Operative Orthopädie und Traumatologie
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Oper Orthop Traumatol · Mar 2009
Comparative Study[Direct posterior approach for the treatment of posteromedial tibial head fractures].
Direct posterior approach requiring minimal soft-tissue dissection for the treatment of posteromedial tibial head fractures. ⋯ From 2001 to 2007, twelve patients (nine female, three male) with "medial split fractures" were treated via the direct posterior approach. Four patients had isolated "medial split fractures", seven patients bicondylar fractures of the tibial plateau, and one patient a four-part fracture. Six of our patients had acute injuries which were primarily treated at the authors' institution. The other six patients presented with malunited fractures or insufficient internal fixation (average 8.4 weeks, 3.5-24 weeks old). In all cases the fracture could be addressed by the described posterior approach. Sufficient reposition and restoration of anatomy could be achieved in all patients.
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Oper Orthop Traumatol · Mar 2009
[Subligamentous transfer of the extensor digitorum brevis tendon for medial malalignment of the lesser toes].
Realignment of medially deviated lesser toes II-IV via subligamentous transfer of the extensor digitorum brevis tendon to treat painful toe disorders. ⋯ 23 of 32 patients with flexible medial malalignment of the lesser toes II and/or III were followed up after a mean of 19 months. Medial malalignment could be reduced markedly (preoperatively 28 degrees, postoperatively 6 degrees). Four patients treated with the tendon transfer alone developed a recurrent deformity with dorsal subluxation at the metatarsophalangeal joint level. These patients revealed a concomitant hallux valgus deformity of >30 degrees. Six patients with an additional metatarsal shortening presented with floating toes. Although all patients were able to stand on tiptoes, the active range of toe motion was decreased. Radiologically, joint congruency was improved. 18 patients revealed a congruent joint, and five patients presented with a medial subluxation of the proximal phalanx.