Retrograde Verriegelungsmarknagelung bei periprothetischer distaler Femurfraktur nach kondylärem Kniegelenkersatz

Ohne Zusammenfassung     

Zur Gefahr eines Fettemboliesyndroms nach Marknagelung bei Femurfraktur und Thoraxverletzung

Following the insertion of an intramedullary nail, the fat embolism is a frequent complication in patients with long bone fractures. The respiratory function of patients with fractures of the femur and accompaning severe chest injuries was improved. In general these patients have a high risk to develop a respiratory distress syndrome. The average age of the 22 polytrauma patients studied was 40 years. The injury's severity as assessed using the Hannover Polytrauma-Score (PTS) and the average score was 29 points. Using Suter's scoring system the severity of the respiratory distress syndrome was assessed (Table 3). The insertion of an intramedullary nail was performed on 18 patients. Four of them developed an ARDS (adult respiratory distress syndrome) up to grade IV for a period of 5 days. Two patients suffered an ARDS grade I for a period of 2 days. In the study no typical features of fat embolism syndrom were found in any of these patients.     

Periprothetische Femurfraktur nach Knietotalendoprothese

Nowadays an increasing number of periprosthetic femoral fractures are observed after revision knee arthroplasty. A 59-year-old male patient who underwent revision knee arthroplasty fell down in the rehab centre and suffered a periprosthetic femoral fracture. After exact preoperative CT planning and measurement of the ratio and linear dimensions a custom-made implant was produced and engrafted on the prosthesis stem accompanied by open reposition. Postoperatively the patient was mobilized with pain-related weight–bearing, and after 12 weeks osseous consolidation and pain-free full weight-bearing were observed. In situ coupling of an endoprosthesis with a slotted hollow nail represents a valuable treatment option for periprosthetic fractures.     

Marknagelung periprothetischer Femurfrakturen nach Revisions-Knietotalendoprothese

Background

With the increasing number of revision operations after knee replacement a growing incidence of periprosthetic femoral fractures which are difficult to treat is observed.

Material and methods

This retrospective study describes the operating procedure for osteosynthetic treatment of periprosthetic femoral fractures using a specially made slotted hollow nail which is engrafted with the purpose of in-situ lengthening of the prosthesis and thus becomes stably clamped. From 1999 to 2008 our patients have included 9 who were treated by this method. There were 5 male and 4 female patients with an average age of 63.4?years (range 47?C80?years). Prerequisites for the performance of this operation are stability of the prosthesis and knowledge of the type of prosthesis or exact preoperative planning based on CT measurement of the thickness and length relationships.

Results

It was possible to conduct a clinical and radiological follow-up examination of all 9 patients after an average time of 29.1 months (range 10?C64?months). In all cases load-bearing stabilization of the fracture was confirmed.

Conclusion

In-situ coupling of an endoprosthesis with a slotted hollow nail represents a valuable treatment option for periprosthetic fractures.     

Harnblasenscheidenfistel und -perforation nach Implantation eines Wallstents bei Ureterstenose

The implantation of metal stents in the ureter is an alternative therapeutic option for treating ureteral strictures of different origins. We report the case of a female patient who was treated with a ureteral wall stent because of stenosis caused by radiotherapy. Subsequently the stent migrated into the bladder and led to incrustation and stone formation. This finally led to development of a vesicovaginal fistula and bladder perforation into the os pubis.     

A.V.-Fistel nach Implantation eines femoropoplitealen Bypasses

The following report concerns a 52-year-old patient suffering from coronary disease, who underwent coronary surgery in a department of heart- and vascular surgery. The implantation of a femoropopliteal bypass with anastomosis in the first popliteal segment was done during the same operation due to a long-distance occlusion of the superficial femoral artery on the right side. Some months later the patient consulted us, complaining of severe pain in his right leg and an immensly reduced walking distance. The arteriography showed an arteriovenous fistula of the right leg after implantation of a femoropopliteal bypass. The cause for this was an anastomosis of the distal part of the bypass with the popliteal vein. The patient underwent surgery again with ligature of the distal part of the bypass and reanastomosis with the original popliteal artery in the first segment. The arteriography done during the operation then showed correct conditions. Afterwards the distance the patient could walk was prolonged and he was without pain.     

Zur operativen Behandlung periprothetischer Oberschenkelfrakturen nach Kniegelenktotalendoprothesen

Zusammenfassung Für die häufigen periprothetischen Oberschenkelfrakturen nach Kniegelenktotalendoprothesen wird ein operatives Vorgehen vorgeschlagen. Die speziellen Umstände der Osteosynthese werden besprochen. Für den Fall technischer Kontraindikationen hierbei wird als Ausweichmethode der partielle distale Femurersatz empfohlen.

