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  • 1
    Article
    Article
    Language: German
    In: Obere Extremität, 2012, Vol.7(4), pp.188-188
    Description: Rund 200 Jahre nach der Beschreibung des körperfernen Speichenbruchs an typischer Stelle durch Abraham Colles 1814 gibt es eine Vielzahl unterschiedlicher Verfahren zur Behandlung der distalen Radiusfraktur. Meilensteine in der Entwicklung der geschlossenen Frakturbehandlung waren die Reposition und Ruhigstellung nach Böhler, die Bohrdrahtosteosynthese nach Willenegger und die intrafokale K-Draht-Osteosynthese in der Technik nach Kapandji. Besondere Bedeutung erlangte auch der Fixateur externe, der unter Nutzung der Ligamentotaxis eine stabile Retention erzielt und insbesondere zur Stabilisierung von Trümmerfrakturen oder offenen Verletzungen und in der Versorgung polytraumatisierter Patienten seinen festen Stellenwert hat.Die offene Frakturbehandlung entwickelte sich gegenüber den geschlossenen Verfahren nur zögerlich. Sie blieb zunächst auf Schraubenosteosynthesen partieller Gelenkverletzungen und abstützende Plattenosteosynthesen von Flexionsfrakturen begrenzt. Plattenosteosynthesen ...
    Keywords: Medicine & Public Health ; Orthopedics ; Surgical Orthopedics ; Medicine/Public Health, General;
    ISSN: 1862-6599
    E-ISSN: 1862-6602
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  • 2
    Language: English
    In: PLoS ONE, 01 January 2015, Vol.10(9), p.e0139078
    Description: Epidemiological data about pelvic fractures are limited. Until today, most studies only analyzed inpatient data. The purpose of this study was to estimate incidence rates of pelvic fractures in the German population aged 60 years or older, based on outpatient and inpatient data. We conducted a retrospective population-based observational study based on routine data from a large health insurance company in Germany. Age and sex-specific incidence rates of first fractures between 2008 and 2011 were calculated. We also standardized incidence rates with respect to age and sex in the German population. Multiple Poisson regression models were used to evaluate the association between the risk of first pelvic fracture as outcome and sex, age, calendar year and region as independent variables. The total number of patients with a first pelvic fracture corresponded to 8,041 and during the study period 5,978 insured persons needed inpatient treatment. Overall, the standardized incidence rate of all first pelvic fractures was 22.4 [95% CI 22.0-22.9] per 10,000 person-years, and the standardized incidence rate of inpatient treated fractures 16.5 [16.1-16.9]. Our adjusted regression analysis confirmed a significant sex (RR 2.38 [2.23-2.55], p 〈 0.001, men as reference) and age effect (higher risk with increasing age, p 〈 0.001) on first fracture risk. We found a slight association between calendar year (higher risk in later years compared to 2008, p = 0.0162) and first fracture risk and a further significant association with region (RR 0.92 [0.87-0.98], p = 0.006, Westfalen-Lippe as reference). The observed incidences are considerably higher than incidences described in the international literature, even if only inpatient treated pelvic fractures are regarded. Besides which, non-inclusion of outpatient data means that a relevant proportion of pelvic fractures are not taken into account. Prevention of low energy trauma among older people remains an important issue.
