@article{PaulMiedenLeferingetal.2023,
  author    = {Paul, Mila M. and Mieden, Hannah J. and Lefering, Rolf and Kupczyk, Eva K. and Jordan, Martin C. and Gilbert, Fabian and Meffert, Rainer H. and Sir{\´e}n, Anna-Leena and Hoelscher-Doht, Stefanie},
  title     = {Impact of a femoral fracture on outcome after traumatic brain injury — a matched-pair analysis of the TraumaRegister DGU\(^®\)},
  series = {Journal of Clinical Medicine},
  volume    = {12},
  journal   = {Journal of Clinical Medicine},
  number    = {11},
  issn      = {2077-0383},
  doi       = {10.3390/jcm12113802},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-319363},
  year      = {2023},
  abstract  = {Traumatic brain injury (TBI) is the leading cause of death and disability in polytrauma and is often accompanied by concomitant injuries. We conducted a retrospective matched-pair analysis of data from a 10-year period from the multicenter database TraumaRegister DGU\(^®\) to analyze the impact of a concomitant femoral fracture on the outcome of TBI patients. A total of 4508 patients with moderate to critical TBI were included and matched by severity of TBI, American Society of Anesthesiologists (ASA) risk classification, initial Glasgow Coma Scale (GCS), age, and sex. Patients who suffered combined TBI and femoral fracture showed increased mortality and worse outcome at the time of discharge, a higher chance of multi-organ failure, and a rate of neurosurgical intervention. Especially those with moderate TBI showed enhanced in-hospital mortality when presenting with a concomitant femoral fracture (p = 0.037). The choice of fracture treatment (damage control orthopedics vs. early total care) did not impact mortality. In summary, patients with combined TBI and femoral fracture have higher mortality, more in-hospital complications, an increased need for neurosurgical intervention, and inferior outcome compared to patients with TBI solely. More investigations are needed to decipher the pathophysiological consequences of a long-bone fracture on the outcome after TBI.},
  language  = {en}
}
@article{BernuthVaterFuchsetal.2023,
  author    = {Bernuth, Silvia and Vater, Adrian and Fuchs, Konrad F. and Meffert, Rainer H. and Jakubietz, Rafael G.},
  title     = {Perfusion changes in perforator-based propeller flaps},
  series = {Journal of Reconstructive Microsurgery Open},
  volume    = {8},
  journal   = {Journal of Reconstructive Microsurgery Open},
  number    = {1},
  issn      = {2377-0813},
  doi       = {10.1055/a-2086-4988},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-350491},
  pages     = {e45-e50},
  year      = {2023},
  abstract  = {Background  To cover soft tissue defects, the perforator-based propeller flap offers the option to rotate healthy tissue into complex wounds. By rotating the flap, the perforator is torqued. As a result, perfusion changes are possible. Methods  A retrospective data analysis of patients was done, who received a propeller flap to cover soft tissue defects of the lower extremity as well as a peri- and postoperative perfusion monitoring with a laser-Doppler-spectrophotometry system. Additionally, patient-specific data were collected. Results  Seven patients were identified. Four patients experienced early complications, two epidermolysis of the distal flap areas, three wound healing disorders, and one partial flap necrosis. Intraoperative perfusion monitoring showed a decline of blood flow after incision of the flap, especially at distal flap site. In case of complications, there were prolonged blood flow declines up to the first postoperative day. Conclusion  Torqueing the perforator by rotating the flap can cause an impairment in inflow and outflow. If the impairment is prolonged, perfusion-associated complications are possible. The identification of a viable perforator is particularly important. In addition, a conservative postoperative mobilization is necessary to compensate for the impaired and adapting outflow.},
  language  = {en}
}
@article{HuflageFieberFaerberetal.2022,
  author    = {Huflage, Henner and Fieber, Tabea and F{\"a}rber, Christian and Knarr, Jonas and Veldhoen, Simon and Jordan, Martin C. and Gilbert, Fabian and Bley, Thorsten Alexander and Meffert, Rainer H. and Grunz, Jan-Peter and Schmalzl, Jonas},
  title     = {Interobserver reliability of scapula fracture classifications in intra- and extra-articular injury patterns},
  series = {BMC Musculoskeletal Disorders},
  volume    = {23},
  journal   = {BMC Musculoskeletal Disorders},
  number    = {1},
  doi       = {10.1186/s12891-022-05146-7},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-299795},
  year      = {2022},
  abstract  = {Background Morphology and glenoid involvement determine the necessity of surgical management in scapula fractures. While being present in only a small share of patients with shoulder trauma, numerous classification systems have been in use over the years for categorization of scapula fractures. The purpose of this study was to evaluate the established AO/OTA classification in comparison to the classification system of Euler and R{\"u}edi (ER) with regard to interobserver reliability and confidence in clinical practice. Methods Based on CT imaging, 149 patients with scapula fractures were retrospectively categorized by two trauma surgeons and two radiologists using the classification systems of ER and AO/OTA. To measure the interrater reliability, Fleiss kappa (κ) was calculated independently for both fracture classifications. Rater confidence was stated subjectively on a five-point scale and compared with Wilcoxon signed rank tests. Additionally, we computed the intraclass correlation coefficient (ICC) based on absolute agreement in a two-way random effects model to assess the diagnostic confidence agreement between observers. Results In scapula fractures involving the glenoid fossa, interrater reliability