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Patella baja after intramedullary nailing of tibial fractures, using an infrapatellar/transtendinous approach, predicts worse patient reported outcome

Graulich, Tilman ; Gerhardy, Julius ; Omar Pacha, Tarek ; [et al.]

Springer Science and Business Media LLC ; 2022

In: European Journal of Trauma and Emergency Surgery Vol. 48, No. 5 ( 2022-10), p. 3669-3675

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In: European Journal of Trauma and Emergency Surgery, Springer Science and Business Media LLC, Vol. 48, No. 5 ( 2022-10), p. 3669-3675

Abstract: After intramedullary nailing of tibial shaft fractures using an infrapatellar/transtendinous approach, several patients suffer anterior knee pain. We suspect that the approach is associated with soft tissue scars and the development of a postoperative patella baja. The goal of the study is to investigate whether the development of patella baja is associated with worse subjective outcomes. Methods We retrospectively analyzed all patients in our orthopedic trauma department between 2011 and 2020 who underwent tibial fracture fixation via intramedullary nailing via an infrapatellar/transtendinous approach. Pre- and postoperative lateral knee x-rays were evaluated by measurement of the Insall-Salvati Index, and nail tip position. All patients were asked to answer the self-assessment Kujala questionnaire and Lysholm questionnaire. Results We included 78 patients (age: 44 ± 18 years) with a minimum follow-up of 12 months. Mean follow up was 59 ± 25 months. We included 50 male and 28 female patients. Patella baja detected by Insall-Salvati Index could be observed in 8 (10.3%) patients. Patients with patella baja showed significant worse function measured by the Kujala score 54 ± 18 vs. 80 ± 14 ( p 〈 0.01). Likewise, Lysholm score did show significant differences between both groups (60 ± 24 vs. 86 ± 11; p 〈 0.01). Nail tip position was not associated with worse subjective function. Conclusions Patella baja in patients after tibial intramedullary nailing via an infrapatellar/transtendinous approach, is associated with worse subjective function and increased pain.

Type of Medium: Online Resource

ISSN: 1863-9933 , 1863-9941

URL: Article

DOI: 10.1007/s00068-021-01807-9

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2022

detail.hit.zdb_id: 2276432-X

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Fluoroscopic Intraoperative Images Produce Higher Image Quality and Decrease Total Radiation Exposure Compared to Radiographic X-ray Images in Patients After Primary Total Knee Arthroplasty

GRAULICH, TILMAN ; GERHARDY, JULIUS ; ÖRGEL, MARCUS ; [et al.]

Anticancer Research USA Inc. ; 2020

In: In Vivo Vol. 34, No. 5 ( 2020), p. 2521-2526

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In: In Vivo, Anticancer Research USA Inc., Vol. 34, No. 5 ( 2020), p. 2521-2526

Type of Medium: Online Resource

ISSN: 0258-851X , 1791-7549

URL: Article

DOI: 10.21873/invivo.12069

Language: English

Publisher: Anticancer Research USA Inc.

Publication Date: 2020

detail.hit.zdb_id: 807031-3

detail.hit.zdb_id: 2492569-X

SSG: 15,3

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Comparison of Preoperative Pedicle Screw Measurement Between Computed Tomography and Magnet Resonance Imaging

OMAR PACHA, TAREK ; OMAR, MOHAMED ; GRAULICH, TILMANN ; [et al.]

International Journal of Spine Surgery ; 2020

In: International Journal of Spine Surgery Vol. 14, No. 5 ( 2020-10), p. 671-680

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In: International Journal of Spine Surgery, International Journal of Spine Surgery, Vol. 14, No. 5 ( 2020-10), p. 671-680

Type of Medium: Online Resource

ISSN: 2211-4599 , 2211-4599

URL: Article

DOI: 10.14444/7098

Language: English

Publisher: International Journal of Spine Surgery

Publication Date: 2020

detail.hit.zdb_id: 2660509-0

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Direct measurement of malrotation of traumatic femoral neck fractures after osteosynthesis: Introduction of a novel method and interrater reliability

Omar Pacha, Tarek ; Sonnow, Lena ; Poehler, Gesa Helen ; [et al.]

