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Showing 1 - 200 of 2329 Journals sorted alphabetically
3D Research     Hybrid Journal   (Followers: 19, SJR: 0.214, h-index: 10)
4OR: A Quarterly J. of Operations Research     Hybrid Journal   (Followers: 9, SJR: 1.073, h-index: 25)
AAPS J.     Hybrid Journal   (Followers: 18, SJR: 1.192, h-index: 74)
AAPS PharmSciTech     Hybrid Journal   (Followers: 5, SJR: 0.718, h-index: 54)
Abdominal Imaging     Hybrid Journal   (Followers: 14, SJR: 0.723, h-index: 60)
Abhandlungen aus dem Mathematischen Seminar der Universitat Hamburg     Hybrid Journal   (Followers: 2, SJR: 0.447, h-index: 12)
Academic Psychiatry     Full-text available via subscription   (Followers: 22, SJR: 0.492, h-index: 32)
Academic Questions     Hybrid Journal   (Followers: 7, SJR: 0.135, h-index: 6)
Accreditation and Quality Assurance: J. for Quality, Comparability and Reliability in Chemical Measurement     Hybrid Journal   (Followers: 26, SJR: 0.378, h-index: 30)
Acoustical Physics     Hybrid Journal   (Followers: 10, SJR: 0.355, h-index: 20)
Acoustics Australia     Hybrid Journal  
Acta Analytica     Hybrid Journal   (Followers: 7, SJR: 0.387, h-index: 6)
Acta Applicandae Mathematicae     Hybrid Journal   (Followers: 1, SJR: 0.624, h-index: 34)
Acta Biotheoretica     Hybrid Journal   (Followers: 5, SJR: 0.419, h-index: 25)
Acta Diabetologica     Hybrid Journal   (Followers: 14, SJR: 1.318, h-index: 46)
Acta Endoscopica     Hybrid Journal   (Followers: 1, SJR: 0.113, h-index: 8)
acta ethologica     Hybrid Journal   (Followers: 4, SJR: 0.465, h-index: 23)
Acta Geochimica     Hybrid Journal   (Followers: 3)
Acta Geodaetica et Geophysica     Hybrid Journal   (Followers: 1, SJR: 0.294, h-index: 13)
Acta Geotechnica     Hybrid Journal   (Followers: 6, SJR: 1.818, h-index: 22)
Acta Informatica     Hybrid Journal   (Followers: 5, SJR: 0.524, h-index: 32)
Acta Mathematica     Hybrid Journal   (Followers: 10, SJR: 8.021, h-index: 47)
Acta Mathematica Hungarica     Hybrid Journal   (Followers: 2, SJR: 0.53, h-index: 29)
Acta Mathematica Sinica, English Series     Hybrid Journal   (Followers: 5, SJR: 0.406, h-index: 30)
Acta Mathematica Vietnamica     Hybrid Journal   (SJR: 0.451, h-index: 5)
Acta Mathematicae Applicatae Sinica, English Series     Hybrid Journal   (SJR: 0.22, h-index: 20)
Acta Mechanica     Hybrid Journal   (Followers: 18, SJR: 0.898, h-index: 52)
Acta Mechanica Sinica     Hybrid Journal   (Followers: 4, SJR: 0.426, h-index: 29)
Acta Metallurgica Sinica (English Letters)     Hybrid Journal   (Followers: 5, SJR: 0.525, h-index: 18)
Acta Meteorologica Sinica     Hybrid Journal   (Followers: 3, SJR: 0.524, h-index: 14)
Acta Neurochirurgica     Hybrid Journal   (Followers: 6, SJR: 0.833, h-index: 73)
Acta Neurologica Belgica     Hybrid Journal   (SJR: 0.348, h-index: 27)
Acta Neuropathologica     Hybrid Journal   (Followers: 3, SJR: 6.61, h-index: 117)
Acta Oceanologica Sinica     Hybrid Journal   (Followers: 3, SJR: 0.295, h-index: 17)
Acta Parasitologica     Hybrid Journal   (Followers: 9, SJR: 0.581, h-index: 28)
Acta Physiologiae Plantarum     Hybrid Journal   (Followers: 2, SJR: 0.551, h-index: 39)
Acta Politica     Hybrid Journal   (Followers: 13, SJR: 0.658, h-index: 20)
adhäsion KLEBEN & DICHTEN     Hybrid Journal   (Followers: 5, SJR: 0.103, h-index: 4)
ADHD Attention Deficit and Hyperactivity Disorders     Hybrid Journal   (Followers: 20, SJR: 0.871, h-index: 15)
Adhesion Adhesives & Sealants     Hybrid Journal   (Followers: 7)
Administration and Policy in Mental Health and Mental Health Services Research     Partially Free   (Followers: 14, SJR: 0.795, h-index: 40)
Adsorption     Hybrid Journal   (Followers: 4, SJR: 0.774, h-index: 52)
Advances in Applied Clifford Algebras     Hybrid Journal   (Followers: 3, SJR: 0.319, h-index: 15)
Advances in Atmospheric Sciences     Hybrid Journal   (Followers: 34, SJR: 0.959, h-index: 44)
Advances in Computational Mathematics     Hybrid Journal   (Followers: 15, SJR: 1.255, h-index: 44)
Advances in Contraception     Hybrid Journal   (Followers: 2)
Advances in Data Analysis and Classification     Hybrid Journal   (Followers: 52, SJR: 1.113, h-index: 14)
Advances in Gerontology     Partially Free   (Followers: 8, SJR: 0.141, h-index: 3)
Advances in Health Sciences Education     Hybrid Journal   (Followers: 23, SJR: 1.397, h-index: 42)
Advances in Manufacturing     Hybrid Journal   (Followers: 3, SJR: 0.2, h-index: 4)
Advances in Polymer Science     Hybrid Journal   (Followers: 40, SJR: 0.637, h-index: 89)
Advances in Therapy     Hybrid Journal   (Followers: 5, SJR: 0.79, h-index: 44)
Aegean Review of the Law of the Sea and Maritime Law     Hybrid Journal   (Followers: 7)
Aequationes Mathematicae     Hybrid Journal   (Followers: 2, SJR: 0.882, h-index: 23)
Aerobiologia     Hybrid Journal   (Followers: 1, SJR: 0.511, h-index: 36)
Aesthetic Plastic Surgery     Hybrid Journal   (Followers: 8, SJR: 0.821, h-index: 49)
African Archaeological Review     Hybrid Journal   (Followers: 14, SJR: 0.612, h-index: 24)
Afrika Matematika     Hybrid Journal   (Followers: 1, SJR: 0.248, h-index: 6)
AGE     Hybrid Journal   (Followers: 7, SJR: 1.358, h-index: 33)
Ageing Intl.     Hybrid Journal   (Followers: 7, SJR: 0.337, h-index: 10)
Aggiornamenti CIO     Hybrid Journal   (Followers: 1)
Aging Clinical and Experimental Research     Hybrid Journal   (Followers: 3, SJR: 0.529, h-index: 55)
Agricultural Research     Hybrid Journal   (Followers: 3)
Agriculture and Human Values     Hybrid Journal   (Followers: 12, SJR: 1.197, h-index: 49)
Agroforestry Systems     Hybrid Journal   (Followers: 20, SJR: 0.64, h-index: 56)
Agronomy for Sustainable Development     Hybrid Journal   (Followers: 10, SJR: 1.732, h-index: 59)
AI & Society     Hybrid Journal   (Followers: 7, SJR: 0.171, h-index: 19)
AIDS and Behavior     Hybrid Journal   (Followers: 13, SJR: 2.006, h-index: 71)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 3, SJR: 0.706, h-index: 19)
Akupunktur & Aurikulomedizin     Full-text available via subscription   (Followers: 1)
Algebra and Logic     Hybrid Journal   (Followers: 2, SJR: 0.566, h-index: 18)
Algebra Universalis     Hybrid Journal   (Followers: 2, SJR: 0.388, h-index: 22)
Algebras and Representation Theory     Hybrid Journal   (Followers: 1, SJR: 0.868, h-index: 20)
Algorithmica     Hybrid Journal   (Followers: 7, SJR: 0.898, h-index: 56)
Allergo J.     Full-text available via subscription   (Followers: 1, SJR: 0.183, h-index: 20)
