Arthroskopische Auff��llung von fehlplatzierten und erweiterten Bohrkan?len mit Beckenkammspongiosa bei Rezidivinstabilit?t nach Ersatzplastik des vorderen Kreuzbandes

Objective

Arhroscopically performed autologous bone grafting of the femoral or tibial tunnel after anterior cruciate ligament (ACL) reconstruction in symptomatic anterior knee instability.

Indications

Subjective and objective instability in cases with recurrent instability following ACL reconstruction with tibial or femoral tunnel malplacement and tunnel widening.

Contraindications

Open growth plates, severe osteoarthritic changes.

Surgical technique

Arthroscopic ACL graft resection and implant removal followed by debridement of the tunnel and the sclerotic tunnel walls. Cortical bone cylinders and cancellous bone grafts are harvested from the iliac crest and transplanted into the enlarged and malplaced tunnels. The harvest site may be filled with bone substitutes.

Results

Arthroscopic filling of malplaced or enlarged bone tunnels was performed in 42?patients (14?men, 28?women, age range 18?C37?years) with recurrent instability after ACL reconstruction. All patients presented with tunnel malplacement, while 38?patients also had tunnel widening. In 39?cases, a tibial bone graft was necessary; in 12?cases the femoral defect was filled with autologous bone. No complications, such as hematomas of infections, were observed. CT scans showed complete integration of the osseous grafts after 3?C6?months.     

How can we optimize anterior iliac crest bone harvesting? An anatomical and radiological study

Purpose

Anterior iliac crest bone is a widely used donor site for bone harvesting. It provides an autologous bone graft consisting of cancellous bone that can be packed or cortical bone with greater structural support. Uses include spinal fusion and fracture non-union surgery. Although its use is common, dedicated anatomical and radiological studies analysing graft dimensions and optimal harvesting site in relation to local anatomical landmarks [anterior superior iliac spine (ASIS), anterior iliac tubercle (AIT) and lateral femoral cutaneous nerve (LFCN)] have not been described.

Methods

Twenty-eight female hemipelvises were dissected for this study. The LFCN, ASIS and AIT were identified. Calliper measurements and CT scan analysis were undertaken to determine the optimum positions in obtaining a 5-mm-thickness tricortical graft whilst remaining safe for the LFCN.

Results

According to our measurements, the optimal location for harvesting a 5-mm-thick tricortical graft with 35-mm height and 47-mm width is situated anterior to a line passing at the level of the thickest point of the AIT. This thickest point was situated at a mean 67 mm from the centre of the EIAS in our study.

Conclusion

This anatomical and radiographic study determined the anatomical iliac crest landmarks to avoid neurological injury when taking an optimal 5-mm-width tricortical bone graft.     

Operative Therapie der Klavikulapseudarthrose

Objective

The objective in treating clavicular non-union is an anatomic reconstruction of the clavicle with an iliac crest bone graft and anatomic locking compression plates.

Indications

Non-union or bony defects of the clavicle larger than 1.5 cm.

Contraindications

Any suspicion of infection, elevated risk of transplant necrosis or recurrent non-union due to concomitant disease, medication, cigarette smoking (>10 cig./d), poor therapeutic compliance regarding specific postoperative management and poor physical status.

Surgical technique

Patient in beach chair position with a flexible affected arm. An longitudinal skin incision is made below the clavicle with subsequent incision through the clavipectoral fascia and the periosteum, complex multidimensional osteotomy of the clavicle with medial and lateral axial correction of the pseudarthrosis up to vital bone, harvesting of a tricortical iliac crest bone graft with the size measured in preoperative computed tomography (CT) according to the length of the healthy contralateral clavicle. Final shaping of the iliac crest bone graft regarding the future clavicular position, positioning of the anatomic plate (LCP superior anterior clavicle plate with or without lateral extension, Depuy Synthes, Umkirch, Germany) and drilling and screw insertion under radiological guidance. If necessary additional attachment of the iliac crest bone graft with suture cerclage (FiberWire, Arthrex, Karlsfeld, Germany) or screw should be carried out. A final radiological examination and hemostasis of the iliac crest with a Lyostypt collagen hemostatic fleece and the clavicle. Drains might be needed and wound closure layer by layer with sutures.

