GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW最新文献

{"title":"Prosthetically guided oral implant surgery. A retrospective cohort study evaluating the 5-year surgical outcome.","authors":"Andreas Sakkas,&nbsp;Stefan Westendorf,&nbsp;Oliver Christian Thiele,&nbsp;Alexander Schramm,&nbsp;Frank Wilde,&nbsp;Sebastian Pietzka","doi":"10.3205/iprs000176","DOIUrl":"https://doi.org/10.3205/iprs000176","url":null,"abstract":"<p><strong>Purpose: </strong>This study primarily evaluated the 5-year implant survival and success rate of prosthetically guided inserted implants. The secondary aim was to evaluate the impact of clinical variables on the development of mucositis, peri-implant bone resorption, peri-implantitis, as well as early and late implant failure.</p><p><strong>Materials and methods: </strong>An observational retrospective single-centre study was conducted on patients who were treated with dental implants in the department of oral and plastic maxillofacial surgery of the military hospital of Ulm University between 2008 and 2010. In all patients, computer-assisted 3D planning after wax-up of the prosthetic restoration and template-guided surgery with titanium implants were performed. Bone augmentation procedures were performed primarily if needed. Intraoperative and postoperative complications as well as technical and mechanical complications after prosthesis loading were evaluated. In a 5-year clinical and radiological follow-up, implant success and implant survival were assessed using descriptive statistics. A multivariable regression analysis evaluated the potential impact of augmentation procedures, wound healing complications, smoking, history of periodontitis, and preoperative API (approximal plaque index) and SBI (sulcus bleeding index) values on peri-implant mucositis, peri-implant bone resorption, peri-implantitis, as well as early and late implant failure.</p><p><strong>Results: </strong>In this study, 466 implants in 283 patients were considered for inclusion, and sufficient data were obtained for analysis from 368 (78.9%) implants in 229 (80.9%) patients. An overall implant survival rate of 98.1% (n=361/368) at the 5-year follow-up was revealed. According to the success criteria of the study, the 5-year success rate was 97.04% (n=263/271). An early implant failure of 1.07% (n=5/466) was recorded. 48.2% of the implants were affected by peri-implant mucositis (n=122/253), while peri-implant bone resorption was detected in 21.7% of the radiologically examined implants (n=59/271). Fifteen cases of peri-implantitis (5.5%) were detected. Peri-implant bone resorption increased significantly after bone augmentation procedures (p=0.028). Wound healing complications after implantation significantly increased the prevalence of late implant failure in the maxilla (p<0.001). Peri-implant bone resorption and peri-implantitis were significantly more prevalent in smokers (p=0.022/p=0.043). Implants in patients with API>20% presented significantly higher rates of peri-implant mucositis (p=0.042). Wound healing complications after augmentation, history of periodontitis, and SBI>20% had no significant impact on the study parameters.</p><p><strong>Conclusions: </strong>The study confirms the reliability of prosthetically guided implant surgery, showing a high implant survival and success rate in a 5-year follow-up. Intraoperative complications and technical or mech","PeriodicalId":43347,"journal":{"name":"GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10486885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10225163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomic variations in retaining ligaments during minimally invasive resection of subcutaneous lipomas.","authors":"Akio Sakamoto,&nbsp;Takashi Noguchi,&nbsp;Shuichi Matsuda","doi":"10.3205/iprs000172","DOIUrl":"https://doi.org/10.3205/iprs000172","url":null,"abstract":"<p><strong>Objective: </strong>Lipomas are common, benign tumors usually located in the subcutaneous tissue. The \"one-inch method\" is a minimally invasive technique for resecting large subcutaneous lipomas through a one-inch incision after blunt dissection of the lipoma from its peripheral retaining ligaments. The limitations of this method are currently unclear.</p><p><strong>Materials and methods: </strong>We assessed twenty-five patients with large lipomas, defined as a tumor diameter greater than 5 cm. The location of the lipoma was at the shoulder in fifteen patients, the extremity in six patients, and the torso in four patients.