Florian Wichlas

Osteochondral Lesions of the Talus: Retrograde Drilling with High-Field-Strength MR Guidance

The institutional review board approved the use of cadaveric specimens, and informed consent was obtained from all volunteers. The authors performed and assessed a magnetic resonance (MR)-assisted navigation method for minimally invasive retrograde drilling of talar osteochondral lesions. For this method, a single imaging plane is sufficient for navigation during intervention. To accomplish this objective, a passive MR navigation device was used to evaluate 16 cadaveric ankle joints. Use of this interactive MR-assisted navigation method in combination with a passive aiming device allowed precise and rapid retrograde drilling of talar osteochondral lesions.

Evaluation of Laparoscopic Liver Resection with Two Different Nd:YAG Lasers for Future Use in a High-Field Open MRI

OBJECTIVE Laparoscopic liver surgery is a safe and feasible technique for the treatment of benign and malignant liver tumors and has been well established at many specialized centers. Many different techniques of tissue dissection have been developed. As an alternative various lasers have been applied to conventional liver resections. Laser surgery is potentially beneficial for laparoscopic liver resection, allowing parenchymal dissection and vessel coagulation. A second advantage is the non-ferromagnetic character of this instrument, which facilitates magnetic resonance (MR)-guided interventions. In this study two different Nd:YAG lasers were evaluated for laparoscopic liver resection in a porcine model. In other studies this technique will be transferred into an interventional open MRI for image-guided liver resection. MATERIALS AND METHODS We used 1064-nm and 1318-nm Nd:YAG lasers for laparoscopic wedge, segmental, and left lateral liver lobe resection. During the intervention blood loss, resection time, and cardiopulmonary parameters were quantified. The resected specimen underwent histomorphometric analysis for thermal tissue effects, including parenchymal carbonization, necrosis, and vessel coagulation. RESULTS The resected volume showed a positive correlation with intraoperative blood loss, which increased from wedge resection (245 mL, SD +/- 71 mL) and segment resection (325 mL), to left lateral resection (455 mL). Total parenchymal dissection was slightly faster with the 1064-nm Nd:YAG laser (9 min, SD +/- 5 min) compared with the 1318-nm Nd:YAG laser (11 min, SD +/- 4 min). Thermally-induced vessel sealing was shown for liver veins and arteries to a maximum diameter of 2 mm. CONCLUSION Laparoscopic liver resection with both Nd:YAG lasers is a safe and feasible technique, allowing parenchymal dissection and coagulation. The 1064-nm Nd:YAG laser showed increased tissue damage with more effective coagulation capability than the 1318-nm Nd:YAG laser. Because of its non-ferromagnetic characteristics, laser-based laparoscopic liver resection is potentially useful for image-guided surgery in an open MRI.

The effect of traumatic brain injury on bone healing: an experimental study in a novel in vivo animal model

INTRODUCTION Among many factors determining the outcome of complex fractures in polytrauma patients, the role of traumatic brain injury (TBI) remains only partly understood. The aim of the present study was to examine the effect of traumatic brain injury on bone healing through the establishment of a novel standardised animal model that sequentially combines traumatic brain injury (TBI) with a long bone injury. MATERIALS AND METHODS Thirty-six female twelve-week old C57/BL6 mice were randomised in two groups (fracture (Fx)-group and combined-trauma (Fx/TBI) group). The methods of the Control Cortical Impact Injury for induction of TBI and of the femoral osteotomy, fixed with an external fixator for the simulation of the long bone fracture, were combined. No TBI was induced in the Fx-group. Bone healing was examined using in vivo micro-CT measurements over a period of three weeks. RESULTS The severity of the TBI was sufficient to stimulate a significantly increased callus formation in the Fx/TBI-group with an acceptable mortality rate. The micro-CT analysis of fracture healing displayed a significantly increased callus volume in the Fx/TBI-group already from the second postoperative week. This difference remained significant throughout the entire study period. DISCUSSION The successful and standardised combination of TBI and fracture in a mouse model allows systematic and quantitative in vivo analysis of underlying pathways that trigger the mutual interaction between musculoskeletal trauma and brain injury, as well as, corresponding differences in fracture healing using micro-CT methods. CONCLUSION The present study offers three new aspects: a standardised model for combined injury of TBI and femoral osteotomy; direct and serial in vivo imaging and quantification of fracture healing response using micro-CT; testing of potentially beneficial therapeutic regimens for fracture treatment in presence of TBI. Thus this model provides a valuable basic approach for the study of the amplifying effect of TBI on callus formation seen in patients with craniocerebral injury and concomitant skeletal trauma.

Development of a signal-inducing bone cement for magnetic resonance imaging

To develop a signal‐inducing bone cement for musculoskeletal procedures in magnetic resonance imaging (MRI).

Sinus pilonidalis in patients of German military hospitals: a review.

