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Biomedical subjects

A Ekkernkamp

Publications and source records attributed to A Ekkernkamp.

At least 19 recordsLinked to original sources
PubMed2006

Does the frontal airbag avoid thoracic injury?

INTRODUCTION: The airbag is an established car safety device. However, recent studies pointed out that even the airbag might cause injuries. Nevertheless, most physicians do consider a lower risk in accident victims sustaining severe injury of the chest, when a deployed frontal airbag has been reported. We set out to verify the frequency and pattern of thoracic injury in car drivers protected by a frontal airbag during traffic accidents. METHODS: This investigation was conducted as part of a prospective surveillance analyzing traffic accidents. Enrolled were car drivers included in a databank between January 2001 and December 2004 consecutively. The chance for sustaining chest injury with or without a frontal airbag was described using the relative risk. RESULTS: A total of 188 car drivers were included in the analysis. In 54 (28.7%) cases a deployed airbag and in 134 (71.3%) the absence of an airbag has been documented. Out of those cases 16 (29.6%) drivers with airbag and 30 (22.4%) without airbag sustained a chest injury. The mean abbreviated injury scale (AIS) of chest injuries in drivers with deployed airbag was 2.3 (1-5; SD +/- 1.45; mean injury severity scale [ISS] 21.1 [SD +/- 17.18]), in drivers without airbag 1.6 (1-4; SD +/- 1.12; mean ISS 15.8 [SD +/- 20.6]). For belted drivers with an airbag the relative risk to sustain chest injury was 1.96 compared to those without an airbag. CONCLUSIONS: The airbag does not avoid chest injury definitively. Much more, it has been demonstrated that the relative risk to sustain relevant thoracic injury seems to be almost higher in restrained drivers with a frontal airbag.

Accidents, Traffic↗
PubMed2006

[Influence of operation time point on the frequency of early complications after surgical femoral neck fracture treatment].

AIM: The current publication deals with surgically treated medial and lateral femoral neck fracture of patients aged 60 and older. MATERIAL/METHODS: All patients were evaluated who received operative treatment between day of trauma and day 14 after trauma. Therefore, 30,254 patients (77,44%) were included. All early complications observed during hospital treatment were recorded as general and special complications, and we calculated whether the day of operation influenced the occurrence of early complications. Statistically significant differences were gained for revision operations. RESULTS: If the primary operation was performed on days 2 to 3 or 4 to 5 after trauma, fewer revisions necessary. Similar results were gained for revisions due to seroma and haematoma or postoperative bleeding. In these cases, fewer revision operations were performed when primary treatment was achieved on day 2 or 3. CONCLUSIONS: From the data presented, it is postulated that early complications provide no decisive reason for treating femoral neck fracture as an emergency. However, considering late complications such as the rate of femoral head necrosis, treatment for retaining the femoral head should be performed as early as possible. German guidelines suggest early but not emergency treatment in case of operations not saving the femoral head. Emergency operation within 6 h is not mandatory.

Aged↗
PubMed2006

[Fracture of the proximal humerus in children and adolescents. The most overtreated fracture].

BACKGROUND: There is great uncertainty among trauma surgeons regarding the correct treatment of rare proximal humerus fractures in children and adolescents, in spite of the great potential of the proximal humeral epiphysis for self-correction, even in cases of gross malalignment. METHODS: Over a span of 6 years, we treated 52 children and adolescents with closed proximal humerus fractures, 45 of whom had no other injuries. In only three cases did we see an indication for operative treatment at our institution. Operations on another three were performed elsewhere. Forty two patients were available for follow-up exams. RESULTS: They all had good or very good results with regard to fracture healing (constant score) independently of age, sex, fracture morphology, and treatment. CONCLUSIONS: We believe it is particularly important to discuss therapy concepts with parents and the involved outpatient physicians in order to avoid unnecessary and stressful operations.

Adolescent↗
PubMed2006

[The clinical use of the ISO-C(3D) imaging system in calcaneus fracture surgery].

We compared in a prospective study including 82 patients treated with ORIF of an intraarticular calcaneus fracture the quality of fluoroscopy, intraoperatively Iso-C(3D) and postoperative CT-scans. Therefore the posterior facet of the calcaneus (PFOC) was divided into three sectors. Joint steps and fracture gaps were detected by two independent investigators and statistically analysed. Another focus was to evaluate if the findings due to intraoperatively Iso-C(3D) assessment performed by the surgeon were correct and subsequently influenced the surgical procedure. There were no statistically differences between the Iso-C(3D)- and CT findings concerning joint steps or fracture gaps in PFOC sectors I-III. With fluoroscopy an assessment of the PFOC sectors I and II was not possible. In six cases (7.3%), intraoperative reduction was redone after performing an Iso-C(3D) scan. In ten cases, 12 malpositioned screws were replaced (12.2%/14.6%). These results suggest that intraoperative 3D Iso-C(3D) imaging provides a high diagnostic reliability. By careful assessment of the images the surgeons receive information which could lead to a change of the operative strategy.

