Einfluss von Musik auf Stressparameter und Anästhetikabedarf während Spinalanästhesie

Hintergrund: Diese doppelblinde, randomisierte und kontrollierte Studie untersucht den Effekt von instrumentaler Musik auf Stresshormone und den Verbrauch von Sedativa während einer in Spinalanästhesie durchgeführten elektiven Hüftprothesenoperation. Methoden: 40 Patienten wurden entweder einer Musikgruppe oder einer Kontrollgruppe zugeteilt. Beiden Gruppen wurde die Musik beziehungsweise der Kontrollstimulus circa zwei Stunden vor und während der gesamten Operation dargeboten. Ergebnisse: Patienten der Musikgruppe hatten einen geringeren Sedativaverbrauch und geringere Cortisolwerte als Patienten der Kontrollgruppe. Schlussfolgerung: Die Ergebnisse dieser Studie zeigen, dass Musik während einer Operation in Spinalanästhesie den Sedativaverbrauch senken und zur Verringerung des Stressniveaus gemessen an den Cortisolwerten beitragen kann. Der Einsatz von Musik in bestimmten klinischen Situationen zur Stressreduktion erscheint deshalb sinnvoll

Mobility improvement in the first 6 postoperative weeks in orthogeriatric fracture patients

BACKGROUND Physical activity is a relevant outcome parameter in orthopedic surgery, that can be objectively assessed. Until now, there is little information regarding objective gait parameters in the orthogeriatric population. This study focuses on the first 6~weeks of postoperative rehabilitation, and delivers objective data about gait speed and step length in typical orthogeriatric fracture patterns. METHODS Thirty-one orthogeriatric fracture patients pertrochanteric femur fractures (PFF), femoral neck (FN), and proximal humerus fractures (PHF) were consecutively enrolled in a maximum care hospital in a prospective study design. All patients wore an accelerometer placed at the waist during the postoperative stay (24~h/d) and at 6-week follow-up, to measure real gait speed and step length. In addition, self-assessment of mobility (Parker mobility score) and activities of daily living (Barthel index) were collected at baseline, during the inpatient stay, and at 6-week follow-up. RESULTS During postoperative hospitalization, significantly higher gait speed (m/s) was observed in the PHF group (0.52 ± 0.27) compared with the FN group (0.36 ± 0.28) and PFF group (0.19 ± 0.28) (p < 0.05). Six~weeks postoperatively, gait speed improved significantly in all groups (PHF 0.90 ± 0.41; FN 0.72 ± 0.13; PFF 0.60 ± 0.23). Similarly, step length (m) differed between groups postoperatively FN 0.16 ± 0.13; PFF 0.12 ± 0.15; PHF 0.31 ± 0.05 (p < 0.005) and improved over time significantly (FN 0.47 ± 0.01; 0.39 ± 0.19; 0.50 ± 0.18). Self-assessment scores indicate that the majority of the patients had minor restrictions in mobility before the fracture. These values decreased immediately postoperatively and improved in the first 6~weeks, but did not reach the initial level. CONCLUSIONS Gait speed, step length, and self-assessment in terms of mobility and activities of daily living improve significantly in the first 6 postoperative weeks in orthogeriatric fracture patients. As very low postoperative mobility during hospitalization was observed, this collective shows great potential in postoperative rehabilitation regardless of their fracture pattern. For this reason, specific aftercare concepts similar to the {\textquotedbl}fast track{\textquotedbl} concepts in primary arthroplasty are crucial for orthogeriatric patients in clinical practice. LEVEL OF EVIDENCE Prospective cohort study, 2

Tibial and femoral osteotomies in varus deformities - radiological and clinical outcome

