First-in-Human Experience of Mechanical Preload Control in Patients With HFpEF During Exercise.

Exercise intolerance remains one of the major factors determining quality of life in heart failure patients. In 6 patients with heart failure with preserved ejection fraction (HFpEF) undergoing invasive cardiopulmonary exercise testing, balloon inflation within the inferior vena cava (IVC) was performed during exercise to reduce and maintain pulmonary arterial (PA) pressures. Partial IVC occlusion significantly reduced PA pressures without reducing cardiac output. Partial IVC occlusion significantly reduced respiratory rate at matched levels of exercise. These findings highlight the importance of pulmonary pressures in the pathophysiology of HFpEF and suggest that therapies targeting hemodynamics may improve symptoms and exercise capacity in these patients.

Evaluation of Meniscal Tissue after Meniscal Repair Using Ultrahigh Field MRI.

The study evaluates the meniscal tissue after primary meniscal suturing using 7-Tesla (T) magnetic resonance imaging with T2* mapping at 6 and 12 months after surgery to investigate the differences between repaired meniscal tissue and healthy meniscal tissue in the medial and lateral compartment. This prospective study included 11 patients (9m/2f) with a mean age of 30.6 years (standard deviation 9.0). Patients with a meniscal tear that was treated arthroscopically with meniscus suturing, using an all-inside technique, were included. All patients and seven healthy volunteers were imaged on a 7-T whole-body system. T2* mapping of the meniscus was applied on sagittal slices. Regions-of-interest were defined manually in the red and white zone of each medial and lateral meniscus to measure T2*-values. In the medial posterior and medial anterior horn similar T2*-values were measured in the red and white zone at 6- and 12-month follow-up. Compared with the control group higher T2*-values were found in the repaired medial meniscus. After 12-months T2*-values decreased to normal values in the anterior horn and remained elevated in the posterior horn. In the red zone of the lateral posterior horn a significant decrease in the T2*-values (from 8.2 milliseconds to 5.9 milliseconds) (p = 0.04), indicates successful repair; a tendency toward a decrease in the white zone between the 6 and 12 months follow-up was observed. In the red zone of the lateral anterior horn the T2*-values decreased significantly during follow-up and in the white zone of the lateral anterior horn T2*-values were comparable. In comparison to the control group higher T2*-values were measured at 6-months; however, the T2*-values showed comparable values in the repaired lateral meniscus after 12 months. The T2* mapping results of the current study indicated a better healing response of the red zone of the lateral posterior horn compared with the medial posterior horn.

The Heart of the Issue: A Case Report of Recurrent Reversible Stress-Induced Cardiomyopathy.

BACKGROUND Stress-induced cardiomyopathy is an increasingly recognized reversible cardiovascular condition. This type of cardiomyopathy usually occurs as an isolated event, and recurrent episodes are rare. Oftentimes, the underlying trigger is not recognized or definitively diagnosed. The differential diagnosis for reversible cardiomyopathy is extensive. A supraphysiologic catecholamine release from a pheochromocytoma can precipitate a recurrent and reversible cardiomyopathy. The highly variable clinical presentation of catecholamine-producing tumors can make timely recognition very challenging. CASE REPORT We present an exceptional case of recurrent reversible stress-induced cardiomyopathy triggered by an unrecognized pheochromocytoma with unusual clinical features. Our patient presented primarily with nonspecific neurological complaints, medication intolerance, and anxiety. The underlying etiology was not discovered until her fourth presentation of stress-induced cardiomyopathy. CONCLUSIONS Pheochromocytomas can have a highly variable clinical presentation with a broad spectrum of signs and symptoms. Our case highlights the importance of performing an exhaustive search for a definitive underlying cause in the setting of recurrent "stress-induced" cardiomyopathy. Providers should consider an underlying catecholamine-producing tumor when presented with recurrent reversible cardiomyopathy. We recommend using plasma, rather than urine, catecholamine studies to screen for the presence of a pheochromocytoma.

Fractures of the Humeral Shaft with Primary Radial Nerve Palsy: Do Injury Mechanism, Fracture Type, or Treatment Influence Nerve Recovery?

