Periazetabuläre Osteotomie nach Ganz

The Bernese periacetabular osteotomy (PAO) is a surgical technique for the treatment of (1) hip dysplasia and (2) femoroacetabular impingement due to acetabular retroversion. The aim of the surgery is to prevent secondary osteoarthritis by improvement of the hip biomechanics. In contrast to other pelvic osteotomies, the posterior column remains intact with this technique. This improves the inherent stability of the acetabular fragment and thereby facilitates postoperative rehabilitation. The birth canal remains unchanged. Through a shortened ilioinguinal incision, four osteotomies and one controlled fracture around the acetabulum are performed. The direction of acetabular reorientation differs for both indications while the sequence of the osteotomies remains the same. This surgical approach allows for a concomitant osteochondroplasty in the case of an aspherical femoral head-neck junction. The complication rate is relatively low despite the complexity of the procedure. The key point for a successful long term outcome is an optimal reorientation of the acetabulum for both indications. With an optimal reorientation and a spherical femoral head, the cumulative survivorship of the hip after 10 years is 80–90?%. For the very first 75 patients, the cumulative 20-year survivorship was 60?%. The preliminary evaluation of the same series at a 30-year follow-up still showed a survivorship of approximately 30?%. The PAO has become the standard procedure for the surgical therapy of hip dysplasia in adolescents and adults.     

Zweizeitige Operation zur Behandlung tiefer Infektionen bei Hüftendoprothesen unter Verwendung eines kanülierten Platzhalters

Objective Eradication of infection through insertion of a solid antibiotic-loaded PMMA spacer during the first stage of a twostage reimplantation for deep infection to prevent shortening, to obtain a high local concentration of antibiotics in and to permit lavage of the medullary canal. Indications Deep infection after total hip arthroplasty (THA) in patients who are candidates for revision surgery, especially in instances where the infection is confined to the region of femoral component. Contraindications Large defect of proximal femur.Poor general health not allowing two procedures. Surgical Technique Extraction of both components, removal of all necrotic material and cement. Intraoperative manual modeling of a cannulated spacer using bone cement premixed with antibiotics, its shape resembling a Moore's prosthesis. The spacer is shaped around a size 16 drain into which a corresponding Kirschner wire is inserted. Once the spacer is completely set, the Kirschner wire is removed and the drain shortened. A size 8 lavage drain tube is then inserted into the spacer and the hip reduced. Results We used the spacer in the treatment of 29 patients with infected THA. The interval between spacer implantation and insertion of the total hip implants was 11.6 weeks. Reinfection after implantation of the spacer was observed twice necessitating a second debridement, implantation of a new spacer, and lavage. Success rate of two-stage revision was 96.5%. The Harris hip score reached an average of 90.1 points. Breakage of the spacer was observed twice, and dislocation occurred in five patients; both did not affect the final result.     

Beitrag zur Behandlung der Hüftluxationen

Ohne Zusammenfassung Mit 3 Textabbildungen.     

Periazetabuläre Navigation

Following a period of conservative treatment of acetabular fractures in the past, the use of classifications and defined acetabular surgery indications was introduced because of an increasing number of extended surgical approaches for operative stabilization of acetabular fractures. This development has enabled minimally invasive procedures using three-dimensional (3D) visualization and navigation techniques in the operating room (OR), with the expectation of reduced intraoperative morbidity and optimized surgical precision. Most common in acetabular navigation is 3D C-arm-based navigation, which has enabled new techniques in combination with other modern OR systems. In special cases, techniques based on computed tomography and 2D C-arms are still used.     

Verwendung der Nahinfrarotspektroskopie zur Kontrolle der Extremitätenperfusion unter venoarterieller ECMO-Therapie

Patients undergoing peripheral venoarterial extracorporeal membrane oxygenation have a high risk of lower limb ischemia. In general, regular controls are carried out based on clinical and laboratory parameters in order to quickly detect and treat complications. These controls are challenging due to states of shock, nonpulsatile flow and vasopressor therapy. As additional monitoring the use of near-infrared spectroscopy (NIRS) is described in the literature as being very successful in detecting ischemia. The present article describes the use and possible limitations of NIRS for the diagnostics of peripheral ischemia.     