</p><p><strong>Results: </strong>The mean operative time for all lesions was 28.3 minutes, with a mean time of 25.9 minutes for lipomas at the shoulder, 21.8 minutes for the extremities, and 47.0 minutes for the torso. We classified patients into three groups according to operative time: the short group (10-29 min), middle group (30-49 min), and long group (50-70 min). For lipomas of the shoulder, there were eleven patients (73%) in the short group, three patients (20%) in the middle group, and one patient (7%) in the long group. For lipomas of the extremity, the groups contained five patients (83%), one patient (17%), and no patients (0%), respectively. For lipomas of the torso, the groups contained one patient (25%), no patients (0%), and three patients (75%), respectively.</p><p><strong>Conclusions: </strong>Lipomas of the torso require a longer operative time than those of the shoulder or extremity; this difference could be due to the number of retaining ligaments present, which is reportedly higher in the back than in the anterior or side body. Lipomas of the back are less amenable to the one-inch method, and posterior shoulder lipomas may take more time than those at other parts of the shoulder or at the extremities.</p>","PeriodicalId":43347,"journal":{"name":"GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10413276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10053914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical education during the COVID-19 pandemic: What students missed and what they did not. A questionnaire-based cross-sectional study.","authors":"Giulia Manzini,&nbsp;Marko Kornmann,&nbsp;Michael Kremer","doi":"10.3205/iprs000175","DOIUrl":"https://doi.org/10.3205/iprs000175","url":null,"abstract":"<p><strong>Background: </strong>Medical education was and still is challenged by the COVID-19 pandemic, and several strategies were implemented by the universities worldwide in order to maintain a good level of education. The aim of this work is to point out how strategies adopted in a German university hospital reached students and how comfortable they felt with the proposed solutions in order to define future possibilities in modern teaching.</p><p><strong>Methods: </strong>A questionnaire was answered by medical students at the end of the 8^th and 10^th semester in a German university hospital asking them about their perception of medical education during the pandemic as well as about strategies adopted by the faculty.</p><p><strong>Results: </strong>A total of 92 out of 117 students answered the questionnaire (78.6% response rate). Students felt disadvantaged in their medical education because of the pandemic on a scale from 0 (not at all) to 10 (completely) (5.34±2.3, range 0-10 points), regardless of semester, gender, and whether they aimed at a surgical career or not. During the pandemic they missed practical exercises most (93.5%), followed by contact with other students (65.2%). Presence lessons were missed (28.3%) the least. Among the strategies offered to maintain education, recorded lessons were appreciated most, followed by skills labs. Live-stream lessons were considered less comfortable.</p><p><strong>Conclusions: </strong>Several aspects of medical education were replaced satisfactorily during the pandemic, others need to be adapted in the future in order to meet the students' needs and expectations. Theoretical online education but not live stream lessons could be an option beyond COVID-19 as they are highly appreciated by students.</p>","PeriodicalId":43347,"journal":{"name":"GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10413253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10053915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using an anterolateral thigh flap in autologous breast reconstruction as a salvage procedure in a patient with adult-onset Still's disease: A case report.","authors":"Tarek Al-Malat,&nbsp;Berivan Taskin,&nbsp;Sebastian Schäller,&nbsp;Daniela Mettal-Minski,&nbsp;Lijo Mannil","doi":"10.3205/iprs000171","DOIUrl":"https://doi.org/10.3205/iprs000171","url":null,"abstract":"<p><p>The deep inferior epigastric artery perforator (DIEP) flap is an excellent option for microsurgical breast reconstruction. In selected cases, e.g. in case of previous abdominoplasty, other autologous options like transverse upper gracilis (TUG) or superior gluteal artery perforator (sGAP) flaps can be considered. The anterolateral thigh (ALT) flap is reported to be used as a salvage procedure in selected cases of breast reconstruction, where other flaps were not available or failed. We present a case of a 41-year-old woman who was undergoing bilateral breast reconstruction after bilateral mastectomies following implant-based mastopexie and multiple infections. She also suffered from an adult onset Still's disease (AOSD) and was thus immunosuppressed. Microsurgical breast reconstruction was performed in a two-stage procedure. The left breast was reconstructed using a TUG flap. On the right side the TUG reconstruction failed due to vascular anomaly, so an ALT flap was successfully used instead. The whole procedure was accompanied by a multidisciplinary approach including a rheumatological complex treatment and enabled a successful bilateral breast reconstruction in this challenging case.