Publications by authors named "Thomas M Tiefenboeck"

33 Publications

Computed Tomography in Limb Salvage and Deformity Correction-3D Assessment, Indications, Radiation Exposure, and Safety Considerations.

J Clin Med 2021 Aug 24;10(17). Epub 2021 Aug 24.

Department of Orthopedics and Trauma-Surgery, Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.

Computed tomography (CT) is an essential tool in orthopedic surgery but is known to be a method with that entails radiation exposure. CT increases the risk of developing fatal cancer, which should not be underestimated. However, patients with bone defects and/or deformities must frequently undergo numerous investigations during their treatment. CT is used for surgical planning, evaluating callus maturation, alignment measurement, length measurement, torsion measurement, and angiography. This study explores the indications in CT scans for limb lengthening and deformity correction and estimates the effective radiation dose. These results should help avoid unnecessary radiation exposure by narrowing the examination field and by providing explicit scanning indications. For this study, 19 posttraumatic patients were included after the bone reconstruction of 21 lower limbs. All patients underwent CT examinations during or after treatment with an external ring fixator. The mean effective dose was 3.27 mSv, with a mean cancer risk of 1:117,014. The effective dose depended on the location and indication of measurement, with a mean dose of 0.04 mSv at the ankle up to 6.8 mSv (or higher) for vascular depictions. CT evaluation, with or without 3D reconstruction, is a crucial tool in complex bone reconstruction and deformity treatments. Therefore, strict indications are necessary to reduce radiation exposure-especially in young patients-without compromising the management of their patients.
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http://dx.doi.org/10.3390/jcm10173781DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432111PMC
August 2021

Maintaining Medical Resources to Treat Paediatric Injuries during COVID-19 Lockdown Is Essential-An Epidemiological Analysis of a Level 1 Trauma Centre in Central Europe.

Int J Environ Res Public Health 2021 05 28;18(11). Epub 2021 May 28.

Department of Trauma Surgery, University Clinic of Orthopaedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria.

Background: This study examined the effect of the COVID-19 pandemic and the resulting decrease in the incidence of various categories of injuries, with the main focus on fractures and mild traumatic brain injuries in a paediatric population.

Methods: This retrospective cohort study evaluated all children from 0 to 18 years of age presenting with an injury at the level 1 trauma centre of the University Clinic of Orthopaedics and Trauma Surgery in Vienna during the lockdown from 16 March to 29 May 2020 compared to records over the same timeframe from 2015 to 2019.

Results: In total, 14,707 patients with injuries were included. The lockdown did not lead to a significant decrease in fractures but, instead, yielded a highly significant increase in mild traumatic brain injuries when compared to all injuries that occurred ( = 0.082 and = 0.0001) as well as acute injuries (excluding contusions, distortions and miscellaneous non-acute injuries) ( = 0.309 and = 0.034).

Conclusions: The percentage of paediatric fractures did not decrease at the level 1 trauma centre, and a highly significant proportional increase in paediatric patients with mild traumatic brain injuries was observed during the COVID-19 lockdown. Therefore, medical resources should be maintained to treat paediatric trauma patients and provide neurological monitoring during pandemic lockdowns.
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http://dx.doi.org/10.3390/ijerph18115829DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8198406PMC
May 2021

Thoracic Injuries in Pediatric Polytraumatized Patients: Epidemiology, Treatment and Outcome.

Injury 2021 Jun 17;52(6):1316-1320. Epub 2021 Feb 17.

Department of Orthopedics and Trauma Surgery, Medical University Vienna, Austria.

Purpose: The purpose of the present study was to assess the influence and contribution, epidemiology, treatment and outcome of thoracic injuries in a cohort of pediatric and adolescent polytraumatized patients.

Material And Methods: All pediatric and adolescent (age < 18 years) polytraumatized patients with associated thoracic injuries were included in this study. Demographic data, mechanism of injury (MOI), injury severity score (ISS), Glasgow Coma Scale (GCS), hemodynamic parameters and pupillary response at ED admission, site of major injury (SOMI), associated chest and non-chest related injuries, length of hospital stay (LOS), procedures performed at the ED as well as outcome variables including mortality and cause of death. Stepwise logistic regression analysis was used to identify risk factors for a poor prognosis and outcome.

Results: The logistic regression found the following variables decreasing the odds for a "bad outcome": lack of a hemodynamically unstable condition (p = 0.009) and the absence of a pathological pupillary response (p < 0.001).

Conclusions: The present study suggests that the severity of concomitant chest injuries in polytraumatized pediatric and adolescent patients contributes substantially to morbidity and mortality. Due to the anatomic features of the immature pediatric bones, careful attention should be drawn to possible severe chest injuries even in the absence of rib fractures.

Level Of Evidence: A retrospective study (level - IV study).
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http://dx.doi.org/10.1016/j.injury.2021.02.033DOI Listing
June 2021

Different storage times and their effect on the bending load to failure testing of murine bone tissue.

Sci Rep 2020 10 15;10(1):17412. Epub 2020 Oct 15.

Department of Orthopaedics and Trauma Surgery, Division of Trauma Surgery, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria.

Cryopreservation is a well-established method for bone storage. However, the ideal timing of mechanical testing after sacrificing the experimental animals is still under discussion and of significant importance to the presentation of accurate results. Therefore, the aim of this study was to investigate and compare different cryopreservation durations to native murine bone and whether there was an influence on mechanical bone testing. For this study the tibias of 57 female C57BL/6 mice-18-weeks of age-were harvested and randomly allocated to one of four groups with varying storage times: (1) frozen at -80 °C for 3 months, (2) frozen at -80 °C for 6 months, (3) frozen at -80 °C for 12 months and (4) native group. The native group was immediately tested after harvesting. The comparison of the mean strength and load to failure rates demonstrated a significant difference between the storage groups compared to the native control (p = 0.007). However, there was no difference in the strength and the load to failure values of bones of all storage groups when compared against each other. Once cryopreservation at -80 °C is performed, no differences of mechanical bone properties are seen up to 12 months of storage. When actual in vivo data is of close interest, immediate testing should be considered and is preferred. If comparison of groups is required and long-time storage is necessary, cryopreservation seems to be an accurate method at present.
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http://dx.doi.org/10.1038/s41598-020-74498-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7562872PMC
October 2020

Prospective Short-Term and Return-to-Sports Results of a Novel Uncemented Short-Stem Hip Prosthesis with Metaphyseal Anchorage.

