The effect of frontal trauma on the edentulous mandible with four different interforaminal implant-prosthodontic anchoring configurations. A 3D finite element analysis.

PURPOSE: The present three-dimensional (3D) finite element analysis (FEA) was aimed to assess the biomechanical effects and fracture risks of four different interforaminal implant-prosthodontic anchoring configurations exposed to frontal trauma. MATERIAL AND METHODS: A symphyseal frontal trauma of 1 MPa was applied to four dental implant models with different configurations (two unsplinted interforaminal implants [2IF-U], two splinted interforaminal implants [2IF-S], four unsplinted interforaminal implants[ 4IF-U], four splinted interforaminal implants [4IF-S]. By using a 3D-FEA analysis the effective cortical bone stress values were evaluated in four defined regions of interest (ROI) (ROI 1: symphyseal area; ROI 2: preforaminal area; ROI 3: mental foraminal area; and ROI 4: condylar neck) followed by a subsequent intermodel comparison. RESULTS: In all models the frontal traumatic force application revealed the highest stress values in the condylar neck region. In both models with a four-implant configuration (4IF-U, 4IF-S), the stress values in the median mandibular body (ROI 1) and in the condylar neck region (ROI 4) were significantly reduced (P <0.01) compared with the two-implant models (2IF-U, 2IF-S). However, in ROI 1, the model with four splinted implants (4IF-S) showed significantly (P < 0.01) reduced stress values compared to the unsplinted model (4IF-U). In addition, all models showed increased stress patterns in the area adjacent to the posterior implants, which is represented by increased stress values for both 2IF-U and 2IF-S in the preforaminal area (ROI 3) and for the four implant-based models (4IF-U, 4IF-S) in the mental foraminal area. CONCLUSION: The configuration of four splinted interforaminal implants showed the most beneficial distribution of stress pattern representing reduced stress distribution and associated reduced fracture risk in anterior symphysis, condylar neck and preforaminal region.

Clinical, radiographic, and histological/histomorphometric analysis of maxillary sinus grafting with deproteinized porcine or bovine bone mineral: A randomized clinical trial.

OBJECTIVE: The present study aimed to compare histomorphometrically evaluated new bone formation, radiographically measured graft stability, and clinical implant outcome between maxillary sinus grafting with either deproteinized porcine bone mineral (DPBM) or deproteinized bovine bone mineral (DBBM). MATERIALS AND METHODS: Thirty maxillary sinuses were initially included and randomly assigned to the test group (TG; DPBM, n = 15) or control group (CG; DBBM, n = 15). After a healing period (6 months), axially retrieved bone biopsies of the molar region were used for histological/histomorphometric analysis of new bone formations. Additionally, radiographically measured graft stability and clinical implant outcome were assessed. RESULTS: Twenty-three sinus sites with 10 sinuses of the TG and 13 of the CG were ultimately available for data and statistical analysis. In the TG, a slightly, but yet significantly (p = .040) higher proportion of new bone formation (TG: 27.7 ± 5.6% vs. CG: 22.9 ± 5.1%) and a lesser (p = .019) amount of connective (non-mineralized) tissue (TG: 47.5 ± 9.5% vs. CG: 56.1 ± 9.5%) was found than in the CG. However, both xenografts showed comparable (n.s.) residual bone graft (TG: 23.7 ± 7.2% vs. CG: 21.1 ± 9.85.6%), bone-to-graft contacts (TG: 26.2 ± 9.8% vs. CG: 30.8 ± 13.8%), similar graft height reduction over time (TG: 12.9 ± 6.7% CG: 12.4 ± 5.8%) and implant survival/success rate (100%). At the 3-year post-loading evaluation, the peri-implant marginal bone loss (TG: 0.52 ± 0.19 mm; CG: 0.48 ± 0.15 mm) and the peri-implant health conditions (TG: 87.5%/CG: 81.2%) did not differ between implants inserted in both xenografts used. CONCLUSIONS: The use of DPBM or DBBM for maxillary sinus augmentation is associated with comparable bone formation providing stable graft dimension combined with healthy peri-implant conditions.

Conditioning of microvascular venous flaps in rats.

