Operative Orthopädie und Traumatologie
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Oper Orthop Traumatol · Dec 2009
Clinical Trial[The surgical treatment of chronic extension deficits of the knee].
Restoration of full knee extension in patients with chronic extension deficits, especially in posttraumatic and postoperative cases. ⋯ 121 patients underwent anterior and posterior arthrolysis between 1990 and 2000. 86 of these patients could be included in this study. The average follow-up was 4.6 years (1-10 years). The extension deficit before surgery averaged 20 degrees compared with the opposite side. At follow-up, the average extension had increased by 17 degrees , no patient had more than 5 degrees of flexion contracture. The Lysholm Score was 84 postoperatively. The Tegner Activity Scale increased from 1.9 to 4.0 after arthrolysis. In the AOSSM Subjective Outcome Score, 35 patients showed excellent and 60 good results. 14 patients were satisfied after surgery and nine were not. Three patients required revision surgery (two synovial fistulas, one hematoma).
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Oper Orthop Traumatol · Dec 2009
Clinical TrialLess invasive plate osteosynthesis in humeral shaft fractures.
Stable internal fixation of the humeral shaft by less invasive percutaneous plate insertion using two separate (proximal and distal) incisions, indirect reduction by closed manipulation and fixation to preserve the soft tissue and blood supply at the fracture zone. Early mobilization of the shoulder and elbow to ensure a good functional outcome. ⋯ Between January 2003 and January 2006, 23 patients were operated on using the less invasive plate osteosynthesis technique. The minimum follow-up period of 12 months was completed in 20 patients. The mean healing time was 14.6 weeks, defined as three of four cortices having stable bridging callus. In one patient with delayed union, healing was observed after 28 weeks. Functional outcomes were evaluated using the Constant Score and the Hospital for Special Surgery (HSS) Score. 19 patients had good to excellent elbow function with a mean HSS Score of 93.5 points. All patients achieved satisfactory shoulder function with a mean Constant Score of 85.8 points compared to 90.6 on the healthy side. Complications observed were one paresthesia of lateral cutaneous nerve of forearm (no radial nerve injury) and one loosening of the LCP (Locking Compression Plate) screws due to technical error.
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Oper Orthop Traumatol · Dec 2009
Clinical Trial[Surgical principles and clinical experiences with the DUROM hip resurfacing system using a lateral approach].
Objective Bone-preserving hip resurfacing in young and active patients using a soft-tissue-sparing, modified transgluteal, lateral approach. ⋯ Analysis involved the pre- and postoperative functions of 72 patients with a total of 82 prostheses and a mean durability time of 29.2 +/- 11 months based on the Harris Hip Score (HHS), the modified UCLA (University of California, Los Angeles) activity index, and the Merle d'Aubigné Score. Postoperatively, prosthetic angle and femoral offset as well as periprosthetic signs of loosening/lytic areas were assessed by means of radiology and compared with the preoperative CCD angle and femoral offset. Compared to the preoperative evaluation, follow-up yielded a significant increase in the average HHS values (94 +/- 4.6 vs. 40.1 +/- 7 points), the modified UCLA activity index (8.9 +/- 2.6 vs. 4.6 +/- 2.2), and the Merle d'Aubigné Score (17.9 +/- 1.9 vs. 7.3 +/- 2.4; p < or = 0.05). In 98.8%, a solid osteointegration of the cup and femoral components was observed. The average deviation of the physiological CCD angle (136.6 degrees +/- 3.6 degrees ) from the postoperative angle of the prosthesis (142.6 degrees +/- 4.9 degrees ) was 6 degrees +/- 2.8 degrees . The postoperative femoral offset was reduced by an average of 2.3 mm compared to the preoperative offset. During clinical follow-up n = 2 prostheses (2.5%) required revision (one femoral neck fracture; one periarticular ossification [Brooker III]).
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Oper Orthop Traumatol · Dec 2009
Treatment of proximal ulna and olecranon fractures by dorsal plating.
Anatomic reconstruction of proximal ulna and olecranon fractures allowing early mobilization and prevention of ulnohumeral arthritis. ⋯ Between 2003 and July 2008, 26 patients were treated with posterior plating of the proximal ulna and olecranon using this strategy. There were 23 acute fractures (of which one was referred for revision after suboptimal fixation a few days earlier), one nonunion that became traumatized, and two nascent malunions. A midline posterior approach allowed addressing both ulna and radial head pathology. The plate was contoured to wrap around the olecranon. All fractures healed. There were one postoperative infection, one transient ulnar neuropathy, one transient radial neuropathy, and one nonresolving ulnar/median neuropathy in a complex upper extremity injury. At follow-up after an average of 18 months, range of motion was on average 132 degrees /18 degrees of flexion/extension, and 75 degrees /70 degrees of pronation/supination. All fractures had healed at an average of 4.8 months. Ten patients had their hardware removed.
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Restoration of axis, length, and rotation of the lower leg. Sufficient primary stability of the osteosynthesis for functional aftercare. Early functional aftercare to maintain joint mobility. Good bony healing in closed and open fractures. ⋯ In a prospective, international multicentric study, 181 patients with 186 fractures were included between July 2004 and May 2005. 57 of these fractures (30.7%) initially were graded open, 15 of them grade I, 32 grade II, and ten grade III. Most of the fractures (36%) were shaft fractures. After 1 year, 146 patients (81%) could be evaluated clinically and radiologically. The overall pseudarthrosis rate was 12.2% (18.2% for open and 9.7% for closed fractures). The risk for secondary operations or revisions (including dynamization of the nail) was 18.8%. Without consideration of dynamization procedures, revisions were necessary in only 5.4% of all patients. The risk for varus, valgus or antecurvation malalignment of more than 5 degrees in any plane on radiologic long leg views was 4.3% for shaft fractures, 1.5% for distal fractures, and 13.6% for proximal fractures. The implant-specific risk for bolt breakage was 3.2%.