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Featured researches published by G. Schiffer.


Clinical Orthopaedics and Related Research | 2003

Elastic stable intramedullary nailing of midclavicular fractures with a titanium nail.

Axel Jubel; Jonas Andermahr; G. Schiffer; Kostas Tsironis; K. E. Rehm

This study presents the results of a minimally invasive operative treatment for markedly displaced midclavicular fractures. In all patients a flexible titanium nail was inserted in an unreamed technique from the sternal end of the clavicle. The result of surgery was determined with clinical and radiographic controls. The clinical outcome was evaluated 12 months after hardware removal using the scoring system of Constant and Murley. Fifty-eight fractures in 55 patients were treated with intramedullary fixation. Postoperatively on Day 3, the mean subjective pain was significantly lower and range of motion was improved compared with the day before surgery. One nonunion occurred. There was no infection and no implant displacement or refracture. Intramedullary nailing of midclavicular fractures with a flexible titanium nail is a safe minimally invasive surgical technique with excellent functional and cosmetic results compared with plate fixation or conservative treatment. Marked pain reduction along with early restoration of shoulder function and early mobilization are advantageous for patients. This technique can be used as an alternative treatment to conservative procedures or plate fixation in patients with markedly displaced midclavicular fractures, multiple trauma, fractures of the lower extremities, or associated shoulder girdle injuries.


Unfallchirurg | 2002

Die Technik der intramedullären Osteosynthese der Klavikula mit elastischen Titannägeln

Axel Jubel; Jonas Andermahr; G. Schiffer; K. E. Rehm

ZusammenfassungAnhand dieser prospektiv kontrollierten Beobachtungsstudie sollten die Ergebnisse der intramedullären Osteosynthese der Klavikula im mittleren Drittel erfasst werden.In Rückenlagerung erfolgt die Eröffnung der ventralen Kortikalis der sternalen Klavikula mit einem 2,5-mm-Bohrer. Der Nagel wird unter Bildwandlerkontrolle nach lateral vorgetrieben und die Fraktur reponiert. Gelingt die geschlossene Reposition nicht, erfolgt eine Hilfsinzision zur direkten Manipulation der Fragmente.In einem Zeitraum von 3,5 Jahren konnte die Technik bei 62 Patienten mit 65 Frakturen angewandt werden. Die subjektive Schmerzempfindung war am 3. postoperativen Tag signifikant (p<0,001) niedriger als präoperativ. Das Bewegungsausmaß im Schultergelenk konnte signifikant (p<0,001) verbessert werden. Wir beobachteten eine Pseudarthrose. Implantatdislokationen, Infekte, und Refrakturen traten nicht auf. Der mittlere Wert des Constant-Score betrug 6 Monate nach der Metallentfernung 96,9±3,3 Punkte.Die intramedulläre Schienung der Klavikulafraktur ist eine sichere, minimal-invasive Operationstechnik, die funktionell und kosmetisch zu guten Resultaten führt.AbstractThis prospective controlled clinical trial was performed to assess fracture healing and clinical outcome after intramedullary nailing of midclavicular fractures.Within 3,5 years elastic-stable intramedullary nailing was performed in 62 patients with 65 midclavicular fractures. Surgery was performed in supine position. The ventral cortex of the proximal clavicle was opened using a 2,5 mm drill. The nail was advanced laterally under fluoroscopic control. If closed reduction failed, an additional incision was made to enable direct manipulation of the fragments.There were no infections, no implant displacements or refractures. Postoperatively, the mean subjective pain was significantly lower, and the range of motion improved. We observed one nonunion. The mean Constant-score 6 months after hardware removal was 96.9 ± 3,3 points.Intramedullary fixation of midclavicular fractures with an elastic titanium nail is a safe minimally invasive surgical technique, producing excellent functional and cosmetic results.


American Journal of Sports Medicine | 2008

Transplantation of De Novo Scaffold-Free Cartilage Implants Into Sheep Knee Chondral Defects

Axel Jubel; Jonas Andermahr; G. Schiffer; Jürgen H. Fischer; K. E. Rehm; Martin J. Stoddart; Hans Jörg Häuselmann

