Franz-Xaver Huber

First histological observations on the incorporation of a novel nanocrystalline hydroxyapatite paste OSTIM® in human cancellous bone

Background:A commercially available nanocrystalline hydroxyapatite paste Ostim® has been reported in few recent studies to surpass other synthetic bone substitutes with respect to the observed clinical results. However, the integration of this implantable material has been histologically evaluated only in animal experimental models up to now. This study aimed to evaluate the tissue incorporation of Ostim® in human cancellous bone after reconstructive bone surgery for trauma.Methods:Biopsy specimens from 6 adult patients with a total of 7 tibial, calcaneal or distal radial fractures were obtained at the time of osteosynthesis removal. The median interval from initial operation to tissue sampling was 13 (range 3–15) months. Samples were stained with Masson-Goldner, von Kossa, and toluidine blue. Osteoid volume, trabecular width and bone volume, and cortical porosity were analyzed. Samples were immunolabeled with antibodies against CD68, CD56 and human prolyl 4-hydroxylase to detect macrophages, osteoblasts, and fibroblasts, respectively. TRAP stainings were used to identify osteoclasts.Results:Histomorphometric data indicated good regeneration with normal bone turnover: mean osteoid volume was 1.93% of the trabecular bone mass, trabecular bone volume – 28.4%, trabecular width – 225.12 μm, and porosity index – 2.6%. Cortical and spongious bone tissue were well structured. Neither inflammatory reaction, nor osteofibrosis or osteonecrosis were observed. The implanted material was widely absorbed.Conclusion:The studied nanocrystalline hydroxyapatite paste showed good tissue incorporation. It is highly biocompatible and appears to be a suitable bone substitute for juxtaarticular comminuted fractures in combination with a stable screw-plate osteosynthesis.

Kyphoplasty for Patients With Multiple Myeloma Is a Safe Surgical Procedure: Results From a Large Patient Cohort

INTRODUCTION Only in recent years has balloon kyphoplasty gained significance in the treatment of vertebral fractures as an adequate minimally invasive vertebral stabilization technique. Kyphoplasty has also increasingly been used to treat vertebral osteolyses caused by multiple myeloma (MM). PATIENTS AND METHODS In our cohort of 76 patients with MM with a total of 190 vertebral fractures treated with kyphoplasty, we performed a 30-day postoperative analysis of cement leakage, neurologic symptoms, pulmonary embolism, and infections. RESULTS Painful osteolytic or fractured vertebrae or even imminent vertebral instability caused by osteolyses were seen as indications for kyphoplasty. One case of pulmonary embolism was observed because of cement leakage as the only postoperative complication. CONCLUSION By careful interdisciplinary indication setting and a standardized treatment model, kyphoplasty presents a very safe and effective procedure for the treatment of vertebral osteolyses and fractures caused by MM.

Crush syndrome due to drug-induced compartment syndrome: A rare condition not to be overlooked

PurposeThe crush syndrome caused by drug-induced compartment syndrome (DCS) is a challenge for surgeons because it is regularly associated with potentially fatal complications. Drug-induced compartment syndrome can often be distinguished from other forms of compartment syndrome by the presence of severe rhabdomyolysis with kidney crush and severe postoperative complications such as local and generalized infection, persistent nerve damage, coagulopathy, and multiorgan failure.MethodsIn the past 15 years, eight prospectively documented, operatively managed, DCS with subsequent crush syndrome cases were recorded.ResultsAll of the patients required renal replacement therapy. The creatine kinase (CK) values in the context of rhabdomyolysis reached an average of 86 (range 47–144) kU/l. The renal function recovered in all surviving patients. The analysis showed that the diagnosis of a DCS is usually made after an average of 13 h. It then took an average of an additional 7 h before a fasciotomy was performed. Six operational revisions were necessary. In three out of eight patients the extremities had to be amputated.ConclusionsIn DCS the decision to open the compartment should be made immediately upon the clinical diagnosis. A protracted intensive phase is expected. The benefit to patients is closely associated with surgical wound debridement along with rigorous intensive therapy.

Students’ Attitude to Modern Teaching Principles in the Field of Traumatology

Introduction:This study evaluates the implementation of the reform study system HeiCuMed (Heidelberger Curriculum Medicinale) in the field of traumatology at the University of Heidelberg. Goals of the reform study system are in close relation to practical knowledge combined with improvement of social and communicative skills of the student.Materials and Methods:At the end of the course, questionnaires are distributed which evaluate three different topics: whether specific goals of the reform study system are achieved, which type of lesson was able to achieve these goals and what was the most effective way to acquire the necessary knowledge. Relevance of answers are evaluated with points (1, 2 no relevance; 4,5 high relevance; 3 neutral).Results:One hundred and forty-eight students undergo traumatological education within the new reform study system. Feedback of questionnaires is 59%. Specific goals like “Recognition of problems” and “interdisciplinary thinking” are considered to be achieved. “Prioritization” and “self responsibility” are achieved to a lesser extent. “Bed-side teaching” and “integrated seminars” are considered as good types of teaching. “Problem-based learning (PBL) sessions” and “subject-oriented lectures” are considered inferior to reach the specific goals in the traumatological education. Less favourably received was “computer based learning”. Required knowledge for board examinations is thought to be acquired best with “classical self study”. Second best way is thought to be the teachers of the HeiCuMed team. “Student learning groups” and “final exam” are considered equal, however, acquisition of knowledge is considered limited. Acquisition of knowledge “from students involved in the HeiCuMed sessions” and “compulsory attendance” was considered negative.Conclusions:The reform study system HeiCuMed in the field of traumatology is overall positively received. Improved motivation of students and self-competence are clearly visible.