89 results on '"H. Lill"'
Search Results
2. [Current trends in reverse fracture arthroplasty]
- Author
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M, Warnhoff, G, Jensen, H, Lill, and A, Ellwein
- Subjects
Fracture Fixation, Internal ,Treatment Outcome ,Shoulder Joint ,Shoulder Fractures ,Humans ,Hemiarthroplasty ,Aged - Abstract
The reliable results of reverse arthroplasty have made this the preferred treatment method for non-reconstructable proximal humeral fractures. The individual consideration of the patient and the morphological features of the fractures are essential. Computed tomography (CT) images provide crucial information on the perfusion of the humeral head relevant for the prognosis and treatment. In this context a differentiation must be made between hard and soft criteria against a reconstruction. Tuberosities should be reduced whenever possible, because reverse arthroplasty with healed tuberosities provides a better range of motion and more strength for external rotation and anteversion, less complications and longer survival rates. In recent years the trend has been towards anatomical designs of prostheses with a humeral inclination of 135°. Revision rates for primary fracture prostheses are overall low with instability as the main reason for revision surgery, followed by periprosthetic fractures and infections. Reverse fracture arthroplasty has comparable or better clinical results compared to conservative treatment, osteosynthesis for geriatric patients, hemiarthroplasty and prosthesis implantation by elective surgery. Reverse arthroplasties, which were implanted in conditions of fracture sequelae, did not achieve significantly poorer clinical outcome at mid-term follow-up and can significantly improve shoulder function.Ihre zuverlässigen Ergebnisse haben die inverse Prothese zur präferierten Versorgungsmethode für nichtrekonstruierbare proximale Humerusfrakturen gemacht. Essenziell bleibt die individuelle Betrachtung des Patienten und der Frakturmorphologie. Prognose- und therapierelevante Aussagen zur Durchblutung des Humeruskopfes können gut anhand von CT-Aufnahmen getroffen werden; hierbei muss zwischen harten und weichen Kriterien gegen eine Rekonstruktion unterschieden werden. Inverse Frakturprothesen mit eingeheilten Tubercula weisen ein besseres Bewegungsausmaß und mehr Kraft für Außenrotation und Anteversion, weniger Komplikationen und eine längere Überlebensrate auf, weshalb diese, wann immer möglich, refixiert werden sollten. Der Trend der letzten Jahre geht zu einem anatomischen Prothesendesign mit einer humeralen Inklination von 135°. Die Revisionsrate bei primären Frakturprothesen ist insgesamt gering, mit der Instabilität als häufigstem Revisionsgrund, gefolgt von periprothetischen Frakturen und Infektionen. Verglichen mit einer konservativen Behandlung, einer Osteosynthese bei höherem Patientenalter, einer Hemiprothese und einer elektiv implantierten Prothese sind die klinische Ergebnisse nach der Versorgung mit einer inverser Frakturprothese besser oder gleichwertig. Auch inverse Prothesen, die wegen Frakturfolgezuständen implantiert wurden, erzielten kein signifikant schlechteres mittelfristiges klinisches Outcome. Selbst sekundär implantierte inverse Prothesen können die Funktion der Schulter signifikant verbessern.
- Published
- 2022
3. Offene Refixation bei proximalen Hamstring-Verletzungen
- Author
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A Partenheimer and H Lill
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Gynecology ,030222 orthopedics ,medicine.medical_specialty ,Hamstring muscles ,business.industry ,Hand surgery ,030229 sport sciences ,03 medical and health sciences ,Plastic surgery ,0302 clinical medicine ,medicine ,Tears ,Open repair ,Orthopedics and Sports Medicine ,Surgery ,Hamstring Tendons ,business ,Hamstring - Abstract
Ziel der operativen Reinsertion ist es, die Kontinuitat der Hamstrings wiederherzustellen und die ausgerissenen Sehnen anatomisch zu refixieren. Bei Patienten mit 2‑fachem Sehnenriss/-abriss mit mehr als 2 cm Retraktion oder bei kompletten 3‑fachen Sehnenrissen sollte die operative Refixation erfolgen. Massive Adipositas, Immobilitat. Die Operation wird uber eine quere Hautinzision in der Glutealfalte durchgefuhrt. Die ausgerissenen Sehnen werden mit Fadenankern am Footprint des Tuber ischiadicum refixiert. Die Nachbehandlung erfolgt mit einer Huftgelenkorthese fur 6 Wochen und Physiotherapie unter Vermeidung der aktiven Beubung der reinserierten Muskeln. Hinsichtlich der operativen Therapie werden in der Literatur eindeutig positive Ergebnisse beschrieben. Bei eigenen klinischen Nachkontrollen bis zu 1 Jahr nach dem Eingriff waren 90 % von insgesamt 31 Patienten, die von 2010 bis 2018 operiert worden waren, mit dem Ergebnis zufrieden und 75 % erreichten ihr vorheriges Aktivitatsniveau.
- Published
- 2019
4. Das Ellenbogenendoprothesenregister der DVSE – erste Daten
- Author
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L. Lehmann, S. Greiner, N. Sadler, Kilian Wegmann, F. Reuther, J. Plath, L. P. Müller, Frank Gohlke, J. Neumann, J. Weber, C. Schoch, H. Lill, M. Hackl, J. Kircher, D. B. Pfau, K. J. Burkhart, S. Studier-Fischer, R. Stangl, A. Ellwein, and C. Gauck
- Subjects
Gynecology ,medicine.medical_specialty ,media_common.quotation_subject ,medicine ,Orthopedics and Sports Medicine ,Surgery ,Art ,media_common - Abstract
Seit 2015 konnen Ellenbogenendoprothesen und Radiuskopfprothesen inklusive der Hemiprothese des distalen Humerus und des Capitulumersatzes im Ellenbogen im Ellenbogenendoprothesenregister der Deutschen Vereinigung fur Schulter- und Ellenbogenchirurgie e. V. (DVSE) dokumentiert werden. Die bis 2018 dokumentierten Primarbogen wurden fur die vorliegende Arbeit ausgewertet. Insgesamt wurden 73 Ellenbogenendoprothesen und 56 Radiuskopfprothesen erfasst. Bei den Ellenbogenendoprothesen wurden eine Hemiprothese des distalen Humerus, 63 gekoppelte Totalendoprothesen ohne und 9 Totalendoprothesen mit Radiuskopfersatz implantiert. Von den 56 Radiuskopfprothesen wurde eine Monobloc- und 55 modulare Prothesen implantiert. Daten zur Geschlechterverteilung, Alter, Operationsindikation, operationstechnischen Details und Fruhkomplikationen wurden ausgewertet. Die bereits dokumentierten 73 Ellenbogenendoprothesen und 56 Radiuskopfprothesen stellen bereits einen guten Anfang dar. Die detaillierte Datenerhebung wird uns bei guter Dokumentation in Zukunft Analysen an groseren Kohorten erlauben.
- Published
- 2019
5. Management of acute knee dislocations: anatomic repair and ligament bracing as a new treatment option—results of a multicentre study
- Author
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Christoph Bartl, C Schöpp, Karl-Heinz Frosch, Maximilian Heitmann, H. Lill, Ralph Akoto, Matthias Krause, Tobias J. Gensior, and Pierre Hepp
- Subjects
Adult ,Joint Instability ,Male ,Reoperation ,medicine.medical_specialty ,Adolescent ,Knee Dislocation ,Knee Joint ,Anterior cruciate ligament ,Joint Dislocations ,Arthroplasty ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Suture (anatomy) ,medicine ,Humans ,Orthopedics and Sports Medicine ,Prospective Studies ,Anterior Cruciate Ligament ,Paresis ,030222 orthopedics ,Braces ,Anterior Cruciate Ligament Reconstruction ,Sutures ,business.industry ,Anterior Cruciate Ligament Injuries ,030229 sport sciences ,Middle Aged ,musculoskeletal system ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Posterior cruciate ligament ,Orthopedic surgery ,Ligament ,Female ,Posterior Cruciate Ligament ,medicine.symptom ,business ,Common peroneal nerve - Abstract
The literature shows no consensus regarding the best method and timing for the treatment of acute knee dislocations. Studies indicate that a one-stage procedure performed in the early stages of injury can lead to superior results. The aim of this study was to evaluate the results after performing early surgical repair with additional suture augmentation (ligament bracing) of all torn ligaments in acute knee dislocations. In this prospective multicentre study, 73 patients with an acute type III or IV knee dislocation were treated with one-stage ligament bracing within 10 days. Twenty-six patients sustained a type III medial dislocation, thirty-nine patients sustained a type III lateral dislocation, and eight patients presented a type IV dislocation. Four patients were lost to follow-up. Within the follow-up evaluation, various scores were collected (International Knee Documentation Committee IKDC Score, Tegner Score and Lysholm Score). Additional stress radiography was performed (Telos™) postoperatively. Sixty-nine knee dislocations (Schenck III and IV) with a follow-up at a mean of 14 ± 1.6 months were evaluated. The average IKDC score was 75.5 ± 14.5, the average Lysholm score was 81.0 ± 15.5, and the median loss of activity in the Tegner score was 1 (range 0–3) point. Stress radiographs showed side-to-side differences at a mean of 3.2 ± 1.3 mm for the anterior cruciate ligament (ACL) and of 2.9 ± 2.1 mm for the posterior cruciate ligament (PCL). The operative revision rate (early and late) was 17.4%. In the early stage, one wound infection and one case of transient common peroneal nerve (CPN) paresis were successfully revised. In the later stage, four patients with knee stiffness and six cases with symptomatic knee instability needed reoperation. Patients without ultra-low velocity (ULV) dislocations or CPN showed good or excellent results in 87.5% according to the Lysholm score. In cases of acute knee dislocation, primary ACL and PCL transosseous sutures with additional suture augmentation predominantly lead to good and excellent clinical results. Obese patients sustaining ultra-low velocity (ULV) dislocations and patients following injury to the CPN show inferior outcomes. In patients without ULV and CPN intraoperative and postoperative complications occurred in 10.1%. The obtained results and revision rates show that early primary suture repair is a promising option. Prospective multicentre study, II.