    Keywords: Sciences (General)
    E-ISSN: 1932-6203
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  • 3
    In: PLoS ONE, 2014, Vol.9(12)
    Description: The increasing incidence of implant-associated infections induced by Staphylococcus aureus (SA) in combination with growing resistance to conventional antibiotics requires novel therapeutic strategies. In the current study we present the first application of the biofilm-penetrating antimicrobial peptide lysostaphin in the context of bone infections. In a standardized implant-associated bone infection model in mice beta-irradiated lysostaphin-coated titanium plates were compared with uncoated plates. Coating of the implant was established with a poly(D,L)-lactide matrix (PDLLA) comprising lysostaphin formulated in a stabilizing and protecting solution (SPS). All mice were osteotomized and infected with a defined count of SA. Fractures were fixed with lysostaphin-coated locking plates. Plates uncoated or PDLLA-coated served as controls. All mice underwent debridement and lavage on Days 7, 14, 28 to determine the bacterial load and local immune reaction. Fracture healing was quantified by conventional radiography. On Day 7 bacterial growth in the lavages of mice with lysostaphin-coated plates showed a significantly lower count to the control groups. Moreover, in the lysostaphin-coated plate groups complete fracture healing were observed on Day 28. The fracture consolidation was accompanied by a diminished local immune reaction. However, control groups developed an osteitis with lysis or destruction of the bone and an evident local immune response. The presented approach of terminally sterilized lysostaphin-coated implants appears to be a promising therapeutic approach for low grade infection or as prophylactic strategy in high risk fracture care e.g. after severe open fractures.
    Keywords: Research Article ; Medicine And Health Sciences ; Physical Sciences ; Research And Analysis Methods
    E-ISSN: 1932-6203
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  • 4
    In: PLoS ONE, 2016, Vol.11(8)
    Description: Trauma represents the leading cause of death among young people in western countries. Among the beneficial role of neutrophils in host defence, excessive priming and activation of neutrophils after major trauma lead to an overwhelming inflammatory response and secondary host tissue injury due to the release of toxic metabolites and enzymes. Hyperbaric oxygen (HBO) therapy has been proposed to possess antiinflammatory effects and might represent an appropriate therapeutic option to lower inflammation in a broad range of patients. Here, we studied the effects of HBO on the activity of neutrophils isolated from severely injured patients (days 1–2 after trauma), in fact on the production of reactive oxygen species (ROS) and release of neutrophil extracellular traps (NETs). We found exposure to HBO therapy to significantly diminish phorbol-12-myristate-13-acetate (PMA)-induced ROS production in neutrophils isolated from patients and healthy volunteers. At the same time, marked decrease in NETs release was found in control cells and a less pronounced reduction in patient neutrophils. Impaired ability to produce ROS following exposure to HBO was demonstrated to be linked to a strong downregulation of the activity of p38 MAPK. Only slight suppression of ERK activity could be found. In addition, HBO did not influence neutrophil chemotaxis or apoptosis, respectively. Collectively, this study shows for the first time that HBO therapy suppresses ROS production in inflammatory human neutrophils, and thus might impair ROS-dependent pathways, e.g. kinases activation and NETs release. Thus, HBO might represent a feasible therapy for patients suffering from systemic inflammation, including those with multiple trauma.
