Operative Orthopädie und Traumatologie
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Oper Orthop Traumatol · Nov 2010
[Percutaneous interspinous distraction for the treatment of dynamic lumbar spinal stenosis and low back pain].
SURGICAL GOAL: Surgical treatment of dynamic lumbar spinal stenosis and discogenic/arthrogenic low back pain with a new percutaneous interspinous spacer as a therapeutic alternative to more invasive standard procedures. ⋯ Good early results (after 2 year follow-up) in 42 patients with 76% subjective patient satisfaction rate. No approach related complications. Avoidance of the more invasive alternative procedure (decompression, fusion, total disc replacement) in 76.2% of the patients.
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Soft-tissue defect closure of the volar and dorsal aspect of the hand and lower arm with a maximum defect size of 10 × 25 cm. ⋯ In a 3-year period, defect closure with a pedicled groin flap was performed in 14 patients. Indications for this procedure were the following: thumb reconstruction for lengthening and defect closure after amputation and burn injury, soft-tissue reconstruction of the dorsum of the hand after decollement and infection, soft-tissue reconstruction of the distal part of the lower arm, wrist and palm after complex and combined trauma, and plastic reconstructive preservation of multiple fingers with subsequent phalangealization and syndactyly release, respectively. In all patients, complete soft-tissue coverage and flap survival could be achieved. The functional and aesthetic result was satisfactory in all cases.
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Oper Orthop Traumatol · Jul 2010
[Treatment of the complex intraarticular fracture of the distal humerus with the latitude elbow prosthesis].
Therapy of comminuted intraarticular distal humerus fractures in elderly patients with primary total elbow arthroplasty to achieve stable and painless function. Use of "third-generation" elbow prosthesis with the following options:--linked total elbow arthroplasty,--unlinked total elbow arthroplasty,--either with or without radial head replacement,--hemiarthroplasty. ⋯ 15 Latitude elbow prostheses were implanted in 2007 and 2008 at the Department of Trauma Surgery of the University Hospital Mainz, Germany, due to the following indications: fractures (n=7), pseudarthrosis (n=4), posttraumatic osteoarthritis (n=3), and rheumatoid arthritis (n=1). Six hemiprostheses, two unlinked and seven linked prostheses were implanted. The mean age of patients was 67 years (31-88 years). For the treatment of acute fractures, the indication was made only in elderly patients. The mean age was 77 years (66-88 years). Eleven of these 15 patients were reexamined after 13.5 months (6-23 months). The mean extension deficit was 15 degrees (0-30 degrees), the mean flexion 119 degrees (95-140 degrees). The mean pronation was 78 degrees (60-90 degrees), the mean supination 79 degrees (50-90 degrees). According to the Mayo Elbow Performance Score, three patients achieved an excellent, seven a good, and one a fair result. The mean Mayo Score was 89.2 (74-100). The mean DASH (Disabilities of the Arm, Shoulder and Hand) Score was 8.4 (0-28).
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Oper Orthop Traumatol · May 2010
Review[Management of severe soft-tissue trauma in the upper extremity - shoulder, upper and lower arm].
Salvage of the respective extremity. Standardized approach to adequate soft-tissue coverage (isolated severe soft-tissue trauma) and preconditioning for fracture healing (in complex trauma) as a basis for functional restoration. Limitation of secondary soft-tissue loss. Prevention of infection. ⋯ Patency rate after vascular reconstruction > 90%, flap survival > 95%, need for amputation is a rare entity; main determinants of prognosis: severity of soft-tissue trauma, neural damage, and potential for reconstruction.
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In 1993, A. Campel published the VEPTR (vertical expandable prosthetic titanium rib) instrumentation for the treatment of thoracic insufficiency syndrome (TIS). The goal of surgery is to lengthen and expand the constricted concave hemithorax to the height of the convex sides to increase thoracic volume, to obtain thoracic symmetry, to improve thoracic function, to maintain these improvement during growth of the child, and to avoid growth inhibition procedures, if possible. ⋯ From 2005 to 2009, 39 patients (24 female, 15 male, mean age at surgery 7.5 years [3-13 years]) were treated with VEPTR. The diagnosis was congenital scoliosis in 16, neurogenic scoliosis in eleven, and EOS in twelve cases. Seven of the 39 patients had undergone previous surgery. The curve was measured according to Cobb. The mean Cobb angle was 65 degrees (45-130 degrees ) preoperatively and 32 degrees (25-75 degrees ) postoperatively. During the first surgery, no complications occurred. Mean operating time was 95 min (65-185 min). Mean blood loss amounted to 125 ml (65-180 ml). 29 of the 39 patients had one to nine lengthening procedures. The mean correction achieved was 15.7 degrees (19.8%). In three cases, the VEPTR instrumentation was removed and a final fusion performed. All parents and patients were satisfied with the operation and would undergo it again.