Venous-only perfusion flaps have not been used widely because of the associated high failure rate. Tissue conditioning offers a broad scope of techniques that can be applied pre-, peri-, or postoperatively to promote the adaptation of the affected tissue to any subsequent stress. This study aimed to assess the survival rates associated with a pure venous perfusion flap and investigate whether the timing of the vascular conditioning can affect free flap survival. Forty-four rats were included in the experiment. Group I underwent veno-arterial anastomoses with epigastric graft with pure venous perfusion without tissue conditioning. Groups II and III were pretreated for 7 or 14 days with ischemic conditioning. These groups were compared with a control group (group IV) of conventionally perfused flaps. After the initial surgery, all flaps were assessed clinically, photometrically, and by indocyanine green videoangiography. The flap success rates were 0% in group I, 49.97% ± 24.34% in group II, and 64.95% ± 20.36% in group III. The control group showed an overall survival of 89.3% ± 6.51%. With suitable conditioning, pure venous blood supply can provide adequate perfusion in the rat epigastric flap model. The timing of vascular conditioning appears to be critical for flap survival.

Platelet-rich fibrin vs. buccal advancement flap for closure of oroantral communications: a prospective clinical study.

OBJECTIVES: The primary aim was to evaluate the success of the defect closure (tight or open) of oroantral communications (OAC) after treatment with platelet-rich fibrin (PRF) clots or a buccal advancement flap (BAF). Secondary outcome measurements were the evaluation of the wound healing, the displacement of the mucogingival border (MGB), and the pain level. MATERIAL AND METHODS: Fifty eligible patients with an OAC defect larger than 3 mm were randomly assigned to either PRF (test group, n = 25) or BAF (control group, n = 25) for defect closure. In a prospective follow-up program of 21 days, the defect closure healing process, the wound healing course using Landry's wound healing index (score: 0-5), the displacement of the MGB, and the postoperative pain score were evaluated. RESULTS: Five patients in each group were lost to follow-up resulting in 40 patients (20 in each group) for continuous evaluation. On postoperative day 21 (study endpoint), no difference regarding success rate (defined as closure of OAC) was noticed between the test (90%; 18/20) and control group (90%; 18/20). A univariate analysis showed significant differences for age and defect size/height for the use of PRF between successful-tight and open-failed defect healing. At the final evaluation, a significantly (p = 0.005) better wound healing score, a lower displacement of the MGB as well as lower pain-score were seen for the use of PRF. CONCLUSIONS: Based on the findings of the current study, the use of platelet-rich fibrin represents a reliable and successful method for closure of oroantral communications. The use of PRF clots for defect filling is associated with lowered pain levels and less displacement of the mucogingival border. CLINICAL RELEVANCE: The defect size should be taken into account when choosing the number and size of PRF plugs.

Biopsies of osseous jaw lesions using 3D-printed surgical guides: a clinical study.

BACKGROUND: Bone biopsies are often necessary to make a diagnosis in the case of irregular bone structures of the jaw. A 3D-printed surgical guide may be a helpful tool for enhancing the accuracy of the biopsy and for ensuring that the tissue of interest is precisely removed for examination. This study was conducted to compare the accuracy of biopsies performed with 3D-printed surgical guides to that of free-handed biopsies. METHODS: Computed tomography scans were performed on patients with bony lesions of the lower jaw. Surgical guides were planned via computer-aided design and manufactured by a 3D-printer. Biopsies were performed with the surgical guides. Bone models of the lower jaw with geometries identical to the patients' lower jaws were produced using a 3D-printer. The jaw models were fitted into a phantom head model and free-handed biopsies were taken as controls. The accuracy of the biopsies was evaluated by comparing the parameters for the axis, angle and depth of the biopsies to the planned parameters. RESULTS: Eight patients were included. The mean deviation between the biopsy axes was significantly lower in guided procedures than in free-handed biopsies (1.4 mm ± 0.9 mm; 3.6 mm ± 1.0 mm; p = 0.0005). The mean biopsy angle deviation was also significantly lower in guided biopsies than in free-handed biopsies (6.8° ± 4.0; 15.4° ± 3.6; p = 0.0005). The biopsy depth showed no significant difference between the guided and the free-handed biopsies. CONCLUSIONS: Computer-guided biopsies allow significantly higher accuracy than free-handed procedures.

