Zeitschrift für Orthopädie und Unfallchirurgie
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Comparative Study
[Ultrasound as a viable alternative to standard X-rays for the diagnosis of distal forearm fractures in children].
Distal forearm fractures are very common in childhood. Radiography of the wrist is the standard diagnostic procedure. But because of higher sensitivity of growing bones to ionising radiation the diagnostic use of X-rays should be minimised as much as possible. Recent studies have shown that distal forearm fractures in children can be safely and reliably diagnosed using only ultrasound. The aim of our study was to evaluate and confirm the safety and applicability of the ultrasound diagnostic procedure in comparison to X-ray diagnosis under routine conditions of our paediatric emergency department. ⋯ We confirm ultrasound is an applicable, rapid and safe alternative to X-rays in diagnosing metaphyseal forearm fractures in children. Even sonographic axis measurement seems to be a viable method. Thereby ultrasound potentially reduces the X-ray burden in children and additionally accelerates the diagnostic procedure.
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Controlled Clinical Trial
[Total knee arthroplasty in post-traumatic osteoarthritis].
This study aims to analyse the outcome and the complications after total knee arthroplasty in post-traumatic osteoarthritis in comparison to TKA in patients with degenerative osteoarthritis. ⋯ Patients after TKA because of post-traumatic osteoarthritis show worse results concerning function and condition compared to patients with degenerative osteoarthritis. Heterogeneous pathogenesis and high rates of revision operations underline the complexity of this group of patients. The treatment has to be adjusted to the patient's requirements as well to the pathoanatomy.
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Minimally invasive procedures for additive ventral stabilisation of dorsal instrumented unstable burst fractures of the thoracolumbar spine have been developed. Typical complications of these standardised techniques have been described in the past. Only limited data exist on injury to upper abdominal organs associated with minimally invasive spondylodesis. ⋯ Retraction of the diaphragm might be the main factor causing this complication. In conclusion, splenic injury is a rare but potentially lethal complication in the operative treatment of thoracolumbar fractures. Therefore postoperative abdominal sonography should routinely be done and in case of haemodynamic instability the possibility of splenic injury must be considered as part of the differential diagnosis.
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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.