OVERVIEW The GRA Marketing Internship Program is offered to students who are interested in gaining valuable work experience through efforts in marketing, membership, sales, and events. Interns work directly to assist the Director of Marketing and Communications on various tasks relating to upcoming GRA events. During this internship, students will work a minimum of 10 hours a week and a maximum of 20 hours a week. Students are encouraged to earn credit for their internship, however this is a paid internship. Students interested in obtaining credit for their internship must consult their academic advisor or the intern coordinator at their academic unit.

Role of WHO.

Introduction
With the advances and improvement of computer-assisted surgery devices, computer-guided pedicle screws insertion has been applied to the lumbar, thoracic and cervical spine. The purpose of the present study was to perform a systematic review of all available prospective evidence regarding pedicle screw insertion techniques in the thoracic and lumbar human spine.

/pdf/accuracy-of-pedicle-screw-placement-a-systematic-review-of-2jz9vln0we.pdf

Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques

The orderly migration of various white blood cell types to inflammatory sites is a highly regulated process that involves a diversity of adhesion and signaling molecules. This cellular influx is initiated by relatively low affinity interactions that allow for leukocytes to roll along the vascular surfa ce. This rolling phe­ nomenon is mediated by adhesive interactions between lectin containing ad­ hesion molecules, termed selectins, on both the vascular endothelium and leukocytes, and car bohydrate ligands immobilized on mucin-like scaffolds. This adhesion allows for a rapid recognition of various cell types under the conditions of vascular flow, with the result that inflammatory cells are spe­

Interactions and the initiation of the inflammatory response

Rationale: Acute lung injury is a common complication after severe trauma, which predisposes patients to multiple organ failure. This syndrome largely accounts for the late mortality that arises and despite many theories, the pathological mechanism is not fully understood. Discovery of histone-induced toxicity in mice presents a new dimension for elucidating the underlying pathophysiology.Objectives: To investigate the pathological roles of circulating histones in trauma-induced lung injury.Methods: Circulating histone levels in patients with severe trauma were determined and correlated with respiratory failure and Sequential Organ Failure Assessment (SOFA) scores. Their cause–effect relationship was studied using cells and mouse models.Measurements and Main Results: In a cohort of 52 patients with severe nonthoracic blunt trauma, circulating histones surged immediately after trauma to levels that were toxic to cultured endothelial cells. The high levels were significantly associated with the incidence of...

/pdf/circulating-histones-are-mediators-of-trauma-associated-lung-19085uuxtp.pdf

Circulating histones are mediators of trauma-associated lung injury.

Transition from acute to chronic pain after surgery.

Background:Substantial fibular torsional deformities were detected after surgery for ankle fractures combined with a lesion of the syndesmotic complex using a novel CT analyzing method.Methods:In a...

Detection of Fibular Torsional Deformities after Surgery for Ankle Fractures with a Novel CT Method

Hook plate fixation of acromioclavicular (AC) joint separations carries the disadvantage of compulsory implant removal, occasional implant fatigue and secondary loss of reduction. This study compares the clinical and radiological outcome of a new polyaxial angular stable hook plate (HP) with absorbable polydioxansulfate (PDS) sling. Between 2002 and 2009, out of a consecutive series of 81 patients with symptomatic Rockwood type V lesions 52 patients received clinical and radiographic follow-up (HP: n = 27; PDS: n = 25). HP patients were prospectively analyzed and retrospectively compared with the PDS group. Radiological follow-up included comparative coraco- and acromioclavicular distance (CCD/ACD) measurements as percentage of the uninjured shoulder. For clinical follow-up a standardized functional shoulder assessment with Constant Score, DASH Score, Taft Score and a self-report questionnaire including the visual analog scale (VAS) was carried out. Direct postoperative radiographs showed an overcorrection of CCD in the HP group (−4.4% of the uninjured side) and failure of anatomic correction in the PDS group (+11.0%). After implant removal, CCD increased in the HP group extensively to 16.7% (overall loss of reduction: 21.1%) and 23.9% in the PDS group. Redisplacement (100% increase of CCD) occurred in five cases (HP: 2, PDS: 3) and partial loss of reduction in four cases of each group. Comparing functional results no differences could be seen between both the groups (Constant-Score HP: 91.2 points, PDS: 94.6 points; Taft-Score HP: 9.4 points, PDS: 10.0 points). The DASH-Score revealed better results for PDS group (3.4 points, HP: 8.0 points). Signs of acromial osteolysis appeared in five cases (18.5%) in HP group. There was no case of implant failure. The X-rays of six patients (HP: 4, PDS: 2) showed AC-joint-osteoarthritis. Hook plate fixation employing a polyaxial angular stable plate finally restores the coracoclavicular distance more accurately than augmentation with a PDS sling. Although in HP group no implant failure occurred, major disadvantages are initial overcorrection and acromial osteolysis. Both have no influence on final functional results.