The influence of different forms of sinus membrane perforation on the prevalence of postoperative complications in lateral window sinus floor elevation: A retrospective study.

BACKGROUND: Maxillary sinus membrane perforation (SMP) during lateral window sinus floor elevation (SFE) might be associated with postoperative complications (PC). OBJECTIVES: To evaluate the prevalence of PC and clinical implant outcome for different forms of SMP with lateral window SFE. MATERIAL AND METHODS: The prevalence of PC such as maxillary sinusitis, graft necrosis and wound infection was retrospectively evaluated for 434 lateral window SFE (334 patients) with 331 SFE (241 patients) without and 103 SFE (93 patients) with SMP. SMP was additionally classified into four subgroups regarding to membrane perforation size (small-moderate [<10 mm] vs. large [>10 mm]) and membrane biotype ([BT] thin vs. thick). Additionally, patient- and surgery-related risk factors affecting PC and the 1-year implant survival rate were evaluated for SFE without and with SMP and subgroups. RESULTS: A significantly higher prevalence including significant odds ratios of PC such as maxillary sinusitis (10/103 [9.7%] vs. 4/331 [1.2%]; p < 0.021; OR: 8.85; p < 0.021) and graft necrosis (7/103[6.8%] vs. 1/103[0.3%]; p < 0.017; OR:7.43; p < 0.017) was found for SFE with than without SMP. The SMP subgroup with large size and thin BT involved significantly (p < 0.005) more PC (15/20[75%]) than all other SMP subgroups (5/20[25%]). For the risk factors evaluated the univariate analysis demonstrated differences of PC for the presence versus absence of SMP (p < 0.001) and for thin versus thick sinus mucosa (p < 0.038; p < 0.006) but not for sex, smoking, sinus septa and surgical stage. In the multivariate risk factors analysis, PC were significantly related to risk factors such as large size with thin BT (OR:18.049; p < 0.007). The 1-year implant survival rate did not differ between SFE without (99.5%) and with SMP (99.1%), regardless of successfully repaired subtype of SMP. CONCLUSION: The synopsis of perforation size and membrane biotype is crucial in differentiating different forms of SMP assessing and anticipating different prevalences of PC in lateral window SFE.

Prevalence, risk factors, and repair mechanism of different forms of sinus membrane perforations in lateral window sinus lift procedure: A retrospective cohort study.

OBJECTIVES: To evaluate prevalences, affecting risk factors and efforts for repair mechanism for different forms of sinus membrane perforations (SMP) during sinus floor elevation (SFE) using the lateral window technique (LWT). MATERIAL AND METHODS: For 334/434 patients, SFE undergoing LWT prevalence of SMP was retrospectively evaluated including a subselection based on membrane perforation size (<10 mm: small-moderate/≥10 mm: large) and biotype (BT; thick BT/thin BT) into four subgroups (SMP1: thick BT/small-moderate; SMP2: thin BT/small-moderate; SMP3: thick BT/large; SMP4: thin BT/large). For the various subgroups, patient- and surgery-related/anatomic risk factors affecting SMP were evaluated and the scope of sinus membrane repair (SSMR) mechanisms rated with 1 (easy) to 5 (complex) was compared. RESULTS: For 103/434 SMP (27.6%) in 93/334 patients (30.8%) the prevalence of various forms of SMP differed significantly (p < 0.001) among the four subgroups. SMP4 with a prevalence of 45.6% (n = 47) was the most frequent type, while SMP3 had low prevalence with 4.85% (n = 5). Small/moderate SMPs with thick (SMP1: n = 26) or thin BT (SMP2: n = 23) were seen in 26.2% and 23.3%, respectively. Univariate analysis showed significant differences between subgroups with large perforations (SMP3/SMP4) and those with small/moderate perforations (SMP1/SMP2) regarding anatomic risk factors such as residual ridge height (p = 0.023) and history of previous oral surgical interventions (OSI; p = 0.026). Most evidently, multivariate analysis showed that induction of large SMP with thin biotype (SMP4) was significantly affected by the presence of sinus septa (p < 0.022, OR: 2.415), reduced residual ridge height (p < 0.001, OR: 1.842), and previous OSI (p < 0.001, OR: 4.545). SSMR differed significantly (p < 0.001) between SMP4 (4.62 ± 0.49) and the subgroups SMP1 (1.11 ± 0.32), SMP2 (1.08 ± 028), and SMP3 (2.2 ± 0.55). CONCLUSION: The most frequently found type of SMP had characteristics of thin biotype and large size associated with risk factors such as sinus septa, reduced residual ridge, and previous surgical interventions and required challenging repair mechanisms assessing clinical impact.