was substantial (κ = 0.722; 95\% confidence interval [CI] 0.676-0.769) for the AO/OTA classification in contrast to moderate agreement (κ = 0.579; 95\% CI 0.525-0.634) for the ER classification system. Diagnostic confidence for intra-articular fracture patterns was superior using the AO/OTA classification compared to ER (p < 0.001) with higher confidence agreement (ICC: 0.882 versus 0.831). For extra-articular fractures, ER (κ = 0.817; 95\% CI 0.771-0.863) provided better interrater reliability compared to AO/OTA (κ = 0.734; 95\% CI 0.692-0.776) with higher diagnostic confidence (p < 0.001) and superior agreement between confidence ratings (ICC: 0.881 versus 0.912). Conclusions The AO/OTA classification is most suitable to categorize intra-articular scapula fractures with glenoid involvement, whereas the classification system of Euler and R{\"u}edi appears to be superior in extra-articular injury patterns with fractures involving only the scapula body, spine, acromion and coracoid process.},
  language  = {en}
}
@article{JordanBroeerFischeretal.2022,
  author    = {Jordan, Martin C. and Br{\"o}er, David and Fischer, Christian and Heilig, Philipp and Gilbert, Fabian and H{\"o}lscher-Doht, Stefanie and Kalogirou, Charis and Popp, Kevin and Grunz, Jan-Peter and Huflage, Henner and Jakubietz, Rafael G. and Erg{\"u}n, S{\"u}leyman and Meffert, Rainer H.},
  title     = {Development and preclinical evaluation of a cable-clamp fixation device for a disrupted pubic symphysis},
  series = {Communications Medicine},
  volume    = {2},
  journal   = {Communications Medicine},
  number    = {1},
  doi       = {10.1038/s43856-022-00227-z},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-299800},
  year      = {2022},
  abstract  = {Background Traumatic separation of the pubic symphysis can destabilize the pelvis and require surgical fixation to reduce symphyseal gapping. The traditional approach involves open reduction and the implantation of a steel symphyseal plate (SP) on the pubic bone to hold the reposition. Despite its widespread use, SP-fixation is often associated with implant failure caused by screw loosening or breakage. Methods To address the need for a more reliable surgical intervention, we developed and tested two titanium cable-clamp implants. The cable served as tensioning device while the clamp secured the cable to the bone. The first implant design included a steel cable anterior to the pubic symphysis to simplify its placement outside the pelvis, and the second design included a cable encircling the pubic symphysis to stabilize the anterior pelvic ring. Using highly reproducible synthetic bone models and a limited number of cadaver specimens, we performed a comprehensive biomechanical study of implant stability and evaluated surgical feasibility. Results We were able to demonstrate that the cable-clamp implants provide stability equivalent to that of a traditional SP-fixation but without the same risks of implant failure. We also provide detailed ex vivo evaluations of the safety and feasibility of a trans-obturator surgical approach required for those kind of fixation. Conclusion We propose that the developed cable-clamp fixation devices may be of clinical value in treating pubic symphysis separation.},
  language  = {en}
}
@article{HeiligFaerberPauletal.2022,
  author    = {Heilig, Philipp and Faerber, Lars-Christopher and Paul, Mila M. and Kupczyk, Eva and Meffert, Rainer H. and Jordan, Martin C. and Hoelscher-Doht, Stefanie},
  title     = {Plate osteosynthesis combined with bone cement provides the highest stability for tibial head depression fractures under high loading conditions},
  series = {Scientific Reports},
  volume    = {12},
  journal   = {Scientific Reports},
  number    = {1},
  doi       = {10.1038/s41598-022-19107-6},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-299782},
  year      = {2022},
  abstract  = {Older patients sustaining tibial head depression fractures often cannot follow the post-operative rehabilitation protocols with partial weight-bearing of the affected limb, leading to osteosynthesis failure, cartilage step-off and arthritis development. Therefore, the aim of this study was to analyse the biomechanical performance of different types of osteosyntheses alone and in combination with bone cement simulating cyclically high loading conditions of tibial head depression fractures. Lateral tibial head depression fractures (AO: 41-B2.2; Schatzker type III) were created in synthetic bones and stabilized using three different osteosyntheses alone and in combination with a commonly used bone cement (chronOS™): 2 screws, 4 screws in the jail technique and a lateral angle-stable buttress plate. After fixation, the lateral tibial plateau was axially loaded in two, from each other independent testing series: In the first test protocol, 5000 cycles with 500 N and in the end load-to-failure tests were performed. In the second test protocol, the cyclic loading was increased to 1000 N. Parameters of interest were the displacement of the articular fracture fragment, the stiffness and the maximum load. The osteosyntheses revealed a higher stiffness in combination with bone cement compared to the same type of osteosynthesis alone (e.g., 500 N level: 2 screws 383 ± 43 N/mm vs. 2 screws + chronOs 520 ± 108 N/mm, increase by 36\%, p < 0.01; 4 screws 368 ± 97 N/mm vs. 4 screws + chronOS 516 ± 109 N/mm, increase by 40\%, p < 0.01; plate: 509 ± 73 N/mm vs. plate + chronOs 792 ± 150 N/mm, increase by 56\%, p < 0.01). Bone cement reduced the displacement of the plate significantly (500 N level: plate: 8.9 ± 2.8 mm vs. plate + chronOs: 3.1 ± 1.4 mm, reduction by 65\%, p < 0.01; 1000 N level: 16.9 ± 3.6 mm vs 5.6 ± 1.3 mm, reduction by 67\%, p < 0.01). Thus, the highest stiffness and lowest displacement values were found when using the plate with bone cement in both loading conditions (500 N level: 2 screws + chronOs 3.7 ± 1.3 mm, 4 screws + chronOs 6.2 ± 2.4 mm; 1000 N level: 2 screws + chronOs 6.5 ± 1.2 mm, 4 screws + chronOs 5.7 ± 0.8 mm). From a biomechanical perspective, plate osteosynthesis of tibial head depression fractures should always be combined with bone cement, provides higher stability than 2-screw and 4-screw fixation and is a valid treatment option in cases where extraordinary stability is required.},
