in-vivo-evaluation-fracture-callus-development-during-bone-healing

<em>In Vivo</em> Evaluation of Fracture Callus Development During Bone Healing in Mice Using an MRI-compatible Osteosynthesis Device for the Mouse Femur

Endochondral fracture healing is a complex process involving the development of fibrous, cartilaginous, and osseous tissue in the fracture callus. The ...

University Medical Center Ulm

Does computer-assisted spine surgery reduce intraoperative radiation doses?

The heart of any surgical department is the operation room area. Any disturbances in the daily routine will affect the work flow of the whole hospital. As an example the major complaints of a university surgical department regarding workflow and communication are outlined. To solve these problems a team "OR organization" was established, which started the work based on a new developed OR statute. Within a short period the contentment of the employees as well as the workflow improved. But as a matter of fact, even in the following years of central OR management there is still the need to further stabilize the system and carefully improve the controlling system.

[Management of the operation room in an university hospital].

Multiple injury results in a complex pathophysiological and immunological response. Depending on the individual injury pattern, the time elapsed after injury, and the systemic "danger response", the surgical treatment has to be modified.

Polytrauma--pathophysiology and management principles.

Computer-assisted surgery (CAS) can act as an intraoperative ruler in high tibial osteotomy (HTO) to visualize continuously the leg during surgery.

Reliability of computer-assisted surgery as an intraoperative ruler in navigated high tibial osteotomy.

Chirurgie assist&eacute;e par ordinateur (CAS) peut agir comme un dirigeant perop&eacute;ratoire dans l&#39;ost&eacute;otomie tibiale haute (HTO) de visualiser en permanence la jambe au cours de la chirurgie.

Fiabilit&eacute; de la chirurgie assist&eacute;e par ordinateur comme un souverain perop&eacute;ratoire dans navigu&eacute; ost&eacute;otomie tibiale haute.

Chirurgia computer-assistita (CAS) pu&ograve; agire come un righello intraoperatorio nella osteotomia Tibia alta (HTO) per visualizzare continuamente la gamba durante l&#39;intervento chirurgico.

Affidabilit&agrave; della chirurgia computer-assistita come un righello intraoperatorio in navigato osteotomia Tibia alta.

[Modern intraoperative imaging techniques, Part I].

Un quir&oacute;fano de h&iacute;brido debe servir a las necesidades m&eacute;dicas de diferentes disciplinas altamente especializadas. Integra t&eacute;cnicas intervencionistas para procedimientos cardiovasculares y permite las operaciones en el campo de la cirug&iacute;a ortop&eacute;dica, Neurocirug&iacute;a y cirug&iacute;a maxilofacial. La integraci&oacute;n de todos los pasos como la planificaci&oacute;n, documentaci&oacute;n y el propio procedimiento ahorra tiempo y recursos valiosos. Los mejores dispositivos de im&aacute;genes disponibles e interfaces de usuario reducen la necesidad de personal extensa en el quir&oacute;fano y facilitan nuevos procedimientos m&iacute;nimamente invasivos. La posibilidad inmediata de im&aacute;genes de control postoperatorio en calidad de CT permite al cirujano reaccionar a problemas durante el mismo procedimiento sin la necesidad de revisar m&aacute;s adelante.

[El quir&oacute;fano h&iacute;brido. P&aacute;gina de inicio de la proyecci&oacute;n de imagen intraoperatoria High-end].

