共查询到20条相似文献，搜索用时 109 毫秒
1.
Objective
Internal fixation of displaced fractures of the greater tuberosity allowing functional aftercare.Indications
Displaced fractures of the greater tuberosity >5 mm. Displaced fractures of the greater tuberosity >3 mm in athletes or overhead workers. Multiply fragmented fractures of the greater tuberosity.Contraindications
Displaced 3? or 4?part fractures of the proximal humerus. Nondisplaced fractures of the greater tuberosity.Surgical technique
Exposure of the fracture of the greater tuberosity by an anterolateral approach. Open reduction and temporary retention with a Kirschner wire or a “Kugelspieß” or reinforcement of the supraspinatus tendon and distal retention. Bending and positioning of the Bamberg plate and fixation by conventional or locking screws. Optional fixation of the rotator cuff to the plate. Exact monitoring of the implant position using the image intensifier to avoid inadequate distalization of the greater tuberosity.Postoperative management
Arm sling (e.?g. Gilchrist) for 2 weeks. Start passive assisted exercise on postoperative day 1. Movement allowed up to the pain threshold. Physiotherapeutic treatment to prevent adhesions and capsular shrinking.Results
In all, 10 patients with displaced fractures of the greater tuberosity underwent osteosynthesis using the Bamberg plate. After a follow-up of at least 6 months, a Constant–Murley score of 94.2 points (range 91–98 points) was achieved. The patients’ average age was 45.6 years (range 29–68 years).2.
Alvin Chao-Yu Chen Chun-Ying Cheng Ying-Chao Chou 《Journal of orthopaedics and traumatology》2017,18(1):37-42
Background
Post-traumatic deformity of the distal radius may lead to multiple sequelae and severe functional impairment. Intramedullary fixation is a novel technique for treatment of distal radius fractures. The present study aimed to evaluate the functional and radiographic outcomes of intramedullary nailing for correction of post-traumatic deformity in late-diagnosed fractures of the distal radius.Materials and methods
From July 2009 to February 2011, 16 patients with late-diagnosed displaced fractures of the distal radius were included. Eligible inclusion was extra-articular fracture for more than 4 weeks. Surgical correction and internal fixation with intramedullary nailing was performed for treatment of ten AO type A2 and six AO type A3 fractures. All patients were followed up radiographically and clinically for an average of 20.3 months.Results
All fractures achieved bone union without major complications. Functional status and radiographic alignment significantly improved postoperatively. There was no significantly secondary displacement comparing early postoperative and final radiographic parameters. The functional results according to the Mayo wrist scoring system were good or excellent in 94 % of patients. The mean score was 83.8.Conclusion
Surgical correction and internal fixation with the intramedullary nail is a feasible and less invasive technique with few complications in the treatment of post-traumatic deformity of the distal radius.Level of evidence
IV.3.
Objective
Anatomical reconstruction of the distal radius after intra-articular fractures with special consideration of the articular surface and treatment of concomitant ligament injuries.Indications
Intra-articular distal radius fractures in adults under 65 years of age.Contraindications
Osteoporotic deterioration of metaphyseal bone, radiocarpal fracture dislocation and open fractures.Surgical technique
Conventional palmar approach for plate fixation of the fracture with a fixed angle locking plate. Arthroscopy of the wrist is performed for reduction of the articular fracture component using the standard 3?4 and 6R portals. Following temporary Kirschner (K) wire fixation of the fracture, angle stable locking screws are inserted into the most distal portion of the plate. Finally, the intercarpal ligaments and the triangular fibrocartilage complex (TFCC) are checked for concomitant lesions and if necessary subsequent treatment within the same operation.Postoperative management
Plaster cast fixation for 4 weeks followed by a physiotherapy program.Results
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).4.