J Clin Med 2020 Jun 24;9(6). Epub 2020 Jun 24.

Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria.

Short-stem hip prostheses were developed to treat active patients requiring total hip arthroplasty (THA). This study provides short-term data about a short-stem total hip arthroplasty system. Functional and radiological outcomes as well as return to sports and activity level were assessed. A series of 55 patients was primarily included. Data were available for 47 patients at an average follow-up of 38 ± 4.6 months. The back-to-sports analysis showed a 98% return-to-sports rate (46/47 patients). The average time for return to sports was 13 weeks (± 8) postoperatively. Five patients (10.6%) were more active postoperatively. The Harris Hip Score (HHS) improved from 34.8 (±9.4) preoperatively to 94.7 (±8.4, 0.001) and the University of California, Los Angeles (UCLA) score improved from 4.5 (±1.8) to 6.9 (±1.9) ( 0.001). The High Activity Arthroplasty Score (HAAS) was 12 (± 3.6) at 3-year follow-up. Pre- and postoperative UCLA and postoperative HHS and HAAS scores had a positive influence on the return-to-sports rate ( 0.05). The collection of radiographic data during all postoperative follow-ups showed no signs of radiolucent lines or bone fissures. The complication rate was at 5%. Short-stem systems are equaling conventional prostheses and offer benefits regarding soft tissue and bone stock preservation. Fast recovery and return to sports can be achieved.
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http://dx.doi.org/10.3390/jcm9061972DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356941PMC
June 2020

Author Correction: Effect of two (short-term) storage methods on load to failure testing of murine bone tissue.

Sci Rep 2020 Jun 16;10(1):9983. Epub 2020 Jun 16.

Department of Orthopaedics and Trauma Surgery, Division of Trauma Surgery, Medical University of Vienna, Vienna, Austria.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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http://dx.doi.org/10.1038/s41598-020-66764-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7298020PMC
June 2020

Management and outcome of traumatic subdural hematoma in 47 infants and children from a single center.

Wien Klin Wochenschr 2020 Sep 24;132(17-18):499-505. Epub 2020 Apr 24.

Department of Orthopaedics and Trauma Surgery, Division of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.

Background: Traumatic brain injury (TBI) is a frequent cause of mortality and acquired neurological impairment in children. It is hypothesized, that with the adequate treatment of SDH in children and adolescence, excellent clinical and functional outcomes can be achieved. The aim of this study was to present the severity and outcome of traumatic SDH in children and adolescence as well as to analyze differences between patients treated surgically and conservatively.

Methods: In this study 47 infants and children with a subdural hematoma (SDH) were treated between 1992 and 2010 at a single level-one trauma center. Data regarding accident, treatment and outcomes were collected retrospectively. To classify the outcomes the Glasgow outcome scale (GOS) scores at hospital discharge and at follow-up visits were used. Severity of SDH was classified according to the Rotterdam score.

Results: In total, 47 cases were treated (21 surgically, 26 conservatively), with 10 patients needing delayed surgery. Overall, 89% of the patients were able to leave hospital, 5 patients died, 2 patients (5%) within 24 h, another 2 (5%) after 48 h and 1 (2%) within 7 days. In 25 patients (53%) a good recovery was recorded at the last follow-up visit. Outcome was mainly influenced by the following factors: age, severity of TBI, and neurological status. Overall, in 70% good clinical and neurological outcomes could be achieved.

Conclusion: The results of this study confirmed that pediatric SDH is a rare, but serious condition. Despite a poor prognosis, most patients could be treated with good outcomes, given that the choice of treatment is correct.

Trial Registration: Research registry 2686.
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http://dx.doi.org/10.1007/s00508-020-01648-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518988PMC
September 2020

Surgery of True Recurring Median Carpal Tunnel Syndrome with Synovial Flap by Wulle Plus Integument Enlargement Leads to a High Patient's Satisfaction and Improved Functionality.

J Clin Med 2019 Dec 1;8(12). Epub 2019 Dec 1.

Department of Plastic Surgery, University Clinic of Vienna, General Hospital of Vienna, 1090 Vienna, Austria.

This prospective study was conducted to investigate electrophysiological qualities and patient's satisfaction of a synovial gliding tissue flap in treating true recurring carpal tunnel syndrome. In 14 patients (11 women, three men), 15 median nerves were included in this retrospective study. For all 15 nerves, motor and sensory nerve conduction velocity, compound muscle action potential, a Visual Analogue Scale-score (VAS-score) questionnaire and an adapted Levine-Test were evaluated pre- and postoperatively. All participants underwent operative neurolysis of the median nerve, which was then enwrapped by a synovial gliding tissue flap. Eleven procedures were completed by integument enlargement. Follow-up period was 12 months. Postoperatively, distal latency decreased significantly by 15.6%. Compound muscle action potential and sensory nerve conduction velocity did not improve significantly. VAS score regarding pain reduced highly significantly with 74.1%. The adapted Levine-Test function score improved highly significantly with 39.2%. The synovial gliding tissue flap lead to an excellent patient's satisfaction for treating true recurring carpal tunnel syndrome. Primary wound closure should be completed with integument enlargement if needed.
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http://dx.doi.org/10.3390/jcm8122094DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947569PMC
December 2019

Fractures of the Humeral Shaft with Primary Radial Nerve Palsy: Do Injury Mechanism, Fracture Type, or Treatment Influence Nerve Recovery?

J Clin Med 2019 Nov 14;8(11). Epub 2019 Nov 14.

Department of Orthopedics and Trauma Surgery, Medical University of Vienna, A-1090 Vienna, Austria.

