Der Unfallchirurg
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Hamstring and patella tendons are usually used for anterior cruciate ligament (ACL) reconstruction and fixed with foreign material, partially executed far from the original point of insertion. Besides the biomechanical questions bone defects are a severe problem in cases of revision. We developed a biological method with diamond cutting instruments for graft fixation with bone dowels near the native insertion. The graft is tensioned and fixed in 120 degrees knee flexion and is self-adapting in extension. The technique has been used in a large number of cases during a prospective study with a follow-up of 10 years for patella tendon and 4 years for hamstring tendon grafts. In this investigation 124 patients with bone-patellar tendon-bone (BPTB) grafts showed an International Knee Documentation Committee (IKDC) score A/B in 87% after a mean follow-up of 9.6 years, a Lachman test (maximum side-to-side difference) of 1.38+/-0.93 mm and a negative pivot shift test in 91% of the cases. Of the 147 patients with hamstring tendon grafts 89% had an IKDC score A/B after a mean follow-up of 4.3 years, a Lachman test of 1.14+/-0.76 mm and no pivot shift in 90% of the cases. The Tegner activity score decreased by -1.8 in both groups. ⋯ This method allows a reliable biological press-fit fixation for every kind of graft near the original point of insertion, preventing bone defects, allowing early intensive rehabilitation and low costs.
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Reconstruction of the anterior cruciate ligament (ACL) is a widely used procedure, but up to now no results have been published on an implant-free technique using a quadriceps tendon autograft and press-fit fixation. ⋯ Reconstruction of the ACL with an autologous quadriceps tendon and an implant-free technique yielded good results compared to established operative methods in the short-term and should be consistently followed-up for long-term confirmation.
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The successful management of open extremity injuries continues to represent a surgical challenge requiring a structured and multidisciplinary treatment concept. The treatment strategy depends on specific parameters, including the overall injury severity, life threatening trauma components, the degree oft soft tissue injury, the ischemia time, the contamination of the wound as well as the age and accompanying diseases of the patient. ⋯ The initial wound management includes radical and serial debridements and vessel reconstruction, followed by the gradual reconstruction of bone, tendons and nerves and a subsequent plastic soft tissue coverage. The sequential and priority-orientated implementation of these treatment steps is decisive for the long term outcome, which ideally results in an regular healing of bone and soft tissue without the presence of infection and good regain of extremity function.
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Comparative Study
[Biomechanical investigation on refixation of tuberosities on shoulder prostheses. Does refixation with different suture materials offer enough stability?].
Elderly patients suffering from complex, non-reconstructable fractures of the proximal humerus are commonly treated by primary implantation of a shoulder endoprosthesis. One of the most critical factors for success or failure of treatment is still the refixation of the tuberosities. ⋯ Due to these results suture materials have a limited usefulness for refixation of tuberosities as an increased risk of obstruction for bony consolidation can result.