Postoperative management

Arm sling protection for 6 weeks with physiotherapeutic exercises and increased range of motion every 2 weeks and unrestricted range of motion from week 7 onwards. Full weight bearing is not allowed before week 12 and X-ray examinations to confirm bone healing should be done 3, 6, 12 and 24 weeks postoperatively. Implant removal at an earliest time point of 2 years can be performed when full osseous integration of the graft is radiologically confirmed.

Results

At our department 10 consecutive patients suffering from clavicular non-union have been treated with this technique with a minimum follow-up of 1 year. All patients showed anatomic restoration of the radiologically confirmed healed clavicle with very good patient satisfaction.     

The clinical outcomes of extracorporeal irradiated and re-implanted cemented autologous bone graft of femoral diaphysis after tumour resection

Purpose

We report the outcome of intercalary resection of the femoral diaphysis and extracorporeal irradiated autologous bone graft reconstruction, without the use of vascularized fibular graft.

Methods

Six patients with Ewing sarcoma of the mid-shaft femur who were treated by limb sparing tumour resection and reconstruction with extracorporeal irradiated autologous bone graft with intramedullary cement between 2002 and 2010 were studied.

Results

Mean age at the time of surgery was ten years (range, four–23). The length of resected femoral bone averaged 23 cm (15–32 cm). The ratio of bone resection length to total femoral length averaged 60 % (56–66 %). The patients had been followed up for between 16 and 79 months (mean, 41 months) at the time of the study. There was no infection nor fracture in this series. Primary union of the distal and proximal osteotomy sites was achieved in three patients. Delayed union of the proximal osteotomy site occurred in one patient that was successfully treated with iliac crest bone grafting. One patient developed non-union at the distal osteotomy site which failed to heal with bone grafting and was therefore converted to endoprosthetic replacement, and another patient was converted to rotationplasty at five months post-surgery because of contaminated margins. Function was excellent in all patients with surviving re-implanted bone. Local recurrence arose in one patient.

Conclusion

Our experience suggests that cement augmentation of extracorporeal irradiated and re-implanted bone autografts offer a useful method of reconstructing large femoral diaphyseal bone defects after excision of primary malignant bone tumours.     

Evaluation of long-term outcomes of pasteurized autografts in limb salvage surgeries for bone and soft tissue sarcomas

Background

Pasteurized autografts used in limb salvage operations for malignant musculoskeletal tumors have several advantages, including reduced disease transmission, economic efficiency, accessibility, and anatomical conformation. However, their use has been associated with bone absorption, fracture, and pseudarthrosis. Few studies exist which have assessed the long-term outcomes of pasteurized autografts. The purpose of this study was to investigate the clinical outcomes of patients treated with pasteurized autografts and to compare these outcomes across various graft types.

Methods

A retrospective analysis of 46 patients treated with pasteurized autografts between 1992 and 2010 was conducted. The analysis included 22 intercalary bone grafts, 17 inlay grafts, 4 composite grafts, and 3 osteochondral grafts, with the mean follow-up period of 8.7?years (2?C17?years).

Results

The 10-year survival rate of the 46 pasteurized autograft cases analyzed was 93.5?%, and the average bone union time between host and pasteurized autogenous bone was 9.5?months. Infections were identified in 6 (13?%) patients, fractures in 7 (15?%) patients, non-union in 8 (17?%) patients, and bone absorption in 6 (13?%) patients. Inlay grafts were completely incorporated with the host bone at the follow-up period. Combination with a vascularized fibular graft significantly reduced the risk of non-union and bone absorption (p?<?0.05 and p?<?0.01, respectively), with an average functional score of 23.1/30 (83.8?%).

Conclusion

Our findings show that pasteurized bone grafts in combination with vascularized fibular grafts have improved outcomes and potential clinical indications.     

