Operative Orthopädie und Traumatologie
-
Oper Orthop Traumatol · Sep 2005
Clinical Trial[Partial midcarpal arthrodesis with excision of the scaphoid for the treatment of advanced carpal collapse].
To eliminate painful arthrosis between the radius and scaphoid and between the lunate and capitate. Stabilization of the carpus with preservation of useful range of motion between the radius and the lunate. ⋯ From 1993 to 2001, 64 partial midcarpal arthrodeses with excision of the scaphoid were performed in 62 patients. 26 of the patients operated up to 1999 were followed up for 27 months and evaluated with the Cooney Score and the DASH Score. The Cooney Score significantly improved, from 46 points preoperatively to 76 points postoperatively. Postoperative DASH Score was 22. Postoperative range of motion, 64 degrees extension/flexion, had hardly changed compared with the preoperative value. Strength increased from 24 to 34 kg on average. Out of the 55 patients available for follow-up (29 interviewed by telephone) 35 were completely satisfied, 13 satisfied with reservations, and seven dissatisfied. 24 patients had no activity-related pain. Different degrees of activity related pain were reported by 28 patients, and pain during minor activities or at rest was reported by three patients.
-
Oper Orthop Traumatol · Sep 2005
[A simple supraacetabular external fixation for pelvic ring fractures].
Closed reduction and maintenance of pelvic ring injuries by external stabilization. ⋯ Retrospective analysis of 64 supraacetabular external fixator applications to stabilize the anterior pelvic ring in 20 type B and 44 type C injuries. Iatrogenic lesions of the lateral femoral cutaneous nerve: 4.5%; all sensory disturbances completely reversed within 1 year. No pin site infection. In two patients (3%) primary perforation of the Schanz screw into the small pelvis not necessitating any treatment. No secondary displacements of the anterior or posterior pelvic ring in type B injuries nor for type C injuries, sacral fractures associated with fractures of the pubic ramus. One pseudarthrosis of the pubic and ischial rami requiring surgical treatment.
-
Oper Orthop Traumatol · Jun 2005
Clinical TrialPrimary total elbow replacement for fractures of the distal humerus.
Achieving stability and pain-free function for osteoporotic intraarticular multifragmentary fractures of the distal humerus in elderly patients by primary total elbow replacement (TER). ⋯ 49 acute distal humeral fractures in 48 patients (average age: 67 years) were treated with TER. 43 fractures were followed at an average of 7 years. According to the AO classification, five fractures were type A, five type B, and 33 type C. The average flexion arc at follow-up was 24-131 degrees, the Mayo Elbow Performance Score averaged 93. Data of complications were obtained from records in all 49 patients. 32 of the 49 elbows had neither a complication nor any further surgery from the time of the index arthroplasty to the most recent follow-up evaluation. Ten additional operative procedures, including five revision arthroplasties, were required. The retrospective review supports recommendation for TER for the treatment of an acute distal humeral fracture, when strict inclusion criteria are observed.
-
Oper Orthop Traumatol · Feb 2005
Clinical TrialInternal fixation of proximal humerus fractures using the locking proximal humerus plate.
Stable fixation of unstable proximal humerus fractures until bony consolidation. Early mobilization of the shoulder and early active rehabilitation program to ensure a good functional outcome and a good restoration of the activities of daily living. ⋯ Between January 1, 1997 and April 30, 2002, 64 patients with acute fractures of the proximal humerus were treated with fixed-angle plating at the UKH Graz. 36 patients meeting the inclusion criteria (that is primary operative stabilization within 14 days after trauma in a standardized way and minimal follow-up period of 12 months) were assessed 31 months after surgery on average, using the Constant Score and the DASH Score. The mean age of the 22 women and 14 men was 57.5 years (21-78 years). According to the AO classification eight fractures were classified as 11-A3, one fracture as B1, five fractures as B2, three fractures as B3, one fracture as C1, 16 fractures as C2, and two fractures as C3. A mean Constant Score of 62.6 points and an age-related Constant Score of 80.7% on average, as well as a DASH Score of 18.0 points were obtained, constituting a satisfactory result in three quarters of all patients. Complications observed were two humeral head necroses, one partial necrosis after a head-splitting fracture with nevertheless good clinical result, and a deep infection in two cases. Breakage of the plate was seen in one patient with an A3.3 fracture without medial buttress; no further surgery was necessary; the fracture healed after a short period of immobilization.
-
Oper Orthop Traumatol · Feb 2005
Clinical TrialLimb lengthening with the Intramedullary Skeletal Kinetic Distractor (ISKD).
Callus distraction of the femur or tibia with an intramedullary distractor, which lengthens mechanically through alternating rotations of at least 3 degrees. ⋯ Intramedullary lengthening with the ISKD was performed in four patients having an average age of 29 years (18-36 years). Two femoral shortenings were combined with complex rotational and angular deformities. The average lengthening of three femora and one tibia was 31 mm (26-40 mm). The average intraoperative blood loss was 230 ml (110-320 ml), the mean surgical time 108 min (90-145 min). The average daily distraction amounted to 1.2 mm (0.9-1.8 mm). Full weight bearing was permitted after 10 weeks (7-14 weeks), return to regular work after 11 weeks (7-16 weeks). At follow-up examination of an average of 2.3 years postoperatively the knee range of motion was full. Consolidation was noted 80 days (51-111 days) postoperatively with an average consolidation index of 2.9 days/mm (1.8-4.1 days/mm). No complications were observed. According to the Paley Score all patients had an excellent outcome.