Adult humeral shaft fractures are associated with primary radial nerve palsy in up to 18% of cases. The purpose of this study was to assess the influence of injury mechanism, fracture type, and treatment on nerve recovery in patients with humeral shaft fractures and primary nerve palsy. Data of fifty patients (age-43.5 ± 21.3; female: male-1:1.8) with humeral shaft fractures and concomitant grade I-II primary radial nerve palsy, who underwent either open reduction and internal fixation (ORIF) or intramedullary nailing at an academic level I trauma center between 1994 and 2013, were evaluated. Factors potentially influencing the time to onset of recovery or full nerve recovery (injury mechanism, fracture type, fracture location and treatment) were analyzed in detail. Thirty patients were treated with ORIF and twenty patients with closed unreamed intramedullary nailing of the humeral shaft, respectively. The mean time to onset of recovery was 10.5 ± 3.4 weeks (2-17 weeks). Twenty-six (52%) patients reported significant clinical improvement within the first 12 weeks. Mean time to full recovery was 26.8 ± 8.9 weeks (4-52 weeks). Twenty-five (50%) patients regained full manual strength within the first six months following the injury. Forty-nine (98%) patients regained full manual strength within the first 52 weeks. Trauma mechanism, fracture type, fracture location, and treatment modality did not influence the time to onset of nerve recovery or time to full recovery following humeral shaft fractures with grade I-II primary radial nerve palsy.
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http://dx.doi.org/10.3390/jcm8111969DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912221PMC
November 2019

Minimally Invasive AC Joint Reconstruction System (MINAR) in Modified Triple-Button Technique for the Treatment of Acute AC Joint Dislocation.

J Clin Med 2019 Oct 15;8(10). Epub 2019 Oct 15.

Department of Orthopedics and Trauma Surgery, Klinikum Wels-Grieskirchen, 4600 Wels, Austria.

Acute acromioclavicular (AC) joint dislocation is a frequent sports injury with more than 100 different operation methods described. A total of 65 patients with an acute AC joint dislocation were treated with the modified MINAR system between 2009 and 2013. Clinical outcome, horizontal and vertical instability, as well as concomitant intraarticular injuries were assessed. We used Zanca, stress and axial X-rays for radiological assessment. A Constant score of 95 (±8.8), University of California Los Angeles Shoulder score (UCLA) of 31 (±4.9), Disabilities of Arm, Shoulder and Hand (DASH) of 9.1 (±14.3), and Visual Analogue Scale (VAS) of 0.9 (±0.126) was found. A total of 30 patients (59%) had no signs of reduction loss, nine patients (18%) a slight loss, 11 patients (22%) a partial loss, and one patient (2%) a total loss. No significant influence on the clinical scores could be shown. The postoperative coracoclavicular (CC) distance negatively affected the Constant ( = 0.007) and UCLA scores ( = 0.035). A longer time interval to surgery had a negative influence on all scores ( ≤ 0.001). We could not find any signs of persistent horizontal instability or intraarticular injuries at follow-up. The MINAR system promises satisfactory functional and radiological results. When setting the correct indication, patients benefit from an early operation. No persisting horizontal instability was observed following suturing of the AC capsule and the delta fascia.
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http://dx.doi.org/10.3390/jcm8101683DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832357PMC
October 2019

Innovative Technique in Extended Intramedullary Humeral Lengthening: A Case Report.

JBJS Case Connect 2019 Jul-Sep;9(3):e0174

Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria.

Case: Intramedullary humeral lengthening is still a very uncommon procedure to treat humeral limb length discrepancy (LLD). This approach has various advantages compared with external devices but is limited in its ability to lengthen bones because of the length of the telescopic nail. This case report describes a middle-aged patient with a short right humerus secondary to a childhood growth plate injury that was successfully lengthened with an off-label application of a tibial distracting device. Hereby, a novel treatment technique with unlocking, backwinding, and reinterlocking of the telescopic nail for extended humeral distraction was performed.

Conclusions: Extended intramedullary humeral lengthening with unlocking, backwinding, and reinterlocking of the nail is a cost-effective, minimally invasive procedure in cases of massive humeral LLD with limitations in the distraction capacity of the telescopic nail.
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http://dx.doi.org/10.2106/JBJS.CC.18.00174DOI Listing
June 2020

Epidemiology, treatment and outcome after compartment syndrome of the thigh in 69 cases - Experiences from a level I trauma centre.

Injury 2019 Jun 5;50(6):1242-1246. Epub 2019 Apr 5.

Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Waehringer Guertel 18-20, A-1090, Vienna, Austria. Electronic address:

Background: Compartment syndrome of the thigh (CST) is a rare condition, and its delayed diagnosis and therapy may lead to devastating adverse effects. Thus, the aim of this study was to present the amassed clinical experiences, regarding diagnosis and treatment of CST at a level I trauma centre.

Materials And Methods: The database was reviewed for all patients with a manifest CST treated surgically between 1995 and 2014.

Results: 69 patients (61 males and 8 females) met the inclusion criteria, with a mean age of 42.9 years (range: 11-87 years). Forty-four patients (64%) presented with an isolated CST. There was a significant association between complication rates and high impact vs. blunt trauma (12/32, 38% vs. 0/20, 0%; p = 0.0022; Fisher's exact test). The number of surgeries in patients with a concomitant femur fracture was significantly increased (in mean: 2.8 vs. 4.9 surgical interventions; p < 0.001; U test).

Conclusion: Patients after high impact trauma showed the highest complication rate. Concomitant femur fractures were associated with an increased number of surgical interventions. The synopsis of trauma mechanism, clinical presentation, age, anticoagulation status and clinical experience of the trauma surgeon seem to be the best tools to correctly diagnose CST.
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http://dx.doi.org/10.1016/j.injury.2019.04.001DOI Listing
June 2019

Effect of two (short-term) storage methods on load to failure testing of murine bone tissue.

Sci Rep 2019 04 11;9(1):5961. Epub 2019 Apr 11.

Department of Orthopaedics and Trauma Surgery, Division of Trauma Surgery, Medical University of Vienna, Vienna, Austria.