Clinical and radiographic outcomes of the treatment of adolescent idiopathic scoliosis with segmental pedicle screws and combined local autograft and allograft bone for spinal fusion: a retrospective case series

Background

High morbidity has been reported with iliac crest bone graft harvesting; however, donor bone is typically necessary for posterior spinal fusion. Autograft bone combined with allograft may reduce the morbidity associated with iliac crest bone harvesting and improve the fusion rate. Our aim in this study was to determine the presence of complications, pseudarthrosis, non-union, and infection using combined in situ local autograft bone and freeze-dried cancellous allograft bone in patients undergoing posterior spinal fusion for the treatment of adolescent idiopathic scoliosis.

Methods

A combination of in situ local autograft bone and freeze-dried cancellous allograft blocks were used in 50 consecutive patients with adolescent idiopathic scoliosis treated by posterior fusion and Moss Miami pedicle screw instrumentation. Results were assessed clinically and radiographically and quality of life and functional outcome was evaluated by administration of a Chinese version of the SRS-22 survey.

Results

There were 41 female and 9 male patients included for analysis with an average age of 14.7 years (range, 12-17). All patients had a minimum follow-up of 18 months (range, 18 to 40 months). The average preoperative Cobb angle was 49.8° (range, 40° to 86°). The average number of levels fused was 9.8 (range, 6-15). Patients had a minimum postoperative follow-up of 18 months. At final follow-up, the average Cobb angle correction was 77.8% (range, 43.4 to 92.5%). There was no obvious loss in the correction, and the average loss of correction was 1.1° (range, 0° to 4°). There was no pseudarthrosis and no major complications.

Conclusions

In situ autograft bone combined with allograft bone may be a promising method enhances spinal fusion in AIS treated with pedicle screw placement. By eliminating the need for iliac crest bone harvesting, significant morbidity may be avoided.     

Ergebnisse bei der Versorgung per- und subtrochantärer Femurfrakturen

Background

Can the helical blade in proximal femur nailing antirotation (PFNA) reach a better bony fixation than proximal femur nailing (PFN), thereby decreasing complication rates and improving clinical outcomes especially in osteoporotic bone?

Materials and methods

In a retrospective study complications and clinical treatment results of pertrochanteric and subtrochanteric femoral fractures were analyzed. For this purpose a group of patients stabilized with PFN (n=65) were compared to a patient group treated with PFNA (n=66). Objective and subjective parameters were acquired and analyzed by clinical follow-up studies using the Merle d’Aubigné score and X-ray evaluation. Individual bone quality was analyzed radiologically by determining the Singh index. The mean follow-up time was 7 months in each group.

Results

The PFNA showed a decrease in postoperative implant-associated complications especially in osteoporotic bone and unstable fracture types.

Conclusion

The philosophy of the PFNA blade with better fixation through an increased implant-bone-interface and smaller cross-section, compaction of cancellous bone as well as an antirotational fixation, seems to show advantages compared to the double screw system of the PFN.     

Clavicular non-union treated with fixation using locking compression plate without bone graft

Background

The articles that have reported on the size at which a segmental defect of clavicular non-union requires bone grafting are scarce. This study evaluated the functional and radiologic results of fixation by locking compression plate (LCP) without bone graft when the defect size is less than 2?cm following bone sclerosis removal for the treatment of clavicular non-union.

Methods

The study included 17 patients with mid-shaft clavicular non-union. All patients underwent bone sclerosis resection and fixation using LCP without bone graft. The patients were evaluated preoperatively, and after a minimum of 24?months (mean, 44.47?months; range, 24 to 60?months) postoperatively in terms of the disabilities of the arm, shoulder and hand (DASH) score, the Constant-Murley score, and radiography.