Pilonidal sinus disease (PSD) most commonly presents in young men when hair follicles enter through damaged epithelium and cause an inflammatory reaction. This results in the formation of fistular tracts. We reviewed studies based on a shared cohort of patients who presented at German military hospitals with PSD. The effect of the morphology of the sinus, perioperative protocol, and aftercare of the surgical treatment on the recurrence of PSD were evaluated. The drainage of acute abscesses before surgery, the application of methylene blue during surgery and open wound treatment were generally found to reduce the recurrence rate. A positive family history, postoperative epilation and primary suture as the healing method were found to elevate the recurrence rate. Long-term follow up of over 15 years was found to be a vital component of patient care as only 60% of the overall recurrences recorded had taken place by year 5 postoperatively.

[Clinical studies outside university clinics : What are the problems to implement this?].

ZusammenfassungDie Forderung nach hochwertiger evidenzbasierter Therapie in der operativen Medizin in Deutschland und das Bewusstsein über die meist erheblich mangelhafte Qualität der chirurgischen Studien macht die Notwendigkeit von randomisiert-kontrollierten Studien deutlich. In 6 öffentlich geförderten operativen Studienzentren wird seit 2006 an der Schaffung einer professionellen Infrastruktur für chirurgische Studien gearbeitet. Ziel ist die Initiierung chirurgischer Multicenterstudien, die durch regionale Vernetzung effektiv durchgeführt werden können. Um eine zeitgerechte Patientenrekrutierung in diesen Studien zu sichern, ist es essenziell, in Zukunft nichtuniversitäre chirurgische Kliniken in die Studiendurchführung zu integrieren. Mithilfe einer Fragebogenaktion in nichtuniversitären chirurgischen Kliniken in Berlin und Brandenburg wurden das Interesse, die Studienerfahrungen und die strukturellen Gegebenheiten in diesen Kliniken evaluiert. Der vorliegende Beitrag diskutiert anhand der Ergebnisse dieser Umfrage, wie zukünftig nichtuniversitäre chirurgische Kliniken in die aktive Studiendurchführung eingebunden werden können und wie zu einer hohen Patientenrekrutierung motiviert werden kann.AbstractThe demand for high quality evidence-based surgical treatment in Germany and awareness of the poor quality of surgical trials highlight the basic necessity of randomized controlled trials. In six surgical trial centers a professional infrastructure for surgical trials is in the process of being established since 2006.The aim is the initiation of surgical multicenter trials which can be effectively conducted by local networking. To accomplish a timely recruitment of patients it is necessary to integrate surgical departments outside university hospitals into multicenter trials. With a questionnaire survey of non-university surgical departments in the federal states of Berlin and Brandenburg, interest, experience in clinical trials and structural conditions in these departments were evaluated. Based on the results of this survey the possibilities to integrate non-university surgical departments into multicenter trials and how a high recruitment of patients can be motivated will be discussed in this article.The demand for high quality evidence-based surgical treatment in Germany and awareness of the poor quality of surgical trials highlight the basic necessity of randomized controlled trials. In six surgical trial centers a professional infrastructure for surgical trials is in the process of being established since 2006.The aim is the initiation of surgical multicenter trials which can be effectively conducted by local networking. To accomplish a timely recruitment of patients it is necessary to integrate surgical departments outside university hospitals into multicenter trials. With a questionnaire survey of non-university surgical departments in the federal states of Berlin and Brandenburg, interest, experience in clinical trials and structural conditions in these departments were evaluated. Based on the results of this survey the possibilities to integrate non-university surgical departments into multicenter trials and how a high recruitment of patients can be motivated will be discussed in this article.

Closed reduction of distal radius fractures: does instability mean irreducibility?

IntroductionThe belief that not all distal radius fractures can be initially anatomically reduced with conservative means is rising. The aim of this study was to examine whether adequate reduction with a closed reduction technique is possible and to assess the importance of each step.Materials and methodsWe prospectively enrolled 63 distal radius fractures (62 patients). A standardized reduction technique was implemented. Reduction was radiologically evaluated in hanging traction, after reduction, and in plaster. Subgroup analysis was performed for fracture-dependent and fracture-independent factors on their influence on reduction.ResultsThe mean radiological values (radial inclination, dorsal tilt, ulnar variance) showed near anatomic reduction of all fractures in plaster. Fracture severity according to AO classification, initial displacement, number of instability criteria and patient age did not affect the reduction outcome.ConclusionsAll types of enrolled fractures were nearly anatomically reduced. This contradicts the opinion that some “severe” fractures are too unstable to be initially reduced by closed means.

Percutaneous transhepatic cholangiodrainage under real-time MRI guidance: Initial experience in an animal model

AIMS To assess percutaneous transhepatic cholangiodrainage (PTCD) under real-time MRI-guidance and compare it to procedures performed under fluoroscopy. METHODS We developed an in vitro model for MRI-guided and conventional PTCD, using an animal organ set including liver and bile ducts placed in an MRI-compatible box and tested it in a 1.0-Tesla open MRI-scanner. Prototype 18G needles and guide wires, standard guide wires, dilatation bougies, and drainages were used (MRI-compatible). MRI-visualization was by means of a bFFE real-time sequence using a surface coil (Flex-L). Outcome measurements were success rates and time needed for bile duct puncture using real-time MRI-guidance versus conventional radiologic methods in the model. Cannulation and drainage placement were also analysed. RESULTS Fifty MRI-guided experiments were performed, leading to rapid (mean: 43s, range: 15-72s) and successful puncture and cannulation in 96% of procedures. Median drainage placement time was 321.5s (range: 241-411s). In 35 control experiments under fluoroscopy, puncture success was 69%, whereas times were significantly longer (mean 273s, range 45-631s). CONCLUSIONS Initial in vitro experience shows that PTCD can be successfully and rapidly performed under real-time MRI-guidance and demonstrates improved performance compared to the conventional radiologic approach.

