Operative Orthopädie und Traumatologie
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Oper Orthop Traumatol · Aug 2007
The Targon PH nail as an internal fixator for unstable fractures of the proximal humerus.
Exercise-stable internal fixation of unstable fractures of the proximal humerus. ⋯ From December 2000 to spring 2004, 133 patients (average age: 74.9 years) with 137 unstable proximal humeral fractures were treated surgically. 97 patients with 99 operated shoulders were followed up for at least 7 months. The patients' average age at follow-up was 74.9 +/- 13.6 years (20-102 years). A Constant Score of 60.0 +/- 16.8 points was achieved and 84.8 +/- 19.4% and 84.0 +/- 15.5% on the age- and gender-related as well as side-related Constant Scores.
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Reduction and fixation of displaced fractures of the humeral head by percutaneous methods. Early functional postoperative management. ⋯ 200 patients (78 men, 122 women) were followed up at least 2 years (24-81 months) postoperatively. The average age was 61.6 years (14-103 years). The average Constant Score for four-part fractures was 87%. 24% of the patients had to be operated on a second time (shortening of the wires or reosteosyntheses). In 8.5% secondary change of management was necessary. In 3% clinically relevant avascular head necrosis occurred, and pseudarthrosis in 3%.
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Oper Orthop Traumatol · Aug 2007
Total hip arthroplasty by a minimally invasive, direct anterior approach.
Implantation of a total hip replacement device through a direct anterior approach to the hip joint with minimal trauma to adjacent tissue. ⋯ 116 consecutive hips in 111 patients were operated on between August 2004 and December 2005. 17 patients were excluded due to fracture or severe dysplasia (Crowe 3 and 4). Mean age was 62.5 years (range, 46-84 years), mean BMI amounted to 23.1 kg/m(2) (range, 18.1-37.7 kg/m(2)). The implantation of a total hip replacement device could be accomplished safely in all patients. No severe intraoperative complication requiring a change of the planned procedure or any additional surgical measures was noted. Mean surgical time was 79 min (45-150 min). The operative time was decreasing gradually during the study period. The mean preoperative Japanese Orthopaedic Association (JOA) score of 47.2 points (range, 18-63 points) improved to 92.3 points (range, 67-100 points) at 3 months postoperatively (p < 0.001) and 94.2 (range, 72-100 months) at the latest follow-up at an average of 17 months (range, 9-26 months).
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Oper Orthop Traumatol · Jun 2007
Review Clinical Trial[Arthroscopic stabilization of the shoulder with suture anchors with special reference to the deep anterior-inferior portal (5.30 o'clock)].
Arthroscopic (re)stabilization of the unstable shoulder by anatomic refixation of the detached capsulolabral complex with suture anchors or reduction of excessive capsule volume by capsule plication. ⋯ At the authors' hospital over 600 arthroscopic shoulder stabilizations using the deep anterior-inferior portal have been completed so far. The redislocation rate for the first 147 patients (average follow-up of 3 years) treated with the technique described here is 6.1% and is slightly higher for arthroscopic revision stabilizations (n=43; of these, redislocation n=3 and reinstability n=3). There were no instances of axillary nerve lesion.
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Oper Orthop Traumatol · Jun 2007
Review Clinical Trial[Open reduction and internal fixation by primary subtalar arthrodesis for intraarticular calcaneal fractures].
To prevent the development of painful posttraumatic degenerative joint disease by a primary one-stage procedure to treat calcaneal fractures involving obvious comminution or severe and extensive cartilage damage to the subtalar facet. ⋯ This operation is performed very rarely. Within a retrospective study including patients over a period of 14 years (1990-2004), a total of 434 patients with a calcaneal fracture were treated surgically. Primary subtalar arthrodesis was performed in only six of these patients. Healing within 4 months was achieved in all six patients. The clinical and radiologic follow-ups took place on average after 4.9 years (2.5-7.5 years). Radiologically, almost anatomic reconstruction of the axes could be achieved (Gissane and Böhler angles, talometatarsal and talocalcaneal angles, calcaneal length and width). The functional outcomes were also good to very good with an average AOFAS (American Orthopaedic Foot and Ankle Society) Score of 88 points (63-94 points) and a Hanover Score of 84 points (62-90 points).