Operative Orthopädie und Traumatologie
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Oper Orthop Traumatol · Nov 2012
Clinical Trial[The isolated subscapularis tendon tear: arthroscopic and open repair].
Arthroscopic or open reconstruction of isolated subscapularis tendon tears with the use of suture anchors to restore the glenohumeral function and joint biomechanics. ⋯ Arthroscopic or open repair of isolated subscapularis tendon tears (Fox type II-IV) was performed in 35 patients. The Constant score increased significantly after 36 m, with no difference between these two groups. The majority of subscapularis tests were postoperatively negative, 6% in both groups showed a rerupture. A symptomatic period of > 6 m prior to the operation and a high grade atrophy and fatty infiltration of the muscle was correlated with poorer results.
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Oper Orthop Traumatol · Sep 2012
[Treatment of bony avulsions of the posterior cruciate ligament (PCL) by a minimally invasive dorsal approach].
Reduction and fixation of bony avulsions of the posterior cruciate ligament (PCL) through a minimally invasive dorsal approach to restore stability of the knee joint. Prevention of soft tissue damage through a minimally invasive procedure and achieving early functional rehabilitation by stable osteosynthesis. ⋯ Between November 2010 and November 2011 three patients were treated with the new minimally invasive posteromedial approach to fix bony avulsions of the PCL. In two cases an osteosynthesis with two screws was performed and in the other patient a comminuted avulsion fracture was fixed with a suture anchor. In the latter patient the posterolateral corner was additionally augmented according to Larson with an autologous semitendinosus tendon. No intraoperative or postoperative complications could be observed. In all three patients an excellent fracture reduction without steps or gaps could be achieved. In two cases an early functional treatment protocol and in one case (suture anchor fixation plus augmentation of the posterolateral corner) a special postoperative PCL rehabilitation protocol was used. Good clinical results with stable knee joints could be achieved in all cases. The minimally invasive dorsal approach for the treatment of bony avulsions of the PCL was demonstrated to be safe and simple with a low complication rate.
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Oper Orthop Traumatol · Sep 2012
Internal fixation of fractures of the proximal humerus with the MultiLoc nail.
Anatomical reduction of two- to four-part fractures of the proximal humerus using indirect reduction techniques. Intramedullary fixation with a short humerus nail. Restoration of a stable bone-implant construct that enables early functional after-treatment. ⋯ During a 6-month period, 160 patients were documented in a prospective clinical multicentre study. According to the AO classification, there were 36% A-type fractures, 41% B- and 23% C-type injuries. A 6-month follow-up was available for 17 patients. The mean age of these patients was 67 years. One patient had an A-type fracture. There were ten B- and six C-type fractures. At the time of follow-up, the mean Constant score was 66 points. Radiographically, all fractures had healed. Intra-articular screw penetration and loss of reduction were both observed once.
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Minimally invasive osteosynthesis of talar fractures. ⋯ From January 1996 to December 2002, 44 talar fractures were operatively treated in our department. Six patients had talar neck fractures type 1 according the Hawkins classification and 3 patients showed fractures of the lateral process of the talus. From those injuries, 3 Hawkins type 1 fractures and 2 fractures of the lateral process were stabilized using minimally invasive osteosynthesis. The clinical outcomes were assessed using the Ankle Hindfoot Scale of the American Orthopedic Foot and Ankle Society. Both groups reached good cosmetic and functional results. We did not observe any avascular talar necrosis or nonunions in the two groups.
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Anatomic reduction of displaced calcaneal fractures with minimal soft tissue alteration. ⋯ Between 1998 and 2008, 68 patients were treated with definite percutaneous fixation for displaced calcaneal fractures. In 37 patients with intraarticular fractures (Sanders types IIA and IIB), anatomic joint reduction was verified with subtalar arthroscopy. No soft tissue-related complications were observed. Thirty-five patients were followed for a minimum of 2 years postoperatively, the average was 5 years postoperatively. Subjectively, 33 of 35 patients were satisfied with the clinical outcome. The AOFAS Hindfoot Score averaged 90.7 (range 64-100) at a mean of 5 years after surgery. Percutaneous screw fixation of calcaneal fractures is associated with minimal soft tissue traumatization and low complication rates. It allows early rehabilitation and excellent results with proper patient selection. With intra-articular fractures, proper reduction of the articular surface has to be confirmed intraoperatively.