- Published
- 2019
6. Neue Entwicklungen in der Ellenbogenchirurgie
- Author
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Lars Peter Müller, H. Lill, and Markus Scheibel
- Subjects
Orthopedics and Sports Medicine ,Surgery - Published
- 2021
7. [Open repair of proximal hamstring tears]
- Author
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A, Partenheimer and H, Lill
- Subjects
Treatment Outcome ,Tendon Injuries ,Suture Anchors ,Humans ,Hamstring Muscles ,Muscle, Skeletal - Abstract
Surgical refixation intends to restore the continuity of the hamstrings and anatomically reattach the torn tendons.In patients with 2‑tendon tear/ruptur with more than 2 cm retraction or with complete 3‑tendon tears, surgical fixation should be performed.Massive obesity, immobility.Surgery is performed via a transverse skin incision in the gluteal fold. Refixation of the torn tendons is achieved by means of suture anchors on the footprint of the ischial tuberosity.Postoperative treatment should be performed with a hip joint orthosis for 6 weeks, accompanied by physiotherapy.Regarding surgical treatment, positive results are clearly described in the literature. Of the 31 patients who underwent surgery between 2010 and 2018, 90 % were satisfied with the surgical results 1 year postoperatively and 75 % reached their previous activity level.
- Published
- 2019
8. Änderungen im Herausgeberboard der ObEx
- Author
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H. Lill, L. P. Müller, and Markus Scheibel
- Subjects
Orthopedics and Sports Medicine ,Surgery - Published
- 2017
9. Dokumentation einer Ellenbogenarthroskopie
- Author
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H. Lill, A. Ellwein, and A. B. Lenich
- Published
- 2018
10. Plattenosteosynthese bei proximaler Humerusfraktur
- Author
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H. Lill, A. Ellwein, and J. C. Katthagen
- Abstract
Die Versorgungsmoglichkeiten proximaler Humerusfrakturen reichen von konservativen Therapieansatzen uber rekonstruktive Verfahren mittels winkelstabiler Platten- oder Nagelosteosynthese bis hin zum Gelenkersatz mittels anatomischer oder inverser Frakturprothese. Hinsichtlich dieser Therapiemasnahmen bestehen Uberschneidungen in der Indikation, sodass unterschiedliche Verfahren nebeneinander ihre Berechtigung haben. Primares Ziel ist der Gelenkerhalt mit Wiederherstellung der Anatomie und Erreichen einer stabilen Situation zur fruhfunktionellen Nachbehandlung. Diesbezuglich stellt die winkelstabile Plattenosteosynthese ein Standardverfahren dar.
- Published
- 2018
11. Die komplexe proximale Humerusfraktur
- Author
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H. Lill, M. Scheibel, and B. Ockert
- Subjects
Orthopedics and Sports Medicine ,Surgery - Published
- 2019
12. Neurocognitive deficits in schizophrenia. Are we making mountains out of molehills?
- Author
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Brooke C. Schneider, H Lill, Steffen Moritz, T Desler, Jan Philipp Klein, and Juergen Gallinat
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Adult ,Male ,Mediation (statistics) ,Psychosis ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,medicine ,Humans ,Cognitive Dysfunction ,Effects of sleep deprivation on cognitive performance ,Applied Psychology ,Confounding ,Neuropsychology ,Middle Aged ,medicine.disease ,030227 psychiatry ,Psychiatry and Mental health ,Schizophrenia ,Female ,Cognitive Assessment System ,Psychology ,Neurocognitive ,030217 neurology & neurosurgery ,Clinical psychology - Abstract
BackgroundMost original studies and all meta-analyses conducted to date converge on the conclusion that patients with schizophrenia display rather generalized neurocognitive deficits. For the present study, we reopen this seemingly closed chapter and examine whether important influences, such as lack of motivation and negative attitudes towards cognitive assessment, result in poorer secondary neuropsychological performance.MethodA sample of 50 patients with an established diagnosis of schizophrenia were tested for routine neurocognitive assessment and compared to 60 nonclinical volunteers. Before and after the assessment, subjective momentary influences were examined (e.g. motivation, concerns about assessment, fear about poor outcome) for their impact on performance using a new questionnaire called theMomentary Influences, Attitudes and Motivation Impact(MIAMI)on Cognitive Performance Scale.ResultsAs expected, patients performed significantly worse than controls on all neurocognitive domains tested (large effect size, on average). However, patients also displayed more subjective momentary impairment, as well as more fears about the outcome and less motivation than controls. Mediation analyses indicated that these influences contributed to (secondary) poorer neurocognitive performance. Differences in neurocognitive scores shrank to a medium effect size, on average, when MIAMI scores were accounted for.ConclusionsThe data argue that performance on measures of neurocognition in schizophrenia are to a considerable extent due to secondary factors. Poor motivation, fears and momentary impairments distinguished patients from controls and these variables heavily impacted performance. Before concluding that neurocognitive deficits in psychiatric patients are present, clinicians should take these confounding influences into account. Although patients with schizophrenia achieved, on average, worse test scores than controls, a large subgroup displayed spared performance.
- Published
- 2017
13. Outcome nach operativer Versorgung von instabilen lateralen Klavikulafrakturen – Gibt es einen Goldstandard?
- Author
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R.-O. Dey Hazra, A. Ellwein, E. Dey Hazra, J. Imrecke, H. Lill, and G. Jensen
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Orthopedics and Sports Medicine ,Physical Therapy, Sports Therapy and Rehabilitation - Published
- 2019
14. Outcome nach Infektion operativ versorgter Tibiakopffrakturen – ein systematischer Review und erste retrospektive Analyse
- Author
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KH Frosch, JT Krause, C Schoepp, C. Josten, R Henkelmann, H. Lill, Dominik Seybold, and Pierre Hepp
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Gynecology ,medicine.medical_specialty ,business.industry ,medicine ,Surgery ,business - Published
- 2016
15. [Plate osteosynthesis after patellar fracture - the technique and initial results of a prospective study]
- Author
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A, Ellwein, H, Lill, G, Jensen, A, Gruner, and J C, Katthagen
- Subjects
Adult ,Aged, 80 and over ,Male ,Knee Joint ,Bone Screws ,Patella ,Middle Aged ,Fracture Fixation, Internal ,Young Adult ,Postoperative Complications ,Humans ,Female ,Prospective Studies ,Range of Motion, Articular ,Bone Plates ,Aged ,Follow-Up Studies - Abstract
Tension band wiring after patellar fractures is related to a high number of implant-related complications (22-53 %). Revision surgery is necessary in 10-55 % of patients mostly with unsatisfactory results. The patella plate is an alternative treatment with the advantages of locked plating. The purpose of this study was to evaluate the first clinical prospective results and complications of this new implant.Between April 2013 and May 2015 all patients that were treated with locked plating for patella fractures were included in this prospective study. Patients were followed-up clinically after six weeks and six months.Included in this study were 17 patients, 6 women and 11 men, with a mean age of 58 years (19-87). The knee range of motion was 120° after 6 weeks and improved to 138° after 6 months, corresponding to 84 % and 97 % of the range of motion of the healthy opposite knee. The Tegner activity scale increased from 2,5 to 3,5 (initial value: 4), the Lysholm score increased from 78 to 92 points (initial value: 97) and the Kujala score increased from 72 to 88 points (initial value: 96). Two complications occurred: one patient had a reactive bursitis prepatellaris and one patient sustained a loss of reduction.Locked plating of patella fractures is a reliable alternative treatment with good functional outcomes and low complication rates.
- Published
- 2016
16. Arthroskopie
- Author
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L. Irlenbusch, P. Hepp, G. Jensen, C. Katthagen, H. Lill, and M. Schulz
- Published
- 2016
17. [Double button Fixation with minimally invasive acromioclavicular cerclage: Arthroscopically-assisted treatment of acute acromioclavicular joint instability]
- Author
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G, Jensen, A, Ellwein, C, Voigt, J C, Katthagen, and H, Lill
- Subjects
Joint Instability ,Arthroscopy ,Fracture Fixation, Internal ,Fractures, Bone ,Evidence-Based Medicine ,Treatment Outcome ,Acromioclavicular Joint ,Suture Techniques ,Humans ,Prosthesis Design ,Bone Plates ,Combined Modality Therapy - Published
- 2015
18. Klinische und MRT-radiologische Ergebnisse nach Refixation der ischiokruralen Muskulatur
- Author
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B. Dietrich, E. Senn, K. Salmoukas, J. Imrecke, A. Partenheimer, and H. Lill
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Orthopedics and Sports Medicine ,Physical Therapy, Sports Therapy and Rehabilitation - Published
- 2017
19. [Injuries of the acromioclavicular joint: Hook plate versus arthroscopy]
- Author
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G, Jensen, A, Ellwein, C, Voigt, J C, Katthagen, and H, Lill
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Arthroscopy ,Fracture Fixation, Internal ,Fractures, Bone ,Evidence-Based Medicine ,Treatment Outcome ,Acromioclavicular Joint ,Suture Techniques ,Humans ,Bone Plates - Abstract
Acute acromioclavicular (AC) joint injuries are common in clinical practice. The hook plate is a well-established conventional operative treatment option for high grade instability; however, arthroscopically-assisted flexible double button techniques are increasingly being used. Both procedures lead to good or excellent results. The advantages of the hook plate are the simple surgical technique and the possibility of an early functional aftercare. The minimally invasive one-step procedure with the possibility of identification and treatment of frequently concomitant glenohumeral pathologies is advantageous for the arthroscopic technique but mobilization is more restrictive. Available comparative studies have shown no significant clinical differences but a tendency towards better results with a higher degree of acceptance among patients for the arthroscopic and minimally invasive non-rigid double button procedures.