Background New cell-based treatments for articular cartilage repair are needed. As the optimal scaffold for cartilage repair has yet to be developed, scaffold-free cartilage implants may remove the complications caused by suboptimal scaffolds. Hypothesis The implantation of a scaffold-free, autologous de novo cartilage implant into standardized full-thickness cartilage defects of femoral condyles in sheep leads to a qualitatively better regenerative tissue than does periosteal flap alone or no treatment. Study Design Controlled laboratory study. Methods Chondral defects 4 mm in diameter (1 per sheep) were created in the center of 1 medial femoral condyle of 48 sheep. Twelve defects were allowed to heal spontaneously, 16 defects were covered with periosteal flaps alone, and 20 defects were filled with autologous de novo cartilage graft and overlaid with a periosteal flap. Differences were assessed macroscopically using the International Cartilage Repair Society score and microscopically using the International Cartilage Repair Society histological score and Mankin score at 26 and 52 weeks. Results The results of the International Cartilage Repair Society Cartilage repair assessment showed that the transplant group was better than was the untreated control at both time periods but not significantly different than was the periosteal flap group. Implanted groups demonstrated a marked improvement in grade of defect filling, cartilage stability, cell distribution, and matrix assessments in each method of assessment. In the transplant group, 2 defects were filled with hyaline cartilage, 5 with mixed hyaline and fibrocartilage, and 2 with fibrocartilage alone. Conclusion Chondral defects treated with de novo cartilage transplantation show qualitatively better microscopic and macroscopic regeneration than do those treated with periosteal flaps alone. Clinical Relevance Results of the current study show that third-generation autologous chondrocyte transplantation is a promising development in the field of biologic cartilage regeneration. Future studies should compare this technique with the original Brittberg technique.


Orthopade | 2004

Experience with elastic stable intramedullary nailing (ESIN) of shaft fractures in children

Axel Jubel; Jonas Andermahr; J. Isenberg; G. Schiffer; A. Prokop; K. E. Rehm

The aim of this prospective clinical controlled trial was to investigate the early and midterm results of shaft fractures in children treated with elastic stable intramedullary nailing (ESIN). From January 1997 to December 2001, elastic stable intramedullary nailing was carried out on 112 children with 118 diaphyseal fractures. The mean age was 7.7 years. There were 51 fractures of the lower arm, 46 femoral fractures, 14 of the lower leg, and 7 of the humerus. A total of 92 children have been followed up for more than 12 months. The mean time of follow-up was 38 months.The mean time of fluoroscopy was 2.2 min. Open reduction was necessary in 3.4 %. In children with injuries of the lower extremity, full weight bearing was achieved after a mean period of 9.3 days. In 1.8% of the children, reoperation was necessary within the first 10 days after the operation. In 3.6 % there was painful skin irritation due to the protruding end of a nail. No infection or delayed union was observed. Implant removal was done after a mean time of 5.6 months. There was no rotational or angular deformity of more than 5 degrees in children with isolated fractures of the lower extremity. Mean lengthening of the injured leg was 2.4 mm. In three children who had fractures of the upper extremity, a deficit in range of motion of the adjacent joints was detected. The current results show that intramedullary fixation of displaced diaphyseal fractures in children with a flexible titanium nail is a safe, minimally invasive surgical technique producing excellent functional and cosmetic results.


Unfallchirurg | 2000

Wirbelsäulenverletzung bei Jockeys Zwei Fallberichte und Literaturübersicht

Jonas Andermahr; G. Schiffer; C. Burger; K. E. Rehm

ZusammenfassungEs werden zwei schwere Wirbelsäulenverletzungen bei professionellen Jockeys vorgestellt. Der Pathomechanismus wurde anhand einer Videoaufzeichnung des Unfallhergangs analysiert. Die aktuellen Therapiekonzepte werden nach Darstellung der Literatur diskutiert. Die schwere Wirbelsäulenverletzung des Jockeys ist ein Arbeitsunfall und bedarf der interdisziplinären Diagnostik und Therapie.AbstractTwo cases of severe spinal cord injuries to professional horse-racing jockeys are presented. There is only one comprehensive study conducted to ascertain the nature and incidence of injuries in the literature. The pathomechanism and surgical therapy of vertebral trauma in jockeys was analysed.