Public Library of Science (PLoS) ; 2021

In: PLOS ONE Vol. 16, No. 4 ( 2021-4-26), p. e0250409-

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In: PLOS ONE, Public Library of Science (PLoS), Vol. 16, No. 4 ( 2021-4-26), p. e0250409-

Abstract: In elderly patients, displaced femoral neck fractures are mostly treated by arthroplasty; however for younger patients ( 〈 50 years), open reduction and internal fixation is considered the gold standard approach. Despite there being no consensus on the specific procedure, everyday clinical practice in a level I trauma center has shown that postoperative maltorsion after internal fixation of femoral neck fractures can have a significantly worse impact on mobilization and outcome. Different methods for measurement of malrotations are reported in literature. However, any reported method for the assessment of a shaft malrotation in the femur does not work here. In femoral neck fractures, the pointer function of the femoral neck, which is absolutely essential for these techniques, is lost and cannot be set in relation to the condylar plane. These circumstances are not addressed in literature thus far. Therefore, we propose here a novel method to fill this diagnostic gap. Methods and findings Three investigators (1 orthopaedic surgeons and 2 radiologists) measured the torsion of 20 legs on 10 patients using the Jarret method and a new geometric technique. To determine the intraobserver reliability the torsional angles were calculated again after 3 months. We applied a new geometric technique, without the need to include the femoral condyles in the measurement, to directly measure the angulation. For torsional difference, the interrater reliability -ICC (interclass correlation) between all investigators was 0.887 (good) (significance level: 95%CI, 0.668–0.969; p 〈 0.001), by using the method of Jarret et al. and 0.933 (good) for the novel technique (significance level: 95%CI, 0.802–0.982; p 〈 0.001). If the examinations are classified according to the patient side, our data show that for established methods, an ICC between the examiners on the right lower extremity is 0.978 (good) (95%CI, 0.936–0.994; p 〈 0.001) and that on the left extremity is 0.955 (good) (95%CI, 0.867–0.988; p 〈 0.001). Comparing with the new method, the right side assumes an ICC of 0.971 (good) (95%CI, 0.914–0.992; p 〈 0.001), while the left side assumes an ICC of 0.910 (good) (95%CI, 0,736–0.976; p 〈 0.001). When it comes to the intraobserver reliability, the measured cohort shows a significant better ICC for the novel method compared to Jarrett et al, with 0.907 respectively 0.786 for comparison in torsional differences. Conclusion The established methods may fail in assessing this special aspect of malrotation after femoral neck fractures. Here, the method presented results in a significant difference between the injured and uninjured side and shows significant differences in results compared to conventional measurement methods. The inter- and intraobserver reliability determined in this study is excellent and even higher in the assessment of torsional differences than the established method. We believe that the measurement method presented in this study is a useful tool to objectify the postoperative deformities in this area and making therapy recommendations in the future.

Type of Medium: Online Resource

ISSN: 1932-6203

URL: Article

DOI: 10.1371/journal.pone.0250409

DOI: 10.1371/journal.pone.0250409.g001

DOI: 10.1371/journal.pone.0250409.g002

DOI: 10.1371/journal.pone.0250409.g003

DOI: 10.1371/journal.pone.0250409.g004

DOI: 10.1371/journal.pone.0250409.g005

DOI: 10.1371/journal.pone.0250409.g006

DOI: 10.1371/journal.pone.0250409.g007

DOI: 10.1371/journal.pone.0250409.g008

DOI: 10.1371/journal.pone.0250409.g009

DOI: 10.1371/journal.pone.0250409.g010

DOI: 10.1371/journal.pone.0250409.g011

DOI: 10.1371/journal.pone.0250409.t001

DOI: 10.1371/journal.pone.0250409.t002

DOI: 10.1371/journal.pone.0250409.t003

DOI: 10.1371/journal.pone.0250409.t004

DOI: 10.1371/journal.pone.0250409.t005

DOI: 10.1371/journal.pone.0250409.s001

DOI: 10.1371/journal.pone.0250409.s002

Language: English

Publisher: Public Library of Science (PLoS)

Publication Date: 2021

detail.hit.zdb_id: 2267670-3

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Limb-sparing resection of axillary soft tissue sarcomas

Stauss, Ricarda ; Graulich, Tilman ; Omar Pacha, Tarek ; [et al.]

Springer Science and Business Media LLC ; 2023

In: Operative Orthopädie und Traumatologie

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In: Operative Orthopädie und Traumatologie, Springer Science and Business Media LLC