Algorithms↗
PubMed2006

[Surgical management of abdominal injury].

PURPOSE: Accompanying abdominal injuries are frequent in multiply injured patients and are a common cause of death. A search of the literature was performed focusing on key aspects of initial surgical procedures in abdominal injury. METHODS: Literature was searched utilizing PubMed Medline, the Cochrane Central Register of Controlled Clinical Trials, and the German Institute for Medical Documentation and Information (DIMDI) database. The articles were classified according to the level of evidence following the suggestions of the Centre for Evidence Based Medicine. RESULTS: Vertical laparotomy should be favored for the initial surgical therapy of abdominal injury. Especially in instable patients, principles of "damage control surgery" should be applied. In case of hollow organ injury, a primary anastomosis should be made whenever possible. A hand suture is most suitable for this. DISCUSSION: Non-surgical treatment of blunt abdominal injury is gaining in importance. However, if a surgical intervention is recommended, especially in hemodynamic, instable patients, damage control principles should be favored.

Abdominal Injuries↗
PubMed2006

[Results after treatment of instable fractures of the proximal humerus using a fixed-angle plate].

BACKGROUND: Fixed-angle implants are being increasingly used in surgery of fractures of the proximal humerus. The aim of this retrospective investigation was to evaluate the outcome after fracture reduction utilizing a fixed-angle plate (Königsee). MATERIALS AND METHODS: Between January 2003 and April 2004, 58 patients were operated, 52 of whom received a fixed-angle implant; 46 cases were harvested for a follow-up examination. Each patient was re examined clinically and radiologically at least 6 and 18 months after surgery. The functional outcome was evaluated using the Constant Score and the Simple Shoulder Test. The results were compared to results of other investigations. RESULTS: The mean patient age was 68.8 years (34-94 years). Fractures were classified using the Neer Classification: 12 were classified as two-part, 25 as three-part, and 9 as four-part fractures. Three of the three-part and four of the four-part fractures were rated as luxation fractures. The overall functional outcome of all cases was good. More than 18 months after surgery the mean general "Constant Score" was 57; the mean side-related "Constant Score" was 89%. The Simple Shoulder Test revealed a pain-free range of motion in 41 (89.1%) of the individuals. The majority of the patients were satisfied with the results regarding remaining range of activity of the injured limb. In five cases significant complications occurred. In two cases the head of the humerus collapsed, and in one case a necrosis of the head occurred. In one individual the implant broke after an additional trauma. In this case a re-osteosynthesis utilizing a tibia plate was performed and the patient was excluded from further follow-up investigations. One soft tissue infection occurred after initial surgery. CONCLUSION: It has been shown that results after fixation of proximal humerus fractures with fixed-angle implants are good. The functional outcome is good and complications are rare. Our results correlate with other investigations regarding fracture reduction using fixed-angle plates and nails.

Adult↗
PubMed2005

Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma.