    Keywords: Research Article ; Biology And Life Sciences ; Biology And Life Sciences ; Biology And Life Sciences ; Medicine And Health Sciences ; Biology And Life Sciences ; Biology And Life Sciences ; Medicine And Health Sciences ; Medicine And Health Sciences ; Medicine And Health Sciences ; Medicine And Health Sciences ; Biology And Life Sciences ; Medicine And Health Sciences ; Medicine And Health Sciences ; Medicine And Health Sciences ; Medicine And Health Sciences ; Medicine And Health Sciences
    E-ISSN: 1932-6203
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  • 5
    Language: English
    In: Deutsches Arzteblatt international, 14 November 2014, Vol.111(46), pp.777-8
    Keywords: Fracture Fixation, Internal -- Instrumentation ; Fractures, Malunited -- Therapy ; Quality of Life -- Psychology ; Radius Fractures -- Therapy ; Splints -- Statistics & Numerical Data
    E-ISSN: 1866-0452
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 6
    Language: English
    In: Critical Care, Jan 13, 2011, Vol.15, p.R20
    Description: Introduction Deregulated apoptosis and overshooting neutrophil functions contribute to immune and organ dysfunction in sepsis and multiple organ failure (MOF). In the present study, we determined the role of soluble Fas (sFas) in the regulation of posttraumatic neutrophil extrinsic apoptosis and the development of sepsis. Methods Forty-seven major trauma patients, 18 with and 29 without sepsis development during the first 10 days after trauma, were enrolled in this prospective study. Seventeen healthy volunteers served as controls. Blood samples from severely injured patients were analyzed at day 1, day 5 and day 9 after major trauma. sFas levels, plasma levels of neutrophil elastase (PMNE) and levels of interleukin (IL)-6 were quantified by enzyme-linked immunosorbent assay and related to patients' Sequential Organ Failure Assessment (SOFA) score and Multiple Organ Dysfunction Score (MODS). Neutrophil apoptosis was determined by propidium iodide staining of fragmented DNA and flow cytometry. sFas-mediated effects on neutrophil apoptosis were investigated in cells cultured with agonistic anti-Fas antibodies in the presence of recombinant sFas, sFas-depleted serum or untreated serum from septic patients. Results Serum levels of sFas in patients who later developed sepsis were significantly increased at day 5 (P [less than] 0.01) and day 9 (P [less than] 0.05) after trauma compared with patients with uneventful recovery. Apoptosis of patient neutrophils was significantly decreased during the observation period compared with control cells. Moreover, Fas-mediated apoptosis of control neutrophils was efficiently inhibited by recombinant sFas and serum from septic patients. Depletion of sFas from septic patient sera diminished the antiapoptotic effects. In septic patients, sFas levels were positively correlated with SOFA at day 1 (r = 0.7, P [less than] 0.001), day 5 (r = 0.62, P [less than] 0.01) and day 9 (r = 0.58, P [less than] 0.01) and with PMNE and leukocyte counts (r = 0.49, P [less than] 0.05 for both) as well as MODS at day 5 (r = 0.56, P [less than] 0.01) after trauma. Conclusions Increased sFas in patients with sepsis development impairs neutrophil extrinsic apoptosis and shows a positive correlation with the organ dysfunction scores and PMNE. Therefore, sFas might be a therapeutic target to prevent posttrauma hyperinflammation and sepsis.
    Keywords: Apoptosis -- Physiological Aspects ; Apoptosis -- Genetic Aspects ; Apoptosis -- Research ; Injuries -- Complications And Side Effects ; Injuries -- Patient Outcomes ; Injuries -- Research ; Multiple Organ Failure -- Risk Factors ; Multiple Organ Failure -- Development And Progression ; Multiple Organ Failure -- Genetic Aspects ; Multiple Organ Failure -- Research ; Sepsis -- Risk Factors ; Sepsis -- Development And Progression ; Sepsis -- Genetic Aspects ; Sepsis -- Research
    ISSN: 1364-8535
    Source: Cengage Learning, Inc.
