Der Unfallchirurg
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Reconstruction of the anterior cruciate ligament (ACL) is a widely used procedure, but up to now no results have been published on an implant-free technique using a quadriceps tendon autograft and press-fit fixation. ⋯ Reconstruction of the ACL with an autologous quadriceps tendon and an implant-free technique yielded good results compared to established operative methods in the short-term and should be consistently followed-up for long-term confirmation.
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The successful management of open extremity injuries continues to represent a surgical challenge requiring a structured and multidisciplinary treatment concept. The treatment strategy depends on specific parameters, including the overall injury severity, life threatening trauma components, the degree oft soft tissue injury, the ischemia time, the contamination of the wound as well as the age and accompanying diseases of the patient. ⋯ The initial wound management includes radical and serial debridements and vessel reconstruction, followed by the gradual reconstruction of bone, tendons and nerves and a subsequent plastic soft tissue coverage. The sequential and priority-orientated implementation of these treatment steps is decisive for the long term outcome, which ideally results in an regular healing of bone and soft tissue without the presence of infection and good regain of extremity function.
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Comparative Study
[Biomechanical investigation on refixation of tuberosities on shoulder prostheses. Does refixation with different suture materials offer enough stability?].
Elderly patients suffering from complex, non-reconstructable fractures of the proximal humerus are commonly treated by primary implantation of a shoulder endoprosthesis. One of the most critical factors for success or failure of treatment is still the refixation of the tuberosities. ⋯ Due to these results suture materials have a limited usefulness for refixation of tuberosities as an increased risk of obstruction for bony consolidation can result.
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Problems related to the use of interference screws for fixation of bone-patellar tendon-bone grafts for anterior cruciate ligament (ACL) replacement have led to increasing interest in press-fit techniques. Most of the described techniques use press-fit fixation on either the femoral or tibial side. Therefore an arthroscopic technique was developed which achieves bone-patellar tendon-bone graft fixation by press-fit on both sides without the need for supplemental fixation material. ⋯ The presented press-fit technique avoids all complications related to the use of interference screws. It achieves primary stable fixation of the bone-patellar tendon-bone graft thereby allowing early functional rehabilitation. However, fixation strength depends on bone quality and the arthroscopic procedure is demanding. The results showed reliable stabilization of the operated knees.