&#x6742;&#x4EA4;&#x624B;&#x672F;&#x5BA4;&#x5FC5;&#x987B;&#x6EE1;&#x8DB3;&#x533B;&#x7597;&#x7684;&#x4E0D;&#x540C;&#x9AD8;&#x5EA6;&#x4E13;&#x95E8;&#x5316;&#x7684;&#x5B66;&#x79D1;&#x3002;&#x5B83;&#x96C6;&#x6210;&#x7A0B;&#x5E8F;&#x5FC3;&#x8840;&#x7BA1;&#x4ECB;&#x5165;&#x6280;&#x672F;&#xFF0C;&#x5141;&#x8BB8;&#x5916;&#x5730;&#x77EB;&#x5F62;&#x5916;&#x79D1;&#x3001; &#x795E;&#x7ECF;&#x5916;&#x79D1;&#x548C;&#x53E3;&#x8154;&#x988C;&#x9762;&#x5916;&#x79D1;&#x7684;&#x884C;&#x52A8;&#x3002;&#x6587;&#x4EF6;&#x548C;&#x7A0B;&#x5E8F;&#x672C;&#x8EAB;&#x7684;&#x6240;&#x6709;&#x6B65;&#x9AA4;&#xFF0C;&#x5982;&#x89C4;&#x5212;&#x6574;&#x5408;&#xFF0C;&#x8282;&#x7701;&#x4E86;&#x65F6;&#x95F4;&#x548C;&#x5B9D;&#x8D35;&#x7684;&#x8D44;&#x6E90;&#x3002;&#x6700;&#x4F73;&#x53EF;&#x7528;&#x6210;&#x50CF;&#x8BBE;&#x5907;&#x548C;&#x7528;&#x6237;&#x63A5;&#x53E3;&#x51CF;&#x5C11;&#x9700;&#x8981;&#x5927;&#x91CF;&#x4EBA;&#x5458;&#x5728;&#x6216;&#x5E76;&#x4FC3;&#x8FDB;&#x65B0;&#x7684;&#x5FAE;&#x521B;&#x624B;&#x672F;&#x3002;&#x7ACB;&#x5373;&#x5728; CT &#x7C7B;&#x4F3C;&#x8D28;&#x91CF;&#x7684;&#x672F;&#x540E;&#x63A7;&#x5236;&#x56FE;&#x50CF;&#x7684;&#x53EF;&#x80FD;&#x6027;&#x4F7F;&#x5916;&#x79D1;&#x533B;&#x751F;&#x5728;&#x540C;&#x4E00;&#x8FC7;&#x7A0B;&#x4E2D;&#x65E0;&#x9700;&#x4EE5;&#x540E;&#x7684;&#x4FEE;&#x8BA2;&#x7248;&#x5BF9;&#x95EE;&#x9898;&#x4F5C;&#x51FA;&#x53CD;&#x5E94;&#x3002;

[&#x6742;&#x4EA4;&#x624B;&#x672F;&#x5BA4;&#x3002;&#x9996;&#x9875;&#x9AD8;&#x7AEF;&#x672F;&#x4E2D;&#x5F71;&#x50CF;]&#x3002;

A hybrid operating room must serve the medical needs of different highly specialized disciplines. It integrates interventional techniques for cardiovascular procedures and allows operations in the field of orthopaedic surgery, neurosurgery and maxillofacial surgery. The integration of all steps such as planning, documentation and the procedure itself saves time and precious resources. The best available imaging devices and user interfaces reduce the need for extensive personnel in the OR and facilitate new minimally invasive procedures. The immediate possibility of postoperative control images in CT-like quality enables the surgeon to react to problems during the same procedure without the need for later revision.

[The hybrid operating room. Home of high-end intraoperative imaging].

Une salle d&#39;op&eacute;ration hybride doit servir les besoins m&eacute;dicaux des diff&eacute;rentes disciplines hautement sp&eacute;cialis&eacute;es. Il int&egrave;gre des techniques interventionnelles pour proc&eacute;dures cardio-vasculaires et permet des op&eacute;rations dans le domaine de la chirurgie orthop&eacute;dique, neurochirurgie et chirurgie maxillo-faciale. L&#39;int&eacute;gration de toutes les &eacute;tapes telles que la planification, documentation et la proc&eacute;dure elle-m&ecirc;me gagner du temps et ressources pr&eacute;cieuses. Le meilleurs des p&eacute;riph&eacute;riques d&#39;imagerie disponibles et des interfaces utilisateur r&eacute;duisent le besoin de personnel approfondie dans l&#39;OR et facilitent de nouvelles proc&eacute;dures minimalement invasives. La possibilit&eacute; imm&eacute;diate d&#39;images de contr&ocirc;le postop&eacute;ratoire dans CT-comme la qualit&eacute; permet au chirurgien de r&eacute;agir &agrave; des probl&egrave;mes au cours de la m&ecirc;me proc&eacute;dure sans la n&eacute;cessit&eacute; d&#39;une r&eacute;vision ult&eacute;rieure.