BACKGROUND: Ultrasonography is regarded as the tool of choice for early diagnostic investigations in patients with suspected blunt abdominal trauma. Although its sensitivity is too low for definite exclusion of abdominal organ injury, proponents of ultrasound argue that ultrasound-based clinical pathways enhance the speed of primary trauma assessment, reduce the number of computed tomography scans and cut costs. OBJECTIVES: To assess the efficiency and effectiveness of trauma algorithms that include ultrasound examinations in patients with suspected blunt abdominal trauma. SEARCH STRATEGY: We searched MEDLINE, EMBASE, CENTRAL, CCMED, publishers' databases, controlled trials registers and the Internet. Bibliographies of identified articles and congress abstracts were handsearched. Trials were obtained from the Cochrane Injuries Group's trials register. Authors were contacted for further information and individual patient data. SELECTION CRITERIA PARTICIPANTS: patients with blunt torso, abdominal or multiple trauma undergoing diagnostic investigations for abdominal organ injury. INTERVENTIONS: diagnostic algorithms comprising emergency ultrasonography (US). CONTROLS: diagnostic algorithms without US ultrasound examinations (e.g. primary computed tomography [CT] or diagnostic peritoneal lavage [DPL]). OUTCOME MEASURES: mortality, use of CT and DPL, cost-effectiveness, laparotomy and negative laparotomy rates, delayed diagnoses, and quality of life. STUDIES: randomised controlled trials (RCTs) and quasi-randomised trials (qRCTs). DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials for inclusion, assessed methodological quality and extracted data. Where possible, data were pooled and relative risks (RRs), risk differences (RDs) and weighted mean differences, each with 95% confidence intervals (CIs), were calculated by fixed- or random-effects modelling, as appropriate. MAIN RESULTS: We identified two RCTs with US in the experimental arm and another with US in the control group. We also considered two qRCTs. Overall, trials were of moderate methodological quality. Few authors responded to our written inquiries seeking to resolve controversial issues and to obtain individual patient data. We were able to pool data from two trials comprising 1037 patients for primary endpoint analysis (i.e. mortality). The relative risk in favour of the no-US arm was 1.4 (95% CI 0.94 to 2.08). Because of a lack of details, the meaning of this observation remains unclear. There was a marginal benefit with US-based pathways in reducing CT scans (random-effects RD -0.46; 95% CI -1.00 to 0.13), offset by trials of higher methodological rigour. No differences were observed in DPL and laparotomy rates. AUTHORS' CONCLUSIONS: There is insufficient evidence from RCTs to justify promotion of ultrasound-based clinical pathways in diagnosing patients with suspected blunt abdominal trauma.

Abdominal Injuries↗
PubMed2005

[Solitary osteochondroma of the scapula. A rare differential diagnosis with unspecific shoulder pain].

Solitary osteochondroma of the scapula is rare. Because of the atypical location with unspecific shoulder pain, the diagnosis is often made late. We present a 35 year old patient with a solitary ostochondroma of the scapula with unspecific pain of the shoulder-neck region over about 4 years. In a thorax x-ray 2 years ago, a tumor like lesion was found. CT and MRI scan led to suspicion of a solitary osteochondroma of the scapula. Because of progressive thoracic pressure pain, a wide excision was made. The problems of diagnosis and therapy are presented and the literature is discussed.

Adult↗
PubMed2005

[Age and survival likelihood of polytrauma patients. "Local tailoring" of the DGU prognosis model].

INTRODUCTION: Age is one of five prognostic parameters identified based on data of the trauma registry of the German Association for Trauma Surgery (DGU). We asked ourselves if the suggested prognostic model provides the same predictive power of data from an independent hospital. Furthermore, we investigated whether age itself or age-associated comorbidity causes an unfavorable prognostic effect. METHODS: The investigation was based on data of 103 multiply injured patients (67 male, 36 female, mean age 35,4+/-SD 19,0 years, ISS 36,8+/-10,9). Data were collected prospectively following the guidelines of the trauma registry of the German Association for Trauma Surgery. Based on documented comorbidities, a risk calculation was performed using the ASA classification. Correlation between age and ASA was analyzed using Spearman's method. The prognostic value of the original model in our patient pool with or without ASA classification, possible interactions, and the discriminatory power of the model were estimated using logistic regression. RESULTS: Attributable mortality was 31,7% (95% CI 22,7-41,7%). Age, ISS, GCS and ASA were included into the final logistic model. Odds ratios of the origin model were reproducible nearly identical in our patinet pool (OR: age 1,048; ISS 1,066; GCS 0,822). In spite of the fact that we have found a strong correlation between age and ASA-Classification (rho=0,60, p<0,0001) there was no prognostic value of comorbidity. CONCLUSION: The suggested prognostic model based on multicenter data evaluation can be applied to a single center with only minimal loss of discriminatory power. In this context, age seems to have a prognostic value independent of comorbidity.

Adult↗
PubMed2005

[Modelling critical information measurement traumatic surgery decisions. "Sequential Information Appraisal Module (SIAM)"].

