Publications by authors named "S Koob"

43 Publications

[Modified percutaneous achillotentomy according to Hoke for minimally invasive treatment of pointed foot].

Oper Orthop Traumatol 2021 Jun 25. Epub 2021 Jun 25.

Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.

Objective: Various underlying diseases can lead to a pointed foot in children and adults. If the gastrocnemius and soleus muscles are structurally shortened, various surgical procedures are available to correct this malposition. A preferred method for restoring a normal dorsiflexion of the upper ankle joint is percutaneous achillotentomy according to Hoke. Consideration of the physiological-anatomical torsion of the Achilles tendon as it corresponds to the White technique and is recommended by some authors shows in our experience no advantages. In the present work, we show a modified, likewise minimally invasive form of this surgical method with which immediate full weight-bearing of the affected lower extremity is possible from postoperative day 1.

Indications: All clinically relevant structural pointed foot, for primary and/or for revision treatment.

Contraindications: Infection in the area of the operation.

Surgical Technique: No tourniquet, 3 incisions with the 15 mm knife: (1) medial distal at the transition from the Achilles tendon to the calcaneus, (2) medial proximal approximately 7 cm proximal to the 1st stab incision, (3) lateral, midway between the first two incisions; no skin suturing, application of a lower leg cast.

Postoperative Management: On postoperative day 1, cast hybridization using Scotchcast (3M Deutschland GmbH, Neuss, Germany), followed by pain-adapted full weight-bearing; removal of the cast in the outpatient department after 4 weeks.

Results: A total of 104 patients underwent surgery, 1 case of a local pressure point, no infections, no overcorrections, no Achilles tendon ruptures, in one case a postoperative relapse due to a broken cast. The risk of overcorrection to the foot, which was considered the main complication in the literature, did not occur in any of the cases.
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June 2021

Towards living guidelines on cardiorenal outcomes in diabetes: A pilot project of the Taskforce of the Guideline Workshop 2020.

Diabetes Res Clin Pract 2021 Jul 24;177:108870. Epub 2021 May 24.

Forschergruppe Diabetes e. V., Ingolstaedter Landstraße 1, 85764 Neuherberg (Munich), Germany. Electronic address:

In June 2020, the Taskforce of the Guideline Workshop 2019 convened via teleconferencing to initiate a pilot project that demonstrates the various processes and considerations involved in developing high-quality, evidence-based clinical practice guidelines for the medical management of individuals with type 2 diabetes (T2D) and its associated comorbidities, including cardiovascular disease (CVD) and chronic kidney disease (CKD). The goal of the pilot project was to create evidence-based guidelines for use of sodium-glucose transport protein 2 inhibitors (SGLT2-I) when managing very high risk T2D patients, evidenced by the presence of both CVD and CKD. For this purpose the Taskforce represented a guideline panel and made use of synthesized evidence from an ongoing BMJ Rapid Recommendations project on SGLT2-I and GLP-1 receptor agonists. Results from the Taskforce pilot project demonstrated the value, feasibility and utility of using a step-wise approach to identifying and grading evidence and then developing actionable recommendations for utilizing SGLT2-I in this at-risk T2D population. This report describes the various steps involved in the process and explains how it can be utilized to rapidly develop recommendations in a format that is easy to use and can be quickly updated as new evidence becomes available, also within the emerging concept of living guidelines.
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July 2021

Litigations in orthopedics and trauma surgery: reasons, dynamics, and profiles.

Arch Orthop Trauma Surg 2021 May 27. Epub 2021 May 27.

Department of Orthopaedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.

Background: In recent literature, the increasing number of medical litigations, both in terms of the number of cases being filed and the substantive costs associated with lawsuits, has been described. This study aims to provide an overview of the profile of litigation for orthopedic and trauma surgery to describe the differences and the development of the number of cases over time.

Patients And Materials: A retrospective review of all litigations between 2000 and 2017 was conducted using the institutional legal database. The causes of litigation were documented and classified into seven major categories. In addition to plaintiff characteristics, the litigation outcomes and the differences between emergency and elective surgery were analyzed.

Results: A total of 230 cases were evaluated. The mean age of the plaintiffs was 44.6 ± 20.1 years, and 56.8% were female. The main reasons for litigation were claimed inappropriate management (46.1%), misdiagnosis (22.6), and poor nursing care (8.3%). Significantly more litigations were filed against surgeons of the orthopedic subspecialty compared with trauma surgeons (78%; p ≤ 0.0001). There were significantly fewer litigations per 1000 cases filed overall in 2009-2017 (65% less; p = 0.003) than in 2000-2008.

Conclusion: Our results could not confirm the often-stated trend of having more litigations against orthopedic and trauma surgeons. Although the absolute numbers increased, the number of litigations per 1000 patients treated declined. Patients who underwent elective surgery were more likely to file complaints than emergency patients.
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May 2021

Biomechanical evaluation of temporary epiphysiodesis at the femoral epiphysis using established devices from clinical practice.

J Mater Sci Mater Med 2021 Apr 1;32(4):41. Epub 2021 Apr 1.

Department for Orthopedic Surgery and Traumatology, Rheinische-Friedrich-Wilhelms-Universität, Bonn, Germany.

The aim of this study is to compare biomechanical features of different devices used in clinical routine for temporary epiphysiodesis (eight-Plate® and FlexTack). The tested implants were divided into four different groups (eight-Plate® vs. FlexTack for lateral and anterior implantation) á 10 samples for testing implanted eight-Plate® vs. FlexTack in fresh frozen pig femora for maximum load forces (F) and axial physis distance until implant failure (l). A servo hydraulic testing machine (858 Mini Bionix 2) was used to exert and measure reproducible forces. Statistical analyses tested for normal distribution and significant (p < 0.05) differences in primary outcome parameters. There were no significant differences between the eight-Plate® lateral group and the FlexTack lateral group for neither F (p = 0.46) nor l (p = 0.65). There was a significant higher F (p < 0.001) and l (p = 0.001) measured in the eight-Plate® group compared to the FlexTack group when implanted anteriorly. In anterior temporary ephiphysiodesis, eight-Plate® demonstrated superior biomechanical stability. At this stage of research, there is no clear advantage of either implant and the choice remains within the individual preference of the surgeon.
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April 2021

[Erratum to: Distal femur replacement in extensive defects of the distal femur in revision arthroplasty].

Oper Orthop Traumatol 2020 Dec;32(6):531

Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms Universität Bonn, Sigmund-Freud Str. 25, 53127, Bonn, Deutschland.

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December 2020