Publications by authors named "Philipp Lechler"

63 Publications

[Cost analysis of inpatient versus outpatient intravenous antibiotic treatment for periprosthetic joint infections : A simulation].

Orthopade 2021 Feb;50(2):150-158

Klinik für Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.

Background: Parenteral antibiotic administration in the treatment of periprosthetic joint infections (PJI) often requires inpatient settings. This is associated with significant costs to the healthcare system.

Objective: The costs of inpatient parenteral antibiotic treatment (IPAT) and simulated costs of outpatient parenteral antibiotic treatment (OPAT) were compared in patients with PJI. Evaluations were carried out from the perspectives of cost bearers (insurances) and healthcare providers (hospitals).

Material And Methods: The analysis and simulations were performed for all cases with the ICD-10 diagnosis T84 in the treatment year 2015.

Results: The simulated reduction of 159 bed-days in the 12 patients included in the study resulted in a reduction of the total costs of>18,000 € from the perspective of the health insurance. From the perspective of the hospitals the pure proceeds were improved by >22,000 €. The total costs of OPAT were >57,000 € for the health insurance. For hospitals the difference of policlinic proceeds and costs of OPAT showed a loss of >1500 €.

Conclusion: For hospitals the OPAT is overall financially advantageous. Further advantages due to opportunity costs seem to be interesting. For cost bearers OPAT is associated with an additional financial expenditure, particularly due to costs of outpatient medication. The private sector should be considered due to the assumed additional burden as well as the assumed patient comfort.
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http://dx.doi.org/10.1007/s00132-020-03889-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7862513PMC
February 2021

Publication rate of abstracts presented at the Congress of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT).

Orthop Traumatol Surg Res 2019 Oct 3:1453-1457. Epub 2019 Oct 3.

Department of Orthopaedics and Traumatology, Cologne University Hospital, Joseph-Stelzmann-Strasse 24, 50931 Cologne, Germany.

Background: The publication rate of presented abstracts is an important parameter to assess the scientific quality of medical congresses. It has been investigated for many congresses in orthopaedics and traumatology, but until now, it has not been studied for the congress of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT). The aims of this study were to determine: (1) the publication rate of the EFORT congress, (2) factors that favour publication of abstracts presented at the EFORT congress, (3) the consistency between the congress abstract and publication in relation to authorship.

Hypothesis: There are factors that favour publication of abstracts presented at the EFORT congress and there is a high consistency between the congress abstract and publication in relation to authorship.

Materials And Methods: All 1624 abstracts presented at the EFORT congress in 2011 were included in this study, to allow a 5-year period for publication after the congress. The characteristics of the abstracts presented were studied and the publication rate in peer-reviewed journals was determined using a Medline search.

Results: The publication rate for studies presented at the 2011 EFORT congress was 42% (677/1624 abstracts), with a mean of 16 months (-56 to 60 months) between congress and publication. The mean impact factor of the publications was 1.8 (0-7.6). A significantly higher publication rate was found for: oral presentations (52%; 322/617) versus posters (35%; 355/1007) (p<0.01), experimental studies (53%; 110/208) versus clinical studies (40%; 507/1254) (p<0.01), and studies with higher levels of evidence of I or II (59%; 144/244) versus studies with lower levels of evidence of III or IV (36%; 362/1005) (p<0.01). A new author was added in 59% (403/677) of the publications.

Discussion: Factors that favour publication of abstracts presented at the EFORT congress are oral presentation, experimental study, and a study with a higher level of evidence of I or II. It is common that a new author is added in the publication. Nevertheless, a high percentage of congress abstracts (58%; 947/1624) remains unpublished.

Level Of Evidence: IV, retrospective study.
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http://dx.doi.org/10.1016/j.otsr.2019.07.014DOI Listing
October 2019

Cost-analysis of inpatient and outpatient parenteral antimicrobial therapy in orthopaedics: A systematic literature review.

World J Clin Cases 2019 Jul;7(14):1825-1836

Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne 50931, Germany.

Background: Increasing numbers of total joint arthroplasties and consecutive revision surgery are associated with the risk of periprosthetic joint infections (PPJI). Treatment of PPJI is complex and associated with immense socio-economic burden. One treatment aspect is parenteral antiinfective therapy, which usually requires an inpatient setting [Inpatient parenteral antibiotic therapy (IPAT)]. An alternative is outpatient parenteral treatment [Outpatient parenteral antibiotic therapy (OPAT)]. To conduct a health economic cost-benefit analysis of OPAT, a detailed cost analysis of IPAT and OPAT is required. So far, there is a lack of knowledge on the health economic effects of IPAT and OPAT for PPJI.

Aim: To review an economic comparison of IPAT and OPAT.

Methods: A systematic literature review was performed through Medline following the PRISMA guidelines.

Results: Of 619 identified studies, 174 included information of interest and 21 studies were included for quantitative analysis of OPAT and IPAT costs. Except for one study, all showed relevant cost savings for OPAT compared to IPAT. Costs for IPAT were between 1.10 to 17.34 times higher than those for OPAT.

Conclusion: There are only few reports on OPAT for PPJI. Detailed analyses to support economic or clinical guidelines are therefore limited. There is good clinical evidence supporting economic benefits of OPAT, but more high quality studies are needed for PPJI.
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http://dx.doi.org/10.12998/wjcc.v7.i14.1825DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6692268PMC
July 2019

[A minimally invasive technique for removal of a firmly fixed Küntscher nail in primary hip arthroplasty].

Unfallchirurg 2019 Aug;122(8):646-649

Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Marburg, Baldingerstraße, 35043, Marburg, Deutschland.

This article reports the case of an 80-year-old male patient who presented to this hospital with symptomatic arthritis of the left hip. The special feature of this case was a Küntscher nail in the left femur that had been in situ for more than 50 years. Before implantation of the total hip arthroplasty the nail first had to be removed. As the Küntscher nail is a rarity nowadays there is no standardized procedure for the removal of such a nail. This case report describes a minimally invasive possibility to remove a Küntscher nail in total hip arthroplasty.
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http://dx.doi.org/10.1007/s00113-019-0624-xDOI Listing
August 2019

Risk factors for secondary displacement in conservatively treated isolated greater tuberosity fractures: An analysis of 82 cases.

Orthop Traumatol Surg Res 2019 04 8;105(2):317-322. Epub 2019 Jan 8.

Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Baldingerstraße, 35043 Marburg, Germany. Electronic address:

Introduction: The optimal treatment of isolated fractures of the greater tuberosity is an important topic of current surgical research. While non-displaced fractures are amenable to conservative treatment, displacement of the fragment can result in rotator cuff malfunction and impingement. For the present study, risk factors predicting secondary fragment displacement were analyzed.

Hypothesis: Certain risk factors determine a higher risk of secondary displacement in patients with greater tuberosity fractures.

Patients And Methods: All patients diagnosed with a fracture of the greater tuberosity and initially treated non-surgically at our Level I trauma center between January 2008 and July 2015 were included in this retrospective analysis. Patients were grouped into: no secondary displacement (group 1) and secondary displacement at follow-up (group 2). The following risk factors were analyzed: age, gender, side of fracture, initial displacement, fragment/head ratio, fragment shape, dislocation, concomitant fractures and concomitant fractures to the same extremity.

Results: 82 patients (42 male, 40 female) were eligible for further analyses. Median follow-up was 8.0±39.5 days. Patients with secondary displacement (group 2) were significantly older (group 1: 51.7±15.5, group 2: 68.3±14.3; p<0.001) and had significantly more shoulder dislocations (p=0.024), whereas gender (p=0.299), side of fracture (p=0.189) and fragment/head ratio (p=0.660) showed no significant different distribution between both groups. Finally, split-type fractures increased the risk of secondary displacement.

Discussion: The present study identified age older than 65 years to be an important risk factor for secondary displacement in the conservative management of fractures of the greater tuberosity. Furthermore, fracture type and shoulder dislocations are factors associated with an increased relative risk for secondary displacement.

Level Of Proof: III, Retrospective comparative study.
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http://dx.doi.org/10.1016/j.otsr.2018.06.017DOI Listing
April 2019

Cement augmentation of glenoid baseplate screws does not improve primary stability in reversed shoulder arthroplasty: A cadaveric study.

Orthop Traumatol Surg Res 2019 04 21;105(2):219-223. Epub 2018 Dec 21.

Center for Orthopeadics and Trauma Surgery, University Hospital Gießen and Marburg, 35043 Marburg, Germany. Electronic address:

Introduction: Cuff tear arthritis and complex proximal humeral fractures are common pathologies that are frequently addressed by the implantation of a reversed shoulder prosthesis. The present cadaveric study aimed to analyze the effect of cement augmentation of the glenoid component on the primary stability in geriatric patients.

Hypothesis: Cement augmentation of glenoid baseplate screws has an influence on primary stability in reversed shoulder arthroplasty (RSA).

Materials And Methods: Glenoid base plates (Delta Xtend, DePuy Synthes, Westchester, USA) were implanted in 6 pairs of formalin-fixated scapulae of 4 female and 2 male donors (average age 83 years). Two angle stable screws were placed at the superior and inferior position. Cement augmentation was performed with 2ml bone cement (Kyphon, Medtronic, Minneapolis, USA) per screw in right specimens. Afterwards, biomechanical testing with 600 to 1000N (100 cycles) at a 65° abduction angle was performed. Finally, a load-to-failure analysis was conducted.

Results: No implant loosening was observed during cyclic tests from 600N to 1000N. In addition no difference in the plastic deformation was detected at 600N (p=0.301), 700N (p=0.522), 800N (p=0.480), 900N (p=0.521) and 1000N (p=0.748). Load-to-failure analyses revealed implant loosening at 3314N (SD 823N) in the cement-augmented implants and at 3059N (SD 974N) in scapulae with non-cemented screws (p=0.522).

Discussion: Cement-augmented fixation of the glenoid component did not result in an increased primary stability in this study. Thus, the application of cement should be critically assessed considering associated risks and increased costs.

Level Of Proof: Basic science study, controlled laboratory study.
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http://dx.doi.org/10.1016/j.otsr.2018.10.006DOI Listing
April 2019

Operative treatment of geriatric ankle fractures with conventional or locking plates. A retrospective case-control study.

Foot Ankle Surg 2019 Dec 23;25(6):766-770. Epub 2018 Oct 23.

Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Marburg, Germany. Electronic address:

Background: The incidence of geriatric ankle fractures continues to rise due to demographic changes. While locking plates have become standard implants for injuries of other body regions, clinical studies on their use for geriatric ankle fractures are rare.

Methods: Therefore, a retrospective case-control study, including 333 patients with a mean age of 73.5 years was performed. 263 patients underwent operative fixation with one- third tubular plates and 70 were treated with locking plates. Early outcomes and complication rates of locking plates as compared with conventional one- third tubular plates are described.

Results: In the present study, patients treated with locking plates were older and suffered from more severe fracture patterns. In addition, these patients had more severe comorbidities. Treatment with conventional or locking plate fixation resulted in a comparable complication and revision rate. A matched pair analysis showed significantly more complications and required revision surgeries and a trend towards more implant failures in the group that underwent conventional plating.

Conclusions: Therefore, we conclude that precontoured locking plates represent an appropriate treatment option for severe ankle fractures in patients suffering from relevant co-morbidities. Prospective randomized trials are warranted to prove superiority of locking plates for treatment of geriatric ankle fractures. Level 3: Retrospective case- control study.
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http://dx.doi.org/10.1016/j.fas.2018.10.002DOI Listing
December 2019

Panobinostat mediated cell death: a novel therapeutic approach for osteosarcoma.

Oncotarget 2018 Aug 31;9(68):32997-33010. Epub 2018 Aug 31.

Department of Visceral, Thoracic and Vascular Surgery, Philipps University of Marburg, Baldingerstrasse 35043 Marburg, Germany.