Orthopade | 2007

Cleavage lines and incisions in foot surgery

Jonas Andermahr; Axel Jubel; Andreas Elsner; P.R. Schulz-Algie; G. Schiffer; Jürgen Koebke

ZusammenfassungHintergrundIm Zuge der immer differenzierter werdenden und an Bedeutung zunehmenden Fußchirurgie ergibt sich die Frage, ob die bisher angewandten Schnittführungen adäquat sind. Die Frage, ob die Langer-Linien bei operativen Eingriffen am Fuß berücksichtigt werden, ist Gegenstand der vorliegenden Untersuchung. Ziel ist es, an Leichenfüßen das Spaltlinienmuster der Haut in allen Fußregionen zu untersuchen und optimale Schnittführung für fußchirurgische Eingriffe zu etablieren.Material und MethodeUntersucht werden 12 Füße von älteren Verstorbenen. Die Präparate sind fixiert. In den einzelnen Hautregionen werden die Spaltlinien dargestellt und ausgewertet. Um die Bedeutung der gewonnenen Erkenntnisse hervorzuheben, werden Spaltlinien und gängige Hautinzisionen der einschlägigen Operationslehren gegenübergestellt.ErgebnisseEs wird gezeigt, dass aktuelle Standardzugänge häufig das Spalthautmuster missachten und somit unkosmetische Narben erklärlich sind. Eine Kartierung idealer Schnittführungen für die einzelnen Operationen wird vorgenommen.SchlussfolgerungDer ideale Schnitt sollte parallel zu den Spaltlinien der Haut erfolgen. Kann dies aus Gründen der optimalen Situseinstellung nicht wahrgenommen werden, so sollten zumindestens große Anteile der Inzision den Linien folgen.AbstractBackgroundIn the constantly evolving, increasingly important field of foot surgery, the question arises as to whether the incision types currently in use are adequate. Whether Langer’s lines should be considered during the operative approach to the foot is examined here. The goal of the current study was to investigate the pattern of skin cleavage lines of cadaveric feet and to establish the optimal incision type for surgical approaches to the foot.Materials and methodsTwelve feet from older deceased subjects were examined. The samples were fixed. The cleavage lines of the individual skin regions were outlined and evaluated. To emphasize the significance of the investigative findings, the cleavage lines and the current, relevant operative approaches were compared.ResultsStandard current approaches often ignore skin cleavage lines, understandably resulting in cosmetically unsatisfactory scars. A chart with ideal incision types for individual operations was created.ConclusionThe ideal incision should run parallel to skin cleavage lines. If this is not completely possible due to operative requirements, then at least a large part of the incision should follow these lines.


Deutsches Arzteblatt International | 2010

Midclavicular fracture: not just a trivial injury: current treatment options.

G. Schiffer; C. Faymonville; Emmanouil Skouras; Jonas Andermahr; Axel Jubel

BACKGROUND Conservative treatment was long recommended for midclavicular fractures because of the excellent results that were reported in the 1960s and 70s. Recently, however, the rucksack bandage has received competition from surgical treatment. The spectrum of operations ranges from classic plate osteosynthesis to intramedullary techniques and angle-stable implants. METHODS We present and evaluate the current treatment options on the basis of a selective review of the literature. RESULTS Recent studies have confirmed some long-held concepts and refuted others. The risk of non-union after conservative treatment was previously reported as 1% to 2% but has turned out to be much higher in selected subgroups such as in patients with severe displacement, female patients, and patients of advanced age. Furthermore, new implants and techniques have made surgery safer and more likely to result in bony union. CONCLUSION In any case of midclavicular fracture, the type of fracture should be precisely analyzed and an individual treatment strategy should be developed in view of the patients particular situation. Current studies show with a high level of evidence (level 1) that patients with dislocated fractures benefit from surgery.


Orthopade | 2007

Die Hautspaltlinien und die Schnittführung bei Fußoperationen

Jonas Andermahr; Axel Jubel; Andreas Elsner; P.R. Schulz-Algie; G. Schiffer; Jürgen Koebke

