Publications by authors named "P Schepers"

20 Publications

Pedestrian falls: A review of the literature and future research directions.

J Safety Res 2017 09 10;62:227-234. Epub 2017 Jul 10.

Utrecht University, Department of Human Geography and Spatial Planning, The Netherlands.

Introduction: Pedestrian falls (PFs) - falls in public spaces without collisions with other road users - are a significant cause of serious transport-related injuries, amounting to three-quarters of all pedestrians admitted to hospital.

Methods: This scoping review examined peer-reviewed research on PFs published between 1995 and 2015. Electronic databases (Scopus, SafetyLit, and PubMed) were used to find studies identifying PFs or outdoor falls (the latter also including falls in gardens).

Results: We identified only 28 studies reporting relevant information on PFs (i.e., 15 prospective, 10 retrospective, and 3 intervention studies). The results show that more walking is related to a lower risk of PFs. Older people, especially older women, have a higher risk of (injurious) PFs. Outdoor fall victims have equally good or better health characteristics and scores on balance tests compared to those who have not experienced such falls. Road factors such as uneven surfaces, busy junctions, stairs, and slippery surfaces seem to play an important role in PFs, but much of the research on these factors is of a qualitative nature.

Conclusions: PF victims are generally in good health (apart from normal age-related problems) but at risk due to road factors.

Practical Applications: We recommend to adopt a human factors approach. The road system should be adapted to human capabilities and limitations including those of pedestrians. Measures such as preventing uneven surfaces and good winter maintenance seem to be effective. However, we advise more quantitative research on road factors to inform design guidelines and standards for public space authorities given the qualitative nature of current research on road factors.
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http://dx.doi.org/10.1016/j.jsr.2017.06.020DOI Listing
September 2017

Silver-coated endoprosthetic replacement of the proximal humerus in case of tumour-is there an increased risk of periprosthetic infection by using a trevira tube?

Int Orthop 2017 Feb 9;41(2):423-428. Epub 2016 Nov 9.

Department for Orthopaedics und Trauma Surgery, Rheinische Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany.

Background And Objectives: The aim of our study was to evaluate if there is an increased risk of periprosthetic infection (PJI) in patients following replacement of the proximal humerus by using a modular tumour prosthesis in combination with a trevira tube.

Methods: Thirty patients were treated by using a modular tumour endoprosthesis (MUTARS®) following intra-articular resection of the proximal humerus. Fifteen patients received treatment by using a trevira tube. In 15 further cases the use of a trevira tube was not necessary. The mean follow-up time was 26 months (range: 24 months to 84 months). Both, Enneking score and range of motion (ROM), was evaluated. Further radiographs were obtained in two planes.

Results: The survival rate one year after surgery was 83 % and 63 % after two years. We recorded a 96 % survival of the limb two years after surgery. We also observed only one case of periprosthetic joint infection (PJI) in the entire follow-up period in one patient who received treatment with a trevira tube. The mean Enneking score was 20 points (range 8 to 26 points). ROM was equal in both study groups. In total 20 % of the treated patients (n = 6) suffered complications.

Conclusions: Replacement of the proximal humerus by using a trevira tube in combination with a modular tumour endoprosthesis is a safe and viable treatment option for both, bone tumours and metastases. There is no statistically significant increased risk of infection by using trevira tube even among immunosuppressed patients.

Level Of Evidence: Level 3, retrospective comparative study.
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http://dx.doi.org/10.1007/s00264-016-3329-6DOI Listing
February 2017

Lower limb reconstruction in tumor patients using modular silver-coated megaprostheses with regard to perimegaprosthetic joint infection: a case series, including 100 patients and review of the literature.

Arch Orthop Trauma Surg 2017 Feb 25;137(2):149-153. Epub 2016 Oct 25.

Department for Orthopaedics und Trauma Surgery, Rheinische Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany.

Purpose And Objective: Bone resection regarding adequate surgical margins is the treatment of choice for malignant bone tumors. In the case of metastasis-related complications, so-called skeletal-related events, it is highly important to achieve pain relief and a stable joint situation to re-mobilize the patients immediately following surgery. To bridge the often large osseous defect zones after tumor resection, both cemented and uncemented modular endoprosthetic systems are widely used. Patients undergoing tumor-related endoprosthetic orthopedic surgery are facing high risk for developing a periprosthetic joint infection (PJI). The immunocompromised condition due to anti-neoplastic treatment and long operation time with large exposure of tissue contributes to a high risk of infection.

Methods: The authors present a case series of 100 patients (31% primary bone tumor and 69% metastasis-related surgery) undergoing tumor-related lower limb salvage surgery with special regard to periprosthetic joint infection and the management of this "difficult to treat" situation. Furthermore, a review of the current literature regarding infection following bone tumor resection and endoprosthetic reconstruction is performed and discussed.

Results: The median follow-up was 24 months (range 12-108 months). Ten patients (10%) suffered from a periprosthetic joint infection. We recorded six acute infections (type I) <4 weeks after surgery, one infection >4 weeks after surgery (type II), and three late infections (type III). According to the definition of Laffer et al., three of our patients (30%) are probably free of infection, one patient died of PJI-associated sepsis, and five patients were free of infection, but without restoration of the affected joint.

