Der Unfallchirurg
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Review Case Reports
[Triceps tendon rupture : Double-row repair and overview of alternative techniques].
Triceps tendon rupture is a rare injury. While partial tendon ruptures can be treated non-operatively, complete ruptures are an indication for surgical treatment in order to restore strength and a full range of motion. ⋯ The injury was treated by open reduction and refixation of the tendon using the double-row technique. The following article describes the technique and highlights its advantages and disadvantages in comparison to other procedures.
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The majority of transfemoral and transtibial amputees can be functionally fitted with conventional suspension sockets; however, due to socket problems using conventional stump care, 60% of the patients have limited function and even in younger patients approximately one sixth are unable to wear the prosthesis daily. After the introduction of transcutaneous osseointegrated prostheses (TOP) the inherent problems of socket-stump care can be avoided for these patients. Against this background this article reviews the recent clinical development of TOP in Sweden, Germany, the Netherlands, Australia and USA currently in nine centers. ⋯ Furthermore, TOP is nowadays also used for transhumeral amputees and after thumb amputation and the development of the indications for this technique are increasing. Future aspects include novel treatment options using implanted intramedullary electrodes allowing permanent and unlimited bidirectional communication with the human body (osseointegrated human-machine gateway). This could possibly realize an innovative form of prosthesis control as well as the combination of TOP and targeted muscle reinnervation (TMR) surgery to create more advanced prosthesis systems for upper and lower extremity amputees.
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Modern trauma room management requires interdisciplinary teamwork and synchronous communication between a team of anaesthesists, surgeons and radiologists. As the length of stay in the trauma room influences morbidity and mortality of a severely injured person, optimizing time is one of the main targets. ⋯ For the individual case interventional therapy methods can be added. Based on current data and on the Frankfurt experience the current diagnostic concepts of trauma diagnostics are presented.
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Review
[The endo-exo prosthesis treatment concept : Improvement in quality of life after limb amputation].
Osseointegrated, percutaneous implants as the force bearer for exoprosthetics after limb amputation have been used in individual cases for clinical rehabilitation of amputees during the past years. Most experience in this field in Germany has been accumulated at the Sana Klinik in Lübeck with the so-called endo-exo prosthesis (EEP) system. The two-step implantation procedure can now be considered as reliable. ⋯ The results are likewise encouraging. The use of EEP for the upper limbs leads to substantial improvement in the range of motion of the shoulder joint with the intramedullary anchored percutaneous implant. Furthermore, new pathbreaking possibilities in the fixation of myoelectrically controlled arm prostheses may arise from the EEP technique.
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Transcutaneous, bone anchored prostheses have proved to be an alternative for amputees. In addition to the safe osseointegration of the implant, the correct prosthetic alignment is also important. Therefore, the interaction between prosthesis components and the prosthesis wearer is significant and the role of the certified prosthetist should not be underestimated. ⋯ Bone anchored prostheses influence the skeleton and joints in a more direct way. This fact requires specific prosthetic measures concerning the connection between the endo-implant and the exoprosthesis. Therefore, specially matched adaptors and the prosthetic alignment are the focus of interest. Prostheses connected to an osseointegrated implant have many biomechanical advantages compared to socket-guided prostheses. Because the quality of rehabilitation is clearly affected by the prosthetic alignment, it has to be carried out extremely carefully and precisely if the prosthesis is connected to an osseointegrated implant. According to the survey, none of the prosthesis wearers wanted to return to a socket-guided prosthesis.