In patients with multiple trauma delayed fracture healing is often diagnosed, but the pathomechanisms are not well known yet. The purpose of the study is to evaluate the effect of a severe hemorrhagic shock on fracture healing in a murine model. 10 male C57BL/6N mice per group (Fx, TH, THFx, Sham) and point in time were used. The Fx-group received an osteotomy after implantation of a fixateur extern. The TH-group got a pressure controlled hemorrhagic shock with a mean arterial blood pressure of 35 mmHg over 90 minutes. Resuscitation with 4 times the shed blood volume of Ringer solution was performed. The THFx group got both. Sham-animals received the implantation of a catheter and a fixateur extern but no blood loss or osteotomy. After 1, 2, 3, 4 or 6 weeks the animals were sacrificed. For the biomechanics the bones were analyzed via X-ray, µCT and underwent a 3-point bending test. The nondecalcified histology based on slices of Technovit 9100. The signaling pathway was analyzed via RT2 Profiler™ PCR Array Mouse Osteoporosis, Western Blot and Quantikine ELISA for RankL and OPG. Statistical significance was set at Purpose
Methods
High tibial osteotomy (HTO) is a commonly used surgical technique for treating moderate osteoarthritis (OA) of the medial compartment of the knee by shifting the center of force towards the lateral compartment. The amount of alignment correction to be performed is usually calculated prior to surgery and it's based on the patient's lower limb alignment using long-leg radiographs. While the procedure is generally effective at relieving symptoms, an accurate estimation of change in intraarticular contact pressures and contact surface area has not been developed. Using electromyography (EMG), Meyer et al. attempted to predict intraarticular contact pressures during gait patterns in a patient who had received a cruciate retaining force-measuring tibial prosthesis. Lundberg et al. used data from the Third Grand Challenge Competition to improve contact force predictions in total knee replacement. Mina et al. performed high tibial osteotomy on eight human cadaveric knees with osteochondral defects in the medial compartment. They determined that complete unloading of the medial compartment occurred at between 6° and 10° of valgus, and that contact pressure was similarly distributed between the medial and lateral compartments at alignments of 0° to 4° of valgus. In the current study, we hypothesised that it would be possible to predict the change in intra-articular pressures based on extra-articular data acquisition. Seven cadavers underwent an HTO procedure with sequential 5º valgus realignment of the leg up to 15º of correction. A previously developed stainless-steel device with integrated load cell was used to axially load the leg. Pressure-sensitive sensors were used to measure intra-articular contact pressures. Intraoperative changes in alignment were monitored in real time using computer navigation. An axial loading force was applied to the leg in the caudal-craneal direction and gradually ramped up from 0 to 550 N. Intra-articular contact pressure (kg) and contact area (mm2) data were collected. Generalised linear models were constructed to estimate the change in contact pressure based on extra-articular force and alignment data.Introduction
Methods
To analyse the influence of upper extremity trauma on the long-term
outcome of polytraumatised patients. A total of 629 multiply injured patients were included in a follow-up
study at least ten years after injury (mean age 26.5 years, standard
deviation 12.4). The extent of the patients’ injury was classified
using the Injury Severity Score. Outcome was measured using the
Hannover Score for Polytrauma Outcome (HASPOC), Short Form (SF)-12, rehabilitation
duration, and employment status. Outcomes for patients with and
without a fracture of the upper extremity were compared and analysed
with regard to specific fracture regions and any additional brachial
plexus lesion.Aims
Patients and Methods