- Published
- 2015
20. [Suprapectoral mini-open biceps tenodesis - functional and sonographic results]
- Author
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J C, Katthagen, P, Grimmas, G, Jensen, C, Voigt, and H, Lill
- Subjects
Adult ,Male ,Shoulder Joint ,Tenodesis ,Middle Aged ,Arthroscopy ,Postoperative Complications ,Suture Anchors ,Humans ,Female ,Range of Motion, Articular ,Aged ,Follow-Up Studies ,Retrospective Studies ,Ultrasonography - Abstract
Aim of this study was to evaluate the effectiveness of a suprapectoral mini-open tenodesis of the long head of the biceps (LHB) tendon with ultrasound assessment. Secondary aim was to compare the results of an extraosseous fixation (group I) to those of an intraosseous fixation technique (group II).25 patients (10 female, 15 male) aged 54 ± 8 (36 to 68) years were followed-up 21 ± 4.7 (13 to 32) months postoperatively. Tenodesis fixation was extraosseous in 12 (group I) and intraosseous in 13 patients (group II). Preoperative shoulder function and intraoperative findings were recorded. At the time of follow-up the fixation of the biceps tendon was evaluated by ultrasound examination. Furthermore, the shoulder function, the simple shoulder test (SST), the Constant-Murley score (CMS) and the "long head of the biceps (LHB) score" were assessed.Failure of tenodesis fixation was observed in 3/12 cases (25 %) of group I and 1/13 cases (8 %) of group II. Shoulder flexion (p 0.001), abduction (p 0.001), external rotation (p 0.001) and the pain level (p 0.001) improved significantly compared to the preoperative status. At time of follow-up the CMS averaged 79.4 ± 13 points, the age and gender related CMS averaged 95.7 ± 16.4 %. Mean SST was 10.6 ± 2.1 points. No significant difference (p = 0.064) could be observed between the LHB of the affected (88.1 ± 9.7) versus the non-affected shoulder (92.7 ± 13.6 points). Age and gender related CMS (p = 0.96), LHB score (p = 0.16) and SST (p = 0.94) of both groups revealed no significant differences.The intraosseous fixation technique seems favourable with less fixation failure compared to the extraosseous suspension technique. The suprapectoral mini-open tenodesis of the LHB is a valuable alternative tenodesis technique with good to excellent clinical results.
- Published
- 2015
21. The Dependence of the Molar Absorptivity of 4-Nitroaniline, 3-Carboxy-4-Nitroaniline and 4-Nitrophenol on the Reaction Conditions
- Author
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P. Lehmann, H. Lill, E. Schaich, and M. Grassl
- Subjects
Reaction conditions ,chemistry.chemical_compound ,Chemistry ,4-Nitrophenol ,4-Nitroaniline ,Molar absorptivity ,Photochemistry ,Nuclear chemistry - Published
- 2015
22. [Corrective osteosynthesis of proximal humeral fractures. Technique and prospective results]
- Author
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H, Lill, C, Voigt, G, Jensen, M, Warnhoff, and J C, Katthagen
- Subjects
Adult ,Male ,Fracture Fixation, Internal ,Treatment Outcome ,Shoulder Fractures ,Humans ,Female ,Prospective Studies ,Middle Aged ,Aged - Abstract
Fracture sequelae of proximal humeral fractures arise following nonoperative and operative forms of treatment. Due to a painful restricted range of motion, in most cases shoulder prostheses are implanted. There is a need for joint-preserving alternatives especially for younger patients.The aim of this study was to evaluate the surgical techniques and prospective results of fracture sequelae of proximal humeral fractures following corrective osteosynthesis.A total of 11 patients (4 female) with an average age of 53 years (range 29-71 years) and a mean follow-up of 19.5 months were included prospectively. The preoperative and postoperative ranges of motion of the affected shoulder were compared by statistical means. At the time of follow-up the constant score (CS), the simple shoulder test (SST) and the simple shoulder value (SSV) were assessed.Fracture sequelae were classified as type II in four patients, as type III in two and as type IV in five patients using the Boileau classification. Shoulder flexion (p = 0.006), abduction (p = 0.003) and external rotation (p = 0.02) improved significantly in the postoperative course. The mean age and gender-adapted CS was 74.8 ± 19.9 % at the time of follow-up, 10.1 out of 12 points were reached in the SST and the mean SSV was 77 %.Corrective osteosynthesis of fracture sequelae (Boileau types II-IV) of proximal humeral fractures appears to be a good alternative to implantation of shoulder prostheses, especially in younger patients ( 60 years of age).
- Published
- 2015
23. Easy and safe: a new surgical fixation technique for acute and chronic anterior instabilities of the sternoclavicular joint: technique and results.
- Author
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Warnhoff M, Jensen G, Dey Hazra RO, Sehmisch S, Lill H, and Ellwein A
- Abstract
Background: Instabilities of the sternoclavicular (SC) joint are a rare injury, accounting for only 3% of all injuries of the shoulder girdle. Although acute posterior dislocations are an emergency and require immediate surgical intervention, anterior instabilities (first and second degree according to Allman) can mostly be treated conservatively. Chronic and highly instable acute anterior instabilities often impose a significant limitation on the lives of affected patients. Currently, there is no established therapeutic algorithm in place., Methods: This retrospective case series with prospective collection of data was performed at a level I trauma center. Patients treated surgically for anterior SC joint instabilities between January 2013 and December 2019 and with a minimum follow-up of 24 months were included. The injuries comprised 6 acute anterior dislocations treated with tape cerclage in a "figure-of-8" configuration; 12 patients with chronic anterior SC instabilities were treated with autologous tendon grafts. For 1 highly unstable chronic anterior instability, in addition to the tendon graft, synthetic suture material was applied. The clinical evaluation consisted of a physical examination and a standardized questionnaire, which included subjective and objective shoulder scores., Results: Of 24 patients, 19 (79%) with an average age of 32 ± 15 years were available for follow-up. A total of 63% of the patients were male. After a mean follow-up of 57 months, the mean age- and sex-adapted Constant-Murley Shoulder Score of acute anterior luxations amounted to 90 ± 20 points, the Nottingham Clavicle Score to 81 ± 22 points, and the Disability of the Arm, Shoulder and Hand Score to 11 ± 18 points. Chronic anterior instabilities had a mean Constant-Murley Shoulder Score of 90 ± 12 points, Nottingham Clavicle Score of 83 ± 17 points, and Disability of the Arm, Shoulder and Hand Score of 4 ± 5 points. The study shows a complication rate of 10%. Two patients underwent revision surgery., Conclusions: To conclude, monocortical SC joint fixation in a "figure-of-8" fashion presents a low risk for complication and a low revision rate and can achieve an equally good functional outcome after the treatment of highly unstable acute and chronic anterior SC joint instabilities as other published techniques. Our approach presents less risk to the neurovascular structures of the mediastinum than other published techniques requiring bicortical drilling, therefore making the technique more accessible to hospitals without a cardiothoracic surgical background., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
24. Proximal humerus fracture and acromioclavicular joint dislocation.
- Author
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Bieling M, Ellwein A, Lill H, Sehmisch S, and Reeh FM
- Abstract
Proximal humerus fractures and injuries to the acromioclavicular joint are among the most common traumatic diseases of the upper extremity. Fractures of the proximal humerus occur most frequently in older people and are an indicator fracture of osteoporosis. While a large proportion of only slightly displaced fractures can be treated non-operatively, more complex fractures require surgical treatment. The choice of optimal treatment and the decision between joint-preserving surgery by means of osteosynthesis or endoprosthetic treatment is often a difficult decision in which both fracture morphology factors and individual factors should be taken into account. If endoprosthetic treatment is indicated, satisfactory long-term functional and clinical results have been achieved with a reverse shoulder arthroplasty. Injuries to the acromioclavicular joint occur primarily in young, athletic individuals. The common classification according to Rockwood divides the injury into 6 degrees of severity depending on the dislocation. This classification forms the basis for the decision on non-operative or surgical treatment. The indication for surgical treatment for higher-grade injuries is the subject of controversial debate in the latest literature. In chronic injuries, an autologous tendon transplant is also performed. Whereas in the past, treatment was often carried out using a hook plate, which was associated with complications, the gold standard today is minimally invasive treatment using Endobutton systems. This review provides an overview of the two injury patterns and discusses the various treatment options., Competing Interests: Competing interests: The authors state no conflict of interest., (© 2024 the author(s), published by De Gruyter, Berlin/Boston.)
- Published
- 2024
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25. Tuberosity refixation improves functional outcome following primary reverse shoulder arthroplasty in proximal humeral fracture.