In-house 3D-printed surgical guides for osseous lesions of the lower jaw: an experimental study.

BACKGROUND: The accuracy of computer-assisted biopsies at the lower jaw was compared to the accuracy of freehand biopsies. METHODS: Patients with a bony lesion of the lower jaw with an indication for biopsy were prospectively enrolled. Two customized bone models per patient were produced using a 3D printer. The models of the lower jaw were fitted into a phantom head model to simulate operation room conditions. Biopsies for the study group were taken by means of surgical guides and freehand biopsies were performed for the control group. RESULTS: The deviation of the biopsy axes from the planning was significantly less when using templates. It turned out to be 1.3 ± 0.6 mm for the biopsies with a surgical guide and 3.9 ± 1.1 mm for the freehand biopsies. CONCLUSIONS: Surgical guides allow significantly higher accuracy of biopsies. The preliminary results are promising, but clinical evaluation is necessary.

Closure of the radial forearm free flap donor site with split-thickness skin graft or amniotic membrane: A prospective randomized clinical study.

The purpose of this study was to compare the clinical, aesthetic, and functional outcomes between amniotic membrane (test group) and split-thickness skin grafts (control group) used for radial forearm free flap defect closure. The primary outcome measurement for both groups was assessment of the defect closure healing process. In addition, aesthetic (Vancouver Scar Scale) and functional outcomes (skin sensitivity, hand/wrist functionality, grip strength) were evaluated. Fifty eligible patients with radial forearm free flap donor site defects were randomly assigned to two groups receiving either amniotic membrane (test group; n = 25) or split-thickness skin graft (control group; n = 25) for defect covering. Forty-seven of the 50 patients (n = 47) were able to be followed up for 6 months and showed a significantly longer healing process (p < 0.001) with amniotic membrane (64.5 ± 38.4 days; n = 24) than with split-thickness skin grafts (29.2 ± 8.9 days; n = 23); however, there were no differences in the prevalence of healing defects/dehiscence and/or wound infections. Forty-two of the 47 patients (21 in each group) were able to be continually followed up for 12 months, and showed no differences in terms of clinical outcome as well as the subjective and objective aesthetic and functional results evaluated. With regard to the clinical, aesthetic, and functional outcomes evaluated for radial forearm free flap defects, coverage with amniotic membrane offers an excellent alternative treatment approach, avoiding secondary induced donor site morbidity.

Edentulous mandible with four splinted interforaminal implants exposed to three different situations of trauma: A preliminary three-dimensional finite element analysis.

BACKGROUND/AIM: An increasing number of elderly patients with implant-prosthodontic rehabilitation of the edentulous mandible frequently show increased life activity, and consequently, a greater number of aged patients is at risk for maxillofacial trauma. The aim of this 3-dimensional (3D) finite element analysis (FEA) was to evaluate the biomechanical effects of the edentulous mandible (EM) with and without four splinted interforaminal implants exposed to three different trauma applications including assessment of different mandibular fracture risk areas. MATERIALS AND METHODS: In a 3D-FEA study design, EM with and without four splinted interforaminal implants were exposed to the application of 1000 N at the symphyseal, parasymphyseal, and mandibular angle region. On four pre-defined superficial cortical mandibular areas (symphysis region, mental foramen region, angle of mandible, and mandibular neck) representing regions of interest (ROI), the von Mises stresses were measured for the three trauma applications. For all ROIs, stress values were evaluated and compared for the different force application sites as well as between EM models with and without interforaminal implants. RESULTS: For EM with and without four splinted interformaninal implants, all traumatic loads generated the highest stress levels at the mandibular neck region. However, in the EM with four splinted interforaminal implants, an anterior symphyseal force application generated significantly (P < .01) increased stress values in the parasymphyseal (mental foramen) region than in EM without implants. For force applications at the parasymphaseal region (mental foramen) and at the angle of the mandible elevated, von Mises stress values were noted directly at the application sites without difference between edentulous mandibles with and without four interforaminal implants. CONCLUSION: In an edentulous mandible model with four splinted interforaminal implants, the condylar neck and the mental foramen represent the predilectional risk areas for mandibular fracture for both anterior symphyseal and lateral parasymphyseal force application.

