Christian Macke

The Aseptic Femoral and Tibial Shaft Non-Union in Healthy Patients – An Analysis of the Health-Related Quality of Life and the Socioeconomic Outcome

Long bone non-unions may lead to recurrent surgical procedures and in-hospital stays. Thus, restrictions of the health-related quality of life and of socioeconomic parameters might be expected. Knowledge of the impact on several parameters of professional life is sparse. Therefore, we analyzed the outcome in patients following non-unions of the tibial and femoral shaft after fracture compared to patients with uneventful healing. Material and Methodology: 51 patients following non-unions of the the femoral (FNU) or tibial shaft (TNU) were compared to 51 patients (groups FH and TH) with uneventful fracture healing. Physical and mental health was assessed using the Short-Form Health Survey (SF-12), Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale (IES). We also analyzed employment status and the usage of medical aids. Results: Scores of the SF-12 physical and psychological were lower in group TNU compared to group TH, the score of SF-12 physical but not psychological was significantly lower in group FNU compared to FH. Compared to uneventful healing, a significantly more frequent usage of medical aids was found in both non-union groups. A higher incidence of early retirement and unemployment was found in group FNU but not in group TNU. Conclusions: There is a profound influence on the quality of life following femoral or tibial non-unions after trauma. Compared to patients with uneventful fracture healing, patients with tibial and even more so femoral non-union show worse scores of the SF-12. Medical aids are frequently used following both, femoral and tibial non-unions. Not tibial, but femoral non-unions frequently lead to severe restrictions in professional life such as early retirement and unemployment.

Is there a benefit for health care workers in testing HIV, HCV and HBV in routine before elective arthroplasty?

INTRODUCTION Occupational infection of clinical health care workers with blood-borne viruses (BBVs) like human immunodeficiency virus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV) is a current and often emotionally discussed issue. HCV and especially HIV are still stigmatized. The consequence is a broad and maybe irrational fear of professional health care workers being infected occupationally. Therefore, we assessed preoperative screening to: (1) answer whether this can detect not previously diagnosed blood-borne virus infections to a great extent, (2) calculate a cost-benefit ratio to find out, if the screenings potential ability to prevent occupational transmission of BBVs to health care workers faces unjustifiable high costs. HYPOTHESIS Preoperative routine screening is limited suitable for enhancement of detecting fomites compared to interview the patient. MATERIALS AND METHODS Retrospective cohort study of preoperative screening for HIV, HBV and HCV (HBsAg, anti-HCV and HIV-Ab/Ag-Combination) for every patient who was admitted to the traumatologic department for elective arthroplasty between 01/01/1997 and 31/12/2008. RESULTS Among the 1534 patients who underwent elective prosthetic surgery [total hip (879) and knee arthroplasty (508), followed by shoulder, elbow and upper ankle joint], 693 (45.2%) patients were male and 841 (54.8) female. Mean age was 64.2±13.8 years. Screening tests were available for 1373 patients (89.5%). Among all screened patients, we found 21 HCV, 10 HBV and 1 HIV infections. 5 HBV (0.5%) and 7 HCV infections (0.7%) were unknown before. Every newly detected infectious patient occasions screening costs about 7250€. Considering this data, the risk of HCV transmission from an index patient with unknown status of infectiousness to health care worker after percutaneous contact to blood is 0.08 ‰ and of HIV transmission is 0.00054 ‰ in our study population. DISCUSSION Routine preoperative screening for BBVs of patients undergoing elective arthroplasty, who were asked for HBV, HCV and HIV, should be reconsidered and is, in times of sparse funds, overpriced. LEVEL OF EVIDENCE IV.

Mini-navigator: a new system for navigated deformity corrections

The purpose of this study is to present a new navigation device for deformity correction surgery and to evaluate its accuracy compared with a conventional electromagnetic navigation system in tracking the orientation of synthetic bony fragments.

Femoral Neck Fractures in the Elderly

Femoral neck fractures in the elderly are common, and their incidence will increase as the population ages. Treatment algorithms are evolving and have progressed from internal fixation to arthroplasty over the last decade. This chapter provides the surgeon with evidence-based recommendations for the treatment of femoral neck fractures, with special emphasis on individual decisions for certain patients’ characteristics.

Connection of a hip prosthesis and an intramedullary nail as a special solution in a subtrochanteric femoral fracture with fibrous dysplasia

Treatment of fractures associated with fibrous dysplasia is difficult because of poor bone quality. In a brief report we present a case in which a hip prosthesis is connected with the distal part of a broken cannulated intramedullary femur nail. Postoperatively, the patient was mobilized with full weight bearing. Radiographs proved the correct position of the implant and a favorable clinical function could be achieved.

Mass Casualties and Damage Control Orthopedics

In general, a mass casualty is defined as any incident in which the existing medical service in terms of personnel resources and equipment is overwhelmed by the number and severity of injured patients generated at one time. Accordingly, the routine course of preclinical and clinical healthcare services could not be maintained. Based on this definition a wide range of events with different variations of severity and diversity of injuries are covered: major accidents (e.g., road traffic, railroads, aircraft) with a large number of injured persons, especially when taking place in rural areas; military situations with explosion and gunshot injuries served by small combat hospitals with marginal medical staff; natural disasters in medical immature systems such as the earthquake in Haiti (2010) with multiple crush injuries; disaster situations in medical well-provided, but dense populated areas with substantial destruction of infrastructure like the earthquake and tsunami in Japan (2011); and casualties of terroristic origin such as the bombing attacks in Madrid (2004) and London (2005) with a mass of injured patients suffering from blast and blunt trauma. Depending on the amount of injured patients, the Advanced Trauma Life Support (ATLS®) concept distinguishes between incidents with multiple casualties (multiple casualty incidents) and mass casualty victims (mass casualty events).