Results

In this study, no patients were lost to follow-up. The mean DASH score improved from 38.76?±?7.76 (31.00–46.52) points preoperatively to 19.88?±?7.18 (12.70–27.06) points 2?years postoperatively (P?<?0.01). The mean Constant-Murley score improved from 41.59?±?8.81 (32.78–50.40) points preoperatively to 75.47?±?13.50 (61.97–88.97) points 2?years postoperatively (P?<?0.01). Radiographs revealed fracture union in all patients. No correlations between the defect size and the postoperative Constant-Murley score or between the defect size and the postoperative DASH score were found based on Pearson tests. No complications, particularly acromioclavicular joint complications and sternoclavicular joint complications, were observed.

Conclusions

In conclusion, we can suggest, from the findings of our study, that bone sclerosis resection and fixation using LCP without bone graft is effective for the treatment of clavicular non-union involving a gap of less than 2?cm and has a low rate of complications.

     

Bone union rate with autologous iliac bone versus local bone graft in posterior lumbar interbody fusion (PLIF): a multicenter study

Purpose

The purpose of this study is to compare bone union rate between autologous iliac bone and local bone graft in patients treated by posterior lumbar interbody fusion (PLIF) using carbon cage for single level interbody fusion.

Methods

The subjects were 106 patients whose course could be observed for at least 2 years. The diagnosis was lumbar spinal canal stenosis in 46 patients, herniated lumbar disk in 12 patients and degenerative spondylolisthesis in 51 patients. Single interbody PLIF was done using iliac bone graft in 53 patients and local bone graft in 56 patients. Existence of pseudo-arthrosis on X-P (AP and lateral view) was investigated during the same follow up period.

Results

No significant differences were found in operation time and blood loss. Significant differences were also not observed in fusion grade at any follow up period or in fusion progression between the two groups. Donor site pain continued for more than 3 months in five cases (9 %). The final fusion rate was 96.3 versus 98.3 %.

Conclusions

Almost the same results in fusion were obtained from both the local bone group and the autologous iliac bone group. Fusion progression was almost the same. Complications at donor sites were seen in 19 % of the cases. From the above results, it was concluded that local bone graft is as beneficial as autologous iliac bone graft for PLIF at a single level.     

Humeral shaft non-union after intramedullary nailing

Background

The humerus shaft is one of the sites with the largest probability of developing pseudoarthrosis after fracture. We present the results of nine patients with atrophic pseudoarthrosis of humeral shaft treated with angular stability plate associated with allograft and platelet-rich plasma (PRP), after a first treatment with intramedullary nail to correct the fracture.

Material and Methods

From January 2012 to December 2014, nine patients were treated for atrophic pseudoarthrosis (PSA) of humeral shaft treated previously using intramedullary nail; seven humeral diaphysis fractures were located in the middle–proximal third and two in the middle third. In one case, a reverse shoulder prosthesis implant was associated to treat a co-existent rotator cuff massive lesion. The mean time between injury and treatment of non-union was 32 weeks (min 16–max 180); all patients were evaluated with Constant, DASH and UCLA score.

Results

At the final follow-up (23.7 months), the mean Dash score was 22.25 pt, the Constant score was 64 pt, and the UCLA score value was 27 pt. The average pain value was 2 for the arm interested and 0 into PSA focus. Radiographic healing was obtained at 7 months.

Conclusions

The humeral shaft non-union is an invalidating problem which affects the daily living. Our treatment with plate, cortical bone graft, and PRP can build a high-stability structure that can help healing and graft integration.

     

Comparative study suggests that human bone morphogenetic proteins have no influence on the outcome of operative treatment of aseptic clavicle non-unions

Purpose

The purpose of this study was to evaluate the clinical and radiological outcome following compression plate fixation in combination with autologous bone grafting, with and without additional application of recombinant human bone morphogenetic protein (rhBMP) for treatment of aseptic clavicle non-union.

Methods

Between April 2004 and April 2015, 82 patients were treated for clavicle fracture and had developed aseptic clavicle non-union. Seventy-three out of 82 patients were available for follow-up at least one year after revision surgery; among them, 27 women and 46 men, with a median age of 49 (range, 19–86) years. Forty-five patients received compression plate osteosynthesis with autologous bone grafting, and 28 patients obtained compression plate fixation with autologous bone grafting and additional application of rhBMP-2 (3/28 patients) or rhBMP-7 (25/28 patients).