</p>","PeriodicalId":43347,"journal":{"name":"GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10279530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10088493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pedicled anterolateral thigh flap: A versatile flap for complex regional defect reconstruction.","authors":"Jiten Kumar Mishra,&nbsp;Shamendra Anand Sahu,&nbsp;Moumita De,&nbsp;Aparajita Saha","doi":"10.3205/iprs000174","DOIUrl":"https://doi.org/10.3205/iprs000174","url":null,"abstract":"<p><strong>Objectives: </strong>Soft-tissue defects of the lower abdomen, perineum, groin, and trochanteric area often involve the loss of composite tissue components and are technically challenging to reconstruct. The goals of reconstruction should include the replacement of the defect with a suitable soft-tissue flap that provides stable coverage while protecting important exposed structures. However, there are limited locations in this region for the creation of pedicled flaps for complex defect reconstruction. The pedicled anterolateral thigh (ALT) flap is considered superior to other comparable flaps due to its varying soft-tissue components and long pedicle with consistent anatomy that allow the reconstruction of locations that are difficult to reach without significant flap donor site morbidity. Herein, we present a case series of our experience of using a pedicled ALT flap to reconstruct regional defects over a range of locations.</p><p><strong>Methods: </strong>The present study comprised ten patients who underwent surgical reconstruction of soft-tissue defects of the lower abdomen, groin, trochanteric, scrotal, and penoscrotal defects using a pedicled ALT flap over a two-year period. The flap was customized according to the defect when required.</p><p><strong>Results: </strong>In our case series, flap loss was not observed with only a few minor complications. All patients accepted the aesthetic appearance of the flap recipient site area without requesting revision surgery. The donor site was closed primarily in half of all cases, with split skin grafting applied in the remaining patients. Graft take at the flap donor site was satisfactory in all cases.</p><p><strong>Conclusion: </strong>A pedicled ALT flap is a reliable and suitable option for complex soft-tissue reconstruction for regional soft-tissue defects of the lower abdomen and perineum.</p>","PeriodicalId":43347,"journal":{"name":"GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10413255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10053916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring natural breast symmetry in the female plastic surgical patient population.","authors":"Helga Henseler","doi":"10.3205/iprs000173","DOIUrl":"https://doi.org/10.3205/iprs000173","url":null,"abstract":"<p><strong>Background: </strong>Breast symmetry remains a challenging quality to measure. The question arises of how much baseline breast symmetry exists in the female plastic surgical patient population.</p><p><strong>Material and methods: </strong>Several linear dimensional assessments were collected based on a retrospective analysis of objective data of women with natural breasts, who presented for an initial consultation in a plastic surgical clinic and were measured with the 3D Vectra Camera by the company Canfield Scientific Inc., U.S.A. The first 100 cases were extracted from the large database in alphabetical order. The nipple positions were examined, including the following linear dimensions: distances from the jugulum to the nipple, from the nipple to the inframammary fold, and from the nipple to midline. Furthermore, the under-breast widths were obtained.</p><p><strong>Results: </strong>The objective three-dimensional imaging method determined that all patients had some degree of asymmetry. The linear distances from the jugulum and midline to the nipple revealed that the measurements were larger on the left side. However, the nipple to the inframammary fold measurements were roughly the same. In the sample of plastic surgical patients, the average distance between the jugulum and nipple was around 20 cm, the distance between the nipple and inframammary fold was around 6.5 cm, the distance between the nipple and midline was around 10 cm, and the under-breast width was around 13 cm. On average, the jugulum-nipple distance on the right side was 19.9±2.3 cm and 20.1±2.4 cm on the left side. The distance between the nipple and the inframammary fold was 6.4±1.1 cm, revealing a similar distribution on both sides. The mean distance from the nipple to the midline was much larger on the left side of the body at 10.0±1.2 cm than on the right side at 9.4±1.3 cm. The under-breast width on the right side was slightly larger than the left side, with measurements of 13.4±1.8 cm versus 13.2±1.7 cm.