Operative Orthopädie und Traumatologie
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Oper Orthop Traumatol · Oct 2006
Comparative StudyIntramedullary stabilization of periprosthetic fractures of the femur taking special account of bone defects.
Healing of the periprosthetic fracture and area of defective bone by the bone healing mechanisms of intramedullary stabilization. Reconstruction of the correct length, axial alignment, and rotation of the fractured femoral shaft by anchoring a revision stem in the intact femoral diaphysis. ⋯ 21 patients (13 women, eight men) aged between 43 and 86 years (mean age: 71.2 years) with periprosthetic fracture of the femur, additional loosening of the stem in eight cases (Vancouver B2) and additional bone loss in 13 cases (Vancouver B3). Postoperative complications: two fractures following another fall (repeat operations: one replacement, one plate), four revisions due to subsidence of the stem (three replacements involving change to a standard stem with healed proximal femur, one replacement with another interlocked revision stem). Bone healing occurred for all fractures after a mean 5.6 months (3-11 months). Follow-up examination after a mean 4.5 years: all patients were able to walk, average Harris Score 70.5 points (29-95 points).
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Oper Orthop Traumatol · Oct 2006
Comparative StudyComputer-assisted minimally invasive treatment of osteochondrosis dissecans of the talus.
Revascularization of areas of necrosis in the talus and stimulation of bone regeneration whilst protecting the talar hyaline cartilage using computer-assisted minimally invasive drilling or retrograde cancellous bone relining of the osteochondrotic zone. ⋯ From December 1999 to January 2005, 41 patients with osteochondrosis dissecans of the talus were selected for computer-assisted treatment by retrograde drilling or retrograde cancellous bone grafting. In 39 of the 41 patients, the osteochondral lesion-as verified by postoperative magnetic resonance imaging (MRI)-was accessed, i.e., the drilled hole led to the lesion. In two cases, irreparable flaws in the materials were discovered intraoperatively, so that the above method was only performed on 39 patients. The 1-year results for the first 15 patients treated with retrograde drilling/parallel drilling and concomitant ankle arthroscopy without retrograde cancellous bone graft are presented here based on the follow-up MRI (position of drill hole, assessment of vitality of the area of osteochondritis) and a clinical score. The four women and eleven men were, on average, 34.1 years old (14-55 years). In the radiologic comparison of the pre- and postoperative stages of the osteochondritis dissecans, 46.7% of patients showed an improvement in the Berndt & Harty stage. 40.0% showed the same osteochondrosis dissecans stage in the postoperative MRI, and in 13.3% it deteriorated by one grade. In the clinical follow-up examination, the AOFAS Score averaged 88.9 points.
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Oper Orthop Traumatol · Oct 2006
Comparative StudyRetrograde transpubic screw fixation of transpubic instabilities.
Reduction and retention of unstable and/or severely displaced fractures of the upper pubic ramus with an associated risk of injury to the pelvic organs with transpubic screw fixation. Restoration of form and function of the pelvis. ⋯ Transpubic screw fixation was performed in 16 patients with displaced fractures of the upper pubic ramus as part of pelvic ring injuries (twice type A, six times type B, eight times type C). Intraoperative complications were not observed. Postoperative complications occurred in two cases (one rectus hernia, one screw pullout with manifestation of chronic osteomyelitis of the pubic ramus). All other fractures healed within 3 months.
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Oper Orthop Traumatol · Sep 2006
Clinical TrialPercutaneous iliosacral screw fixation of unstable pelvic injuries by conventional fluoroscopy.
Closed reduction and retention of translatory unstable pelvic injuries (type C injuries), in order to restore the form and function of the posterior pelvis by percutaneous iliosacral screw osteosynthesis, using conventional fluoroscopy. ⋯ 20 patients with a transforaminal sacral fracture consistent with a type C pelvic injury underwent screw fixation with fluoroscopy with 7.3-mm cannulated screws, placed in a transiliosacral position in the vertebral body of S1. The average preoperative displacement of 3.8 mm was decreased by closed reduction to 1.6 mm postoperatively. The average operating time was 55 min, the average screening time 2.22 min. Incorrect screw position with no consequences was observed in three patients; iatrogenic nerve damage was not found. All fractures healed within 3 months.
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Oper Orthop Traumatol · Jun 2006
Clinical Trial[Intramedullary locked fixation and compression nail (IP-XS-Nail): treatment of ankle joint fractures].
Reconstruction of the anatomy of the ankle joint while protecting the soft tissue, and osteosynthesis to maintain stability for function and weight bearing. ⋯ In the period from 05/2000 to 01/2002, 194 ankle fractures were treated with the IP-XS-Nail((R)). Follow-up examinations were conducted on 162 patients with an average age of 51.2 years after an average of 15 months. 62 Weber B fractures (38.3%) and 45 Weber C fractures (27.7%) were evaluated. There were bimalleolar fractures in 55 cases (34.0%). According to the Olerud Score (clinical and radiologic score), 95 patients (58.6%) had an excellent, 54 (33.3%) a good, nine (5.5%) a moderate, and four (2.4%) an unsatisfactory result.