Allergo J. Intl.     Hybrid Journal   (Followers: 2)
Alpine Botany     Hybrid Journal   (Followers: 4, SJR: 0.729, h-index: 20)
ALTEX : Alternatives to Animal Experimentation     Open Access   (Followers: 3, SJR: 1.392, h-index: 32)
AMBIO     Hybrid Journal   (Followers: 14, SJR: 1.094, h-index: 87)
American J. of Cardiovascular Drugs     Hybrid Journal   (Followers: 10, SJR: 0.864, h-index: 39)
American J. of Community Psychology     Hybrid Journal   (Followers: 24, SJR: 1.237, h-index: 83)
American J. of Criminal Justice     Hybrid Journal   (Followers: 7, SJR: 0.634, h-index: 13)
American J. of Cultural Sociology     Hybrid Journal   (Followers: 11, SJR: 0.283, h-index: 3)
American J. of Dance Therapy     Hybrid Journal   (Followers: 4, SJR: 0.175, h-index: 13)
American J. of Potato Research     Hybrid Journal   (Followers: 2, SJR: 0.558, h-index: 35)
American J. of Psychoanalysis     Hybrid Journal   (Followers: 21, SJR: 0.293, h-index: 13)
American Sociologist     Hybrid Journal   (Followers: 11, SJR: 0.18, h-index: 13)
Amino Acids     Hybrid Journal   (Followers: 7, SJR: 1.362, h-index: 83)
AMS Review     Partially Free   (Followers: 4)
Analog Integrated Circuits and Signal Processing     Hybrid Journal   (Followers: 5, SJR: 0.21, h-index: 37)
Analysis and Mathematical Physics     Hybrid Journal   (Followers: 4, SJR: 0.665, h-index: 7)
Analysis in Theory and Applications     Hybrid Journal  
Analysis of Verbal Behavior     Hybrid Journal   (Followers: 4)
Analytical and Bioanalytical Chemistry     Hybrid Journal   (Followers: 28, SJR: 1.096, h-index: 123)
Anatomical Science Intl.     Hybrid Journal   (Followers: 2, SJR: 0.301, h-index: 26)
Angewandte Schmerztherapie und Palliativmedizin     Hybrid Journal  
Angiogenesis     Hybrid Journal   (Followers: 3, SJR: 2.212, h-index: 69)
Animal Cognition     Hybrid Journal   (Followers: 15, SJR: 1.122, h-index: 55)
Annales françaises de médecine d'urgence     Hybrid Journal   (Followers: 1, SJR: 0.156, h-index: 4)
Annales Henri Poincaré     Hybrid Journal   (Followers: 3, SJR: 1.377, h-index: 32)
Annales mathématiques du Québec     Hybrid Journal   (Followers: 4)
Annali dell'Universita di Ferrara     Hybrid Journal   (SJR: 0.504, h-index: 14)
Annali di Matematica Pura ed Applicata     Hybrid Journal   (Followers: 1, SJR: 1.167, h-index: 26)
Annals of Behavioral Medicine     Hybrid Journal   (Followers: 12, SJR: 2.112, h-index: 98)
Annals of Biomedical Engineering     Hybrid Journal   (Followers: 18, SJR: 1.182, h-index: 94)
Annals of Combinatorics     Hybrid Journal   (Followers: 3, SJR: 0.849, h-index: 15)
Annals of Data Science     Hybrid Journal   (Followers: 8)
Annals of Dyslexia     Hybrid Journal   (Followers: 9, SJR: 0.857, h-index: 40)
Annals of Finance     Hybrid Journal   (Followers: 28, SJR: 0.686, h-index: 14)
Annals of Forest Science     Hybrid Journal   (Followers: 4, SJR: 0.929, h-index: 57)
Annals of Global Analysis and Geometry     Hybrid Journal   (Followers: 1, SJR: 1.136, h-index: 23)
Annals of Hematology     Hybrid Journal   (Followers: 13, SJR: 1.117, h-index: 62)
Annals of Mathematics and Artificial Intelligence     Hybrid Journal   (Followers: 6, SJR: 0.593, h-index: 42)
Annals of Microbiology     Hybrid Journal   (Followers: 9, SJR: 0.402, h-index: 26)
Annals of Nuclear Medicine     Hybrid Journal   (Followers: 5, SJR: 0.68, h-index: 45)
Annals of Operations Research     Hybrid Journal   (Followers: 8, SJR: 1.186, h-index: 78)
Annals of Regional Science     Hybrid Journal   (Followers: 7, SJR: 0.405, h-index: 42)
Annals of Software Engineering     Hybrid Journal   (Followers: 12)
Annals of Solid and Structural Mechanics     Hybrid Journal   (Followers: 10, SJR: 0.553, h-index: 8)
Annals of Surgical Oncology     Hybrid Journal   (Followers: 11, SJR: 1.902, h-index: 127)
Annals of Telecommunications     Hybrid Journal   (Followers: 7, SJR: 0.315, h-index: 25)
Annals of the Institute of Statistical Mathematics     Hybrid Journal   (Followers: 1, SJR: 0.931, h-index: 31)
Antonie van Leeuwenhoek     Hybrid Journal   (Followers: 5, SJR: 0.992, h-index: 87)
Apidologie     Hybrid Journal   (Followers: 4, SJR: 1.14, h-index: 57)
APOPTOSIS     Hybrid Journal   (Followers: 8, SJR: 1.554, h-index: 87)
Applicable Algebra in Engineering, Communication and Computing     Hybrid Journal   (Followers: 2, SJR: 0.354, h-index: 27)
Applications of Mathematics     Hybrid Journal   (Followers: 1, SJR: 0.274, h-index: 20)
Applied Biochemistry and Biotechnology     Hybrid Journal   (Followers: 44, SJR: 0.575, h-index: 80)
Applied Biochemistry and Microbiology     Hybrid Journal   (Followers: 17, SJR: 0.267, h-index: 26)
Applied Categorical Structures     Hybrid Journal   (Followers: 2, SJR: 0.361, h-index: 21)
Applied Composite Materials     Hybrid Journal   (Followers: 46, SJR: 0.705, h-index: 35)
Applied Entomology and Zoology     Partially Free   (Followers: 2, SJR: 0.554, h-index: 34)
Applied Geomatics     Hybrid Journal   (Followers: 3, SJR: 0.323, h-index: 9)
Applied Geophysics     Hybrid Journal   (Followers: 7, SJR: 0.541, h-index: 13)
Applied Intelligence     Hybrid Journal   (Followers: 14, SJR: 0.777, h-index: 43)
Applied Magnetic Resonance     Hybrid Journal   (Followers: 3, SJR: 0.358, h-index: 34)
Applied Mathematics & Optimization     Hybrid Journal   (Followers: 4, SJR: 0.955, h-index: 33)
Applied Mathematics - A J. of Chinese Universities     Hybrid Journal   (SJR: 0.275, h-index: 8)
Applied Mathematics and Mechanics     Hybrid Journal   (Followers: 4, SJR: 0.37, h-index: 26)
Applied Microbiology and Biotechnology     Hybrid Journal   (Followers: 61, SJR: 1.262, h-index: 161)
Applied Physics A     Hybrid Journal   (Followers: 7, SJR: 0.535, h-index: 121)
Applied Physics B: Lasers and Optics     Hybrid Journal   (Followers: 23, SJR: 0.983, h-index: 104)
Applied Psychophysiology and Biofeedback     Hybrid Journal   (Followers: 6, SJR: 0.677, h-index: 47)
Applied Research in Quality of Life     Hybrid Journal   (Followers: 10, SJR: 0.288, h-index: 15)
Applied Solar Energy     Hybrid Journal   (Followers: 15, SJR: 0.251, h-index: 6)
Applied Spatial Analysis and Policy     Hybrid Journal   (Followers: 4, SJR: 0.351, h-index: 9)
Aquaculture Intl.     Hybrid Journal   (Followers: 22, SJR: 0.613, h-index: 40)
Aquarium Sciences and Conservation     Hybrid Journal   (Followers: 1)
Aquatic Ecology     Hybrid Journal   (Followers: 30, SJR: 0.646, h-index: 44)