Hook plate fixation for acromioclavicular joint separations restores coracoclavicular distance more accurately than PDS augmentation, however presents with a high rate of acromial osteolysis

The optimal surgical treatment for displaced proximal humeral fractures continues to be controversial. Different treatment modalities are available. Mechanical implant-related problems, however, and the preservation of the biological integrity of the humeral head remain unsolved. New implants providing angular stability are expected to maintain the intraoperative result of reduction until definitive healing. The purpose of this study was to evaluate the functional outcome and the complication rate of an angular and sliding stable antegrade interlocking nail for the treatment of displaced proximal humeral fractures. In a prospective study, 112 consecutive patients with displaced proximal humeral fractures were treated. Complete 12 months postoperative follow-up was available for 74 patients. Fracture types were classified according to the Neer-classification. Clinical, functional and radiographic follow-up evaluations were performed 3, 6 and 12 months after surgery. The Constant Score (CS) was used to assess shoulder function. All fractures were united. The CS (MV ± SD) of the injured side 3, 6 and 12 months after surgery were 42.1 ± 15.1, 56.1 ± 20.1 and 70.9 ± 19.3, respectively. Patients sustaining Neer III and VI/3 fractures revealed better shoulder function (68.8 ± 14.7, 74.9 ± 17.6) 12 months postoperatively than those with Neer IV/4 fractures (60.7 ± 23.2), where most complications occurred. Complications requiring surgical therapy were seen in a total of 24 patients (30%) and included backing out of screws in nails without peak inlay (20%; 2000–2003), protrusion of screws into the gleno-humeral joint (5%), loss of reduction with malunion (9%) and major tubercle displacement (7%). The treatment of displaced proximal humeral fractures with an angular and sliding stable antegrade nail (Targon-PH) led to good functional results, especially in 2- and 3-part fractures. There exists a substantial risk for postoperative complications and bad motor function in Neer IV/4 fractures. Lateral backing out of screws was abolished by implant modifications (PEEK-inlay) from 2003 onwards. Additional tension wire banding of the major tubercle may further reduce the risk of secondary displacement.

Angular and sliding stable antegrade nailing (Targon PH) for the treatment of proximal humeral fractures.

