Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1999
Combined Kirschner wire fixation in the treatment of Colles fracture. A prospective, controlled trial.
For surgical treatment of the unstable Colles fracture we developed a new form of osteosynthesis, which consists in a modification of the dynamic Kirschner wire fixation described by Kapandji. It allows early motion without the typical risk of palmar dislocation noted with the Kapandji method. We prefer this method in elderly patients with reduced bone quality. ⋯ A minor loss of reduction by dorsal impaction was observed in the follow-up evaluation, but it had no functional relevance. The most frequent complication was paraesthesia within the area of the superficial radial nerve. According to the NYOH score the following results were achieved: excellent 35%, good 50%, fair 10%, poor 5%.
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Eleven patients with high-standing greater trochanter (13 joints) aged 13-36 years underwent surgery. Distal transfer of the greater trochanter (group T) was performed in 4 patients (5 joints) and lateral displacement osteotomy (group L) in 7 (8 joints). The average follow-up duration was 13.4 years in group T and 5.9 years in group L. ⋯ The lever arm ratio (LAR) did not change significantly in group T, but it decreased from 1.97 to 1.60 in group L (P = 0.004). This means that the lever arm of the abductors can certainly be extended by lateral displacement osteotomy. Lateral displacement osteotomy is the most effective procedure for high-standing greater trochanter.
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Arch Orthop Trauma Surg · Jan 1999
Comparative Study Clinical TrialEndoscopy of the femoral canal in revision arthroplasty of the hip.A new method for improving the operative technique and analysis of implant failure.
Femoral endoscopy using a special endoscope was performed in 28 revision arthroplasties with the aim of improving the operative technique and to analyze implant failure. Before clinical application, the method was used to analyze the implant bed in clinically and radiographically well-fixed prostheses in autopsy cases without implant failure. Initially, it was performed on 4 experimental implantations of newly designed revision devices into cadaver femurs to obtain additional information concerning the design rationale of implants and instruments for revision surgery. ⋯ Further, it was possible to directly visualize the shape and condition of the primary implant bed after removal of the implant. Femoral endoscopy improved the surgical technique in revision arthroplasty. In addition, it is a very useful tool for the analysis of the implant bed in clinical and autopsy cases as well as in experimental implantations.
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Arch Orthop Trauma Surg · Jan 1999
Cryosurgery in long bones; an experimental study of necrosis and revitalization in rabbits.
Cryosurgery is an established adjuvant treatment of bone tumors which reduces the local recurrence rate. In this study, cryosurgical experiments were carried out in rabbits to study the temperature field, the extent of necrosis, and the revitalization process in order to optimize treatment. Intramedullary freezing of long bones with a closed liquid nitrogen cryoprobe and three consecutive sessions induces osteonecrosis down to the -10 degrees C isotherm without compromising the soft tissues. ⋯ In clinical practice, no profound periosteal bone apposition and a high risk for pathologic fractures during the remodelling phase were noted. Future research should focus on bone strength during the remodelling phase of cryosurgically treated long bones, to decide on the role of preventive osteosynthesis or postoperative restrictions. This animal model is not advised for these biomechanical experiments because of its profuse periosteal bone apposition.
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Arch Orthop Trauma Surg · Jan 1999
Comparative StudyErrors of computer-assisted migration analysis in conventional radiographs of femoral hip implants--an experimental study.
Several methods have been described in the literature in order to analyze migration of femoral hip implants in conventional radiographs. However, no measurements were done regarding the potential errors inherent in such unstandardized radiographs of daily routine. In order to quantify this lack of reproducibility, we carried out experimental examinations with radiographs of a hip revision prosthesis, where different variables of technical X-ray conditions and femoral positions were changed. ⋯ Significant errors for the migration analysis in the transverse and rotational planes were only found under conditions of varying the femoral position, and not under different technical X-ray conditions. From these experimental results, we derived the following criteria to minimize failure in a quantitative radiographic migration analysis: (1) the patient's leg has to be placed into an antirotation device to ensure identical object position; (2) the same source-to-film distance has to be used; (3) the central X-ray focus has to be localized on the center of the film-cassette; (4) film-screen systems should be of the same type and size; (5) the object has to be placed in the same position as in previous radiographs. As a conclusion, only if these standardization criteria are respected in the daily routine of conventional radiographs will an effective and meaningful use of migration analysis systems be possible to prove or to exclude mechanical failure of femoral hip implants in prospective longitudinal follow-up series.