Die operative Behandlung der sekundäre Hüftluxation bei der infantilen Zerebralparese

The surgical treatment of secondary dislocation of the hip is one of the most challenging issues in cerebral palsy. The selection and application of adequate surgical techniques require an outstanding knowledge of pathophysiology in order to achieve a good outcome with minimal operative expenditure.The hips of cerebral palsied children show no pathological findings at birth. The dislocation of the hip is a secondary process, due to the influence of permanently deteriorating muscle dysbalances that first cause a decentration and finally result in a complete dislocation.Physiotherapeutic treatment supports the development of gait, muscle balance and weight bearing in the early childhood, however, severe hip dislocation can not be prevented with physiotherapy alone.Surgical treatment aims to prevent hip dislocation in order to maintain the ability to walk and to sit, and to avoid secondary skin ulcers. Soft tissue release is performed to neutralize muscle dysbalances. Progressive dislocation requires extended surgical treatment. The combination of soft tissue release, varisation osteotomy and acetabular osteotomy enable an adequate repositioning of the hip and have proved to preserve hips from reluxation. Palliative operations including soft tissue release in combination with angulation osteotomy, and proximal femoral head resection are restricted to failed reconstruction operations or severe luxations, and are performed to attempt pain reduction or the facilitation of perineal care.Surgical planning distinguishes patients able to walk from those who are unable to walk or to sit without support. The manifestation of cerebral palsy and the aim of adequate pain reduction and the maintenance of statomotoric abilities also have a great impact on surgical planning.The treatment of secondary hip dislocation in cerebral palsy is facilitated by the use of a graduated treatment concept with early preventive soft tissue release, extended reconstruction and optional palliative care.     

Beiträge zur Behandlung der Knochenbrüche

Ohne Zusammenfassung (Mit 7 Abbildungen.)     

Beitrag zur unblutigen Behandlung der congenitalen Hüftverrenkungen

Ohne Zusammenfassung (Mit 22 Abbildungen.)     

Beitrag zur Behandlung der Schädeldachosteomyelitis unter besonderer Berücksichtigung des kosmetischen Ergebnisses

Zusammenfassung Es wird über eine neue Art der Behandlung der Schädeldachosteomyelitis berichtet, die darin besteht, daß unter Antibioticaschutz der betroffene Knochenanteil nach Anlegen von 4 Bohrlöchern, die weit im Gesunden liegen, herausgeschnitten wird. Nach Sterilisieren des Knochens wird dieser wieder eingesetzt und fixiert und darüber die Kopfschwarte geschlossen. Es werden 3 so behandelte Fälle, die ohne jegliche Reaktion ausheilten, beschrieben. Ein weiterer verläuft gleichfalls symptomlos, jedoch liegt die Operation erst 4 1/2 Monate zurück.Es müssen jedoch folgende Forderungen erhoben werden: 1. Dura und Kopfschwarte müssen dem sterilisierten Knochen beiderseits fest anliegen. 2. Die in den ersten Tagen nach der Operation auftretende epidurale Sekretion und Nachblutung muß laufend durch Punktion beseitigt werden. 3. Die Behandlung muß unter Antibioticaschutz erfolgen.Die Methode hat den Vorteil, daß der osteomyelitische Prozeß bereits beim ersten Mal vollständig erfaßt und gleichzeitig ein gutes kosmetisches Ergebnis erzielt wird.Mit 9 TextabbildungenHerrn Prof. Dr.K. Vogeler zum 70. Geburtstag gewidmet.     

Beitrag zur funktionellen Behandlung der angeborenen Hüftverrenkung

Ohne ZusammenfassungMit 2 Textabbildungen     

Zur Behandlung der Unterschenkelgeschwüre

Ohne Zusammenfassung (Mit 13 Abbildungen.) Vortrag, gehalten im ?rztlichen Verein zu Essen, Ruhr, am 12. Dez. 1911.     

Beiträge zur Kenntnis der Zungenbasisgeschwüre

Ohne Zusammenfassung (Mit 5 Abbildungen.) Ein Erratum zu diesem Beitrag ist unter zu finden.     