Internal fixation is the established dorsal standard procedure for the treatment of thoracolumbar fractures. The main problem of the procedure is the false positioning of the pedicle screws. The exact determination of pedicle screws has up to now only been possible through postoperative computed tomography. This study was intended to clarify the diagnostic value of intraoperative 3D scans after pedicle screw implantation in thoracolumbar spine surgery. The direct intraoperative consequences of the 3D scans are reported and the results of the 3D scans are compared with the postoperative computed tomography images. Intraoperative 3D scans were prospectively carried out from June 2006 to October 2008 on 95 patients with fractures of the thoracolumbar spine that have been treated with internal fixation. Screws positions were categorised intraoperatively, screws in relevant malposition were repositioned immediately. A computed tomography of the involved spinal section was carried out postoperatively for all patients. The positions of the pedicle screws were determined and compared in the axial reconstructions of both procedures. Four hundred and fourteen pedicles with enclosed screws were evaluated by the 3D scans. The time needed for carrying out the 3D scan amounts to an average of 8.2 min. Eleven screws (2.7%) in ten patients were primarily intraoperatively repositioned on the basis of the 3D scan evaluation. Two of 95 patients had to have false positions of the screws revised secondarily following evaluation of the computed tomographies. The secondary postoperative revision rate of the patients amounts to 2.1%. In relation to the number of screws, this is a revision rate of 0.5%. The postoperative computed tomographies showed 323 pedicles without cortical penetration by the screws (78.0%). Ninety-one screws penetrated the pedicle wall (22%). It was possible to postoperatively compare the position classifications of 406 pedicle screws. The CT showed 378 correct screw positions, while 28 screws were positioned falsely. On the basis of the 3D scans, 376 of 378 correct positions were correctly assessed. Twenty-one of 28 false positions could be correctly classified. The sensitivity of all 3D scans reached 91.3% and the specificity 98.2%. The position of 97.8% of the pedicle screws was correctly recognised by the intraoperative 3D scan. Nine screws were classified falsely (2.2%). The comparison of the classification results showed significantly higher error findings by the 3D scan in the spinal section T1–10 (P = 0.014). The image quality of the 3D scan correlates significantly with the width of the scanned pedicle, with the body mass index, the scanned spinal section and the extent of the fixation assembly. 3D scans showed a high accuracy in predicting pedicle screw position. Primary false placement of screws and primary neurovascular damage cannot be avoided. But intraoperative evaluation of the 3D scans resulted in a primary revision rate of 2.7% of the pedicle screws and we could lower the secondary revision rate to 0.5%.

/pdf/benefit-and-accuracy-of-intraoperative-3d-imaging-after-1detpeg9sj.pdf

Benefit and accuracy of intraoperative 3D-imaging after pedicle screw placement: a prospective study in stabilizing thoracolumbar fractures

Objective Head-preserving fracture care especially for the elderly may be complicated by acetabular screw penetration, cut out, delayed union or femoral head necrosis. The following comparative study analyses whether a new angular stable device may overcome these shortcomings. Material and methods The Targon FN plate (BBraun/Aesculap, Germany) employs up to four angular stable telescoping screws for the fixation of the head fragment. In a prospective study patients with displaced and undisplaced intracapsular femoral neck fractures where treated by closed reduction and fracture fixation using either the Targon FN implant or a standard sliding hip screw (SHS). Patients were followed up clinically, radiographically and via telephone at a mean of follow-up time of 15.5 months. Results Fifty-two patients (mean age: 67 years) with femoral neck fractures were treated with either Targon FN (27 patients) or SHS (25 patients). Time for surgery did not differ within the two groups (56 min Targon FN vs. 55 min SHS). Eight patients with SHS (32%) and four patients (15%) with Targon FN experienced cut out of the lag screw and received hip replacement (p  Conclusions The study revealed less subsidence of the head fragment, lower cut out rate and a lower rate of conversion to hemiarthroplasty after Targon FN fixation in comparison to a standard SHS fixation in a small number of patients with hip fractures. However, this was not accompanied by functional limitations in the SHS group.

Philip Gierer

Papers

Detection of Fibular Torsional Deformities after Surgery for Ankle Fractures with a Novel CT Method

Hook plate fixation for acromioclavicular joint separations restores coracoclavicular distance more accurately than PDS augmentation, however presents with a high rate of acromial osteolysis

Angular and sliding stable antegrade nailing (Targon PH) for the treatment of proximal humeral fractures.

Benefit and accuracy of intraoperative 3D-imaging after pedicle screw placement: a prospective study in stabilizing thoracolumbar fractures

Angular stable multiple screw fixation (Targon FN) versus standard SHS for the fixation of femoral neck fractures