[Digitalization in rehabilitation]. / Digitalisierung in der Rehabilitation.

BACKGROUND: The term digitalization is in trend. In addition to modernizing existing structures and converting analogue to digital processes, there are now a large number of digital applications available in the medical field. This is also increasingly influencing prehabilitation and rehabilitation. OBJECTIVE: The aim of this article is to provide an overview of digitalization options in the field of rehabilitation, taking the current literature into account. MATERIAL AND METHODS: A systematic literature search was carried out on the topic of digitalization in rehabilitation, especially in relation to interventions and diseases of the knee joint, using among others PubMed and PEDro. RESULTS AND CONCLUSION: Having arrived in "Rehabilitation 4.0", the networking of all infrastructures as well as the increasing use of artificial intelligence, the individualization of offers for healthcare companies and patients are playing an increasing role and are experiencing a real hype due to the supposedly infinite possibilities; however, the data situation on various digital offers in rehabilitation is inconsistent. The digital transformation provides many opportunities and challenges for rehabilitation, but despite all the euphoria it has to be critically questioned.

Influence of mediolateral tibial baseplate position in TKA on knee kinematics and retropatellar pressure.

PURPOSE: Anterior knee pain is a major reason for unsatisfied patients after total knee arthroplasty (TKA). Since malposition and increased retropatellar peak pressure are supposed to contribute to pain, we conducted this in vitro study to analyse the influence of mediolateral tibial component position on tibiofemoral and patella kinematics as well as retropatellar pressure. METHODS: Eight fresh frozen cadaver specimens were tested after a fixed-bearing TKA. To evaluate the influence of mediolateral tibial component position, special inlays with 3 mm of medialization and lateralization were constructed. For the analysis, a weight-bearing knee rig under a loaded squat from 20° to 120° of flexion was used. Tibiofemoral and patella kinematics were measured with an ultrasonic-based three-dimensional motion analysis system. Additionally, retropatellar pressure distribution was registered with a pressure-sensitive film. RESULTS: Alteration of mediolateral tibial component position by 3 mm did not reveal a significant influence on retropatellar peak pressure (7.5 ± 2.5 vs. 7.2 ± 2.6 MPa). Regarding tibiofemoral kinematics, 3-mm medialization of the tibial baseplate significantly increased lateral femoral rollback and femorotibial external rotation. Medialization of 3 mm also significantly increased the relative medial patella shift and decreased lateral patella tilt. DISCUSSION: Medialization of the tibial baseplate came along with more lateral rollback and external femorotibial rotation. For the positioning of the tibial baseplate, rotational alignment seems to be more important than mediolateral orientation. Since retropatellar peak pressure remained rather unchanged, the tibial baseplate should be placed by the surgeon looking for a maximal tibial coverage without overhang.

Analysis of death in major trauma: value of prompt post mortem computed tomography (pmCT) in comparison to office hour autopsy.

BACKGROUND: To analyze diagnostic accuracy of prompt post mortem Computed Tomography (pmCT) in determining causes of death in patients who died during trauma room management and to compare the results to gold standard autopsy during office hours. METHODS: Multiple injured patients who died during trauma room care were enrolled. PmCT was performed immediately followed by autopsy during office hours. PmCT and autopsy were analyzed primarily regarding pmCT ability to find causes of death and secondarily to define exact causes of death including accurate anatomic localizations. For the secondary analysis data was divided in group-I with equal results of pmCT and autopsy, group-II with autopsy providing superior results and group-III with pmCT providing superior information contributing to but not majorly causing death. RESULTS: Seventeen multiple trauma patients were enrolled. Since multiple trauma patients were enrolled more injuries than patients are provided. Eight patients sustained deadly head injuries (47.1%), 11 chest (64.7%), 4 skeletal system (23.5%) injuries and one patient drowned (5.8%). Primary analysis revealed in 16/17 patients (94.1%) causes of death in accordance with autopsy. Secondary analysis revealed in 9/17 cases (group-I) good agreement of autopsy and pmCT. In seven cases autopsy provided superior results (group-II) whereas in 1 case pmCT found more information (group-III). DISCUSSION: The presented work studied the diagnostic value of pmCT in defining causes of death in comparison to standard autopsy. Primary analysis revealed that in 94.1% of cases pmCT was able to define causes of death even if only indirect signs were present. Secondary analysis showed that pmCT and autopsy showed equal results regarding causes of death in 52.9%. CONCLUSIONS: PmCT is useful in traumatic death allowing for an immediate identification of causes of death and providing detailed information on bony lesions, brain injuries and gas formations. It is advisable to conduct pmCT especially in cases without consent to autopsy to gain information about possible causes of death and to rule out possible clinical errors.

Early Dynamics of Cerebrospinal CD14+ Monocytes and CD15+ Granulocytes in Patients after Severe Traumatic Brain Injury: A Cohort Study.