Objective
Arthroscopic decompression (wafer procedure) of the ulnocarpal compartment in patients with ulnar impaction syndrome.Indications
The arthroscopic wafer procedure is recommended in ulnar-plus situations with up to 3 mm length-excess. To perform this procedure the ulnar head needs to be accessible for the burr through a pre-existing, impaction-related, centroradial lesion of the triangular fibrocartilage complex (TFCC). The additional presence of a distal radioulnar joint (DRUJ) type C confirms the indication.Contraindications
The wafer procedure is contraindicated if there is no consistent TFCC injury ensuring access to the ulnar head and furthermore in ulna-plus situations of more than 3 mm. Relative contraindications: in young patients due to lack of evidence-based studies.Surgical technique
Arthroscopic, semicircular, partial resection of the ulnar head in terms of oblique–helicoidal osteotomy using a 4.2 mm burr, while sparing the DRUJ and the dorsal and the palmar radioulnar ligaments.Postoperative management
Immobilization for 1 week in a palmar splint with immediate intensive exercising of pro- and supination under physiotherapeutic instruction.Results
Between 2008 and 2010, an arthroscopic wafer procedure was performed in 24 patients. The resection of the ulnar head was 2.5 mm on average. After a mean follow-up time of 13.25 months, very good results were archived in 23 of 24 patients; the ulnar impingement test was negative. On a visual analog scale (0–10) average postoperative pain was 1.16 at rest and 4.5 under stress. The mean postoperative DASH score was 13.4.5.
Michael Schlageter Reinhard Hoffmann Michael Sauerbier 《Trauma und Berufskrankheit》2016,18(3):157-163
Background
Even today malunions still not infrequently remain after conservative or operative therapy of the most common fracture in humans, multiform fractures of the distal radius, which raises the question of a correction.Objective, material and methods
This article presents the techniques of corrective osteotomy for extra-articular and especially of intra-articular malunions of the distal radius based on the literature and own cases. The indications and possible complications of this demanding intervention are elaborated.Results and discussion
The results of the many publications since 1935 have shown a significant improvement in wrist mobility and rotation, the grip force of the hand and pain relief after extra-articular, mostly three dimensional restoration of the distal radius in shape and length. The intra-articular corrective osteotomy has also proven to be safe and effective. As a result of improved postoperative joint congruence, a beneficial effect on the formation of osteoarthritis can be expected.6.
The problem
Dislocated intra-articular fractures of the distal radius are operatively treated to achieve anatomical reconstruction of the joint. In complex distal radial fractures with multiple joint fragments, fixation with angular stable plates alone may be technically challenging. Smaller fragments, such as the lip of ulnopalmar joint, are often difficult to control.The solution
The supplementary application of mini plates, as employed in maxillofacial surgery, is a helpful tool for reduction and fixation.Result
In this article the operative technique, clinical and radiographic results of 4 complex distal intra-articular radial fractures are presented.7.
Background
The treatment of patients with distal humeral fractures and reduced bone quality or complex fracture patterns is still complicated. Using angular stable implants should lead to better functional results.Objective
The clinical and functional results were analyzed as well as the complications after treatment of patients with distal humeral fractures using angular stable plate osteosynthesis.Material and methods
A questionnaire was sent to patients treated in our hospital for distal humeral fractures and they were invited for a follow-up examination. We investigated the DASH (Disability of the Arm, Shoulder and Head) score, Mayo Elbow Performance Score (MEPS) and EQ-5D-3?L for evaluation of functional results, as well as the VAS (“visuelle Analogskala”) score for evaluation of pain. Using radiographs the fracture patterns were classified and interpreted for complications.Results
A total of 28 patients returned the questionnaire after a minimum of 6 months following the operation and 10 attended a follow-up examination in our clinic. The DASH score was 38.40 and the MEPS 72.31. The results for 15 patients were good to excellent. The EQ-5D-3?L was 0.790 and the VAS 2.76. We found a significant correlation between the DASH score and patient age (p = 0.028), as well as an inverse correlation of the DASH score and the EQ-5D-3?L (p < 0.001). The complication rate was 53.6%. The three biggest groups of complications were neuronal complications, healing disorders and problems with the osteosynthesis material.Discussion
The treatment results showing that unsatisfactory results are possible even if angular stable plates are used. An inferior functional result as assessed by the DASH score reduces the quality of life measured by EQ-5D-3?L. A follow-up after 6 months appears to be sufficient to assess the outcome after complicated distal humeral fractures.8.