Aquatic Geochemistry     Hybrid Journal   (Followers: 3, SJR: 0.764, h-index: 39)
Aquatic Sciences     Hybrid Journal   (Followers: 12, SJR: 1.172, h-index: 53)
Arabian J. for Science and Engineering     Hybrid Journal   (Followers: 5, SJR: 0.345, h-index: 20)
Arabian J. of Geosciences     Hybrid Journal   (Followers: 1, SJR: 0.417, h-index: 16)
Archaeological and Anthropological Sciences     Hybrid Journal   (Followers: 21, SJR: 1.056, h-index: 15)
Archaeologies     Hybrid Journal   (Followers: 12, SJR: 0.397, h-index: 13)
Archiv der Mathematik     Hybrid Journal   (Followers: 1, SJR: 0.597, h-index: 29)
Archival Science     Hybrid Journal   (Followers: 52, SJR: 0.804, h-index: 22)
Archive for History of Exact Sciences     Hybrid Journal   (Followers: 7, SJR: 0.28, h-index: 15)
Archive for Mathematical Logic     Hybrid Journal   (Followers: 1, SJR: 0.946, h-index: 23)
Archive for Rational Mechanics and Analysis     Hybrid Journal   (SJR: 4.091, h-index: 66)
Archive of Applied Mechanics     Hybrid Journal   (Followers: 4, SJR: 0.865, h-index: 40)
Archives of Computational Methods in Engineering     Hybrid Journal   (Followers: 4, SJR: 2.841, h-index: 40)
Archives of Dermatological Research     Hybrid Journal   (Followers: 6, SJR: 0.9, h-index: 65)
Archives of Environmental Contamination and Toxicology     Hybrid Journal   (Followers: 10, SJR: 0.846, h-index: 84)
Archives of Gynecology and Obstetrics     Hybrid Journal   (Followers: 16, SJR: 0.695, h-index: 47)
Archives of Microbiology     Hybrid Journal   (Followers: 8, SJR: 0.702, h-index: 85)
Archives of Orthopaedic and Trauma Surgery     Hybrid Journal   (Followers: 8, SJR: 1.039, h-index: 56)
Archives of Osteoporosis     Hybrid Journal   (Followers: 2, SJR: 1.092, h-index: 13)
Archives of Sexual Behavior     Hybrid Journal   (Followers: 9, SJR: 1.198, h-index: 74)
Archives of Toxicology     Hybrid Journal   (Followers: 16, SJR: 1.595, h-index: 76)
Archives of Virology     Hybrid Journal   (Followers: 5, SJR: 1.086, h-index: 90)
Archives of Women's Mental Health     Hybrid Journal   (Followers: 13, SJR: 1.264, h-index: 50)
Archivio di Ortopedia e Reumatologia     Hybrid Journal  
Archivum Immunologiae et Therapiae Experimentalis     Hybrid Journal   (Followers: 2, SJR: 1.2, h-index: 42)
ArgoSpine News & J.     Hybrid Journal   (SJR: 0.102, h-index: 3)
Argumentation     Hybrid Journal   (Followers: 5, SJR: 0.295, h-index: 18)
Arid Ecosystems     Hybrid Journal   (Followers: 3)
Arkiv för Matematik     Hybrid Journal   (Followers: 1, SJR: 0.948, h-index: 22)
Arnold Mathematical J.     Hybrid Journal   (Followers: 1)
Arthropod-Plant Interactions     Hybrid Journal   (Followers: 1, SJR: 0.797, h-index: 17)
Arthroskopie     Hybrid Journal   (Followers: 1, SJR: 0.145, h-index: 8)
Artificial Intelligence and Law     Hybrid Journal   (Followers: 10, SJR: 0.288, h-index: 25)
Artificial Intelligence Review     Hybrid Journal   (Followers: 15, SJR: 0.948, h-index: 48)
Artificial Life and Robotics     Hybrid Journal   (Followers: 8, SJR: 0.231, h-index: 14)
Asia Europe J.     Hybrid Journal   (Followers: 4, SJR: 0.247, h-index: 9)
Asia Pacific Education Review     Hybrid Journal   (Followers: 9, SJR: 0.371, h-index: 17)
Asia Pacific J. of Management     Hybrid Journal   (Followers: 11, SJR: 1.676, h-index: 50)
Asia-Pacific Education Researcher     Hybrid Journal   (Followers: 11, SJR: 0.353, h-index: 13)
Asia-Pacific Financial Markets     Hybrid Journal   (Followers: 2, SJR: 0.19, h-index: 15)
Asia-Pacific J. of Atmospheric Sciences     Hybrid Journal   (Followers: 20, SJR: 1.006, h-index: 14)
Asian Business & Management     Hybrid Journal   (Followers: 7, SJR: 0.41, h-index: 10)
Asian J. of Business Ethics     Hybrid Journal   (Followers: 7)
Asian J. of Criminology     Hybrid Journal   (Followers: 5, SJR: 0.263, h-index: 8)
AStA Advances in Statistical Analysis     Hybrid Journal   (Followers: 2, SJR: 0.681, h-index: 15)
AStA Wirtschafts- und Sozialstatistisches Archiv     Hybrid Journal   (Followers: 5, SJR: 0.195, h-index: 5)
ästhetische dermatologie & kosmetologie     Full-text available via subscription  
Astronomy and Astrophysics Review     Hybrid Journal   (Followers: 21, SJR: 4.511, h-index: 44)
Astronomy Letters     Hybrid Journal   (Followers: 19, SJR: 0.58, h-index: 30)
Astronomy Reports     Hybrid Journal   (Followers: 12, SJR: 0.473, h-index: 23)
Astrophysical Bulletin     Hybrid Journal   (Followers: 2, SJR: 0.469, h-index: 11)

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Journal Cover Archives of Orthopaedic and Trauma Surgery
  [SJR: 1.039]   [H-I: 56]   [8 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1434-3916 - ISSN (Online) 0936-8051
   Published by Springer-Verlag Homepage  [2329 journals]
  • Three-dimensional motion analysis for validation of shoulder internal
    • Authors: Michael W. Maier; Sarah Erhard; Mirjam Niklasch; Thomas Bruckner; Sebastian I. Wolf; Felix Zeifang; Patric Raiss
      Pages: 735 - 741
      Abstract: Background 10% of the points for the Constant–Murley score (CMS) are allocated for the capacity for internal rotation (IR), measured as unassisted active movement of the dorsum of the hand or the thumb to reach different anatomical landmarks. However, there is little information about the validity of this method and no three-dimensional measurement of the degree of IR that is necessary to reach these landmarks. Methods Sixteen volunteers with healthy shoulders were recruited. The degree of IR was defined using the following landmarks as described in the CMS: (1) lateral aspect of thigh, (2) buttock, (3) sacroiliac joint, (4) level of waist, (5) vertebra T12, (6) interscapular. The validity of IR measurement was assessed by simultaneous 3D motion analysis. Results Using the thumb as pointer, there were significant increases in IR from 39.3° at position 1 to 80.4° at position 2, followed by 105.1°, 108.6°, 110.1°, and 125.3° at position 3–6. Taking the dorsum of the hand as pointer, there were significant increases in IR between all positions, starting from 71.2° (position 1) and followed by 99.3°, 104.1°, 110.3°, 115.2°, and 119.7° at positions 2 to 6. Comparing the two measurement methods, a significant difference was found for the amount of IR between positions 1 and 2. Conclusion Measurement of IR as described in the CMS is a suitable method. However, there was an increase of only 10° in IR between positions 3 and 5, which may be hard to measure with a standard goniometer in clinical practice.