- Author
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Derksen A, Lill H, Ellwein A, and Imrecke J
- Subjects
- Male, Humans, Female, Aged, Middle Aged, Aged, 80 and over, Prospective Studies, Treatment Outcome, Reoperation, Range of Motion, Articular, Retrospective Studies, Arthroplasty, Replacement, Shoulder methods, Shoulder Fractures diagnostic imaging, Shoulder Fractures surgery, Shoulder Joint diagnostic imaging, Shoulder Joint surgery
- Abstract
Introduction: The purpose of this prospective study was to examine clinical results of tuberosity refixation in RSA for the treatment of displaced PHF in elderly patients. We hypothesized that tuberosity refixation would increase clinical outcome., Methods: In this prospective study, 50 patients were included after receive a primary RSA for complex proximal humeral fracture between March 2013 and December 2015 for follow-up after three, 12 and 24 months. A functional and radiological assessment was performed on the patients., Results: At final follow-up after a mean period of 25.1 months, data were available for 30 women and 6 men (74% of the included overall study collective) with a mean age of 77 years (range 55-93 years) at time of surgery. The tuberosities were refixated in 74% (n = 37) and in 26% (n = 13) resected. RSA with tuberosity refixation resulted in better clinical shoulder function compared to RSA with non-refixated tuberosities. The data show an external rotation with a significant difference (24.9° vs. 14°, p < 0.05) in favor of participants with refixation. The raw CMS was statistically significant (71.3 vs. 56.3, p < 0.05) after refixation, and SSV was significant improved (82.7% vs. 68%, p < 0.05) in the same group. Among 3 of 50 patients a total of 3 complications occurred with a total of 6% surgical revision., Conclusions: In this prospective study, tuberosity refixation as part of fracture treatment using RSA results in better external rotation, subjective assessment of shoulder recovery (measured by SSV and by raw CMS) in elderly patients, compared with tuberosity excision., Level of Evidence: II, Prospective comparative study., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)
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- 2024
- Full Text
- View/download PDF
26. [Management of muscle trauma in popular sports].
- Author
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Partenheimer A, Warnhoff M, and Lill H
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- Humans, Muscles, Athletic Injuries diagnosis, Sports, Warm-Up Exercise, Soft Tissue Injuries complications
- Abstract
Muscle injuries make up the majority of injuries in popular sports. The causes for the development are multifactorial and can be divided into functional disorders and a lack of knowledge regarding training control. Insufficient warm-up and overtraining both increase the danger of the occurrence of the injury. Knowledge of the different types of muscle injuries and their incorporation into an exact classification enable the establishment of a correct treatment plan and can have a positive influence on the healing process. In addition to acute treatment the knowledge and application of preventive programs are necessary as these can significantly reduce the prevalence of muscle injuries in sports., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)
- Published
- 2023
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27. Implant-dependent behavior of tunnel widening and clavicular button migration after arthroscopic-assisted treatment of acromioclavicular joint instabilities.
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Dey Hazra RO, El Bajjati H, Hanhoff M, Warnhoff M, Ellwein A, Fossum BW, Lill H, and Jensen G
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- Humans, Arthroscopy adverse effects, Arthroscopy methods, Prostheses and Implants, Radiography, Acromioclavicular Joint surgery, Joint Instability etiology, Joint Instability surgery, Joint Instability diagnostic imaging, Joint Dislocations surgery
- Abstract
Introduction: Despite ongoing discussions for the previous few decades, there is still no consensus regarding the optimal surgical technique for acromioclavicular joint instabilities. The purpose of this study was to determine the impact of various implant materials following arthroscopically assisted stabilization of acromioclavicular joint instabilities on tunnel widening and implant migration. We hypothesized an implant-dependent behavior for tunnel widening and implant migration with differences when comparing acute and chronic acromioclavicular joint instabilities., Methods: This study compared 105 patients with acromioclavicular joint instabilities that were managed operatively with coracoclavicular double button constructs. Two of the groups containing acute cases were treated with either a double button construct with a wire (TR) or a tape (D) as a central pillar. The two groups with chronic cases were either treated with a wire (T+) or tape D+ as a central pillar and additional hamstring tendon augmentation (+). One central transclavicular-transcoracoidal drill channel was made in the acute cases, while additional medial and lateral drill channels to augment the central pillar with the hamstring tendon were made. The central drill channel in all cases and the medial/lateral drill channels in chronic cases were subsequently radiologically analyzed immediately postoperatively and at follow-up. Following this, additional radiological analysis of the implant migration of the clavicular button took place., Results: All groups showed significant tunnel widening of the central drill channel at follow-up (p ≤ 0.001). The TR+ technique demonstrated significant widening in both the medial (p ≤ 0.001) and lateral (p ≤ 0.001) drill channels. The D and D+ group displayed significant higher rates of clavicular button migration to a cortical and intraosseous level (p ≤ 0.002)., Conclusion: Tunnel widening and implant migration following arthroscopically assisted management of acromioclavicular joint instabilities are dependent on the chosen implant. The stable tape showed a significantly increased degree of tunnel widening with respect to the central drill channel in comparison with the wire. In contrast, a higher degree of load capacity of the tape ultimately favors a protected intraosseous graft healing for chronic cases, which leads to less tunnel widening of the medial and lateral drill channel. Finally, the D/D+ implant groups showed higher rates of implant migration due to lower contact surface area of the implant at the upper clavicular cortex., (© 2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)
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- 2023
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28. Superior clinical results for early arthroscopic treatment of grade IIIb and V acromioclavicular joint instability compared to delayed operative treatment.
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Dey Hazra RO, Hanhoff M, Kühnapfel A, Rutledge JC, Warnhoff M, Ellwein A, Lill H, and Jensen G
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- Humans, Treatment Outcome, Retrospective Studies, Radiography, Arthroscopy methods, Joint Dislocations surgery, Acromioclavicular Joint surgery, Acromioclavicular Joint injuries, Joint Instability surgery, Joint Instability diagnostic imaging
- Abstract
Background: Arthroscopy-assisted cortical fixation devices have been increasingly used in the operative management of both acute and chronic cases of acromioclavicular joint instability (ACJI). It has been hypothesized that delayed surgical management leads to inferior clinical and radiologic outcomes compared to acute treatment. The purpose of this study is to compare clinical and radiologic outcomes, scapula dyskinesia, and failure or revision rates of arthroscopically treated acute and chronic ACJI., Methods: This retrospective study of prospectively collected data included all surgically treated patients with grade IIIb and V chronic ACJI between 2013 and 2017, matched 1:1 to a group of acute grade IIIb and V ACJI patients treated during the same time period. Chronic ACJI was defined as delayed surgical treatment >21 days after injury. Chronic cases received an additional hamstring autograft next to the suture pulley systems. Follow-up was obtained at an average of 3.2 years (range: 1.4-6.2). Clinical outcome scores included the Constant-Murley Score (CMS), Taft Score (TF), Nottingham Clavicle Score (NCS), ACJI Score, Sick Scapula Score (SSS), Subjective Shoulder Value (SSV), Subjective Shoulder Test (SST), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, and the visual analog scale pain score. Radiologic follow-up was obtained pre- and postoperatively and at final follow-up. The 2-year results were compared to the results of a 1:1 matched-pair group comprising patients who were treated with an acute ACJI during the same period., Results: Thirty-three (80.5%) of 41 chronic ACJI cases were available for follow-up and were compared with 33 matched-pair cases of acute ACJI (of 41). The clinical scores were significantly better in the acute cohort for the CMS (92 ± 8 vs. 88 ± 8, P = .030), ASES (91 ± 13 vs. 85 ± 13, P = .002), SSS (1.4 ± 1.6 vs. 3.4 ± 2.5, P = .0004), NCS (86 ± 13 vs. 81 ± 13, P = .049), TF (9.9 ± 1.9 vs. 9.0 ± 2.1, P = .030), and ACJI (83 ± 13 vs. 75 ± 1, P = .003). In contrast to the chronic cohort, the acute cohort illustrated a significant loss of reduction at follow-up (P = .020)., Conclusion: Based on the results of this study, early arthroscopy-assisted operative treatment of grade IIIb and V ACJIs seems superior to delayed surgical intervention of grade IIIb and V ACJIs. Furthermore, an additional autograft loop leads to less loss of reduction compared with suture pulley/suspensory loop fixation standalones., (Copyright © 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
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- 2023
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29. Arthroscopically assisted single tunnel reconstruction for acute high-grade acromioclavicular joint dislocation with an additional acromioclavicular joint cerclage.
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Jensen G, Dey Hazra RO, Al-Ibadi M, Salmoukas K, Katthagen JC, Lill H, and Ellwein A
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- Humans, Treatment Outcome, Arthroscopy methods, Ligaments, Articular, Acromioclavicular Joint surgery, Shoulder Dislocation surgery, Joint Instability surgery, Joint Dislocations surgery
- Abstract
Purpose: Purpose of this study was to demonstrate that a single tunnel reconstruction of high-grade acromioclavicular (AC) joint instabilities with implants of the second generation is sufficient for stabilisation, especially in combination with an AC cerclage., Methods: Patients with an acute AC-joint dislocation type Rockwood III-B and V were included. Besides clinical follow-up examination, radiographs were analysed. The functional outcome measures were Constant Score (CS), Taft score (TS), ACJI score and patient's satisfaction. Horizontal instability was evaluated by clinical examination and radiological with an Alexander view., Results: Thirty-five patients with a mean follow-up of 29 months were included. Ninety-seven per cent were satisfied with their result, with an average Subjective Shoulder Value of 90%. The CS averaged at 90 ± 10 points, TS at 11 ± 1 points and ACJI at 78 ± 18 points. Radiologically, 3 of 29 patients (10%) showed a persisting horizontal instability. The coracoclavicular (CC) distance improved from 22 preoperative to 10 mm postoperative, which was comparable to the contralateral side (10 mm, p = 0.103). At follow-up the CC distance increased to 13 mm (p = 0.0001)., Conclusion: AC-joint stabilisation with a single tunnel reconstruction using a second-generation implant results in good to excellent clinical results with high patient satisfaction. The additional AC augmentation improves stability in horizontal instable AC-joints and is recommended in all high-grade AC joint stabilisations. Nonetheless, reduction was slightly lost over time due to an elongation or suture failure of the coraco-clavicular fixation., Level of Evidence: IV., (© 2022. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)
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- 2023
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30. Minimum 2-year results of the second-generation CFR-PEEK locking plate on the proximal humeral fracture.