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  • 7
    Language: English
    In: Critical Care, Jan 13, 2011, Vol.15, p.R20
    Description: Introduction Deregulated apoptosis and overshooting neutrophil functions contribute to immune and organ dysfunction in sepsis and multiple organ failure (MOF). In the present study, we determined the role of soluble Fas (sFas) in the regulation of posttraumatic neutrophil extrinsic apoptosis and the development of sepsis. Methods Forty-seven major trauma patients, 18 with and 29 without sepsis development during the first 10 days after trauma, were enrolled in this prospective study. Seventeen healthy volunteers served as controls. Blood samples from severely injured patients were analyzed at day 1, day 5 and day 9 after major trauma. sFas levels, plasma levels of neutrophil elastase (PMNE) and levels of interleukin (IL)-6 were quantified by enzyme-linked immunosorbent assay and related to patients' Sequential Organ Failure Assessment (SOFA) score and Multiple Organ Dysfunction Score (MODS). Neutrophil apoptosis was determined by propidium iodide staining of fragmented DNA and flow cytometry. sFas-mediated effects on neutrophil apoptosis were investigated in cells cultured with agonistic anti-Fas antibodies in the presence of recombinant sFas, sFas-depleted serum or untreated serum from septic patients. Results Serum levels of sFas in patients who later developed sepsis were significantly increased at day 5 (P [less than] 0.01) and day 9 (P [less than] 0.05) after trauma compared with patients with uneventful recovery. Apoptosis of patient neutrophils was significantly decreased during the observation period compared with control cells. Moreover, Fas-mediated apoptosis of control neutrophils was efficiently inhibited by recombinant sFas and serum from septic patients. Depletion of sFas from septic patient sera diminished the antiapoptotic effects. In septic patients, sFas levels were positively correlated with SOFA at day 1 (r = 0.7, P [less than] 0.001), day 5 (r = 0.62, P [less than] 0.01) and day 9 (r = 0.58, P [less than] 0.01) and with PMNE and leukocyte counts (r = 0.49, P [less than] 0.05 for both) as well as MODS at day 5 (r = 0.56, P [less than] 0.01) after trauma. Conclusions Increased sFas in patients with sepsis development impairs neutrophil extrinsic apoptosis and shows a positive correlation with the organ dysfunction scores and PMNE. Therefore, sFas might be a therapeutic target to prevent posttrauma hyperinflammation and sepsis.
    Keywords: Apoptosis -- Physiological Aspects ; Apoptosis -- Genetic Aspects ; Apoptosis -- Research ; Injuries -- Complications And Side Effects ; Injuries -- Patient Outcomes ; Injuries -- Research ; Multiple Organ Failure -- Risk Factors ; Multiple Organ Failure -- Development And Progression ; Multiple Organ Failure -- Genetic Aspects ; Multiple Organ Failure -- Research ; Sepsis -- Risk Factors ; Sepsis -- Development And Progression ; Sepsis -- Genetic Aspects ; Sepsis -- Research
    ISSN: 1364-8535
    Source: Cengage Learning, Inc.
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  • 8
    Language: English
    In: Biomaterials, October 2013, Vol.34(30), pp.7314-7327
    Description: In the present work, we have examined the impact of an inorganic orthosilicic acid-releasing spun fiber fleece (SIFIB) on wound closure in a porcine wound model as well as on wound healing-relevant parameters . SIFIB was completely bio-degradable and had no negative effects on wound closure or the wound healing process. In the experiments, SIFIB had no negative effects on proliferation of human skin fibroblast (FB) and endothelial cell (EC) cultures but strongly retarded the growth of the human monocyte cell line THP-1, and effectively inhibited human skin keratinocyte (KC) proliferation, which based on significantly enhanced KC differentiation. Furthermore, SIFIB exhibited strong anti-inflammatory properties, which based on SIFIB-dependent inhibition of expression and activity of NF-кB and/or concomitant enhanced expression of IкB, a NF-кB-inhibiting protein. Additionally, SIFIB significantly inhibited TGFβ-induced fibroblast differentiation and collagen synthesis as well as effectively reduced TGF-β synthesis of activated fibroblasts. We have demonstrated wound healing-relevant biological activities of a silica-based bio-degradable inorganic material, which might represent a new therapeutic tool in the treatment of chronic wounds.
