In-hospital mortality of pelvic ring fractures in older adults now and then: A pelvic registry study.

Aim: With the predicted demographic change, the treatment of geriatric patients will become a major issue for health systems worldwide. The majority of pelvic ring fractures occur in older adults, and their treatment might be associated with a distinct mortality. Herein, we analyzed the data of 5665 patients with pelvic ring fractures aged ≥60 years included in the German Pelvic Trauma Registry from 1991 to 2013.

Pelvic ring fractures in the elderly now and then - a pelvic registry study.

Objectives: To analyze the changes in demographic data stratified for age, sex and type of injury of elderly patients suffering from pelvic ring fractures over a 22-year observation period.

Design/setting: Data has been collected prospectively, multi-centrically in hospitals participating in the German Pelvic Trauma Registry.

Patients: We analyzed the data of 5665 patients with an age ≥60years included in the German Pelvic Trauma Registry from 1991 to 2013.

Surgical treatment of pelvic ring fractures in the elderly now and then: a pelvic registry study.

Background: With the demographic change, the treatment of elderly patients has become a major issue for health systems worldwide.

Aims: The aim of this study was to analyze the change in the rate of surgical treatment of pelvic ring fractures in patients with an age of ≥60 years over a 22-year period depending on fracture type, age and sex.

Methods: Data of 5665 patients with an age of ≥60 years, who were treated for pelvic ring fractures from 1991 to 2013 in one of 31 hospitals participating in the German Pelvic Trauma Registry, were included.

A novel tool for continuous fracture aftercare - Clinical feasibility and first results of a new telemetric gait analysis insole.

Weight bearing after lower extremity fractures still remains a highly controversial issue. Even in ankle fractures, the most common lower extremity injury no standard aftercare protocol has been established. Average non weight bearing times range from 0 to 7 weeks, with standardised, radiological healing controls at fixed time intervals.

Predictors of mortality for complex fractures of the pelvic ring in the elderly: a twelve-year review from a German level I trauma center.

Study Objective: To document mortality rate and predictors of mortality in elderly patients with complex pelvic fractures.

Methods: We reviewed a total of 84 subjects whose ages were above 70 years with complex pelvic fractures, admitted to our hospital from January 2001 to December 2012. A multivariate linear regression model was used to determine the predictors of mortality in the study population.

Pelvic fracture in multiple trauma: are we still up-to-date with massive fluid resuscitation?

Until today the mortality of complex pelvic trauma remains unacceptably high. On the one hand this could be attributed to a biological limit of the survivable trauma load, on the other hand side an ongoing inadequate treatment might be conceivable too. For the management of multiple trauma patients with life-threatening pelvic fractures, there is ongoing international debate on the adequate therapeutic strategy, e.

Endostatin inhibits Callus remodeling during fracture healing in mice.

Information on the impact of endogenous anti-angiogenic factors on bone repair is limited. The hypothesis of the present study was endostatin, an endogenous inhibitor of angiogenesis, disturbs fracture healing. We evaluated this hypothesis in a closed femoral fracture model studying two groups of mice, one that was treated by a daily injection of 10 µg recombinant endostatin subcutaneously (n = 38) and a second one that received the vehicle for control (n = 37).

Trauma registry record linkage: methodological approach to benefit from complementary data using the example of the German Pelvic Injury Register and the TraumaRegister DGU(®).

Background: In Germany, hospitals can deliver data from patients with pelvic fractures selectively or twofold to two different trauma registries, i.e. the German Pelvic Injury Register (PIR) and the TraumaRegister DGU(®) (TR).

What are predictors for patients' quality of life after pelvic ring fractures?

Background: Data from literature on predictors for patients' quality of life after pelvic ring fractures are conflicting and based on small study populations.

Questions/purposes: We therefore evaluated predictors for health-related quality of life in patients with pelvic ring injuries at a minimum of 1 year postfracture.

Methods: We surveyed 172 patients of the German Pelvic Trauma Registry admitted to four medical centers between February 3, 2004, and May 11, 2011.

Delayed fracture healing in aged senescence-accelerated P6 mice.

Background: Osteoporosis is characterized by poor bone quality. However, it is still controversially discussed whether osteoporosis compromises fracture healing. Herein, we studied whether the course of healing of a femur fracture is affected by osteoporosis or age.

Excess dietary methionine does not affect fracture healing in mice.

Background: An elevated serum concentration of homocysteine (hyperhomocysteinemia) has been shown to disturb fracture healing. As the essential amino acid, methionine, is a precursor of homocysteine, we aimed to investigate whether excess methionine intake affects bone repair.

Material/methods: We analyzed bone repair in 2 groups of mice.

Soft tissue fibroblasts from well healing and chronic human wounds show different rates of myofibroblasts in vitro.

Due to an increasing life expectancy in western countries, chronic wound treatment will be an emerging challenge in the next decades. Because therapies are improving slowly appropriate diagnostic tools enabling the early prediction of the healing success remain to be developed. We used a well-established in vitro assay in combination with the analysis of 27 cytokines to discriminate between fibroblasts from chronic (n = 6) and well healing (n = 8) human wounds.

Early detection of subclinical organ dysfunction by microdialysis of the rectus abdominis muscle in a porcine model of critical intra-abdominal hypertension.

The aim of this study was to evaluate microdialysis of the rectus abdominis muscle (RAM) for early detection of subclinical organ dysfunction in a porcine model of critical intra-abdominal hypertension (IAH). Microdialysis catheters for analyses of lactate, pyruvate, and glycerol levels were placed in cervical muscles (control), gastric and jejunal wall, liver, kidney, and RAM of 30 anesthetized mechanically ventilated pigs. Catheters for venous lactate and interleukin 6 samples were placed in the jugular, portal, and femoral vein.