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Dey Hazra RO, Szewczyk K, Ellwein A, Blach R, Jensen G, Kühnapfel A, Lill H, and Warnhoff M
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- Humans, Middle Aged, Retrospective Studies, Benzophenones, Bone Plates adverse effects, Fracture Fixation, Internal methods, Treatment Outcome, Polymers, Shoulder Fractures
- Abstract
Purpose: The aim of this study was to analyse and compare the 24-month range of motion results of patients treated with CFR-PEEK2 versus conventional titanium plate osteosyntheses (TAL-P). We hypothesized similar clinical outcomes but a better range of motion in the CFR-PEEK2 group than the TAL-P group in the 2-year follow-up., Methods: This retrospective study analysing prospectively collected data included all patients that presented with a PHF and were treated with CFR-PEEK2 between November 2016 and April 2018. Follow-up was performed after a minimum of 24 months, evaluating the functional degree of movement functional scores, including the Subjective Shoulder Value (SSV) as well as an age- and sex-adapted Constant-Murley score (CMS). The 2-year results were compared to the results of a matched pair group comprising patients that were treated with TAL-P during the same period., Results: Of the 35 patients included (mean age: 61.2 [18-78] years), 30 (86%) patients completed the 24-month follow-up in the CFR-PEEK2-group. After 24 months, the mean CMS was 89.9 points (pt) (44.5-100 pt) and the mean SSV was 86.7% (35-100%). Compared to the matched-pair TAL-P cohort, the 24-month follow-up showed similar results (CMS: 88.6 pt. (40.5-100 pt.) [p = 0.9]; SSV: 76% (30-100%) [p = 0.05]). However, significantly better degrees of forward flexion and internal rotation as well as a better range of motion in abduction was recorded in patients treated with CFR-PEEK2 plates than TAL-P., Conclusion: At the 24-month follow-up, patients who received treatment with CFR-PEEK2 compared to those that received TAL-P showed enhanced range of motion whilst having similar clinical scores., (© 2022. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)
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- 2023
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31. Assessment of Complication Risk in the Treatment of Proximal Humerus Fractures: A Retrospective Analysis of 4019 Patients.
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Henkelmann R, Hepp P, Mester B, Dudda M, Braun PJ, Kleen S, Zellner J, Galler M, Koenigshausen M, Schildhauer TA, Saier T, Trulson I, Dey Hazra RO, Lill H, Glaab R, Bolt B, Wagner M, Raschke MJ, and Katthagen JC
- Abstract
(1) Background: The treatment of proximal humeral fractures (PHFs) is debated controversially. Current clinical knowledge is mainly based on small single-center cohorts. The goal of this study was to evaluate the predictability of risk factors for complications after the treatment of a PHF in a large clinical cohort in a multicentric setting. (2) Methods: Clinical data of 4019 patients with PHFs were retrospectively collected from 9 participating hospitals. Risk factors for local complications of the affected shoulder were assessed using bi- and multivariate analyses. (3) Results: Fracture complexity with n = 3 or more fragments, cigarette smoking, age over 65 years, and female sex were identified as predictable individual risk factors for local complications after surgical therapy as well as the combination of female sex and smoking and the combination of age 65 years or older and ASA class 2 or higher. (4) Conclusion: Humeral head preserving reconstructive surgical therapy should critically be evaluated for patients with the risk factors abovementioned.
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- 2023
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32. Rapid and Highly Stable Membrane Reconstitution by LAiR Enables the Study of Physiological Integral Membrane Protein Functions.
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Godoy-Hernandez A, Asseri AH, Purugganan AJ, Jiko C, de Ram C, Lill H, Pabst M, Mitsuoka K, Gerle C, Bald D, and McMillan DGG
- Abstract
Functional reintegration into lipid environments represents a major challenge for in vitro investigation of integral membrane proteins (IMPs). Here, we report a new approach, termed LMNG Auto-insertion Reintegration (LAiR), for reintegration of IMPs into lipid bilayers within minutes. The resulting proteoliposomes displayed an unprecedented capability to maintain proton gradients and long-term stability. LAiR allowed for monitoring catalysis of a membrane-bound, physiologically relevant polyisoprenoid quinone substrate by Escherichia coli cytochromes bo
3 (c bo3 ) and bd (c bd ) under control of the proton motive force. LAiR also facilitated bulk-phase detection and physiological assessment of the "proton leak" in c bo3 , a controversial catalytic state that previously was only approachable at the single-molecule level. LAiR maintained the multisubunit integrity and higher-order oligomeric states of the delicate mammalian F-ATP synthase. Given that LAiR can be applied to both liposomes and planar membrane bilayers and is compatible with IMPs and lipids from prokaryotic and eukaryotic sources, we anticipate LAiR to be applied broadly across basic research, pharmaceutical applications, and biotechnology., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)- Published
- 2023
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33. Cytochrome bd-I from Escherichia coli is catalytically active in the absence of the CydH subunit.
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Goojani HG, Besharati S, Chauhan P, Asseri AH, Lill H, and Bald D
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- Cytochrome b Group genetics, Cytochrome b Group chemistry, Cytochromes genetics, Cytochromes chemistry, Electron Transport Chain Complex Proteins genetics, Electron Transport Chain Complex Proteins chemistry, Heme, Escherichia coli genetics, Escherichia coli metabolism, Escherichia coli Proteins chemistry, Escherichia coli Proteins genetics, Escherichia coli Proteins metabolism
- Abstract
Cytochrome bd-I from Escherichia coli is a terminal oxidase in the respiratory chain that plays an important role under stress conditions. Cytochrome bd-I was thought to consist of the major subunits CydA and CydB plus the small CydX subunit. Recent high-resolution structures of cytochrome bd-I demonstrated the presence of an additional subunit, CydH/CydY (called CydH here), the function of which is unclear. In this report, we show that in the absence of CydH, cytochrome bd-I is catalytically active, can sustain bacterial growth and displays haem spectra and susceptibility for haem-binding inhibitors comparable to the wild-type enzyme. Removal of CydH did not elicit catalase activity of cytochrome bd-I in our experimental system. Taken together, in the absence of the CydH subunit cytochrome bd-I retained key enzymatic properties., (© 2022 Federation of European Biochemical Societies.)
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- 2023
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34. Prospective clinical results of an additive ligament bracing for stabilizing simple and complex elbow instabilities.
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Ellwein A, Janning L, DeyHazra RO, Smith T, Lill H, and Jensen G
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- Humans, Elbow, Braces adverse effects, Range of Motion, Articular, Treatment Outcome, Elbow Joint surgery, Joint Instability surgery, Joint Instability etiology, Collateral Ligaments surgery, Ossification, Heterotopic
- Abstract
Introduction: Ligament bracing augments ligament repair using a non-absorbable suture tape. Although biomechanically an increase in primary stability has been proven, there is a lack of clinical evidence. Purpose of this study was to evaluate clinical results of patients treated with ligament bracing due to primary elbow instability, including an analysis of complications. Furthermore, clinical results for patients treated with and without early functional mobilization were compared., Materials and Methods: This prospective case-series evaluated clinical and functional results from patients treated with ligament bracing due to primary elbow instability. Clinical outcome measures were range of motion (ROM) as well as objective and subjective elbow scores [Mayo Elbow Performance Score (MEPS); Disabilities of Arm, Shoulder and Hand Score (DASH score)]. Stability was evaluated sonographically by humero-radial gapping under varus stress., Results: This study involved 34 patients treated with ligament bracing. After a mean follow-up of 12.9 months ROM was 112° ± 29, MEPS 88 ± 13 points, DASH 91 ± 11 points, and 84% were satisfied with their result. Lateral joint gapping was 2.4 mm. No significant difference was observed regarding a postoperative mobilization with and without limitations. Most common complication after ligament bracing was elbow stiffness including heterotopic ossifications in four patients (12%)., Conclusion: Operatively treated elbow instability with additional ligament bracing results in good clinical outcomes with high patient satisfaction and recovery of elbow stability. The high primary stability of the ligament bracing allows early functional mobilization without bracing, which facilitates postoperative rehabilitation. Elbow stiffness with heterotopic ossification seems to be a potential complication. Furthermore, the optimal tensioning of the ligament bracing remains challenging, including the risk of an over tensioning., Level of Evidence: III., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2022
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35. Biomechanical Comparison of Two Fixation Techniques for Lateral Ulnar Collateral Ligament Repair With Ligament Bracing.
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Ellwein A, Stryga M, Ferle M, Pastor MF, Lill H, and Smith T
- Subjects
- Biomechanical Phenomena, Braces, Cadaver, Humans, Collateral Ligament, Ulnar surgery, Collateral Ligaments surgery, Elbow Joint surgery
- Abstract
Purpose: Ligament bracing is a technique of suture reinforcement that can be used to augment lateral ulnar collateral ligament repair in the treatment of posterolateral rotatory instability of the elbow, thereby improving early stability of the repair. However, multiple failures of the ulnar anchor during implantation have been documented. We hypothesized that the use of a cortical button for ulnar fixation of the ligament brace would be biomechanically comparable to a suture anchor construct., Methods: Sixteen elbows were tested with a materials testing machine. The intact, dissected, and repaired lateral collateral ligament complex was tested with a cyclic varus rotational torque of 0.5-3.5 Nm in 120°, 90°, 60°, and 30° elbow flexion. For the repair, the specimens were randomized into 2 groups: ulnar fixation of the ligament bracing using a suture anchor and ulnar fixation of the ligament bracing using a cortical button. The number of implant failures was documented. A load-to-failure protocol was conducted in 90° elbow flexion., Results: Load to failure was comparable and was found to be 20.7 Nm in the suture anchor group and 21.8 Nm in the cortical button group. Laxity after ligament bracing did not differ significantly between suture anchor and cortical button fixation. Compared with the native ligament, the laxity was significantly reduced after ligament bracing. The failure mode was slippage of the suture tape through the humeral anchor in all cases. Additionally, the capitellum was damaged in 9 of 16 cases., Conclusions: A cortical button for ulnar fixation of the ligament bracing was comparable with a suture anchor fixation with regard to biomechanical properties such as laxity and load to failure., Clinical Relevance: A cortical button fixation is less prone to failure of insertion. This would improve the implantation technique, while clinical results are expected to be comparable., (Copyright © 2022 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)
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- 2022
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36. Anterior Locking Plate Osteosynthesis of Patellar Factures - Analysis of Complications and Functional Outcome.