Use of amniotic membrane for radial forearm free flap donor site coverage: clinical, functional and cosmetic outcomes.

OBJECTIVE: To evaluate the clinical, functional and aesthetic outcomes for radial forearm free flap (RFFF) donor sites covered with amniotic membrane (AM). MATERIAL AND METHODS: The healing process of patients with RFFF donor sites covered with AM was prospectively followed for 1 year. Additionally at the 12-month evaluation, objective scoring systems were used to assess the aesthetic (Vancouver scar scale, VSS: range 1-13) and functional outcome (skin sensibility, hand/wrist functionality [goniometer], grip strength [score 1 = excellent, 5 = poor]). By using a subjective rating system (score 1 = excellent, 5 = poor), the patient-reported aesthetic and functionality outcome was correlated with objective data analysis. RESULTS: Twenty-one out of 23 patients were followed for 12 months (dropout: 2 patients at 3 months). In 17/23 (73.9%) patients RFFF defect covered with AM showed an uneventful healing period (< 3 months). Prolonged healing periods (> 3 months < 6) for 6 patients (26.1%) were attributed to wound infections (4×), seroma (1×) and inflammation (1×). At the 1-year evaluation, there was a significant (p < 0.01) correlation between subjective (2.0 ± 0.71) and objective aesthetic scores (VVS 3.74 ± 2.18), and a successful grip strength (score 1.67 ± 0.86); however, thumb hyposensibility in 76.2% was seen. A high body mass index (BMI) was in conjunction with a negative (p = 0.012) and the use of antihypertensive medications provided positive effects (p = 0.041) on the aesthetic outcome. CONCLUSION: RFFF donor site defects covered using AM show excellent clinical, aesthetic and functional outcome representing patient comorbidities (BMI, antihypertensive drugs) might affect the aesthetic outcome. CLINICAL RELEVANCE: In relation to the excellent outcomes found, the use of AM offers an alternative treatment procedure for RFFF defect covering.

Analysis of the bony geometry of the acromio-clavicular joint.

BACKGROUND: The primary goal of this study was to analyse the anatomic configuration of the acromio-clavicular joint in a healthy population to be able to develop a classification in a second step. On the basis of the primary findings a secondary goal was to find potential clinical indications in refer to AC-joint dislocation and lateral clavicle fractures. METHODS: The upper thoracic aperture including both shoulder joints as well as both sterno-clavicular joints was retrospectively reformatted in a bone kernel in axial orientation with 0.6 mm slice thickness out of existing multiple trauma or post mortem computed tomography (CT) scans. The DICOM data was converted into the STL file format using a three dimensional (3D) reconstruction software (Smartbrush, Brainlab, Feldkirchen, Germany). The data analysis was performed using a 3D-Computer Aided Detection (CAD) Software (BioCAD, Technical University Munich, Germany). For the analysis, the angle between the cranial surface of the acromion and the tangent to its articular surface was evaluated. Accordingly, the angle between the cranial surface of the clavicle and the tangent to its articular surface was assessed. RESULTS: Overall CT-datasets of 80 healthy patients (40 males, 40 females, mean age 45 ± 8 years) were enrolled and evaluated regarding the configuration of the AC-joint. In this context, three statistically significant (p < 0.001) different configurations of the AC-joint in terms of overhanging acromion, neutral type, overhanging clavicle were identified. The "overhanging acromion" type of AC-joint configuration turned out to be the most common type (46.2%) followed by the "neutral type" (38.4%) and finally the "overhanging clavicle type" (15.4%). CONCLUSIONS: We assume that the shown differences of the AC joint congruency might play an important role in the development of different shoulder injuries resulting from the similar trauma mechanism. However, the proof of these assumptions will be the focus of future studies.