In traumatic brain injury (TBI) the analysis of neuroinflammatory mechanisms gained increasing interest. In this context certain immunocompetent cells might play an important role. Interestingly, in the actual literature there exist only a few studies focusing on the role of monocytes and granulocytes in TBI patients. In this regard it has recently reported that the choroid plexus represents an early, selective barrier for leukocytes after brain injury. Therefore the aim of this study was to evaluate the very early dynamics of CD14+ monocytes and CD15+ granulocyte in CSF of patients following severe TBI with regard to the integrity of the BBB. Cytometric flow analysis was performed to analyze the CD14+ monocyte and CD15+ granulocyte population in CSF of TBI patients. The ratio of CSF and serum albumin as a measure for the BBB's integrity was assessed in parallel. CSF samples of patients receiving lumbar puncture for elective surgery were obtained as controls. Overall 15 patients following severe TBI were enrolled. 10 patients were examined as controls. In patients, the monocyte population as well as the granulocyte population was significantly increased within 72 hours after TBI. The BBB's integrity did not have a significant influence on the cell count in the CSF.

Long-term functional outcome and quality of life following rotationplasty for treatment of malignant tumors.

BACKGROUND: Malignant bone tumors of the lower extremity are more frequently found in children and adolescents than in adults. Modern treatment regimens led to high limb salvage rates and offer the choice between endoprosthetic replacement and rotationplasty in many cases. Rotationplasty has proven to be an effective, highly functional option in short- and mid-term studies. Aim of this study was to assess long-term results regarding quality of life and functionality after rotationplasty and to compare the obtained results to a representative healthy German sample cohort. METHODS: In total 12 patients who underwent rotationplasty between 1991 and 2001 were enrolled in this study. After physical examination, they were evaluated regarding health related quality of life, functional outcome and psychosocial status. While quality of life was mainly assessed using the SF-36 (The Short Form (36) Health Survey v2), functional outcome was measured using the musculoskeletal tumor society score (MSTS) as well as the Tegner activity level scale. RESULTS: Average age at the time of surgery was 19 ± 10 year. and 32 ± 11 year. at the time of follow up. Mean follow-up was 14 ± 9 years. The SF-36 scores accounted for 80.4 ± 15.7 regarding physical functioning, for 78.1 ± 24.1 regarding the physical role functioning, for 74.1 ± 17.6 regarding bodily pain and for 71.8 ± 26.1 regarding general health. SF-36 score for vitality was 75.0 ± 12.8, for social functioning 98.9 ± 3.6, 88.2 ± 23.9 for emotional role functioning and 89.6 ± 10.1 for the mental health. Comparison to a representative German sample cohort revealed significantly higher patient's scores for vitality, social functioning and mental health (p < 0.05). The overall MSTS resulted in an average of 64 ± 12 % and the Tegner activity level scale accounted for 4.1 ± 0.6 pts. CONCLUSIONS: The presented long-term results indicate that rotationplasty provides a high quality of life. Patients are satisfied with a good functional outcome regarding activities of daily life and even sports.

The gel box - a testing device for the characterization of cryo- and radiofrequency lesions employed in interventional pain therapy.

BACKGROUND: Radiofrequency (RF) and cryolesioning are established methods for the therapeutic interruption of sensory nerve supply to facet joints and other painful musculoskeletal structures. The varying clinical success rates of these treatments have - among other technical issues - been attributed to the small size of these lesions combined with the limited precision in placing them. Since there are 2 different physical methods for lesioning and a wide range of probes and lesion generators available, it is likely that the lesions generated by them may be of different size. OBJECTIVES: We sought to devise an experimental setup that would allow for the reproducible and comparable evaluation of the size of cryo and RF lesions as they are being used in interventional pain therapy. METHODS: A wide range of potential media was evaluated for this purpose. Based on technical specifications, as well as on preliminary testing, a specific agar agar gel with a gel point of between 32 degrees C and 35 degrees C and a melting point of between 80 degrees C and 85 degrees C was selected for these experiments. Two different testing containers were constructed from transparent acrylic: one with a volume of 1,500 mL and the other with a volume of 12 mL. Each of them allows for the introduction of a cryo or a RF probe and 2 bundles of thermoelements into the gel volume. A water bath was used to maintain the gels at 37 degrees C and bundled, ultrafine NiCr-Ni thermoelements type K were used for measuring the isotherms. A series of RF and cryolesions were performed within these experimental setups to evaluate their suitability for the comparative testing of cryo and RF probes and generators. RESULTS: Both testing setups generated reproducible results and proved to be suitable for measuring RF as well as cryolesions. Visual observation of the lesions was better with the small testing container and rewarming / recooling after performing a cryo / RF lesion was more rapid with the smaller gel volume. LIMITATIONS: Our setup allows for the comparative measurement of RF and cryolesions, but it cannot simulate the realities within living tissue. While convection as a confounding factor was excluded by use of a gel, capillary perfusion and the specific characteristics of different tissues cannot be simulated. CONCLUSIONS: The testing setup described in this manuscript can serve for the comparative and reproducible study of RF and cryolesions that are commonly used in interventional pain therapy.