@article{ZellnerHierlMuelleretal., author = {Zellner, Johannes and Hierl, Katja and Mueller, Michael and Pfeifer, Christian and Berner, Arne and Dienstknecht, Thomas and Krutsch, Werner and Geis, Sebastian and Gehmert, Sebastian and Kujat, Richard and Dendorfer, Sebastian and Prantl, Lukas and Nerlich, Michael and Angele, Peter}, title = {Stem cell-based tissue-engineering for treatment of meniscal tears in the avascular zone}, series = {Journal of Biomedical Materials Research Part B Applied Biomaterials}, volume = {101}, journal = {Journal of Biomedical Materials Research Part B Applied Biomaterials}, number = {7}, editor = {Gilbert, Jeremy}, doi = {10.1002/jbm.b.32922}, pages = {1133 -- 1142}, abstract = {Meniscal tears in the avascular zone have a poor self-healing potential, however partial meniscectomy predisposes the knee for early osteoarthritis. Tissue engineering with mesenchymal stem cells and a hyaluronan collagen based scaffold is a promising approach to repair meniscal tears in the avascular zone. 4 mm longitudinal meniscal tears in the avascular zone of lateral menisci of New Zealand White Rabbits were performed. The defect was left empty, sutured with a 5-0 suture or filled with a hyaluronan/collagen composite matrix without cells, with platelet rich plasma or with autologous mesenchymal stem cells. Matrices with stem cells were in part precultured in chondrogenic medium for 14 days prior to the implantation. Menisci were harvested at 6 and 12 weeks. The developed repair tissue was analyzed macroscopically, histologically and biomechanically. Untreated defects, defects treated with suture alone, with cell-free or with platelet rich plasma seeded implants showed a muted fibrous healing response. The implantation of stem cell-matrix constructs initiated fibrocartilage-like repair tissue, with better integration and biomechanical properties in the precultured stem cell-matrix group. A hyaluronan-collagen based composite scaffold seeded with mesenchymal stem cells is more effective in the repair avascular meniscal tear with stable meniscus-like tissue and to restore the native meniscus.}, subject = {Meniskusschaden}, language = {en} } @article{FuechtmeierEgersdoerferMaietal., author = {F{\"u}chtmeier, Bernd and Egersdoerfer, Stefan and Mai, Ronny and Hente, Rainer and Dragoi, Daniel and Monkman, Gareth J. and Nerlich, Michael}, title = {Reduction of femoral shaft fractures in vitro by a new developed reduction robot system "RepoRobo"}, series = {Injury}, volume = {35}, journal = {Injury}, number = {1, Supplement}, publisher = {Elsevier}, organization = {Elsevier}, issn = {1879-0267}, doi = {10.1016/j.injury.2004.05.019}, pages = {113 -- 119}, abstract = {Closed reduction of the long bones is associated with the use of considerable force. This force must be maintained for the reduction maneuver and fixation process. At present, apart from the extension table or the large AO distractor, only rather inadequate reduction aids are available. A solution to this problem is being sought in the form of a robotic system with which precision can be improved and the holding effort reduced. In the research project presented here, a synthetic femur with integrated tensioned mainspring and a 32-A3 type fracture served as a bone reduction model. The fracture was stabilized with a standard AO fixator. A St{\"a}ubli robot (model RX130) was converted by appropriate modification so that it could be used for the reduction of femoral shaft fractures in vitro. The robot was equipped with a pneumatic 2-fingered gripper, on which the fingers have been modified so that they can grip the AO fixator clamp. A Force-Feedback-Sensor was inserted between the gripper and the robot to obtain online recordings of the forces and moments in all three axes. With this setup it is possible to achieve precise reduction of the fracture in all planes under visual control.}, language = {en} } @article{SchmitzNeumannNeumannetal., author = {Schmitz, Paul and Neumann, Christoph Cornelius and Neumann, Carsten and Nerlich, Michael and Dendorfer, Sebastian}, title = {Biomechanical analysis of iliac crest loading following cortico-cancellous bone harvesting}, series = {Journal of Orthopaedic Surgery and Research}, volume = {13}, journal = {Journal of Orthopaedic Surgery and Research}, number = {108}, publisher = {Springer Nature}, doi = {10.1186/s13018-018-0822-1}, pages = {1 -- 8}, abstract = {Background Iliac crest bone harvesting is a frequently performed surgical procedure widely used to treat bone defects. The objective of this study is to assess the biomechanical quantities related to