Operative Orthopädie und Traumatologie
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Oper Orthop Traumatol · Jun 2013
Reinforcement of lumbosacral instrumentation using S1-pedicle screws combined with S2-alar screws.
Increasing construct stability of lumbosacral instrumentations using S2-ala screws as an alternate to iliac screws. ⋯ Retrospective review of 80 patients undergoing S2-ala screw fixation. Main diagnosis was degenerative lumbar instability, adult scoliosis, high-grade listhesis, and nonidiopathic scoliosis. In 66% of patients, the instrumentation using S2-ala screws was part of a major lumbosacral revision surgery. Follow-up averaged 26 months. There were no deaths or major neurovascular complications. First time fusion rate at L5-S1 was greater than 90%. Eight patients (10%) experienced a complication which could be related to the S2-ala screws. Out of 160 S2-ala screws, 16 screws were judged to cause focal irritation and were removed, indicating a survival rate of 90% for the S2-ala screw.
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Oper Orthop Traumatol · Jun 2013
Clinical Trial[Dorsolateral access and interbody spinal fusion in spondylodiscitis of the thoracolumbar spine (TLIF technique)].
SURGICAL GOAL: Resolve infection and achieve primary stability of instrumentation and permanent fusion of the affected spinal segment by means of debridement of the focus of infection. Defect-filling using autologous/allograft bone or a spacer, as well as immobilization by means of dorsal instrumentation. ⋯ Successful fusion of affected segments, including resolution of infection, is reported in over 90% of cases described in the literature. The revision rate among our mostly multimorbid patient group with an average age of 66 years was 16%. Of 39 of the 114 (34%) patients with preoperative neurological deficits, 26 (66%) demonstrated postoperative regression. Nine patients (23%) showed no improvement, whilst exacerbation of existing neurological deficits was seen in four patients (11%). Staphylococcus was the major pathogen in 34% of cases.
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Oper Orthop Traumatol · Jun 2013
[Operative treatment of pronation fracture--dislocations of the ankle].
Early reduction of the dislocation and anatomic reconstruction of axial alignment, ankle mortise and articular congruity with special focus on syndesmotic stability. ⋯ The presence of a dislocation at the time of injury represents a negative prognostic factor in malleolar fractures. Higher rates of posttraumatic arthritis are also observed with trimalleolar fracures, especially fractures of the posterior tibial rim, cartilage damage, and syndesmotic disruption. Irrespective of the fracture classsification, good to excellent results can be obtained in 75-89% of cases with anatomic reconstruction of the ankle mortise and the articular surfaces. Proper reduction of the distal fibula into the tibial incisura is of utmost importance in cases of frank syndesmotic diastasis.