Johannes Pauser

Incisional negative pressure wound therapy after hemiarthroplasty for femoral neck fractures – reduction of wound complications

The aim of the study was to evaluate the use of incisional negative pressure wound therapy (iNPWT) in wound healing after femoral neck fracture (FNF) treated with hip hemiarthroplasty (HA) and its influence on postoperative seromas, wound secretion, as well as time and material consumption for dressing changes. The study is a prospective randomised evaluation of iNPWT in patients with large surgical wounds after FNF. Patients were randomised either to be treated by iNPWT (group A) or a standard wound dressing (group B). Follow‐up included ultrasound measurements of seroma volumes on postoperative days 5 and 10, duration of wound secretion, and time and material spent for wound dressing changes. For comparison of the means, we used the t‐test for independent samples, P > 0·05 was considered significant. There were 21 patients randomised in this study. Group A (11 patients, 81·6 ± 5·2 years of age) developed a seroma of 0·257 ± 0·75 cm3 after 5 days and had a secretion of 0·9 ± 1·0 days, and the total time for dressing changes was 14·8 ± 3·9 minutes, whereas group B (ten patients, 82·6 ± 8·6 years of age) developed a seroma of 3·995 ± 5·01 cm3 after 5 days and had a secretion of 4·3 ± 2·45 days, and the total time for dressing changes was 42·9 ± 11·0 minutes. All mentioned differences were significant. iNPWT has been used on many different types of traumatic and non‐traumatic wounds. This prospective, randomised study has demonstrated decreased development of postoperative seromas, reduction of total wound secretion days and reduction of needed time for dressing changes.

Negative pressure wound therapy for seroma prevention and surgical incision treatment in spinal fracture care

To evaluate the clinical use and economic aspects of negative pressure wound therapy (NPWT) after dorsal stabilisation of spinal fractures. This study is a prospective randomised evaluation of NPWT in patients with large surgical wounds after surgical stabilisation of spinal fractures by internal fixation. Patients were randomised to either standard wound dressing treatment (group A) or NPWT (group B). The wound area was examined by ultrasound to measure seroma volumes in both groups on the 5th and 10th day after surgery. Furthermore, data on economic aspects such as nursing time for wound care and material used for wound dressing were evaluated. A total of 20 patients (10 in each group) were enrolled. Throughout the whole study, mean seroma volume was significantly higher in group A than that in group B (day 5: 1·9 ml versus 0 ml; P = 0·0007; day 10: 1·6 ml versus 0·5 ml; P <0·024). Furthermore, patients of group A required more wound care time (group A: 31 ± 10 minutes; group B 13·8 ± 6 minutes; P = 0·0005) and more number of compresses (total number; group A 35 ± 15; group B 11 ± 3; P = 0·0376). NPWT reduced the development of postoperative seroma, reduced nursing time and reduced material required for wound care.

Magnesium-Based Absorbable Metal Screws for Intra-Articular Fracture Fixation

MAGNEZIX® (Syntellix AG, Hanover, Germany) is a biodegradable magnesium-based alloy (MgYREZr) which is currently used to manufacture bioabsorbable compression screws. To date, there are very few studies reporting on a limited number of elective foot surgeries using this innovative implant. This case report describes the application of this screw for osteochondral fracture fixation at the humeral capitulum next to a loose radial head prosthesis, which was revised at the same time. The clinical course was uneventful. Degradation of the magnesium alloy did not interfere with fracture healing. Showing an excellent clinical result and free range-of-motion, the contour of the implant was still visible in a one-year follow-up.

Soccer boots elevate plantar pressures in elite male soccer professionals.

Objective:The present study measured the difference in peak plantar pressure between running shoes and soccer shoes in male soccer professionals [mean (SD): age, 23 (4) years; height, 184 (7) cm; weight, 81 (6) kg]. Design:Case series. Setting:Institutional study. Participants:A total of 17 elite male soccer professionals [mean (SD): age, 23 (4) years; height, 184 (7) cm; weight 81 (6) kg]. Interventions:Fifteen right and left steps with sensor-loaded insoles (99 sensors, 50 Hz) while running (3.3 m/s) in running shoes and then chosen soccer shoes (12-stud profile). The players were equipped with running shoes from the supplier without any medical supervision. Main Outcome Measures:Changes of peak plantar pressure for 9 defined foot portions between soccer boots and running shoes. Results:A statistically significant increase of peak plantar pressure was found for the lateral midfoot (P < 0.001 for preferred and nonpreferred foot), the first metatarsal head (preferred foot: P < 0.001, nonpreferred foot: P = 0.002), the metatarsal heads 4/5 (preferred foot: P = 0.001, nonpreferred foot: P = 0.002), and the big toe (preferred foot: P = 0.001, nonpreferred foot: P < 0.001), but not for the lateral and medial hindfoot, the medial midfoot, and lesser toes. Conclusions:In running, soccer boots generate excessive foot loadings predominantly under the lateral midfoot, as compared with running shoes. Players should be trained with a thoughtfully designed workout regimen that allows performing as many straight running exercises as possible in running shoes instead of soccer boots. This may help to prevent fifth metatarsal stress fractures in elite male soccer players.

