Operative Orthopädie und Traumatologie
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Oper Orthop Traumatol · Oct 2008
Clinical Trial[Surgical treatment of fractures of the distal tibia in adolescents].
Injury to the epiphyseal cartilage during the period of growth plate closure in adolescence results in specific stereotyped injury patterns due to the change in biomechanics. According to the number of fragments, fractures of the distal tibia can be categorized into so-called two-plane and triplane I and II fractures. Since these fractures are involving the joint, the most important aspect for further therapy is the reconstruction of the joint surface. As the growth plate has already begun to close at this stage, relevant growth disturbances are unlikely. ⋯ While short-term results are generally good, data on long-term outcome and possible development of arthrosis is still insufficient.
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Oper Orthop Traumatol · Sep 2008
[The distally based sural neurocutaneous island flap for coverage of soft-tissue defects on the distal lower leg, ankle and heel].
Stable coverage of soft-tissue defects in the critical regions of the distal lower leg, ankle and heel by avoidance of a microsurgically transplanted free flap. ⋯ In a retrospective study, eleven out of twelve patients (including six high-risk patients) with a distally based sural neurocutaneous flap were examined on average 3.7 years postoperatively. The mean age was 54.9 years (28-80 years). A stable coverage of the defect was achieved in all twelve patients. In ten of twelve sural flaps the defect site was closed by primary wound healing, additional procedures were necessary in two cases (meshed skin grafting of flap border, excision of skin necrosis). All patients examined were satisfied with the result of the primary operative target, the stable coverage of the defect. Stated disadvantages were loss of sensation in the area of sural nerve function (four times), aesthetic impairment (twice), and pain resulting from sural nerve neuroma above donor site (once).
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Oper Orthop Traumatol · Jun 2008
Percutaneous reduction and fixation of intraarticular calcaneal fractures.
Percutaneous reduction by distraction and subsequent percutaneous screw fixation to restore calcaneal and posterior talocalcaneal facet anatomy. The aim of this technique is to improve functional outcome and to diminish the rate of secondary posttraumatic arthrosis compared to conservative treatment and, secondly, to reduce infectious complications compared to open reduction and internal fixation (ORIF). ⋯ Between 1999 and 2004, 59 patients with 71 fractures were treated by percutaneous skeletal triangular distraction and percutaneous fixation. A total of 50 patients with 61 fractures and a minimum follow-up of 1 year were available for follow-up. According to the American Orthopaedic Foot and Ankle Society Hindfoot Score, 72% had a good to excellent result. A secondary subtalar arthrodesis was performed in five patients and planned in four (total 15%). Böhler's angle increased by about 20 degrees postoperatively. Sagittal motion was 90% and subtalar motion 70% compared to the healthy foot.
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Oper Orthop Traumatol · Jun 2008
[Distally pedicled posterior interosseous artery flap for the coverage of defects on the wrist and hand].
Coverage of defects on the upper limb with the distally pedicled, fasciocutaneous posterior interosseous artery flap. ⋯ From November 2005 until June 2007, 25 distally pedicled posterior interosseous artery flaps were performed. With this type of flap, it was possible to successfully enlarge the 1st interdigital web space in two patients and to cover the whole thumb in two cases of degloving injury. In nine patients, the flap was used to cover the median and/or ulnar nerve at the level of the wrist and/or palm of the hand, and in four cases, to cover defects after tumor resection on the palm of the hand. Exposed extensor tendons and/or bony structures were covered with this flap in another eight patients. In two of the 25 flaps, distinct necroses of the most distal edge of the skin island were seen. After surgical debridement and split-skin transplantation, all of these small superficial defects healed well. Absence of the distal anastomosis as well as complete flap failure could not be observed in this series.