Osteosarcoma is an aggressive cancer with a poor long term prognosis. Neo-adjuvant poly-chemotherapy followed by surgical resection remains the standard treatment, which is restricted by multi-drug resistance. If first-line therapy fails, disease control and patient survival rate drop dramatically. We aimed to identify alternative apoptotic mechanisms induced by the histone deacetylase inhibitor panobinostat in osteosarcoma cells. Saos-2, MG63 and U2-OS osteosarcoma cell lines, the immortalized human osteoblast line hFOB and the mouse embryo osteoblasts (MC3T3-E1) were treated with panobinostat. Real time viability and FACS confirmed the cytotoxicity of panobinostat. Cell stress/death related factors were analysed by RT-qPCR and western blot. Cell morphology was assessed by electron microscopy. 10 nM panobinostat caused cell viability arrest and death in all osteosarcoma and osteoblast cells. P21 up-regulation was observed in osteosarcoma cells, while over-expression of p73 was restricted to Saos-2 (TP53). Survivin and Bcl-2 were suppressed by panobinostat. Endoplasmic reticulum (ER) stress markers BiP, CHOP, ATF4 and ATF6 were induced in osteosarcoma cells. The un-spliced Xbp was no further detectable after treatment. Autophagy players Beclin1, Map1LC3B and UVRAG transcripts over-expressed after 6 hours. Protein levels of Beclin1, Map1LC3B and p62 were up-regulated at 72 hours. DRAM1 was stable. Electron micrographs revealed the fragmentation and the disappearance of the ER and the statistically significant increase of autophagosome vesiculation after treatment. Panobinostat showed a synergistic suppression of survival and promotion of cell death in osteosarcoma cells. Panobinostat offers new perspectives for the treatment of osteosarcoma and other malignant bone tumours.
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http://dx.doi.org/10.18632/oncotarget.26038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6152475PMC
August 2018

Influence of calibration on digital templating of hip arthroplasty.

Int Orthop 2019 08 21;43(8):1799-1805. Epub 2018 Aug 21.

Department of Spine Surgery, Schön Klinik Düsseldorf, Düsseldorf, Germany.

Introduction: Digital templating for total joint replacement is the current standard. For image calibration, external calibration markers (ECM) are used. However, there are concerns regarding the precision of the method. This study aimed to identify the direct influence of calibration errors on digital templating.

Patients And Methods: A retrospective analysis of 100 post-operative radiographs with unilateral total hip arthroplasty was performed. The magnification factor of the ECM and of the internal prosthetic femoral head (ICM) as a reference value was calculated for each radiograph. Two blinded observers performed templating of the contralateral hip using a randomized list for all radiographs and both markers. The component size templated by the ECM magnification was compared to the reference by the ICM magnification.

Results: Mean magnification factors of ICM and ECM differed significantly (p = 0.006). The absolute difference was 5.2% (range 0.0-23.3%, SD 4.8%). Templating of the acetabular or the femoral component showed no significant differences (p = 0.120, p = 0.599). Differences of more than one size were found in 26% of the acetabular components and 14% of the femoral components and differences over two sizes in 10% respectively 3%. Correlation coefficients for magnification error and size differences of acetabular components were - 0.645 (p < 0.001) and for the femoral component - 0.607 (p < 0.001).

Interpretation: The calibration error of external calibration markers in digital templating for hip replacement influences component sizes significantly. Thus, correct positioning of ECM is of utmost importance.
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http://dx.doi.org/10.1007/s00264-018-4120-7DOI Listing
August 2019

Dual-position calibration markers for total hip arthroplasty: theoretical comparison to fixed calibration and single marker method.

Int Orthop 2019 03 20;43(3):589-595. Epub 2018 Jun 20.

Department of Spine Surgery, Schön Klinik Düsseldorf, Düsseldorf, Germany.

Purpose: Digital templating is considered a standard for total hip arthroplasty. Different means for the necessary calibration of radiographs are known. While single marker calibration with radiopaque spheres is the most common, it is associated with possible significant deviations from the true magnification of the hip. Notably, fixed magnification factors showed better results. Therefore, a dual-position calibration marker method was simulated and compared to the established methods.

Methods: First, an empirical fixed magnification factor was identified and applied to a series of radiographs. Second, three magnification factors were generated based on sagittal patient data of 398 CT scans. These methods were compared to the fixed factor.

Results: The fixed factor was 122.6%. In the clinical application, the error of the fixed factor was 2.5% while the error of the single marker was 5.2%. In the CT cohort, the mean reference factor was 120.5% in females and 120.3% in males. The reference factor was compared to sex-specific means, sex-specific linear functions, and sex-specific cubic functions. The best results were found for the linear regression model with a mean difference of 0.8% from the reference value. No proportional bias was found (p = 0.623).

Conclusion: The simulation of the dual-position marker method using the linear regression model showed promising results, superior to all other methods. In future studies, its clinical application should be tested.
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http://dx.doi.org/10.1007/s00264-018-4034-4DOI Listing
March 2019

Standardised pre-operative diagnostics and treatment of peripheral arterial disease reduce wound complications in geriatric ankle fractures.

Int Orthop 2018 02 14;42(2):395-400. Epub 2017 Dec 14.

Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Baldingerstraße, D-35043, Marburg, Germany.

Purpose: The aim of this study was to evaluate a standardised algorithm to assess and treat impaired limb perfusion prior to surgical fixation of geriatric ankle fractures and determine the prevalence of peripheral arterial disease (PAD) in geriatric patients presenting with ankle fractures.

Methods: Eighty-four patients >65 years pre-operatively diagnosed and treated according to an algorithm (study group) were compared with 84 patients diagnosed and treated before the algorithm was introduced (control group).

Results: In 14 patients of the study group, clinical noninvasive examination revealed signs of relevant PAD, which was confirmed with computed tomographic angiography (CTA) in nine patients, all of whom had successful angioplasty prior to surgical fixation of the ankle fracture. In three of these patients, PAD had previously been diagnosed. After standardised diagnostics and treatment of malperfusion, a significantly reduced overall and, particularly, wound complication rate was found.

Conclusion: PAD is an underdiagnosed condition in geriatric patients presenting with ankle fractures. This study underlines the relevance of limb perfusion for adequate wound healing in geriatric ankle fractures. Therefore, special attention should be paid to diagnose and-if indicated-optimise limb perfusion prior to surgical fixation of geriatric ankle fractures.
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http://dx.doi.org/10.1007/s00264-017-3705-xDOI Listing
February 2018

Multiple Trauma and Emergency Room Management.

Dtsch Arztebl Int 2017 Jul;114(29-30):497-503

Center for Orthopedics and Trauma Surgery, Gießen and Marburg University Hospital, Marburg Campus, Marburg.

Background: The care of severely injured patients remains a challenge. Their initial treatment in the emergency room is the essential link between first aid in the field and definitive in-hospital treatment.

Methods: We present important elements of the initial in-hospital care of severely injured patients on the basis of pertinent publications retrieved by a selective search in PubMed and the current German S3 guideline on the care of severely and multiply traumatized patients, which was last updated in 2016.