Since mechanical testing of bone quality is often delayed following euthanasia, the method of bone storage is of high importance in animal studies. Different storage methods may cause a change in the properties of bone tissue during mechanical testing. Therefore, the aim of this study was to investigate the biomechanical effects of two different fixation methods for bone tissue. We hypothesized that there is a difference between the load to failure values between the two groups. The tibias of fifteen 18-week-old female C57BL/6 mice were harvested and randomly allocated to three different groups with varying storage methods: (1) frozen at -80 °C, (2) paraformaldehyde working solution, and (3) native group. A storage time of two weeks prior to testing was chosen for groups 1 and 2. In group 3, referred to as the "native group", bones were immediately tested after the harvesting procedure. The comparison of the mean load to failure of all 3 groups (group 1: 28.7 N ± 6.1 N, group 2: 23.8 N ± 3.8 N and group 3: 23.7 N ± 5.7 N) did not reveal a significant difference. There was also no difference in strength or stiffness. The findings of the present study demonstrate that the two most common storage methods, do not have an influence on the biomechanical properties of murine bone over a two week period.
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http://dx.doi.org/10.1038/s41598-019-42476-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459877PMC
April 2019

Traumatic periimplant fracture after nail arthrodesis of the knee in a limb reconstruction case.

Trauma Case Rep 2019 Apr 8;20:100173. Epub 2019 Feb 8.

Medical University of Vienna, Department of Trauma Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria.

Many principles of bone reconstruction were successfully applied in this unique case of a 1.92m (6 ft 3 in.) tall 15 year old boy with intercalary leg amputation. This patient suffered from a 26 cm (10.2 in.) bone loss of his left distal femur and severe soft tissue damage with an irreparable extensor mechanism after motor cycle accident. After periimplant fracture below the knee arthrodesis nail, definite treatment consisted of implant exchange to an 870 mm (34.3 in.) long custom made nail, which is to our knowledge the longest implanted arthrodesis nail in literature. Therefore the aim of the study was to present our treatment strategies and pitfalls after traumatic periimplant arthrodesis nail fracture in an unusual case of limb reconstruction.
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http://dx.doi.org/10.1016/j.tcr.2019.100173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6369247PMC
April 2019

The buried knot technique for all inside graft link preparation leads to superior biomechanical graft link stability.

Sci Rep 2019 02 6;9(1):1488. Epub 2019 Feb 6.

Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Medical University of Vienna, Vienna, Austria.

The aim of this study was to measure and compare the biomechanical properties of two different graft link preparation techniques for anterior cruciate ligament reconstruction. We hypothesised that there would be differences in elongation, load at failure and failure mode due to the different graft link preparation techniques. Thirty fresh-frozen anatomical specimen knees were used. Both tendons (semitendinosus and gracilis) were harvested and randomly assigned to two groups. Graft links prepared with a continuous loop technique were allocated to group 1, whereas those prepared with a buried-knot technique were allocated to group 2. The mechanical properties of both techniques were measured. A mean load to failure of 731 N and an overall graft elongation of 6 mm was found in the continuous loop group. In the buried-knot group, a higher load to failure (848 N) and a lower mean overall elongation (5 mm) was found. The buried-knot technique showed better results with significantly higher load to failure and significantly less elongation compared to the continuous loop technique. It is essential in clinical practice to choose the most accurate technique for graft link preparation to ensure graft stability, especially in the early phase of recovery.
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http://dx.doi.org/10.1038/s41598-018-38150-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365500PMC
February 2019

Risk factors predicting prognosis and outcome of elderly patients with isolated traumatic brain injury.

J Orthop Surg Res 2018 Nov 3;13(1):277. Epub 2018 Nov 3.

Department of Orthopaedics and Trauma Surgery, Division of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18 - 20, A - 1090, Vienna, Austria.

Background: Traumatic brain injury (TBI), particularly in the elderly patient population, is known to be the single largest cause of death and disability worldwide. The purpose of this retrospective study was to evaluate clinical factors predicting poor outcome with special emphasis on the impact of respiratory failure (RF) on mortality in elderly patients with isolated severe TBI.

Methods: All elderly patients (age ≥ 65 years) with isolated severe head injury, admitted to this level I trauma center, during a period of 18 years (from January 1992 to December 2010) were identified from the trauma registry. The medical records were reviewed for demographics, mechanism of injury (MOI), GCS score at admission, RF, pupillary light reflex (LR), CT findings (subdural hematoma, subarachnoid hematoma, edema, midline-shift), and whether there was conservative treatment or surgical intervention and the Glasgow Outcome Score (GOS) at hospital discharge. Stepwise logistic regression analysis was used to identify risk factors for a poor prognosis and outcome.

Results: The following variables influenced the mortality: respiratory failure, pupillary response, and the injury severity score (ISS). A significant increased risk of death was also found for patients with a midline shift of over 15 mm.

Conclusions: The present study predicts a strong correlation between respiratory failure, pathological pupillary response, a higher ISS, and substantial midline shift with poor outcomes in elderly patients sustaining an isolated severe TBI.

Trial Registration: Clinical trials: ID: NCT02386865 . Registered 12 March 2015-retrospectively registered.
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http://dx.doi.org/10.1186/s13018-018-0975-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6215630PMC
November 2018

A bigger suture diameter for anterior cruciate ligament all-inside graft link preparation leads to better graft stability: An anatomical specimen study.

Knee 2018 Jun 6;25(3):427-433. Epub 2018 Apr 6.

Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.

Background: In anterior cruciate ligament reconstruction, different suture types are used for graft link preparation. Thus the aim of this study was to determine whether differences in the diameter of the suture used influence biomechanical stability of the prepared graft. We hypothesized that the use of a greater suture diameter leads to a higher load to failure rate in tested graft links.

Methods: In an anatomic specimen study, ligament preparation was enrolled in 15 cadaveric knees. The material used was the semitendinosus/gracilis tendon, which was fresh frozen (-80°) after harvesting for four weeks. The grafts were then defrosted, randomized into two groups and prepared with the same technique: 12 with a suture; FiberWire No. 2 and 12 with a FiberWire No. 0.

Results: Overall, the group using FiberWire No. 2 presented with a mean load to failure rate of 730.67N, mean overall final elongation of the graft was 5.98mm. In the FiberWire No. 0 group mean load to failure was with a mean overall elongation of the graft of 6.96mm. Significant differences (P=0.006) between the two groups with regard to the load to failure rate were found, with FiberWire No. 2 withstanding forces better. There was no difference in elongation of the grafts or mode to failure between the two groups.

Conclusions: Graft preparation with a bigger suture type is recommended to gain better load to failure rates, also in smaller-diameter grafts. Regarding the elongation rate, different suture types did not influence the outcome.