Differentialdiagnostische Erwägungen zur Diagnose Hüftdysplasie unter besonderer Berücksichtigung der Rachitis

Ohne ZusammenfassungMit 6 Textabbildungen     

Interdisziplinäre Behandlung der Weichgewebesarkome der Extremitäten

Soft tissue sarcomas are a rare and heterogeneous group of tumors. Surgery clearly remains the standard therapy of non-metastatic soft tissue sarcoma. A pretreatment biopsy is necessary to determine the histology and grade of soft tissue sarcomas and to diagnose entities that can be treated by targeted therapies, such as dermatofibrosarcoma protuberans or alveolar soft tissue sarcoma once they are in a metastatic stage. Nevertheless, locally advanced disease requires multimodal treatment and interdisciplinary treatment decisions. Limb sarcoma of borderline resectability (encasement of vessels, invasion of joints or close proximity to motor nerves) may profit from isolated limb perfusion with recombinant tumor necrosis factor and melphalan. Preoperative chemotherapy may be applied in locally advanced high grade tumors when clear resection margins are difficult to achieve. Deep wave hyperthermia has proven to be a useful addition to systemic chemotherapy in such a neoadjuvant setting. Also preoperative radiation therapy has proven to be effective in controlling locally advanced sarcoma despite higher perioperative morbidity which pays off in the long run by better limb function. Postoperative adjuvant external beam irradiation therapy with the best available technique is recommended for any tumor larger than 5 cm with (FNLCC) grades 2 and 3 (American Joint Committee on Cancer stage IIb/III). Given all these therapeutic options, it is absolutely crucial that interdisciplinary decision-making starts early in the therapeutic process. Patients are often seen first by the surgeon. For an optimal treatment surgeons need to know the efficacy and toxicity of the multimodal treatment options described.     

Die Hämophilie und ihre Behandlung unter besonderer Berücksichtigung der Knochen- und Gelenksveränderungen

Langenbeck's Archives of Surgery - Es wird über die Hämophilie und zwar ausschließlich über die klassische Form berichtet und dabei näher auf Gerinnungsdefekt,...     

Azetabuläre Defektrekonstruktion in der Revisionschirurgie der Hüfte

The treatment of periprosthetic bone defects of the acetabulum is a therapeutic challenge in hip revision surgery. The aims are the biological reconstruction of osseous acetabular defects and the restoration of a load-bearing acetabular bone stock as well as restoring the physiological joint biomechanics and achieving primary and load-stable fixation of the revision graft in the vital pelvic bone. The biological reconstruction of the acetabular bone stock should include what is referred to as “down-grading” of the acetabular defect situation in case a repeat revision procedure becomes necessary. Nowadays, a large variety of grafts and reconstruction procedures are available for the reconstruction of acetabular defects. The choice of suitable materials (osseous or metallic) for the restoration of a load-bearing acetabular bone stock is currently the subject of controversial discussion. This article reviews the various options for the reconstruction of acetabular bone defects taking into consideration the current findings in the scientific literature.     

Spätresultate der hochdiaphysären Osteotomie in der Behandlung der irreponiblen Luxatio coxae congenita

Ohne ZusammenfassungMit 6 Textabbildungen     

Ein Vorschlag zur blutsparenden,operativen Behandlung der Hämangiome

Zusammenfassung Um ein blutsparendes Operieren eines H?mangioms zu erreichen, wird vorher in dieses hypertonische Zuckerl?sung (Varikosmon, Varixulin), auch von mehreren Stellen und wiederholt, eingespritzt, wodurch es in den Blutr?umen zu Thrombosen kommt und durch Schrumpfung und Ver?dung das H?mangiom in eine solide Geschwulst umgewandelt wird, deren operative Entfernung dann ohne Blutung m?glich ist. Durch Injektion von 20%iger Abrodill?sung in das H?mangiom und darauffolgende R?ntgenaufnahme (vor der Behandlung mit der Zuckerl?sung) k?nnen vor dem operativen Eingriff die Ausdehnung des H?mangioms und seine Verbindungen mit den benachbarten Venengebieten r?ntgenologisch festgestellt werden. Beleg durch eigene Krankenbeobachtungen.

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Auszugsweise vorgetragen in der Gesellschaft der ?rzte in Wien, 12. V. 33.