@article{EdenZieglerGilbertetal.2015,
  author    = {Eden, Lars and Ziegler, Dirk and Gilbert, Fabian and Fehske, Kai and Fenwick, Annabel and Meffert, Rainer H.},
  title     = {Significant pain reduction and improved functional outcome after surgery for displaced midshaft clavicular fractures},
  series = {Journal of Orthopaedic Surgery and Research},
  volume    = {10},
  journal   = {Journal of Orthopaedic Surgery and Research},
  number    = {190},
  doi       = {10.1186/s13018-015-0336-z},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-146357},
  year      = {2015},
  abstract  = {Purpose Displaced midshaft clavicular fractures can be treated conservatively as well as operatively by titan elastic nail (TEN) or plate fixation. This survey was performed to evaluate the clinical results of each treatment method and elaborate advantages or possible complications of each modality. Methods Between 2008 and 2013, 102 patients were prospectively included in our study—37 patients for conservative treatment with a rucksack bandage for 4 to 6 weeks, 41 patients for plate osteosynthesis, and 24 for intramedullary stabilization with TEN. Disabilities of the Arm, Shoulder and Hand (DASH), Constant Murley Score (CMS), and visual analog scale (VAS) for pain and function as well as time of invalidity were recorded over a 1-year period. Results The clinical data collected reveals that all three different therapies lead to good or excellent clinical results after 1 year. However, one can observe advantages of operative treatment in comparison to conservative therapy in some characteristics. Conclusion Our data shows that there are several indications where operative treatment has advantages compared to conservative treatment. In special fracture types (Robinson 2B1), TEN gives the best results. Plate fixation is extraordinarily sufficient in pain reduction within the first 5 weeks and indicated in more-part fractures (Robinson 2B2). Nevertheless, conservative treatment is always a good and promising way to treat clavicular fractures, so that individual indications and thorough patient informative talks are inevitable.},
  language  = {en}
}
@article{JordanHoelscherDohtFehskeetal.2015,
  author    = {Jordan, Martin C. and Hoelscher-Doht, Stefanie and Fehske, Kai and Gilbert, Fabian and Jansen, Hendrik and Meffert, Rainer H.},
  title     = {Bunnell or cross-lock Bunnell suture for tendon repair? Defining the biomechanical role of suture pretension},
  series = {Journal of Orthopaedic Surgery and Research},
  volume    = {10},
  journal   = {Journal of Orthopaedic Surgery and Research},
  number    = {192},
  doi       = {10.1186/s13018-015-0331-4},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-126262},
  year      = {2015},
  abstract  = {Background Suture pretension during tendon repair is supposed to increase the resistance to gap formation. However, its effects on the Bunnell suture technique are unknown. The purpose of this study was to determine the biomechanical effects of suture pretension on the Bunnell and cross-lock Bunnell techniques for tendon repair. Methods Eighty porcine hindlimb tendons were randomly assigned to four different tendon repair groups: those repaired with or without suture pretension using either a simple Bunnell or cross-lock Bunnell technique. Pretension was applied as a 10 \% shortening of the sutured tendon. After measuring the cross-sectional diameter at the repair site, static and cyclic biomechanical tests were conducted to evaluate the initial and 5-mm gap formation forces, elongation during cyclic loading, maximum tensile strength, and mode of failure. The suture failure mechanism was also separately assessed fluoroscopically in two tendons that were repaired with steel wire. Results Suture pretension was accompanied by a 10 to 15 \% increase in the tendon diameter at the repair site. Therefore, suture pretension with the Bunnell and cross-lock Bunnell repair techniques noticeably increased the resistance to initial gap formation and 5-mm gap formation. The tension-free cross-lock Bunnell repair demonstrated more resistance to initial and 5-mm gap formation, less elongation, and higher maximum tensile strength than the tension-free Bunnell repair technique. The only difference between the tensioned cross-lock Bunnell and tensioned Bunnell techniques was a larger resistance to 5-mm gap formation with the cross-lock Bunnell technique. Use of the simple instead of cross-lock suture configuration led to failure by suture cut out, as demonstrated fluoroscopically. Conclusion Based on these results, suture pretension decreases gapping and elongation after tendon repair, and those effects are stronger when using a cross-lock, rather than a regular Bunnell suture. However, pretension causes an unfavorable increase in the tendon diameter at the repair site, which may adversely affect wound healing.},
  language  = {en}
}