Level Of Evidence: Anatomical specimen study, Level III.
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http://dx.doi.org/10.1016/j.knee.2018.03.010DOI Listing
June 2018

Damage control surgery - experiences from a level I trauma center.

BMC Musculoskelet Disord 2017 Sep 11;18(1):391. Epub 2017 Sep 11.

Department of Trauma Surgery, Medical University of Vienna, Waehringerguertel 18-20, A-1090, Vienna, Austria.

Background: There is still no evidence in literature for damage control orthopaedics (DCO), early total care (ETC) or using external fixation solely in fractures of the long bones in multi-system-trauma. The aim of this study was to determine parameters influencing the choice of treatment in clinical routine (DCO, ETC, or EF) in femoral or tibial shaft fractures in combination with multi-system-trauma, severe soft tissue damage or both.

Methods: Data of 236 patients with 280 fractures of long bones of the lower extremities treated at a level I trauma center were analysed. Clinical parameters on arrival (age, sex [m/f], ISS, fracture site [femur/tibia], soft tissue damage [closed or open fractures according to the Gustilo-Anderson classification], pulmonary injury [yes/no]) were collected and analysed whether they influence the choice of upcoming treatment (DCO/ETC/EF).

Results: Our findings showed that high ISS and severe soft tissue damage (grade III) significantly correlated with DCO. High ISS, old age, female sex and fracture site (tibia) correlated with EF. This group of sole use of external fixation had highest rate of complications, 69% were associated with at least one complication.

Conclusion: Severely injured patients are treated significantly more often with DCO or EF. The presence of higher ISS (≥16) and of type III open fractures increased the use of DCO. However, ISS, fracture-site, patient's age, type III open fractures or sex (female) increased the use of EF compared to ETC.
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http://dx.doi.org/10.1186/s12891-017-1751-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5594486PMC
September 2017

Acromioclavicular joint dislocation treated with Bosworth screw and additional K-wiring: results after 7.8 years - still an adequate procedure?

BMC Musculoskelet Disord 2017 Aug 4;18(1):339. Epub 2017 Aug 4.

Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.

Background: The acromioclavicular (AC) joint dislocation is a major reason for shoulder instability. Different concepts of treatment and surgical methods are described in the literature. Thus, the purpose of this study was to present our data of long-term follow-up of patients having undergone treatment of acromioclavicular (AC) joint dislocation using the Bosworth Screw with additional K-wiring.

Methods: This study was conducted as a retrospective single centre data analysis. All patients treated operatively for AC joint dislocation with a Bosworth screw and additional K-wire fixation at our Department were asked to participate in this study.

Results: The study population consisted of 22 patients, 20 male and 2 female, with a mean age of 40 years ±15.6 years. Three grade-II lesions, 13 grade-III lesions, four grade-IV lesions and two grade-V lesions according to the Rockwood classification were found. The overall mean clinical outcome at the latest follow up was: Constant 95, DASH 6.4, ASES 94.6, SST 99.02, UCLA 33.1, ACJI 91.82 and VAS 0.29 - representing a good-to-excellent long-term outcome in all patients after at least 2 years follow-up (range; 2 - 19 years). Overall, 19 patients (86%) reported to be very satisfied with the achieved result, 15 patients (68%) reported to be able to participate in every sports activity and 16 patients (73%) reported to be able to perform their daily work without limitations. Overall, complications occurred in three patients (14%). Only one patient remained unsatisfied with the achieved result.

Conclusion: Summarizing, our reported results showed that surgical fixation of acute AC joint dislocation with a Bosworth screw and additional K-wire fixation leads to good-to-excellent functional outcome and highly satisfactory results in the majority of patients. Despite its complications, in accordance with our results, Bosworth screw fixation with additional K-wiring in AC joint dislocation represents an adequate surgical procedure.

Level Of Evidence: Level IV, retrospective study.
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http://dx.doi.org/10.1186/s12891-017-1692-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5545010PMC
August 2017

Computer navigation-assisted surgery for musculoskeletal tumors: a closer look into the learning curve.

Eur J Orthop Surg Traumatol 2017 Aug 24;27(6):851-858. Epub 2017 Jun 24.

Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.

Background: Computer navigation-assisted surgery for musculoskeletal tumors has shown to reduce the risk of intra-lesional margins in resection. Experiences with this method are still limited to smaller case series.

Method: We reviewed our first experiences in 24 patients in whom computer navigation-assisted surgery had been performed. In 7 of these patients (6 male and 1 female), this has influenced the surgical treatment plan and navigation was used for both tumor resection and reconstruction. Three of the patients suffered from a chondrosarcoma, 2 from an osteosarcoma, 1 from a fibrosarcoma and 1 from an Ewing's sarcoma. Tumors were localized in the femur (n = 2), the tibia (n = 1), the sacrum (n = 1), the humerus (n = 1), the ilium (n = 1) and in the gluteal region (n = 1).

Results: The mean registration error was 0.9 mm. No intra-operative complications occurred. Two postoperative complications were observed which required revision surgery. Except for one marginal resection, all tumors were excised with wide margins. One patient suffered from a local recurrence, and one patient died of disease after distant metastatic dissemination.

Conclusion: Computer navigation-assisted surgery represents a safe and helpful tool for the resection of musculoskeletal tumors and may influence surgical treatment plans in selected cases to provide more limited resections. Surgeons should be aware of risks considering biomechanical and oncological consequences in doing so. Further investigations and the evaluation of newer techniques (e.g., computed tomography-guided navigation) are needed to assess long-term outcomes of computer navigation assistance in musculoskeletal tumor surgery.
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http://dx.doi.org/10.1007/s00590-017-2004-yDOI Listing
August 2017

Progression of function and pain relief as indicators for returning to sports after arthroscopic isolated type II SLAP repair-a prospective study.

BMC Musculoskelet Disord 2017 Jun 13;18(1):257. Epub 2017 Jun 13.

AUVA Trauma Center Vienna Meidling, Kundratstraße 37, 1120, Vienna, Austria.

Background: One of the currently used surgical techniques in isolated type II SLAP lesions is arthroscopic SLAP repair. Postoperatively, patients tend to suffer from a prolonged period of pain and are restricted in their sports activities for at least 6 months. The aim of this study was to prospectively evaluate the clinical outcome as well as the postoperative course of pain after arthroscopic type II SLAP repair.