Adult humeral shaft fractures are associated with primary radial nerve palsy in up to 18% of cases. The purpose of this study was to assess the influence of injury mechanism, fracture type, and treatment on nerve recovery in patients with humeral shaft fractures and primary nerve palsy. Data of fifty patients (age-43.5 ± 21.3; female: male-1:1.8) with humeral shaft fractures and concomitant grade I-II primary radial nerve palsy, who underwent either open reduction and internal fixation (ORIF) or intramedullary nailing at an academic level I trauma center between 1994 and 2013, were evaluated. Factors potentially influencing the time to onset of recovery or full nerve recovery (injury mechanism, fracture type, fracture location and treatment) were analyzed in detail. Thirty patients were treated with ORIF and twenty patients with closed unreamed intramedullary nailing of the humeral shaft, respectively. The mean time to onset of recovery was 10.5 ± 3.4 weeks (2-17 weeks). Twenty-six (52%) patients reported significant clinical improvement within the first 12 weeks. Mean time to full recovery was 26.8 ± 8.9 weeks (4-52 weeks). Twenty-five (50%) patients regained full manual strength within the first six months following the injury. Forty-nine (98%) patients regained full manual strength within the first 52 weeks. Trauma mechanism, fracture type, fracture location, and treatment modality did not influence the time to onset of nerve recovery or time to full recovery following humeral shaft fractures with grade I-II primary radial nerve palsy.

The Importance of Sex Differences on Outcome after Major Trauma: Clinical Outcome in Women Versus Men.

PURPOSE: The purpose of this study was to evaluate epidemiological and clinically relevant sex-related differences in polytraumatized patients at a Level 1 Trauma Center. METHODS: 646 adult patients (210 females and 436 males) who were classified as polytraumatized (at the point of admission) and treated at our Level I Trauma Center were reviewed and included in this study. Demographic data as well as mechanism of injury, injury severity, injury pattern, frequency of preclinical intubation, hemodynamic variables on admission, time of mechanical ventilation and of intensive care unit (ICU) treatment, as well as the incidence of acute respiratory distress syndrome (ARDS), multi organ failure (MOF), and mortality were extracted and analyzed. RESULTS: A total of 210 female and 436 male patients formed the basis of this report. Females showed a higher mean age (44.6 vs. 38.3 years; p < 0.0001) than their male counterparts. Women were more likely to be injured as passengers or by suicidal falls whereas men were more likely to suffer trauma as motorcyclists. Following ICU treatment, female patients resided significantly longer at the casualty ward than men (27.1 days vs. 20.4 days, p = 0.013) although there was no significant difference regarding injury severity, hemodynamic variables on admission, and incidence of MOF, ARDS, and mortality. CONCLUSION: The positive correlation of higher age and longer in-hospital stay in female trauma victims seems to show women at risk for a prolonged in-hospital rehabilitation time. A better understanding of the impact of major trauma in women (but also men) will be an important component of efforts to improve trauma care and long-term outcome.

Risk factors predicting prognosis and outcome of elderly patients with isolated traumatic brain injury.

BACKGROUND: Traumatic brain injury (TBI), particularly in the elderly patient population, is known to be the single largest cause of death and disability worldwide. The purpose of this retrospective study was to evaluate clinical factors predicting poor outcome with special emphasis on the impact of respiratory failure (RF) on mortality in elderly patients with isolated severe TBI. METHODS: All elderly patients (age ≥ 65 years) with isolated severe head injury, admitted to this level I trauma center, during a period of 18 years (from January 1992 to December 2010) were identified from the trauma registry. The medical records were reviewed for demographics, mechanism of injury (MOI), GCS score at admission, RF, pupillary light reflex (LR), CT findings (subdural hematoma, subarachnoid hematoma, edema, midline-shift), and whether there was conservative treatment or surgical intervention and the Glasgow Outcome Score (GOS) at hospital discharge. Stepwise logistic regression analysis was used to identify risk factors for a poor prognosis and outcome. RESULTS: The following variables influenced the mortality: respiratory failure, pupillary response, and the injury severity score (ISS). A significant increased risk of death was also found for patients with a midline shift of over 15 mm. CONCLUSIONS: The present study predicts a strong correlation between respiratory failure, pathological pupillary response, a higher ISS, and substantial midline shift with poor outcomes in elderly patients sustaining an isolated severe TBI. TRIAL REGISTRATION: Clinical trials: ID: NCT02386865 . Registered 12 March 2015-retrospectively registered.

Introduction of a new repair technique in bony avulsion of the FDP tendon: A biomechanical study.

