Operative Orthopädie und Traumatologie
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Restoration of axis, length, and rotation of the lower leg. Sufficient primary stability of the osteosynthesis for functional aftercare. Early functional aftercare to maintain joint mobility. Good bony healing in closed and open fractures. ⋯ In a prospective, international multicentric study, 181 patients with 186 fractures were included between July 2004 and May 2005. 57 of these fractures (30.7%) initially were graded open, 15 of them grade I, 32 grade II, and ten grade III. Most of the fractures (36%) were shaft fractures. After 1 year, 146 patients (81%) could be evaluated clinically and radiologically. The overall pseudarthrosis rate was 12.2% (18.2% for open and 9.7% for closed fractures). The risk for secondary operations or revisions (including dynamization of the nail) was 18.8%. Without consideration of dynamization procedures, revisions were necessary in only 5.4% of all patients. The risk for varus, valgus or antecurvation malalignment of more than 5 degrees in any plane on radiologic long leg views was 4.3% for shaft fractures, 1.5% for distal fractures, and 13.6% for proximal fractures. The implant-specific risk for bolt breakage was 3.2%.
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Oper Orthop Traumatol · Dec 2009
Clinical Trial[The surgical treatment of chronic extension deficits of the knee].
Restoration of full knee extension in patients with chronic extension deficits, especially in posttraumatic and postoperative cases. ⋯ 121 patients underwent anterior and posterior arthrolysis between 1990 and 2000. 86 of these patients could be included in this study. The average follow-up was 4.6 years (1-10 years). The extension deficit before surgery averaged 20 degrees compared with the opposite side. At follow-up, the average extension had increased by 17 degrees , no patient had more than 5 degrees of flexion contracture. The Lysholm Score was 84 postoperatively. The Tegner Activity Scale increased from 1.9 to 4.0 after arthrolysis. In the AOSSM Subjective Outcome Score, 35 patients showed excellent and 60 good results. 14 patients were satisfied after surgery and nine were not. Three patients required revision surgery (two synovial fistulas, one hematoma).
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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.
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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.