[Show abstract][Hide abstract] ABSTRACT: This study was performed to compare the clinical results of a minimally invasive technique for acute acromioclavicular (AC) joint dislocation repair with the traditional hook plate fixation.
Knee Surgery Sports Traumatology Arthroscopy 09/2014; · 2.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Complex midfoot injuries could lead to severe functional impairment of mobility and quality of daily living. Aim of this study was to compare the clinical and functional outcomes of Chopart, Lisfranc fractures and multiple metatarsal shaft fractures.
Archives of Orthopaedic and Trauma Surgery 07/2014; 134(10). · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to compare the biomechanical properties of tibial fixation of a free tendon graft in ACL reconstruction using the Shim, a new wedge-shaped implant, in an outside-in technique to fixation by the Shim used in an inside-out technique and fixation by interference screw in a porcine model.
Archives of Orthopaedic and Trauma Surgery 06/2014; · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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.
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.
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.
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.
[Show abstract][Hide abstract] ABSTRACT: Fractures of the proximal femur are among the most common fractures of all bones. Currently nearly every trauma surgeon has to be able to treat proximal femur fractures either with osteosynthesis or with a prosthesis. An increase of 200-300 % of fractures of the proximal femur is expected within the next 30 years. In addition an increase of periprosthetic fractures of the proximal and distal femur can be observed. The correct treatment of these complications is a challenging objective for the trauma surgeon.
This article provides an overview on complications after osteosynthesis of the proximal femur. It contributes treatment options depending on the implant, the patient specific risk factors and the special problems of postoperative care.
A selective review of the literature using Pubmed under consideration of experiences gained in the treatment of complications after osteosynthesis of the proximal femur was performed.
Due to the increasing incidence of fractures of the proximal femur on the one hand and complications after operative treatment of these fractures on the other, the trauma surgeon must provide differentiated therapy concepts depending on the individual risk factors of different patients. Moreover, trauma surgeons must know how to treat the potential complications of these procedures.
[Show abstract][Hide abstract] ABSTRACT: Anatomical repositioning of isolated fractures of the anterior process of the calcaneus. Internal fixation for sufficiently large fragment sizes, for small fragments and evidence of instability of the calcaneocuboid (CC) joint in association with Chopart luxation fractures, transfixation of the CC joint.
Dislocated fragments and intra-articular fractures (contraindication to open repositing: critical soft tissue relationships) and temporary stabilization for Chopart luxation fractures.
Infections and peripheral arterial occlusive disease (pAOD).
Supine position especially with accompanying injuries or placing in a side position for isolated fractures. Anterolateral access, fine repositioning by manipulation of the fragments with Kirschner wires, control of joint repositioning, definitive internal fixation with small fragments or miniscrews. For fragments not to be addressed, resection if necessary and transfixation with Kirschner wires.
Movement exercises of the ankle joint from postoperative day 1. From day 2 mobilization with partial loading of the affected leg with 20 kg for 6-8 weeks. After transfixation, removal of the wires after 6 weeks and gradually increased loading. After subsidence of postoperative edema, patients can wear their own shoes or if necessary use a walker.
Isolated fractures of the the anterior process of the calcaneus are rare and often initially overlooked injuries of the foot. In the literature there are only few case descriptions. From November 2009 to June 2011 a total of 5 isolated dislocated fractures of the anterior process with large fragments (type III), of which 3 were initially overlooked, were treated by osteosynthesis. In all cases the exact diagnosis could only be confirmed by computed tomography. In the follow-up after 2 years and 5 months all patients showed consolidation of the fractures, especially those with delayed therapy. Clinically all patients had recovered full function with no evidence of posttraumatic arthrosis. In this small case series extended diagnostics in cases of suitable fracture mechanisms seems to be reasonable in order not to overlook rare fractures of the calcaneus. Operative therapy by anatomical repositioning and internal fixation of fractures of the anterior process of the calcaneus is a suitable therapy for treatment of these rare injuries.
