Publications by authors named "R Pfeifer"

283 Publications

Proximal humerus fractures (PHFs): comparison of functional outcome 1 year after minimally invasive plate osteosynthesis (MIPO) versus open reduction internal fixation (ORIF).

Eur J Trauma Emerg Surg 2021 Jul 3. Epub 2021 Jul 3.

Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.

Purpose: Osteosynthetic treatment strategies of PHFs include MIPO or ORIF techniques. The aim of this study was to compare the 1 year outcome following either technique in type B PHFs.

Methods: This study was designed as a retrospective cohort study of patients treated at one academic Level 1 trauma center. Patients from 2009 to 2019 who required surgical treatment of a type B PHF were eligible to be included in this study. Patients with A- or C-type fractures or patients requiring arthroplasty were excluded. All patients were treated with Proximal Humerus Interlocking System (PHILOS) and stratified according the approach into Group MIPO or Group ORIF. Outcome measures include local complications that occurred during hospitalization, nonunion after 12 months, and range of motion after 1 year follow-up.

Results: This study included 149 (75.3%) patients in Group ORIF, and 49 (24.7%) in Group MIPO. The fracture morphology and concomitant injuries were comparable amongst these groups. When compared with Group MIPO, Group ORIF had a 2.6 (95% CI 0.6-11.7) higher risk of suffering from local complications. The rate of postoperative nerve lesions was comparable (OR 0.9, 95% CI 0.1-9.7) as was the rate of soft tissue complications (OR 2.0, 95% CI 0.2-17.2). The risk for nonunion was 4.5 times higher (95% 1.1-19.5) in Group ORIF when compared with Group MIPO. Group MIPO had a higher chance of flexion above 90° (OR 8.2, 95% CI 2.5-27.7).

Conclusion: This study provides indications that patients following surgical treatment of PHFs in MIPO technique might have favourable outcome. Large-scale and high-quality studies are warranted to confirm these results.
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http://dx.doi.org/10.1007/s00068-021-01733-wDOI Listing
July 2021

Incidence of Fat Embolism Syndrome in Femur Fractures and Its Associated Risk Factors over Time-A Systematic Review.

J Clin Med 2021 Jun 21;10(12). Epub 2021 Jun 21.

Department of Trauma, University Hospital Zurich, Raemistr. 100, 8091 Zürich, Switzerland.

Background: Fat embolism (FE) continues to be mentioned as a substantial complication following acute femur fractures. The aim of this systematic review was to test the hypotheses that the incidence of fat embolism syndrome (FES) has decreased since its description and that specific injury patterns predispose to its development.

Materials And Methods: Data Sources: MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases were searched for articles from 1 January 1960 to 31 December 2019.

Study Selection: Original articles that provide information on the rate of FES, associated femoral injury patterns, and therapeutic and diagnostic recommendations were included.

Data Extraction: Two authors independently extracted data using a predesigned form.

Statistics: Three different periods were separated based on the diagnostic and treatment changes: Group 1: 1 January 1960-12 December 1979, Group 2: 1 January 1980-1 December 1999, and Group 3: 1 January 2000-31 December 2019, chi-square test, χ test for group comparisons of categorical variables, -value < 0.05.

Results: Fifteen articles were included ( = 3095 patients). The incidence of FES decreased over time (Group 1: 7.9%, Group 2: 4.8%, and Group 3: 1.7% ( < 0.001)). FES rate according to injury pattern: unilateral high-energy fractures (2.9%) had a significantly lower FES rate than pathological fractures (3.3%) and bilateral high-energy fractures (4.6%) ( < 0.001).

Conclusions: There has been a significant decrease in the incidence of FES over time. The injury pattern impacts the frequency of FES. The diagnostic and therapeutic approach to FES remains highly heterogenic to this day.
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http://dx.doi.org/10.3390/jcm10122733DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8234368PMC
June 2021

Teacher Self-Efficacy and Mental Health-Their Intricate Relation to Professional Resources and Attitudes in an Established Manual-Based Psychological Group Program.

Front Psychiatry 2021 28;12:510183. Epub 2021 May 28.

Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany.