Klinische Studien außerhalb von Universitätskliniken

ZusammenfassungDie Forderung nach hochwertiger evidenzbasierter Therapie in der operativen Medizin in Deutschland und das Bewusstsein über die meist erheblich mangelhafte Qualität der chirurgischen Studien macht die Notwendigkeit von randomisiert-kontrollierten Studien deutlich. In 6 öffentlich geförderten operativen Studienzentren wird seit 2006 an der Schaffung einer professionellen Infrastruktur für chirurgische Studien gearbeitet. Ziel ist die Initiierung chirurgischer Multicenterstudien, die durch regionale Vernetzung effektiv durchgeführt werden können. Um eine zeitgerechte Patientenrekrutierung in diesen Studien zu sichern, ist es essenziell, in Zukunft nichtuniversitäre chirurgische Kliniken in die Studiendurchführung zu integrieren. Mithilfe einer Fragebogenaktion in nichtuniversitären chirurgischen Kliniken in Berlin und Brandenburg wurden das Interesse, die Studienerfahrungen und die strukturellen Gegebenheiten in diesen Kliniken evaluiert. Der vorliegende Beitrag diskutiert anhand der Ergebnisse dieser Umfrage, wie zukünftig nichtuniversitäre chirurgische Kliniken in die aktive Studiendurchführung eingebunden werden können und wie zu einer hohen Patientenrekrutierung motiviert werden kann.AbstractThe demand for high quality evidence-based surgical treatment in Germany and awareness of the poor quality of surgical trials highlight the basic necessity of randomized controlled trials. In six surgical trial centers a professional infrastructure for surgical trials is in the process of being established since 2006.The aim is the initiation of surgical multicenter trials which can be effectively conducted by local networking. To accomplish a timely recruitment of patients it is necessary to integrate surgical departments outside university hospitals into multicenter trials. With a questionnaire survey of non-university surgical departments in the federal states of Berlin and Brandenburg, interest, experience in clinical trials and structural conditions in these departments were evaluated. Based on the results of this survey the possibilities to integrate non-university surgical departments into multicenter trials and how a high recruitment of patients can be motivated will be discussed in this article.The demand for high quality evidence-based surgical treatment in Germany and awareness of the poor quality of surgical trials highlight the basic necessity of randomized controlled trials. In six surgical trial centers a professional infrastructure for surgical trials is in the process of being established since 2006.The aim is the initiation of surgical multicenter trials which can be effectively conducted by local networking. To accomplish a timely recruitment of patients it is necessary to integrate surgical departments outside university hospitals into multicenter trials. With a questionnaire survey of non-university surgical departments in the federal states of Berlin and Brandenburg, interest, experience in clinical trials and structural conditions in these departments were evaluated. Based on the results of this survey the possibilities to integrate non-university surgical departments into multicenter trials and how a high recruitment of patients can be motivated will be discussed in this article.

Fracture severity of distal radius fractures treated with locking plating correlates with limitations in ulnar abduction and inferior health-related quality of life

Introduction/background: The operative treatment of distal radius fractures has significantly increased after the introduction of locking plates. The aim of the present study was the evaluation of health-related quality of life, functional and radiological outcome of patients with distal radius fractures treated with the locking compression plate (LCP). Materials and methods: In the present study 128 patients (130 fractures) that were operatively treated with the LCP (2.4 mm/3.5 mm, Synthes®) were retrospectively evaluated. Mean follow-up was 22.7 months (SD 10.6). The fractures were radiographically evaluated (radial inclination, palmar tilt, ulnar variance) pre-, postoperatively and at the last follow-up visit. Range of motion (ROM) was documented. Grip strength was assessed with the use of a JAMAR dynamometer. The score for disabilities of the arm, shoulder and hand (DASH) and the Gartland-Werley score (GWS) were evaluated. Health-associated quality of life was assessed with use of SF-36 Health Survey. Results: Postoperative reduction was excellent; at the last follow-up visit only minimal reduction loss was observed. Except for pronation, a statistically significant decrease of ROM was present; in most cases that was not disturbing for the patients. The injured side achieved 83.9% of grip strength of the intact side. Mean DASH was 18.9 and mean GWS was 3.5. Health-associated quality of life was generally not compromised. However, limitations in ulnar abduction correlated with inferior quality of life. Fracture severity correlated with inferior quality of life, despite the absence of correlation with the functional and radiological outcome. Complication rate was low. Conclusions: Fracture severity seems to affect ulnar abduction and therefore patient quality of life, despite almost anatomical reduction; the objective and subjective scores were in most cases excellent. Modern everyday activities, such as keyboard typing, could be associated with the present results.