Der Unfallchirurg
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Case Reports
[Iatrogenic "metalloma" (titanoma) caused by implant failure in "metal-backed" patellar joint surface replacement].
Patellofemoral problems frequently provide the cause for revisions after total knee replacements (TKR). Problems with metal-backed patellae, in particular, have been reported on in the past, with a failure rate of 33%. As a result of implant failure, there is an increase of polyethylene and metallic wear, which eventually leads to a synovialitis and metallosis. ⋯ Energy dispersive X-ray microanalysis showed a high level of titanium within the intra- and extracellular deposits. In differential diagnosis these findings were postulated as "metalloma" (titanoma). In cases of periprosthetic pseudotumors, particular those with implant failure, a iatrogenic-induced metalloma should be considered.
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This study describes the anatomical basis of direct visualization of the radial nerve and of fracture reduction in humeral shaft nailing and reports first clinical results. Fourteen cadavers were random selected and dissected in order to determine the exact course of the radial nerve in relationship to anatomical landmarks. In individuals with a total humeral length between 25-33 cm the radial nerve was found to cross the humeral shaft exactly in the middle of the long axis of the humeral shaft. ⋯ Using these landmarks in six clinical cases fracture reduction, visualization of the radial nerve and intramedullary nailing could be achieved with endoscopic control. There were no surgical complications such as secondary radial nerve palsy, hematomas or wound healing problems. With the use of the endoscope the number of secondary radial nerve palsies associated with intramedullary humeral shaft nailing might be reduced in the future.
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Injuries of the posterior pelvic with combined anterior and posterior instability require the stabilisation of both the anterior and posterior pelvic ring. If the injury only involves the ligamental connections, then a transileosacral osteosynthesis with screws is the minimal invasive and biomechanically suitable method of choice. The difficulty with this approach is the correct placement of the screws. ⋯ The postoperative CT scans showed no intraspinal or intraforminal malplacement of the screws. In two cases a slight tangential screwthread penetration through the ventral sacrum was found. Our first experiences with this novel technology are encouraging and clearly demonstrate the advantages of fluoroscopic supported passive navigation systems for the optimal placement of ileosacral screws.
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The performance of the external fixation regarding severe fractures of the distal radius was evaluated by means of a very detailed retrospective study. Between 1989 and 1994 74 Patients with 76 fractures of the distal radius with a mean age of 69 years for female and 39 years for male patients were treated with the external fixator. 37% were open fractures. Using the ASIF classification, 21% were type A-fractures, 8% were type B-fractures and 71% were type C-fractures. ⋯ With the Sarmiento score as well as the Castaing score, 84% could be classified as very good or good, 16% as fair, no poor results were recorded. From this study we conclude that the primary treatment of complex fractures of the distal radius can be performed with external fixation along with the additional procedures necessary (K-wires etc.). Because of the reliable elimination of pain caused by the fracture, it forms a preventive measure against reflex sympathic dystrophy.