Operative Orthopädie und Traumatologie
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Oper Orthop Traumatol · Aug 2021
[Minimally invasive implantation technique of a system for spinal cord stimulation].
Spinal cord stimulation (SCS) targets structures of the dorsal column and dorsal horn of the spinal cord with electrical impulses, thereby, modulating pain perception. For chronic pain patients, e.g., in failed back surgery syndrome (FBSS), the aim is to achieve pain relief and enable patients to improve their quality of life. ⋯ In all, 19 consecutive patients with FBSS were treated by high frequency SCS (HF-SCS) and included in a prospective prognostic study. In 18 patients, an internal pulse generator (IPG) for HF-SCS was permanently implanted. Therapy success was assessed using the Oswestry Disability Index (ODI), visual analogue pain scale (VAS) and painDetect questionnaire. Neuropathic pain of the legs versus the back (median values: VAS leg 71 mm, VAS back 69 mm) was dominant in the patients at a preoperative mean ODI of 63%. With HF-SCS therapy, a pronounced pain reduction was seen and persisted in the follow-up after 6 months (VAS leg 18 mm, VAS back 24 mm). The ODI showed an improvement to a mean of 24% after 6 months.
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Restoring humeral shaft alignment using direct or indirect reduction techniques with subsequent intramedullary stabilisation with an antegrade or retrograde inserted humeral nail. Achieving osseous union and restoration of painfree upper arm function. ⋯ Very good healing results with excellent clinical and radiological healing are achieved in more than 90% of cases after both antegrade and retrograde nailing. Intraoperative problems that have been reported in up to 40% of cases occurred mainly with former generation nails or were attributable to technical errors. Correspondingly, with the closed reduction technique postoperative infections are rare (< 3%). Undesirable distraction at the fracture site is successfully corrected by intraoperative interfragmentary compression. Success and complication rates after intramedullary nailing and plate fixation are not significantly different. Functional shoulder-related problems may occur after antegrade nailing, whereas elbow problems may occur after retrograde nailing.
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Oper Orthop Traumatol · Dec 2020
Minimally invasive double-plating osteosynthesis of the distal femur.
Technical description of minimally invasive double-plating of the distal femur. ⋯ Between 2015 and December 2018, minimally invasive double-plate osteosynthesis using a medial helical shaped plate was performed in 11 patients. In 6 cases it was applied in patients (81 years ± 7 SD) with a supracondylar peri- or interprosthetic femoral fracture. No implant failure or loss of reduction was seen after postoperative unrestricted weight bearing. In the additional 5 cases double-plating was used in salvage procedures ([infected] non-unions, hardware failure). One of these patients developed a fracture-related infection for which all material was removed. The fracture healed after a new attempt of antegrade nailing combined with an additional locking plate. In the remaining patients complete bone healing without hardware failure was seen.
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Oper Orthop Traumatol · Oct 2020
Review[Palmar radioscapholunate arthrodesis with distal scaphoidectomy].
Radioscapholunate (RSL) arthrodesis with distal scaphoidectomy using an angular stable plate and palmar access in post-traumatic or degenerative osteoarthritis limited to the radiocarpal joint. ⋯ Palmar RSL arthrodesis and distal scaphoidectomy using angular stable plate fixation shows a high union rate and pain relief while maintaining good residual mobility of the wrist.
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Oper Orthop Traumatol · Feb 2020
[Modular arthrodesis system TITAN (KAM-TITAN) after failed revision total knee arthroplasty : Operative technique and clinical experience].
Restoration of a painless, weight-bearing extremity with a modular knee arthrodesis system based on a cementless modular revision stem for rotationally stable, diaphyseal anchorage. ⋯ Between 2007 and 2012 clinical data were collected and analyzed retrospectively. A total of 27 patients had been treated within a two-stage exchange procedure with implantation of a modular intramedullary arthodesis nail TITAN (KAM-TITAN). The mean follow-up was 30.9 ± 12.0 months. A functional evaluation was performed using the Oxford Knee Score (OKS). The analyzed patients showed a mean score of 39.2 ± 8.3. To determine the pain level the Visual Analog Scale (VAS) for pain was used and showed a mean score of 2.9 ± 1.3. The rate of definitely free of infection (using Laffer criteria) at last follow-up was 85.2%.