risk for pelvic fracture after harvesting an autologous bone graft at the anterior iliac crest. Methods Finite element models with a simulated harvest site (sized 15 × 20 mm, 15 × 35 mm, 30 × 20 mm and 30 × 35 mm) in the iliac wing are created. The relevant loading case is when the ipsilateral leg is lifted off the ground. Musculoskeletal analysis is utilized to compute the muscle and joint forces involved in this motion. These forces are used as boundary conditions for the finite element analyses. Bone tissue stress is analyzed. Results Critical stress peaks are located between the anterior superior iliac spine (ASIS) and the anterior edge of the harvest site. Irrespective of the graft size, the iliac wing does not show any significant stress peaks with the harvest site being 20 to 25 mm posterior to the ASIS. The harvest area itself inhibits the distribution of the forces applied on the ASIS to extend to the posterior iliac wing. This leads to a lack of stress posterior to the harvest site. A balanced stress distribution with no stress peaks appears when the bone graft is taken below the iliac crest. Conclusion A harvest site located at least 20 to 25 mm posterior to the ASIS should be preferred to minimize the risk of iliac fatigue fracture.}, subject = {Beckenkammknochen}, language = {en} } @article{EnglertAngeleFierlbecketal., author = {Englert, Carsten and Angele, Peter and Fierlbeck, J. and Dendorfer, Sebastian and Schubert, T. and M{\"u}ller, R. and Lienhard, S. and Zellner, J. and Nerlich, Michael and Neumann, Carsten}, title = {Conductive bone substitute material with variable antibiotic delivery}, series = {Der Unfallchirurg}, volume = {110}, journal = {Der Unfallchirurg}, number = {5}, publisher = {Springer}, doi = {10.1007/s00113-007-1229-3}, pages = {408 -- 413}, abstract = {A new bone substitute, consisting of hydroxylapatite and calcium sulphate, was prepared in two formulations and analysed for its mechanical strength and antibiotic elution.The bone substitute PerOssal has osteoconductive and degradable properties. The material has a built-in capillary structure, which results in an immediate fluid uptake. Antibiotics absorbed to the bone substitute resulted in a prolonged release rate. Mechanical strength was investigated by an unconfined compression test up to failure under both wet and dry conditions for both formulations of the bone substitute. Antibiotic release was analysed microbiologically for two antibiotics, vancomycin and gentamicin, over an elution period of 10 days using the agar diffusion method.The drug release analysis resulted in a prolonged release rate of both antibiotics over 10 days. In vitro the amount of gentamicin and vancomycin eluted at day 10. From one pellet still exceeded the minimal inhibitory concentration of most aetiologically important pathogens. Formulation two of the present bone substitute is significantly harder in both wet and dry conditions when compared to formulation one. Both formulations lose strength in the wet condition relative to their performance in the dry condition. However, formulation two is as hard under wet conditions as formulation one is when dry.PerOssal is a suitable new degradable osteoconductive bone substitute that can be loaded with antibiotic solutions, which are released in effective doses over 10 days. The mechanical strength of PerOssal is sufficient to support cancellous bone defects in non-weight-bearing areas or in combination with osteosynthesis.}, subject = {Knochenersatz}, language = {en} } @article{LenichBachmeierDendorferetal., author = {Lenich, Andreas and Bachmeier, S. and Dendorfer, Sebastian and Mayr, E. and Nerlich, Michael and F{\"u}chtmeier, Bernd}, title = {Development of a test system to analyze different hip fracture osteosyntheses under simulated walking}, series = {Biomedizinische Technik. Biomedical engineering}, volume = {57}, journal = {Biomedizinische Technik. Biomedical engineering}, number = {2}, doi = {10.1515/bmt-2011-0999}, pages = {113 -- 119}, abstract = {The mechanical complications of osteosyntheses after hip fractures are previously investigated by mostly static or dynamic uniaxial loading test systems. However, the physiologic loading of the hip joint during a normal gait is a multiplanar, dynamic movement. Therefore, we constructed a system to test osteosyntheses for hip fractures under physiologic multiplanar loading representative of normal gait. To evaluate the testing system, 12 femora pairs were tested under 25,000 cycles with two standard osteosyntheses (Proximal Femoral Nail Antirotation/Gamma3 Nail). For angular movement, the