  language  = {en}
}
@article{JordanHufnagelMcDonoghetal.2022,
  author    = {Jordan, Martin C. and Hufnagel, Lukas and McDonogh, Miriam and Paul, Mila M. and Schmalzl, Jonas and Kupczyk, Eva and Jansen, Hendrik and Heilig, Philipp and Meffert, Rainer H. and Hoelscher-Doht, Stefanie},
  title     = {Surgical fixation of calcaneal beak fractures — biomechanical analysis of different osteosynthesis techniques},
  series = {Frontiers in Bioengineering and Biotechnology},
  volume    = {10},
  journal   = {Frontiers in Bioengineering and Biotechnology},
  issn      = {2296-4185},
  doi       = {10.3389/fbioe.2022.896790},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-282792},
  year      = {2022},
  abstract  = {The calcaneal beak fracture is a rare avulsion fracture of the tuber calcanei characterized by a solid bony fragment at the Achilles tendon insertion. Treatment usually requires osteosynthesis. However, lack of biomechanical understanding of the ideal fixation technique persists. A beak fracture was simulated in synthetic bones and assigned to five different groups of fixation: A) 6.5-mm partial threaded cannulated screws, B) 4.0-mm partial threaded cannulated screws, C) 5.0-mm headless cannulated compression screws, D) 2.3-mm locking plate, and E) 2.8-mm locking plate. Different traction force levels were applied through an Achilles tendon surrogate in a material-testing machine on all stabilized synthetic bones. Outcome measures were peak-to-peak displacement, total displacement, plastic deformation, stiffness, visual-fracture-line displacement, and mode of implant failure. The 2.3- and 2.8-mm plating groups showed a high drop-out rate at 100 N tension force and failed under higher tension levels of 200 N. The fracture fixation using 4.0-mm partial threaded screws showed a significantly higher repair strength and was able to withhold cyclic loading up to 300 N. The lowest peak-to-peak displacement and the highest load-to-failure and stiffness were provided by fracture fixation using 6.5-mm partial threaded cannulated screws or 5.0-mm headless cannulated compression screws. As anticipated, large 6.5-mm screw diameters provide the best biomechanical fixation. Surprisingly, the 5.0-mm headless cannulated compression screws yield reliable stability despite the absent screw head and washer. When such large screws cannot be applied, 4.0-mm screws also allow reasonable fixation strength. Plate fixation should be implemented with precaution and in combination with a restrictive postoperative motion protocol. Finally, clinical cases about the surgical application and recovery are included.},
  language  = {en}
}
@article{JordanJaeckleScheidtetal.2021,
  author    = {Jordan, Martin C. and J{\"a}ckle, Veronika and Scheidt, Sebastian and Gilbert, Fabian and H{\"o}lscher-Doht, Stefanie and Erg{\"u}n, S{\"u}leyman and Meffert, Rainer H. and Heintel, Timo M.},
  title     = {Trans-obturator cable fixation of open book pelvic injuries},
  series = {Scientific Reports},
  volume    = {11},
  journal   = {Scientific Reports},
  number    = {1},
  doi       = {10.1038/s41598-021-92755-2},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-261212},
  year      = {2021},
  abstract  = {Operative treatment of ruptured pubic symphysis by plating is often accompanied by complications. Trans-obturator cable fixation might be a more reliable technique; however, have not yet been tested for stabilization of ruptured pubic symphysis. This study compares symphyseal trans-obturator cable fixation versus plating through biomechanical testing and evaluates safety in a cadaver experiment. APC type II injuries were generated in synthetic pelvic models and subsequently separated into three different groups. The anterior pelvic ring was fixed using a four-hole steel plate in Group A, a stainless steel cable in Group B, and a titan band in Group C. Biomechanical testing was conducted by a single-leg-stance model using a material testing machine under physiological load levels. A cadaver study was carried out to analyze the trans-obturator surgical approach. Peak-to-peak displacement, total displacement, plastic deformation and stiffness revealed a tendency for higher stability for trans-obturator cable/band fixation but no statistical difference to plating was detected. The cadaver study revealed a safe zone for cable passage with sufficient distance to the obturator canal. Trans-obturator cable fixation has the potential to become an alternative for symphyseal fixation with less complications.},
  language  = {en}
}
@article{JordanJansenMeffertetal.2021,
  author    = {Jordan, Martin C. and Jansen, Hendrik and Meffert, Rainer H. and Heintel, Timo M.},
  title     = {Comparing porous tantalum fusion implants and iliac crest bone grafts for spondylodesis of thoracolumbar burst fractures: Prospectice Cohort study},
  series = {Scientific Reports},
  volume    = {11},
  journal   = {Scientific Reports},
  number    = {1},
  doi       = {10.1038/s41598-021-96400-w},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-261706},
  year      = {2021},
