Operative Orthopädie und Traumatologie
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Oper Orthop Traumatol · Dec 2011
Clinical Trial[Intramedullary nailing of the distal tibia illustrated with the Expert(TM) tibia nail].
Restoration of axis, length, and rotation of the lower leg. Sufficient primary stability of the osteosynthesis for functional aftercare and to maintain joint mobility. Good bony healing in closed and open fractures. ⋯ Between July 2004 and May 2005, 180 patients were included in a multicenter study. The follow-up rate was 81% after 1 year. Of these, 91 fractures (50.6%) were located in the distal third of the tibia. In this segment, the rate of delayed union was 10.6%. Malalignment of > 5° was observed in 5.4%. A secondary malalignment after initial good reduction was detected in only 1.1% of all cases. The implant-specific risk for screw breakage was 3.2%. One patient sustained a deep infection. If additional fibula plating was performed an 8-fold higher risk for delayed bone healing was observed (95%CI: 2.9-21.2, p< 0.001). If the fracture of the fibula was at the same height as on the tibia, the risk for delayed healing was even 14-fold (95% CI: 3.4-62.5, p< 0.001). Biomechanically plating of the fibula does not increase stability in suprasyndesmal distal tibia-fibular fractures treated with an intramedullary nail. Using the ETN with its optimized locking options, fibula plating is not recommended, thus, avoiding soft tissue problems and potentially delayed bone healing.
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Oper Orthop Traumatol · Dec 2011
Multicenter Study Clinical Trial[Stabilization of inter- and subtrochanteric femoral fractures with the PFNΑ®].
Intramedullary nail system fixation of inter- and subtrochanteric femoral fractures allows early weight-bearing, especially in osteoporotic bone. Restoration of anatomical shape and early return to function of the injured leg. ⋯ Between April 2004 and June 2005, the AO multicenter study at 11 European trauma centers included 313 patients (mean age 80.6 years, 77% women, 23% men) with 315 unstable trochanteric fractures treated with a Peroximal Femoral Nail Antirotation® (PFNΑ®) device for consecutive follow-up [24]. In 82%, the fractures were 31-A2, while in 18% the fractures were 31-A3. Average operation time for A2 fractures was 56 min and 66 min for A3 fractures. Average duration of hospital stay in the trauma center was 12 days. Surgical reduction and fracture fixation that permitted full weight-bearing immediately after operation was achieved in 72% of cases. Of 165 complications, 46 were surgery-related with unplanned revision surgery in 28 cases (including 7 femur fractures and 4 acetabular penetrations). Follow-up for more than 1 year was possible in 56% of patients. After 1 year, 89% of the fractures were consolidated. The highest complication rate was found in fractures type 31-A2.3 and in patients older than 90 years. The recorded number of implant-related complications (14.6%) is comparable to the results of other intramedullary and extramedullary implants.
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Oper Orthop Traumatol · Dec 2011
Clinical TrialFixing simple olecranon fractures with the Olecranon Osteotomy Nail (OleON).
Stable fixation of simple olecranon fractures or olecranon osteotomies in order to allow early functional treatment. ⋯ Using this technique in 21 patients (mean age 42 years) with acute fractures or osteotomies, sound fracture healing was achieved in 19 of 21 patients. The active range of motion was 130.2° flexion, 10.6° extension deficit, and a normal pro-supination arch. In one patient, delayed union caused implant failure. In this patient, a surgical error jeopardized stability. In a second patient, a peri-implant fracture after adequate trauma made a change in therapy necessary.
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Oper Orthop Traumatol · Dec 2011
Clinical Trial[Elastic stable intramedullary nailing after corrective osteotomy of symptomatic malunited midshaft clavicular fractures].
To restore alignment and length of the clavicle, to relieve typical symptoms of malunion, and to improve functional outcome and aesthetic results. ⋯ In 5 patients (3 men, 2 women) with a mean age of 34 years (range, 23-44 years) with symptomatic malunion after clavicular fractures, a corrective osteotomy and elastic stable intramedullary nailing (ESIN) was performed. After 6 months (mean 4.4 months), all osteotomies were healed and the nails were removed. There were no complications. At final follow-up (12 months), the DASH and Constant scores were significantly improved compared to preoperative values. Patients were significantly more satisfied with the appearance of the shoulder girdle and overall outcome.
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Autologous bone transplantation is a treatment of choice in patients with large bone defects. However, the iliac crest bone graft harvest is associated with numerous limitations: low volume of graft, long operation times, acute and chronic pain. ⋯ The RIA system allows large amounts (25-90 cm3) of high quality bone graft to be harvested. This alternative technique is associated with less donor site morbidity and lower rates of minor and major complications when compared with conventional harvest methods (iliac crest).