Operative Orthopädie und Traumatologie 12/2013; · 0.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Operationsziel
Anatomische Reposition isolierter Frakturen des Processus anterior calcanei. Bei ausreichender Fragmentgröße interne Fixierung, bei kleinen Fragmenten und Nachweis einer Instabilität des Kalkaneokuboidgelenks im Zusammenhang mit Chopart-Luxationsfrakturen Transfixation des CC-Gelenks.
Dislozierte Fragmente sowie intraartikuläre Frakturen (Kontraindikation zur offenen Reposition: kritische Weichteilverhältnisse), temporäre Stabilisierung bei Chopart-Luxationsfrakturen.
Infektion, periphere arterielle Verschlusskrankheit (pAVK).
Lagerung in Rückenlage insbesondere bei Begleitverletzungen oder in Seitenlage bei isolierten Frakturen. Anterolateraler Zugang, Feinreposition durch Manipulation der Fragmente mittel Kirschner-Drähten, Kontrolle der Gelenkreposition, definitive interne Fixierung mittels Kleinfragment- oder Minischrauben. Bei nicht zu adressierenden Fragmenten ggf. Resektion und Transfixation mittels Kirschner-Drähten.
Bewegungsübungen des oberen Sprunggelenks ab dem 1. postoperativen Tag. Ab dem 2. postoperativen Tag Mobilisation unter Teilbelastung des betroffenen Beins mit 20 kg für 6–8 Wochen. Bei Transfixation Entfernung der Drähte nach 6 Wochen und Belastungsaufbau. Nach Abklingen des postoperativen Ödems können die eigenen Schuhe getragen, ggf. Walker.
Isolierte Frakturen des Processus anterior calcanei gehören zu den seltenen und initial häufig übersehenen Verletzungen des Fußes. In der Literatur finden sich nur wenige Fallbeschreibungen. Von November 2009 bis Juni 2011 wurden 5 isolierte Abrissfrakturen des Processus anterior mit großem Fragment (Typ III), wovon 3 initial übersehen wurden, mittels Osteosynthese behandelt. In allen Fällen konnte die exakte Diagnose nur mittels Computertomographie gesichert werden. Im Follow-up nach 2 Jahren und 5 Monaten zeigten alle Patienten eine Konsolidierung der Frakturen, insbesondere auch die verzögert therapierten. Klinisch zeigten die Patienten eine volle Funktion ohne Nachweis einer posttraumatischen Arthrose. In dieser kleinen Fallserie erscheint die erweiterte Diagnostik bei geeignetem Frakturmechanismus sinnvoll, um seltene Frakturen des Kalkaneus nicht zu übersehen. Die operative Therapie durch anatomische Reposition und interne Fixierung der Processus-anterior-calcanei-Fraktur ist eine geeignete Therapie zur Behandlung dieser seltenen Verletzungen.
Operative Orthopädie und Traumatologie 12/2013; 25(6). · 0.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Osteoporotic fractures of the distal femur (primary as well as periprosthetic) are a growing problem in today's trauma and orthopaedic surgery. Therefore, this feasibility study should identify the biomechanical potential of a (commercially available) spiral blade in the distal femur as compared to a single screw without any additional plate fixation. Additionally, the influence of cement augmentation was investigated.
An artificial low density bone model was either instrumented with a perforated spiral blade or a 5 mm locking screw only. Additionally, the influence of 1 ml cement augmentation was investigated. All specimens were tested with static pull-out and cyclic loading (50 to 250 N with an increment of 0.1 N/cycle).
In the non-augmented groups, the mean pull-out force was significantly higher for the blade fixation (p < 0.001). In the augmented groups, the difference was statistically not significant (p = 0.217). Augmentation could increase pull-out force significantly by 72 % for the blade and 156 % for the screw, respectively (p = 0.001). The mean number of cycles to failure in the non-augmented groups was 12,433 (SD 465) for the blade and 2,949 (SD 215) for the screw, respectively (p < 0.001). In the augmented group, the blade reached 13,967 (SD 1,407) cycles until failure and the screw reached 4,413 (SD 1,598), respectively (p < 0.001).
