Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Aug 2007
Remodeling of the spine in spondylodiscitis of children at the age of 3 years or younger.
Spondylitis/spondylodiscitis is still an uncommon diagnosis often with a delay in diagnosis and treatment due to the uncharacteristic symptoms. The aim of this study is to increase the awareness and outline a pattern of investigation and treatment. We present six children with an average age of 23 months (19-33 months) at time of diagnosis, conservative treated and with a mean follow-up of 31 months (12-65 months). ⋯ Spondylitis/spondylodiscitis should be considered as diagnosis in children with refusal to walk or gait disturbances especially in combination with elevated ESR. MRI is the tool of choice to set the diagnosis early. With an adequate and early therapy of bracing (body-plaster-cast), antibiotics and clinical monitoring good long-term result without spine instability or deformity can be achieved.
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Arch Orthop Trauma Surg · Aug 2007
Comparative StudyAntegrade intramedullary splinting or percutaneous retrograde crossed pinning for displaced neck fractures of the fifth metacarpal?
It is generally accepted that severely displaced or malrotated neck fractures of the fifth metacarpal should be treated by closed reduction and pinning. As antegrade intramedullary splinting avoids adhesions of the extensor hood and provides intramedullary stability this technique seems to be advantageous in comparison with traditional retrograde percutaneous crossed pinning. We raised the question whether the antegrade technique would give clinical and radiological results superior to the retrograde technique and investigated this within a comparative clinical study. ⋯ From our clinical and radiological data we conclude that antegrade intramedullary splinting is superior to retrograde percutaneous crossed pinning and thus should be preferentially considered for displaced neck fractures of the fifth metacarpal.
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Arch Orthop Trauma Surg · Aug 2007
Mechanical torque measurement predicts load to implant cut-out: a biomechanical study investigating DHS anchorage in femoral heads.
Bone strength plays an important role in implant anchorage. Bone mineral density (BMD) is used as surrogate parameter to quantify bone strength and to predict implant anchorage. BMD can be measured by means of quantitative computer tomography (QCT) or dual energy X-ray absorptiometry (DXA). These noninvasive methods for BMD measurement are not available pre- or intra-operatively. Instead, the surgeon could determine bone strength by direct mechanical measurement. We have evaluated mechanical torque measurement for (A) its capability to quantify local bone strength and (B) its predictive value towards load at implant cut-out. ⋯ Mechanical peak torque measurement is able to quantify bone strength. In an experimental setup, peak torque identifies those specimens that are likely to fail at low load. In clinical routine, implant migration and cut-out depend on several parameters, which are difficult to control, such as fracture type, fracture reduction achieved, and implant position. The predictive value of peak torque towards cut-out in a clinical set-up therefore has to be carefully validated.
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Arch Orthop Trauma Surg · Jul 2007
Assessing leg length discrepancy following elastic stable intramedullary nailing for paediatric femoral diaphyseal fractures.
Femoral overgrowth is a recognised phenomenon following fractures of the femoral diaphysis in children. This study was designed to assess leg length discrepancy (LLD) following elastic stable intramedullary nailing (ESIN) and its clinical significance. ⋯ ESIN is a successful treatment for paediatric diaphyseal femoral fractures and allows early mobilisation and discharge. A statistically significant LLD is observed in children aged 4-8 years although clinically only one patient in the entire series was aware of a leg length discrepancy. In addition clinical methods of leg length measurement are sensitive for LLD and we conclude that routine radiographic follow up is not necessary unless clinically indicated.
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Arch Orthop Trauma Surg · Jul 2007
Comparative StudyFive-year follow-up examination after purely minimally invasive posterior stabilization of thoracolumbar fractures: a comparison of minimally invasive percutaneously and conventionally open treated patients.
It is well known that during posterior stabilization of the spinal column conventionally open methods are predominantly used. However, in this study a minimally invasive method was chosen to decrease the morbidity of the operative access and to protect the paravertebral musculature, which serves as an important spine-stabilizing factor during posterior stabilization. The aims of this retrospective non-randomized case-control study were to compare the clinical and radiological results of minimally invasive on the one hand and conventionally open posterior surgery on the other with each other and to measure the loss of correction after purely posterior stabilization. ⋯ The minimally invasive posterior stabilization leads to lower blood loss in comparison to the conventionally open method and can be carried out without any special effort limited to A-fractures without any neurological symptoms.