Abstract: For patients with soft tissue sarcoma, surgical resection is a key element of curative therapy. Surgery is performed as a wide resection with microscopically negative margins (R0 resection) and as limb-sparing procedure whenever possible to preserve maximum function. Indications Soft tissue sarcoma, metastases. Contraindications Extensive disease with major neurovascular involvement, placement of biopsy tract necessitates extensive resection, palliative care. Surgical technique Extended deltopectoral approach. Release of pectoralis major and minor tendons. Vascular and neurologic exploration, identification of the axillary vessels and brachial plexus, placing of loops around major structures. Mobilization of these structures to achieve adequate exposure. Clipping of vessels entering the tumor. Tumor resection, suture marking for histological analysis. Soft tissue reconstruction by transosseous reinsertion of the pectoralis minor to the coracoid process. Drill channel placement, transosseous refixation of the pectoralis major to the humerus. Postoperative management Shoulder abduction brace for 6 weeks, passive mobilization for 6–12 weeks followed by active mobilization. Compression sleeve. Oncological follow-up. Results Between 2017 and 2022, wide resection was performed in 6 consecutive cases including 4 primary soft tissue sarcomas and 2 metastases. Primary R0 resection was achieved in 100%. Mean follow-up was 22.5 months (3–60 months). There were no local recurrences. Mean active shoulder abduction was 135.0 ± 41.4° (90–180°). Neurological deficits were not observed. Mean subjective shoulder function was 80.0 ± 21.0% (50–100%). The mean Musculoskeletal Tumor Society (MSTS) score was 89.5% (32–100%), indicating good functional outcome in the study cohort.

Type of Medium: Online Resource

ISSN: 0934-6694 , 1439-0981

URL: Article

DOI: 10.1007/s00064-023-00824-8

Language: German

Publisher: Springer Science and Business Media LLC

Publication Date: 2023

detail.hit.zdb_id: 2001071-0

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Management of fracture-related infections

Clausen, Jan-Dierk ; Mommsen, Philipp ; Omar Pacha, Tarek ; [et al.]

Springer Science and Business Media LLC ; 2022

In: Der Unfallchirurg Vol. 125, No. 1 ( 2022-01), p. 41-49

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In: Der Unfallchirurg, Springer Science and Business Media LLC, Vol. 125, No. 1 ( 2022-01), p. 41-49

Type of Medium: Online Resource

ISSN: 0177-5537 , 1433-044X

URL: Article

DOI: 10.1007/s00113-021-01116-1

Language: German

Publisher: Springer Science and Business Media LLC

Publication Date: 2022

detail.hit.zdb_id: 3120926-9

detail.hit.zdb_id: 1461952-0

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Risk factors for dislocation after bipolar hemiarthroplasty: a retrospective case–control study of patients with CT data

Graulich, Tilman ; Graeff, Pascal ; Jaiman, Ashish ; [et al.]

Springer Science and Business Media LLC ; 2021

In: European Journal of Orthopaedic Surgery & Traumatology Vol. 31, No. 4 ( 2021-05), p. 627-633

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In: European Journal of Orthopaedic Surgery & Traumatology, Springer Science and Business Media LLC, Vol. 31, No. 4 ( 2021-05), p. 627-633

Abstract: Bipolar hemiarthroplasty has been shown to have a lower rate of dislocation than total hip arthroplasty. However, as the influencing risk factors for bipolar hemiarthroplasty dislocation remain unclear, we aimed to analyse patient and surgeon-specific influencing risk factors for bipolar hemiarthroplasty dislocation. Methods We retrospectively analysed patients who were operated between 2012 and 2018 and had dislocated bipolar hemiarthroplasty and matched them to patients without a dislocated bipolar hemiarthroplasty, operated between 2018 and 2019. The study was limited to patients who received either a pre- or postoperative pelvic computed tomography. Besides demographic, morphologic, and physiologic data, we analysed duration of surgery; ASA score; Charlson Comorbidity Index; Almelo Hip Fracture Score; Parker Score; and acetabular morphology angles including acetabular anteversion angle, posterior acetabular sector angle, posterior wall angle, and acetabular roofing. Results We included nine patients with a dislocated bipolar hemiarthroplasty and 30 with a non-dislocated bipolar hemiarthroplasty. Patient-specific factors prompting a higher risk for dislocated bipolar hemiarthroplasty were longer duration of surgery (min) (115 ± 50 vs. 80 ± 27, p = 0.01); dementia (56% vs. 13%, p 〈 0.01); smaller posterior acetabular sector angle (°) (96 ± 6 vs. 109 ± 10, p 〈 0.01); and smaller posterior wall angle (°) (67 ± 6 vs. 77 ± 10, p = 0.02). Conclusion Dementia and insufficient posterior wall angle were associated with higher risk of dislocation in bipolar hemiarthroplasty

Type of Medium: Online Resource

ISSN: 1633-8065 , 1432-1068

URL: Article

DOI: 10.1007/s00590-020-02819-8

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2021

detail.hit.zdb_id: 1478935-8

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Validation of direct CT measurement of malrotation in femoral neck fractures: A bone model study

Liodakis, Emmanouil ; Pöhler, Gesa Helen ; Sonnow, Lena ; [et al.]

