Operative Orthopädie und Traumatologie
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Minimally invasive stabilization of articular and extra-articular fractures of the distal femur with anatomically preshaped, locking compression plates. ⋯ Between January 2009 and November 2011, minimally invasive plate osteosynthesis using the minimally invasive cerclage passer or the collinear reduction clamp was performed in 21 patients with 23 distal femoral fractures. None of the patients suffered from postoperative malalignment or malrotation. Mean time to adequate fracture consolidation was 128 days (range 53-470 days).
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Acetabular fractures pose a great surgical challenge for orthopedic trauma surgeons. We believe that the Stoppa approach with an iliac window extension, previously described as a modified Stoppa approach is adequate for the majority of acetabular fractures excluding those with predominant posterior wall involvement. In this paper we will present our experience in using the Stoppa approach, its indications, preparations, the detailed surgical approach, complications and the different tips used in this relatively modern approach. ⋯ In a 5-year review of 60 acetabular fractures that underwent open reduction and internal fixation using the modified Stoppa approach, there were 36% anterior column fractures, 28% both-column fractures, the rest being anterior column with posterior hemi transverse fractures, transverse and T-fractures. Any extension of the fracture to the iliac wing necessitated an additional lateral window (93% of cases). In cases with posterior displacement, an additional approach was utilized to address a posterior wall fracture. All fractures healed within 12 weeks. Mean Merle d'Aubigné score was 15.22. Postoperative radiological evaluation revealed anatomical reduction in 54% of the patients, satisfactory in 43%, and unsatisfactory in 3% of the patients. Overall there were 15 minor and major complications.
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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.
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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.
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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.