experimental-strategies-to-bridge-large-tissue-gaps-injured-spinal

Experimental Strategies to Bridge Large Tissue Gaps in the Injured Spinal Cord after Acute and Chronic Lesion

After a spinal cord injury (SCI) a scar forms in the lesion core which hinders axonal regeneration. Bridging the site of injury after an insult to the ...

BG Trauma Center Hamburg

A computerized robotic surgical system was developed from 1986 by the Thomas J. Watson Research Center. In 1992 the system unit Orthodoc and the milling robot Robodoc were first used on humans. We present the results achieved with Robodoc-assisted total hip arthroplasty in 97 hips.

Results of total hip replacement using the Robodoc surgical assistant system: clinical outcome and evaluation of complications for 97 procedures.

Complete transection of the spinal cord leaves a gap of several mm which fills with fibrous scar tissue. Several approaches in rodent models have used tubes, foams, matrices or tissue implants to bridge this gap. Here, we describe a mechanical microconnector system (mMS) to re-adjust the retracted spinal cord stumps. The mMS is a multi-channel system of polymethylmethacrylate (PMMA), designed to fit into the spinal cord tissue gap after transection, with an outlet tubing system to apply negative pressure to the mMS thus sucking the spinal cord stumps into the honeycomb-structured holes. The stumps adhere to the microstructure of the mMS walls and remain in the mMS after removal of the vacuum. We show that the mMS preserves tissue integrity and allows axonal regrowth at 2, 5 and 19 weeks post lesion with no adverse tissue effects like in-bleeding or cyst formation. Preliminary assessment of locomotor function in the open field suggested beneficial effects of the mMS. Additional inner micro-channels enable local substance delivery into the lesion center via an attached osmotic minipump. We suggest that the mMS is a suitable device to adapt and stabilize the injured spinal cord after surgical resection of scar tissue (e.g., for chronic patients) or traumatic injuries with large tissue and bone damages.

A mechanical microconnector system for restoration of tissue continuity and long-term drug application into the injured spinal cord.

Different hexapod-based external fixators are increasingly used to treat bone deformities and fractures. Accuracy has not been measured sufficiently for all models.

Accuracy of a hexapod parallel robot kinematics based external fixator.

To analyse the results of the treatment of aseptic femoral non-unions using a singular locked implant.

Is the Wave Plate Still a Salvage Procedure for Femoral Non-union? Results of 75 Cases Treated with a Locked Wave Plate.

We report a series of 37 consecutive patients with both bone infection and septic arthritis of the knee following fracture of the proximal tibia. Aim of this study is to evaluate treatment results using a standardized treatment regime. The treatment regime consisted of an aggressive surgical approach to both the bone and the joint. In 61% the joint function was preserved, in the reminder an arthrodesis was required, there were no amputations. The difficulties in dealing with this condition are described as well as the clinical, radiological and occupational results.

Osteitis and Septic Arthritis after Tibial Head Fracture: Results of a Radical Treatment Regime.

The objective of this study is to determine the treatment result of severe fractures of the tibial pilon using a two-stage treatment plan with a singular implant type. The setting is a level 1 trauma centre, the design a consecutive series of patients with a retrospective data evaluation. Due to anatomical circumstances, soft-tissue treatment is extremely important for fractures of the tibial plafond. After promising results reported about a two-staged treatment plan with external fixation and secondary internal fixation, we incorporated this method in our treatment protocol. This consisted in a second stage of internal fixation with a specifically developed locked pilon plate with multi-directional applicable screws. Between March 2000 and February 2005, 42 patients with high-energy fractures of the tibial plafond were treated using a two-staged treatment plan: firstly the fracture was stabilized with an external fixator immobilizing the ankle joint. Secondly, after stabilization of the soft-tissue situation (mean 9.2 days) open reduction and internal fixation with a locked-screw plate was performed. Complications experienced included three cases of superficial wound necrosis, in two cases a deep vein thrombosis occurred. All fractures healed but two patients needed an early bone graft because of insufficient bony consolidation. At follow-up, six Patients had no deficit in the range of movement of the ankle compared with the unaffected side, 19 patients experienced a deficit of movement of less then one third compared to the opposite side. In 27 cases no or only mild posttraumatic arthritis of the ankle occurred. There was no secondary loss of reduction or need for arthrodesis. The mean AOFAS score was 73.4 (52-97). A two-stage treatment plan in fractures of the distal lower limb with external fixation followed by locked-plate osteosynthesis reduces local complications with a good functional result.

Severe Fracture of the Tibial Pilon: Results with a Multidirectional Self-locking Osteosynthesis Plate Utilizing a Two-stage Procedure.

Large studies about the management of pediatric patients with unstable flexion-distraction injuries of the midcervical spine are rare. We present the case of a 12-year-old girl who sustained a cervical spinal injury with unilateral facet dislocation and discuss details and problems of diagnostic procedures and treatment in the light of the recent literature. The management and pitfalls of a unilateral facet dislocation in a child are summarized. After initial reposition, a multisegmental instability with neurology developed. Although distraction-flexion cervical spine injuries are common in adults and often occur with concomitant neurological sequelae, they also can occur in the pediatric population. In conclusion, an MRI seems advisable. A treatment of postoperative malalignment with reposition via a halo-fixator cannot be recommended. Repositioning is possible but was lost when the fixator was removed. Comparing the historic and recent literature there is only weak evidence overall, nevertheless a ventral fusion seems to be the treatment option of choice.

Article	Year
Results of total hip replacement using the Robodoc surgical assistant system: clinical outcome and evaluation of complications for 97 procedures. The international journal of medical robotics + computer assisted surgery : MRCAS\| PubMed ID: 18000945	2007
A mechanical microconnector system for restoration of tissue continuity and long-term drug application into the injured spinal cord. Biomaterials\| PubMed ID: 24090837	2013
Accuracy of a hexapod parallel robot kinematics based external fixator. The international journal of medical robotics + computer assisted surgery : MRCAS\| PubMed ID: 25273822	2015
Is the Wave Plate Still a Salvage Procedure for Femoral Non-union? Results of 75 Cases Treated with a Locked Wave Plate. European journal of trauma and emergency surgery : official publication of the European Trauma Society\| PubMed ID: 26814765	2009
Osteitis and Septic Arthritis after Tibial Head Fracture: Results of a Radical Treatment Regime. European journal of trauma and emergency surgery : official publication of the European Trauma Society\| PubMed ID: 26815090	2007
Severe Fracture of the Tibial Pilon: Results with a Multidirectional Self-locking Osteosynthesis Plate Utilizing a Two-stage Procedure. European journal of trauma and emergency surgery : official publication of the European Trauma Society\| PubMed ID: 26815817	2008
Unstable Cervical Spinal Injury in Children - Case Report and Review of the Literature. European journal of trauma and emergency surgery : official publication of the European Trauma Society\| PubMed ID: 26815998	2008

Klaus Seide

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