Operative Orthopädie und Traumatologie
-
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.
-
The primary aim of minimally invasive osteosynthesis (MIO) is the anatomical reconstruction of the distal tibial articular surface, with preservation of the soft tissue to allow early functional postoperative management. This should lead to a normal bone healing and recovery without arthrosis. ⋯ Advantages of minimally invasive osteosynthesis of pilon fractures compared to conventional open reduction and osteosynthesis, include protection of the soft tissue and no further disturbances of circulation-ideal prerequisites for undisturbed bone healing. In 129 patients after osteosynthesis of pilon fracture, no reoperations were necessary when using MIO, but reoperation was necessary with other techniques in 17.6% of all patients. In addition, no infections were observed with MIO vs. 13.4% of patients with other techniques. The average Olerud/Molander Score was 95 points for the MIO group vs. 58.91 points for all patients treated, while MIO plus an external fixator received a score of 50 points. The average Ankle Hindfoot Score was 64.9 points, for MIO 87.5 points, and for operations consisting of MIO plus an external fixator 58 points.
-
Oper Orthop Traumatol · Sep 2012
[Minimally invasive plating osteosynthesis of proximal humeral shaft fractures with long PHILOS plates].
Closed reduction and minimally invasive stabilization of proximal humeral shaft fractures with long PHILOS plates. The presented technique enables stable extramedullary fixation of the fractures without affecting surrounding nerves. ⋯ Between 2005 and 2011 a total of 16 patients (8 women and 8 men) were treated with the presented technique. The patients mean age was 61 years. According to the AO classification, five fractures were classified as type A, eight as type B and three fractures as type C. All patients had clinical and radiological follow-up examinations after a mean of 24 months (12-38 months). All fractures showed complete bony consolidation at the final follow-up. The mean Constant-Murley score was 81 points representing 84% of the Constant-Murley score of the healthy contralateral shoulder. The average DASH score was 33 points and the mean SF36 was 85 points.
-
Oper Orthop Traumatol · Sep 2012
[Soft tissue protective and minimally invasive osteosynthesis for metacarpal fractures II-V].
Soft tissue protection, closed reduction or short open reconstruction of length, rotation and articulation of metacarpals. Aftercare: early active exercises protected by additive orthesis. ⋯ In this retrospective study we analyzed metacarpal (MC) fractures that were treated with minimally invasive osteosynthesis during the period 2009-2010 and 65 patients (mean age 34.8 years, female/male 13/52) with 75 metacarpal fractures were enrolled. Fractures affected MC-2 (n=9), MC-3 (n=5), MC-4 (n=15) and MC-5 (n=46). Removal of implant was performed after 6-12 weeks in 44 patients. All fractures except one showed bony healing in x-ray. At 2-months follow-up 61 patients could be evaluated and at 27-months (15-37) follow-up 34 patients could be evaluated according to the DASH score. Median DASH score results were 16 points (SD 49, n = 61) after 2 months and median DASH score results were 5 points (SD 23, n = 34) after 27 months (15-37). Range of motion was limited in 6 patients after 8 weeks (range 6-12 weeks) with a deficit in flexion of finger to distal palmar crease of 1.0 cm (range 0.5-1.5 cm), 2 patients showed a deficit in finger extension of 10° in the metacarpophalangeal joint. One patient showed restricted finger extension of 15° in the proximal phalangeal joint after tendon rupture and tendon reconstruction. Complications were observed, such as circumscribed redness in two patients at the entry point of k-wires which was managed by early removal of the implant. Perforation of the k-wire occurred in one patient with subcapital and diaphyseal fracture and was managed by plate osteosynthesis. One diaphyseal transverse refracture healed after plate osteosynthesis, three circumscribed cases of paresthesia occurred, one at the entry point of the K-wires and two at the level of fracture.
-
Oper Orthop Traumatol · Sep 2012
[Minimally invasive augmentation of the medial collateral ligament with autologous hamstring tendons in chronic knee instability].
Medial collateral ligament reconstruction in chronic unstable knees. ⋯ A total of 9 patients with a median age of 39 (18-70) years received an augmentation of the MCL complex due to a chronic instability using the described technique. Follow-up examination was performed after 16 (11-56) months. All patients reported a stable knee. The median value of the Lysholm score at follow-up was 90 (72-96) points and the Tegner score prior to trauma was 4 (2-6) points and 3 (2-6) points during follow-up. No grade 2 or 3 instability could be observed during follow-up. There were no complications using the above mentioned technique.