varus collapse to cut out (∝CO) (∝CO=4.8°±2.1° for blade and ∝CO=7.8°±3.8° for screw) was the dominant failure mode, and only slight rotational angle shifts (∝Rot) (∝Rot=1.7°±0.4° for blade and ∝Rot=2.4°±0.3° for screw) of the femoral head around the implant axis were observed. Angular displacements in varus direction and rotation were higher in specimens reinforced with screws. Hence, the cut out model and the migration directions showed a distinction between helical blade and hip screw. However, there were no significant differences between the different implants. The new setup is able to create clinical failures and allows to give evidence about the anchorage stability of different implant types under dynamic gait motion pattern.}, subject = {H{\"u}ftgelenk}, language = {en} } @inproceedings{WoehlHuberLoibletal., author = {W{\"o}hl, Rebecca and Huber, Michaela and Loibl, Markus and Riebschl{\"a}ger, Birgit and Nerlich, Michael and Palm, Christoph}, title = {The Impact of Semi-Automated Segmentation and 3D Analysis on Testing New Osteosynthesis Material}, series = {Bildverarbeitung f{\"u}r die Medizin 2017; Algorithmen - Systeme - Anwendungen; Proceedings des Workshops vom 12. bis 14. M{\"a}rz 2017 in Heidelberg}, booktitle = {Bildverarbeitung f{\"u}r die Medizin 2017; Algorithmen - Systeme - Anwendungen; Proceedings des Workshops vom 12. bis 14. M{\"a}rz 2017 in Heidelberg}, publisher = {Springer}, address = {Berlin}, doi = {10.1007/978-3-662-54345-0_30}, pages = {122 -- 127}, abstract = {A new protocol for testing osteosynthesis material postoperatively combining semi-automated segmentation and 3D analysis of surface meshes is proposed. By various steps of transformation and measuring, objective data can be collected. In this study the specifications of a locking plate used for mediocarpal arthrodesis of the wrist were examined. The results show, that union of the lunate, triquetrum, hamate and capitate was achieved and that the plate is comparable to coexisting arthrodesis systems. Additionally, it was shown, that the complications detected correlate to the clinical outcome. In synopsis, this protocol is considered beneficial and should be taken into account in further studies.}, subject = {Osteosynthese}, language = {en} } @article{WoehlMaierGehmertetal., author = {W{\"o}hl, Rebecca and Maier, Johannes and Gehmert, Sebastian and Palm, Christoph and Riebschl{\"a}ger, Birgit and Nerlich, Michael and Huber, Michaela}, title = {3D Analysis of Osteosyntheses Material using semi-automated CT Segmentation}, series = {BMC Musculoskeletal Disorders}, volume = {19}, journal = {BMC Musculoskeletal Disorders}, publisher = {Springer Nature}, doi = {10.1186/s12891-018-1975-0}, pages = {1 -- 8}, abstract = {Backround Scaphoidectomy and midcarpal fusion can be performed using traditional fixation methods like K-wires, staples, screws or different dorsal (non)locking arthrodesis systems. The aim of this study is to test the Aptus four corner locking plate and to compare the clinical findings to the data revealed by CT scans and semi-automated segmentation. Methods: This is a retrospective review of eleven patients suffering from scapholunate advanced collapse (SLAC) or scaphoid non-union advanced collapse (SNAC) wrist, who received a four corner fusion between August 2011 and July 2014. The clinical evaluation consisted of measuring the range of motion (ROM), strength and pain on a visual analogue scale (VAS). Additionally, the Disabilities of the Arm, Shoulder and Hand (QuickDASH) and the Mayo Wrist Score were assessed. A computerized tomography (CT) of the wrist was obtained six weeks postoperatively. After semi-automated segmentation of the CT scans, the models were post processed and surveyed. Results During the six-month follow-up mean range of motion (ROM) of the operated wrist was 60°, consisting of 30° extension and 30° flexion. While pain levels decreased significantly, 54\% of grip strength and 89\% of pinch strength were preserved compared to the contralateral healthy wrist. Union could be detected in all CT scans of the wrist. While X-ray pictures obtained postoperatively revealed no pathology, two user related technical complications were found through the 3D analysis, which correlated to the clinical outcome. Conclusion Due to semi-automated segmentation and 3D analysis it has been proved that the plate design can keep up to the manufacturers' promises. Over all, this case series confirmed that the plate can compete with the coexisting techniques concerning clinical outcome, union and complication rate.}, subject = {Handchirurgie}, language = {en} }