Zentralblatt für Chirurgie
-
Sacral fractures are frequently misdiagnosed or overlooked, as the majority of the patients are suffering from polytrauma situations. Obvious clinical signs both of the fracture and the associated neurological complications are missing. A poor longterm outcome with pain and urogenital disorders is frequent. ⋯ A complete anatomical sacral reconstruction was achieved in 80 % of the cases, another 16 % had close to anatomic (< 5 mm) reconstruction. In eight cases a primary neurologic deficit was present, with five complete or partial recoveries directly postoperative. Complications occurred in seven patients with two secondary displacements.
-
Comparative Study
[Cemented versus uncemented hip replacement--rational decision making using the BiCONTACT total hip system].
The BiCONTACT femoral stem has been developed as a modular system which is suitable for both cemented and uncemented implantation. A highly standardized procedure using an identical set of instruments for both modes of fixation ensures bone preservation. Primary stability is achieved by special design parameters. ⋯ The BiCONTACT stem is in use in the BG Trauma Center Tuebingen since 14 years and a consecutive series of 250 cases (series A) with uncemented implantation and of 250 cases (series B) with cemented implantation has been analyzed in two different prospective follow-up studies. Long-term survival after 11 years was 97.1 % (95 % confidence limits: 93.8 %-98.7 %) for series A, the follow-up rate was 99.2 %. For series B, the follow up-rate was also 99.2 %, survival estimate after 11 years was 97.5 % (95 % CI: 94.2 %-99.0 %).
-
The new method of antegrade intramedullary fixation of humeral head fractures is based on a straight proximal humeral nail with special head fixation screws and conventional interlocking screws at the proximal end of the shaft fragment leaving an axillary nerve shelter space in between. The nail acts as a central load carrier. The head fixation screws run through threaded holes in the proximal end of the nail thus being held in a stiff angle and without gliding. ⋯ We found an ongoing improvement of the postoperative results up to an average Constant Score of 85.7 pts after one year. The complication rate was 16 %. The main complication was the screw protrusion into the joint.
-
Aim of the study was to analyse the results following osteosynthesis of proximal humerus fractures with cannulated blade plate 90 degrees (Synthes, Mathys Medizinaltechnik AG, Bettlach, Schweiz) in elderly patients. Between 6/1998 and 12/1999 we treated 20 patients (12 female, 8 male) > 65 years (65-92 y, 75 y) with the cannulated blade plate (fracture type according to AO: 8 x 11-A3, 5 x 11-B1, 3 x 11-B2, 1 x 11-B3 und 3 x 11-C2). Regarding to mechanical and functional advantages we modified the 90 degrees angulation of the implant by bending intraoperatively up to 110-120 degrees. ⋯ The cannulated blade plate 90 degrees represents a justified alternative in the treatment of displaced fractures of the proximal humerus in elderly patients. Commendable indications are fracture types A and B according to AO with stable fixation of the blade plate in the humeral head, which allow early physiotherapy and avoid an alteration of the rotator cuff. C-type fractures tend to complications (2/3).