</p><p><strong>Conclusion: </strong>Breast dimensions can be described comprehensively by an objective three-dimensional imaging process, which can detect asymmetry in all patients. The differences related to the nipple position were larger on the left side than the right regarding the distances from the jugulum and particularly the midline to the nipple, which seems to be of special importance, but not from the nipple to the inframammary fold. The linear measurements for the distances from the jugulum and the midline to the nipple are essential to accurate symmetry assessments and form an aesthetic triangle of the breast, which is a new term and the key to a simplified shape analysis.</p>","PeriodicalId":43347,"journal":{"name":"GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10413273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10053917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socio-demographic aspects and treatment-related factors on oral cancer patients' participation in rehabilitation.","authors":"Philippe Korn,&nbsp;Simon Spalthoff,&nbsp;Joachim Hammersen,&nbsp;Gertrud Krüskemper,&nbsp;Frank Tavassol,&nbsp;Jan Winterboer,&nbsp;Fritjof Lentge,&nbsp;Nils-Claudius Gellrich,&nbsp;Philipp Jehn","doi":"10.3205/iprs000168","DOIUrl":"https://doi.org/10.3205/iprs000168","url":null,"abstract":"<p><strong>Objectives: </strong>After resection of an oral carcinoma, patients are faced with physical, psychological, and socioeconomic challenges. Rehabilitation plays an essential role in patients' reintegration into their social and professional environment. This study evaluated whether socioeconomic aspects affect oral cancer patients' participation in rehabilitation treatment.</p><p><strong>Materials and methods: </strong>A retrospective analysis was conducted with 1,532 patients following surgical treatment of oral cancer during an international multicenter rehabilitation study of the German-Swiss-Austrian Cooperative Working Group on Maxillofacial Tumors using a questionnaire comprising disease-related and psychosocial items postoperatively and at least 6 months after surgery.</p><p><strong>Results: </strong>Only 35.4% of patients participated in rehabilitation. Age (p<0.001), sex (p<0.001), and marital status (p<0.05) significantly influenced participation in rehabilitation. Postoperative impairment (p<0.05) as well as quality of life (p<0.01) were significantly worse in patients who participated in rehabilitation. Nevertheless, this group of patients returned to work significantly more often, although later, than those who did not participate in rehabilitation (p<0.05).</p><p><strong>Conclusions: </strong>The findings show social inequalities and suggest a general undersupply of rehabilitative follow-up treatment in patients with oral cancer. More patients, especially older people and women should be referred to rehabilitation.</p>","PeriodicalId":43347,"journal":{"name":"GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9577562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40649318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative profile of total protein and six angiogenically-active growth factors in three platelet products.","authors":"Scott Custo,&nbsp;Byron Baron,&nbsp;Alex Felice,&nbsp;Elisa Seria","doi":"10.3205/iprs000167","DOIUrl":"https://doi.org/10.3205/iprs000167","url":null,"abstract":"<p><strong>Objectives: </strong>Platelet-derived products have been shown as promising novel therapeutic agents for chronic wounds. However, their clinical use requires a greater degree of method standardisation, part of which involved more extensive cataloguing of their biochemical composition. This study aimed to quantify and compare total protein and 6 angiogenically-active growth factors in three distinct platelet products.</p><p><strong>Methods: </strong>Platelet Lysate (PL, n=5), Calcium-activated Platelet Rich Plasma (Ca-PRP, n=5) and Platelet-Rich Fibrin (PRF, n=5) were prepared from pooled platelet apheresis products (n=10). Ca-PRP and PRF were prepared from the same units (n=5) by activation with 20 mmolL^-1 calcium chloride. PL was prepared from the remaining (n=5) units using an established lysate. Total protein was quantified with the Bradford Assay. Sandwich enzyme-linked immunosorbent assay was used to quantify six growth factors: epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF), stromal cell derived growth factor-1α (SDF-1α), endostatin, and transforming growth factor-β1 (TGF-β1).</p><p><strong>Results: </strong>Protein retrieval differed significantly (p<0.05) between the three products: PL (11.35±0.80 mg/mL) < Ca-PRP (20.44±8.17 mg/mL) < PRF (40.67±3.13 mg/mL). Growth factor yield was considerable in all three products and differed significantly for: VEGF (PL<PRF); EGF (Ca-PRP<PRF); HFG (PL<Ca-PRP); Endostatin (PL<Ca-PRP, PRF<Ca-PRP, PL<PRF) and TGF-β1 (Ca-PRP<PL, Ca-PRP<PRF).