ZusammenfassungHintergrundIm Zuge der immer differenzierter werdenden und an Bedeutung zunehmenden Fußchirurgie ergibt sich die Frage, ob die bisher angewandten Schnittführungen adäquat sind. Die Frage, ob die Langer-Linien bei operativen Eingriffen am Fuß berücksichtigt werden, ist Gegenstand der vorliegenden Untersuchung. Ziel ist es, an Leichenfüßen das Spaltlinienmuster der Haut in allen Fußregionen zu untersuchen und optimale Schnittführung für fußchirurgische Eingriffe zu etablieren.Material und MethodeUntersucht werden 12 Füße von älteren Verstorbenen. Die Präparate sind fixiert. In den einzelnen Hautregionen werden die Spaltlinien dargestellt und ausgewertet. Um die Bedeutung der gewonnenen Erkenntnisse hervorzuheben, werden Spaltlinien und gängige Hautinzisionen der einschlägigen Operationslehren gegenübergestellt.ErgebnisseEs wird gezeigt, dass aktuelle Standardzugänge häufig das Spalthautmuster missachten und somit unkosmetische Narben erklärlich sind. Eine Kartierung idealer Schnittführungen für die einzelnen Operationen wird vorgenommen.SchlussfolgerungDer ideale Schnitt sollte parallel zu den Spaltlinien der Haut erfolgen. Kann dies aus Gründen der optimalen Situseinstellung nicht wahrgenommen werden, so sollten zumindestens große Anteile der Inzision den Linien folgen.AbstractBackgroundIn the constantly evolving, increasingly important field of foot surgery, the question arises as to whether the incision types currently in use are adequate. Whether Langer’s lines should be considered during the operative approach to the foot is examined here. The goal of the current study was to investigate the pattern of skin cleavage lines of cadaveric feet and to establish the optimal incision type for surgical approaches to the foot.Materials and methodsTwelve feet from older deceased subjects were examined. The samples were fixed. The cleavage lines of the individual skin regions were outlined and evaluated. To emphasize the significance of the investigative findings, the cleavage lines and the current, relevant operative approaches were compared.ResultsStandard current approaches often ignore skin cleavage lines, understandably resulting in cosmetically unsatisfactory scars. A chart with ideal incision types for individual operations was created.ConclusionThe ideal incision should run parallel to skin cleavage lines. If this is not completely possible due to operative requirements, then at least a large part of the incision should follow these lines.


Unfallchirurg | 2015

[Type 2 dens fracture in the elderly and therapy-linked mortality : Conservative or operative treatment].

Gregor Stein; Carolin Meyer; L. Marlow; H. Christ; Lars Peter Müller; J. Isenberg; P. Eysel; G. Schiffer; C. Faymonville

BACKGROUND Type II fractures of the odontoid process of the axis are the most common injury of the cervical spine in elderly patients. Only little evidence exists on whether elderly patients should be treated conservatively or surgically. MATERIAL AND METHODS The mortality and survival probability of 51 patients were determined in a retrospective study. The range of motion, pain and the neck disability index were clinically investigated. RESULTS Of the 51 patients 37 were treated surgically and 14 conservatively. The conservatively treated group showed a higher mortality (64 % vs. 32 %). Kaplan-Meier analysis revealed a median survival of the conservatively treated group of 29 months, whereby during the first 3 months of treatment this group showed a higher survival probability and afterwards the surgically treated group showed a higher survival probability. The clinical examination of 20 patients revealed limited range of motion of the cervical spine. Additionally, moderate levels of pain and complaints were recorded using the neck disability index. CONCLUSION Fractures of the odontoid process pose a far-reaching danger for elderly patients. A balanced assessment of the general condition should be carried out at the beginning of treatment of these patients. In the early phase following trauma no differences were found with respect to survival rates but for long-term survival the operatively treated group showed advantages; however, these advantages cannot be causally attributed to the choice of therapy.


Unfallchirurg | 2015

Typ-II-Densfrakturen des alten Menschen und therapiebedingte Mortalität

Gregor Stein; Carolin Meyer; L. Marlow; H. Christ; Lars Peter Müller; J. Isenberg; P. Eysel; G. Schiffer; C. Faymonville

BACKGROUND Type II fractures of the odontoid process of the axis are the most common injury of the cervical spine in elderly patients. Only little evidence exists on whether elderly patients should be treated conservatively or surgically. MATERIAL AND METHODS The mortality and survival probability of 51 patients were determined in a retrospective study. The range of motion, pain and the neck disability index were clinically investigated. RESULTS Of the 51 patients 37 were treated surgically and 14 conservatively. The conservatively treated group showed a higher mortality (64 % vs. 32 %). Kaplan-Meier analysis revealed a median survival of the conservatively treated group of 29 months, whereby during the first 3 months of treatment this group showed a higher survival probability and afterwards the surgically treated group showed a higher survival probability. The clinical examination of 20 patients revealed limited range of motion of the cervical spine. Additionally, moderate levels of pain and complaints were recorded using the neck disability index. CONCLUSION Fractures of the odontoid process pose a far-reaching danger for elderly patients. A balanced assessment of the general condition should be carried out at the beginning of treatment of these patients. In the early phase following trauma no differences were found with respect to survival rates but for long-term survival the operatively treated group showed advantages; however, these advantages cannot be causally attributed to the choice of therapy.

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A. Prokop

University of Cologne

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P. Eysel

University of Cologne

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