The investigated spiral blade was mechanically superior, significantly, as compared to a screw in the distal femur. These results back up the further development of a distal femoral blade with spiral blade fixation for the treatment of osteoporotic distal femur fractures.
Archives of Orthopaedic and Trauma Surgery 10/2013; · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The augmentation of fixation with bone cement is increasingly being used in the treatment of severe osteoporotic fractures. We investigated the influence of bone quality on the mechanics of augmentation of plate fixation in a distal femoral fracture model (AO 33 A3 type). Eight osteoporotic and eight non-osteoporotic femoral models were randomly assigned to either an augmented or a non-augmented group. Fixation was performed using a locking compression plate. In the augmented group additionally 1 ml of bone cement was injected into the screw hole before insertion of the screw. Biomechanical testing was performed in axial sinusoidal loading. Augmentation significantly reduced the cut-out distance in the osteoporotic models by about 67% (non-augmented mean 0.30 mm (sd 0.08) vs augmented 0.13 mm (sd 0.06); p = 0.017). There was no statistical reduction in this distance following augmentation in the non-osteoporotic models (non-augmented mean 0.15 mm (sd 0.02) vs augmented 0.15 mm (sd 0.07); p = 0.915). In the osteoporotic models, augmentation significantly increased stability (p = 0.017). Cite this article: Bone Joint J 2013;95-B:1406-9.
The bone & joint journal. 10/2013; 95-B(10):1406-1409.
[Show abstract][Hide abstract] ABSTRACT: The incidence of proximal fractures of the femur will increase with the demographic change in the German population. Besides osteosynthesis, which in most cases of femoral neck, pertrochanteric and femoral head fracture is the method of choice, arthroplasty of the hip is likewise an established therapy. Indications are dislocated femoral neck fractures of the elderly. But there are good results for arthroplasty after proximal femoral fractures in younger active patients as well, when the fracture was not recognized or treated immediately. The outcome of hip arthroplasty after fracture is influenced by the elderly and unhealthy patient himself and the difficult planning and operation conditions due to fracture and its morphology. Most important for the best result are an interdisciplinary preparation of the patient and a well-planned surgery. In these cases common complications like thromboembolism, massive intraoperative blood loss and general infections like urinary tract infection can be reduced. For hip arthroplasty after fracture total hip replacement as well as hemiarthroplasty with bipolar prosthesis should be considered. The implant chosen and the implantation technique with or without bone cement has to be determined. Facts like the general state of health, biological age, level of activity and comorbidities should be taken into account appropriately.
[Show abstract][Hide abstract] ABSTRACT: PurposeOsteoporotic fractures of the distal femur are an underestimated and increasing problem in trauma and orthopaedic surgery. Therefore, this study investigates the biomechanical potential of implant augmentation in the treatment of these fractures.Methods
Twelve osteoporotic surrogate distal femora were randomly assigned to the augmented or non-augmented group. All specimens were fixed using the LCP DF. In the augmented group additionally 1 ml Vertecem V+ was injected in each screw hole before screw positioning. The construct represents an AO 33 A3 fracture. Biomechanical testing was performed as sinusoidal axial loading between 50 and 500 N with 2 Hz for 45,000 cycles, followed by loading between 50 and 750 N until failure.ResultsThe augmented group showed significant higher axial stiffness (36%). Additionally the displacement after 45,000 cycles was 3.4 times lower for the augmented group (0.68 ± 0.2 mm vs. 2.28 ± 0.2 mm). Failure occurred after 45,130 cycles (SD 99) in all of the non-augmented specimens and in two specimens of the augmented group after 69,675 cycles (SD 1729). Four of the augmented specimens showed no failure. The failure mode of all specimens in both groups was a medial cut-out.Conclusions
This study shows a promising potential of implant augmentation in the treatment of osteoporotic distal femur fractures.