The purpose of this study was to determine the biomechanical characteristics of an innovative surgical technique based on a tension banding principle using a suture anchor in the repair of bony avulsions of the flexor digitorum profundus tendon. After injury simulation in 45 fresh frozen distal phalanges from human cadavers, repair was performed with minifragment screws, interosseous sutures and the innovative technique (15 per group). All repairs were loaded for a total of 500 cycles. Subsequently the specimens were loaded to failure. Load at failure, load at first noteworthy displacement (>2 mm), elongation of the system, gap formation at the avulsion site, and the mechanism of failure were assessed. The new techniques' superior performance in load at failure (mean: 100.5 N), load at first noteworthy displacement (mean 77.4 N), and gap formation (median 0 mm) was statistically significant, which implies a preferable rigidity of the repair. No implant extrusion or suture rupture during cyclic loading were recorded when the new technique was applied. This innovative repair technique is superior biomechanically to other commonly used surgical tendon reattachment methods, particularly with respect to an early passive mobilisation protocol. Further, due to its subcutaneous position, reduction of complications may be achieved.

Treatment of primary total distal biceps tendon rupture using cortical button, transosseus fixation and suture anchor: A single center experience.

INTRODUCTION: There remains as of yet no consensus on the optimal treatment for total or partial distal biceps tendon repairs. As such, the purpose of this study was to assess functional outcome, the impact of complications and cost effectiveness, in patients undergoing primary distal biceps tendon repair by either cortical button (CB), transosseous suture (TO) or suture anchor (SA). HYPOTHESIS: There is no difference in functional outcome and cost effectiveness, in patients undergoing distal biceps tendon repair. MATERIAL & METHODS: A retrospective analysis was performed on prospectively collected data from 47 consecutive patients treated for total or partial distal biceps tendon rupture. Functional outcome was assessed by the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Strength measurements (e.g., flexion, supination and pronation) in the operated and non-operated extremities were recorded with the use of a dynamometer. Furthermore, all complications, as well as their impact on functional outcome and costs for surgical intervention were evaluated. RESULTS: Minimum follow-up time was 35 weeks, average 46.3±13.8 weeks. The overall DASH score was 7.9±4.7. There were no differences in functional outcome (i.e., DASH score) between CB, TO, SA (p=0.32), nor were there differences in regards to strength (supination, flexion and pronation) (p=0.60) and ability to return to work & sports activity. The total complication rate was 21.6%. Complications had a significant impact on functional outcome (p=0.003). Re-rupture occurred 2 times in the SA group. In 5 patients, revisional surgery had to be performed. The shortest operation times and the lowest material costs were observed in the TO group (p=0.004). DISCUSSION: All reported fixation methods for total or partial distal biceps tendon rupture yielded good functional results. However, transosseous suture fixation for total distal biceps tendon rupture, performed through a double incision approach by an experienced surgeon, seems to be a simple, inexpensive and successful method, offering satisfying clinical results. LEVEL OF EVIDENCE: IV, a retrospective, comparative study.

Damage control surgery - experiences from a level I trauma center.

BACKGROUND: There is still no evidence in literature for damage control orthopaedics (DCO), early total care (ETC) or using external fixation solely in fractures of the long bones in multi-system-trauma. The aim of this study was to determine parameters influencing the choice of treatment in clinical routine (DCO, ETC, or EF) in femoral or tibial shaft fractures in combination with multi-system-trauma, severe soft tissue damage or both. METHODS: Data of 236 patients with 280 fractures of long bones of the lower extremities treated at a level I trauma center were analysed. Clinical parameters on arrival (age, sex [m/f], ISS, fracture site [femur/tibia], soft tissue damage [closed or open fractures according to the Gustilo-Anderson classification], pulmonary injury [yes/no]) were collected and analysed whether they influence the choice of upcoming treatment (DCO/ETC/EF). RESULTS: Our findings showed that high ISS and severe soft tissue damage (grade III) significantly correlated with DCO. High ISS, old age, female sex and fracture site (tibia) correlated with EF. This group of sole use of external fixation had highest rate of complications, 69% were associated with at least one complication. CONCLUSION: Severely injured patients are treated significantly more often with DCO or EF. The presence of higher ISS (≥16) and of type III open fractures increased the use of DCO. However, ISS, fracture-site, patient's age, type III open fractures or sex (female) increased the use of EF compared to ETC.