  abstract  = {The aim of this study was to compare two different techniques of performing one-level spondylodesis for thoracolumbar burst fractures using either an autologous iliac crest bone graft (ICBG) or a porous tantalum fusion implant (PTFI). In a prospective nonrandomized study, 44 patients (20 women, 24 men; average age 43.1 +/- 13.2 years) suffering from severe thoracolumbar burst fractures were treated with combined anterior-posterior stabilization. An ICBG was used in 21 cases, and a PTFI was used in the other 23 cases. A two-year clinical and radiographic follow-up was carried out. There were no statistically significant differences in age, sex, localization/classification of the fracture, or visual analog scale (VAS) before injury between the two groups. All 44 patients were followed up for an average period of 533 days (range 173-1567). The sagittal spinal profile was restored by an average of 11.1 degrees (ICBG) vs. 14.3 degrees (PTFI) (monosegmental Cobb angle). Loss of correction until the last follow-up tended to be higher in the patients treated with ICBG than in those treated with PTFI (mean: 2.8 degrees vs. 1.6 degrees). Furthermore, significantly better restoration of the sagittal profile was obtained with the PTFI than with the iliac bone graft at the long-term follow-up (mean: ICBG 7.8 degrees, PTFI 12.3 degrees; p < 0.005). Short-segment posterior instrumentation combined with anterior one-level spondylodesis using either an ICBG or a PTFI resulted in sufficient correction of posttraumatic segmental kyphosis. PTFI might be a good alternative for autologous bone grafting and prevent donor site morbidities.},
  language  = {en}
}
@article{FuchsEdenGilbertetal.2021,
  author    = {Fuchs, Konrad F. and Eden, Lars and Gilbert, Fabian and Bernuth, Silvia and Wurmb, Thomas and Meffert, Rainer H. and Jordan, Martin C.},
  title     = {F{\"u}hrt eine COVID-19-bedingte Ausgangsbeschr{\"a}nkung zu einer Reduktion schwer verletzter Patienten an einem {\"u}berregionalen Traumazentrum?},
  series = {Der Unfallchirurg},
  volume    = {124},
  journal   = {Der Unfallchirurg},
  number    = {5},
  doi       = {10.1007/s00113-020-00924-1},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-265268},
  pages     = {352-357},
  year      = {2021},
  abstract  = {Hintergrund Intensiv- und Beatmungskapazit{\"a}ten sind f{\"u}r die Behandlung COVID-19-erkrankter Patienten essenziell. Unabh{\"a}ngig davon beanspruchen auch schwer verletzte Patienten h{\"a}ufig Intensiv- und Beatmungskapazit{\"a}ten. Daraus ergibt sich folgende Fragestellung: F{\"u}hrt eine Ausgangsbeschr{\"a}nkung zu einer Reduktion schwer verletzter Patienten, und kann hierdurch mit frei werdenden Intensivkapazit{\"a}ten gerechnet werden? Material und Methoden Es erfolgte eine retrospektive Auswertung schwer verletzter Patienten mit einem Injury Severity Score (ISS) ≥16 zwischen dem 17.03.2020 und 30.04.2020 (landesweiter Shutdown) an einem {\"u}berregionalen Traumazentrum. Erfasst wurden der Unfallmechanismus, ISS, Versicherungstr{\"a}ger (BG vs. GKV/PKV), ob es sich um einen dokumentierten Suizidversuch handelte, und ob eine operative Intervention innerhalb der ersten 24 h erforderlich war. Als Kontrollgruppe wurden die Daten des gleichen Zeitraums der Jahre 2018 und 2019 ausgewertet. Ergebnisse Es konnte keine wesentliche Ver{\"a}nderung bez{\"u}glich der Anzahl an schwer verletzten Patienten festgestellt werden (2018 n = 30, 2019 n = 23, 2020 n = 27). Es zeigten sich insgesamt keine deutlichen Ver{\"a}nderungen der absoluten Zahlen bez{\"u}glich der Intensivpflichtigkeit in den ersten 24 h und der Beatmungspflichtigkeit beim Verlassen des Schockraums. Die Anzahl an Patienten, die eine Operation innerhalb der ersten 24 h nach Eintreffen im Schockraum ben{\"o}tigten, war 2020 sogar leicht erh{\"o}ht, jedoch nicht statistisch signifikant. Der durchschnittliche ISS blieb konstant. Bez{\"u}glich der Unfallursache zeigte sich 2020 kein Motorradfahrer, der einen nicht berufsgenossenschaftlich versicherten Unfall erlitt (2018 n = 5, 2019 n = 4, 2020 n = 0). Es wurde 2020 ein erh{\"o}hter Anteil an Arbeitsunf{\"a}llen mit einem ISS ≥16 festgestellt (2018: 10 \%, 2019: 26,1 \%, 2020: 44,4 \%). Diskussion Eine Ausgangsbeschr{\"a}nkung f{\"u}hrte zu keiner Reduktion verletzter- und intensivpflichtiger Patienten am untersuchten Zentrum. Auch unter einer landesweiten Ausgangsbeschr{\"a}nkung muss f{\"u}r dieses Patientenkollektiv eine ausreichende Menge an Intensiv- und OP-Kapazit{\"a}ten vorgehalten werden. Die Best{\"a}tigung dieser Ergebnisse durch Auswertung nationaler Register steht noch aus.},
  language  = {de}
}
@article{FuchsEdenGilbertetal.2021,
  author    = {Fuchs, Konrad F. and Eden, Lars and Gilbert, Fabian and Bernuth, Silvia and Wurmb, Thomas and Meffert, Rainer H. and Jordan, Martin C.},
  title     = {F{\"u}hrt eine COVID-19 bedingte Ausgangsbeschr{\"a}nkung zu einer Reduktion schwerverletzter Patienten an einem {\"u}berregionalen Traumazentrum?},
  series = {Der Unfallchirurg},
  volume    = {124},
  journal   = {Der Unfallchirurg},
  issn      = {0177-5537},
  doi       = {10.1007/s00113-020-00924-1},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-232547},
  pages     = {352-357},
  year      = {2021},
  abstract  = {Hintergrund Intensiv- und Beatmungskapazit{\"a}ten sind f{\"u}r die Behandlung COVID-19-erkrankter Patienten essenziell. Unabh{\"a}ngig davon beanspruchen auch schwer verletzte Patienten h{\"a}ufig Intensiv- und Beatmungskapazit{\"a}ten. Daraus ergibt sich folgende Fragestellung: F{\"u}hrt eine Ausgangsbeschr{\"a}nkung zu einer Reduktion schwer verletzter Patienten, und kann hierdurch mit frei werdenden Intensivkapazit{\"a}ten gerechnet werden? Material und Methoden Es erfolgte eine retrospektive Auswertung schwer verletzter Patienten mit einem Injury Severity Score (ISS) ≥16 zwischen dem 17.03.2020 und 30.04.2020 (landesweiter Shutdown) an einem {\"u}berregionalen Traumazentrum. Erfasst wurden der Unfallmechanismus, ISS, Versicherungstr{\"a}ger (BG vs. GKV/PKV), ob es sich um einen dokumentierten Suizidversuch handelte, und ob eine operative Intervention innerhalb der ersten 24 h erforderlich war. Als Kontrollgruppe wurden die Daten des gleichen Zeitraums der Jahre 2018 und 2019 ausgewertet. Ergebnisse Es konnte keine