Rainer Gumpert

The three-dimensional morphometry of the odontoid peg and its impact on ventral screw osteosynthesis

Ventral screw osteosynthesis is a common surgical method for treating fractures of the odontoid peg, but there is still no consensus about the number and diameter of the screws to be used. The purpose of this study was to develop a more accurate measurement technique for the morphometry of the odontoid peg (dens axis) and to provide a recommendation for ventral screw osteosynthesis. Images of the cervical spine of 44 Caucasian patients, taken with a 64-line CT scanner, were evaluated using the measuring software MIMICS. All measurements were performed by two independent observers. Intraclass correlation coefficients were used to measure inter-rater variability. The mean length of the odontoid peg was 39.76 mm (SD 2.68). The mean screw entry angle α was 59.45° (SD 3.45). The mean angle between the screw and the ventral border of C2 was 13.18° (SD 2.70), the maximum possible mean converging angle of two screws was 20.35° (SD 3.24). The measurements were obtained at the level of 66% of the total odontoid peg length and showed mean values of 8.36 mm (SD 0.84) for the inner diameter in the sagittal plane and 7.35 mm (SD 0.97) in the coronal plane. The mean outer diameter of the odontoid peg was 12.88 mm (SD 0.91) in the sagittal plane and 11.77 mm (SD 1.09) in the coronal plane. The results measured at the level of 90% of the total odontoid peg length were a mean of 6.12 mm (SD 1.14) for the sagittal inner diameter and 5.50 mm (SD 1.05) for the coronal inner diameter. The mean outer diameter of the odontoid peg was 11.10 mm (SD 1.0) in the sagittal plane and 10.00 mm (SD 1.07) in the coronal plane. In order to calculate the necessary screw length using 3.5 mm cannulated screws, 1.5 mm should be added to the measured odontoid peg length when anatomical reduction seems possible. The cross-section of the odontoid peg is not circular but slightly elliptical, with a 10% greater diameter in the sagittal plane. In the majority of cases (70.5%) the odontoid peg offers enough room for two 3.5 mm cannulated cortical screws.

Successful prolonged resuscitation involving the use of tenecteplase without neurological sequelae

Prehospital cardiac arrest is associated with a very poor prognosis. We report a case of complete neurological recovery after prolonged resuscitation involving the use of tenecteplase in a patient with undifferentiated cardiac arrest with a return of spontaneous circulation after 1 hour of resuscitation, where basic life support was commenced immediately by a bystanding family member. Factors associated with an increased chance of survival from out-of-hospital cardiac arrest are discussed as well as the role of thrombolytics in cardiopulmonary resuscitation.

Penetrating neck trauma causing tracheal rupture, spinal cord injury, and massive pneumocephalus.

We describe a case in which tracheal, esophageal, and spinal cord injuries associated with massive pneumocephalus were caused by a flying chainsaw segment. To our knowledge, this is the first such case reported in the medical literature. The management challenges inherent in this exceedingly rare combination of injuries are discussed, and a novel theory explaining the possible pathophysiological mechanism that led to pneumocephalus in our patient is put forth.

Outcome of type C (AO) distal humeral fractures: follow-up of 22 patients with bicolumnar plating osteosynthesis

BACKGROUND In the last 40 years, 220 patients with type C distal humeral fractures (AO13-C1-3) were treated at our hospital operatively. Aim of this study is to present results of patients treated by dual plating osteosynthesis in the last decade and to compare them with our previous series (A-C). MATERIALS AND METHODS From 1999 to 2008, 48 distal humeral fractures were treated operatively by perpendicular dual plating osteosynthesis. Twenty-two patients (mean age 43.5 years) were available for follow-up. These patients were allocated on the basis of retrospective evaluation, exploration of their medical history, x-rays based on the AO-classification, and functional outcome using CASSEBAUM, JUPITER, and Quick-DASH (Disabilities of the Arm, Shoulder and Hand) scores. RESULTS The dominant side was affecting in 42.9%. Transolecranon approach was chosen in 86.4%. Good/excellent results were found in 86.4% (CASSEBAUM) and 81.8% (JUPITER). Mean Quick-DASH was 36.1 ± 28.4. Mean range of motion (ROM) was 0/10.9°/128.2°. Mean hospitalization time was 12.9 days, 22.7% were polytrauma patients. Early mobilization was possible in 81.8%. CONCLUSION Early mobilization was possible in the majority of cases, which may be a prerequisite for satisfying functional results. Using new locking plates, early mobilization could be maintained even in an aging population.

Subacute Progressive Ascending Myelopathy from L2 to C4 after A Burst Fracture of the Second Lumbar Vertebra

Subacute progressive ascending myelopathy is a rare, poorly understood neurological complication of spinal cord injury, unrelated to mechanical compression, instability, or syrinx formation at the level of injury or above. To date, there is no known treatment for this dramatic spinal cord injury complication. We present a case of subacute progressive myelopathy after lumbar spine trauma. The therapy consisted of plasmapheresis, hyperbaric oxygen, high-dose cortisol, antibiotic, and antiviral drugs. At 1 year post injury, the patient had recovered most of his lost upper-extremity function and MRI demonstrated only discrete signal intensity alterations extending to T3/4.

Transdiaphragmatic repositioning of the heart in the setting of emergency laparotomy after blunt trauma

Cardiac luxation after blunt trauma is a rare condition that carries a high mortality rate. We report a case of a left pericardial rupture with partial dislocation of the heart into the left pleural cavity and cardiac strangulation in a polytraumatized patient after a severe motor vehicle accident. This case is of special interest because the patient not only had cardiovascular compromise but was also actually in cardiac arrest and being resuscitated when an emergency repositioning of the heart through the diaphragm in the setting of damage control laparotomy restored circulation. This report stresses the need for a high index of suspicion for accurate early diagnosis of pericardial rupture.

Refractory ventricular fibrillation with prolonged resuscitation in dialysis-sensitive dysrhythmic patient.

Sudden cardiac death is a leading cause of death in chronic renal failure patients. We present a case of refractory ventricular fibrillation with successful prolonged resuscitation (> 1 hour) without neurological sequel in an outpatient dialysis centre. Implantation of a cardioverter-defibrillator is able to identify patients as dialysis-sensitive. Smoother potassium removal during hemodialysis could eliminate dysrhythmias. Prehospital (point-of-care) blood gas analysis can be helpful especially in prolonged resuscitation.