Results: The goal of initial emergency room care is the rapid recognition and prompt treatment of acutely life-threatening injuries in the order of their priority. The initial assessment includes physical examination and ultrasonography according to the FAST concept (Focused Assessment with Sonography in Trauma) for the recognition of intraperitoneal hemorrhage. Patients with penetrating chest injuries, massive hematothorax, and/or severe injuries of the heart and lungs undergo emergency thoracotomy; those with signs of hollow viscus perforation undergo emergency laparotomy. If the patient is hemo - dynamically stable, the most important diagnostic procedure that must be performed is computerized tomography with contrast medium. Therapeutic decision-making takes the patient's physiological parameters into account, along with the overall severity of trauma and the complexity of the individual injuries. Depending on the severity of trauma, the immediate goal can be either the prompt restoration of organ structure and function or so-called damage control surgery. The latter focuses, in the acute phase, on hemostasis and on the avoidance of secondary damage such as intra-abdominal contamination or compartment syndrome. It also involves the temporary treatment of fractures with external fixation and the planning of definitive care once the patient's organ functions have been securely stabilized.

Conclusion: The care of the severely injured patient should be performed in structured fashion according to the A-B-C-D-E scheme, which involves the securing of the airway, breathing, and circulation, the recognition of neurologic deficits, and whole-body examination by the interdisciplinary team.
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http://dx.doi.org/10.3238/arztebl.2017.0497DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569556PMC
July 2017

The Modified Femoral Neck-Shaft Angle: Age- and Sex-Dependent Reference Values and Reliability Analysis.

Biomed Res Int 2016 14;2016:8645027. Epub 2016 Dec 14.

Center of Orthopedic and Trauma Surgery, University of Giessen and Marburg, Marburg, Germany.

. The femoral neck-shaft angle (NSA) is of high importance for the diagnostics and treatment of various conditions of the hip. However, rotational effects limit its precision and applicability using plain radiographs. This study introduces a novel method to measure the femoral NSA: the modified NSA (mNSA), possibly being less susceptible against rotational effects compared to the conventional NSA. . The method of measurement is described and its applicability was tested in 400 pelvis computed tomography scans (800 hips). Age- and gender-dependent reference values are given and intra- and interrater reliability are analyzed. . The mean age of all 400 patients (800 hips) was 54.32 years (18-100, SD 22.05 years). The mean mNSA was 147.0° and the 95% confidence interval was 146.7°-147.4°. Differences of the mNSA between sexes, age groups, and sides were nonsignificant. The absolute difference between NSA and mNSA was 16.3° (range 3-31°; SD 4.4°); the correlation was high (0.738; < 0.001). Overall, the intra- and interrater reliability were excellent for the mNSA. . We introduced a novel concept for the analysis of the neck-shaft angle. The high reliability of the measurement has been proven and its robustness to hip rotation was demonstrated.
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http://dx.doi.org/10.1155/2016/8645027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5192320PMC
February 2017

Association of an In-House Blood Bank with Therapy and Outcome in Severely Injured Patients: An Analysis of 18,573 Patients from the TraumaRegister DGU®.

PLoS One 2016 3;11(11):e0148736. Epub 2016 Nov 3.

Department of Trauma, Hand and Reconstructive Surgery, University Hospital Gießen and Marburg, Marburg, Germany.

Introduction: Hemorrhagic shock remains one of the most common causes of death in severely injured patients. It is unknown to what extent the presence of a blood bank in a trauma center influences therapy and outcome in such patients.

Material And Methods: We retrospectively analyzed prospectively recorded data from the TraumaRegister DGU® and the TraumaNetzwerk DGU®. Inclusion criteria were Injury Severity Score (ISS) ≥ 16, primarily treated patients, and hospital admission 2 years before or after the audit process.

Results: Complete data sets of 18,573 patients were analyzed. Of 457 hospitals included, 33.3% had an in-house blood bank. In trauma centers with a blood bank (HospBB), packed red blood cells (PRBCs) (21.0% vs. 17.4%, p < 0.001) and fresh frozen plasma (FFP) (13.9% vs. 10.2%, p <0.001) were transfused significantly more often than in hospitals without a blood bank (Hosp0). However, no significant difference was found for in-hospital mortality (standard mortality ratio [SMR, 0.907 vs. 0.945; p = 0.25). In patients with clinically apparent shock on admission, no difference of performed transfusions were present between HospBB and Hosp0 (PRBCs, 51.4% vs. 50.4%, p = 0.67; FFP, 32.7% vs. 32.7%, p = 0.99), and no difference in in-hospital mortality was observed (SMR, 0.907 vs. 1.004; p = 0.21).

Discussion: In HospBB transfusions were performed more frequently in severely injured patients without positively affecting the 24h mortality or in-house mortality. Easy access may explain a more liberal transfusion concept.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0148736PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094683PMC
June 2017

Relationship of Prolonged Operative Time and Comorbidities With Complications After Geriatric Ankle Fractures.

Foot Ankle Int 2017 Jan 1;38(1):41-48. Epub 2016 Oct 1.

1 Center for Orthopaedics and Trauma Surgery, University Hospital of Giessen and Marburg, Marburg, Germany.

Background: The incidence of geriatric ankle fractures has increased during the last few decades. In contrast to younger patients, increased complication rates have been observed. Thus, the goal of the present study was to identify risk factors for perioperative complications following open reduction and internal fixation of geriatric ankle fractures.

Methods: Two hundred thirty-seven patients over the age of 65 years (mean, 72.5 ± 6.1 years) treated for ankle fractures in our institution between 2004 and 2014 were included. Complications associated with operative treatment as well as complications requiring revision surgery were analyzed. In a multivariate analysis, risk factors were determined.

Results: In 68 patients (28.7%), 74 complications were documented. The most common complications were impaired wound healing and operative site infections. The multivariate analysis revealed that the operative time was the only independent risk factor for the development of a complication. The operative time as well as the presence of an open fracture represented risk factors for needing revision surgery. Comorbidities did not influence the development of complications.

Conclusion: The operative management of geriatric ankle fractures was associated with a high complication rate. In the present study, the operative time was the only modifiable factor for the development of a complication that required revision surgery. During preoperative preparation, we believe that perfusion of the affected limb should be optimized to reduce the incidence of wound complications.

Level Of Evidence: Level III, retrospective cohort study.
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http://dx.doi.org/10.1177/1071100716667315DOI Listing
January 2017

Is there a benefit of proximal locking screws in osteoporotic distal radius fractures? - A biomechanical study.

Injury 2016 Aug 9;47(8):1631-5. Epub 2016 May 9.

