Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Apr 2004
The impact of Syme amputation in surgical treatment of patients with diabetic foot syndrome and Charcot-neuro-osteoarthropathy.
Charcot-neuro-osteoarthropathy with its severe destruction of bones remains a challenge for physicians and surgeons. The aim of the study was to characterise a patient population treated in a specialised foot care centre who underwent surgical treatment for their diabetic foot syndrome. Special attention was paid to patients who suffered from Charcot-neuro-osteoarthropathy and the impact of Syme amputation if amputation of the foot was inevitable. ⋯ The crucial diagnostic tool for decision-making in diabetic foot syndrome was MRI, which normally shows osteomyelitis with high sensitivity and specificity. In patients with Charcot-neuro-osteoarthropathy, the bone marrow oedema of the involved parts of the skeleton might misleadingly suggest the diagnosis of osteomyelitis. If amputation is inevitable in severe abscess formation combined with instability and perforation of the dislocated and destroyed bones in Charcot-neuro-osteoarthropathy, these patients might benefit from a foot amputation according to the technique Syme described. For this procedure the blood supply of the posterior tibial artery is essential. All these patients were able to walk without support. The material presented helps to generate hypotheses for further prospective studies.
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Arch Orthop Trauma Surg · Apr 2004
Use of a synthetic bone void filler to augment screws in osteopenic ankle fracture fixation.
Sufficiently stable constructs may be difficult to obtain with ankle fractures in patients with severe osteopenic bone. Augmentation of the osteosynthesis with a new synthetic bone void filler may help to solve this problem, and it can improve the clinical outcome. ⋯ Augmentation of bone screws with this new synthetic bone void filler was an effective means of gaining screw anchorage. Screw stabilisation with the new synthetic bone void filler proved to be safe and effective in the ORIF of ankle fractures in patients with osteopenic bone.
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Arch Orthop Trauma Surg · Apr 2004
Treatment of nonunions with irretrievable broken nail pieces in the distal fragment.
We present our experience in the treatment of nonunited fractures of long bones in the presence of a retained fragment of the broken intramedullary nail. ⋯ Ring fixation using thin wires or half pins inserted beside fragments of the broken nail provides a simple and minimally traumatic method of treatment in patients when encountering difficulties extracting a retained fragment of broken intramedullary nails.
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Arch Orthop Trauma Surg · Mar 2004
Review Meta AnalysisThe reliability of clinical examination in detecting pelvic fractures in blunt trauma patients: a meta-analysis.
Several studies have recently questioned whether routine radiographic screening for pelvic fractures is necessary in the initial evaluation of blunt trauma patients. Therefore, we assessed how sensitive and specific the clinical examination is in detecting fractures of the pelvis. ⋯ In stable and alert trauma patients, a thorough clinical examination will detect pelvic fractures with nearly 100% sensitivity, thus rendering initial radiography unnecessary in this group of patients.
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Arch Orthop Trauma Surg · Mar 2004
Comparative StudyDifference in metallic wear distribution released from commercially pure titanium compared with stainless steel plates.
Stainless steel and commercially pure titanium are widely used materials in orthopedic implants. However, it is still being controversially discussed whether there are significant differences in tissue reaction and metallic release, which should result in a recommendation for preferred use in clinical practice. ⋯ We conclude from the increased release of toxic, allergic, and potentially carcinogenic ions adjacent to stainless steel that commercially pure Ti should be treated as the preferred material for osteosyntheses if a removal of the implant is not intended. However, neither material provoked a foreign-body reaction in the local tissues, thus cpTi cannot be recommend as the 'golden standard' for osteosynthesis material in general.