Methods: Outcome measures were assessed using the Individual Relative Constant Score (CS), the American Shoulder and Elbow Surgeons (ASES) Score, the Visual Analogue Scale (VAS), and the Short Form 36 (SF-36). Data were collected preoperatively, as well as at 3, 6, 12 and >24 months postoperatively.

Results: Eleven patients with an average age of 31.8 years (range: 22.8-49.8 years) underwent arthroscopic repair of isolated type II SLAP lesions. Mean follow-up time was 41.9 months (range: 36.1-48.4 months). 6 months after surgery, there was a statistically significant improvement of function according to the CS (p = 0.004), the ASES Score (p = 0.006), and the SF-36 subscale "physical functioning" (p = 0.014) and a statistically significant decrease of pain according to the VAS (p = 0.007) and the SF-36 subscale "bodily pain" (p = 0.022) compared to preoperative levels.

Conclusions: Arthroscopic repair of isolated type II SLAP lesions with suture anchors leads to a satisfactory functional outcome and return to pre-injury sports levels, with delayed, but significant pain relief observed 6 months after surgery. Thus, a return to sports should not be allowed earlier than 6 months after surgery, when patients have reached pain-free function and recovered strength.

Trial Registration: Researchregistry1761 (UIN).
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http://dx.doi.org/10.1186/s12891-017-1620-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470215PMC
June 2017

Osteoporosis associated vertebral fractures-Health economic implications.

PLoS One 2017 22;12(5):e0178209. Epub 2017 May 22.

Department of Trauma Surgery, Medical University of Vienna, Austria.

Introduction: Osteoporosis-associated vertebral fractures represent an increasing clinical and public health problem, one with important socioeconomic effects within western countries. The purpose of this study was to analyse demographic, medical, gender and socioeconomic aspects of osteoporotic vertebral fractures of the thoracic or lumbar spine over a period of at least 10-years.

Material And Methods: Included for analysis were 694 patients who had suffered a vertebral fracture due to primary or secondary osteoporosis, and who were treated at our Level-I trauma center between 2000 and 2013. Collected data included demographic, medical and socioeconomic aspects.

Results: Clinical results revealed that 669 patients (96%) were treated conservatively. The remaining 25 patients (4%) underwent surgical therapy: 4 were treated with vertebroplasty, 15 with kyphoplasty and 6 patients with posterior stabilization. The mean age was 75.6 years (range: 50-98), with the vast majority of patients being female (n = 515). A statistically significant demographic difference (i.e., increase) in fractures was observed between the age groups 60-69 and 70-79 (p = 0.041). Concerning socioeconomic aspects, statistical analysis showed that the number of sick leaves and the need for professional domestic help was higher in female patients. Concerning treatment costs, statistical analysis did not reveal any significant differences between female and male patients.

Conclusion: Significant gender differences-to the detriment of the female population-could be demonstrated within this study. A regrettably low rate of adequate treatment after diagnosis of osteoporosis and its associated fractures-specifically relating to primary and secondary prevention-could also be identified. To prospectively avoid complications and consequential cost increases, more awareness of the necessity for prevention, early diagnosis and adequate treatment of osteoporosis and its related fractures should be considered.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0178209PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5439946PMC
September 2017

Displaced Neer Type IIB distal-third clavicle fractures-Long-term clinical outcome after plate fixation and additional screw augmentation for coracoclavicular instability.

BMC Musculoskelet Disord 2017 01 23;18(1):30. Epub 2017 Jan 23.

Department of Trauma Surgery, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria.

Background: Unstable Neer Type IIB fractures require meticulous surgical treatment. Thus, the aim of this study was to present long-term outcomes after plate fixation and minimally invasive coracoclavicular (CC) stabilization using screw fixation.

Methods: A consecutive series of patients with unstable Neer Type IIB displaced clavicle fractures, treated by open reduction and internal fixation (ORIF) with a plate and additional screw fixation for coracoclavicular ligament instability, was reviewed in order to determine long-term clinical and radiological outcome.

Results: Seven patients, six males and one female, with a mean age of 37 ± 8 years (median: 36 years; range, 28-51 years), were evaluated. At latest follow-up, after a mean of 67 months (range, 11-117 months), patients presented with the following mean scores: DASH: 0.57, ASES: 98.81, UCLA: 34.29, VAS: 0.43, Simple Shoulder Test: 11.57. However, two complications were observed: one case of implant loosening and one non-union. There were no differences observed between the CC distances comparing postoperative X-rays to those in final follow-up. In 25% of our patients early postoperative complications occurred. In all patients reoperation was necessary to remove the implanted screw.

Conclusion: The results of the present study indicate that the treatment of Neer Type IIB lateral clavicle fractures with ORIF using a plate and additional CC screw fixation, leads to satisfying clinical and radiological outcomes in the long-term. However, considering an early postoperative complication rate of 25% and a 100% rate of secondary surgery due to removal of the CC screw does not seem to justify this technique anymore.
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http://dx.doi.org/10.1186/s12891-017-1398-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5259881PMC
January 2017

Displaced juvenile Tillaux fractures : Surgical treatment and outcome.

Wien Klin Wochenschr 2017 Mar 17;129(5-6):169-175. Epub 2016 Aug 17.

Department of Trauma Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.

Background: Approximately 15 % of all juvenile injuries of the long bones involve the epiphyseal growth plate, and 2.9 % of these are juvenile Tillaux fractures. The Tillaux fracture is of great importance because it involves a major weight-bearing articular surface. Treatment protocols in the literature are not uniform for this kind of fracture, and numerous case reports can be found describing various treatment methods. The aim of this study was to present the clinical outcome at long-term follow-up after treatment of displaced Tillaux fractures.

Methods: In all, 168 children and adolescent patients with physeal injuries of the distal tibia were treated from 2003 to 2012. Seven patients were identified as having Tillaux fractures requiring surgical treatment and therefore were included in our study and evaluated retrospectively.

Results: Seven patients with Tillaux fractures underwent surgical reconstruction by open or closed reduction. Excellent results were achieved in 90 % of the patients, with a mean Foot and Ankle Score at the last follow-up of 98.71.