[La salle hybride. Accueil de l&#39;imagerie perop&eacute;ratoire haut de gamme].

Ein Hybrid-Operationssaal muss die medizinischen Bed&uuml;rfnisse der hoch spezialisierten Disziplinen dienen. Es integriert interventionelle Techniken f&uuml;r Herz-Kreislauf-Verfahren und Ma&szlig;nahmen im Bereich der Orthop&auml;die, Neurochirurgie und Kieferchirurgie. Die Integration aller Schritte wie Planung, Dokumentation und das Verfahren selbst spart Zeit und wertvolle Ressourcen. Die besten verf&uuml;gbaren imaging-Ger&auml;te und Benutzeroberfl&auml;chen reduzieren die Notwendigkeit f&uuml;r umfangreiche Personal im OP und Erleichterung neue minimal-invasive Verfahren. Die unmittelbare M&ouml;glichkeit, postoperative Kontrolle Bilder in CT-&auml;hnliche Qualit&auml;t erm&ouml;glicht den Chirurgen, w&auml;hrend das gleiche Verfahren ohne die Notwendigkeit einer sp&auml;teren Revision auf Probleme reagieren.

[Der Hybrid-OP-Saal. Startseite der High-End-intraoperative Bildgebung].

Una sala operatoria ibrida deve servire le esigenze mediche di diverse discipline altamente specializzati. Esso integra tecniche interventistiche per procedure cardiovascolari e consente operazioni nel campo della chirurgia ortopedica, neurochirurgia e chirurgia maxillo-facciale. L&#39;integrazione di tutti i passaggi come la pianificazione, documentazione e la procedura stessa fa risparmiare tempo e risorse preziose. I migliori dispositivi di imaging disponibili e interfacce utente riducono la necessit&agrave; di personale estese in OR e facilitano nuove procedure minimamente invasive. La possibilit&agrave; immediata di immagini per il controllo post-operatorio in CT-come qualit&agrave; permette al chirurgo di reagire ai problemi durante la stessa procedura senza necessit&agrave; di revisione successiva.

[Sala operatoria ibrida. Casa di fascia alta imaging intraoperatorio].

