Operative Orthopädie und Traumatologie
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Oper Orthop Traumatol · Nov 2009
Review[The hemiresection-interposition arthroplasty of the distal radioulnar joint].
Restoration of forearm rotation and pain relief at the distal radioulnar joint by resection of the joint surfaces of the ulnar head, interposition of a capsular-retinacular flap, and preservation or reconstruction of the ulnocarpal complex. ⋯ The hemiresection-interposition arthroplasty of the distal radioulnar joint improves the range of forearm rotation. Pain is significantly reduced and grip strength increased. Instability of the distal ulna may persist or result; however, this gives rise to moderate complaints only in some patients. Patients' satisfaction is high and the functional results are good.
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Oper Orthop Traumatol · Nov 2009
Clinical Trial[Pedicled vascularized bone grafts from the dorsum of the distal radius for treatment of scaphoid nonunions].
Bony healing and reconstruction of the scaphoid with use of a reverse-flow pedicle vascularized bone graft from the dorsal aspect of the distal radius. Revitalization of the proximal fragment in case of avascular necrosis. ⋯ 48 scaphoid nonunions were treated with 1,2-ICSRA-based (intercompartmental supraretinacular artery) vascularized bone grafts: 34 scaphoid nonunions went on to union at an average of 15.6 weeks after surgery.
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Arthrodesis of the wrist in order to improve functional use of the hand by reducing pain and improving grip strength. ⋯ 26 (18 men, eight women) of the authors' first patients with arthrodesis of the wrist using the AO fusion plate were reexamined after a mean follow-up time of 18 months (minimum 6, maximum 32 months). The mean modified Mayo Wrist Score was 47 points (minimum 20, maximum 70 points), the DASH Score (Disabilities of the Arm, Shoulder and Hand) averaged 46 points (minimum 4, maximum 81 points). 20 of the 26 patients were satisfied, but not all patients were completely free of pain. Eight out of a total of ten patients (seven men, three women) with a bilateral wrist arthrodesis were reexamined after a mean follow-up time of 66 months (minimum 27, maximum 74 months). The DASH Score was 55 points on average (minimum 38, maximum 73 points). All patients stated that their clinical situation had improved and that they were able to manage their daily activities without help. So it can be concluded that bilateral arthrodesis of the wrist is a valuable option, if all other possibilities are exhausted.
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Oper Orthop Traumatol · Nov 2009
Clinical Trial[Stabilization of the scaphoid according to Brunelli as modified by Garcia-Elias, Lluch, and Stanley for the treatment of chronic scapholunate dissociation].
Stabilization of the scaphoid correcting rotary subluxation and replacement of the biomechanically essential dorsal part of the scapholunate ligament for prevention of osteoarthritis. ⋯ 14 out of 17 patients were available for a clinical and radiologic examination after a mean follow-up time of 10.5 months (minimum 6, maximum 15 months). Two of these patients had to undergo another operative procedure in the meantime, one partial and the other total wrist fusion. The remaining twelve patients had a mean DASH Score (Disabilities of the Arm, Shoulder and Hand) of 25 (minimum 0, maximum 59 points) and a mean modified Mayo Wrist Score of 80 points (minimum 60, maximum 97 points). Contrary to the good clinical results, the final radiologic examination demonstrated a tendency toward loss of correction compared to the postoperative X-rays.
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Oper Orthop Traumatol · Nov 2009
Clinical Trial[NITINOL shape memory staple for osteosynthesis of the scaphoid].
Reconstruction of the scaphoid with use of NITINOL shape "memory" staples. ⋯ From October 1995 to December 2006, the authors used NITINOL staples for 65 osteosyntheses of the scaphoid. Indications were 15 unstable fractures, 47 nonunions, and three partial necroses. 61 out of 65 scaphoids healed without further surgery, three of the 61 patients showed a delayed healing. Two of the four nonunions were related to the use of the NITINOL staples. Seven staples were removed, one for loosening. NITINOL shape memory staples have proven to be very helpful for osteosynthesis in fractures and nonunion of the scaphoid, if the prerequisites are given for their use.