Inaccuracy of a Physical Strain Trainer for the Monitoring of Partial Weight Bearing

OBJECTIVE To investigate the use of a physical strain trainer for the monitoring of partial weight bearing. DESIGN Case series with healthy volunteers. SETTING Orthopedic clinic. PARTICIPANTS Healthy volunteers (N=10) with no history of foot complaints. INTERVENTIONS Volunteers were taught to limit weight bearing to 10% body weight (BW) and 50% BW, monitored by a physical strain trainer. MAIN OUTCOME MEASURES The parameters peak pressure, maximum force, force-time integral, and pressure-time integral were assessed by dynamic pedobarography when volunteers walked with full BW (condition 1), 50% BW (condition 2), and 10% BW (condition 3). RESULTS With 10% BW (condition 3), forces with normative gait (condition 1) were statistically significantly reduced under the hindfoot where the physical strain trainer is placed. All pedobarographic parameters were, however, exceeded when the total foot was measured. A limitation to 10% BW with the physical strain trainer (condition 3) was equal to a bisection of peak pressure and maximum force for the total foot with normative gait (condition 1). Halved BW (condition 2) left a remaining mean 82% of peak pressure and mean 59% of maximum force from full BW (condition 1). CONCLUSIONS The concept of controlling partial weight bearing with the hindfoot-addressing device does not represent complete foot loading. Such devices may be preferably applied in cases when the hindfoot in particular must be off-loaded. Other training devices (eg, biofeedback soles) that monitor forces of the total foot have to be used to control partial weight bearing of the lower limb accurately.

Foot loading with an ankle-foot orthosis: the accuracy of an integrated physical strain trainer

PurposeTo investigate the value of a built-in physical strain trainer for the monitoring of partial weight bearing with an ankle-foot orthosis.Methods12 healthy volunteers were asked to perform three trials. Plantar peak pressure values from normal gait (trial one) were defined as 100% (baseline). The following trials were performed with the Vacoped® dynamic vacuum ankle orthosis worn in a neutral position with full weight bearing (trial two) and a restriction to 10% body weight (BW) (trial three), as monitored with an integrated physical strain trainer. Peak plantar pressure values were obtained using the pedar® X system.ResultsPeak pressure values were statistically significantly reduced wearing the Vacoped® shoe with full weight bearing for the hindfoot to 68% of the baseline (normal gait) and for the midfoot and forefoot to 83% and 60%, respectively. Limited weight bearing with 10% BW as controlled by physical strain trainer further reduced plantar peak pressure values for the hindfoot to 19%, for the midfoot to 43% of the baseline and the forefoot to 22% of the baseline.ConclusionsThe Vacoped® vacuum ankle orthosis significantly reduces plantar peak pressure. The integrated physical strain trainer seems unsuitable to monitor a limitation to 10% BW adequately for the total foot. The concept of controlling partial weight bearing with the hindfoot-addressing device within the orthosis seems debatable but may be useful when the hindfoot in particular must be off-loaded.

Bioabsorbable metal screws in traumatology: A promising innovation

MAGNEZIX® CS (Syntellix AG, Hanover, Germany) is a bioabsorbable compression screw made of a magnesium alloy (MgYREZr). Currently there are only two clinical studies reporting on a limited number of elective patients who received this screw in a hallux valgus operation. We applied MAGNEZIX® CS for fixation of distal fibular fracture in a trauma patient who had sustained a bimalleolar fracture type AO 44-B2.3. Clinical course was uneventful, fracture healing occurred within three months. Follow-up X-rays showed a radiolucent area around the implant for some months, yet this radiolucent area had disappeared in the 17-months follow-up X-ray.

Assessment of Plantar Pressure in Hindfoot Relief Shoes of Different Designs

BACKGROUND Although there are several different concepts of hindfoot relief footwear, there are no studies on the extent of pressure reduction to be achieved by this footwear. Therefore, we sought to evaluate the reduction in plantar pressure to be achieved with two different hindfoot relief shoes. METHODS Ten healthy volunteers performed three trials at a self-selected speed. Peak pressure values in mass-produced shoes (normal gait) were considered as 100% and were compared with measurements in two differently designed hindfoot relief shoes. Foot portions were defined as heel (0%-15% of total insole length), hindfoot (16%-30%), midfoot (31%-60%), and forefoot (61%-100%). RESULTS Heel and hindfoot peak pressures were significantly reduced in both shoes compared with normal gait (P < .05), but the extent of peak pressure reduction under the heel and hindfoot varied significantly between the tested shoes. Midfoot peak pressure was not significantly reduced in tested shoes compared with baseline (P > .05) but differed significantly between the two shoes. Forefoot peak pressure was significantly reduced with one of the tested shoes (to a median 73% baseline; P = .004) but not with the other (median, 88% baseline). CONCLUSIONS Hindfoot relief shoes leave a considerable amount of peak pressure, predominantly under the hindfoot. The extent of peak pressure reduction for the heel and the hindfoot varies between different hindfoot relief shoes. Depending on the affected foot area, the kind of hindfoot relief shoe should be carefully chosen.