Conclusion: Anatomical reduction is required for every displaced epiphyseal fracture via open reduction and internal fixation, especially in cases with ≥2 mm fragment displacement. Plaster cast immobilization and non-weight-bearing mobilization for at least 4 weeks might be a good way of ensuring optimal surgical results and preventing complications.
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http://dx.doi.org/10.1007/s00508-016-1059-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5346147PMC
March 2017

Intramedullary magnetically actuated limb lengthening in a patient with congenital humeral limb shortening.

Injury 2016 Jul 3;47(7):1597-600. Epub 2016 May 3.

Medical University of Vienna, Department of Trauma Surgery, Austria. Electronic address:

The treatment of leg length discrepancy has become a common procedure in orthopaedic surgery. However, lengthening of humeral deformities is still infrequent. The purpose of this case report was to present humeral lengthening with a new intramedullary lengthening device (PRECICE® P2 for tibia) in a 32 year old female patient with congenital shortening. Hereby the telescopic device presents a promising tool for humeral limb lengthening with excellent outcome at short-term in this case.
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http://dx.doi.org/10.1016/j.injury.2016.04.019DOI Listing
July 2016

Do Patients After Chondrosarcoma Treatment Have Age-appropriate Bone Mineral Density in the Long Term?

Clin Orthop Relat Res 2016 Jun 16;474(6):1508-15. Epub 2016 Feb 16.

Department of Orthopaedic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.

Background: In long-term survivors of osteosarcoma and Ewing sarcoma treated with the addition of radio- and chemotherapy, low bone mineral density (BMD) and fractures have been observed, presumably resulting from these adjuvants. Because patients with chondrosarcoma usually are not treated with conventional adjuvant treatment, observation of low BMD in patients with chondrosarcoma presumably would be the result of other mechanisms. However, BMD in patients with a history of chondrosarcoma has not been well characterized.

Questions/purposes: The aim of our study was to address the following questions: (1) Do long-term survivors of chondrosarcoma have normal BMD and, if not, which factors contribute to low BMD? (2) Is there a greater risk of fracture and does the Fracture Risk Assessment Tool (FRAX(®)) score reflect fracture likelihood?

Methods: All known patients with a history of chondrosarcoma treated at our institution before 2006 were identified. Of 127 patients believed to be alive at the time of this study, 30 agreed to participate in this study (11 females, 19 males; mean age at surgery, 39 ± 12 years; mean followup, 12 ± 5 years). With the data available, the 30 participants were not different from the 97 nonparticipants in terms of age, sex, BMI, tumor grade, tumor location (axial versus appendicular, lower extremity versus elsewhere), and use of any treatment known to influence osteopenia (chemotherapy, lower extremity surgery). BMD was measured and history of fractures was assessed using a questionnaire. The patients´ BMD measurements in this study were sex- and age-matched with a normative sex- and age-categorized reference population reported by Kudlacek et al. Associations were tested by univariate regressions and ANOVAs of all measures of BMD and eligible oncologic and demographic factors.

Results: Eighteen of 30 (60%) patients had a pathologic BMD according to the WHO dual-energy x-ray absorptiometry definition, 15 (50%) had osteopenia, and three (10%) had osteoporosis. T-scores in the study cohort were lower than reference values for the femur neck (mean difference, 0.64; 95% CI, 0.27-1.01; p < 0.0015), but not for the spine (mean difference, 0.39; 95% CI, -0.06 to 0.84; p = 0.09). Thirteen patients (45%) reported a history of fractures not distinguishing between low and high impact. The incidence of fractures was 2.8 greater than expected from a comparison with a published microcensus survey of the Austrian population. No effect of the FRAX(®) score on fracture risk could be identified (p = 0.057).

Conclusions: Long-term survivors of chondrosarcoma appear to be at greater risk for having low BMD develop than the healthy population. Although these results are preliminary and based on a very small sampling of patients, if they can be confirmed in larger studies, BMD assessment by dual-energy x-ray absorptiometry might be considered as these patients are followed posttreatment by sarcoma care units. The reasons for low BMD still must be elucidated.

Level Of Evidence: Level IV, prognostic study.
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http://dx.doi.org/10.1007/s11999-016-4741-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4868166PMC
June 2016

Management and Outcome of Dens Fracture Nonunions in Geriatric Patients.

J Bone Joint Surg Am 2016 Feb;98(3):193-8

Department of Trauma Surgery, Medical University of Vienna, Austria.

Background: Dens fractures are known to have high rates of pseudarthrosis. The aim of this study was to define clinical and radiographic long-term outcomes, specifically in relation to osseous union, cervical spine movement, neurological sequelae, and quality of life, in a geriatric cohort (sixty-five years of age or older) treated operatively or nonoperatively for a dens fracture nonunion.

Methods: Forty-four patients (twenty-eight women and sixteen men; average age, seventy-two years) met the inclusion criteria and were enrolled in this study. Sixteen patients (36%) underwent operative stabilization with posterior cervical arthrodesis, and twenty-eight (64%) were treated nonoperatively with a predefined protocol. All patients had a post-treatment follow-up period of at least five years.

Results: Radiographic evaluation showed osseous union at the site of the C1-C2 arthrodesis in all sixteen patients who had undergone surgical treatment. Clinical follow-up revealed that fourteen had satisfactory results following postoperative rehabilitation. In contrast, radiographic evaluation of the twenty-eight nonoperatively treated patients showed persistence of the pseudarthrosis of the dens in twenty-six and osseous union of the dens in two. All twenty-eight patients (100%) had a satisfactory clinical outcome.

Conclusions: C1-C2 arthrodesis was a reliable treatment option for dens fracture nonunions that were unstable, those associated with neurological symptoms, and those causing persistent pain. Clinical and radiographic monitoring was an acceptable nonoperative treatment option but was associated with a very low rate of osseous union of the dens.
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http://dx.doi.org/10.2106/JBJS.O.00101DOI Listing
February 2016

Clinical and Functional Outcome of All-Inside Anterior Cruciate Ligament Reconstruction at a Minimum of 2 Years' Follow-up.

Arthroscopy 2016 Feb 23;32(2):332-7. Epub 2015 Oct 23.

