Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jul 2013
Randomized Controlled TrialA multi-level rapid prototyping drill guide template reduces the perforation risk of pedicle screw placement in the lumbar and sacral spine.
The method of free-hand pedicle screw placement is generally safe although it carries potential risks. For this reason, several highly accurate computer-assisted systems were developed and are currently on the market. However, these devices have certain disadvantages. We have developed a method of pedicle screw placement in the lumbar and sacral region using a multi-level drill guide template, created with the rapid prototyping technology and have validated it in a clinical study. The aim of the study was to manufacture and evaluate the accuracy of a multi-level drill guide template for lumbar and first sacral pedicle screw placement and to compare it with the free-hand technique under fluoroscopy supervision. ⋯ The method significantly lowers the incidence of cortex perforation and is therefore potentially applicable in clinical practice, especially in some selected cases. The applied method, however, carries a potential for errors during manufacturing and practical usage and therefore still requires further improvements.
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Arch Orthop Trauma Surg · Jul 2013
Case ReportsClosed rupture of flexor tendon by hyperextension mechanism in wrist level (zone V): a report of three cases.
Closed flexor tendon ruptures due to trauma without external wound are rare. When the flexor tendon has excessive loading, failure occurs at the tendon insertion or its origin from the bone. It is likely to result in avulsion fracture rather than rupture of the proper portion of the tendon by forceful grasping with hyperextension. ⋯ On physical examination, these patients could not flex interphalangeal joint of thumb or distal interphalangeal joint of the fifth finger. All patients underwent MRI or ultrasonography to find out the location of loss in continuity of the flexor tendons before the operation. After identifying the location, flexor tendon repair or tendon graft using palmaris longus were performed.
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Arch Orthop Trauma Surg · Jul 2013
Case ReportsAtypical forearm fractures associated with long-term use of bisphosphonate.
Recent reports on atypical femoral fracture have raised concerns about the long-term use of bisphosphonate. More recent case series focus specifically on the subtrochanteric fractures. But, there is relatively rarity and unawareness of atypical fracture in upper extremity. ⋯ The other woman had a fracture in the radial shaft. This report suggests atypical fractures associated long-term use of bisphosphonate could occur in bones other than femur. More study is required to identify the magnitude of clinical features of this emerging concern.
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Arch Orthop Trauma Surg · Jul 2013
How bilateral iliolumbar fusion increases the stability of horizontal osteosynthesis in unstable pelvic ring injuries?
In type C pelvic ring injuries, the operative stabilization of the posterior ring is absolutely indicated. There exist four different types of operative methods: iliosacral screw fixation, transsacral plate synthesis, ventral plate fixation (primarily for sacroiliac luxations), and local plate synthesis performed on the dorsal cortex of the sacrum. In our current article, we analyzed the stability of fixation methods used together with bilateral iliolumbar techniques. ⋯ In unilateral pelvis injuries, if a non-weight bearing status cannot be achieved on the injured side, unilateral iliolumbar fusion reinforcement is justified, since the contralateral lower limb must also be non-weight bearing due to the pelvis injury itself. In the case of the most unstable sacrum fracture--"jumper's fracture", bilateral iliolumbar fusion is necessary, in which case the patient will be able to bear weight during the early postoperative period.
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Arch Orthop Trauma Surg · Jul 2013
Surgical treatment of vertically unstable lateral clavicle fractures (Neer 2b) with locked plate fixation and coracoclavicular ligament reconstruction.
The present study evaluates the outcome of patients treated with a combination of locked plate fixation and minimal-invasive coracoclavicular (CC) ligament reconstruction for unstable lateral clavicle fractures type IIb according to Neer. ⋯ A combination of locked plate fixation and CC ligament augmentation in a minimal-invasive manner can be regarded as suitable for the treatment of vertically unstable lateral clavicle fractures and is associated with excellent clinical and radiological outcomes and a low complication rate.