&#x30CF;&#x30A4;&#x30D6;&#x30EA;&#x30C3;&#x30C9; &#x30AA;&#x30DA;&#x30EC;&#x30FC;&#x30C6;&#x30A3;&#x30F3;&#x30B0; &#x30EB;&#x30FC;&#x30E0;&#x7570;&#x306A;&#x308B;&#x5C02;&#x9580;&#x6027;&#x306E;&#x9AD8;&#x3044;&#x5206;&#x91CE;&#x306E;&#x533B;&#x7642;&#x30CB;&#x30FC;&#x30BA;&#x306B;&#x5FDC;&#x3048;&#x308B;&#x5FC5;&#x8981;&#x304C;&#x3042;&#x308A;&#x307E;&#x3059;&#x3002;&#x3053;&#x308C;&#x306F;&#x5FC3;&#x8840;&#x7BA1;&#x624B;&#x7D9A;&#x304D;&#x306E;&#x30A4;&#x30F3;&#x30BF;&#x30FC;&#x30D9;&#x30F3;&#x30B7;&#x30E7;&#x30F3;&#x6280;&#x8853;&#x3092;&#x7D71;&#x5408;&#x3057;&#x3001;&#x6574;&#x5F62;&#x5916;&#x79D1;&#x3001;&#x8133;&#x795E;&#x7D4C;&#x5916;&#x79D1;&#x30FB;&#x53E3;&#x8154;&#x5916;&#x79D1;&#x5206;&#x91CE;&#x3067;&#x64CD;&#x4F5C;&#x3067;&#x304D;&#x307E;&#x3059;&#x3002;&#x3059;&#x3079;&#x3066;&#x306E;&#x30B9;&#x30C6;&#x30C3;&#x30D7;&#x306E;&#x8A08;&#x753B;&#x306A;&#x3069;&#x306E;&#x7D71;&#x5408;&#x3001;&#x30C9;&#x30AD;&#x30E5;&#x30E1;&#x30F3;&#x30C8;&#x3068;&#x30D7;&#x30ED;&#x30B7;&#x30FC;&#x30B8;&#x30E3;&#x81EA;&#x4F53;&#x6642;&#x9593;&#x3068;&#x8CB4;&#x91CD;&#x306A;&#x30EA;&#x30BD;&#x30FC;&#x30B9;&#x4FDD;&#x5B58;&#x3057;&#x307E;&#x3059;&#x3002;&#x6700;&#x9AD8;&#x4F7F;&#x7528;&#x53EF;&#x80FD;&#x306A;&#x30A4;&#x30E1;&#x30FC;&#x30B8;&#x30F3;&#x30B0; &#x30C7;&#x30D0;&#x30A4;&#x30B9;&#x3068;&#x30E6;&#x30FC;&#x30B6;&#x30FC; &#x30A4;&#x30F3;&#x30BF;&#x30FC;&#x30D5;&#x30A7;&#x30A4;&#x30B9;&#x307E;&#x305F;&#x306F;&#x8C4A;&#x5BCC;&#x306A;&#x4EBA;&#x6750;&#x306E;&#x5FC5;&#x8981;&#x6027;&#x3092;&#x6E1B;&#x3089;&#x3059;&#x3057;&#x3001;&#x65B0;&#x3057;&#x3044;&#x4F4E;&#x4FB5;&#x8972;&#x3092;&#x4FC3;&#x9032;&#x3057;&#x307E;&#x3059;&#x3002;CT &#x306E;&#x3088;&#x3046;&#x306A;&#x54C1;&#x8CEA;&#x3067;&#x306E;&#x8853;&#x5F8C;&#x30B3;&#x30F3;&#x30C8;&#x30ED;&#x30FC;&#x30EB; &#x30A4;&#x30E1;&#x30FC;&#x30B8;&#x306E;&#x5373;&#x6642;&#x53EF;&#x80FD;&#x6027;&#x5916;&#x79D1;&#x533B;&#x306F;&#x3001;&#x4EE5;&#x964D;&#x306E;&#x30EA;&#x30D3;&#x30B8;&#x30E7;&#x30F3;&#x3092;&#x5FC5;&#x8981;&#x3068;&#x305B;&#x305A;&#x540C;&#x3058;&#x624B;&#x9806;&#x306E;&#x5B9F;&#x884C;&#x4E2D;&#x306B;&#x554F;&#x984C;&#x3092;&#x53CD;&#x5FDC;&#x3059;&#x308B;&#x3053;&#x3068;&#x304C;&#x3067;&#x304D;&#x307E;&#x3059;&#x3002;

[&#x30CF;&#x30A4;&#x30D6;&#x30EA;&#x30C3;&#x30C9; &#x30AA;&#x30DA;&#x30EC;&#x30FC;&#x30C6;&#x30A3;&#x30F3;&#x30B0; &#x30EB;&#x30FC;&#x30E0;&#x3002;&#x30CF;&#x30A4;&#x30A8;&#x30F3;&#x30C9;&#x306E;&#x8853;&#x4E2D;&#x30A4;&#x30E1;&#x30FC;&#x30B8;&#x30F3;&#x30B0;&#x306E;&#x5BB6;]&#x3002;