Osteoporosis associated vertebral fractures-Health economic implications.

INTRODUCTION: Osteoporosis-associated vertebral fractures represent an increasing clinical and public health problem, one with important socioeconomic effects within western countries. The purpose of this study was to analyse demographic, medical, gender and socioeconomic aspects of osteoporotic vertebral fractures of the thoracic or lumbar spine over a period of at least 10-years. MATERIAL AND METHODS: Included for analysis were 694 patients who had suffered a vertebral fracture due to primary or secondary osteoporosis, and who were treated at our Level-I trauma center between 2000 and 2013. Collected data included demographic, medical and socioeconomic aspects. RESULTS: Clinical results revealed that 669 patients (96%) were treated conservatively. The remaining 25 patients (4%) underwent surgical therapy: 4 were treated with vertebroplasty, 15 with kyphoplasty and 6 patients with posterior stabilization. The mean age was 75.6 years (range: 50-98), with the vast majority of patients being female (n = 515). A statistically significant demographic difference (i.e., increase) in fractures was observed between the age groups 60-69 and 70-79 (p = 0.041). Concerning socioeconomic aspects, statistical analysis showed that the number of sick leaves and the need for professional domestic help was higher in female patients. Concerning treatment costs, statistical analysis did not reveal any significant differences between female and male patients. CONCLUSION: Significant gender differences-to the detriment of the female population-could be demonstrated within this study. A regrettably low rate of adequate treatment after diagnosis of osteoporosis and its associated fractures-specifically relating to primary and secondary prevention-could also be identified. To prospectively avoid complications and consequential cost increases, more awareness of the necessity for prevention, early diagnosis and adequate treatment of osteoporosis and its related fractures should be considered.

Treatment options and outcome after bony avulsion of the flexor digitorum profundus tendon: a review of 29 cases.

INTRODUCTION: The objective of this retrospective review was to evaluate the functional and esthetic outcomes in patients with non- or minimally (<2 mm), and severely (>2 mm) displaced bony avulsions of the flexor digitorum profundus (FDP) tendon. MATERIALS AND METHODS: Between 1996 and 2010, 29 patients with a bony avulsion of the FDP tendon were treated. The displacement magnitude of the avulsed fragment determined, whether conservative or surgical treatment was performed. Persisting functional deficit, radiological findings, remaining disabilities using the Disability of the Arm, Shoulder, and Hand (DASH) score, as well as treatment-related deformities and complications were evaluated retrospectively and at a mean follow-up of 7 years. RESULTS: In 16 patients, conservative therapy by initial static splinting due to a fragment displacement of <2 mm was conducted. These patients reported no functional impairment at follow-up. In 13 cases, major displacement (>2 mm) of the bony fragment led to an open reconstruction of the avulsion injury either by screw fixation or a Lengemann pull-out wire. In a majority, an extension deficit in the DIP joint and a decrease of tip pinch strength by 25% was present at follow-up. In five patients, peri- or short-term postoperative complications occurred and in five, a nail deformity remained. DASH score revealed satisfying results after both therapeutic approaches. CONCLUSIONS: Conservative treatment in non- or minimally displaced avulsions leads to satisfying functional results. Patients receiving surgery after major fragment displacement need to be aware of a possible impaired ROM at the DIP joint. The use of the Lengemann pull-out wire may place patients at an increased complication risk and frequently induces nail deformities. LEVEL OF EVIDENCE: Therapeutic, level IV.

Retrospective case series with one year follow-up after radial nerve palsy associated with humeral fractures.

PURPOSE: The purpose of this study was to assess recovery and clinical outcome in patients with primary or secondary radial nerve palsy following humeral shaft fracture. METHODS: We retrospectively assessed 102 patients (45 female and 57 male) with humeral shaft fracture and concomitant radial nerve palsy, who were followed up for 12 months. Patients were divided into two groups with primary or secondary radial nerve palsy depending on the onset. Muscle function was measured according to Daniels classification and degree of nerve damage was assessed by the Sunderland classification. RESULTS: The average time for onset of recovery after primary RNP was 10.5 ± 3.31 weeks, in the case of secondary RNP it was 8.9 ± 7.98 weeks (p < 0.05). Full recovery or significant improvement was achieved with average of 26.7 ± 8.86 weeks and 23.9 ± 6.04 weeks respectively (p < 0.05). Trauma mechanism and type of treatment had no significant influence on time of onset of recovery or time to full recovery (p < 0.904). CONCLUSION: Secondary RNP shows tendency for earlier recovery and is more commonly associated with ORIF.