Center for Orthopaedics and Trauma Surgery, University Hospital Gießen and Marburg, Location Marburg, Baldingerstr., 35043 Marburg, Germany. Electronic address:

Introduction: The distal radial fracture is a common fracture and frequently seen in geriatric patients. During the last years, volar plating has become a popular treatment option. While the application of locking screws at the distal fragment is widely accepted, there is no evidence for their use at the radial shaft.

Materials And Methods: In six osteoporotic pairs of matched human cadaver radii an extra-articular model creating an AO 23-A2.1 fracture was employed. Osteosynthesis were performed using the APTUS 2.5 Adaptive TriLock Distal Radius System (Medartis AG) with locking (LS) or non-locking screws (NLS) for proximal fixation. Biomechanical testing was performed in a staircase fashion: starting with 50 cycles at 200N, the load was continuously increased by 50N every 80 cycles up to a maximum force of 400N. Finally, load to failure was analyzed with failure defined as sudden loss of force measured (20%) or major deformation of the radii (10mm).

Results: At 200N, 250N, 300N, 400N and load to failure, the NLS group showed a higher degree of elastic modulus. In contrast, the LS group showed higher elastic modulus at 350N. Maximum force was higher in the LS group without reaching statistical significance. Reasons for loss of fixation were longitudinal shaft fractures, horizontal peri-implant fractures and distal cutting out. No difference was seen between the two groups concerning the development of the above mentioned complications.

Conclusion: Our study did not show biomechanical superiority for distal radius fracture fixation by using locking screws in the proximal holes in an osteoporotic cadaver study. At load to failure, longitudinal shaft fractures and peri-implant fractures seemed to be a more relevant problem rather than failure of the proximal fixation.
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http://dx.doi.org/10.1016/j.injury.2016.04.005DOI Listing
August 2016

The osseous morphology of nondegenerated shoulders shows no side-related differences in elderly patients: an analysis of 102 computed tomography scans.

J Shoulder Elbow Surg 2016 Aug 27;25(8):1297-302. Epub 2016 Apr 27.

Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany. Electronic address:

Background: A precise understanding of glenohumeral anatomy is required to optimize preoperative planning in shoulder joint arthroplasty, which is difficult in the presence of degenerative disease. In unilateral disease, the contralateral shoulder can be used as a representation of normal anatomy; however, intrasubject differences in shoulder morphology have not been investigated.

Methods: A retrospective study of all patients aged >65 years who received whole body computed tomography at our trauma center from 2010 through 2014 was conducted. Right and left shoulder computed tomography scans were examined, and the following anatomic parameters were measured: humeral head diameter in anteroposterior and axial views, glenoid diameter in anteroposterior and axial views, glenoid surface, scapula neck depth, neck-shaft angle, glenoid inclination, glenoid/head ratio, and glenoid version. Patients with inadequate scan quality, osseous lesions, pre-existing anatomic abnormality, or metallic implant at the shoulder region and significant osteoarthritis were excluded.

Results: The study analyzed 102 shoulders of 51 patients. Mean age was 71.4 ± 8.2 years. Humeral head and glenoid diameters, scapula neck depth (right, 36 ± 8 mm; left, 36 ± 7 mm; P = .684), glenoid/head ratio (right, 0.6 ± 0.1; left, 0.6 ± 0.0; P = .961), and glenoid surface (right, 790 ± 152 mm(2); left, 754 ± 134 mm(2); P = .215) showed no significant side-related differences. In addition, no significant difference was found regarding the neck-shaft angle (P = .211) and glenoid anteversion or retroversion (right, 65% [n = 33] anteversion and 35% [n = 18] retroversion; left, 69% [n = 35] anteversion and 31% [n = 16] retroversion; P = .417).

Conclusion: There are no significant side-dependent differences in the osseous anatomy of the glenohumeral joint. In patients with unilateral shoulder degeneration, the contralateral shoulder can provide reference values during the planning of shoulder replacement surgery.
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http://dx.doi.org/10.1016/j.jse.2015.12.024DOI Listing
August 2016

Agreement Between Proximal Femoral Geometry and Component Design in Total Hip Arthroplasty: Implications for Implant Choice.

J Arthroplasty 2016 08 17;31(8):1842-8. Epub 2016 Feb 17.

Center of Orthopedic and Trauma Surgery, University of Giessen and Marburg, Marburg, Germany.

Background: The present study aimed to analyze the agreement between proximal femoral geometry of adult hips and femoral component design in total hip arthroplasty.

Methods: Anatomical femoral offset (FOAnat) and the anatomical neck-shaft angle (NSAAnat) of 800 adult hips were measured by computed tomography scans, and anatomical femoral neck height (FHAnat) was calculated. Corresponding best-fit implants of the most common hip system (standard, high offset and varus variant) were identified for each hip. Finally, the precision of the best possible anatomic reconstruction was assessed.

Results: The mean FOAnat was 38.0 mm (range: 19.8-57.9 mm, standard deviation [SD]: 6.4 mm), the mean NSAAnat was 130.8° (range: 107.1°-151.9°; SD: 6.5°), and the mean FHAnat was 32.6 mm (range: 14.4-52.0 mm; SD: 5.5 mm). In 450 (56.3%) hips, the standard variant was identified to be the best-fit implant, followed by the varus (n = 282, 35.3%) and the high offset (n = 68, 8.5%) variants. The mean minimal distance from the best-fit implant was 4.5 mm (range: 0.1-20.2 mm, SD: 3.4 mm). Excellent agreement (distance: <2 mm) between hip anatomy and best-fit implant was found in 203 (25.4%) hips, combined excellent and acceptable agreement (distance: <6 mm) in 569 (71.1%) hips, whereas 213 (28.9%) hips were graded as poor (distance: ≥6 mm).

Conclusion: The present study revealed a mismatch between proximal femoral anatomy of a relevant proportion of adult hips and implant geometry of the most common femoral component in total hip arthroplasty.
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http://dx.doi.org/10.1016/j.arth.2016.02.015DOI Listing
August 2016

The neck shaft angle: CT reference values of 800 adult hips.

Skeletal Radiol 2016 Apr 23;45(4):455-63. Epub 2015 Dec 23.

Center of Orthopedic and Trauma Surgery, University of Giessen and Marburg, Marburg, Germany.

Objective: A precise understanding of the radiological anatomy and biomechanics as well as reliable reference values of the hip are essential. The primary goal of this study was to provide reference values of the neck-shaft angle (NSA) for adult patients based on the analysis of rotation corrected computed tomography (CT) scans of 800 hips. The secondary aim was to compare these measurements with simulated anteroposterior roentgenograms of the pelvis.