Public Library of Science (PLoS) ; 2023

In: PLOS ONE Vol. 18, No. 4 ( 2023-4-4), p. e0278850-

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In: PLOS ONE, Public Library of Science (PLoS), Vol. 18, No. 4 ( 2023-4-4), p. e0278850-

Abstract: While postoperative malrotation in the subtrochanteric region is a well-known problem, malrotation after osteosynthesis in proximal femoral fractures has not been extensively studied. In this context, many methods for perioperatively assessment of femoral torsion have been described, but none of them is applicable in the basicervical region of the proximal femur. As an important difference in femoral neck fractures, the discontinuous neck fails to serve as a significant “pointer” for measurements and malfunctions to be placed in relation to the condylar plane. Considering postoperative maltorsion at any location as a substantial negative effect on patients’ outcome and functional expectations, precise and patient-friendly rotation measurement standards in femoral neck fractures are desired in clinical practice. Recently, a novel computed tomography (CT) based geometric technique was described named “direct measurement” with promising results covering this diagnostic disparity, but still requires validation. Thus, we aimed to validate the previously described technique using a controlled range of displacement in a femoral neck fracture Sawbone ® model. Methods and findings A goniometer was designed to set retro- and anteversion of the proximal femur in a reproducible manner. Prospectively, all femurs underwent a CT scan and were measured 3D for displacement. The interclass correlation between the CT measurements and the goniometer measurements was calculated and was found to be very high (1.00, 95% confidence interval: 0.99–1.00; p 〈 0.001). For the mean of all measurements, the Pearson’s correlation was 1.00 (p 〈 0.001). No significant differences in the measurements of both investigators were observed, with 20° of retroversion not significant (-1.20 ± 1.71; 95% confidence interval: -2.43–0.03; p = 0.054). Conclusion This CT-based 3D measurement technique may allow for perioperative malrotation assessment in basicervical femoral neck fractures and appears to be feasible in femoral neck fractures when it comes to rare cases of osteosynthesis. Further investigations are still needed to define the thresholds of malrotation provoking functional impairment after osteosynthesis in basicervical femoral neck fractures.

Type of Medium: Online Resource

ISSN: 1932-6203

URL: Article

DOI: 10.1371/journal.pone.0278850

DOI: 10.1371/journal.pone.0278850.g001

DOI: 10.1371/journal.pone.0278850.g002

DOI: 10.1371/journal.pone.0278850.g003

DOI: 10.1371/journal.pone.0278850.g004

DOI: 10.1371/journal.pone.0278850.g005

DOI: 10.1371/journal.pone.0278850.g006

DOI: 10.1371/journal.pone.0278850.t001

DOI: 10.1371/journal.pone.0278850.t002

DOI: 10.1371/journal.pone.0278850.t003

DOI: 10.1371/journal.pone.0278850.s001

DOI: 10.1371/journal.pone.0278850.s002

Language: English

Publisher: Public Library of Science (PLoS)

Publication Date: 2023

detail.hit.zdb_id: 2267670-3

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Reduction of Patella-baja and Pseudo-patella-baja Does Not Improve Range of Motion in Patients After Mega-TKA

GRAULICH, TILMAN ; KRANZ, CAROLINE ; ZHANG, DAFANG ; [et al.]

Anticancer Research USA Inc. ; 2020

In: In Vivo Vol. 34, No. 3 ( 2020), p. 1153-1158

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In: In Vivo, Anticancer Research USA Inc., Vol. 34, No. 3 ( 2020), p. 1153-1158

Type of Medium: Online Resource

ISSN: 0258-851X , 1791-7549

URL: Article

DOI: 10.21873/invivo.11887

Language: English

Publisher: Anticancer Research USA Inc.

Publication Date: 2020

detail.hit.zdb_id: 807031-3

detail.hit.zdb_id: 2492569-X

SSG: 15,3

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Possible Correlation Between Kyphosis of Lumbar Osteoporosis Fractures and the Spinal Signal Intensity Ratio (SSIR)

Omar Pacha, Tarek ; Ghasemi, Amir ; Omar, Mohamed ; [et al.]

International Journal of Spine Surgery ; 2021

In: International Journal of Spine Surgery Vol. 15, No. 3 ( 2021-06), p. 478-484

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In: International Journal of Spine Surgery, International Journal of Spine Surgery, Vol. 15, No. 3 ( 2021-06), p. 478-484

Type of Medium: Online Resource

ISSN: 2211-4599 , 2211-4599

URL: Article

DOI: 10.14444/8069

Language: English

Publisher: International Journal of Spine Surgery

Publication Date: 2021

detail.hit.zdb_id: 2660509-0

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