Management and Outcome of Dens Fracture Nonunions in Geriatric Patients.

BACKGROUND: Dens fractures are known to have high rates of pseudarthrosis. The aim of this study was to define clinical and radiographic long-term outcomes, specifically in relation to osseous union, cervical spine movement, neurological sequelae, and quality of life, in a geriatric cohort (sixty-five years of age or older) treated operatively or nonoperatively for a dens fracture nonunion. METHODS: Forty-four patients (twenty-eight women and sixteen men; average age, seventy-two years) met the inclusion criteria and were enrolled in this study. Sixteen patients (36%) underwent operative stabilization with posterior cervical arthrodesis, and twenty-eight (64%) were treated nonoperatively with a predefined protocol. All patients had a post-treatment follow-up period of at least five years. RESULTS: Radiographic evaluation showed osseous union at the site of the C1-C2 arthrodesis in all sixteen patients who had undergone surgical treatment. Clinical follow-up revealed that fourteen had satisfactory results following postoperative rehabilitation. In contrast, radiographic evaluation of the twenty-eight nonoperatively treated patients showed persistence of the pseudarthrosis of the dens in twenty-six and osseous union of the dens in two. All twenty-eight patients (100%) had a satisfactory clinical outcome. CONCLUSIONS: C1-C2 arthrodesis was a reliable treatment option for dens fracture nonunions that were unstable, those associated with neurological symptoms, and those causing persistent pain. Clinical and radiographic monitoring was an acceptable nonoperative treatment option but was associated with a very low rate of osseous union of the dens.

Incidence, characteristics, and long-term follow-up of sternoclavicular injuries: An epidemiologic analysis of 92 cases.

BACKGROUND: The majority of published studies concerning sternoclavicular injuries are case series or systematic reviews. Prospective studies on the subject are hindered by the low incidence of these lesions. The aims of the present study were to provide an overview of this rare entity compared with those described in the literature and to present the long-term clinical outcome. METHODS: We performed a retrospective data analysis of all sternoclavicular injuries treated at a single Level I trauma center from 1992 to 2011. Long-term clinical outcome was assessed using the ASES [American Shoulder and Elbow Surgeons], SST [Simple Shoulder Test], UCLA [University of California-Los Angeles] Shoulder Scale, and VAS [Visual Analog Scale] at latest follow-up. RESULTS: We detected an overall incidence of 0.9% of sternoclavicular injuries related to all shoulder-girdle lesions. Ninety-two patients (52 males and 40 females) with a mean (SD) age of 39.2 (19.5) years (median, 41 years; range, 4-92 years) were included in this study. The main trauma mechanism was fall. Classification was performed according to Allman, the time point of treatment after initial trauma, and the direction of the dislocation. Nine patients of the 15 Grade III lesions were treated conservatively by closed reduction and immobilization, while four patients were treated surgically by open reduction and internal fixation. Forty-nine percent of the patients were available for long-term follow-up at a median of 11.3 years (range, 5.3-22.6 years) with a mean ASES score of 96.21, SST score of 11.69, UCLA score of 31.89, and VAS score of 0.47. CONCLUSION: We found an overall incidence of 0.9% of sternoclavicular joint injuries related to all shoulder-girdle lesions and of 1.1% related to all dislocations, which is slightly lower compared with those described in the literature. Furthermore, we observed a high number of physeal sternoclavicular injuries with a percentage of 16% and overall good-to-excellent results at long-term follow-up. LEVEL OF EVIDENCE: Epidemiologic study, level IV.

The "Labral Bridge": A Novel Technique for Arthroscopic Anatomic Knotless Bankart Repair.

Arthroscopic Bankart repair with suture anchors is widely considered a mainstay for surgical treatment of anterior shoulder instability after recurrent anterior shoulder dislocations. Traditionally, the displaced capsulolabral complex is restored and firmly attached to the glenoid by placing multiple suture anchors individually from a 5- to 3-o'clock position. A variety of different techniques using different anchor designs and materials have been described. Knotless anchors are widely used nowadays for shoulder instability repair, providing a fast and secure way of labral fixation with favorable long-term outcomes. However, these techniques result in a concentrated point load of the reduced labrum to the glenoid at each suture anchor. We describe a technique, developed by the first author, using a 1.5-mm LabralTape (Arthrex, Naples, FL) in combination with knotless suture anchors (3.5-mm PEEK [polyether ether ketone] PushLock anchors; Arthrex), for hybrid fixation of the labrum. The LabralTape is used to secure the torn labrum to the glenoid between each suture anchor, thus potentially providing a more even pressure distribution.

