Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · May 2001
In-vitro reconstruction of massive rotator cuff ruptures with triceps tendon or coracoacromial ligament.
The possibility of reconstructing a massive rotator cuff rupture with a free graft of the triceps tendon or the coracoacromial ligament was tested experimentally in an anatomical and biophysical cadaver investigation. After dissection of the rotator cuff, a section of the supraspinatus tendon was removed to simulate a defect in the cuff. In dissection of the grafts, a bony squama was incorporated by osteotomy. ⋯ The tensile strength and the elasticity of the grafts were compared with that of the supraspinatus tendon in rupture tests. The mean value of the maximum load determined (FRm) was greatest for the triceps tendon (706.451 N), while very much lower values were found for the coracoacromial ligament (395.836 N) and the supraspinatus tendon (496.792 N). The mean value of the maximum elasticity (LAm) was lowest for the coracoacromial ligament (4.701%); the supraspinatus tendon (7.047%) and the triceps tendon (8.250%) showed very much greater elasticity.
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Arch Orthop Trauma Surg · May 2001
An improved surgical technique to treat femoral shaft malunion: revised reamed intramedullary nailing technique.
Twenty-four consecutive adult patients who sustained a femoral shaft angular or rotational deformity, with or without significant shortening, were treated with skeletal traction of the femoral condyle, transverse femoral osteotomy, realignment of the shaft axis with or without lengthening, stable reamed intramedullary nail stabilization, and corticocancellous bone grafting. Twenty-one patients who underwent the treatment were followed-up for at least 1 year (range 1.0-4.5 years), and all achieved a solid union. The union rate was 100% (21/21) with a union period of 4.9+/-0.5 months. ⋯ All patients achieved a satisfactory outcome as indicated by patient satisfaction and physician assessment of outcome (p < 0.001, Fisher's exact test). In the present series, the use of this revised reamed nailing technique resulted in a high success rate and a low complication rate. It provides an effective alternative treatment in indicated cases.
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Arch Orthop Trauma Surg · May 2001
Cement removal with an endoscopically controlled ballistically driven chiselling system. A new device for cement removal and preliminary clinical results.
In this paper, we introduce a newly developed miniaturised chiselling system (Swiss OrthoClast) which allows endoscopically controlled cement removal even from deep within the femur in hip revision arthroplasty. The intraoperative handling is demonstrated and illustrated. The device consists of a control unit, a handpiece, a set of chisels of different lengths, shape, and tip geometry, a set of plug extraction tools, and a special intrafemoral endoscope. ⋯ The duration of the procedure varied from 13 to 75 min, with an average of 32 min. In all but one case, the cement was completely removed. We noted one case of cortical fissuring.
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Arch Orthop Trauma Surg · May 2001
Autologous osteochondral transplantation using the diamond bone-cutting system (DBCS): 6-12 years' follow-up of 35 patients with osteochondral defects at the knee joint.
Thirty-five patients with severe osteochondral defects were treated by autologous osteochondral transplantation between 1986 and 1992. The majority of patients (27) suffered from osteochondrosis dissecans, while 8 patients presented with posttraumatic osteochondral defects. The grafts were harvested with a diamond bone cutter from the posterior part of the medial or lateral femoral condyle. ⋯ The majority of patients improved their activity level and the functional status of the joint. Twelve patients developed new radiological signs of osteoarthrosis with a decrease in the radiological score of Kellgren and Lawrence by about one stage. We conclude that autologous osteochondral transplantation with the diamond bone-cutting system is an effective method in the treatment of severe osteochondral defects.
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Arch Orthop Trauma Surg · Jan 2001
Randomized Controlled Trial Clinical TrialImmunohistochemical characterization of the perivascular infiltrate cells in tissues adjacent to stainless steel implants compared with titanium implants.
Metallic orthopaedics implants are composed of elements that are known to be skin sensitizers in the general population. In this study, we analyzed the cells of perivascular infiltration in the tissue adjacent to titanium (n = 23) and steel (n = 8) implants after explantation of the metals by immunohistochemical methods. The following panel of monoclonal antibodies were used as parameters: CD 1a (Langerhans cells), CD 4 (T-helper cells), CD 8 (T-suppressor cells), CD 11c (monocytes and macrophages), CD 45 RO (memory cells), CD 45 RA (naive cells), eosinophil cationic proteins (ECP), neutrophil elastase, and HLA-DR. ⋯ We conclude that sensitization to metals is possible in the tissue adjacent to steel and titanium implants, because all cells which play an important role in allergic delayed-type hypersensitivity (type IV) reactions are present. This phenomenon may be called a 'pre-sensitization' phase, because no sensitization or allergic reactions were seen in our cases. Second, in the present study, a statistical difference was not seen in the number of infiltrate cells in the tissue adjacent to steel compared with titanium implants.