&#xD558;&#xC774;&#xBE0C;&#xB9AC;&#xB4DC; &#xC218;&#xC220; &#xC2E4; &#xB2E4;&#xB978; &#xACE0;&#xB3C4;&#xB85C; &#xC804;&#xBB38;&#xD654; &#xB41C; &#xBD84;&#xC57C;&#xC758; &#xC758;&#xB8CC; &#xC694;&#xAD6C;&#xC5D0; &#xBD80;&#xC751; &#xD574;&#xC57C; &#xD569;&#xB2C8;&#xB2E4;. &#xC2EC;&#xD608; &#xAD00; &#xC808;&#xCC28;&#xB294; &#xC911;&#xC7AC; &#xAE30;&#xC220;&#xC744; &#xD1B5;&#xD569;&#xC640; &#xC815;&#xD615; &#xC678;&#xACFC;, &#xC2E0;&#xACBD;&#xC678;&#xACFC; &#xBC0F; &#xC545; &#xC548; &#xBA74; &#xC218;&#xC220;&#xC758; &#xBD84;&#xC57C;&#xC5D0;&#xC11C; &#xC791;&#xC5C5;&#xC744; &#xD5C8;&#xC6A9; &#xD569;&#xB2C8;&#xB2E4;. &#xACC4;&#xD68D; &#xB4F1; &#xBAA8;&#xB4E0; &#xB2E8;&#xACC4;&#xC758; &#xD1B5;&#xD569; &#xC124;&#xBA85;&#xC11C; &#xBC0F; &#xD504;&#xB85C;&#xC2DC;&#xC800; &#xC790;&#xCCB4; &#xC800;&#xC7A5; &#xC2DC;&#xAC04; &#xBC0F; &#xADC0;&#xC911; &#xD55C; &#xC790;&#xC6D0;. &#xCD5C;&#xACE0;&#xC758; &#xC0AC;&#xC6A9; &#xAC00;&#xB2A5;&#xD55C; &#xC774;&#xBBF8;&#xC9D5; &#xC7A5;&#xCE58; &#xBC0F; &#xC0AC;&#xC6A9;&#xC790; &#xC778;&#xD130;&#xD398;&#xC774;&#xC2A4; &#xB610;&#xB294; &#xAD11;&#xBC94;&#xC704; &#xD55C; &#xC778;&#xC0AC;&#xC5D0; &#xB300; &#xD55C; &#xD544;&#xC694;&#xC131;&#xC744; &#xC808;&#xAC10; &#xD558; &#xACE0; &#xC0C8;&#xB85C;&#xC6B4; &#xCD5C;&#xC18C;&#xD55C; &#xCE68;&#xB7B5; &#xC801; &#xC808;&#xCC28;&#xB97C; &#xC6A9;&#xC774; &#xD558; &#xAC8C;. CT &#xAC19;&#xC740; &#xD488;&#xC9C8;&#xC758; &#xC218;&#xC220; &#xD6C4; &#xCEE8;&#xD2B8;&#xB864; &#xC774;&#xBBF8;&#xC9C0;&#xC758; &#xC989;&#xAC01;&#xC801;&#xC778; &#xAC00;&#xB2A5;&#xC131; &#xB098;&#xC911;&#xC758; &#xAC1C;&#xC815;&#xC5D0; &#xB300; &#xD55C; &#xD544;&#xC694; &#xC5C6;&#xC774; &#xB3D9;&#xC77C;&#xD55C; &#xC808;&#xCC28; &#xB3D9;&#xC548; &#xBB38;&#xC81C;&#xC5D0; &#xBC18;&#xC751; &#xD558;&#xB294; &#xC678;&#xACFC; &#xC758;&#xC0AC; &#xC218; &#xC788;&#xC2B5;&#xB2C8;&#xB2E4;.

[&#xD558;&#xC774;&#xBE0C;&#xB9AC;&#xB4DC; &#xC218;&#xC220; &#xC2E4;&#xC785;&#xB2C8;&#xB2E4;. &#xC0C1;&#xD55C; &#xC790;&#xAC00; &#xC601;&#xC0C1; &#xC9D1;]&#xC785;&#xB2C8;&#xB2E4;.

[Modern intraoperative imaging techniques, part II].

[Winter sport injuries].

[Magnetic resonance imaging].

[Augmented osteosynthesis].

After severe blunt chest trauma, the development of an acute lung injury (ALI) is often associated with severe or even lethal complications. Especially in multiple injured patients after blunt chest trauma ALI/ARDS [acute respiratory distress syndrome (ARDS)] is frequent. However, in the initial posttraumatic phase, inflammatory clinical signs are often not apparent and underlying changes in gene-expression profile are unknown.

The molecular fingerprint of lung inflammation after blunt chest trauma.

After severe trauma, the immune system is challenged with a multitude of endogenous and exogenous danger molecules. The recognition of released danger patterns is one of the prime tasks of the innate immune system. In the last two decades, numerous studies have established the complement cascade as a major effector system that detects and processes such danger signals. Animal models with engineered deficiencies in certain complement proteins have demonstrated that widespread complement activation after severe injury culminates in complement dysregulation and excessive generation of complement activation fragments. Such exuberant pro-inflammatory signaling evokes systemic inflammation, causes increased susceptibility to infections and is associated with a detrimental course of the disease after injury. We discuss the underlying processes of such complementopathy and recapitulate different intervention strategies within the complement cascade. So far, several orthogonal anti-complement approaches have been tested with varying success in a large number of rodent, in several porcine and few simian studies. We illustrate the different features among those intervention strategies and highlight those that hold the greatest promise to become potential therapeutic options for the intricate disease of traumatic injury.

