Mid-term results of a stemless ceramic on polyethylene shoulder prosthesis - A prospective multicentre study.

INTRODUCTION: Early reports of stemless shoulder arthroplasty have shown promising clinical and radiological outcomes. The purpose of this study was to report on the mid-term results of an implant that utilises a ceramic humeral head. METHODS: A prospective, consecutive, multicentre study of stemless shoulder prosthesis with a minimum of four years of follow-up was conducted between August 2009 and May 2012. The adjusted Constant-Murley Score (CMS), revision rate and presence of radiolucent lines were recorded at intervals. RESULTS: A total of 207 patients were eligible for study inclusion; 62.8% were female and mean age was 64.8 years (range 30-86). Mean follow-up was 70.7 months (range 48-100), 73% underwent TSA and 27% hemiarthroplasty. The mean CMS improvement was 42.6 (p < 0.0001) at 48 months. Radiolucencies were present in 2.7% of humeral zones and 14% of glenoid zones at 48-month follow-up. The revision rate was 6.3% with rotator cuff failure (2.9%) the most common indication. CONCLUSIONS: Mid-term results demonstrate that the studied stemless implant with a ceramic humeral head had clinical and radiological outcomes that are comparable to other reported studies.

[Newly developed modular reverse fracture endoprosthesis in non-reconstructable humeral head fracture in old people]. / Modulare inverse Frakturendoprothese bei nichtrekonstruierbarer Humeruskopffraktur des alten Menschen.

OBJECTIVE: Primary endoprosthetic joint replacement in non-reconstructable proximal humeral fracture in the elderly. Alternative to fracture hemi-endoprosthesis with resorption of tuberosities and secondary rotator cuff insuffiency which leads to unsatisfying functional results. INDICATIONS: Non-reconstructable proximal humeral fracture in mainly old patients with osteoporotic bone, multifragment tuberosity fracture and degenerative rotator cuff lesion. CONTRAINDICATIONS: Patient not fit for surgery, pre-existing shoulder infection or sepsis, severe general medical condition, nerve damage (axillay nerve, Plexus) SURGICAL TECHNIQUE: Deltopectoral or delta-split approach. Removal of head fragments. Reinforcement of tuberosities and exposure of glenoid. Implantation of the metaglene and fixation of glenosphere after removal of labrum and capsule. Reaming of humeral shaft and cementing of the prosthesis stem. The retroversion and height of the reverse central part then can be adjusted freely. The tuberosities can be fixed with suture at the middle part. With a titanium cable an additional compression osteosynthesis of the tuberosities can be done by direct pressing on the osseoinductive coated central part. POSTOPERATIVE MANAGEMENT: Positioning of the arm on an abduction pillow for 4 weeks, then active exercise treatment until week 6. Free movement exercise under guidance for 6 months. RESULTS: Multicentre study with 43 patients (40 women, 3 men), average age 79.8 years (range 66.9-95.8 years), 36 patients with 4-part-fracture according to Neer classification. To date, follow-up of 24 patients after at least 24 months, 9 patients lost to follow-up. Mean Constant Score 65.5 points, age and gender corrected Constant Score 96.7 %. Visual Analog Scale (VAS) for pain 1.9. VAS for subjective satisfaction 7.5. Mean American Shoulder and Elbow Surgeons Shoulder Score (ASES) 72.8 points. Mean active range of motion: flexion 142.3°, abduction 135.9°, external rotation 18.6°, internal rotation 47°, the radiological evaluation so far did not show any signs of scapular notching. COMPLICATIONS: One dislocated acromion fracture.

[Intrapelvic dislocation of lag screw in gamma nailing]. / Mediale Dislokation der Schenkelhalsschraube bei Gammanagelung ins kleine Becken.

Within the last decade, intramedullary nailing systems have gained enormous popularity in the treatment of fractures of the trochanteric region. However, these implants are not free of any complications. Commonly reported treatment failures include stress-derived femur fracture, rotational displacement, varus deformity of the femoral neck and head, and implant cutout through the femoral neck. So far, there are only five cases known in the literature describing dislocation of the medial leg screw into the pelvis. The patient history, operative intervention, and course are reported. The incidence of such cases is discussed. Modifications of intramedullary nailing systems are mentioned.