Materials And Methods: Pelvic CT scans of 400 patients (54.3 years, range 18-100 years; 200 female) were reconstructed in the derotated coronal plane of the proximal femur and as CT-based simulated anteroposterior roentgenograms of the pelvis in the anterior pelvic plane. Femora were categorized as coxa vara (<120°), physiologic (≥120° to <135°), and coxa valga (≥135°). Intra- and inter-rater reliability were analyzed.

Results: Primary research question: Mean NSA for male adults was 129.6° (range 113.2°-148.2°; SD 5.9°) and 131.9° (range 107.1°-151.9°; SD 6.8°) for females in derotated coronal reconstructions. Age (p < 0.001 in both views) and sex influenced the NSA significantly (p = 0.002 and p < 0.001); no significant differences were found between sides (p = 0.722 and p = 0.955). Overall, an excellent reliability of repeated measurements of one or two observers was found (ICC 0.891-0.995). Secondary research question: NSA values measured in the simulated anteroposterior roentgenogram and the rotation corrected coronal reconstruction differed significantly (p < 0.001).

Conclusions: While anteroposterior pelvis radiographs are susceptible to rotational errors, the coronal reconstruction of the proximal femur in the femoral neck plane allows the correct measurement of the NSA.
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http://dx.doi.org/10.1007/s00256-015-2314-2DOI Listing
April 2016

Creating reproducible thoracolumbar burst fractures in human specimens: an in vitro experiment.

J Neurosurg Spine 2016 Apr 18;24(4):580-5. Epub 2015 Dec 18.

Department of Trauma, Hand and Reconstructive Surgery, Philipps University of Marburg, University Hospital Giessen and Marburg, Marburg, Germany.

Object: The treatment of traumatic burst fractures unaccompanied by neurological impairment remains controversial and ranges from conservative management to 360° fusion. Because of the heterogeneity of fracture types, classification systems, and treatment options, comparative biomechanical studies might help to improve our knowledge. The aim of the current study was to create a standardized fracture model to investigate burst fractures in a multisegmental setting.

Methods: A total of 28 thoracolumbar fresh-frozen human cadaveric spines were used. The spines were dissected into segments (T11-L3). The T-11 and L-3 vertebral bodies were embedded in Technovit 3040 (cold-curing resin for surface testing and impressions). To simulate high energy, a metallic drop tower was designed. Stress risers were used to ensure comparable fractures. CT scans were acquired before and after fracture. All fractures were classified using the AO/OTA classification.

Results: The preparation and embedding of the spine segments worked well. No repositioning or second embedding of the specimen, even after fracture, was required. It was possible to create single burst fractures at the L-1 level in all 28 spine segments. Among the 28 fractures there were 16 incomplete burst fractures (Type A3.1), 8 burst-split fractures (Type A3.2), and 4 complete burst fractures (Type A3.3). The differences before and after fracture for stiffness and for anterior, posterior, and central heights were all significant (p < 0.05).

Conclusions: The ability to create reproducible burst fractures of a single vertebral body in a thoracolumbar spine segment may serve as a basis for future biomechanical studies that will provide better understanding of mechanical properties or fixation techniques.
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http://dx.doi.org/10.3171/2015.6.SPINE15176DOI Listing
April 2016

Surgical complications following ESIN for clavicular mid-shaft fractures do not limit functional or patient-perceived outcome.

Injury 2016 Apr 22;47(4):899-903. Epub 2015 Nov 22.

Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Baldingerstrasse, 35043 Marburg, Germany. Electronic address:

Elastic intramedullary nailing (ESIN) has been proposed as an alternative minimal-invasive method for the operative management of mid-shaft fractures of the clavicle. However, a relevant complication rate has been reported in previous cohorts. The present retrospective single-centre study aimed to analyse the complications following ESIN in adult patients with clavicular mid-shaft fractures (Allman type I) and their impact on functional and patient-perceived outcome measures. Results were compared to a control group receiving locking plate osteosynthesis. The clinical course and outcome of operatively managed patients with clavicular mid-shaft fractures were retrospectively analysed. Patients were assigned to group A (ESIN) and group B (plate fixation). Radiological, functional (Constant Murley Shoulder Outcome Score (CS), the Disabilities of the Arm, Shoulder and Hand (DASH) Score, the Oxford Shoulder Score (OSS)), and patient perceived aesthetic and clinical outcome were measured. A total of 47 (33 male, 14 female) operatively managed patients with a mean age of 26.7 ± 14.9 years and a follow up time of 38.1 ± 19.4 months were analysed. 36 patients were treated by ESIN (Group A), whereas 11 patients received open reduction and internal plate fixation (Group B). Patients were operatively treated with a mean delay of 7.4 ± 9.3 days (group A: 6.6 ± 8.7 days, group B: 10.2 ± 11.1 days, p=0.326) between trauma and the surgical index procedure. There were no significant differences in the functional (CS: p=0.338, DASH: p=0.247, OSS: p=0.434) and patient-perceived (p=0.346) outcome measures between both groups. Surgical complications were noted in 14 patients (group A: 12, group B: 2) and non-union in 4 patients (group A: 3, group B: 1). There was no correlation between the recorded complications as assessed by the Clavien and Dindo classification and the functional as well as the patient-perceived outcome measures. Despite a relevant incidence rate of surgical complications, ESIN provides good to excellent functional and patient-perceived results in the treatment of clavicular mid-shaft fractures.
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http://dx.doi.org/10.1016/j.injury.2015.11.025DOI Listing
April 2016

RETRACTED ARTICLE: The benefit of arthroscopically assisted therapy for concomitant glenohumeral injuries in patients with unstable lateral clavicle fractures.

Knee Surg Sports Traumatol Arthrosc 2016 10 12;24(10):3376. Epub 2015 Dec 12.

Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043, Marburg, Germany.

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http://dx.doi.org/10.1007/s00167-015-3909-9DOI Listing
October 2016

Calibration Marker Position in Digital Templating of Total Hip Arthroplasty.

J Arthroplasty 2016 Apr 26;31(4):883-7. Epub 2015 Oct 26.

Centre for Orthopedic and Trauma Surgery, University of Giessen and Marburg, Marburg, Germany.

Background: We report a mathematical method to assess the vertical and horizontal positions of spherical radiopaque objects of known size in conventional radiographs.