</p><p><strong>Conclusions: </strong>Platelet apheresis products contain a substantial quantity of the investigated pro- and anti-angiogenic growth factors. Their release varies depending on the manufacturing protocol used. Clinically, alternate products could thus be combined to provide a therapeutically optimal mix of growth factors.</p>","PeriodicalId":43347,"journal":{"name":"GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9284722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40658109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New and innovative biomaterials, techniques and therapy concepts: Biologization in maxillofacial surgery, oral surgery and dentistry is in full swing. PRF, PRGF, PRP, blood plasma-stabilized augmentations, supplementation of micronutrients and vitamins - what opportunities do such \"biological\" approaches actually offer? We introduce them here.","authors":"Ralf Smeets,&nbsp;Anders Henningsen,&nbsp;Oliver Zernial,&nbsp;Ewa Stürmer,&nbsp;Imke Fiedler,&nbsp;Sogand Schäfer,&nbsp;Martin Gosau,&nbsp;Robert Gaudin,&nbsp;Carolin Stolzer,&nbsp;Anna Reinelt,&nbsp;Sandra Fuest","doi":"10.3205/iprs000166","DOIUrl":"https://doi.org/10.3205/iprs000166","url":null,"abstract":"<p><p>Biomaterials of natural origin have recently gained increasing attention in the field of dental implantology. The requirements for such materials, however, are very high. In addition to high clinical efficiency in tissue regeneration, wound healing should be demonstrably positively influenced. The translational division for regenerative orofacial medicine of the Clinic and Polyclinic for Oral and Maxillofacial Surgery of the University Medical Center Hamburg-Eppendorf (UKE) is examining this research topic by investigating which innovative treatment methods for the reconstruction of bone defects or for augmentative procedures can be applied in the future or are already being applied in the field of oral and maxillofacial surgery.</p>","PeriodicalId":43347,"journal":{"name":"GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9285113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40658110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of fracture severity on postoperative outcome and quality of life after locking plate fixation of proximal humeral fractures","authors":"S. Thelen, J. Grassmann, M. Schneider, C. Jaekel, Dana M. Meier, M. Betsch, M. Hakimi, M. Wild","doi":"10.3205/iprs000164","DOIUrl":"https://doi.org/10.3205/iprs000164","url":null,"abstract":"Objective: For proximal humeral fractures open reduction und internal fixation (ORIF) with a fixed-angle plate is considered the gold standard for surgical management. However, it can lead to poor functional outcomes and is associated with postoperative complications. Therefore, the purpose of this study was to investigate the influence of fracture severity by applying a new classification (simple versus complex) on clinical outcome and quality of life after ORIF of proximal humerus fractures. Methods: We conducted a prospective clinical study with an average follow-up period of 12 (SD 1) months after ORIF of proximal humeral fractures with a fixed-angle plate. The postoperative function and quality of life was measured using the Oxford Shoulder Score (OSS) and the Constant Score. Data was tested for statistical significance with the Mann-Whitney test and Fisher's exact test. Based on the findings of this study a simplified fracture classification system has been developed. Results: Seventy-two patients with a mean age of 65 years (SD 12) with 69% being males were included. According to the Neer classification, 35% (n=25) non-displaced (“one-part fractures”), 19% (n=14) two-part fractures, 15% (n=11) three-part fractures and 31% (n=22) four-part fractures were detected. Regarding the AO/OTA classification, 18% (n=13) were type A fractures, 43% (n=31) type B and 39% (n=28) type C fractures. From these criteria we derived our own fracture classification, including 50% (n=36) simple and 50% (n=36) severe fractures. Patients with simple fracture types achieved significantly higher total values in the Constant Score as well as the OSS (p=0.008; p=0.013). The cumulative incidence of complications in the entire patient collective was 14% (n=10) with humeral head necrosis (n=5) occurring only in the severe fracture group. Conclusions: The postoperative clinical outcome as well as the incidence of humeral head necrosis after ORIF of proximal humeral fractures with a fixed-angle plate correlates with the fracture type and severity. The newly derived fracture classification into simple and severe fractures is suitable with regard to clinical results and complication rate. However, prospective studies comparing ORIF vs. conservative treatment of proximal humeral fractures of the same severity are required. Level of Evidence: III","PeriodicalId":43347,"journal":{"name":"GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45365475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}