    Keywords: Inflammation ; Silica ; Il-1β ; Il-6 ; Il-8 ; Nf-Кb ; Medicine ; Engineering
    ISSN: 0142-9612
    E-ISSN: 1878-5905
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  • 9
    Language: English
    In: Obere Extremitat, Dec, 2012, Vol.7(4), p.200(9)
    Description: Byline: Tim Logters (1), Michael Schadel-Hopfner (1), Joachim Windolf (1) Keywords: Distale Radiusfraktur; Winkelstabile Platte; Palmar; Komplikation; Kosten; Distal radius fracture; Locking plate; Volar; Complication; Costs Abstract (German): Die Einfuhrung der palmaren winkelstabilen Plattenosteosynthese hat zu einem Paradigmenwechsel in der Versorgung von distalen Radiusfrakturen gefuhrt. Sie stellt heute ein etabliertes Verfahren zu deren Behandlung dar und fuhrt bei sachgerechter Indikation zu guten klinischen und radiologischen Ergebnissen. Anhand randomisierter Studien und deren Metaanalysen konnte aber noch keine signifikante Uberlegenheit der palmaren Platte gegenuber den Alternativverfahren nachgewiesen werden. In dieser Ubersichtsarbeit wird auf der Basis der aktuellen Literatur dargestellt, welche Patientengruppen und Frakturformen von der Implantation der palmaren Plattenosteosynthese einen besonderen Nutzen haben. Wahrend fur junge Patienten die mit der palmaren Platte erzielten guten Repositionsergebnisse im Vordergrund stehen, profitieren altere Patienten insbesondere von der fruhfunktionellen Behandlung des verletzten Handgelenks. Unter Kenntnis der Anatomie und der Frakturmorphologie am distalen Radius sowie Berucksichtigung der Implantatlage kann das Risiko von Beuge- und Strecksehnenrupturen deutlich gesenkt werden. Anhand klinischer und radiologischer Indikatoren konnen zudem Patienten identifiziert werden, die nach knocherner Konsolidierung der Fraktur von einer Implantatentfernung profitieren. Die Anwendung der palmaren Platte fuhrt im Vergleich zu den Alternativimplantaten zu deutlich hoheren Personal- und Materialkosten. Innerhalb des DRG-Vergutungssystems ist mit den palmaren Platten weiterhin eine kostendeckende Versorgung moglich. Der Nachweis, dass die mit der palmaren Plattenosteosynthese erzielte Fruhfunktionalitat auch aus volkswirtschaftlicher Sicht einen Vorteil darstellt, steht jedoch noch aus. Abstract: The introduction of volar locking plate fixation has led to a paradigm shift and it now represents an established procedure for the treatment of distal radius fracturesresulting in good clinical and radiological outcomes. However, no randomized trials and meta-analyses could show any significant superiority for volar locking plates compared to the alternative methods. This review article based on the current literature presents which patient groups and types of fractures have a special advantage from locking plates. While for younger patients the good reduction results by locking plates are of high relevance, elderly patients in particular benefit from early functional treatment of injured wrists after surgery. Knowing the anatomy and morphology of fractures of the distal radius as well astaking plate position into consideration significantly decreases the risk of flexor and extensor tendon injuries. There are clinical and radiological indicators that can identify patients who will benefit from implant removal after fracture consolidation. The application of volar locking plates results in significantly higher labor and material costs compared to alternative implants. In the German diagnosis-related groups (DRG) payment system, cost-effective treatment with palmar plates remains possible. Evidence that the early functionality after surgery attained with volar plate fixation is an advantage from an economic perspective is still pending. Author Affiliation: (1) Klinik fur Unfall- und Handchirurgie, Universitatsklinikum Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Deutschland Article History: Registration Date: 02/10/2012 Received Date: 21/06/2012 Accepted Date: 02/07/2012 Online Date: 30/11/2012
    Keywords: Hand Injuries -- Analysis
    ISSN: 1862-6599
    Source: Cengage Learning, Inc.
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  • 10
    Language: English
    In: Journal of Hand Surgery, August 2012, Vol.37(8), pp.1718-1725
    Description: Despite the frequency of distal radius fractures, the optimal treatment remains without consensus opinion. A trend toward increased distal radius fracture open reduction and internal fixation has been identified, with biomechanical and clinical studies suggesting treatment advantages of certain fixation methods over others. Well-controlled patient trials are still missing to lend objective findings to management algorithms. This article reviews the literature over the past 5 years to guide our management regarding this common upper-extremity injury.
    Keywords: Distal ; Radius ; Fracture ; Surgical ; Fixation
    ISSN: 0363-5023
    E-ISSN: 1531-6564
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