Methods: The reliability and validity of the method were tested in an experimental setting and applied to 100 anteroposterior pelvic radiographs with external calibration markers and unilateral total hip arthroplasty (THA).

Results: We found excellent reliabilities; intraclass correlation coefficients for interobserver and intraobserver reliabilities were 0.999-1.000 (P = .000). The mean normal height of THA was 198 mm (range: 142-243 mm, standard deviation: 18 mm) above the detector. Vertical and horizontal external marker positions differed significantly from the true hip center (THA; P < .001 and P = .017).

Conclusion: This method could enhance patient safety by enabling automated detection of malpositioned calibration markers by templating software.
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http://dx.doi.org/10.1016/j.arth.2015.10.009DOI Listing
April 2016

Stimulation with bone morphogenetic protein-2 (BMP-2) enhances bone-tendon integration in vitro.

Connect Tissue Res 2016 11;57(2):99-112. Epub 2015 Nov 11.

a Center for Orthopaedics and Trauma Surgery , University of Giessen and Marburg , Marburg , Germany.

Purpose: Preclinical studies have reported that bone morphogenetic protein (BMP)-2 promotes bone-tendon healing following anterior cruciate ligament reconstruction. We examined the region-specific effects of BMP-2 on osteoblast and fibroblast differentiation in a highly standardized murine in vitro co-culture model of bone-tendon integration.

Materials And Methods: We used quantitative PCR to measure the dose- and time-dependent influence of BMP-2 on the expression of alkaline phosphatase, osteocalcin, collagen type 1 (alpha 1 chain), runt-related transcription factor 2, osteopontin, collagen type 1 (alpha 2 chain), collagen type 5 (alpha 1 chain), decorin, fibromodulin, mohawk homeobox, bone morphogenetic protein receptor, type 1A, bone morphogenetic protein receptor, type 2, and Noggin in the osteoblast, interface, and fibroblast regions of a co-culture model of the murine preosteoblast cell line MC3T3-E1 and the fibroblast cell line 3T6.

Results: Stimulation with BMP-2 resulted in a significant upregulation of alkaline phosphatase (p < 0.001), osteocalcin (p < 0.001), collagens (p < 0.001), runt-related transcription factor 2 (p < 0.05), and osteopontin (p < 0.001) expression in the osteoblast region. In the interface region, BMP-2 exposure led to dose- and time-dependent upregulation of alkaline phosphatase (p < 0.001), osteocalcin (p < 0.001), osteopontin (p < 0.001), runt-related transcription factor 2 (p < 0.001), and markers of extracellular matrix production (p < 0.001). Both BMP receptors showed a significant BMP-2-dependent upregulation at the interface region, and Noggin was downregulated at the osteoblast and interface region following BMP-2 exposure.

Conclusions: Exposure to BMP-2 upregulated the expression of genes associated with bone-tendon integration in vitro, suggesting the stimulation of transdifferentiation processes at the interface and fibroblast regions as well as the induction of positive feedback mechanisms. Further studies will be needed to establish BMP-2 dose and treatment algorithms following tendon reinsertion and reconstruction.
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http://dx.doi.org/10.3109/03008207.2015.1087516DOI Listing
December 2016

Femoral offset following trochanteric femoral fractures: a prospective observational study.

Injury 2015 Oct;46 Suppl 4:S88-92

Center for Orthopaedics and Trauma Surgery, University of Giessen and Marburg, Marburg, Germany. Electronic address:

Background: Reconstruction of the femoral offset reportedly improves outcome following total hip arthroplasty, but little is known of its influence following hip fractures. We aimed to establish the effect of the femoral offset on the medium-term functional outcome in elderly patients who had sustained trochanteric fractures requiring proximal femoral nailing.

Patients And Methods: We measured the rotation corrected femoral offset (FORC) and relative femoral offset (FORL) on plain anteroposterior radiographs of the hip in 188 patients (58 male, 130 female) with a trochanteric fracture who underwent proximal femoral nailing at our institution. The primary outcome measure was the Harris hip score (HSS) 6 and 12 months postoperatively; the Barthel index was assessed as a secondary outcome.

Results: The mean FORC after surgery was 58 mm (±11 mm), while the mean FORL was 1.21 (±0.22). At final follow up, we found significant inverse relationships (Spearman's rank correlation coefficient, ρ) between FORC and FORL and the functional outcome assessed by the HSS (FORC: ρ = -0.207, p = 0.036; FORL: ρ = -0.247, p = 0.012), and FORL and the Barthel index (FORC: ρ = -147, p = 0.129; FORL: ρ = -0.192, p = 0.046). A consistent trend was observed after adjustment for confounding variables.

Conclusions: Our results underline the biomechanical importance of the femoral offset for medium-term outcomes in elderly patients with trochanteric fractures. In contrast with the published findings on total hip arthroplasty, we found an inverse correlation between functional outcome and the extent of the reconstructed femoral offset.

Level Of Evidence: Level I - Prognostic study.
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http://dx.doi.org/10.1016/S0020-1383(15)30024-3DOI Listing
October 2015

The effect of osteoarthritis on functional outcome following hemiarthroplasty for femoral neck fracture: a prospective observational study.

BMC Musculoskelet Disord 2015 Oct 16;16:304. Epub 2015 Oct 16.

Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Baldinger Straße, 35043, Marburg, Germany.

Background: The influence of pre-existing radiographic osteoarthritis on the functional outcome of elderly patientents with displaced intracapsular fractures of the femoral neck treated by hemiarthroplasty is unclear.

Methods: We prospectively examined the impact of pre-existing osteoarthritis on the functional outcome of 126 elderly patients with displaced intracapsular fracture of the femoral neck treated by hemiarthroplasty.

Results: The mean age of the cohort was 82.7 years. At 12 months, we observed no statistically significant differences in the Harris hip score (p = 0.545), the timed up and go test (p = 0.298), the Tinetti test (p = 0.381) or the Barthel Index (p = 0.094) between patients with Kellgren and Lawrence grades 3 or 4 osteoarthritis, and patients with grades 0 to 2 changes. Furthermore, there were no differences in complication or revision rates.

Conclusions: Our findings challenge the hypothesis that pre-existing osteoarthritis is a contraindication to hemiarthroplasty in elderly patients with femoral neck fracture.
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http://dx.doi.org/10.1186/s12891-015-0767-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4609155PMC
October 2015

Nonoperative management of blunt hepatic trauma: A systematic review.