      PubDate: 2017-06-01
      DOI: 10.1007/s00402-017-2656-4
      Issue No: Vol. 137, No. 6 (2017)
  • The extent of environmental and body contamination through aerosols by
           hydro-surgical debridement in the lumbar spine
    • Authors: David Putzer; Ricarda Lechner; Debora Coraca-Huber; Astrid Mayr; Michael Nogler; Martin Thaler
      Pages: 743 - 747
      Abstract: Introduction Surgical site infections occur in 1–6% of spinal surgeries. Effective treatment includes early diagnosis, parenteral antibiotics and early surgical debridement of the wound surface. Materials and methods On a human cadaver, we executed a complete hydro-surgery debridement including a full surgical setup such as draping. The irrigation fluid was artificially contaminated with Staphylococcus aureus (ATCC 6538). Surveillance cultures were used to detect environmental and body contamination of the surgical team. Results For both test setups, environmental contamination was observed in an area of 6 × 8 m. Both test setups caused contamination of all personnel present during the procedure and of the whole operating theatre. However, the concentration of contamination for the surgical staff and the environment was lower when an additional disposable draping device was used. Conclusions The study showed that during hydro-surgery debridement, contaminated aerosols spread over the whole surgical room and contaminate the theatre and all personnel.
      PubDate: 2017-06-01
      DOI: 10.1007/s00402-017-2668-0
      Issue No: Vol. 137, No. 6 (2017)
  • Radiographic outcomes of single versus dual plate fixation of acute
           mid-shaft clavicle fractures
    • Authors: Xiaobin Chen; Steven F. Shannon; Michael Torchia; Bradley Schoch
      Pages: 749 - 754
      Abstract: Introduction The clavicle exhibits considerable movement in three planes making rigid fixation challenging. The addition of a second plate may be considered to improve fixation rigidity, but risks compromising the blood supply to the fracture site. The purpose of this study is to assess if extraperiosteal dual plate fixation increases the rate of non-union, reoperation, and complications at 1 year for surgically treated acute mid-shaft clavicle fractures. Methods Between June 1998 and June 2013, surgically treated mid-shaft clavicle fractures undergoing open reduction internal fixation within 4 weeks of injury were retrospectively reviewed. Patients undergoing single plate fixation were compared to dual plate fixation. Patients were followed for a minimum of 1 year. Charts were reviewed to assess union rates, reoperation, and complications. Results One hundred and sixty-three clavicles (125 single plates, 34 dual plates) were evaluated. All patients (100%) in dual plating group and one hundred and fourteen (91%) in single plating group obtained bony union by 1 year (p = 0.13). Six patients (4.8%) experienced a non-union in the single plating cohort compared to the dual plating cohort who had a 100% union rate. Seven patients required reoperation in the single plate cohort due to implant failure (N = 4), infection (N = 2), and non-union (N = 1). Conclusions This limited series of patients demonstrates dual plate fixation is a reliable option for acute mid-shaft clavicle fractures, with excellent union rates and low complication rates. Compared to single plate fixation, no significant differences in outcomes were identified. In the case of more complex fracture patterns, application of a second extraperiosteal plate may be utilized without compromising healing or increasing complication rates.
      PubDate: 2017-06-01
      DOI: 10.1007/s00402-017-2676-0
      Issue No: Vol. 137, No. 6 (2017)
  • Do clinical outcomes correlate with bone density after open reduction and
           internal fixation of tibial plateau fractures
    • Authors: Elizabeth Gausden; Matthew R. Garner; Peter D. Fabricant; Stephen J. Warner; Andre D. Shaffer; Dean G. Lorich
      Pages: 755 - 760
      Abstract: Introduction The operative management of tibial plateau fractures in elderly patients has historically led to inconsistent results, and these clinical outcomes were thought to be associated with poor bone quality often in elderly patients. The goal of this study was to investigate the relationship between bone density and subjective clinical outcome scores after open reduction and internal fixation of tibial plateau fractures. Materials and methods This is a retrospective cohort study from a single-surgeon conducted at an Academic, Level 1 Trauma Center. A preoperative computed tomography (CT) scan was obtained for all patients. Bone density of the distal femur was quantified with Hounsfield units (HU) as measured on axial CT scans. Inter-rater reliability of HU measurements was assessed using interclass correlation coefficients. Regression models controlling for age were used to identify relationships between bone density (HU) and the following variables: articular subsidence and 1-year subjective clinical outcomes scores [Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS), and Short-Form-36 (SF-36) physical and mental component scores (PCS, MCS)]. Results Sixty-one patients with a mean age of 59.3 years (range 27–85 years) and a minimum of 12 months of clinical follow-up were included in the study. The majority of the fractures (32 of 61) were classified as Schatzker II tibial plateau fractures, and there were 13 Schatzker V fractures, 11 Schatzker VI fractures, 2 Schatzker IV fractures and 1 Schatzker 1 fracture. HU measurements demonstrated an almost perfect inter-observer reliability (ICC = 0.97). Age was negatively correlated with HU measurements (r = −0.51, p < 0.001), and using a geriatric cut-off of 65 years of age, the geriatric group had a lower mean HU compared to the non-geriatric group (78.2 versus 114.8, p = 0.018). There was no significant relationship between bone quality, as assessed by distal femoral HU, and any subjective clinical outcome score. Conclusions Inferior bone mineral density alone does not appear to affect clinical outcomes 1 year postoperatively when bone grafting is used to restore osseous voids. Poor bone quality should not be used as an indication for non-operative management of tibial plateau fractures.