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Tengler MB, Lill H, Wente M, and Ellwein A
- Subjects
- Bone Plates adverse effects, Bone Wires, Fracture Fixation, Internal adverse effects, Fracture Fixation, Internal methods, Humans, Patella surgery, Postoperative Complications etiology, Postoperative Complications surgery, Retrospective Studies, Treatment Outcome, Fractures, Bone surgery, Fractures, Comminuted surgery, Joint Dislocations, Knee Injuries
- Abstract
Background: Tension band wiring is the standard procedure for patellar fractures, but is associated with a high rate of implant related complications and implant failure. Tension band wiring may fail, especially with multifragmentary and comminuted fractures. Plate fixation of complex patellar fractures seems to be superior to wiring, both clinically and biomechanically. The aim of this study was to evaluate complications after locking plate fixation in patellar fractures two years after surgery and to access the functional outcome., Material and Methods: As part of a prospective case series, all patients who had received locking plate fixation of a patellar fracture between April 2013 and May 2018 were clinically examined two years postoperatively and potential complications were evaluated., Results: A total of 38 patients aged 19 - 87 years were included. Complications occurred in a total of five patients (13%), including one reactive prepatellar bursitis, one chronic infection and loss of reduction due to a dislocated pole fragment in three cases. The average active range of motion of the affected knee joint two years postoperatively was 133°. The Tegner activity scale score reached 3 points, the Lysholm score 95 points and the Kujala score 95 points., Conclusion: With an overall relatively low complication rate and good clinical outcome, dislocated distal pole fragments are a common complication after plate fixation of patellar fractures. If preoperative diagnostic testing shows a pole fragment, a modified hook-plate can be used, with the possibility of fixing the pole fragment., Competing Interests: The authors declare that they have no conflict of interest./Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)
- Published
- 2022
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37. Response of Mycobacterium smegmatis to the Cytochrome bcc Inhibitor Q203.
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Chauhan P, van der Meulen SA, Simões Caetano JM, Goojani HG, Botman D, van Spanning R, Lill H, and Bald D
- Subjects
- Cytochromes metabolism, Humans, Imidazoles, Mycobacterium smegmatis, Oxidoreductases metabolism, Piperidines, Pyridines, Mycobacterium tuberculosis metabolism, Tuberculosis drug therapy
- Abstract
For the design of next-generation tuberculosis chemotherapy, insight into bacterial defence against drugs is required. Currently, targeting respiration has attracted strong attention for combatting drug-resistant mycobacteria. Q203 (telacebec), an inhibitor of the cytochrome bcc complex in the mycobacterial respiratory chain, is currently evaluated in phase-2 clinical trials. Q203 has bacteriostatic activity against M. tuberculosis, which can be converted to bactericidal activity by concurrently inhibiting an alternative branch of the mycobacterial respiratory chain, cytochrome bd . In contrast, non-tuberculous mycobacteria, such as Mycobacterium smegmatis, show only very little sensitivity to Q203. In this report, we investigated factors that M. smegmatis employs to adapt to Q203 in the presence or absence of a functional cytochrome bd , especially regarding its terminal oxidases. In the presence of a functional cytochrome bd , M. smegmatis responds to Q203 by increasing the expression of cytochrome bcc as well as of cytochrome bd , whereas a M. smegmatis bd -KO strain adapted to Q203 by increasing the expression of cytochrome bcc . Interestingly, single-cell studies revealed cell-to-cell variability in drug adaptation. We also investigated the role of a putative second cytochrome bd isoform postulated for M. smegmatis . Although this putative isoform showed differential expression in response to Q203 in the M. smegmatis bd -KO strain, it did not display functional features similar to the characterised cytochrome bd variant.
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- 2022
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38. [Current trends in reverse fracture arthroplasty].
- Author
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Warnhoff M, Jensen G, Lill H, and Ellwein A
- Subjects
- Aged, Fracture Fixation, Internal methods, Humans, Treatment Outcome, Hemiarthroplasty, Shoulder Fractures surgery, Shoulder Joint surgery
- Abstract
The reliable results of reverse arthroplasty have made this the preferred treatment method for non-reconstructable proximal humeral fractures. The individual consideration of the patient and the morphological features of the fractures are essential. Computed tomography (CT) images provide crucial information on the perfusion of the humeral head relevant for the prognosis and treatment. In this context a differentiation must be made between hard and soft criteria against a reconstruction. Tuberosities should be reduced whenever possible, because reverse arthroplasty with healed tuberosities provides a better range of motion and more strength for external rotation and anteversion, less complications and longer survival rates. In recent years the trend has been towards anatomical designs of prostheses with a humeral inclination of 135°. Revision rates for primary fracture prostheses are overall low with instability as the main reason for revision surgery, followed by periprosthetic fractures and infections. Reverse fracture arthroplasty has comparable or better clinical results compared to conservative treatment, osteosynthesis for geriatric patients, hemiarthroplasty and prosthesis implantation by elective surgery. Reverse arthroplasties, which were implanted in conditions of fracture sequelae, did not achieve significantly poorer clinical outcome at mid-term follow-up and can significantly improve shoulder function., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)
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- 2022
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39. [Endoprosthetics for fractures of the upper extremities].
- Author
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Lill H
- Subjects
- Humans, Upper Extremity surgery, Fractures, Bone surgery
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- 2022
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40. Latest Trends in the Current Treatment of Proximal Humeral Fractures - an Analysis of 1162 Cases at a Level-1 Trauma Centre with a Special Focus on Shoulder Surgery.
- Author
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Dey Hazra RO, Blach RM, Ellwein A, Katthagen JC, Lill H, and Jensen G
- Subjects
- Aged, Aged, 80 and over, Bone Plates adverse effects, Female, Fracture Fixation, Internal methods, Humans, Male, Middle Aged, Retrospective Studies, Shoulder, Trauma Centers, Treatment Outcome, Osteoporosis, Shoulder Fractures diagnostic imaging, Shoulder Fractures epidemiology, Shoulder Fractures surgery
- Abstract
Background: The management of proximal humeral fracture (PHF) is not only complex but ever changing. Published epidemiological data are often dated and do not factor in demographic changes or the latest developments in implant material and surgical techniques., Aims: The primary aim of this study was to evaluate changes in the epidemiology and actual treatment of PHF at a level-1 trauma centre, with a special focus on shoulder surgery., Hypotheses: 1. Between 2009 to 2012 and 2014 to 2017, an increase in complex PHF entities can be observed. 2. In correlation with fracture complexity, an increasing number of comorbidities, especially osteoporosis, can be observed., Methods: Between 2014 and 2017, a total of 589 patients (73% female; mean age: 68.96 ± 14.9 years) with 593 PHFs were treated. Patient records and imaging (XRs and CTs) of all patients were analysed. Fractures with ad latus displacement of a maximum of 0,5 cm and/or humeral head angulation of less than 20° were classified as non-displaced. Patients with displaced fractures were included in the analysis of the therapeutic algorithm. These results were compared to those of a cohort 2009 to 2012 (566 patients, 569 PHFs), which used the same inclusion criteria., Results: The two cohorts showed comparable patient numbers, as well as gender and age distributions. Between 2009 to 2012 and 2014 to 2017, a decrease in 2-part fractures (13.9 to 8.6%) and a simultaneous increase in 4-part fractures (20.4 to 30%), and thus fracture complexity was observed. Further decreases were observed in conservative therapy (27.8 to 20.6%), nail osteosynthesis (10.7 to 2.7%) and anatomic shoulder arthroplasty (5,4 to 1%). Furthermore, there was an increase in the use of locking plate osteosynthesis (43.2 to 56.7%) and reverse shoulder arthroplasty (9 to 18.4%). The general trend shows an increase in surgical therapy between the years (72.2 to 79.4%), as well as an increase in osteoporosis incidence (13 to 20.6%). The greatest numbers of comorbidities were found in 3- and 4-part fractures., Conclusion: There is an increase in both the complexity of fractures and the number of surgically treated fractures between 2009 and 2012. Furthermore, an increase in osteoporosis numbers can be observed. New implants (PEEK, fenestrated screws for cement augmentation) and new surgical techniques (double plating osteosynthesis) were used as a result of increasing fracture complexity. Moreover, reverse total shoulder arthroplasty was used more commonly., Competing Interests: Conflict of interest. H. Lill is consultant with Arthrex (Naples, USA) and DePuy Synthes (Umkirch, Deutschland). R-O Dey Hazra, RM. Blach, A. Ellwein, JC. Katthagen and G. Jensen state that there are no conflicts of interest./Helmut Lill ist als Berater sowie Referent für die Firma Arthrex sowie als Referent für die Firma DePuy Synthes tätig. Rony-Orijit Dey Hazra, Robert Maximilian Blach, Alexander Ellwein, Jan Christoph Katthagen und Gunnar Jensen geben an, dass im Zusammenhang zu diesem Artikel, kein Interessenskonflikt vorliegt., (Thieme. All rights reserved.)
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- 2022
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41. Additional coracoclavicular augmentation reduces revision rates in the treatment of lateral clavicle fractures as compared to angle-stable plate osteosynthesis alone.