Complement therapeutic strategies in trauma, hemorrhagic shock and systemic inflammation - closing Pandora's box?

[Infections in orthopaedics and trauma surgery : Diagnostics and therapy].

Mice are extensively used for experimental bone-healing studies. However, there are few established nondestructive in vivo techniques for longitudinal fracture-healing analysis in mice, including in vivo micro-computed tomography (μCT) and radiography. Importantly, none of the established methods can discriminate between non-mineralized fibrous tissue and cartilage in the soft fracture callus. Therefore, the objective was to establish high-resolution in vivo magnetic resonance imaging (MRI) for the longitudinal assessment of soft callus formation during bone healing in mice. C57BL/6J mice received a femur osteotomy stabilized using an external fixator and were randomly assigned to five groups. Group 1 mice were scanned three times longitudinally during fracture healing using an optimized MRI scanning protocol to establish an algorithm to characterize the different fracture-callus tissues. Mice of groups 2-4 were scanned once on day 10, 14 or 21, respectively, euthanized after scanning and their femurs subjected to ex vivo μCT and histomorphometric analysis to compare the data assessed by MRI with μCT and histology. Control group 5 mice were not scanned. After 28 days, mice of groups 1 and 5 were euthanized and the fracture-healing outcome was evaluated by bending-test, μCT and histology to determine whether the repeated anesthesia, handling and the MRI measurements themselves influenced fracture healing. The callus-tissue values determined by MRI were mostly comparable to those obtained by μCT and histomorphometric analysis. However, at time points characterized by small relative bone or cartilage areas, MRI measurements were weakly comparable to histomorphometric data, possibly due to the inferior spatial resolution. Importantly, at the early and intermediate phases of healing, cartilage and fibrous-tissue values obtained by MRI were highly accurate. Furthermore, repeated anesthesia, handling and MRI scans did not impact bone healing. Therefore, we demonstrated the feasibility of high-resolution in vivo MRI for longitudinal assessment of soft callus formation during murine endochondral fracture healing.

Article	Year
Does computer-assisted spine surgery reduce intraoperative radiation doses? Spine\| PubMed ID: 16924222	2006
[Management of the operation room in an university hospital]. Zentralblatt fur Chirurgie\| PubMed ID: 17004195	2006
Polytrauma--pathophysiology and management principles. Langenbeck's archives of surgery\| PubMed ID: 18431593	2008
Reliability of computer-assisted surgery as an intraoperative ruler in navigated high tibial osteotomy. Archives of orthopaedic and trauma surgery\| PubMed ID: 20603710	2011
[Modern intraoperative imaging techniques, Part I]. Der Unfallchirurg\| PubMed ID: 22331226	2012
[The hybrid operating room. Home of high-end intraoperative imaging]. Der Unfallchirurg\| PubMed ID: 22331228	2012
[Modern intraoperative imaging techniques, part II]. Der Unfallchirurg\| PubMed ID: 22367518	2012
[Winter sport injuries]. Der Unfallchirurg\| PubMed ID: 24306179	2014
[Magnetic resonance imaging]. Der Unfallchirurg\| PubMed ID: 24622901	2014
[Augmented osteosynthesis]. Der Unfallchirurg\| PubMed ID: 26286181	2015
The molecular fingerprint of lung inflammation after blunt chest trauma. European journal of medical research\| PubMed ID: 26303896	2015
Complement therapeutic strategies in trauma, hemorrhagic shock and systemic inflammation - closing Pandora's box? Seminars in immunology\| PubMed ID: 27157701	2016
[Infections in orthopaedics and trauma surgery : Diagnostics and therapy]. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen\| PubMed ID: 27604236	2016
Evaluation of high-resolution In Vivo MRI for longitudinal analysis of endochondral fracture healing in mice. PloS one\| PubMed ID: 28333972	2017

Florian Gebhard

Biography

JoVE Journal Publications

Other Publications