Zeitschrift für Orthopädie und Unfallchirurgie
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In this paper we present our first experience in the application of a new, fixed-angle plate fixation: the locking attachment plate (LAP, Synthes, Oberdorf, Switzerland). We examined whether the LAP is a useful addition to the existing technical palette for periprosthetic fractures. The LAP is used for periprosthetic fractures with stable prostheses or intramedullary implants. The plate can be installed, e.g., on a 4.5 mm locking compression plate (LCP). Locking screws or cortical screws can be placed through its 4 diagonal fixed-angle arms, bicortical around the prosthesis stem into the bone. The LAP is designed to prevent lateral screw pull-out, to stabilise the prosthesis stem and thus to allow early postoperative mobilisation of patients. ⋯ Periprosthetic fractures are an increasingly common complication in old, often multi-morbid patients. A contemporary therapeutic intervention and early postoperative mobilisation contribute substantially to the success of treatment. The first results in the use of the LAP as a new implant option for periprosthetic fractures of the femur, tibia and humerus are promising. Further studies are necessary to show whether our overall good results are reproducible in larger groups of patients and whether the LAP can be given a firm position in the technical repertoire for treatment of periprosthetic fractures.
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The results of a national survey from 1998 showed that only around 10 % of orthopaedic surgeons in Germany had strictly implemented modern third-generation cementing techniques in total hip arthroplasty (THA). A 2005 update showed an improvement up to 29.4 %. The study was repeated in 2010 in order to evaluate the current situation and to determine whether modern cementing techniques have become more popular. ⋯ The results of this survey demonstrate that, in comparison to 2005, the current state of cemented THA, in particular cementing technique has generally significantly improved. Future emphasis should focus on continued surgeon education and training, as the cementing techniques are of utmost importance for long-term durability.
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Due to the aging population, we are confronted with a growing number of osteoporotic and insufficiency fractures of the pelvic ring. They are the result of a low-energy trauma. With conventional X-rays, it is not always possible to identify the lesions. ⋯ The choice of treatment is determined by the degree and the localization of the instability. Osteosynthesis techniques differ from the techniques we use in adults. The trans-sacral positioning bar, iliolumbar fixation and angle stable plate osteosynthesis are used increasingly often.