Polymorphonuclear (PMN) elastase in patients after severe traumatic brain injury.

BACKGROUND: Data on PNM elastase levels in cerebrospinal fluid following traumatic brain injury (TBI) in humans are not available in the literature. Therefore, the aim of this prospective study was to evaluate the dynamics of PMN elastase in the cerebrospinal fluid (CSF) of patients after TBI. METHODS: Patients suffering from isolated, closed TBI, presenting with an initial Glasgow coma score ≤ 8 and with intracerebral hemorrhage on the initial cranial computed tomography scan (performed within 90 min after TBI) were enrolled. CSF and blood samples were obtained immediately, 12 h, 24 h, 48 h, and 72 h after admission. ELISA testing was used to quantify the PMN elastase levels in CSF. In addition, the ratio of CSF albumin to serum albumin was calculated to evaluate the role of the blood-cerebrospinal fluid barrier (BCSFB). As controls, CSF samples were taken from patients receiving spinal anesthesia for elective orthopedic surgery of the lower extremity. RESULTS: Twenty-three patients meeting the inclusion criteria and ten control patients were enrolled. The PMN elastase showed a significant elevation at 48 and 72 h after TBI. When comparing the PMN elastase levels of patients with intact BCSFB to patients with defective BCSFB, there was no significant difference for the respective observation points. CONCLUSIONS: This is the first study to demonstrate that the PMN elastase levels in CSF significantly increased in the early posttraumatic phase (48 h and 72 h after TBI) in patients. The function of the BCSFB showed no significant influence on the PMN levels.

Potential accuracy of navigated K-wire guided supra-acetabular osteotomies in orthopedic surgery: a CT fluoroscopy cadaver study.

BACKGROUND: The aim of this study was to evaluate the accuracy of supra-acetabular pelvic tumor resections in human, full-body cadavers and under realistic operation room conditions with the help of a navigation system and K-wires as guidance for the oscillating saw. METHODS: Seven hemipelvises from fresh, human, male, full-body cadavers were used. A preoperative and a postoperative CT was performed. Under control of the navigation system K-wires were inserted and served as guidance for the oscillating saw to reduce the error by vibration and jerking movements. The accuracy of the computer aided resections was compared with the accuracy of freehand resections in customized 3D printed pelvises with geometries identical to the cadavers used. RESULTS: The mean deviation of the navigated osteotomies was 1.9 mm (standard deviation 1.0 mm) significantly (P < 0.001) lower than the mean deviation of freehand osteotomies at 9.2 mm (standard deviation 3.7 mm). CONCLUSION: Navigated K-wires for supra-acetabular osteotomies allow significantly higher accuracy than freehand procedures under simulated operation room conditions. Copyright © 2016 John Wiley & Sons, Ltd.

Evaluation of a new imaging tool for use with major trauma cases in the emergency department.

BACKGROUND: The aim of this study was to evaluate potential benefits of a new diagnostic software prototype (Trauma Viewer, TV) automatically reformatting computed tomography (CT) data on diagnostic speed and quality, compared to CT-image data evaluation using a conventional CT console. METHODS: Multiple trauma CT data sets were analysed by one expert radiology and one expert traumatology fellow independently twice, once using the TV and once using the secondary conventional CT console placed in the CT control room. Actual analysis time and precision of diagnoses assessment were evaluated. The TV and CT-console results were compared respectively, but also a comparison to the initial multiple trauma CT reports assessed by emergency radiology fellows considered as the gold standard was performed. Finally, design and function of the Trauma Viewer were evaluated in a descriptive manner. RESULTS: CT data sets of 30 multiple trauma patients were enrolled. Mean time needed for analysis of one CT dataset was 2.43 min using the CT console and 3.58 min using the TV respectively. Thus, secondary conventional CT console analysis was on average 1.15 min shorter compared to the TV analysis. Both readers missed a total of 11 diagnoses using the secondary conventional CT console compared to 12 missed diagnoses using the TV. However, none of these overlooked diagnoses resulted in an Abbreviated Injury Scale (AIS) > 2 corresponding to life threatening injuries. CONCLUSIONS: Even though it took the two expert fellows a little longer to analyse the CT scans on the prototype TV compared to the CT console, which can be explained by the new user interface of the TV, our preliminary results demonstrate that, after further development, the TV might serve as a new diagnostic feature in the trauma room management. Its high potential to improve time and quality of CT-based diagnoses might help in fast decision making regarding treatment of severely injured patients.