- Author
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Dey Hazra RO, Blach RM, Ellwein A, Lill H, Warnhoff M, and Jensen G
- Subjects
- Adult, Bone Plates, Female, Fracture Fixation, Internal methods, Humans, Ligaments, Articular surgery, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Clavicle surgery, Fractures, Bone surgery
- Abstract
Introduction: There is no uniform approach to the management of lateral clavicle fractures. Recent studies have investigated additive coracoclavicular (CC) augmentation as a treatment option; however, it is unclear whether it is superior to conventional locking plate osteosynthesis., Methods: We carried out a retrospective analysis of 40 patients with lateral clavicle fracture (Neer type IIb) who were treated between 2014 and 2017 with either a hybrid locking plate osteosynthesis/additive arthroscopy-assisted CC augmentation (HP) procedure or a locking plate osteosynthesis only (PO) approach to determine which strategy was more effective. At follow-up, subjective shoulder value, age- and sex-adjusted Constant-Murley score, Taft (TF) score, American Shoulder and Elbow score, Nottingham clavicle score, and Visual Analogue Scale score were compared between patient groups. A radiologic evaluation was also conducted., Results: A total of 14/17 patients (83%; 9 male/5 female, mean age: 43 ± 15 years) were followed up in the PO group. The mean follow-up time was 29 ± 12.4 months. In the HP group, 17/23 patients (74%; 9 male/8 female, mean age: 43 ± 17 years) were followed up, with a mean follow-up time of 18 ± 7.1 months. There were no significant differences in clinical parameters between the HP and PO groups; notably, the shoulder girdle-specific TF score was comparable in the 2 groups (HP: 11.3 ± 1.1 points and PO: 10.9 ± 0.9 points). In the HP group, additional pathologies were identified and arthroscopically treated in 35% of cases. Radiologic examination revealed a significant difference between pre- and postoperative CC distance in the HP group (P = 0.001)., Conclusion: Additive CC augmentation in combination with locking plate osteosynthesis seems to improve the vertical stability and reduces the revision rate in patients with a lateral clavicle fracture. Furthermore, an arthroscopy-assisted procedure allows for an intraoperative detection and single-step treatment of accompanying intraarticular pathologies., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2022
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42. Are Patient-Reported Outcome Scores a Reasonable Substitute for Clinical Follow-up After Surgically Managed Acromioclavicular Joint Injuries?
- Author
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Dey Hazra RO, Blach RM, Ziert Y, Ellwein A, Warnhoff M, Hanhoff M, Lill H, and Jensen G
- Abstract
Background: Various clinical outcome scores have been described to evaluate postoperative shoulder function after operatively treated acromioclavicular joint (ACJ) instability. Clinical outcome scores can be divided between patient-reported outcome measures (PROMs) and examiner-dependent outcome measures (EDOMs) after a clinical examination by a physician. The correlation between PROMs and EDOMs, and thus their interchangeability with regard to operatively treated ACJ instability, has not yet been evaluated., Purpose: To investigate whether PROMs are a reasonable substitute for EDOMs. Correlations between global shoulder (GS) and ACJ-specific outcome measures were also investigated., Study Design: Cohort study (diagnosis); Level of evidence, 3., Methods: Included in this study were 131 consecutive patients with operatively treated ACJ instability between 2011 and 2017. Postoperative shoulder function was measured using PROMs, including the Subjective Shoulder Value (SSV), Subjective Shoulder Test, and Nottingham Clavicle Score (NCS), and EDOMs, including the Constant-Murley score (CMS), Taft score, ACJ instability (ACJI) score, and SICK Scapula Score (SSS). Associations between PROM and EDOM scores were calculated using the Pearson and Spearman correlation coefficients for linear and nonlinear variables, respectively, and were interpreted using the Cohen classification. The scores were further stratified into GS versus ACJ-specific measures., Results: A strong correlation was observed between several PROMs and EDOMs (CMS vs SSV [ r = 0.59; P = .02] and CMS vs NCS [ r = 0.79; P ≤ .001]) and between several GS and ACJ-specific scores (CMS vs NCS; CMS vs ACJI [ rs = 0.69; P < .001]; and CMS vs SSS [ r = -0.68; P < .001])., Conclusion: Based on the results of this study, PROMs such as the SSV (a GS measure) and the NCS (an ACJ-specific measure) can substitute for EDOMs., Clinical Relevance: PROMs that can be substituted for EDOMs can enable the conduct of clinical studies in circumstances in which in-person clinical follow-up of the patient by a physician is not possible., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: H.L. has received consulting fees from Arthrex and DePuy Synthes. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2022.)
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- 2022
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43. [Arthroscopic-assisted management of intra-articular scapular fractures in a rugby player].
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Szewczyk K, Mann J, Ellwein A, Jensen G, Warnhoff M, Hahner F, Lill H, and Dey Hazra RO
- Subjects
- Adult, Arthroscopy methods, Fracture Fixation, Internal methods, Humans, Male, Range of Motion, Articular, Retrospective Studies, Rugby, Scapula diagnostic imaging, Scapula injuries, Scapula surgery, Treatment Outcome, Fractures, Bone diagnostic imaging, Fractures, Bone surgery, Shoulder Fractures surgery
- Abstract
Scapular fractures are a rare injury entity accounting for 0,4-1 % of all fractures and 3-5 % of fractures involving the shoulder girdle. This study focuses on a 29-year-old male patient who sustained an intraarticular scapular fracture during a "Rugby Bundesliga" match after direct impact with another player. The clinical and radiological examinations showed a dislocated multifragmentary transverse scapular fracture involving the superior border, the medial border and the glenoid (Euler and Rüedi D2b/AO 14 F1.3e). The patient was subjected to arthroscopic surgery and underwent early postoperative functional rehabilitation without weight-bearing and with a limited range of motion of 90° abduction/anteversion. In the first match of the second half of the season (5 months post-operatively), the patient was available to play, and in the clinical follow-up 6 months post-operatively, he was pain-free with excellent clinical results (CS 100 pt, SSV 98 %, OSS 12 pt, ASES 100 pt). No pain or restrictions in the range of motion were reported. In conclusion, the arthroscopic-assisted management of intra-articular scapular fractures is a safe and effective choice of treatment in young and active patients., Competing Interests: H. Lill is consultant with Arthrex (Naples, USA) and DePuy Synthes (Umkirch, Deutschland). R. O. Dey Hazra, K. Szewczyk, A. Ellwein, J. Mann, M. Warnhoff, F. Hahner and G. Jensen state that there are no conflicts of interest., (Thieme. All rights reserved.)
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- 2022
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44. [Correction: Innovative surgical concept for septic sternoclavicular arthritis: case presentation of a simultaneous joint resection and stabilization with gracilis tendon graft including literature review].
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Hanhoff M, Jensen G, Dey Hazra RO, and Lill H
- Abstract
Competing Interests: Helmut Lill ist als Berater und Referent für die Firma Arthrex sowie als Referent für die Firma DePuy Synthes tätig. Marek Hanhoff, Gunnar Jensen und Rony-Orijit Dey Hazra geben an, dass kein Interessenskonflikt vorliegt.
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- 2022
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45. Innovative Surgical Concept for Septic Sternoclavicular Arthritis: Case Presentation of a Simultaneous Joint Resection and Stabilization with Gracilis Tendon Graft Including Literature Review.
- Author
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Hanhoff M, Jensen G, Dey Hazra RO, and Lill H
- Subjects
- Escherichia coli isolation & purification, Humans, Male, Middle Aged, Tendons transplantation, Treatment Outcome, Arthritis, Infectious diagnosis, Arthritis, Infectious surgery, Sternoclavicular Joint microbiology, Sternoclavicular Joint surgery
- Abstract
Introduction: Septic arthritis of the sternoclavicular joint (SCJ) is a rarity in everyday surgical practice with 0.5 - 1% of all joint infections. Although there are several risk factors for the occurrence of this disease, also healthy people can sometimes be affected. The clinical appearance is very variable and ranges from unspecific symptoms such as local indolent swelling, redness or restricted movement of the affected shoulder girdle to serious consequences (mediastinitis, sepsis, jugular vein thrombosis). Together with the low incidence and the unfamiliarity of the disease among practicing doctors in other specialties, this often results in a delay in the diagnosis, which in addition to a significant reduction in the quality of life can also have devastating consequences for the patient., Patient and Method: According to a stage-dependent procedure, the therapy strategies range from antibiotic administration only to radical resection of the SC joint and other affected structures of the chest wall in severe cases with the following necessity for flap reconstruction. The aspect of possible post-interventional instability after resection of the SCJ receives little or no attention in the current literature. In the present case report of a 51-year-old, otherwise healthy gentleman with isolated monoarthritis of the right SCJ with Escherichia coli (E. coli) shortly after two prostatitis episodes, the possibility of a new surgical approach with a one-stage eradication and simultaneous stabilization of the SCJ is presented. Therefore, a joint resection including extensive debridement is performed while leaving the posterior joint capsule and inserting an antibiotic carrier. In the same procedure, the SCJ is then stabilized with an autologous gracilis tendon graft by using the "figure of eight" technique, which has become well established particularly for anterior instabilities of the SCJ in recent years., Results and Conclusion: One year after operative therapy, the patient presented symptom-free with an excellent clinical result (SSV 90%, CS89 points, CSM 94 points, TF 11 points, DASH 2.5 points). It is concluded that in selected cases with an infection restricted to the SCJ without major abscessing in the surrounding soft tissues, the demonstrated procedure leads to good and excellent clinical results with stability of the joint. If the focus of infection and germ are known, stabilization using an autologous graft can be carried out under antibiotic shielding. To the best of the authors' knowledge, this surgical procedure has not yet been described in the current literature. Depending on the extent of the resection, an accompanying stabilization of the SCJ should be considered to achieve stable conditions and an optimal clinical outcome., Competing Interests: Helmut Lill works as an advisor and lecturer for Arthrex as well as lecturer for DePuy Synthes. Marek Hanhoff, Gunnar Jensen und Rony-Orijit Dey Hazra confirm that there are no conflicts of interest to declare./Helmut Lill ist als Berater und Referent für die Firma Arthrex sowie als Referent für die Firma DePuy Synthes tätig. Marek Hanhoff, Gunnar Jensen und Rony-Orijit Dey Hazra geben an, dass kein Interessenkonflikt vorliegt., (Thieme. All rights reserved.)