Results

Seventy out of 73 non-unions (96 %) healed within 12 months after revision surgery. Functional outcome according to the DASH Outcome Measure (with rhBMP, 33.16 ± 1.17 points; without rhBMP, 30.58 ± 2.12 points [mean ± SEM]; p?=?0.81), non-union healing (p?=?0.86), time interval between revision surgery and bone healing (p?=?0.37), as well as post-operative complications, did not demonstrate relevant differences between the treatment groups and were not age-dependent.

Discussion

Functional and radiological results demonstrate that successful healing of aseptic clavicle non-union is dependent on radical resection of non-union tissue, restoration of length of the shoulder girdle and application of stable locking-plate osteosynthesis in combination with autologous bone grafting, but not dependent on application of additional rhBMP.

     

Radiologischer Vergleich zweier Verfahren zur ventralen Spondylodese

Background

The objective of this study was the radiological evaluation of osseous integration of autologous iliac crest graft and bovine bone graft after spondylodesis based on a standardized score.

Material and methods

Spondylodesis was performed on 18 sheep, divided into 2 groups, 1 with an autologous iliac crest graft and the other with a bovine bone graft. Computed tomography was performed 12 and 24 weeks postoperatively. The osseous integration was assessed by the Tübinger Score.

Results

The evaluation of the CT scans demonstrated a significantly better osseous integration of the autologous iliac crest graft compared to the bovine bone graft.

Conclusions

Based on our results, the bovine bone graft as a transplant for spondylodesis is inadvisable.     

Corticocancellous olecranon autograft for metacarpal defect reconstruction: a case report

Background

High-energy injuries to the hand frequently lead to bone defects as well as soft tissue loss. Early bone grafting of defects is well established in the literature; however, few options are available for autologous corticocancellous grafts. Most frequently cited studies describe the iliac crest or the distal radius donor sites.

Methods

In this case report, we describe a new technique of obtaining corticocancellous bone graft from the olecranon.

Results

Complete union of the segmental defect was achieved with this technique.

Conclusions

The olecranon donor site is outside the zone of injury and therefore safe to access, but within the upper extremity, thus avoiding the need for harvest from a distant site such as the iliac crest or the distal femur. Additional benefits of this site are the greater volume of graft that can be harvested compared to the distal radius as well as a more optimal ratio of cancellous to cortical graft available, compared to the iliac crest where the graft may be excessively cortical in nature.     

Autologous platelet-rich plasma induces bone formation of tissue-engineered bone with bone marrow mesenchymal stem cells on beta-tricalcium phosphate ceramics

Background

The purpose of the study is to investigate whether autologous platelet-rich plasma (PRP) can serve as bone-inducing factors to provide osteoinduction and improve bone regeneration for tissue-engineered bones fabricated with bone marrow mesenchymal stem cells (MSCs) and beta-tricalcium phosphate (β-TCP) ceramics. The current study will give more insight into the contradictory osteogenic capacity of PRP.

Methods

The concentration of platelets, platelet-derived growth factor-AB (PDGF-AB), and transforming growth factor-β1 (TGF-β1) were measured in PRP and whole blood. Tissue-engineered bones using MSCs on β-TCP scaffolds in combination with autologous PRP were fabricated (PRP group). Controls were established without the use of autologous PRP (non-PRP group). In vitro, the proliferation and osteogenic differentiation of MSCs on fabricated constructs from six rabbits were evaluated with MTT assay, alkaline phosphatase (ALP) activity, and osteocalcin (OC) content measurement after 1, 7, and 14 days of culture. For in vivo study, the segmental defects of radial diaphyses of 12 rabbits from each group were repaired by fabricated constructs. Bone-forming capacity of the implanted constructs was determined by radiographic and histological analysis at 4 and 8 weeks postoperatively.