      PubDate: 2017-06-01
      DOI: 10.1007/s00402-017-2679-x
      Issue No: Vol. 137, No. 6 (2017)
  • Why does total elbow arthroplasty fail today? A systematic review of
           recent literature
    • Authors: Ante Prkic; Chantal Welsink; Bertram The; Michel P. J. van den Bekerom; Denise Eygendaal
      Pages: 761 - 769
      Abstract: Background Total elbow arthroplasty is a relatively uncommon type of arthroplasty, which has undergone several design changes in the past four decades. However, research on improvement requires knowledge of failure mechanisms that can be addressed. Therefore, we conducted a systematic review on modes of failure of total elbow arthroplasty. Methods We conducted searches on PubMed/Medline, Embase and Cochrane databases to identify studies describing modes of failure of primary total elbow arthroplasties. The results were coupled per type of total elbow arthroplasty and individual arthroplasty models. Results A total of 70 articles were included in this systematic review. 9308 individual total elbow arthroplasties were identified with 1253 revisions (13.5%). Aseptic loosening was the most prevalent reason for revision (38%), followed by deep infection (19%) and periprosthetic fractures (12%). Conclusion Revision rates have been found similar to a systematic review published in 2003. The revision percentage of total elbow arthroplasty for rheumatoid arthritis is significantly higher than for trauma and post-traumatic osteoarthritis. Aseptic loosening was seen less in linked implants. Infections and periprosthetic fractures did not differ between linkage design groups. Aseptic loosening remains the most frequent cause for revision of primary total elbow arthroplasty. Therefore, more research on the occurrence, progression and risk factors of aseptic loosening should be performed and lead to higher implant survival.
      PubDate: 2017-06-01
      DOI: 10.1007/s00402-017-2687-x
      Issue No: Vol. 137, No. 6 (2017)
  • Outcome and revision rate of uncemented glenohumeral resurfacing (C.A.P.)
           after 5–8 years
    • Authors: P. C. Geervliet; M. P. J. van den Bekerom; P. Spruyt; M. Curvers; A. van Noort; C. P. J. Visser
      Pages: 771 - 778
      Abstract: Background Resurfacing of the glenohumeral joint for patients with glenohumeral arthritis has gained popularity since the first introduction. We report the mid-term results of the Global C.A.P. uncemented resurfacing shoulder prosthesis (DePuy Synthes). Methods From January 2007 to December 2009, 48 humeral cementless resurfacing prostheses in 46 patients were performed. All patients were diagnosed with primary glenohumeral osteoarthritis. Patients were contacted for review; the Constant Score, visual analog pain scale, Dutch Simple Shoulder Test, SF-12 scores and physical examination were assessed both preoperatively and yearly postoperatively. Complications and revision surgery were documented. Radiographs were evaluated for component size, offset, inclination, height, loosening and subluxation. Results Forty-six patients (12 males) with a mean age of 72 years old (range 59–89) were included. At a mean 6.4-year follow-up (range 5–8), the Constant Score, visual analog pain scale and the Dutch Simple Shoulder Test scores improved significantly (p < 0.05) from baseline. Three patients were lost to follow-up. One patient died and two patients were not able to attend the follow-up appointments, due to other health-related issues. Eleven patients (23%) had a revision operation. Conclusions The most important findings of this study of the Global C.A.P. shoulder resurfacing arthroplasty were an increase of range of motion, a reduction of pain complaints, but a concerning high rate of revision after mid-term follow-up. Level of evidence Therapeutic Level IV.
      PubDate: 2017-06-01
      DOI: 10.1007/s00402-017-2688-9
      Issue No: Vol. 137, No. 6 (2017)
  • Femoral neck fracture osteosynthesis by the biplane double-supported screw
           fixation method (BDSF) reduces the risk of fixation failure: clinical
           outcomes in 207 patients
    • Authors: Orlin Filipov; Karl Stoffel; Boyko Gueorguiev; Christoph Sommer
      Pages: 779 - 788
      Abstract: Introduction Osteosynthesis of femoral neck fractures is related up to 46% rate of complications. The novel method of biplane double-supported screw fixation (BDSF; Filipov’s method) offers better stability using three medially diverging cannulated screws with two of them buttressed on the calcar. Biomechanically, the most effective component is the distal screw placed at steeper angle and supported on a large area along the distal and posterior cortex of the femoral neck following its spiral anterior curve. Thereby, BDSF achieves the strongest possible distal-posterior cortical support for the fixation construct, which allows for immediate full weight-bearing. The aim of this study was to evaluate the outcomes from the first 5-year period of BDSF clinical application. Materials and methods Subject of this retrospective study were 207 patients with displaced Garden III–IV femoral neck fractures treated with BDSF. Three 7.3-mm cannulated screws were laid in two medially diverging oblique planes. The distal and the middle screws were supported on the calcar. The distal screw had additional support on the posterior neck cortex. Results The outcomes in 207 patients were analysed in 29.6 ± 16.8 months follow-up. Bone union occurred in 96.6% of the cases (males 97.6%, females 96.4%, P = 0.99). Rate of nonunion was 3.4%, including fixation failure (2.4%), pseudoarthrosis (0.5%) and nonunion with AVN (0.5%). Rate of AVN was 12.1% (males 4.8%, females 13.9%, P = 0.12). Modified Harris hip score was 86.2 ± 18.9 (range 10–100), with no significant difference between genders, P = 0.07. Older patients were admitted with significantly more comorbidities (P = 0.001), and on follow-up they were significantly less mobile (P = 0.005) and had significantly more difficulties to put socks and shoes on (P < 0.001). Conclusions By providing additional cortical support, the novel BDSF method enhances femoral neck fracture fixation strength.
      PubDate: 2017-06-01
      DOI: 10.1007/s00402-017-2689-8
      Issue No: Vol. 137, No. 6 (2017)
  • Using an anatomically preshaped low-profile locking plate system leads to
           reliable results in comminuted radial head fractures
    • Authors: Moritz Crönlein; Michael Zyskowski; Marc Beirer; Florian B. Imhoff; Dominik Pförringer; Gunther H. Sandmann; Chlodwig Kirchhoff; Peter Biberthaler; Sebastian Siebenlist
      Pages: 789 - 795
      Abstract: Introduction For comminuted and displaced fractures of the radial head open reduction and internal fixation (ORIF) is recommended nowadays as the treatment of choice. Due to the development of locking plates the possibilities of ORIF in complex fracture types were extended. The purpose of this retrospective survey therefore was to review the preliminary subjective and objective results in patients treated by anatomically preshaped locked plating. A reliable fracture healing for these recently introduced plating devices was hypothesized. Materials and methods Subjective and objective criteria included patient’s satisfaction, pain rating on a visual analogue scale (VAS) and active range of motion (ROM) compared to the contralateral armside. Functional scoring included the Morrey elbow performance score (MEPS), the QuickDASH and the elbow self-assessment score (ESAS). Furthermore, follow-up radiographs were reviewed. Results Between 2011 and 2014 a total of 24 patients were managed with ORIF using anatomically preshaped low-profile locking plates. All patients had suffered from comminuted radial head fractures (type III–IV according to Mason classification). Twenty of 24 patients returned for follow-up examination after a mean of 30 months (range 18–53 months). Patients' satisfaction was rated as highly satisfied in 17 cases and satisfied in 3 cases. An unrestricted ROM for extension-flexion arc and pronation-supination arc was rated in 10 cases. Minor ROM deficiencies with a 5° limited extension compared to the contralateral side was evaluated in 6 cases. Only four patients were rated with and extension and supination deficiency of 10°, one of whom with an additional pronation deficiency of 10°. The calculated MEPS was Ø 98 ± 4 (range 85–100), and the QuickDASH was Ø 3 ± 6 (range 0–21). The ESAS was completed by 18 patients with a mean of Ø 96.54 ± 2.95 (range 94–100) indicating a non-restricted elbow function. Conclusions The treatment of comminuted radial head fractures using anatomically preshaped locking radial head plates represents a reliable and safe surgical approach, leading to good to excellent functional results. Being aware of the importance of the radial head for elbow stability, open reduction and internal fixation should be preferred prior to radial head resection or replacement in complex radial head fractures. Further trials with a higher number of patients are needed to confirm the advantages of preshaped radial head plates.