A new model to analyze metaphyseal bone healing in mice.

Background: Despite the increasing clinical problems with metaphyseal fractures, most experimental studies investigate the healing of diaphyseal fractures. Although the mouse would be the preferable species to study the molecular and genetic aspects of metaphyseal fracture healing, a murine model does not exist yet. Using a special locking plate system, we herein introduce a new model, which allows the analysis of metaphyseal bone healing in mice.

What are predictors of mortality in patients with pelvic fractures?

Background: Our knowledge of factors influencing mortality of patients with pelvic ring injuries and the impact of associated injuries is currently based on limited information.

Questions/purposes: We identified the (1) causes and time of death, (2) demography, and (3) pattern and severity of injuries in patients with pelvic ring fractures who did not survive.

Methods: We prospectively collected data on 5340 patients listed in the German Pelvic Trauma Registry between April 30, 2004 and July 29, 2011; 3034 of 5340 (57%) patients were female.

Initial experience using a pelvic emergency simulator to train reduction in blood loss.

Background: Because the average exposure of surgeons to pelvic injuries with life-threatening hemorrhage is decreasing, training opportunities are necessary to prepare surgeons for the rare but highly demanding emergency situations. We have developed a novel pelvic emergency simulator to train surgeons in controlling blood loss.

Questions/purposes: We (1) described the design and use of the simulator; and (2) determined whether the simulator correctly identified proper and improper mechanical stabilization and bleeding control.

Increased osteoblast and osteoclast activity in female senescence-accelerated, osteoporotic SAMP6 mice during fracture healing.

Background: Previous studies have shown that fracture healing depends on gender and that in females, ovariectomy-induced osteoporosis impairs the healing process. There is no information, however, whether the alteration of fracture healing in osteoporosis also depends on gender.

Materials And Methods: Therefore, we herein studied fracture healing in female and male senescence-accelerated osteoporotic mice, strain P6 (SAMP6), including biomechanical, histomorphometric, and protein biochemical analysis.

High bone concentrations of homocysteine are associated with altered bone morphology in humans.

Accumulation of homocysteine and S-adenosylhomocysteine in bone has been shown to be associated with reduced bone quality in rats. The aim of the present study was to investigate whether high bone concentrations of homocysteine and S-adenosylhomocysteine as well as a low methylation capacity are related to an impaired bone morphology in humans. Concentrations of homocysteine and its precursors S-adenosylhomocysteine and S-adenosylmethionine were measured in femoral bone samples of eighty-two males and females (age 71 (SD 8) years) who underwent elective hip arthroplasty.

Exercise enhances angiogenesis during bone defect healing in mice.

The aim of the present study was to investigate the effect of exercise on angiogenesis during bone defect healing in mice. We evaluated angiogenesis during cranial bone defect healing by intravital fluorescence microscopy (IVM) at days 0-21. To characterize the type of bone repair, we performed additional histomorphometric analyses at days 3-15.

Sildenafil accelerates fracture healing in mice.

Sildenafil, a cyclic guanosine monophosphate (cGMP)-dependent phospodiesterase-5 inhibitor, has been shown to be a potent stimulator of angiogenesis through upregulation of pro-angiogenic factors and control of cGMP concentration. Herein, we determined whether sildenafil also influences angiogenic growth factor expression and bone formation during the process of fracture healing. Bone healing was studied in a murine closed femur fracture model using radiological, biomechanical, histomorphometric, and protein biochemical analysis at 2 and 5 weeks after fracture.

Melatonin impairs fracture healing by suppressing RANKL-mediated bone remodeling.

Background: Melatonin, the major pineal hormone, is known to regulate distinct physiologic processes. Previous studies have suggested that it supports skeletal growth and bone formation, most probably by inhibiting bone resorption. There is no information, however, whether melatonin affects fracture healing.

The LockingMouseNail--a new implant for standardized stable osteosynthesis in mice.

Background: Mouse models are of increasing interest to study cellular and molecular mechanisms during fracture healing. However, unlike in large animals and in humans, stable fixation of fractures has been difficult due to the small size of the mouse.

Methods: Based on μCT-scans of a mouse femur, we developed a new intramedullary implant system comparable to a human locking nail.

Compartment pressure of the rectus sheath accurately reflects intra-abdominal pressure in a porcine model.

Background: To investigate whether the compartment pressure of the rectus sheath (CPRS) reflects the intra-abdominal pressure (IAP) under various conditions of intra-abdominal hypertension (IAH) in a pig model.

Design: Prospective experimental study with in vivo pressure measurements.

Setting: Institute for Clinical and Experimental Surgery, University of Saarland.

Hyperhomocysteinemia is not associated with reduced bone quality in humans with hip osteoarthritis.

Background: Recent clinical and animal studies suggest that increased serum homocysteine (HCY) concentrations may be a risk factor for osteoporosis. In vitro studies showed that increasing HCY concentrations stimulate the activity of human osteoclasts. However, there is no data demonstrating that circulating HCY is related to structural and biomechanical properties of human bones.

An internal locking plate to study intramembranous bone healing in a mouse femur fracture model.

In most murine fracture models, the femur is stabilized by an intramedullary implant and heals predominantly through endochondral ossification. The aim of the present study was to establish a mouse model in which fractures heal intra-membraneously. Femur fractures of 16 SKH-mice were stabilized by an internal locking plate.