Operative Orthopädie und Traumatologie
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Oper Orthop Traumatol · Sep 2009
Review Clinical Trial[Operative treatment of T-type fractures of the acetabulum via surgical hip dislocation or Stoppa approach].
Anatomic reduction and stable fixation by means of tissue- preserving surgical approaches. INDICATIONS Displaced acetabular fractures. Surgical hip dislocation approach with larger displacement of the posterior column in comparison to the anterior column, transtectal fractures, additional intraarticular fragments, marginal impaction. Stoppa approach with larger displacement of the anterior column in comparison to the posterior column. A combined approach might be necessary with difficult reduction. CONTRAINDICATIONS Fractures > 15 days (then ilioinguinal or extended iliofemoral approaches). Suprapubic catheters and abdominal problems (e.g., previous laparotomy due to visceral injuries) with Stoppa approach (then switch to classic ilioinguinal approach). ⋯ 17 patients with a mean follow-up of 3.2 years. Ten patients were operated via surgical hip dislocation, two patients with a Stoppa approach, and five using a combined or alternative approach. Anatomic reduction was achieved in ten of the twelve patients (83%) without primary total hip arthroplasty. Mean operation time 3.3 h for surgical hip dislocation and 4.2 h for the Stoppa approach. Complications comprised one delayed trochanteric union, one heterotopic ossification, and one loss of reduction. There were no cases of avascular necrosis. In two patients, a total hip arthroplasty was performed due to the development of secondary hip osteoarthritis.
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Oper Orthop Traumatol · Sep 2009
Review Clinical Trial[Angle-stable intramedullary nailing of proximal humerus fractures with the PHN (proximal humeral nail)].
Stable fixation of two- and three-part fractures of the proximal humerus through minimally invasive operative technique and rapid bone healing as well as restoration of original anatomy. Early functional training with the goal of restoration of former mobility and daily activities. ⋯ 151 proximal humeral fractures were treated with a proximal humeral nail (PHN). 108 patients could be followed up 1 year postoperatively. Significant complications were perforation of the articular surface through bolts or blades (n = 8), implant-related pain (n = 10), fragment dislocation (n = 2), nonunion (n = 2), humeral head necrosis (n = 3), and superficial infection (n = 1). 1 year after the operation, the Constant-Murley Score showed a median value of 75.3 in the injured shoulder and of 89.9 in the uninjured shoulder. The DASH (Disability of the Arm, Shoulder and Hand) Score was 5.9 preoperatively and 9.3 at 1 year postoperatively. The worst results regarding the Constant-Murley Score as well as the DASH Score were found in C-type fractures.
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Oper Orthop Traumatol · Sep 2009
Review[Reconstruction of fractures of the anterior wall and the anterior column of the acetabulum using an ilioinguinal approach].
Restoration of the congruence of the hip joint. Correction of gaps or steps in the articular surface, especially in the main weight-bearing area of the acetabular dome. Correction of femoral head subluxation. Restoration of joint stability in order to enable early postoperative mobilization. ⋯ Excellent and good functional results are observed in 73-85% of the isolated anterior column fractures. The anterior wall fracture is a seldom injury. Functional results are worse in comparison to the other simple fracture types. Good or excellent results can only be observed in two thirds of cases. This observation is related to the fact that anterior wall fractures often occur in elderly patients with osteoporotic bone.
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Oper Orthop Traumatol · Sep 2009
Clinical TrialExtended posterior circumferential approach to thoracic and thoracolumbar spine.
Posterior spinal surgical approach to achieve a retropleural/ retroperitoneal corpectomy with circumferential spinal cord decompression following subtotal vertebrectomy, posterior instrumentation and interbody spacer placement under compression as well as kyphosis correction with spinal column shortening. ⋯ 22 patients were operated in the last 8 years with tuberculosis (18 patients - twelve paraplegics), osteoporotic fractures (two patients), congenital kyphosis and Ewing's sarcoma (one patient each). All patients were followed up at 3, 6, 9, and 12 months and then annually. At each followup, clinical, hematologic and radiologic parameters were assessed. All interbody grafts and cages incorporated without significant loss of correction. Ten of twelve tuberculous paraplegics recovered. No patient had postoperative infection, interbody spacer- or implant-related complications.
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Oper Orthop Traumatol · Sep 2009
Review Clinical Trial[Internal fixation of acetabular posterior wall fractures].
Open anatomic reduction and stable internal fixation of a posterior wall fracture of the acetabulum by screw and plate osteosynthesis via the Kocher-Langenbeck appoach. ⋯ Between January 1, 1972 and December 31, 2005, 137 patients with fractures of the posterior wall of the acetabulum were treated operatively. A high-velocity trauma was the cause of injury in 91.1% of cases. 94.1% of these patients had an additional hip dislocation, which was reduced within 6 h post injury in 83.7%. A primary sciatic nerve injury was present in 22.2%. Additional injuries to the acetabular cartilage were found in 43%, additional femoral head lesions in 27.4%, and Pipkin fractures in 14.1%. Anatomic joint reconstruction (0-1 mm) was observed in 96.3%, the other five patients had near anatomic reconstructions (2-5 mm). All hip joints were congruent on conventional radiography. The overall complication rate was 11.8%. Osteosynthesis-related complications were seen in 6.7%. 86 patients had follow-up results after a mean of 52 months. A perfect or good functional result (Merle d'Aubigné Score) was observed in 73.3% of cases, a posttraumatic arthrosis of the hip joint was present in 31.4%.