Introduction
Kirschner wire osteosynthesis is considered to be the standard technique for surgical fixation of displaced supracondylar humeral and distal radial fractures in children. The Kirschner wires can be left exposed or buried under the skin. Advantages of the epicutaneous technique are, e.?g. the efficiency (cost, effort) and the possibility for wire removal without the necessity of a second anesthesia. On the other hand, there is a concern about higher infection rates as well as traumatization of the children due to externally visible wires.Methods
A web-based survey of members of the DGU, DGOU, DGOOC, and the pediatric traumatology section of the DGU (SKT) was performed to evaluate current treatment concepts in Germany. The pros and cons for each technique were recorded and the need for a clinical study was examined. In addition, a cost analysis was performed for both methods. The results from the literature are summarized and discussed.Results
A total of 710 questionnaires were evaluated. The majority of the respondents were trauma surgeons working in a hospital (80%). The buried technique was superior in both fracture groups (supracondylar humeral fractures 73% and distal radius fractures 69%), whereas a relevant difference could be found depending on the profession. The main reason for the subcutaneous technique was anxiety or observed higher infections using the epicutaneous technique.Conclusion
In Germany, the majority of wires are buried under the skin due to a fear of higher infection rates. In addition, other influencing factors such as pain and traditional approaches play a significant role. With respect to the results in the literature as well as a possible improvement of efficiency and avoidance of a second anesthesia, a multicentric clinical study seems necessary in the future to compare both techniques.9.
H. Resch D. Krappinger P. Moroder M. Blauth J. Becker 《Operative Orthopadie und Traumatologie》2016,28(2):104-110
Objective
Treatment of displaced periprosthetic acetabular fractures in elderly patients. The goal is to stabilize an acetabular fracture independent of the fracture pattern, by inserting the custom-made roof-reinforcement plate and starting early postoperative full weight-bearing mobilization.Indications
Acetabular fracture with or without previous hemi- or total hip arthroplasty.Contraindications
Non-displaced acetabular fractures.Surgical technique
Watson-Jones approach to provide accessibility to the anterior and supraacetabular part of the iliac bone. Angle-stable positioning of the roof-reinforcement plate without any fracture reduction. Cementing a polyethylene cup into the metal plate and restoring prosthetic femoral components.Postoperative management
Full weight-bearing mobilization within the first 10 days after surgery. In cases of two column fractures, partial weight-bearing is recommended.Results
Of 7 patients with periprosthetic acetabular fracture, 5 were available for follow-up at 3, 6, 6, 15, and 24 months postoperatively. No complications were recognized and all fractures showed bony consolidation. Early postoperative mobilization was started within the first 10 days. All patients except one reached their preinjury mobility level. This individual and novel implant is custom made for displaced acetabular and periprosthetic fractures in patients with osteopenic bone. It provides a hopeful benefit due to early full weight-bearing mobilization within the first 10 days after surgery.Limitations
In case of largely destroyed supraacetabular bone or two-column fractures according to Letournel additional synthesis via an anterior approach might be necessary. In these cases partial weight bearing is recommended.10.
C. Neuerburg S. Mehaffey M. Gosch W. Böcker M. Blauth C. Kammerlander 《Operative Orthopadie und Traumatologie》2016,28(3):164-176
Objective
Use of standardized cement augmentation of the proximal femur nail antirotation (PFNA) for the treatment of trochanteric fragility fractures, which are associated with high morbidity and mortality, to achieve safer conditions for immediate full weight-bearing and mobilization, thus, improving preservation of function and independency of orthogeriatric patients.Indications
Trochanteric fragility fractures (type 31-A1–3).Contraindications
Ipsilateral arthritis of the hip, leakage of contrast agent into the hip joint, femoral neck fractures.Surgical technique
Reduction of the fracture on a fracture table if possible, or minimally invasive open reduction of the proximal femur, i.?e., using collinear forceps if necessary. Positioning of guidewires for adjustment of the PFNA and the spiral blade, respectively. Exclusion of leakage of contrast agent and subsequent injection of TRAUMACEM? V+ into the femoral head–neck fragment via a trauma needle kit introduced into the spiral blade. Dynamic or static locking of the PFNA at the diaphyseal level.Postoperative management
Immediate mobilization of the patients with full weight-bearing and secondary prevention, such as osteoporosis management is necessary to avoid further fractures in the treatment of these patients.Results
A total of 110 patients older than 65 years underwent the procedure. Of the 72 patients available for follow-up (average age 85.3 years), all fractures healed after an average of 15.3 months. No complications related with cement augmentation were observed. Approximately 60?% of patients achieved the mobility level prior to trauma.11.
