Operative Orthopädie und Traumatologie
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Oper Orthop Traumatol · Apr 2017
Review[Operative treatment of terrible triad injury of the elbow : Open reduction and internal fixation].
Reconstruction of the most important ligamentous and osseus structures of the elbow after terrible triad injury via the radial head to the lateral collateral ligament complex (LCL) and if necessary beginning at the coronoid process. The aim is a stable concentrically guided elbow with early functional follow-up treatment. The approach depends on the intraoperatively tested stability. ⋯ Control of 15 terrible triad patients (mean age 45.9 years, range 20-87 years) after 9.6 months (range 2.6-31.6 months), extent of movement flexion/extension 131/14/0°, pronation/supination 78/0/67°. Arthrolysis after an average of 38 weeks in 4 patients, signs of joint arthrosis in 8, heterotopic ossification in 7 and neuropathic complaints in the region of the ulnar nerve in 1 patient. Early functional therapy with reproducible results by stabilization of osteoligamentous structures.
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Oper Orthop Traumatol · Apr 2017
Review[Corrective osteotomies for posttraumatic elbow deformities].
Correcion of elbow joint deformities that usually develop secondary to direct or indirect trauma of the arm or elbow with subsequent inadequate healing and consecutive axial/rotational malalignment and may be associated with cosmetic or functional deficits of the arm. ⋯ In general, the results for a three-dimensional osteotomy of the distal humerus are expected to be good to very good. Only in rare cases (2.5%) is a mostly transient irritation of the ulnar nerve observed.
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Oper Orthop Traumatol · Feb 2017
Clinical TrialBicompartmental individualized knee replacement : Use of patient-specific implants and instruments (iDuo™).
Bicompartmental knee replacement in patients with combined osteoarthritis (OA) of the medial or lateral and patellofemoral compartment. Patient-specific instruments and implants (ConforMIS iDuo™) with a planning protocol for optimal implant fit. ⋯ In all, 44 patients with bicompartmental OA of the medial and patellofemoral compartment were treated. Mean age 59 years. Minimum follow-up 12 months. Implant converted to TKA due to tibial loosening (1 patient); patella resurfacing (3 patients). No further revisions or complications. Radiographic analyses demonstrated ideal fit of the implant with less than 2 mm subsidence or overhang. KSS pain scores improved from preoperatively 5.7 to 1.7 postoperatively with level walking, and from 7.3 preoperatively to 2.8 postoperatively with climbing stairs or inclines. The WOMAC score improved from preoperatively 43 to 79 postoperatively.
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Oper Orthop Traumatol · Aug 2016
Clinical Trial[Arthroscopically assisted osteosynthesis of intraarticular distal radius fractures].
Anatomical reconstruction of the distal radius after intra-articular fractures with special consideration of the articular surface and treatment of concomitant ligament injuries. ⋯ After arthroscopically assisted reduction of an intra-articular distal radius fracture, 17 out of the 23 patients were available for follow-up examination an average of 31 months after the procedure. The mean disabilities of the arm, shoulder and hand (DASH) score was 4.9 and the mean patient-rated wrist evaluation (PRWE) score was 6.0 at final follow-up. Except for wrist flexion, an active range of motion at the wrist as well as forearm rotation of more than 90 % was achieved compared with the uninjured contralateral side. Grip strength averaged 96 % compared with the contralateral side and pain levels under stress varied between 1 and 3 on a visual analog scale (range 0-10).
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The goal of this operation technique is a stable refixation of the triangular fibrocartilage complex (TFCC) to the fovea ulnaris. The stability of the distal radio-ulnar joint (DRUJ) should be re-established. The patients pain and the feeling of instability should be reduced. ⋯ Clinical studies of this technique showed a significant amelioration of pain perception, improved range of motion and DASH score in all patients after anchor fixation. The results are comparable to other techniques. All patients returned to work after the operation. Accordingly, using this technique a very good stabilization of the DRUJ with low complications can be achieved.