wesentliche Ver{\"a}nderung bez{\"u}glich der Anzahl an schwer verletzten Patienten festgestellt werden (2018 n = 30, 2019 n = 23, 2020 n = 27). Es zeigten sich insgesamt keine deutlichen Ver{\"a}nderungen der absoluten Zahlen bez{\"u}glich der Intensivpflichtigkeit in den ersten 24 h und der Beatmungspflichtigkeit beim Verlassen des Schockraums. Die Anzahl an Patienten, die eine Operation innerhalb der ersten 24 h nach Eintreffen im Schockraum ben{\"o}tigten, war 2020 sogar leicht erh{\"o}ht, jedoch nicht statistisch signifikant. Der durchschnittliche ISS blieb konstant. Bez{\"u}glich der Unfallursache zeigte sich 2020 kein Motorradfahrer, der einen nicht berufsgenossenschaftlich versicherten Unfall erlitt (2018 n = 5, 2019 n = 4, 2020 n = 0). Es wurde 2020 ein erh{\"o}hter Anteil an Arbeitsunf{\"a}llen mit einem ISS ≥16 festgestellt (2018: 10 \%, 2019: 26,1 \%, 2020: 44,4 \%). Diskussion Eine Ausgangsbeschr{\"a}nkung f{\"u}hrte zu keiner Reduktion verletzter- und intensivpflichtiger Patienten am untersuchten Zentrum. Auch unter einer landesweiten Ausgangsbeschr{\"a}nkung muss f{\"u}r dieses Patientenkollektiv eine ausreichende Menge an Intensiv- und OP-Kapazit{\"a}ten vorgehalten werden. Die Best{\"a}tigung dieser Ergebnisse durch Auswertung nationaler Register steht noch aus.},
  language  = {de}
}
@article{FrischholzBerberichBoecketal.2020,
  author    = {Frischholz, Sebastian and Berberich, Oliver and B{\"o}ck, Thomas and Meffert, Rainer H. and Blunk, Torsten},
  title     = {Resveratrol counteracts IL-1β-mediated impairment of extracellular matrix deposition in 3D articular chondrocyte constructs},
  series = {Journal of Tissue Engineering and Regenerative Medicine},
  volume    = {14},
  journal   = {Journal of Tissue Engineering and Regenerative Medicine},
  number    = {7},
  doi       = {10.1002/term.3031},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-215471},
  pages     = {897 -- 908},
  year      = {2020},
  abstract  = {When aiming at cell-based therapies in osteoarthritis (OA), proinflammatory conditions mediated by cytokines such as IL-1β need to be considered. In recent studies, the phytoalexin resveratrol (RSV) has exhibited potent anti-inflammatory properties. However, long-term effects on 3D cartilaginous constructs under inflammatory conditions with regard to tissue quality, especially extracellular matrix (ECM) composition, have remained unexplored. Therefore, we employed long-term model cultures for cell-based therapies in an in vitro OA environment and evaluated effects of RSV. Pellet constructs made from expanded porcine articular chondrocytes were cultured with either IL-1β (1-10 ng/ml) or RSV (50 μM) alone, or a cotreatment with both agents. Treatments were applied for 14 days, either directly after pellet formation or after a preculture period of 7 days. Culture with IL-1β (10 ng/ml) decreased pellet size and DNA amount and severely compromised glycosaminoglycan (GAG) and collagen content. Cotreatment with RSV distinctly counteracted the proinflammatory catabolism and led to partial rescue of the ECM composition in both culture systems, with especially strong effects on GAG. Marked MMP13 expression was detected in IL-1β-treated pellets, but none upon RSV cotreatment. Expression of collagen type I was increased upon IL-1β treatment and still observed when adding RSV, whereas collagen type X, indicating hypertrophy, was detected exclusively in pellets treated with RSV alone. In conclusion, RSV can counteract IL-1β-mediated degradation and distinctly improve cartilaginous ECM deposition in 3D long-term inflammatory cultures. Nevertheless, potential hypertrophic effects should be taken into account when considering RSV as cotreatment for articular cartilage repair techniques.},
  language  = {en}
}
@article{JordanJovicGilbertetal.2020,
  author    = {Jordan, Martin C. and Jovic, Sebastian and Gilbert, Fabian and Kunz, Andreas and Ertl, Maximilian and Strobl, Ute and Jakubietz, Rafael G. and Jakubietz, Michael G. and Meffert, Rainer H. and Fuchs, Konrad F.},
  title     = {Qualit{\"a}tssteigerung der Abrechnungspr{\"u}fung durch Smartphone-basierte Fotodokumentation in der Unfall-, Hand-, und Plastischen Chirurgie},
  series = {Der Unfallchirurg},
  volume    = {124},
  journal   = {Der Unfallchirurg},
  issn      = {0177-5537},
  doi       = {10.1007/s00113-020-00866-8},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-232415},
  pages     = {366-372},
  year      = {2020},
  abstract  = {Hintergrund Die Fotodokumentation von offenen Frakturen, Wunden, Dekubitalulzera, Tumoren oder Infektionen ist ein wichtiger Bestandteil der digitalen Patientenakte. Bisher ist unklar, welchen Stellenwert diese Fotodokumentation bei der Abrechnungspr{\"u}fung durch den Medizinischen Dienst der Krankenkassen (MDK) hat. Fragestellung Kann eine Smartphone-basierte Fotodokumentation die Verteidigung von erl{\"o}srelevanten Diagnosen und Prozeduren sowie der Verweildauer verbessern? Material und Methoden Ausstattung der Mitarbeiter mit digitalen Endger{\"a}ten (Smartphone/Tablet) in den Bereichen Notaufnahme, Schockraum, OP, Sprechstunden sowie auf den Stationen. Retrospektive Auswertung der Abrechnungspr{\"u}fung im Jahr 2019 und Identifikation aller Fallbesprechungen, in denen die Fotodokumentation eine Erl{\"o}sver{\"a}nderung bewirkt hat. Ergebnisse Von insgesamt 372 Fallbesprechungen half die Fotodokumentation in 27 F{\"a}llen (7,2 \%) zur Best{\"a}tigung eines Operationen- und Prozedurenschl{\"u}ssels (OPS) (n = 5; 1,3 \%), einer Hauptdiagnose (n = 10; 2,7 \%), einer Nebendiagnose (n = 3; 0,8 \%) oder der Krankenhausverweildauer (n = 9; 2,4 \%). Pro oben genanntem Fall mit Fotodokumentation ergab sich eine durchschnittliche Erl{\"o}ssteigerung von 2119 €. Inklusive Aufwandpauschale f{\"u}r die Verhandlungen wurde somit ein Gesamtbetrag von 65.328 € verteidigt. Diskussion Der Einsatz einer Smartphone-basierten Fotodokumentation kann die Qualit{\"a}t der Dokumentation verbessern und Erl{\"o}seinbußen bei der Abrechnungspr{\"u}fung verhindern. Die Implementierung digitaler Endger{\"a}te mit entsprechender Software ist ein wichtiger Teil des digitalen Strukturwandels in Kliniken.},