Background
The treatment of proximal humeral fractures (PHF) is challenging. Recently, more restrictive displacement criteria have been introduced and the lack of treatment algorithms in the literature has been emphasized.Purpose
The primary purpose of this study was to evaluate the epidemiology and treatment reality of PHF at a specialized level-1 trauma center according to current displacement criteria. The secondary aim was to assess whether a standardized treatment algorithm can be adhered to during daily clinical routine.Methods
In all, 566 patients (71.4?% female; average age, 68.1 ± 15 years) with 569 PHF were included in this retrospective cohort study. All medical records and existing x?rays as well as computed tomography scans were analyzed. Only fractures with ad latus displacement of max 0.5 cm and/or a humeral head angulation of less than 20º were classified as nondisplaced. Patients with displaced fractures were included for evaluation of a standardized treatment algorithm.Results
The most common fracture type was a three-part fracture (39.9?%, n = 227); 70.9?% of fractures (389/569) were displaced and therefore treated operatively. The accordance between the final operative treatment that patients received and the recommended surgical treatment on the basis of the algorithm was 90.2?% (351/389).Conclusion
In contrast to the rate of 15?% dislocated fractures reported by Charles Neer in 1970, more than 70?% of fractures were found to be displaced when more restrictive displacement criteria were applied. More than 90?% of displaced fractures were treated as recommended by the treatment algorithm. Fractures that fitted the least into the treatment scheme were more complex fractures of patients aged 60 years and older.12.
Objective
Anatomic reconstruction of the posterior facet by primary stabilization of the calcaneal fracture with a locking nail.Indications
All intraarticular calcaneal fractures and unstable two-part fractures independent of the degree of closed/open soft tissue trauma.Contraindications
High perioperative risk, soft tissue infection, beak fracture (type II fracture) and still open apophysis.Surgical technique
Anatomic reduction of the posterior facet using a sinus tarsi approach. Reduction and temporary fixation of the sustentacular, tuberosity, and anterior process fragments with 1.8–2.0 mm Kirschner wires. Thereafter, the C-Nail (calcaneus nail) is introduced with its guiding device stabilizing the sustentacular, tuberostity, and anterior process fragments through its three guiding arms with 6 or 7 locking screws.Postoperative management
Passive and active motion starts on postoperative day 2. Lymph drains help reduce swelling. Partial weightbearing with 20 kg for 6–8 weeks in the patient’s own shoes is recommended. X?ray controls are done at 4 and 8 weeks as well as after 6 and 12 months.Results
A total of 107 calcaneal fractures treated with the C-Nail between 2011 and 2014 were evaluated according to the AOFAS score 6 months and 1 year after surgery. The measured values were on average 93.0 (range 65–100) points at 6 months and 94.1 (range 75–100) points 12 months after the surgery. Böhler’s angle with initial traumatic values of 6.2° (?30 to +13°) improved postoperatively to 31.8°, after 3 months slightly decreased to 29.6°, and after 12 months to 28.3°. There were 2 cases of superficial wound necrosis (1.9?%) and 1 case a deep infection (0.93?%) with need of early C-Nail removal.13.