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.

Management of musculoskeletal tumors during pregnancy: a retrospective study.

BACKGROUND: In recent years, scientific research has increasingly focused on malignancies during pregnancy. However, the development of musculoskeletal tumors during pregnancy has only been the subject of a few studies so far. The primary aim of this study was to identify the incidence of sarcomas during pregnancy at our musculoskeletal tumor center (MSTC). Secondarily we intended to analyze these cases and discuss possible recommendations regarding diagnostic work-up as well as therapy on the basis of the literature. METHODS: All female patients who had been treated for soft tissue or bone sarcoma at our academic MSTC in the period between the years 2002 and 2010 were screened retrospectively for anamnestic annotations of pregnancy or records of pregnancy in the obstetrical database of our university hospital. The patients who met the criteria for inclusion (diagnosed sarcoma and pregnancy) were enrolled. For every pregnant patient two age-matched female control patients that suffered from tumors with the same histologic type were included. RESULTS: In the period between 2002 and 2010, 240 female patients between the age of 16 and 45 were treated for sarcoma. In eight out of the 240 cases the tumor disease developed or progressed during pregnancy. The delay in diagnosis was approximately eight months and turned out to be significantly higher for pregnant patients compared to non- pregnant controls. Each woman's tumor was misdiagnosed at least once. CONCLUSIONS: Diagnostic follow-up of pregnant women presenting with a growing or painful mass, which is suspected to be a musculoskeletal tumor, should be performed at a specialized tumor center. We recommend a multidisciplinary approach and discussing all possible consequences for mother and child intensively in accordance with the available literature.

Does a minimal invasive approach reduce anterior chest wall numbness and postoperative pain in plate fixation of clavicle fractures?

BACKGROUND: Fractures of the clavicle present very common injuries with a peak of incidence in young active patients. Recently published randomized clinical trials demonstrated an improved functional outcome and a lower rate of nonunions in comparison to non-operative treatment. Anterior chest wall numbness due to injury of the supraclavicular nerve and postoperative pain constitute common surgery related complications in plate fixation of displaced clavicle fractures. We recently developed a technique for mini open plating (MOP) of the clavicle to reduce postoperative numbness and pain. The purpose of this study was to analyze the size of anterior chest wall numbness and the intensity of postoperative pain in MOP in comparison to conventional open plating (COP) of clavicle fractures. METHODS: 24 patients (mean age 38.2 ± 14.2 yrs.) with a displaced fracture of the clavicle (Orthopaedic Trauma Association B1.2-C1.2) surgically treated using a locking compression plate (LCP) were enrolled. 12 patients underwent MOP and another 12 patients COP. Anterior chest wall numbness was measured with a transparency grid on the second postoperative day and at the six months follow-up. Postoperative pain was evaluated using the Visual Analog Scale (VAS). RESULTS: Mean ratio of skin incision length to plate length was 0.61 ± 0.04 in the MOP group and 0.85 ± 0.06 in the COP group (p < 0.05). Mean ratio of the area of anterior chest wall numbness to plate length was postoperative 7.6 ± 5.9 (six months follow-up 4.7 ± 3.9) in the MOP group and 22.1 ± 19.1 (16.9 ± 14.1) in the COP group (p < 0.05). Mean VAS was 2.6 ± 1.4 points in the MOP group and 3.4 ± 1.6 points in the COP group (p = 0.20). CONCLUSIONS: In our study, MOP significantly reduced anterior chest wall numbness in comparison to a conventional open approach postoperative as well as at the six months follow-up. Postoperative pain tended to be lower in the MOP group, however this difference was not statistically significant. TRIAL REGISTRATION: ClinicalTrials.gov NCT02247778 . Registered 21 September 2014.