Primary fracture arthroplasty of the proximal humerus using a new and freely adjustable modular prosthesis combined with compression osteosynthesis of the tuberosities.

OBJECTIVE: Prosthetic joint replacement in case of non-reconstructable proximal humerus fracture in order to obtain a pain-free shoulder and an acceptable range of motion. INDICATIONS: The non-reconstructable proximal humerus fracture in aged, frail patients (over 70 years of age or ASA 3). CONTRAINDICATIONS: Patient inoperable or rehabilitation is inacceptable, pre-existing infection of the shoulder, coexisting bacteremia, or rotator cuff insufficiency. SURGICAL TECHNIQUE: Using a deltopectoral or deltoid split approach, the head fragment is removed. After reaming of the humeral canal, a stem is cemented in place. The Affinis Fracture prosthesis consists of three parts: the stem (3 sizes), a metaphyseal part (2 sizes), and a ceramic head (3 sizes). The retroversion of the metaphyseal part is freely adjustable (360°) after cementing the stem. The length can be adjusted over 1 cm. After reconstruction of the height and retroversion, the tuberosities are reattached anatomically. Finally, a compression osteosynthesis of the tuberosities is realized, using a metal cable, compressing the tuberosities directly upon the metaphyseal part. POSTOPERATIVE MANAGEMENT: As the stability of this construct is very high, early postoperative mobilization is allowed. In order to avoid adhesion, rehabilitation exercises are started the day after surgery. During the first few days, passive mobilization, within pain limits, is performed. As soon as possible, active assisted mobilization is started. No stretching is performed, especially in rotation, before the sixth postoperative week. The arm is supported in a sling, only for analgesic reasons. RESULTS: Using this technique, anatomical healed tuberosities were obtained in 84% of the 44 patients with a mean Constant score of 59 points.

[Avoidance of wrong site surgery. Experiences by the introduction of measures for quality control and patient safety in a surgical casualty hospital]. / Vermeidung von Eingriffsverwechslungen. Erfahrungen bei der Einführung von Massnahmen zur Qualitätssicherung und Patientensicherheit in einer Unfallchirurgischen Klinik.

Wrong site surgery leads to substantial individual injury to the affected patient. Therefore, organizations such as the WHO, the Joint Commission International (JCI) and the Action Alliance Patient Safety (APS) have developed procedures for avoidance of wrong site surgery. This is based on the active incorporation of patients in the process of intervention identification. In this manner the disclosure to the patient, marking of the site of surgery, identification before induction of anesthesia and the team time out are documented in a checklist recommended by the APS before the operation begins. In the DRK Clinics in Berlin the procedure for avoidance of wrong site surgery was introduced before the second recertification by the JCI for implementation of the patient safety recommendations and compliance with the four stages documented in a standard form. For successful implementation all members of staff and in particular the heads of the clinics and departments must be actively involved in order to obtain the acceptance permanently and to ensure that wrong site surgery no longer occurs in the DRK Clinics Berlin.

Modification of spontaneous emission of (CdSe)ZnS nanocrystals embedded in nanoimprinted photonic crystals.

Highly luminescent (CdSe)ZnS nanocrystals, with band edge emission in the red region of the visible spectrum, were successfully synthesized and incorporated in a resist, namely mr-NIL 6000. The nanocomposite material was imprinted by using conventional nanoimprint lithography (NIL) process. We report on the fabrication and characterization of nanoimprinted photonic crystals in this new functional material. Experiments showed good imprint properties of the NC/polymer based material and that the surface nanostructuration improves the light extraction efficiency by over 2 compared to a nanoimprinted unpatterned surface.

Photoluminescence enhancement in nanoimprinted photonic crystals and coupled surface plasmons.

A method to enhance the photoluminescence of dye chromophores-loaded by coupling the emission to surface plasmons in nanoimprinted photonic crystals is reported. A 9-fold enhancement in the spontaneous emission intensity of a rhodamine-doped polymer film is achieved on a silver layer due to surface plasmon excitation. By changing the surface plasmon frequency, this enhancement can be suppressed. When the polymer film is patterned by nanoimprint lithography with a twodimensional photonic crystal the photoluminescence intensity increases up to 27 times compared to unpatterned samples on a quartz substrate.