Characteristics and clinical outcome in patients after popliteal artery injury.

BACKGROUND: The treatment of popliteal artery injury (PAI) caused by blunt or penetrating mechanism is demanding. Concomitant injuries and prolonged ischemia are the major causes of lower extremity morbidity and poor rates of limb salvage. This study assessed the amputation rate and, subsequently, the therapeutic management and clinical outcomes regarding the affect of concomitant injuries among patients with PAI in a setting of central European trauma care. METHODS: Sixty-four patients (20 female and 44 male), with an average age of 44 years (range, 17-79 years) at the time of injury, were evaluated for clinical characteristics, concomitant injuries, complications, amputation rates, and functional outcome after traumatic PAI. The mechanism of injury was blunt trauma in 35 patients (54.7%) and penetrating trauma in 29 (45.3%). The Mangled Extremity Severity Score and the Injury Severity Score were assessed initially and the modified Functional Independence Measure (FIM) Score at 12 months after the primary surgery. RESULTS: Thirty patients (47%) returned to their normal activity level within 1 year after trauma, and 16 (25%) were limited in their daily activity or suffered from chronic pain symptoms. Within the blunt trauma group 26 of 35 patients (74%) sustained severe concomitant injuries, whereas two of 29 patients (7%) in the penetrating group showed severe concomitant injuries (P < .046). Eleven patients (17%) had to undergo revision surgery due to their associated injuries. The median modified FIM score was 10.3, whereas patients with blunt trauma had significantly lower FIM score (P < .0082). The median Mangled Extremity Severity Score was 6 points (range, 6-16 points). Primary or secondary amputation was required in 18 patients (28%) due to failure of revascularization. Patients who sustained blunt trauma had significantly higher amputation rates than those with penetrating injuries (P < .035). CONCLUSIONS: Clinical outcome and limb salvage of patients with PAI were influenced by the mechanism of trauma, concomitant injuries, prolonged ischemia time, and the type of surgical procedure. Patients after blunt trauma had a higher incidence of concomitant injuries, and (comminuted) fractures or knee dislocations and severe soft tissue damage had the highest effect on the amputation rate.

Limb salvage and functional outcomes among patients with traumatic popliteal artery injury: a review of 64 cases.

BACKGROUND: Traumatic popliteal arterial injury carries the greatest risk of limb loss among all peripheral vascular injuries and is associated with high levels of morbidity and worse functional outcomes. The purpose of this study is to analyse the functional outcome among patients with popliteal artery injury (PAI) due to blunt and penetrating trauma and identify influencing factors. METHODS: We critically reviewed 64 cases of PAI due to blunt and penetrating trauma treated at our institution over a 20-year period. We evaluated the influence of parameters, such as patient demographics, injury mechanism, initial ISS and performed interventions, on limb amputation rates and functional outcomes. Functional outcome was examined within the 12-months follow-up using the Functional Independence Measure (FIM) score for feeding, expression and locomotion. FIM scores for each category ranged from 1 (full assistance required) to 4 (fully independent), with a maximum total FIM score of 12 representing full independence. RESULTS: The mechanism of injury was blunt in 55 % and penetrating in 45 % of the patients. The overall amputation rate in our series was 28 %. Out of these, 83.3 % of all performed amputations in our series were due to blunt trauma and 88.6 % of all blunt trauma patients were severely injured (ISS > 9) or polytraumatized (ISS > 15). Blunt mechanism of injury has also shown a negative effect on the functional outcome. Analysis of the 1-year clinical follow-up showed that 30 patients (65.3 %) returned to their normal activity level within 1 year after trauma. A total of 16 patients (34.7 %) were recorded to have limited activity levels, 76.5 % of them sustained a blunt trauma. Using the FIM score to quantify the level of disability, we detected significantly worse results in both FIM total (8.8 vs. 10.4) and FIM locomotion score (3.1 vs. 2.7) following blunt trauma. CONCLUSION: The main findings of the present study were that PAI due to blunt trauma is associated with a high percentage of severely injured or even polytraumatized patients. Amputation rates following blunt trauma were significantly higher compared to penetrating trauma. Functional independence measurement, assessed 12 months after injury, also showed significantly worse results in both FIM total and FIM locomotion score after blunt trauma. Other factors that seem to have a negative influence on the outcome in terms of amputation rates after PAI are patient's age, presence of associated injuries and prolonged lower extremity ischemia.