---

Surgical treatment of peri-prosthetic fractures after total knee replacement

Summary An operative procedure is described for the treatment of periprosthetic fractures of the femur after total knee replacement. The special problems of osteosynthesis are being discussed. In case of technical contraindications the partial replacement of the distal femur is being recommended as an alternative procedure.

     

Extremitätenerhalt bei Clostridienmyonekrose nach geschlossener Femurfraktur

Zusammenfassung. Ein 24 j?hriger gesunder Mann entwickelte nach Plattenosteosynthese einer geschlossenen mehrfragment?ren Femurfraktur eine Clostridienmyonekrose mit schwerem septischem Krankheitsbild. Durch die weitgehende Entfernung der Fascien an Ober- und Unterschenkel, an der Hüftmuskulatur und am M. iliopsoas, einer radikalen Resektion der nekrotischen Muskulatur, einem Unterbruch der paraaortalen infrarenalen Lymphabflusswege, t?glichen Nachdébridements über zwei Wochen und einer systemischen Antibiose konnte die Extremit?t erhalten werden. Bei einem erneuten Schub der Gasbrandsepsis wurde die Platte entfernt, ein Resektionsdébridement am Femur und eine tempor?re Stabilisierung mittels Fixateur externe durchgeführt. Nach definitiver Weichteilsanierung wurde die Fraktur intern mit einem Plattenfixateur stabilisiert. Der Patient zeigte in der Folge diffuse heterotope Ossifikationen vor allem der Quadricepsmuskulatur mit einer deutlichen Bewegungseinschr?nkung im Kniegelenk (0 °/0/20 °). Nach 5 Monaten wurde die Knieflexion durch eine Teilresektion der heterotopen Ossifikationen vorübergehend verbessert. Bei der gleichen Operation wurde der Knochendefekt des Femurs mit autologer Spongiosaplastik aufgefüllt. Die Fraktur war 10 Monate nach dem Unfall durchbaut. Der Patient arbeitet zu 100 % in seinem angestammten Beruf als Mechaniker. Zur Verbesserung der Knieflexion ist eine offene Arthrolyse und eine Quadricepssehnenplastik geplant.      

In-situ-Kopplung eines hohlen Marknagels mit einer gestielten Knieprothese bei periprothetischer Fraktur

Periprosthetic fractures often reveal problems and complications because of poor bone quality. A case report is presented, in which a hollow intramedullary nail was connected, in situ, with the stem of a knee prosthesis (Blauth knee). Two plate osteosyntheses had previously failed. As ultima ratio, a hollow intramedullary nail was placed antegrade on the stem of the knee prosthesis. Afterwards excellent callus formation developed and resulted in consolidation.     

Auftreten eines Karzinosarkoms nach Radiotherapie eines Lokalrezidivs nach radikaler Prostatektomie

Carcinosarcoma of the prostate is an extremely rare tumor. In the case of rapid tumor progression, especially after radiation therapy to the pelvis or after hormone deprivation therapy because of prostate cancer, this tumor entity should be considered, and immediate histological confirmation is required. The only curative therapy is immediate radical surgical excision. We report about the first case of a carcinosarcoma after salvage radiation therapy for local recurrence of adenocarcinoma of the prostate years after radical prostatectomy.     

Auftreten eines Hallux valgus nach Entfernung eines Sesambeins

Ohne ZusammenfassungMit 1 Textabbildung     

Proximale Femurfraktur

Trauma und Berufskrankheit - Die proximale Femurfraktur gehört zu den häufigsten Frakturen v. a. der älteren Bevölkerungsgruppen. Aufgrund steigender Lebenserwartung...     

Korrektureingriffe nach Implantation von Vorhofelektroden

Zusammenfassung In einem Zeitraum von 3 Jahren wurden bei 39 nach strengen hämodynamischen Kriterien ausgewählten Patienten insgesamt 41 Vorhofelektroden (36 J-Elektroden, 5 Schraubelektroden) zur Stimulation oder Steuerung implantiert. Bei 7 Patienten (18%) mußten im Beobachtungszeitraum Korrektureingriffe wegen Reizschwellenanstieg (4mal) oder Dislokation bzw. instabiler Lage der Elektrode (3mal) durchgeführt werden. Eine nachträgliche Lagekorrektur war nur in einem Fall erfolgreich, 4mal wurde das System nach Implantation einer Kammerelektrode geändert (AAI VVI) und 2mal wurde die Störung durch Wechsel des Elektrodentyps behoben.

