fracture Fixation/methods , Fractures, Compression/pathology , Lumbar Vertebrae/pathology , Osteoporosis/pathology , Animals , Biomechanical Phenomena , Bone Density , Calcium/deficiency , Diet , Disease Models, Animal , Female , Fractures, Compression/etiology , Fractures, Compression/surgery , Osteoporosis/complications , Osteoporosis/etiology , Ovariectomy , Phosphorus/deficiency , Sheep, Domestic , Vitamin D Deficiency
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