We studied the quality and quantity of information leading to the emergency physician's decision to intubate severely injured patients on scene. Our aim was to assess intuitive aspects of clinical decision making. The experiment involved three different phases, with a fourth phase examining retest reliability. We used trauma register data from 98 patients. Based on various parameters (physiological data, injury assessment on scene, definite injury pattern), three emergency surgeons were requested to decide on the need for endotracheal intubation.We applied multivariate logistic regression to estimate the likelihood of intubation given certain clinical characteristics or combinations of characteristics. We compared the participants' decisions to those made by "true" emergency physicians on scene. Kappa statistics marked inter-observer agreement beyond chance. The Glasgow Coma Scale (GCS) was the only single predictor of intubation in the ideal test setting (area under the receiver operating characteristics curve [AUC] >98%) as well as on scene (AUC 0.85, 95% confidence interval 0.78-0.92). There was no difference between the discriminatory features of the single item GCS and complex multivariate models that included anatomically defined injury scales (best model in phase 2: AUC 0.96, best model in phase 3: AUC 0.98). Overall inter-observer agreement was substantial in phase 1 (kappa=0.74), fair to moderate in phase 2 (kappa=0.49) and slight to fair in phase 3 (kappa=0.23). Retest reliability ranged from 51% to 91%. Doctors give priority to only a small part of the information available in deciding for or against a particular intervention.

Decision Support Systems, Clinical↗
PubMed2005

Second-line treatment of limb-threatening diabetic foot infections with intravenous fosfomycin.

Diabetic foot infections (DFI) expanding to bones and joints are associated with a poor prognosis of limb salvage. The bactericidal epoxide fosfomycin accumulates in inflamed soft and bone tissue, and may represent a potential treatment option for targeting severe DFI. Fifty-two patients (35 men, 17 women, mean age 62.9 +/- SD 9.2 years) with limb-threatening DFI (that is, Wagner grade 3 and higher) were enrolled in a multi-center compassionate use program of fosfomycin. Twenty-two patients (42.4%) had unsuccessfully been pretreated with other antimicrobials. Besides standard treatment (topical wound care and surgical debridement), eligible subjects received a combination of 8 to 24 g fosfomycin daily, and a conventional antibiotic agent, usually a beta-lactam compound. Treatment duration averaged 14.4 +/- 8.3 days. Limb-sparing surgery was possible in 48 patients (92.3%, 95% confidence interval 81.5-97.9%). Only four participants faced mild drug-related side effects (nausea, rash). Logistic regression analysis showed a trend towards better results with prolonged treatment, whereas a dose increase above 12 g daily did not affect outcomes. In DFI being resistant to conventional antibiotic agents, intravenous fosfomycin offers an effective treatment choice that may increase the likelihood of limb preservation. The present data warrant a larger comparative trial to stabilize effect estimates.

Aged↗
PubMed2004

[Intraoperative imaging with the ISO C(3D)].

Computed tomography (CT) scanning is the gold standard for displaying and visualizing complex anatomic structures such as the calcaneus, pelvis, and spine, etc. In orthopedic surgery CT scanning is unfortunately not available in the OR where it would be highly effective if scans could be done prior to wound closure. The reasons are high costs, need for constructional changes in the OR, and additional staff (radiologic technologist), etc. For the first time the ISO C(3D) enables the surgeon to generate multiplanar reconstruction (MPR) pictures during surgery within an acceptable time frame at a reasonable price with a familiar instrument (a modified C-arm). Since February 2001 we have been able to use the ISO C(3D) in our hospital and meanwhile we have scanned 442 surgical sites including the calcaneus, cervical spine, and acetabulum, etc. The intraoperative scans revealed fracture gaps and steps, unsatisfactory fragment alignment, or incorrectly positioned implants, leading to an overall revision rate of 7.3%The ISO C(3D) is a first step towards a new future for bone visualization. The next steps will bring an increase in scan area and resolution, and the high-contrast pictures will be replaced by ones very similar to modern CT slices showing certain soft tissue structures.

Acetabulum↗
PubMed2004

[A rapid review of the minimum quality problems using total knee arthroplasty as an example. Where do the magical threshold values come from?].

We set out to clarify whether in hospitals with a large volume morbidity and mortality rates after total knee arthroplasty (TKA) can be improved, whether the effects are consistent, and whether minimum recommendable caseloads can be inferred. We conducted a systematic review using MEDLINE, EMBASE, CENTRAL, and CINAHL and performed a hand search without restrictions on language or publication types. We identified 1406 citations, of which 13 studies including 1,110,962 patients met our inclusion criteria. Of these, six studies explored the same administrative data source. Five studies enrolling 448,897 were eligible for quantitative analysis. All studies corresponded to evidence level 2b (prospective or retrospective cohort study with >80% follow-up). We found homogeneous results about hospital mortality. Between 2551 and 821 TKA must be performed by high-volume rather than by low-volume providers to prevent 1 extra death. Absolute event rates are notably small.

Arthroplasty, Replacement, Knee↗
PubMed2004

[Glossary on patient safety -- a contribution to on-target-definition and to appreciate the subjects of "patient safety"].