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- 2022
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46. Age-Independent Clinical Outcome in Proximal Humeral Fractures: 2-Year Results Using the Example of a Precontoured Locking Plate.
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Dey Hazra RO, Illner J, Szewczyk K, Warnhoff M, Ellwein A, Blach RM, Lill H, and Jensen G
- Abstract
Introduction: The optimal treatment strategy for the proximal humeral fracture (PHF) remains controversial. The debate is centered around the correct treatment strategy in the elderly patient population. The present study investigated whether age predicts the functional outcome of locking plate osteosynthesis for this fracture entity., Methods: A consecutive series of patients with surgically treated displaced PHF between 01/2017 and 01/2018 was retrospectively analyzed. Patients were treated by locking plate osteosynthesis. The cohort was divided into two groups: Group 1 (≥65 years) and Group 2 (<65 years). At the follow-up examination, the SSV, CMS, ASES, and Oxford Shoulder Score (OS), as well as a radiological follow-up, was obtained. The quality of fracture reduction is evaluated according to Schnetzke et al. Results: Of the 95 patients, 79 were followed up (83.1%). Group 1 consists of 42 patients (age range: 65-89 years, FU: 25 months) and Group 2 of 37 patients (28-64 years, FU: 24 months). The clinical results showed no significant differences between both groups: SSV 73.4 ± 23.4% (Group 1) vs. 80.5 ± 189% (Group 2). CMS: 79.4 ± 21 vs. 81.9 ± 16, ASES: 77.2 ± 20.4 vs. 77.5 ± 23.1, OS: 39.5 ± 9.1 vs. 40.8 ± 8.2; OS: 39.5 ± 9.1 vs. 40.8 ± 8.2. In the radiological follow-up, fractures healed in all cases. Furthermore, the quality of fracture reduction in both groups is comparable without significant differences. The revision rate was 9.5% in Group 1 vs. 16.2% in Group 2., Discussion: Both age groups show comparable functional outcomes and complication rates. Thus, the locking plate osteosynthesis can be used irrespective of patient age; the treatment decision should instead be based on fracture morphology and individual patient factors.
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- 2022
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47. Promising Mid-Term Outcomes after Humeral Head Preserving Surgery of Posterior Fracture Dislocations of the Proximal Humerus.
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Heilmann LF, Katthagen JC, Raschke MJ, Schliemann B, Lill H, El Bajjati H, Jensen G, and Dey Hazra RO
- Abstract
Background: The aim of this study was to evaluate the clinical outcome after humeral head preserving surgical treatment of posterior fracture dislocations of the proximal humerus., Methods: Patients with a posterior fracture dislocation of the proximal humerus that were operatively treated in two level-1 trauma centers within a timeframe of 8 years were identified. With a minimum follow-up of 2 years, patients with humeral head preserving surgical treatment were invited for examination., Results: 19/24 fractures (79.2%; mean age 43 years) were examined with a mean follow-up of 4.1 ± 2.1 years. Of these, 12 fractures were categorized as posteriorly dislocated impression type fractures, and 7 fractures as posteriorly dislocated surgical neck fractures. Most impression type fractures were treated by open reduction, allo- or autograft impaction and screw fixation ( n = 11), while most surgical neck fractures were treated with locked plating ( n = 6). Patients with impression type fractures showed significantly better ASES scores ( p = 0.041), Simple Shoulder Test scores ( p = 0.003), Rowe scores ( p = 0.013) and WOSI scores ( p = 0.023), when compared to posteriorly dislocated surgical neck fractures. Range of motion was good to excellent for both groups with no significant difference., Conclusions: This mid-term follow-up study reports good to very good clinical results for humeral head preserving treatment.
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- 2021
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48. Double plating - surgical technique and good clinical results in complex and highly unstable proximal humeral fractures.
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Warnhoff M, Jensen G, Dey Hazra RO, Theruvath P, Lill H, and Ellwein A
- Subjects
- Bone Plates, Fracture Fixation, Internal, Humans, Male, Middle Aged, Radiography, Retrospective Studies, Treatment Outcome, Shoulder Fractures diagnostic imaging, Shoulder Fractures surgery
- Abstract
Introduction: A stable fixation of highly unstable proximal humerus fractures remains challenging and complication rates, especially secondary varus dislocation, remains high. Different techniques of double plate osteosynthesis have been suggested for the treatment of complex proximal humeral fractures as they are well established for other fractures. The aim of this study was to evaluate an operative technique using an angular stable lateral plate supported by a one-third tubular plate positioned anteriorly at the lesser tuberosity for unstable proximal humeral fractures., Patients and Methods: Retrospectively, patients treated with a double plate osteosynthesis were included between January 2014 and December 2017. Out of 31, 25 patients (80.6%) with an average age of 53.1 years ± 12.5 were available for follow-up. 60% of the patients were male. The clinical evaluation consisted of a physical examination and standardised questionnaire including subjective and objective shoulder scores like the Constant-Murley Shoulder Score, Simple Shoulder Score, and Subjective Shoulder Value., Results: After a mean follow-up of 30.9 months (range, 12-76 months) eighteen patients (72%) had either excellent or good results regarding the Constant-Murley Shoulder Score with a mean value of 77 points ± 17. Average Simple Shoulder Score was 76% ± 0.2 and Subjective Shoulder Value 72% ± 0.2%. Mean NSA at time of follow-up 135° ± 13°. Nine patients had an implant-removal, five in combination with arthrolysis after a mean of 7.2 months. Three patients underwent surgery for secondary arthroplasty. The study shows a complication rate of 16%. No revision-surgery because of secondary varus dislocation was reported., Discussion: Arthroplasty is the less favourable treatment for a younger, active cohort of patients with highly unstable proximal humeral fractures as results are not as good and options for revision are limited. Double plate osteosynthesis can be used in addition to calcar screws, bone graft augmentation, cement augmentation and additional free screws for more multidirectional stability and shows good clinical results despite a higher rate of avascular necrosis and high primary stability with comparable complication-rates to single plate osteosynthesis. It seems to be a valid alternative to primary fracture arthroplasty and can prevent secondary varus displacement., Competing Interests: H. Lill is consultant for DePuySynthes (Umkirch, Deutschland). All other authors declared that they have no conflicts of interest in the authorship and publication of this contribution., (Copyright © 2021. Published by Elsevier Ltd.)
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- 2021
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49. [Avulsion of the hamstring muscles].
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Partenheimer A and Lill H
- Subjects
- Humans, Magnetic Resonance Imaging, Rupture, Thigh diagnostic imaging, Thigh surgery, Hamstring Muscles diagnostic imaging, Hamstring Muscles surgery, Tendon Injuries diagnostic imaging, Tendon Injuries surgery
- Abstract
Background: Avulsion injuries of the proximal hamstring muscles are rare but very severe injuries to the dorsal thigh musculature., Objective: Due to improved diagnostics and experience in treatment, the decision for surgical treatment is becoming more and more frequent. Presentation of the surgical method, follow-up treatment and outcome., Material and Methods: Description of the anatomy, origin, diagnostics and treatment of avulsions of the hamstring musculature., Results: Due to improvement of knowledge and diagnostics, avulsion injuries of the hamstring muscles are identified more frequently. The rapid expansion of the diagnostics, including magnetic resonance imaging (MRI) is decisive for a better identification of the extent and severity of the injury. Even if the differences in long-term results between surgical and conservative treatment are not significant in the literature, there is a clear improvement in function and resilience after surgical treatment of avulsion injuries of the hamstring muscles., Conclusion: In view of the poor results of nonsurgical treatment and the clearly positive reports of surgical success, open refixation is recommended for recent proximal hamstring ruptures.
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- 2021
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50. Cardiolipin enhances the enzymatic activity of cytochrome bd and cytochrome bo 3 solubilized in dodecyl-maltoside.
- Author
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Asseri AH, Godoy-Hernandez A, Goojani HG, Lill H, Sakamoto J, McMillan DGG, and Bald D
- Subjects
- Electron Transport Chain Complex Proteins metabolism, Corynebacterium glutamicum enzymology, Corynebacterium glutamicum metabolism, Geobacillus enzymology, Cytochromes metabolism, Solubility, Oxidoreductases metabolism, Oxygen Consumption, Detergents chemistry, Detergents pharmacology, Cardiolipins metabolism, Glucosides metabolism, Escherichia coli metabolism, Cytochrome b Group metabolism, Escherichia coli Proteins metabolism
- Abstract
Cardiolipin (CL) is a lipid that is found in the membranes of bacteria and the inner membranes of mitochondria. CL can increase the activity of integral membrane proteins, in particular components of respiratory pathways. We here report that CL activated detergent-solubilized cytochrome bd, a terminal oxidase from Escherichia coli. CL enhanced the oxygen consumption activity ~ twofold and decreased the apparent K
M value for ubiquinol-1 as substrate from 95 µM to 35 µM. Activation by CL was also observed for cytochrome bd from two Gram-positive species, Geobacillus thermodenitrificans and Corynebacterium glutamicum, and for cytochrome bo3 from E. coli. Taken together, CL can enhance the activity of detergent-solubilized cytochrome bd and cytochrome bo3 .- Published
- 2021
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