Background
The purpose of this study was to determine the anatomical features of the pronator quadratus muscle related to minimally invasive plate osteosynthesis for distal radius fractures.Methods
Ten cadaver forearms were used. The width from the proximal edge to the distal edge of the muscle and the distance from the distal edge of the muscle to the joint surface of the distal radius were measured. After inserting the plate under the pronator quadratus muscle, the distal part of the plate was held over the distal part of the radius and the proximal part of the plate was lifted up from the radius with a fixed locking sleeve. When the pronator quadratus muscle fiber showed signs of tearing, the distance from the volar cortex of the radius to the proximal edge of the plate was measured.Results
The average width of the pronator quadratus muscle was 35.4 mm. The average distance from the pronator quadratus muscle to the joint surface of the distal radius was 16.6 mm, and the average distance from the cortex to the proximal edge of the plate was 12.2 mm.Conclusions
The length of the plate should be more than 52 mm to prevent damage to the pronator quadratus muscle. Adjustment of the position of the plate under the muscle should be done in a 12-mm area under the pronator quadratus muscle. The data might provide a useful basis regarding the potential efficacy of minimally invasive plate osteosynthesis for the preservation of pronator quadratus muscle.14.
Y. P. Acklin U. Stöckle C. Sommer 《European journal of trauma and emergency surgery》2016,42(3):351-356
Background
The locked screw plate construct is often cited as being too rigid and prolonging healing in patients with metaphyseal fractures. The newly introduced dynamic locking screws (DLS) allow 0.2 mm of axial motion, which should optimize healing near the near cortex. The purpose of this study was to analyze the clinical results of dynamic locking screws in distal tibia fractures.Methods
Data were acquired retrospectively. Only distal meta-diaphyseal tibia fractures treated with minimally invasive plate osteosynthesis and DLS were evaluated. Cortical and locking head screws were used for distal plate fixation to minimize soft tissue irritation over the medial malleolus, and DLS were used in the proximal plate fixation. Clinical and radiographic data were evaluated after 6 weeks, 3 months, 6 months and 1 year until fracture union.Results
Twenty-two patients were treated with minimally invasive plate osteosynthesis and DLS. Six patients could not be evaluated because they returned to a foreign residence after the procedure. Fourteen fractures healed after a mean of 3.1 months. Two fractures with insufficient reduction showed delayed union and healed after 9 and 9.5 months, respectively. The callus index peaked at 6 months.Conclusions
Dynamic fracture fixation might be a promising concept to reduce the frequency of metaphyseal non-unions in distal tibia fractures. But nevertheless, the dynamic construct cannot compensate for insufficient reduction.15.
L. Walle B. Hohendorff T. Pillukat J. van Schoonhoven 《Operative Orthopadie und Traumatologie》2016,28(1):38-46
Objective
Closure of a palmar soft tissue defect of the proximal phalanx after limited fasciectomy in recurrent Dupuytren’s contracture.Indications
A palmar soft tissue defect between the distal flexion crease of the palm and the flexion crease of the proximal interphalangeal joint (PIP) after limited fasciectomy in Dupuytren’s contracture.Contraindications
Scars at the lateral–dorsal portion of the proximal phalanx (e.g., after burns).Surgical technique
Modified incision after Bruner (“mini-Bruner”). Removal of the involved fascial cord. If necessary, arthrolysis of the PIP. Raising the lateral–dorsal transposition flap from distal to proximal and rotating it into the palmar soft tissue defect of the proximal phalanx. Closure of the donor site with a skin transplant.Postoperative management
Dorsal plaster of Paris with extended fingers and compressive dressing in the palm for 2 days. Afterwards static dorsal splint and daily physiotherapy.Results
Between 2002 and 2007, a total of 32 lateral–dorsal transposition flaps in 30 patients with recurrent Dupuytren’s disease of the little finger underwent surgery. In a retrospective study, 19 patients with 20 flaps were available for follow-up evaluation after a mean of 6 years. All flaps had healed. The median flexion contracture of the metacarpophalangeal joint was 0° (preoperatively, 20°), and of the PIP 20° (preoperatively, 85°) according to Tubiana stage 1 (preoperatively, Tubiana stage 3). The median grip strength of both the operated and the contralateral hand was 39 kg. The DASH score averaged 11 points. Overall, 11 patients were very satisfied, 6 patients were satisfied, 1 patient was less satisfied, and 1 patient was unsatisfied.16.