J Trauma Acute Care Surg 2015 Oct;79(4):654-60

From the Department of Orthopaedic and Trauma Surgery (C.K.B., M.H., L.P.M.), University Hospital of Cologne, Cologne; and Department of Trauma, Hand and Reconstructive Surgery (S.R., M.F., P.L.), University of Giessen and Marburg, Marburg, Germany.

Background: Nonoperative management (NOM) has become the standard treatment in hemodynamically stable patients with blunt hepatic injuries. While the reported overall success rates of NOM are excellent, there is a lack of consensus regarding the risk factors predicting the failure of NOM. The aim of this systematic review was to identify the incidence and prognostic factors for failure of NOM in adult patients with blunt hepatic trauma.

Methods: Prospective studies reporting prognostic factors for the failure of nonoperative treatment of blunt liver injuries were identified by searching MEDLINE and the Cochrane Central Register of Controlled Trials.

Results: We screened 798 titles and abstracts, of which 8 single-center prospective observational studies, reporting 410 patients, were included in the qualitative and quantitative synthesis. No randomized controlled trials were found. The pooled failure rate of NOM was 9.5% (0-24%). Twenty-six prognostic factors predicting the failure of NOM were reported, of which six reached statistical significance in one or more studies: blood pressure (p < 0.05), fluid resuscitation (p = 0.02), blood transfusion (p = 0.003), peritoneal signs (p < 0.0001), Injury Severity Score (ISS) (p = 0.03), and associated intra-abdominal injuries (p < 0.01).

Conclusion: There is evidence that patients presenting with clinical signs of shock, a high ISS, associated intra-abdominal injuries, and peritoneal signs are at an increased risk of failure of NOM for the treatment of blunt hepatic injuries.

Level Of Evidence: Systematic review, level III.
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http://dx.doi.org/10.1097/TA.0000000000000814DOI Listing
October 2015

The femoral neck-shaft angle on plain radiographs: a systematic review.

Skeletal Radiol 2016 Jan 25;45(1):19-28. Epub 2015 Aug 25.

Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Marburg, Germany.

Objective: The femoral neck-shaft angle (NSA) is an important measure for the assessment of the anatomy of the hip and planning of operations. Despite its common use, there remains disagreement concerning the method of measurement and the correction of hip rotation and femoral version of the projected NSA on conventional radiographs. We addressed the following questions: (1) What are the reported values for NSA in normal adult subjects and in osteoarthritis? (2) Is there a difference between non-corrected and rotation-corrected measurements? (3) Which methods are used for measuring the NSA on plain radiographs? (4) What could be learned from an analysis of the intra- and interobserver reliability?

Material And Methods: A systematic literature search was performed including 26 publications reporting the measurement of the NSA on conventional radiographs.

Results: The mean NSA of healthy adults (5,089 hips) was 128.8° (98-180°) and 131.5° (115-155°) in patients with osteoarthritis (1230 hips). The mean NSA was 128.5° (127-130.5°) for the rotation-corrected and 129.5° (119.6-151°) for the non-corrected measurements.

Conclusion: Our data showed a high variance of the reported neck-shaft angles. Notably, we identified the inconsistency of the published methods of measurement as a central issue. The reported effect of rotation-correction cannot be reliably verified.
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http://dx.doi.org/10.1007/s00256-015-2236-zDOI Listing
January 2016

The Influence of Hip Rotation on Femoral Offset Following Short Stem Total Hip Arthroplasty.

J Arthroplasty 2016 Jan 17;31(1):312-6. Epub 2015 Jul 17.

Department of Orthopaedic Surgery, Hannover Medical School, Hannover, Germany.

Short stem total hip arthroplasty (THA) is thought to be an advantageous surgical option for young patients. Femoral offset has been identified as an important factor for clinical outcome of THA. However, little is known on functional implications of femoral offset after short stem THA. Importantly, hip rotation influences the projected femoral offset and may lead to significant underestimation. Therefore, a novel method to identify and account for hip rotation was applied to a prospectively enrolled series of 37 patients (48 radiographs) undergoing short stem THA. Repeated measurements were performed and intraobserver and interobserver reliability was assessed and femoral offset was corrected for rotation. Based on this study, rotation-correction of femoral offset is of highest relevance for the correct interpretation in future studies.
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http://dx.doi.org/10.1016/j.arth.2015.07.027DOI Listing
January 2016

Impact of Parkinson's disease on the acute care treatment and medium-term functional outcome in geriatric hip fracture patients.

Arch Orthop Trauma Surg 2015 Nov 8;135(11):1519-26. Epub 2015 Aug 8.

Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043, Marburg, Germany.

Introduction: Patients with Parkinson's disease (PD) have a heightened risk of sustaining hip fractures due to disturbed balance and gait insecurity. This study aims to determine the impact of PD on the perioperative course and medium-term functional outcome of patients with hip fractures.

Materials And Methods: A total of 402 hip fracture patients, aged ≥60 years, were prospectively enrolled. On admission, the American Society of Anesthesiologists score, Mini-Mental Status Examination, and Barthel Index (BI), among other scales, were documented. The Hoehn and Yahr scale was used to assess the severity of PD. The functional outcome was assessed by performance on the BI, Tinetti test (TT), and Timed Up and Go test (TUG) at discharge and at the 6-month follow-up. Additionally, the length of hospitalization, perioperative complications, and discharge management were documented. A multivariate regression analysis was performed to control for influencing factors.

Results: A total of 19 patients (4.7%) had a concomitant diagnosis of PD. The functional outcome (BI, TT, and TUG) was comparable between groups (all p > 0.05). Grade II (52.6 vs. 26.1%; OR = 4.304, p = 0.008) and IV complications (15.8 vs. 4.4%; OR = 7.785, p = 0.012) occurred significantly more often among PD patients. While the diagnosis of PD was associated with a significantly longer mean length of hospital stay (β = 0.119, p = 0.024), the transfer from acute hospital care showed no significant difference (p = 0.246). Patients with an additional diagnosis of PD had inferior results in BI at the 6-month follow-up (p = 0.038).

Conclusion: PD on hospital admission is not an independent risk factor for in-hospital mortality or an inferior functional outcome at hospital discharge. However, patients with PD are at risk for specific complications and longer hospitalization at the time of transfer from acute care so as for reduced abilities in activities of daily living in the medium term.
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http://dx.doi.org/10.1007/s00402-015-2298-3DOI Listing
November 2015