---

Reinterventions following the implantation of atrial electrodes

Summary During the past 3 years 41 atrial electrodes (36 J-leads and 5 screw-in electrodes) were implanted for stimulation and/or triggering in 39 patients selected by haemodynamic criteria. In seven patients (18%) reinterventions had to be performed because of a rise in threshold (four cases) and dislocation or unstable position of the electrode (three cases). Reposition of the electrode was successful in only one case, while in four cases a ventricular electrode was implanted and the stimulation mode converted to ventricular pacing. In two other patients the complication was managed by changing the type of electrode.

Vortrag gehalten auf der 97. Tagung der Deutschen Gesellschaft für Chirurgie     

Periprothetische Femurfraktur

The incidence of periprosthetic femoral fractures will continue to rise because of the high number of total hip and knee replacements currently performed in Germany. The fractures are often caused by low energy trauma or a predisposition to fractures around loose stems. One of the risk factures in the geriatric patient population is the implantation of uncemented hip prostheses. The hip fractures are classified according to the Vancouver classification and those around the knee according to Rorabeck and Taylor. As with proximal femoral fractures, surgical treatment should be commenced as soon as possible with immediate full weight bearing in the postoperative period. A large selection of implants and revision prostheses are available.     

Infrasternale Installation bei Implantation eines Herzschrittmachers

Ohne ZusammenfassungVortragender:K. Vossschulte-Gießen.     

Versorgung periprothetischer Frakturen

Background

Periprosthetic fractures represent a common and complex challenge in the clinical practice in orthopedics and trauma surgery. Due to demographic changes characterized by increased life expectancy and higher numbers of primary arthroplasties, the number of periprosthetic fractures is increasing as well. Factors such as osteoporosis, multimorbidity and a highly active aging population additionally increase the complexity of periprosthetic fractures.

Injury patterns

Most periprosthetic fractures affect the proximal and distal femur; however, periprosthetic fractures of the tibial head, the ankle, shoulders and the upper extremities as well as complex interprosthetic fractures pose an increasing challenge for orthopedic and trauma surgeons.

Therapy

Many therapeutic options exist and the number of implants especially designed to treat periprosthetic fractures is steadily rising. Principally, loosened prostheses are indicative for replacement operations whereas for periprosthetic fractures of well-anchored prostheses as a rule osteosynthesis is necessary. A standardized treatment algorithm does not yet exist and usually the decision of how to treat these fractures has to be made on an individual basis.

Perspectives

The present article demonstrates the current state of open reduction and internal fixation of periprosthetic fractures with respect to biomechanical principles and furthermore provides an overview on implant augmentation.     

Glutealnekrose nach Ausschaltung eines rupturierten Iliakalaneurysmas

Chronic hypoperfusion of the hypogastric arteries due to aortoiliac surgery leads to a complex of symptoms well known as Lerich's syndome. In contrast, acute ischemia of the pelvic arterial tree leads to lethal complications [2, 4, 5, 9, 10, 12, 13]. Acute interruption of the hypogastric perfusion mainly occurs after aortoiliac surgery or after selective transcatheter embolisation of the internal iliac artery for control of pelvic bleeding [1, 8]. Several complications may occur after total occlusion: urinary bladder necrosis [6], left colon ischemia, spinal cord ischemia [10], nerve palsy, necrosis of the rectum and gluteal musculature [2, 11–13]. Despite adequate therapy, mortality is over 70% [2]. We report the case of a 66-year-old patient who survived after acute occlusion of the iliac arteries with gluteal necrosis following replacement of the infrarenal aorta with an aortobiiliacal graft.     

Entwicklung eines Weichteilulkus nach periduraler Langzeitinfusion

Local anaesthetic agents (LA) in clinical concentrations have the potential for tissue toxicity, although this is rarely observed in clinical practice. The case of a 74-year-old female patient (BMI 16.8 kg/m(2)) with a metastasising bronchial carcinoma is reported, who suffered from severe back pain due to tumour infiltration. For pain management a tunnelled continuous thoracic peridural catheter (PC) was placed and a mixture of bupivacaine 0.49%, morphine 0.0036% and clonidine 0.0001% was infused at 3 ml/h. After 8 weeks of continuous infusion an ulcer developed in the soft tissue close to the thoracic spine containing whitish crystalline material (CM). A computed tomography examination revealed a subcutaneously displaced PC with extensive fluid collection reaching down to the sacrospinalis muscle. Histologically an unreactive necrosis with enclosed CM of unknown etiology was found. The result of the chemical analysis of the deposits demonstrated bupivacaine, morphine and sodium chloride. It is concluded that the soft tissue ulcer was probably caused by precipitation of the LA mixture.