  language  = {de}
}
@article{FuchsHeiligMcDonoghetal.2020,
  author    = {Fuchs, Konrad F. and Heilig, Philipp and McDonogh, Miriam and Boelch, Sebastian and Gbureck, Uwe and Meffert, Rainer H. and Hoelscher-Doht, Stefanie and Jordan, Martin C.},
  title     = {Cement-augmented screw fixation for calcaneal fracture treatment: a biomechanical study comparing two injectable bone substitutes},
  series = {Journal of Orthopaedic Surgery and Research},
  volume    = {15},
  journal   = {Journal of Orthopaedic Surgery and Research},
  doi       = {10.1186/s13018-020-02009-6},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-230336},
  year      = {2020},
  abstract  = {Background The role of cement-augmented screw fixation for calcaneal fracture treatment remains unclear. Therefore, this study was performed to biomechanically analyze screw osteosynthesis by reinforcement with either a calcium phosphate (CP)-based or polymethylmethacrylate (PMMA)-based injectable bone cement. Methods A calcaneal fracture (Sanders type IIA) including a central cancellous bone defect was generated in 27 synthetic bones, and the specimens were assigned to 3 groups. The first group was fixed with four screws (3.5 mm and 6.5 mm), the second group with screws and CP-based cement (Graftys (R) QuickSet; Graftys, Aix-en-Provence, France), and the third group with screws and PMMA-based cement (Traumacem (TM) V+; DePuy Synthes, Warsaw, IN, USA). Biomechanical testing was conducted to analyze peak-to-peak displacement, total displacement, and stiffness in following a standardized protocol. Results The peak-to-peak displacement under a 200-N load was not significantly different among the groups; however, peak-to-peak displacement under a 600- and 1000-N load as well as total displacement exhibited better stability in PMMA-augmented screw osteosynthesis compared to screw fixation without augmentation. The stiffness of the construct was increased by both CP- and PMMA-based cements. Conclusion Addition of an injectable bone cement to screw osteosynthesis is able to increase fixation strength in a biomechanical calcaneal fracture model with synthetic bones. In such cases, PMMA-based cements are more effective than CP-based cements because of their inherently higher compressive strength. However, whether this high strength is required in the clinical setting for early weight-bearing remains controversial, and the non-degradable properties of PMMA might cause difficulties during subsequent interventions in younger patients.},
  language  = {en}
}
@article{JakubietzSchmidtHolzapfeletal.2020,
  author    = {Jakubietz, Rafael G. and Schmidt, Karsten and Holzapfel, Boris M. and Meffert, Rainer H. and Jakubietz, Michael G.},
  title     = {Pedicled perforator flaps for mid-tibial soft tissue reconstruction in medically compromised patients},
  series = {JPRAS Open},
  volume    = {24},
  journal   = {JPRAS Open},
  doi       = {10.1016/j.jpra.2020.02.002},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-229473},
  pages     = {47-55},
  year      = {2020},
  abstract  = {Background: The soft tissue of the central pretibial area is difficult to reconstruct often requiring free tissue transfer. Especially medi- cally compromised patients are not ideal candidates for free tissue transfer and may benefit from expeditiously harvested local flaps with limited donor site morbidity. As muscle flaps are rare, pedi- cled flaps based on lateral perforators represent an alternative as the arc of rotation can often be limited to 90 °. Material and Methods: A retrospective analysis of patient data was conducted to identify patients over the age of 60 years with comor- bidities that underwent pretibial soft tissue reconstruction with a single-pedicle perforator flap. Patient demographics, size and cause of the defect, flap dimension, arc of rotation and complications were recorded. Results: Five patients with an average age of 71.4 years were in- cluded. The arc of rotation was 69 °, all flaps healed. There were two recurrences of osteomyelitis. Conclusion: Lateral perforators originating from the anterior tib- ial artery or peroneal artery are adequate source vessels for single pedicled perforator flaps even in medically compromised patients. A perforator located proximal to the defect allows limiting the arcof rotation to less than 90 °, which increases the safety of the flap. Patients benefit from a simple procedure without a microvascular anastomosis and a donor site confined to one extremity},
  language  = {en}
}
@article{JordanJaeckleScheidtetal.2020,
  author    = {Jordan, Martin C. and J{\"a}ckle, Veronika and Scheidt, Sebastian and Eden, Lars and Gilbert, Fabian and Heintel, Timo M. and Jansen, Hendrik and Meffert, Rainer H.},
  title     = {Ergebnisse nach Plattenstabilisierung der Symphysensprengung},
  series = {Der Unfallchirurg},
  volume    = {123},
  journal   = {Der Unfallchirurg},
  issn      = {0177-5537},
  doi       = {10.1007/s00113-020-00804-8},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-232447},
  pages     = {870-878},
  year      = {2020},