      PubDate: 2017-06-01
      DOI: 10.1007/s00402-017-2693-z
      Issue No: Vol. 137, No. 6 (2017)
  • A comparison of apixaban and dabigatran etexilate for thromboprophylaxis
           following hip and knee replacement surgery
    • Authors: Adriane Mayer; Philipp Schuster; Bernd Fink
      Pages: 797 - 803
      Abstract: Introduction Patients who have undergone hip or knee replacement surgery are exposed to a high risk of developing a post-operative venous thromboembolus and so have a need for an effective, medication-based, thrombosis prophylaxis. New orally active anticoagulants have been available for a few years now. These specific substances directly block either thrombin (e.g., dabigatran etexilate) or Factor Xa (e.g., apixaban). It is not clear whether there are any efficacy differences between these two substances because there have never been any head-to-head studies carried out. Materials and methods We have carried out a study comparing two new orally active anticoagulants dabigatran etexilate (Pradaxa®) and apixaban (Eliquis®) that were each given to two groups of 200 patients respectively, who had undergone elective hip or knee arthroplasty (100 each). Each patient was assessed for pre- and post-operative hemoglobin concentrations, post-operative blood loss, the number of transfused erythrocyte concentrates, the duration of wound secretion, clinical thromboembolic complications (deep vein thrombosis, pulmonary embolism, myocardial infarct), as well as gastrointestinal, intracranial or wound-related bleeding complications. Results Dabigatran etexilate treatment led to a significant increase in the duration of wound secretion in both arthroplasty groups when compared to apixaban: wound secretion lasted 1.2 days longer on average in the dabigatran etexilate group than in the apixaban group (4.1 ± 2.1 vs. 2.9 ± 1.8 days). There were no significant differences observed between the two anticoagulant groups when comparing pre- and post-operative Hb values, post-operative blood loss and the other clinical parameters. Conclusions Thus, it appears that the direct thrombin inhibitor, dabigatran etexilate, is associated with a longer period of wound secretion following the implantation of hip and knee endoprostheses than that associated with the Factor Xa inhibitor, apixaban.
      PubDate: 2017-06-01
      DOI: 10.1007/s00402-017-2697-8
      Issue No: Vol. 137, No. 6 (2017)
  • Relationship between size of disc and early postoperative outcomes after
           lumbar discectomy
    • Authors: Derick C. En’Wezoh; Dana A. Leonard; Andrew J. Schoenfeld; Mitchel B. Harris; Jay M. Zampini; Christopher M. Bono
      Pages: 805 - 811
      Abstract: Background Previous studies suggest that patients with larger disc herniations (greater than 6 mm) will have better outcomes following discectomy. This has not been validated in a large series of patients. Purpose We sought to empirically evaluate this relationship in a series of patients who had data collected prospectively as part of a randomized trial. Methods This retrospective review included 63 consecutive adult patients who underwent a single-level, primary lumbar discectomy. Outcomes were VAS for leg and back pain and the modified oswestry disability index (MODI). Statistical tests were used to compare patients using different cutoffs of preoperative disc diameters and disc volume removed. Regression analysis was performed to determine if there was a relationship between outcomes and the measured parameters. Results While patients who achieved substantial clinical benefit (SCB) for MODI had larger disc diameters, this relationship was not found for leg or back pain for any of the measured parameters. Using 5, 6, 7, or 8 mm as a cutoff for disc diameter demonstrated no differences. Regression analysis did not demonstrate a significant relationship between disc volume removed and final MODI scores. Conclusion While patients with larger disc herniations on average might have a greater likelihood of superior clinical outcomes, the previously suggested “6 mm rule” was not supported.
      PubDate: 2017-06-01
      DOI: 10.1007/s00402-017-2699-6
      Issue No: Vol. 137, No. 6 (2017)
  • Total wrist arthrodesis for septic wrist arthritis and loss of the bony
           carpus following percutaneous pinning of the fifth carpometacarpal joint:
           a case report
    • Authors: C. Deml; S. A. Euler; G. Schmidle; S. Erhart; M. Gabl; R. Arora
      Pages: 813 - 816
      Abstract: We report on a patient who developed septic wrist arthritis with destruction of the entire carpus due to osteomyelitis following percutaneous pinning of a fifth metacarpal base fracture. Arthrodesis was performed using a 6 cm vascularized iliac bone graft. This case report may sharpen the surgeon’s awareness of risks in orthopedic surgeries, even though the procedure seems to be rather simple and the patient is young and seems to be healthy.
      PubDate: 2017-06-01
      DOI: 10.1007/s00402-017-2660-8
      Issue No: Vol. 137, No. 6 (2017)
  • Computer-aided analysis for optimal screw insertion in lateral mass of C1:
           An anatomical study
    • Authors: Renate Krassnig; Jakob Andrea Orlandi; Ellen Tackner; Gloria Hohenberger; Paul Puchwein
      Pages: 817 - 822
      Abstract: Introduction Motion preserving techniques in C1 ring fractures are increasingly used especially in young patients. Therefore, lateral mass screws are inserted in the first vertebra and connected by a rod. The purpose of this study was to determine safe zones regarding the vertebral arteries and the medulla oblongata for optimal lateral mass screw positioning when fusing the C1-ring. Materials and methods Images of the cervical spine of 50 patients (64-line CT scanner) were evaluated and virtual screws were positioned in both lateral masses of the first vertebra using 3D-reconstructions of CT scans. The length of the screws, the insertion angles in two planes, the distance to the vertebral artery, and the spinal canal was investigated. Descriptive statistics was used and gender-dependent differences were calculated using student t-test. A diameter of 4 mm was chosen for the screws. Results The mean screw length was 30.0 ± 2.3 mm on the right and 30.1 ± 2.1 mm on the left side. The arithmetic mean for the transverse angle was 16.4 ± 5.6° on the right and 15.6 ± 6.3° on the left, the sagittal angle averaged 8.3 ± 3.8° on the right, and 11.0 ± 4.9° on the left side. The mean distance between screw and spinal canal has been determined on the right with 2.4 ± 0.7 mm and 2.2 ± 0.6 mm on the left side. The distance from the C1 lateral mass screw to the vertebral artery was on average 7.1 ± 1.5 mm on the right side (significant correlation with gender, p value: 0.03) and 7.4 ± 1.4 mm on the left side. Conclusions Screws should be positioned with a slightly converging angle of 16° and a slightly ascending angle of 10°. Due to the required high precision technique intraoperatively multiplanar 2 D or 3 D imaging is recommended to avoid harm to the vertebral artery or the spinal canal.