Background: Varus deformities of the knee are frequently corrected by osteotomies, which should be performed at the level of origin. But in contrast to high tibial osteotomies (HTO), little data exists for distal femoral osteotomies (DFO). This study evaluates radiological and clinical outcomes after valgisation osteotomies in the proximal tibia and distal femur. Methods: We used an observational cohort study design and prospectively performed preoperative long standing radiographs (LSR), lateral x-rays and clinical questionnaires (SF-36, Lysholm score, VAS). Postoperative LSR and lateral x-rays were obtained on average 18 months postoperative and postoperative clinical questionnaires at final visit (mean follow up 46 months). A subgroup analysis of the different surgical techniques (oHTO vs. cDFO) was performed, with regards to radiological and clinical outcomes. Results: Finally 28 osteotomies with medial tibial opening (oHTO) or lateral femoral closing (cDFO) wedge osteotomies in 25 consecutive patients (mean age 40 years) were identified. There were 17 tibal and 11 femoral procedures. All osteotomies were performed at the origin of deformity, which was of different etiology. The average deviation of the final HKA compared to the preoperative planning was 2.4° ± 0.4°. Overall, there was a significant improvement in all clinical scores (SF-36: 61.8 to 79.4, p < 0.001; Lysholm-score: 72.7 to 90.4, p < 0.001; VAS: 3 to 1, p < 0.001). There was no significant correlation between surgical accuracy and outcome scores. Conclusion: Valgisation osteotomies lead to a significant improvement in all clinical scores with the demonstrated treatment protocol. An appreciable proportion of varus deformities are of femoral origin. Since cDFO provides comparable radiological and clinical results as oHTO, this is an important treatment option for varus deformities of femoral origin

Rekonstruktion großer osteochondraler Defekte des distalen Femurs und der proximalen Tibia

The reconstruction of large osteochondral defects is still a challenge in musculoskeletal surgery. Fresh frozen allografts are a frequently used resource for the treatment of such tissue defects. Furthermore, 3D-printed models enable multiple options in the preoperative planning and intraoperative adaptation of the allografts, so that healing is optimal and the best functional outcome for the patient is achieved.Die Rekonstruktion großer osteochondraler Defekte stellt nach wie vor eine Herausforderung in der muskuloskeletalen Chirurgie dar. Frisch gefrorene Allografts sind eine häufig genutzte Ressource für die Behandlung solcher Gewebedefekte. Darüber hinaus ermöglichen 3D-gedruckte Kunststoffmodelle vielfältige Optionen in der präoperativen Planung und bei der intraoperativen Anpassung der Transplantate, sodass sie optimal einheilen und das bestmögliche funktionelle Ergebnis für den Patienten erreicht wird

Gluteales Kompartmentsyndrom nach Liegetrauma bei Opiatabusus

Es wird von einem 42-jährigen Patienten berichtet, der sich bei einem opiatinduzierten Liegetrauma ein gluteales Kompartmentsyndrom mit Affektion des N. ischiadicus und nachfolgender Rhabdomyolyse zugezogen hat. Im Gegensatz zum Kompartmentsyndrom des Unterarms oder des Unterschenkels stellt dieses eine Rarität dar. Nach notfallmäßiger Kompartmentspaltung und Anlage eines Vakuumsystems zum vorübergehenden Wundverschluss konnte mittels forcierter Diurese eine Hämofiltration bei akutem Nierenversagen vermieden werden. Die Sensomotorik der unteren Extremität besserte sich bereits nach der initialen Versorgung; nach einer Woche konnte der sekundäre Wundverschluss durchgeführt werden, elf Tage nach Aufnahme konnte der Patient mit intakter Sensomotorik und normwertigen Retentionsparametern entlassen werden

Reliability of 3D planning and simulations of medial open wedge high tibial osteotomies

Purpose: In medial open-wedge high tibial osteotomy (HTO) hinge axis and osteotomy plane influence the resulting anatomy, but accurate angular quantifications using 3D-planning-simulations are lacking. The objectives of this study were developing a standardized and validated 3D-planning method of an HTO and to perform several simulated realignments to explain unintended anatomy changes. Methods: The cutting direction of the main osteotomy was defined parallel to the medial tibial slope and the hinge axis 1.5 cm distal to the lateral plateau. For interobserver testing, this 3D planning was performed on 13 digital models of human tibiae by two observers. In addition, four different hinge axis positions and five differently inclined osteotomy planes each were simulated. The osteotomy direction ranged from medial 0°–30° anteromedial, while the tilt of the osteotomy plane compared to the tibial plateau was −10° to +10°. All anatomic angular changes were calculated using 3D analysis. Results: Multiple HTO plannings by two medical investigators using standardized procedures showed only minimal differences. In the 3D-simulation, each 10° rotation of the hinge axis resulted in a 1.7° significant increase in slope. Tilting the osteotomy plane by 10° resulted in significant torsional changes of 2°, in addition to minor but significant changes in the medial proximal tibial angle (MPTA). Conclusion: Standardized 3D-planning of the HTO can be performed with high reliability using two-observer planning. 3D-simulations suggest that control of the osteotomy plane is highly relevant to avoid unintended changes in the resulting anatomy, but this can be a helpful tool to modify specific angles in different pathologies in the HTO