Zeitschrift für Orthopädie und Unfallchirurgie
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Review Meta Analysis
[Effect of continuous passive motion for cartilage regenerative surgery - a systematic literature review].
The aim of this systematic review was to evaluate treatment effects of continuous passive motion (CPM) after surgical cartilage repair. ⋯ Three studies described significant improvements with regard to subjective outcome such as pain, swelling, Quality Life Survey, Knee Society score, WOMAC score or rating Cincinnati due to the surgical treatment and the CPM intervention of cartilage defects in the knee. Six (case) studies suggested an enhanced cartilage quality of the patients after CPM. More high-quality randomised controlled trials are needed to provide high level evidence.
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Review Case Reports
[A rare complication of kyphoplasty is PMMA-cement loosening - case report and literature review].
For vertebral body fractures combined with strong back pain, the kyphoplasty is an established method for pain reduction. A balloon effects an excavation in the vertebral body, which will be filled up with cement. We distinguish between cements of polymethyl metacrylate (PMMA) and calcium phosphate. Their diverse chemical qualities enable different indications. ⋯ Injuries of the vertebral body frame cannot be operated exclusively with kyphoplasty. The reason for this is the instability of the vertebral body despite the injection of the PMMA cement. We advise to stabilise the spine in such cases with a dorsal internal fixator additively.
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The goal in treatment of metacarpal fractures is to restore the normal function of the hand. Although a majority of these fractures can be treated non-operatively, surgery is recommended for displaced fractures and in case of a patient wish for primary stability for practise. A poor clinical outcome is described for metacarpal shortening of more than 5 millimeters and for rotational deformity. Whereas plate osteosynthesis may lead to soft tissue irritation involving tendon adhesions and scar formation, we have used the elastic stable intramedullary nailing [ESIN] technique using titanium elastic nails (TEN) for intramedullary splinting of short metacarpal shaft and neck fractures. ⋯ Minimally invasive intramedullary stabilisation of short metacarpal shaft and neck fractures with a TEN is a safe surgical technique and achieves primary stability for practise. It reliably leads to fracture healing and produces excellent functional results.
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The incidence of proximal fractures of the femur will increase with the demographic change in the German population. Besides osteosynthesis, which in most cases of femoral neck, pertrochanteric and femoral head fracture is the method of choice, arthroplasty of the hip is likewise an established therapy. Indications are dislocated femoral neck fractures of the elderly. ⋯ For hip arthroplasty after fracture total hip replacement as well as hemiarthroplasty with bipolar prosthesis should be considered. The implant chosen and the implantation technique with or without bone cement has to be determined. Facts like the general state of health, biological age, level of activity and comorbidities should be taken into account appropriately.