Operative Orthopädie und Traumatologie
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Oper Orthop Traumatol · Oct 2006
Comparative StudyMinimally invasive total hip replacement with the patient in the supine position and the contralateral leg elevated.
Supine positioning of the patient taking into account - the demands of anesthesia in an emergency requiring intubation, - minimal time for sterile draping, - patient position can be adjusted by the assistants, - easier implant positioning due to the supine position. Reduction of operative trauma with earlier mobilization and shorter rehabilitation time compared with conventional technique. Application of standard instruments and implants. ⋯ 185 total hip replacements were performed with this positioning and surgical technique from September 2004 to June 2005. The first 108 minimally invasive procedures were compared with 117 conventional procedures. The patients operated in minimally invasive technique generally did better in terms of operating time, blood loss, use of analgesics, rehabilitation time, and functional outcomes. In seven patients, shaft fissures occurred within the first 3 months due to too abrupt intraoperative dislocation of the leg (learning curve!), but were all treated by application of cerclage and healed uneventfully.
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Oper Orthop Traumatol · Oct 2006
Comparative StudyIntramedullary stabilization of periprosthetic fractures of the femur taking special account of bone defects.
Healing of the periprosthetic fracture and area of defective bone by the bone healing mechanisms of intramedullary stabilization. Reconstruction of the correct length, axial alignment, and rotation of the fractured femoral shaft by anchoring a revision stem in the intact femoral diaphysis. ⋯ 21 patients (13 women, eight men) aged between 43 and 86 years (mean age: 71.2 years) with periprosthetic fracture of the femur, additional loosening of the stem in eight cases (Vancouver B2) and additional bone loss in 13 cases (Vancouver B3). Postoperative complications: two fractures following another fall (repeat operations: one replacement, one plate), four revisions due to subsidence of the stem (three replacements involving change to a standard stem with healed proximal femur, one replacement with another interlocked revision stem). Bone healing occurred for all fractures after a mean 5.6 months (3-11 months). Follow-up examination after a mean 4.5 years: all patients were able to walk, average Harris Score 70.5 points (29-95 points).
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Oper Orthop Traumatol · Oct 2006
Comparative StudyComputer-assisted minimally invasive treatment of osteochondrosis dissecans of the talus.
Revascularization of areas of necrosis in the talus and stimulation of bone regeneration whilst protecting the talar hyaline cartilage using computer-assisted minimally invasive drilling or retrograde cancellous bone relining of the osteochondrotic zone. ⋯ From December 1999 to January 2005, 41 patients with osteochondrosis dissecans of the talus were selected for computer-assisted treatment by retrograde drilling or retrograde cancellous bone grafting. In 39 of the 41 patients, the osteochondral lesion-as verified by postoperative magnetic resonance imaging (MRI)-was accessed, i.e., the drilled hole led to the lesion. In two cases, irreparable flaws in the materials were discovered intraoperatively, so that the above method was only performed on 39 patients. The 1-year results for the first 15 patients treated with retrograde drilling/parallel drilling and concomitant ankle arthroscopy without retrograde cancellous bone graft are presented here based on the follow-up MRI (position of drill hole, assessment of vitality of the area of osteochondritis) and a clinical score. The four women and eleven men were, on average, 34.1 years old (14-55 years). In the radiologic comparison of the pre- and postoperative stages of the osteochondritis dissecans, 46.7% of patients showed an improvement in the Berndt & Harty stage. 40.0% showed the same osteochondrosis dissecans stage in the postoperative MRI, and in 13.3% it deteriorated by one grade. In the clinical follow-up examination, the AOFAS Score averaged 88.9 points.
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Oper Orthop Traumatol · Oct 2006
Comparative StudyRetrograde transpubic screw fixation of transpubic instabilities.
Reduction and retention of unstable and/or severely displaced fractures of the upper pubic ramus with an associated risk of injury to the pelvic organs with transpubic screw fixation. Restoration of form and function of the pelvis. ⋯ Transpubic screw fixation was performed in 16 patients with displaced fractures of the upper pubic ramus as part of pelvic ring injuries (twice type A, six times type B, eight times type C). Intraoperative complications were not observed. Postoperative complications occurred in two cases (one rectus hernia, one screw pullout with manifestation of chronic osteomyelitis of the pubic ramus). All other fractures healed within 3 months.