Conclusion: In conclusion, our own results show that perimegaprosthetic joint infection among silver-coated implants, in patients undergoing tumor-related surgery of the lower limb, is lower compared to non-silver-coated implants. Due to heterogeneity of patients and potential treatment options, the treatment regime should be tailored for the patients' individual situation.
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http://dx.doi.org/10.1007/s00402-016-2584-8DOI Listing
February 2017

[The Role of a Modular Universal Tumour and Revision System (MUTARS®) in Lower Limb Endoprosthetic Revision Surgery - Outcome Analysis of 25 Patients].

Z Orthop Unfall 2017 Feb 15;155(1):61-66. Epub 2016 Sep 15.

Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn.

With extended life expectancy, the number of primary joint arthroplasties has also increased. Revision surgery is also more often necessary, due to aseptic or septic loosening of the prosthesis or periprosthetic fracture. Large bone defects often occur in these patients and several non-modular, conventional implants are available to handle this difficult situation. Custom made implants offer an individually designed and defect-adapted shape with perfect covering of the lesion, but may delay the operation. The Modular Universal Tumor And Revision System (MUTARS®) offers the possibility to vary the length and angle of the femoral neck and the antetorsion angle. Thus, it permits intraoperative adaption to the individual patient's defect. The aim of our study is to present clinical, functional results and the rate of complications in a cohort of patients undergoing revision surgery for failed endoprosthetic replacement or failed trauma surgery, using the Modular Universal Tumor And Revision System with short-to midterm follow-up. Between August 2005 and September 2014, 25 patients (17 female, 8 male) with an average age of 72 years (min. 56, max. 92 years) were included in a retrospective study using the MUTARS® system. The patients underwent surgical revision of osseous defects that were not susceptible to conventional care. The mean follow-up was 16 months (min. 12, max. 72 months). The indications which led to revision surgery were as follows: loosened metal-on-metal prosthesis with an acetabular defect caused by a metal-induced granuloma (n = 1), pseudoarthrosis after implantation of femur nail (n = 2), cut-out of a femur nail (n = 1), aseptic loosening of an implanted endoprosthesis (n = 4), septic loosening of an implanted endoprosthesis (n = 1), periprosthetic fracture (n = 6) and periprosthetic infection after two stage revision surgery (infection consolidated Girdlestone situation) (n = 10). All patients were followed up at regular intervals, both clinically and radiologically. Apart from comorbidities, clinical and functional parameters were measured, including the Harris Hip Score. An outcome analysis was also performed with respect to peri- and postoperative complications. Serial plain X-rays were followed-up. In all patients, stable reconstruction without the use of an allograft was possible. In total, 23 patients underwent surgery by using a proximal femur prosthesis; three patients also received a custom made acetabular component. One patient was treated by using a distal femur and one patient was treated by implantation of a total femur prosthesis. The average length of hospital stay was 25 days (min.11, max. 47 days). The Harris Hip Score improved from 28 points preoperatively to 81 points after surgery.In total we recorded 24 % of complications after surgery. Two patients suffered recurrent periprosthetic infection and the prosthesis had to be revised in a further two stage exchange; one patient had a tractus gap and was revised by surgery. Two patients suffered periprosthetic fracture due to trauma and the patient with the total femur prosthesis suffered recurrent periprosthetic infection of the silver - coated mega-prosthesis and committed suicide triggered by an episode of major depression. Because of its modular nature, the Modular Tumor And Revision System (MUTARS®) can be used for highly variable intraoperative defect adaption. Good clinical and functional results were achieved in patients with excessive bone defects. However, the high rate of infection, even with silver coated mega-implants, is still a problem and should be studied further.
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http://dx.doi.org/10.1055/s-0042-114704DOI Listing
February 2017

Can cycling safety be improved by opening all unidirectional cycle paths for cycle traffic in both directions? A theoretical examination of available literature and data.

Accid Anal Prev 2017 Aug 1;105:38-43. Epub 2016 Jun 1.

Institute for Sensible Transport, Australia.

Many studies have found bicycle-motor vehicle crashes to be more likely on bidirectional cycle paths than on unidirectional cycle paths because drivers do not expect cyclists riding at the right side of the road. In this paper we discuss the hypothesis that opening all unidirectional cycle paths for cycle traffic in both directions prevent this lack of expectancy and accordingly improves cycling safety. A new national standard requires careful consideration because a reversal is difficult once cyclists are used to their new freedom of route choice. We therefore explored the hypothesis using available data, research, and theories. The results show that of the length of cycle paths along distributor roads in the Netherlands, 72% is bidirectional. If drivers would become used to cyclists riding at the left side of the road, this result raises the question of why bidirectional cycle paths in the Netherlands still have a poor safety record compared to unidirectional cycle paths. Moreover, our exploration suggested that bidirectional cycle paths have additional safety problems. It increases the complexity of unsignalized intersections because drivers have to scan more directions in a short period of time. Moreover, there are some indications that the likelihood of frontal crashes between cyclists increases. We reject the hypothesis that opening all unidirectional cycle paths for cycle traffic in both directions will improve cycle safety. We recommend more attention for mitigating measures given the widespread application of bidirectional cycle paths in the Netherlands.
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http://dx.doi.org/10.1016/j.aap.2016.05.018DOI Listing
August 2017
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