Operative Orthopädie und Traumatologie
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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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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[Fixation of fractures of the distal radius using the "nail-plate"].
Stable fixation of unstable distal radius fractures by means of a "nail-plate" with the distal plate section lying on the dorsal surface of the distal radius fragment, and the proximal nail section inside the diaphysis of the radius. ⋯ In the time between April 2005 and October 2006, 32 distal radius fractures were treated at the author's institution using the "nail-plate". Two complications were observed: loosening of a locking screw, and rupture of the extensor pollicis longus tendon 4 months postoperatively. In a study of more than 200 cases, only few complications were reported: a wound hematoma in a dialysis patient, loss of fixation of an articular fracture that was poorly indicated, and hypertrophic scar formation. In one patient complaining of persistent discomfort at the implantation site, the implant was removed.
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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.