Operative Orthopädie und Traumatologie
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Oper Orthop Traumatol · Oct 2014
Clinical Trial[Correction of posttraumatic lower leg deformities using the Taylor Spatial Frame].
Correction of posttraumatic lower leg deformities using percutaneous osteotomy, external fixation with a ring fixator, and computer-assisted gradual correction with the Taylor Spatial Frame (TSF). ⋯ The correction of posttraumatic lower leg deformities using the TSF was performed in 6 cases. The mean deformity was 15° (12-22°) in the frontal plane and 6° (4-8°) in the sagittal plane. The correction time was 19 days (14-22 days). The deviation between planned and achieved correction was 0-3° in the frontal plane and 0-2° in the sagittal plane. The osseous consolidation of the osteotomy site was carried out in the TSF in 5 cases with a mean external fixation time of 112 days (94-134 days). In one case, the TSF was removed after the correction and the osteotomy site was fixed using an intramedullary nail. Pin site infections were observed in 3 cases. There were no further complications. The treatment goal was achieved in all cases. The examination at final follow-up was performed after 1 year. All patients were able to walk without walking aids and with no pain at that time. They were able to perform all of their activities of the daily life and their leisure activities without limitations.
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Oper Orthop Traumatol · Oct 2014
Clinical TrialRevision arthroplasty in periprosthetic fractures of the proximal femur.
Hip revision arthroplasty of a loose stem in the case of Vancouver type B2 and B3 periprosthetic fractures and cerclage wiring of the femoral shaft. ⋯ In all, 23 patients with periprosthetic fractures of Vancouver type B2 (15 patients) and type B3 (eight patients)-in 15 women and eight men in the age range of 70.7 ± 12.2 (42-88) years-were followed up for at least 5 years. All fractures healed with a mean time of 14.4 ± 5.3 weeks. No cases of subsidence of the stem were observed and, according to the classification of Engh et al. concerning the biological fixation of the stem, there was bony ingrowth fixation in 21 cases and two cases of stable fibrous fixation. One dislocation occurred and there were no cases of intraoperative fracture. The Harris Hip Score rose continually following the operations: from a 3-month postoperative score of 65.0 ± 16.8 points, it rose to 86.9 ± 16.2 points after 24 months and to 89.0 ± 14.3 points after 5 years. According to the classification of Beals and Tower, all results were rated as excellent, i.e., the prefracture functional status was restored in all cases.
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Oper Orthop Traumatol · Oct 2014
Multicenter Study Clinical Trial[Femoral nailing using a helical nail shape (LFN(®))].
Antegrade femoral nailing through a greater trochanteric entry portal avoids damage to the proximal external rotators and to the ramus profundus of the medial femoral circumflex artery, furthermore eases insertion in adipose subjects. However a helical nail shape is necessary for this pathway because bending in two perpendicular planes has to be passed by the nail. ⋯ In a prospective mulicentric study, 227 helical femoral nails were used for antegrade femoral nailing. Follow-up after 12 month was available in 74 %. Surgeons' rating for ease of identifying entry site was excellent or good in 89 %. Functional and radiological results after 12 months do not prove significant benefits over conventional antegrade femoral nails.
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Oper Orthop Traumatol · Oct 2014
Clinical TrialIpsilateral free semitendinosus tendon graft with interference screw fixation for minimally invasive reconstruction of chronic tears of the Achilles tendon.
Minimally invasive ipsilateral semitendinosus reconstruction of large chronic tears aims to be advantageous for the patient in terms of plantar flexion recovery, anthropometric measures, fast return to daily and sport activity, is safe, with low donor site co-morbidities, low risks of wound complications and neurovascular injuries. ⋯ Between 2008 and 2010, the procedure was performed on 28 consecutive patients (21 men and 7 women, median age 46 years). At the 2-year follow-up, average ATRS scores significantly improved (p < 0.0001) compared to average preoperative scores with good to excellent outcomes for 26 out of 28 patients (93 %); the maximum calf circumference also improved considerably whereby no clinical or functional relevance compared to the contralateral side observed. Of the 28 patients 16 (57 %) could practice sport at the same preinjury level, whereby 1 patient experienced persistent pain over the distal wound, which ameliorated after desensitization therapy.
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Oper Orthop Traumatol · Oct 2014
Clinical Trial[Retrograde intramedullary nailing for periprosthetic fractures of the distal femur].
Intramedullary stabilization of periprosthetic distal femoral fractures by interlocking nailing. Closed reduction by retrograde nail can be combined with the use of transmedullary support screws (TMS principle of Stedtfeld). ⋯ Out of 101 fractures treated between 2000 and 2013 with a Targon RF nail (Aesculap, Tuttlingen, Germany) 10 were periprosthetic, all were classified as Rorabeck type II and of these 6 fractures were metaphyseal and 4 were diaphyseal. In four cases proximal implants were present. The mean operative time for periprosthetic fracture fixation did not significantly differ from that for normal retrograde femoral nailing. There were no postoperative infections, fixation failures or delayed unions. There was one revision for secondary correction of maltorsion.