Injury severity in ice skating: an epidemiologic analysis using a standardised injury classification system.

PURPOSE: Although injuries sustained during ice skating have been reported to be more serious than other forms of skating, the potential injury risks are often underestimated by skating participants. The purpose of this study was to give a descriptive overview of injury patterns occurring during ice skating. Special emphasis was put on injury severity by using a standardised injury classification system. METHODS: Over a six month period, all patients treated with ice-skating-related injuries at Europe's largest hospital were included. Patient demographics were collected and all injuries categorised according to the Abbreviated Injury Scale (AIS) 2005. A descriptive statistic and logistic regression analysis was performed. RESULTS: Three hundred and forty-one patients (134 M, 207 F) were included in this study. Statistical analysis revealed that age had a significant influence on injury severity. People > 50 years had a higher risk of sustaining a more severe injury according to the AIS compared with younger skaters. Furthermore, the risk of head injury was significantly lower for people aged between 18 and 50 years than for people < 18 years (p = 0.0007) and significantly higher for people > 50 years than for people aged between 18 and 50 years (p = 0.04). CONCLUSION: The severity of ice-skating injuries is associated with the patient's age, showing more severe injuries in older patients. Awareness should be raised among the public and physicians about the risks associated with this activity in order to promote further educational interventions and the use of protective gear.

Primary cementless hip arthroplasty as a potential risk factor for non-union after long-stem revision arthroplasty in periprosthetic femoral fractures.

PURPOSE: In case of stem loosening in periprosthetic femoral fractures (PPFF), revision arthroplasty should be performed. The first hypothesis of this study was that advanced patient age and female gender shows higher non-union rates. The second hypothesis was that primary cementless arthroplasty is associated with a higher non-union rate compared to cemented primary hip arthroplasty. METHODS: All PPFF occurring between January 2000 and June 2010 treated by revision arthroplasty were included. Multiple regression analysis was performed to identify independent variables leading to fracture non-union. RESULTS: Eighty one patients (78 % female) met the inclusion criteria. In 20/81 patients (24.7 %) no adequate fracture healing could be determined on radiographs 12 months after revision surgery. Although age and female gender showed a positive correlation with bony non-union after PPFF as expected, the p-values were not statistically significant. Multiple regression analysis revealed primary cementless prosthesis (p = 0.001) to be the only independent variable associated with non-union. CONCLUSION: Non-cemented primary prosthesis might be a negative predicting factor for the development of non-union after long-stem revision arthroplasty in PPFF. We therefore recommend the thorough debridement of pannus tissue thus inducing bone healing before the implantation of revision prostheses.

Primary anterior cruciate ligament reconstruction in athletes: a 5-year follow up comparing patellar tendon versus hamstring tendon autograft.

INTRODUCTION: ACL reconstruction with quadruple hamstring graft (HT) as well as bone-patellar tendon-bone autograft (PT) is a frequent procedure in athletes after ACL rupture. Both techniques are reported to provide for satisfying results but only few articles compare both techniques. MATERIAL AND METHODS: Prospective evaluation was performed on 96 patients with isolated ACL rupture undergoing reconstruction with a HT or PT autograft by a single surgeon at our institution. Long time follow-up after five years included the IKDC and KOOS evaluation form as well as clinical assessment (ROM, Lachmann testing, KT-2000). RESULTS: Comparing both methods revealed no significant differences regarding IKDC and KOOS. The KT-2000 arthrometer testing showed a slightly increased mean laxity in the HT group. There were no differences regarding harvest side symptoms comparing HT and PT as well as one and two incision technique. Kneeling pain was significantly less common after HT autograft. HT as well as PT autograft achieve equally good clinical results in athletes at five year follow-up with no significant difference regarding knee stability. Although no difference concerning the harvest site was identified, HT seems to be favorable for patients who work in a kneeling position.