Der Orthopäde
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The movement of the forearm follows a complex interplay of three main components: the proximal and distal radioulnar joint and the interosseous membrane. Injuries to one or even all components have a huge impact on the integrity of this system. The Essex-Lopresti lesion presented a high challenge in clinical diagnostics as well as therapy. ⋯ If a reconstruction of the radial head by osteosynthesis is not possible, a radial head prosthesis should be implanted in the case of longitudinal instability - avoiding overlapping and/or oversizing. The reconstruction of the interosseous membrane should be considered, as well as the assessment of the distal radioulnar joint and/or the triangular fibrocartilage complex. Various reconstruction options are available in this regard.
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The aim of this study was to systematically review the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) and fenestration discectomy (FD) in the treatment of lumbar disc herniation (LDH). ⋯ The Percutaneous transforaminal endoscopic discectomy is associated with better postoperative ODI score, better results in length of incision, lower blood loss, shorter operation time, postoperative bed time and hospitalization time. The complications did not differ significantly between PTED and FD in the treatment of lumbar disc herniation. These findings provide evidence to support PTED is efficacious for LDH; however, scar repair of a ruptured anulus fibrosus needs a long time and the patients undergoing PTED should be advised to stay in bed for a long time even if the symptoms are markedly relieved. These results are not limited to randomized controlled trials and lack data about the long-term outcome.
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Accurate placement of cervical pedicle screws remains a surgical challenge. This study aimed to test the feasibility of using a novel three-dimensional (3D-)printed navigational template to overcome this challenge. ⋯ A navigational template can be designed by removing the soft tissue from the bony surface in a CT-generated 3D model. This guiding tool may effectively prevent intraoperative drifting and accurately places cervical pedicle screws.
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Complex spinal surgery in elderly patients mostly treats degenerative spine alterations. The use of multimodal intraoperative neuromonitoring (IONM) has proven to be a useful tool to recognize neural deterioration during such operations. Elderly patients often have preexisting neural impairment, which leads to difficulties in deriving some potentials or can even lead to not obtaining any potentials at all. ⋯ For reliable benefits from IONM a combined use of monitoring and mapping methods as well as the right choice of methods according to the spine level to be treated and a definition of the neural structures in danger is needed. This article intends to explain IONM methods in procedures treating degenerative spine alterations in a comprehensive way and to show our point of view on pedicle stimulation. Readers should be motivated to deepen their knowledge in these methods and to gain confidence and experience to increase the safety of these operations for the benefit of our patients.
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Review Case Reports
[Reconstruction of osseous defects using the Masquelet technique].
The Masquelet procedure or induced membrane technique presents a treatment option for relatively large osseous defects, e.g. after trauma, tumour resection or osteomyelitis even in the presence of unfavourable soft tissues. Initially developed at the end of the last century by the French surgeon Masquelet, the technique relies on a bioactive membrane that forms a foreign body reaction around a cement spacer. This spacer is implanted in the residual defect after rigorous debridement of bone and soft tissue during a first-stage procedure. ⋯ After adequate stabilisation using standard techniques, a gradual corticalisation of the graft can be observed over the duration of several months, with remodelling in the long-term course. The following article describes the original technique, our preferred approach including indication, surgical technique and postoperative follow-up. Additionally, the biological background and clinical tips and tricks are presented.