Teaching is considered a mentally challenging occupation. Teacher self-efficacy is a personal resource which buffers the experience of stress and may be important in maintaining mental health. The preventive intervention "Manual-Based Psychological Group Program for Teachers" (MBPGPT) was applied and evaluated state-wide to improve the mental health of teachers. This study aims to investigate the intricate relation between teacher self-efficacy and mental health and their changes in the course of the intervention. Using a single-group pre-/post-design, the relation between teacher self-efficacy and mental health was investigated in 742 teachers. Pre- and post-changes in teacher self-efficacy and their interaction with mental health were examined in a subsample of 171 teachers, who met the conservative inclusion criteria. In ancillary analyses, correlations with underlying changes in work-related behavior and experience patterns were analyzed to better understand the intricate link between teacher self-efficacy and mental health. Teacher self-efficacy showed a significant, moderate correlation with mental health. Self-efficacy was moderately higher after the intervention than before the intervention, but independent of changes in mental health. Teacher self-efficacy was related to work-related psychological resistance and positive emotions. An increase in teacher self-efficacy was accompanied by an improvement in life satisfaction and distancing ability. A decrease in teacher self-efficacy went hand in hand with reduced experience of social support. This study confirmed teacher self-efficacy as an important, reliable resource and its correlation with psychological resistance. The absence of a control group limits what causal conclusions can be drawn from the study. Nevertheless, self-efficacy seems to be a worthwhile goal of preventive interventions for teachers and should be promoted due to its wide-ranging implications. Suggestions for further studies and interventions are made.
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http://dx.doi.org/10.3389/fpsyt.2021.510183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8193039PMC
May 2021

Standardized porcine unilateral femoral nailing is associated with changes in PMN activation status, rather than aberrant systemic PMN prevalence.

Eur J Trauma Emerg Surg 2021 Jun 10. Epub 2021 Jun 10.

Department of Traumatology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.

Purpose: Intramedullary nailing (IMN) of fractures is associated with increased rates of inflammatory complications. The pathological mechanism underlying this phenomenon is unclear. However, polymorphonuclear granulocytes (PMNs) seem to play an important role. We hypothesized that a femur fracture and standardized IMN in pigs is associated with altered appearance of PMNs in circulation and enhanced activation status of these cells.

Methods: A porcine model including a femur fracture and IMN was utilized. Animals were randomized for control [anesthesia + mechanical ventilation only (A/MV)] and intervention [A/MV and unilateral femur fracture (FF) + IMN] conditions. PMN numbers and responsiveness, integrin (CD11b), L-selectin (CD62L) and Fcγ-receptor (CD16 and CD32)-expression levels were measured by flowcytometry of blood samples. Animals were observed for 72 h.

Results: Circulatory PMN numbers did not differ between groups. Early PMN-responsiveness was retained after insult. PMN-CD11b expression increased significantly upon insult and peaked after 24 h, whereas CD11b in control animals remained unaltered (P = 0.016). PMN-CD16 expression levels in the FF + IMN-group rose gradually over time and were significantly higher compared with control animals, after 48 h (P = 0.016) and 72 h (P = 0.032). PMN-CD62L and CD32 expression did not differ significantly between conditions.

Conclusion: This study reveals that a femur fracture and subsequent IMN in a controlled setting in pigs is associated with enhanced activation status of circulatory PMNs, preserved PMN-responsiveness and unaltered circulatory PMN-presence. Indicating that monotrauma plus IMN is a specific and substantial stimulus for the cellular immune system. Early alterations of circulatory PMN receptor expression dynamics may be predictive for the intensity of the post traumatic response.
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http://dx.doi.org/10.1007/s00068-021-01703-2DOI Listing
June 2021

Early myocardial damage (EMD) and valvular dysfunction after femur fracture in pigs.

Sci Rep 2021 Apr 19;11(1):8503. Epub 2021 Apr 19.

Department of Traumatology, Hand, Plastic and Reconstructive Surgery, Center of Surgery, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.

Musculoskeletal injuries are the most common reason for surgery in severely injured patients. In addition to direct cardiac damage after physical trauma, there is rising evidence that trauma induces secondary cardiac structural and functional damage. Previous research associates hip fractures with the appearance of coronary heart disease: As 25% of elderly patients developed a major adverse cardiac event after hip fracture. 20 male pigs underwent femur fracture with operative stabilization via nailing (unreamed, reamed, RIA I and a new RIA II; each group n = 5). Blood samples were collected 6 h after trauma and the concentration of troponin I and heart-type fatty acid binding protein (HFABP) as biomarkers for EMD were measured. At baseline and 6 h after trauma, transesophageal ECHO (TOE) was performed; and invasive arterial and left ventricular blood pressure were measured to evaluate the cardiac function after femur fracture. A systemic elevation of troponin I and HFABP indicate an early myocardial damage after femur fracture in pigs. Furthermore, various changes in systolic (ejection fraction and cardiac output) and diastolic (left ventricular end-diastolic pressure, mitral valve deceleration time and E/A ratio) parameters illustrate the functional impairment of the heart. These findings were accompanied by the development of valvular dysfunction (pulmonary and tricuspid valve). To the best of our knowledge, we described for the first time the development of functional impairment of the heart in the context of EMD after long bone fracture in pigs. Next to troponin and HFABP elevation, alterations in the systolic and diastolic function occurred and were accompanied by pulmonary and tricuspid valvular insufficiency. Regarding EMD, none of the fracture stabilization techniques (unreamed nailing, reaming, RIA I and RIA II) was superior.
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http://dx.doi.org/10.1038/s41598-021-86151-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055677PMC
April 2021
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