  abstract  = {Hintergrund Die Symphysensprengung mit entsprechender Diastase kann durch eine Symphysenplatte stabilisiert werden. Fragestellung Welche Beckenverletzungen werden mit einer Symphysenplatte stabilisiert und wie ist das Outcome? Material und Methoden Retrospektive Auswertung von 64 Patienten {\"u}ber einen Untersuchungszeitraum von 24 Monaten. Ergebnisse Es waren 56 Patienten m{\"a}nnlich, 8 weiblich und das mittlere Alter betrug 44 Jahre (SD ± 17). Unf{\"a}lle im Straßenverkehr waren der f{\"u}hrende Grund f{\"u}r die Beckenverletzung. Die Verteilung nach AO-Klassifikation zeigte sich wie folgt: 14-mal B1-, 10-mal B2-, 5‑mal B3-, 23-mal C1-, 9‑mal C2- und 3‑mal C3-Verletzungen. Die Verteilung nach Young und Burgess ergab: 9‑mal APC-I-, 18-mal APC-II-, 13-mal APC-III-, 9‑mal LC-I-, 3‑mal LC-II-, 2‑mal LC-III- und 10-mal VS-Verletzungen. Der mittlere Injury Severity Score (ISS) betrug 32 und die mittlere station{\"a}re Verweildauer 29 Tage (pos. Korrelation p ≤ 0,001). Im Verlauf war eine radiologische Implantatlockerung bei 52 Patienten nachweisbar. Therapierelevante Komplikationen gab es in 14 F{\"a}llen. Hierbei war das Implantatversagen (n = 8) der Hauptgrund f{\"u}r eine operative Revision. Diskussion Obwohl die radiologische Implantatlockerung h{\"a}ufig beobachtet wird, ist sie nur selten Grund f{\"u}r einen Revisionseingriff. Kommt es hingegen zum vollst{\"a}ndigen Implantatversagen, tritt dies meist innerhalb der ersten postoperativen Wochen auf und ist revisionsbed{\"u}rftig. Eine fr{\"u}hzeitige Abkl{\"a}rung durch R{\"o}ntgenbildgebung sollte bei Verdacht erfolgen.},
  language  = {de}
}
@article{BauerOpitzFilseretal.2019,
  author    = {Bauer, Maria and Opitz, Anne and Filser, J{\"o}rg and Jansen, Hendrik and Meffert, Rainer H. and Germer, Christoph T. and Roewer, Norbert and Muellenbach, Ralf M. and Kredel, Markus},
  title     = {Perioperative redistribution of regional ventilation and pulmonary function: a prospective observational study in two cohorts of patients at risk for postoperative pulmonary complications},
  series = {BMC Anesthesiology},
  volume    = {19},
  journal   = {BMC Anesthesiology},
  doi       = {10.1186/s12871-019-0805-8},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-200730},
  pages     = {132},
  year      = {2019},
  abstract  = {Background Postoperative pulmonary complications (PPCs) increase morbidity and mortality of surgical patients, duration of hospital stay and costs. Postoperative atelectasis of dorsal lung regions as a common PPC has been described before, but its clinical relevance is insufficiently examined. Pulmonary electrical impedance tomography (EIT) enables the bedside visualization of regional ventilation in real-time within a transversal section of the lung. Dorsal atelectasis or effusions might cause a ventral redistribution of ventilation. We hypothesized the existence of ventral redistribution in spontaneously breathing patients during their recovery from abdominal and peripheral surgery and that vital capacity is reduced if regional ventilation shifts to ventral lung regions. Methods This prospective observational study included 69 adult patients undergoing elective surgery with an expected intermediate or high risk for PPCs. Patients undergoing abdominal and peripheral surgery were recruited to obtain groups of equal size. Patients received general anesthesia with and without additional regional anesthesia. On the preoperative, the first and the third postoperative day, EIT was performed at rest and during spirometry (forced breathing). The center of ventilation in dorso-ventral direction (COVy) was calculated. Results Both groups received intraoperative low tidal volume ventilation. Postoperative ventral redistribution of ventilation (forced breathing COVy; preoperative: 16.5 (16.0-17.3); first day: 17.8 (16.9-18.2), p < 0.004; third day: 17.4 (16.2-18.2), p = 0.020) and decreased forced vital capacity in percentage of predicted values (FVC\%predicted) (median: 93, 58, 64\%, respectively) persisted after abdominal surgery. In addition, dorsal to ventral shift was associated with a decrease of the FVC\%predicted on the third postoperative day (r = - 0.66; p < 0.001). A redistribution of pulmonary ventilation was not observed after peripheral surgery. FVC\%predicted was only decreased on the first postoperative day (median FVC\%predicted on the preoperative, first and third day: 85, 81 and 88\%, respectively). In ten patients occurred pulmonary complications after abdominal surgery also in two patients after peripheral surgery. Conclusions After abdominal surgery ventral redistribution of ventilation persisted up to the third postoperative day and was associated with decreased vital capacity. The peripheral surgery group showed only minor changes in vital capacity, suggesting a role of the location of surgery for postoperative redistribution of pulmonary ventilation.},
  language  = {en}
}
@article{JakubietzJakubietzHorchetal.2019,
  author    = {Jakubietz, Rafael G. and Jakubietz, Danni F. and Horch, Raymund E. and Gruenert, Joerg G. and Meffert, Rainer H. and Jakubietz, Michael G.},
  title     = {The microvascular peroneal artery perforator flap as a "lifeboat" for pedicled flaps},
  series = {Plastic and Reconstructive Surgery - Global Open},
  volume    = {7},
  journal   = {Plastic and Reconstructive Surgery - Global Open},
  number    = {9},
  doi       = {10.1097/GOX.0000000000002396},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-202233},
  pages     = {e2396},
  year      = {2019},
  abstract  = {Background: Pedicled perforator flaps have expanded reconstructive options in extremity reconstruction. Despite preoperative mapping, intraoperative findings may require microvascular tissue transfer when no adequate perforators can be found. The free peroneal artery perforator flap may serve as a reliable back-up plan in small defects. Methods: In 16 patients with small soft tissue defects on the upper and lower extremities, perforator-based propeller flaps were planned. The handheld Doppler device was used to localize potential perforators for a propeller flap in close proximity to the defect. Perforators of the proximal peroneal artery were also marked to allow conversion to microvascular tissue transfer. Results: In 6 cases, no adequate perforators were found intraoperatively. In 4 patients, the peroneal artery perforator flap was harvested and transferred. The pedicle length did not exceed 4 cm. No flap loss occurred. Conclusions: When no adequate perforator capable of nourishing a propeller flap can be found intraoperatively, the free peroneal artery flap is a good option to reconstruct small soft tissue defects in the distal extremities. The short vascular pedicle is less ideal in cases with a large zone of injury requiring a more distant site of anastomosis or when recipient vessels are located in deeper tissue planes.},