Influence of the molecular weight and imprint conditions on the formation of capillary bridges in nanoimprint lithography.

Sub-100 nm patterns can be duplicated by nanoimprint lithography with high reproducibility, even on 200 mm wafers. Nevertheless, several problems have to be solved before this technique reaches a mature state for industrial applications. Several kinds of defect appear frequently in printed polymers. Some of them are induced by capillary effects and are related to mould deformation. Capillary bridges are observed on the flat surfaces around the pattern areas, or inside the printed structures. In this paper, the influence of the polymer molecular weight (M(w)) on the capillary bridge distribution is presented. It will be shown that for smaller M(w), they appear first around the pattern areas and move towards the structures more rapidly. It is also demonstrated that this evolution depends directly on the printing temperature and pattern filling related to the feature density and the film thickness. Finally, it is shown that the influence of these parameters is related to the polymer viscosity, which is the dominant property of the capillary effects, and a trade-off has to be made between the limitation due to the capillary bridges, the decrease of the temperature, which is important to reduce the cycle time, and the sticking defects.

[Open Bankart shoulder stabilization using bioabsorbable staples. Technique and results]. / Die offene Schulterstabilisierung nach Bankart unter Verwendung von resorbierbaren Dübeln. Technik und Ergebnisse.

In the supply of anterior unidirectional instability the open Bankart repair still represents the standard procedure. In a retrospective study 48 patients with an open repair were supplied with bioabsorbable staples and the result with 42 patients (88%) was postoperative clinically examined following 18-48 months. The middle number of dislocations of the affected shoulder was 8.8. After surgery the average Rowe Score amounted to 96.1 points. Reluxations arose with two patients. The middle external rotation of the affected side was reduced in comparison to the opposite side by 9.7 degrees. With the open supply of the unidirectional instability by absorbable staples (Suretac) an easy procedure of the open operation according to Bankart is available. Reproducible results occurred in our patients. Thus the advantages of arthroscopical operation technology with those of the open execution of capsular shift are combined applicable, providing both patient and operating surgeon a high security at a low rate of reluxation.

Low incidence of SV40-like sequences in ependymal tumours.

Between 1955 and 1963, millions of children and adults were exposed to SV40-contaminated poliovirus vaccines. The oncogenic potential of this polyomavirus was revealed when intracerebral inoculation of SV40 into newborn hamsters resulted in the development of ependymomas and choroid plexus papillomas. Subsequently, SV40-like sequences were repeatedly detected in human ependymomas with broadly ranging incidence rates of 7-90%. Most epidemiological studies, however, have not described an increased occurrence of ependymomas. To gain more data on this controversial issue, this study examined 62 archived ependymal tumours from 31 children and 31 adults who underwent surgery between 1990 and 1999. Only three (5%) of the tumours--including 24 classical, 20 anaplastic, and 12 myxopapillary ependymomas; one subependymoma; and five ependymoblastomas--revealed subgenomic SV40 sequences. None of the ependymomas in patients born between 1920 and 1960 demonstrated SV40-like sequences. The positive tumours represent 7% of grade II and III ependymomas (two paediatric and one adult tumour). DNA sequencing of the PCR product revealed identical sequences of SV40 in the positive ependymal tumours. Compared with the results from other countries, this incidence rate is relatively low. Therefore, it seems likely that significant differences between individual countries exist regarding the prevalence of SV40-positive ependymomas. These differences may reflect different degrees of exposure to SV40-contaminated polio vaccine.

Microviscosity of water-containing heterogeneous systems. An ESR spin probe study.

The microstructure of maltodextrin gels was studied by ESR spin probe technique. From investigations of the time dependence of the gelling process and from the Arrhenius plot of the rotational correlation time, important information about the phase behaviour of the system is obtained. The microviscosity decreases with swelling time, whereas the macroviscosity increases. The conclusion is drawn that the maltodextrin gel is a two-phase system and can be characterized in the nomenclature of Papkov as a gel of the second type.