Since the release of the report "To Err is Human" by the American Institute of Medicine (IOM) the subject "Medical Risks, Errors and Patient Safety" has gained increasing interest in literature. In Germany, neither extensive statistics nor generally significant epidemiological studies regarding common errors associated with damages caused to patients' health exist. In recent years the subject has become increasingly interesting both in specialist discussion and it the lay press; it has become evident that the different use of terms, especially those originating from the Anglo-Saxon language, can lead to misunderstandings. Hence, as one of the first steps of its action programme, the expert panel "Patient Safety" of the German Agency for Quality in Medicine has compiled a glossary of technical terms to provide adequate support to the discussion this important subject of nomenclature.

Germany↗
PubMed2003

[Informed consent on heparin-induced thrombocytopenia during thrombosis prophylaxis. A pilot study including 460 patients].

BACKGROUND: The practicability and acceptance of written information about heparin thrombosis prophylaxis and the associated risk of heparin-induced thrombocytopenia (HIT) was evaluated in a pilot study. PATIENTS AND METHODS: All patients consecutively admitted to the department of trauma- and reconstructive surgery at the Ernst-Moritz-Arndt-University, Greifswald, Germany, with an indication for heparin thrombosis prophylaxis were give written information about thrombosis prophylaxis and the undesired drug effect HIT. After this, acceptance was evaluated using a standardized questionnaire. Primary endpoint was refusal of heparin for thrombosis prophylaxis, secondary endpoint acceptance and comprehensibility of the information. RESULTS: None of the 460 patients included in the study subsequently refused thrombosis prophylaxis with heparin. The majority welcomed the information and thought it should be given to all patients that are about to be treated with heparin. Only 0.9 % of patients judged comprehensibility of the information to be insufficient. Anticipation of imminent heparin therapy (good/very good in 90 %) and appreciation of the quality of care was not judged to be unacceptable by any patient. CONCLUSIONS: The present study demonstrates that giving information about heparin-induced thrombocytopenia during explanation of the risks and benefits of heparin thrombosis prophylaxis is feasible. This information--given in writing in our pilot study--was judged by patients to be comprehensible and necessary and did not lead to refusal of treatment. Lower incidence of HIT with use of low molecular weight heparins should be considered in the choice of drug for thrombosis prophylaxis.

Adult↗
PubMed2003

[Clinical trials in orthopedic and trauma surgery: randomized or non-randomized?].

Drawing inferences on a causal relationship between a particular intervention and the observed outcome requires to conduct a clinical experiment which controls for study conditions and systematic errors (bias). This is best to be achieved by randomization in which known and unknown biological risk factors are distributed equally among treatment arms. Trauma and orthopedic surgery,however, occupies an exceptional position in clinical medicine. Random allocation of subjects is often considered difficult because of the tight time frame between patient presentation and the urgent need for surgical treatment, and the dependence of operative results upon technical skills. Evidence of a true treatment effect does not only depend on design issues (i.e., randomized or non-randomized treatment assignment), but on both the prior probability of efficacy and the observed effect size as well. Even though our knowledge of the efficacy of osteosynthesis comparing with, let's say, plaster immobilization or (fictive) placebo therapy is hardly supported by randomized trials, the biologically plausible principle of stable operative fixation of fracture fragments has established itself as the scientific basis to propagate surgical rather than other treatment options. Thus, the efficacy of a medical intervention can be well demonstrated without randomization. Regarding the ultimate goals of stabilization, pain removal, and mobilization,osteosynthesis of a pertrochanteric fracture fits these principles in terms of an all-or-none effect (so called level Ic evidence): without the intervention, effects will not be observed. On the other hand, endpoints such as healing and infection rates or duration of rehabilitation may be severely influenced by confounding factors (e.g., concomitant diseases, age, or gender). Under these circumstances,the goal of quantifying treatment effects of different interventions (i.e., interlocking nails, plates, K-wires) and of discriminating these effects from bias might be solved more reliably by a randomized than by a non-randomized trial.Obviously,the need for randomization relies on the choice of the main endpoint of interest.The postulated overestimation of treatment effects by nonrandomized trials has been proven only for methodologically weak investigations. In contrast, high quality studies led to comparable findings regardless of randomization. In conclusion, there are thinkable alternative designs to randomized trials in trauma surgery, accounting for selected clinical questions and objectives. It must be emphasized that these designs will require a similarly rigorous planning (i.e., study protocols, ethics, sample size considerations) and analysis of the results.

Bias↗