Results

PRP produced significantly higher concentration of platelets, PDGF-AB, and TGF-β1 than whole blood. In vitro study, MTT assay demonstrated that the MSCs in the presence of autologous PRP exhibited excellent proliferation at each time point. The results of osteogenic capacity detection showed significantly higher levels of synthesis of ALP and OC by the MSCs in combination with autologous PRP after 7 and 14 days of culture. In vivo study, radiographic observation showed that the PRP group produced significantly higher score than the non-PRP group at each time point. For histological evaluation, significantly higher volume of regenerated bone was found in the PRP group when compared with the non-PRP group at each time point.

Conclusions

Our study findings support the osteogenic capacity of autologous PRP. The results indicate that the use of autologous PRP is a simple and effective way to provide osteoinduction and improve bone regeneration for tissue-engineered bone reconstruction.

     

6-Year follow-up of ventral monosegmental spondylodesis of incomplete burst fractures of the thoracolumbar spine using three cortical iliac crest bone grafts

Introduction

Autologous bone graft is the gold standard for vertebral body replacement. Currently, after modern implants for vertebral body replacement are available, controversies exist regarding the optimal implant strategy.

Patients and methods

Between 2002 and 2003, 17 patients were included in this study, all suffering from incomplete burst fractures of the thoracolumbar spine. All of them were treated by ventral monosegmental spondylodesis using iliac crest bone graft. The individual treatment strategy depended on the fracture situation and patient’s condition. After an average of 74?months (range 66–84) a clinical and computer tomographic follow-up examination was performed in 14 patients (average age, 35.2?years) including VAS spine score and SF 36 score. Nine patients were treated ventral only five patients dorsoventrally.

Results

Complete osseous consolidation was visible in nine, partial consolidation (>30?%) in four, and lysis in one patient, without any significant differences between ventral only or dorsoventral approach. After removal of the fixateur interne the level of consolidation improved in all patients, treated dorsoventrally. There was no significant correlation between percentage of osseous consolidation and the clinical follow-up parameters. After 6?years, 71?% of the patients suffered from persistent pain associated with the approach to the iliac crest. Two revision surgeries have been necessary.

Conclusion

High rates of osseous consolidation are visible 6?years after ventral spondylodesis by iliac crest bone grafts. A further improvement of consolidation can be expected after dorsal implant removal. But the surgical approach to the iliac crest is accompanied with a relevant complication rate.     

Papineau debridement,Ilizarov bone transport,and negative-pressure wound closure for septic bone defects of the tibia

Purpose

Ilizarov pioneered bone transport using a circular external fixator. Papineau described a staged technique for the treatment for infected pseudarthrosis of the long bones. This article presents a single-stage Papineau technique and Ilizarov bone transport, and postoperative negative-pressure wound dressing changes for septic bone defects of the tibia.

Materials and methods

We studied the files of seven patients (mean age, 32 years) with septic bone defects of the tibia treated with a Papineau technique and Ilizarov bone transport in a single stage, followed by postoperative negative-pressure wound dressing changes. All patients had septic pseudarthrosis and skin necrosis of the tibia. The technique included a single-stage extensive surgical debridement of necrotic bone, open bone grafting with cancellous bone autograft and bone transport, and postoperative negative-pressure wound dressing changes for wound closure. The mean time from the initial injury was 6 months (range, 4–8 months). The mean follow-up was 14 months (range, 10–17 months).

Results

All patients experienced successful wound healing at a mean of 29 days. Six patients experienced successful bone regeneration and union at the docking side at a mean of 6 months. One patient experienced delayed union at the docking site, which was treated with autologous cancellous bone grafting. Two patients experienced pin track infection, which was successfully treated with antibiotics and pin site dressing changes. All patients were able to return to their work and previous levels of activity, except one patient who had a stiff ankle joint and had to change his job. No patient experienced recurrence of infection, or fracture of the regenerated or transported bone segment until the period of this study.

Conclusion

The combined Papineau and Ilizarov bone transport technique with negative-pressure wound closure provides for successful eradication of the infection, reconstruction of the bone defect, and soft-tissue closure. A single-stage surgical treatment is feasible, without any complications.     