N. Schmelzer-Schmied 《Operative Orthopadie und Traumatologie》2016,28(4):251-262
Objective
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.Indications
Lesions of the foveal component of the TFCC resulting in DRUJ instability. Combined lesions of both components of the TFCC. Complete detachment of the TFCC from the ulna either without fracture of the styloid process of the ulna or with fracture (floating styloid).Contraindications
Severe lacerations of the TFCC and clinically relevant arthrosis of the DRUJ. Severely osteoporotic bone.Surgical technique
Following diagnostic arthroscopy and performance of stability control of the TFCC with a palpation hook, reduction of the DRUJ with supination position of the wrist. Bone anchor fixation through the direct foveal portal (DF). Under arthroscopic control through the 3/4 portal, the suture from the DF portal is placed through the TFCC. Pull out and tie the strands through the 6 U portal.Postoperative management
Restriction of rotation of the forearm in a Munster cast or special cast brace for 6 weeks. Self-controlled exercise of the wrist after 6 weeks. Physiotherapy and strength building 8 weeks postoperatively.Results
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.17.
S. A. Euler F. S. Kralinger C. Hengg M. Wambacher M. Blauth 《Operative Orthopadie und Traumatologie》2016,28(3):153-163
Objective
Achieve stable fixation to initially start full range of motion (ROM) and to prevent secondary displacement in unstable fracture patterns and/or weak and osteoporotic bone.Indications
(Secondarily) displaced proximal humerus fractures (PHF) with an unstable medial hinge and substantial bony deficiency, weak/osteoporotic bone, pre-existing psychiatric illnesses or patient incompliance to obey instructions.Contraindications
Open/contaminated fractures, systemic immunodeficiency, prior graft-versus-host reaction.Surgical technique
Deltopectoral approach. Identification of the rotator cuff. Disimpaction and reduction of the fracture, preparation of the situs. Graft preparation. Allografting. Fracture closure. Plate attachment. Definitive plate fixation. Radiological documentation. Postoperative shoulder fixation (sling).Postoperative management
Cryotherapy, anti-inflammatory medication on demand. Shoulder sling for comfort. Full active physical therapy as tolerated without pain. Postoperative radiographs (anteroposterior, outlet, and axial [as tolerated] views) and clinical follow-up after 6 weeks and 3, 6, and 12 months.Results
Bony union and allograft incorporation in 9 of 10 noncompliant, high-risk patients (median age 63 years) after a mean follow-up of 28.5 months. The median Constant–Murley Score was 72.0 (range 45–86). Compared to the uninjured contralateral side, flexion was impaired by 13?%, abduction by 14?%, and external rotation by 15?%. Mean correction of the initial varus displacement was 38° (51° preoperatively to 13° postoperatively).18.
Objective
Operative stabilization is recommended even for non-displaced or only slightly displaced femoral neck fractures. In addition to the known osteosynthetic procedures, an angular stabile implant system (Targon® FN) has been established since 2006 for treatment of such fractures.Indications
Displaced femoral neck fractures (Garden III and IV) and non-displaced fractures (Garden I and II).Contraindications
Fractures close to the hip joint, which are not classified as typical medial femoral neck fractures and patients with advanced osteoarthritis of the hip who would profit from an endoprosthetic procedure.Surgical technique
The operative procedure is shown after fracture reposition and central positioning of the guide wire as a standard course.Postoperative Management
Early postoperative mobilization under guidance of a physiotherapist. Initially, partial weight bearing only in selected cases with severe displacement.Results
In our patients collective the Targon® FN has been implanted in over 100 cases. Revision indications and secondary endoprosthesis were documented in only 9?% of the cases. This angular stable screw osteosynthesis system is a safe procedure to achieve patient mobility if the indications are adhered to and implantation is correctly carried out.19.
20.
B. Hohendorff F. Biber H. Sauer C. Ries C. Spies J. Franke 《Operative Orthopadie und Traumatologie》2016,28(1):4-11