Department of Trauma Surgery, Medical University Vienna, Vienna, Austria. Electronic address:

Purpose: To evaluate the clinical and functional outcomes for anatomic anterior cruciate ligament (ACL) reconstruction using the all-inside technique with a minimum follow-up of 24 months.

Methods: Patients undergoing anatomic ACL reconstruction via the all-inside technique between January 2011 and October 2012 were reviewed for inclusion in this study. Functional outcome measures, including the Lysholm score, International Knee Documentation Committee score, visual analog scale score, and Tegner Activity Scale, were used to evaluate outcomes before surgery and at 3, 6, 12, and > 24 months. At final follow-up, anteroposterior knee stability was assessed with KT-2000 (MEDmetric, San Diego, CA) measurements.

Results: Of the 92 patients who underwent primary all-inside ACL reconstruction, 79 patients returned to final follow-up with a minimum of 2 years. There were 53 men and 26 women with a mean age of 29 years (range, 18 to 54 years) and a mean follow-up of 29 months (range, 24 to 45 months). The International Knee Documentation Committee score (44.6 v 89.7, P < .0001), Lysholm score (53.4 v 93.1, P < .001), visual analog scale score (5 v 0.1, P < .001), and Tegner activity score (2 v 6, P < .001) showed a significant improvement between baseline and final clinical follow-up. The mean side-to-side KT-2000 difference at final follow-up was 1.7 mm (range; 0 to 6 mm). Overall 10 patients (12.7%) sustained an ACL graft rerupture after a mean of 17.6 months (range, 6.9 to 28.6 months).

Conclusions: The current data support our first hypothesis that primary anatomic ACL reconstruction using the all-inside technique leads to improved functional outcomes between baseline and clinical follow-up at 24 months. Further, there was no difference in knee stability between the ACL reconstructed- and the contralateral normal knee at 24 months, which confirms our second hypothesis.
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http://dx.doi.org/10.1016/j.arthro.2015.08.014DOI Listing
February 2016

Treatment of proximal humerus fractures in children and young adolescents.

Wien Klin Wochenschr 2016 Feb 6;128(3-4):120-4. Epub 2015 Nov 6.

Department of Trauma Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.

Background: Fractures of the proximal humerus in children are rare and represent approximately 0.45% of all paediatric fractures. These injuries are common in patients up to an age of 16 years. The treatment of displaced subcapital fractures is still controversially discussed in literature. Therefore the aim of this study was to evaluate the short-term outcome and to provide guidelines for surgical treatment of these fractures in children and adolescents.

Methods: Clinical and radiological results of 231 patients between 0 and 17 years with subcapital humerus fractures were evaluated. Patients were devided according to their treatment as followed (1) conservative treatment group (2) operative treatment group.

Results: A total of 191 patients (82.7%) underwent conservative treatment and 40 (17.3%) underwent operative treatment. Surgical treatment consisted of open reduction and internal fixation (ORIF) (35.0%) or closed reduction and internal fixation (CRIF) (52.5%). In all operated patients an axial deviation of more than 20° was observed preoperatively. According to our groups; the surgical group presented in 90% (N = 36) of the patients with an excellent result, in 5% (N = 2) an average result was observed and in 5% (N = 2) a poor result according to Constant Murley Score was achieved. In the conservative treatment group in 185 patients (96.9%) excellent results were achieved and in 6 patients (3.1%) an average result in the Constant Murley Score was achieved.

Conclusion: Conservative treatment in children < 10 years and an angulation angle < 20°, as well as surgical treatment with ORIF or CRIF in patients > 10 years and with an angulation angle > 20° leads to excellent short-term outcome. However, studies with longer observation time are needed to evaluate long-term complications like limb length discrepancy.
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http://dx.doi.org/10.1007/s00508-015-0879-3DOI Listing
February 2016

Incidence, characteristics, and long-term follow-up of sternoclavicular injuries: An epidemiologic analysis of 92 cases.

J Trauma Acute Care Surg 2016 Feb;80(2):289-95

From the Department of Trauma Surgery (S.B., M.W., T.M.T., P.P.), Division of General Anaesthesia and Intensive Care Medicine (A.B.), and Center for Medical Physics and Biomedical Engineering (W.H.), Medical University of Vienna; and AUVA Trauma Hospital Meidling (C.F.), Vienna; and Department of Trauma Surgery (M.G.), University Hospital St. Poelten, Lower Austria, Austria.

Background: The majority of published studies concerning sternoclavicular injuries are case series or systematic reviews. Prospective studies on the subject are hindered by the low incidence of these lesions. The aims of the present study were to provide an overview of this rare entity compared with those described in the literature and to present the long-term clinical outcome.

Methods: We performed a retrospective data analysis of all sternoclavicular injuries treated at a single Level I trauma center from 1992 to 2011. Long-term clinical outcome was assessed using the ASES [American Shoulder and Elbow Surgeons], SST [Simple Shoulder Test], UCLA [University of California-Los Angeles] Shoulder Scale, and VAS [Visual Analog Scale] at latest follow-up.

Results: We detected an overall incidence of 0.9% of sternoclavicular injuries related to all shoulder-girdle lesions. Ninety-two patients (52 males and 40 females) with a mean (SD) age of 39.2 (19.5) years (median, 41 years; range, 4-92 years) were included in this study. The main trauma mechanism was fall. Classification was performed according to Allman, the time point of treatment after initial trauma, and the direction of the dislocation. Nine patients of the 15 Grade III lesions were treated conservatively by closed reduction and immobilization, while four patients were treated surgically by open reduction and internal fixation. Forty-nine percent of the patients were available for long-term follow-up at a median of 11.3 years (range, 5.3-22.6 years) with a mean ASES score of 96.21, SST score of 11.69, UCLA score of 31.89, and VAS score of 0.47.

Conclusion: We found an overall incidence of 0.9% of sternoclavicular joint injuries related to all shoulder-girdle lesions and of 1.1% related to all dislocations, which is slightly lower compared with those described in the literature. Furthermore, we observed a high number of physeal sternoclavicular injuries with a percentage of 16% and overall good-to-excellent results at long-term follow-up.

Level Of Evidence: Epidemiologic study, level IV.
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http://dx.doi.org/10.1097/TA.0000000000000888DOI Listing
February 2016
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