      PubDate: 2017-06-01
      DOI: 10.1007/s00402-017-2678-y
      Issue No: Vol. 137, No. 6 (2017)
  • Treatment and outcome with traumatic lesions of the olecranon and
           prepatellar bursa: a literature review apropos a retrospective analysis
           including 552 cases
    • Authors: Christoph Raas; René Attal; Peter Kaiser; Marina Popovscaia; Michael Zegg
      Pages: 823 - 827
      Abstract: Background Traumatic lesions of the olecranon bursa (OB) and prepatellar bursa (PB) are injuries commonly seen in orthopaedic trauma units. These injuries are associated with a high rate of complications. At present, only little is known about the incidence, complication rate, and treatment approaches in patients with acute open bursae. Materials and methods A total of 552 patients who had been treated for acute traumatic lesions of either the olecranon bursa or the prepatellar bursa, or both at our department were retrospective identified in the years between 2009 and 2014. An analysis of the medical history of these patients was carried out to investigate the incidence of bursa injuries, circumstances, concomitant injuries, complication rate, and treatment approaches. In addition, a systematic literature search on PubMed was conducted. Results The incidence of traumatic lesions of the OB or PB in trauma patients was 0.2% (198/100,000; 62% OB, 38% PB). Bursectomy was performed in 83.7%. Concomitant injuries were present in 41% of the cases, with no significant influence on the complication rate (P = 0.367). The overall complication rate was 19.7%. Revision surgery was necessary in 4.5% of the patients. No significant differences between OB and PB injuries were noted with regard to the complication rate (P = 0.221). There were also no significant differences in the complication rate between patients who received bursectomy and those with conservative treatment (P = 0.364). Regression analyses showed that prophylactic antibiotic administration significantly reduced the risk of infection (P = 0.04). Conclusions Traumatic lesions of the OB and PB are associated with a high risk of complications. Prophylactic antibiotic therapy can potentially reduce the risk of infection and the need for revision surgery.
      PubDate: 2017-06-01
      DOI: 10.1007/s00402-017-2690-2
      Issue No: Vol. 137, No. 6 (2017)
  • Suprapectoral biceps tenodesis using a suture plate: clinical results
           after 2 years
    • Authors: Christian Schoch; Michael Geyer; Björn Drews
      Pages: 829 - 835
      Abstract: Purpose Several techniques for performing a tenodesis of the long head of biceps (LHB) are described. Only few outcome studies are published. This note describes a unicortical fixation via a suture plate—comparable to a distal biceps refixation-performed arthroscopically or mini-open via standard suprapectoral approach. The aim of this study is to show the clinical outcome after 6, 12, and 24 months. Materials and methods A consecutive series of 50 (35 male, 15 female) patients at the mean age of 49 years (range 23–75) who underwent tenodesis of the LHB were followed for 2 years. All patients were operated by a single surgeon (CS). The clinical evaluation included Constant score, Scheibel LHB score and VAS. Structural integrity of the tenodesis was checked by ultrasound control. Integrity of the tenodesis was evaluated indirectly by detecting the LHB-tendon up to the ultrasound-reflex of the button. No tendon at the button-reflex was considered as failure of the tenodesis. An independent examiner who was not the operating surgeon performed all evaluations. (MG evaluated the patients operated by CS). Results Mean follow-up was 29.5 (range 22–32) months. The mean pre-operative Constant Murley score (CMS) was 67.4 points (range 45–78) and increased to 84.7 points (range 51–99) after 2 years. LHB Score was 90.8 after 24 months. We identified 2 failed biceps fixations (4%). Pain relief was achieved in most patients within the first 12 weeks. After 2 years, the mean biceps flexion strength averaged 84% of the healthy arm. Conclusions Tenodesis of the LHB with a unicortical suture plate is a safe fixation technique with good-to-excellent clinical results after a minimum follow-up of 2 years. Long-term follow-up is needed.
      PubDate: 2017-06-01
      DOI: 10.1007/s00402-017-2664-4
      Issue No: Vol. 137, No. 6 (2017)
  • The frequency of cartilage lesions in non-injured knees with symptomatic
           meniscus tears: results from an arthroscopic and NIR- (near-infrared)
           spectroscopic investigation
    • Authors: Gunter Spahn; Holger Plettenberg; Martin Hoffmann; Holm-Torsten Klemm; Christoph Brochhausen-Delius; Gunther O. Hofmann
      Pages: 837 - 844
      Abstract: Introduction Are symptomatic tear injuries to the menisci of the knee frequently or always associated with cartilage damage to the corresponding articular surfaces and other joint surfaces, respectively? Methods A total of 137 patients (medial n = 127; lateral n = 10) underwent a meniscus resection. These patients showed no signs of a clear radiographic arthrosis and no MRI-detectable cartilage lesions > grade II. Traumatic injury was ruled out with a thorough medical history. The indication for operation was made exclusively on the basis of distinct, clinically apparent meniscus signs. In addition to the ICRS classification, all articular surfaces were examined spectroscopically (NIRS, near-infrared spectroscopy). Results In 76.6% (n = 105) of all knees examined, clear cartilage damage (ICRS-grade III/IV) was found. For 43.8%, these were in the area of the patella, while for 34.3% they were in the area of the medial femur, and for 17.5%, in the area of the medial tibial plateau. More rarely, this damage was localized to the area of the trochlea (8.8%) or the lateral joint compartment (femoral 2.2%, tibial 15.3%). There were no significant differences between patients with medial or lateral meniscus lesions with respect to the distribution pattern of the joint injuries. During spectroscopic examination, pathological values were demonstrated (objective evidence of cartilage degeneration) in at least one of the examined articular surfaces (media n = 6, range 1–6). Conclusion Through our investigations, a high, if not complete, concomitance of degenerative cartilage lesions and degenerative meniscus damage was demonstrated. From this it can be concluded that the entity of “isolated degenerative meniscus damage” clearly does not exist in practice. It is therefore highly probable that degenerative meniscus lesions, as a part of general joint degeneration, are to be interpreted in the context of the development of arthrosis. The practical consequences still are unclear. Patients after partial meniscectomy need a longer follow-up to detect potential cartilage lesions as well as an OA progression.
      PubDate: 2017-06-01
      DOI: 10.1007/s00402-017-2672-4
      Issue No: Vol. 137, No. 6 (2017)
  • Quantification of dynamic posterior translation in modified bilateral
           Alexander views and correlation with clinical and radiological parameters
           in patients with acute acromioclavicular joint instability
    • Authors: Marvin Minkus; Carmen Hann; Markus Scheibel; Natascha Kraus
      Pages: 845 - 852
      Abstract: Introduction Classification of AC-joint instability is based on radiologic evaluation of anteroposterior (a.p.) stress views of both shoulders, neglecting the horizontal component of instability. Recent studies have proposed an association of dynamic posterior translation (DPT) and inferior clinical results. The purpose of this study was to quantify DPT in modified Alexander views and correlate it with other radiological and clinical data. Materials and methods Thirty-two patients (4 f, 28 m, mean age 34.1) with acute AC-joint dislocation (16 = RW III, 16 = RW V) underwent radiological examination including bilateral a.p. stress views with measurement of the coracoclavicular distance (CCD) and bilateral modified Alexander views with different approaches to quantify DPT (overlapping area OAAC, overlapping length OLAC). In addition, the Constant Score, Subjective Shoulder Value, Taft Score (TF), and the Acromioclavicular Joint Instability Score (ACJI) were obtained. Results In Rockwood (RW) type III injuries, a mean CCD of 15.8 (9.8–22.8) mm, OAAC of 50.9 (0–216.6) mm2, and OLAC of 6.5 (−4.7–17.9) mm were found. RW V patients showed a CCD of 23.1 (13.7–32.0) mm; OAAC 7.0 (0–92.3) mm2; and OLAC −4.8 (−19.6–9.8) mm. Particularly in RW III the CCD, OAAC and OLAC revealed significant correlation with the ACJI (r = −0.64/r = 0.72/r = 0.68, p < 0.05) and TF (r = −0.56/r = 0.68/r = 0.51, p < 0.05). The proposed quantification tools for DPT were found to have a moderate-to-strong correlation with the score results, especially with AC-joint specific scores. RW type V injuries had a moderate correlation with clinical parameters (OAAC with ACJI: r = 0.44, p > 0.05 and OLAC with TF: r = −0.45, p > 0.05). Conclusions Measuring the OLAC is a convenient way for quantifying DPT in modified Alexander views. It showed significant correlation with clinical scores, indicating the relevance of DPT in patients with AC-joint injury.