  language  = {en}
}
@article{JakubietzSchmidtBernuthetal.2019,
  author    = {Jakubietz, Rafael G. and Schmidt, Karsten and Bernuth, Silvia and Meffert, Rainer H. and Jakubietz, Michael G.},
  title     = {Evaluation of the intraoperative blood flow of pedicled perforator flaps using indocyanine green-fluorescence angiography},
  series = {Plastic and Reconstructive Surgery - Global Open},
  volume    = {7},
  journal   = {Plastic and Reconstructive Surgery - Global Open},
  number    = {9},
  doi       = {10.1097/GOX.0000000000002462},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-202625},
  pages     = {e2462},
  year      = {2019},
  abstract  = {Background: Although indocyanine-green fluorescence angiography (ICG-FA) has been established as a useful tool to assess perfusion in free tissue transfer, only few studies have applied this modality to pedicled perforator flaps. As both volume and reach of pedicled perforator flaps are limited and tip necrosis often equals complete flap failure, ICG-FA may help to detect hypoperfusion in pedicled flaps. Methods: In 5 patients, soft tissue reconstruction was achieved with pedicled perforator flaps. ICG-FA was utilized intraoperatively to visualize flap perfusion. Results: Three pedicled anterolateral thigh flap flaps and 2 propeller flaps were transferred. ICG-FA detected hypoperfusion in 2 flaps. No flap loss occurred; in 2 cases, prolonged wound healing was encountered. Conclusions: ICG-FA confirmed clinical findings and reliably detected tissue areas with hypoperfusion. A clear cut-off point between nonvital tissue and such that stabilized in the following clinical course could not be found. ICG-FA is a promising technology which could also be used in pedicled perforator flaps.},
  language  = {en}
}
@article{JansenHeintelJordanetal.2019,
  author    = {Jansen, Hendrik and Heintel, Timo M. and Jordan, Martin and Meffert, Rainer H. and Frey, Soenke P.},
  title     = {Survived traumatic hemipelvectomy with salvage of the limb in a 14  months old toddler},
  series = {Trauma Case Reports},
  volume    = {22},
  journal   = {Trauma Case Reports},
  doi       = {10.1016/j.tcr.2019.100220},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-202207},
  pages     = {100220},
  year      = {2019},
  abstract  = {We report on a 14 months old toddler who sustained a traumatic hemipelvectomy by being crushed between a car and a stone wall. After stabilization in the resuscitation room he was treated operatively by laparotomy, osteosynthesis of the pelvic ring, reconstruction of the both external iliac vessels and the urethra and reposition of the testicles. After 66 days he was discharged into rehabilitation. Implants were removed after eight months. 20 months after the injury, the leg was plegic, initial radiological signs of femoral head necrosis showed up but the infant was able to walk with an orthesis and a walker. Up to our knowledge, this is the youngest patient described in the literature with a survived traumatic hemipelvectomy and salvaged limb.},
  language  = {en}
}
@article{GilbertJakubietzMeffertetal.2018,
  author    = {Gilbert, Fabian and Jakubietz, Rafael G. and Meffert, Rainer H. and Jakubietz, Michael G.},
  title     = {Does distal radio-ulnar joint configuration affect postoperative functional results after ulnar shortening osteotomy?},
  series = {PRS Global Open},
  volume    = {6},
  journal   = {PRS Global Open},
  number    = {4},
  doi       = {10.1097/GOX.0000000000001760},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-176265},
  pages     = {e1760},
  year      = {2018},
  abstract  = {Background: Reverse oblique distal radio-ulnar joint (DRUJ) configuration is assumed to show inferior postoperative results in ulnar-shortening osteotomy due to osteoarthritis, as the joint force pressure in the DRUJ may be increased. An evaluation and comparison of the postoperative functional results with regard to clinical and radiographic signs of arthritis among different DRUJ configurations was carried out retrospectively. Methods: Sixty-two patients after ulnar shortening osteotomy were included. The minimum follow-up was 5 years. Preoperative x-rays were assessed for the DRUJ configuration according to the Tolat classification, whereas postoperative radiographs were evaluated with regard to signs of osteoarthritis using the Kallgren-Lawrence-Score. Functional results were evaluated using the disabilities of the arm, shoulder and hand (DASH) and Mayo Wrist Score and measuring range of motion and grip strength. Results: Significantly better functional results were found in patients with parallel configuration of the DRUJ (Tolat type 1 configuration) with regard to DASH score, grip strength, and supination compared with nonparallel configurations. In the Tolat type 1, configurated DRUJ mean DASH score was 9 compared with 18 in the Tolat type 2 and 3 groups. Apart from supination, no differences were observed in range of motion among groups. Conclusion: Although long-term postoperative range of motion failed to display statistically significant differences between DRUJ configurations except for supination, better results regarding grip strength and DASH scores were seen in a parallel-aligned DRUJ configuration. Although onset of osteoarthritis does not seem to become apparent within the observation period, nonparallel aligned configuration predisposes to inferior results.},
  language  = {en}
}