The comparison of the effect of corticosteroids and platelet-rich plasma (PRP) for the treatment of plantar fasciitis

Introduction

In this study, the results of local injection of platelet-rich plasma (PRP) and corticosteroids in the treatment of plantar fasciitis were compared.

Patients and methods

Sixty patients who were diagnosed as plantar fasciitis and treated conservatively for at least 3?months and had no response to conservative treatment modalities were involved in this study. The first 30 consecutive patients were treated by local injection of 2?mL of 40?mg Methylprednisolone with 2?mL of 2% prilocaine (metilprednizalone) and the second 30 patients were treated by injecting 3?mL PRP after 2?mL of 2% prilocaine injection. Patients were evaluated according to the modified criteria of the Roles and Maudsley scores and visual analog scale before injection and 3?weeks and 6?months following injection.

Results

The mean VAS heel pain scores measured 6?months after treatment were 3.4 in steroid group and 3.93 in PRP group, and the scores in both groups were significantly lower when compared with pretreatment levels (6.2 in steroid group and 7.33 in PRP group). There was no significant difference between steroid and PRP groups in visual analog scale scores and modified criteria of the Roles and Maudsley scores measured at 3?weeks and 6?months (P?>?0.05).

Conclusion

Our results revealed that both methods were effective and successful in treating plantar fasciitis. When the potential complication of corticosteroid treatment was taken into consideration, PRP injection seems to be safer and at least having same effectivity in the treatment of plantar fasciitis.     

Knochenresorption bei posttraumatischer Dystrophie

Background

In posttraumatic dystrophy the resorption of cancellous bone remains an unsolved phenomenon.

Objectives

The possible effects of arteriovenous (av) anastomoses, hypoxia and acidosis in posttraumatic dystrophy on cancellous bone structures should be elucidated.

Material and methods

In posttraumatic dystrophy of the hand after distal radius fracture, hand fractures and elective hand surgery [20] the results suggest that persistent av anastomoses could be the reason for this syndrome. Possible pathways for the occurrence of cancellous bone resorption are discussed in context with the literature.

Results and conclusion

Intraosseous av anastomoses with acidosis and hypoxia of the tissues are probably responsible for the excessive activity of osteoclasts in acute posttraumatic dystrophy. Even enhancements in the late static phase of the three phase bone scan (TPBS) are in agreement with this hypothesis. In cancellous bone these enhancements are induced by the bone seeking tracers. The nomenclature for these tracer molecules is in line with the recommendations of International Union of Pure and Applied Chemistry (IUPAC) as methylene bisphosphonate and hydroxymethylene bisphosphonate. From this, therapeutic recommendations for posttraumatic dystrophy can be derived. The term diphosphonates should be changed to bisphosphonates.     

Korrekturosteotomie der fehlverheilten Radiusfraktur von palmar

Background

The conservative as well as the operative treatment of distal radius fractures poses a risk of inadequate reduction or secondary dislocation. The consequences may be limited use of the hand with pain and restricted movement.

Materials and methods

Out of 21?patients with malunited fractures of the distal radius which were corrected operatively through a palmar approach, 19 have been assessed clinically as well as radiologically. The mean age was 60?years (range 45–84?years) and the mean follow-up period was 342 days. In 10 cases no autologous bone graft was inserted into the osteotomy gap.

Results

Postoperatively the average extension was 51.8° (±14.9°) and flexion 53.5° (±14°) as well as a supination of 83.8° (±11.2°) and pronation of 84.7° (±12°). The wrist score averaged 85 points, the disabilities of the arm, shoulder and hand (DASH) functional value averaged 17 points. A mean preoperative palmar inclination of ?20.9° (±10.1°) improved to 5.4° (±3.8°) after surgery and the ulnar inclination from 9° (±8.5°) to 18.1° (±6.2°).

Discussion

The correction of malunited distal radius fractures led to an improvement in function with less pain. Our data indicate that under certain circumstances interposition of an autologous bone graft does not need to be performed.