      PubDate: 2017-06-01
      DOI: 10.1007/s00402-017-2691-1
      Issue No: Vol. 137, No. 6 (2017)
  • Does the tibia component design affect the need for offset stems in
           revision total knee arthroplasty?
    • Authors: X. Foruria; T. Schmidt-Braekling; D. Arana Nabarte; M. Faschingbauer; M. Kasparek; F. Boettner
      Pages: 853 - 860
      Abstract: Introduction The stem/keel location varies between anatomic and symmetric revision tibial baseplates. The current study investigates the impact of an anatomic versus symmetric stem location on the need for offset couplers in revision total knee arthroplasty. Materials and methods Hip to ankle standing radiographs and lateral radiographs of 75 patients were analyzed using digital templating software. The offset in the anterior–posterior as well as medial–lateral plane between the center of the tibial diaphysis and the stem of the tibial baseplate were determined for an anatomic and symmetric tibial baseplate, respectively. Measurements were repeated for 4 resection levels: tip of fibular head (0), 10 mm (1), 15 mm (2) and 20 mm (3) below the tip of the fibula head. Results Anatomic tibial baseplates require less offset for resection levels up to the tip of the fibula: total offset 2.28 versus 5.44 mm (p < 0.001). However, for defects that result in resection levels below the tip of the fibula symmetric tibial baseplates require less offset: resection level 1: 3.18 versus 2.4 mm (p = 0.008), 2: 4.81 versus 1.67 mm (p < 0.001) and resection level 3: 5.66 versus 1.52 mm (P < 0.001). Conclusion The current study suggests that while asymmetric anatomic tibial baseplates have benefits for revisions with minimal bone loss, symmetric tibial baseplates require less offset when larger bone defects are encountered.
      PubDate: 2017-06-01
      DOI: 10.1007/s00402-017-2677-z
      Issue No: Vol. 137, No. 6 (2017)
  • Impingement of the patellar component against the tibial post after
           posterior stabilized and constrained TKA: a pilot study
    • Authors: Yukihide Minoda; Ryo Sugama; Yoichi Ohta; Hiroaki Nakamura
      Pages: 861 - 865
      Abstract: Introduction Patella-post impingement (PPI), contact of the patellar component with the tibial post, occurs during deep knee flexion after posterior stabilized total knee arthroplasty (TKA). PPI can cause anterior knee pain, increased patellar pressure, wear of the polyethylene patellar component and tibial post, and poor range of motion. There have been no reports on the relationship between PPI and tibial post design. The aim of this study was to compare different tibial post designs with regard to PPI incidence. Materials and methods Five posterior stabilized total knee prostheses were implanted in full-length models of the femur and tibia (Sawbones) using a navigation system. The thickness of the tibial component was 10 mm in all prostheses. The patella was set on a transparent polypropylene sheet, which was fixed to the tibial tubercle. The distance between the lower edge of the patellar component and the cut surface of the tibia was defined as the tibial–patellar clearance (TPC), which represents the length of the patellar tendon. The TPC was varied from 18 to 40 mm and the knee was moved from full extension to deep flexion while the knee angle at which PPI occurred (PPI angle) was recorded. Results The PPI angle differed between tibial post designs (p < 0.05). Shorter TPCs resulted in smaller PPI angles and longer TPCs resulted in larger PPI angles (p < 0.05). Conclusions This is the first study to analyze the relationship between PPI and the design of tibial post. Our results clearly show that tibial post design and TPC affect PPI. To avoid patellar component and tibial post impingement in deep flexion, appropriate TPC must be achieved during surgery. Improvements in tibial post design, especially in constrained prostheses, are also desirable. This study highlights the potential risk of PPI during deep flexion after TKA.
      PubDate: 2017-06-01
      DOI: 10.1007/s00402-017-2682-2
      Issue No: Vol. 137, No. 6 (2017)
  • A modified Matti–Russe technique of grafting scaphoid non-unions
    • Authors: Moritz Dustmann; Ralf Bajinski; Alexander Tripp; Joachim Gülke; Nikolaus Wachter
      Pages: 867 - 873
      Abstract: Introduction In treatment of scaphoid non-union bone healing requires beside vital tissue and stability, enduring compression and a good interface between the graft and scaphoid fragments. While fixation techniques show a good primary stability, they reduce sintering and thus compression of fragments in the long term. Therefore, a modified technique optimising the cancellous interface between graft and scaphoid but still providing enough stability without fixating implants should be evaluated. Materials and methods A corticocancellous bone graft from iliac crest was shaped ellipsoid and was implanted in a modified Matti–Russe press fit-technique. Thereby the cancellous side contacts the scaphoid fragments. In a retrospective design, we reviewed 52 patients with documented non-unions of the scaphoid. The average length of follow-up was 8.6 months. Range-of-motion, pain and grip-strength was measured and compared with contralateral wrist. Radiological assessment included beside X-rays CT scans. Results were further measured by DASH score and Mayo wrist score. Results The average postoperative pain was 0.9 based on NRS-Score. The mean range-of-motion was satisfactory with a dorsal-palmar arch of 115.3°, radial-ulnar: 48.2° and pro-supination: 171.3°. Mayo Wrist Score showed with 91.2 out of 100 an excellent result. The analysis of DASH score revealed a mild subjective constriction (9.2/100). Regarding roentgenographic findings complete union was confirmed in 44 of the 52 patients (84.6%). Patients with non-union were significantly older than patients with union (p < 0.05). Grip-strength on average was equal to that of the uninjured hand although in failure cases a slightly reduced grip-strength was seen. Conclusions The modified technique of Matti–Russe provided a good contact of the cancellous part of the bone graft to the scaphoid in grafting a scaphoid pseudarthrosis with a high healing rate. However, since age, previous failed surgery and a proximal fracture line are the most important handicaps for bone healing in this study, for patients at risk gadolinium-enhanced MRI scan could be helpful to estimate vascularisation preoperatively. In cases of poor vitality, vascularised bone grafting should be considered.
      PubDate: 2017-06-01
      DOI: 10.1007/s00402-017-2680-4
      Issue No: Vol. 137, No. 6 (2017)
  • Unusual cause of the thumb basal joint pain: osteoid osteoma of the
    • Authors: Ji Hun Park; Tae Wook Kang; Jong Woong Park
      Pages: 875 - 878
      Abstract: The trapezium is rare site of osteoid osteoma development. The diagnostic challenge lies in its rare occurrence, and requires differentiation from various disease entities causing thumb basal joint pain. We report the case of a 29-year-old male who presented with severe thumb basal joint pain. He was initially treated for calcific periarthritis because of concomitant calcifications around the thumb basal joint, but had undiscovered osteoid osteoma. A high index of suspicion to a patient with wrist pain unresponsive to prior treatment is necessary for diagnosis of osteoid osteoma.
      PubDate: 2017-06-01
      DOI: 10.1007/s00402-017-2692-0
      Issue No: Vol. 137, No. 6 (2017)
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