[Show abstract][Hide abstract] ABSTRACT: PURPOSE: Pelvis ring fractures of geriatric patients are currently a serious problem in orthopedic and trauma surgery. One controversy that remains is the insufficiency fracture of the sacrum with treatment options ranging from conservative to operative. We modified standard 7.3-mm screws with additional perforations at the tip to allow cement injection trough the screw to improve implant anchorage. METHOD: We describe a new method of treatment of sacral insufficiency fractures. We use modified cannulated 7.3-mm screws (Synthes) with additional perforations at the screw tip. This allows the implant augmentation after proper implant positioning and contrast medium instillation for leakage detection. RESULTS: All patients (12 female) treated this way, are allowed to weight bear as tolerated immediately after surgery. The pain level (measured by the visual analog scale-VAS) was significantly reduced due to surgery (mean 8.2 pre-operatively, mean 2.6 postoperatively), the pain medication could be reduced rapidly. CONCLUSION: The described procedure for the treatment of sacral insufficiency fractures has the potential to increase the safety of cement injection into the sacrum because of the possibility of contrast agent instillation prior to cement injection. Furthermore, the amount of cement can be reduced and additional stability can be attained due to iliosacral screw osteosynthesis compared to sacroplasty.
International Orthopaedics 04/2013; · 2.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Schlüsselwörter: matrixassoziierte autologe Chondrozyten-Trans-plantation – Revision – Knorpelschaden – traumatischer Gelenk-schaden – Arthrose Zusammenfassung Innerhalb der letzen Jahre ha-ben sich Indikationsfeld und therapeutische Möglichkeiten bei Knorpelläsionen erweitert. Die therapeutischen Ansätze bei Knorpelläsion reichen von symptombezogenen Maßnah-men wie Debridement und Denervierung bis zu knor-pelregenerativen Eingriffen. Eine autologe Chondrozyten-Transplantation (Knorpelzell-transplantation, ACT) kann bei großflächigen III und IV° Schäden durchgeführt wer-den. Ziel dieses Beitrages ist es, einen Überblick über die Indikation, die Technik und die Ergebnisse nach autolo-ger Knorpelzelltransplantation zu geben. Bei der autologen Knorpel-zelltransplantation handelt es sich um eine zweizeitige Ope-rationsstrategie. Im Rahmen einer ersten Operation erfolgt die arthroskopische Biop-sieentnahme. Anschließend werden die Knorpelzellen kul-tiviert und die Suspension mit einer zweiten Operation unter einen Periostlappen oder eine Matrix gespritzt. Die Knorpel-zellen können auch auf einer Matrix kultiviert werden, die zeitgleich als Gerüst zur Ein-heilung dient (so genannte matrixassoziierte autologe Chondrozyten-Transplantati-on). Die Implantation erfolgt als zweiter Operationsschritt in einem offenen Verfahren, kann bei bestimmten Defekt-lokalisationen auch arthros-kopsich durchgeführt werden. Eine Literaturübersicht er-bringt 11 prospektiv randomi-sierte Studien mit unterschied-lichen Vergleichsgruppen. Mit Hilfe der Knorpelzelltrans-plantation kann die klinische Symptomatik deutlich verbes-sert werden. Aufgrund der ge-ringeren Revisionsraten sollte die matrixassoziierte Technik gegenüber der Periostlappen-technik bevorzugt werden. Bei der Knorpelzelltransplan-tation handelt es sich um eine effektive operative The-rapie zur Behandlung von tiefgreifenden und größeren Knorpelschäden. Assoziierte Pathologien wie ligamentäre Instabilitäten und Achsdevia-tion beeinflussen zwangswei-se das therapeutische Vorge-hen.
OUP - Zeitschrift für die orthopädische und unfallchirurgische Praxis. 03/2013; 47(2).
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: In trauma surgery, lag screws are commonly used. However, in osteoporotic bone, anchorage can be considerably compromised. This study investigates the biomechanical potential of cement augmentation in terms of improved fixation. METHODS: 36 Surrogate osteoporotic bone specimens were utilised in three biomechanical experiments, each comparing 6 augmented with 6 non-augmented samples. Standard partially-threaded lag screws (Synthes) were placed following surgical standard. For the augmented groups, 0.4 ml of polymethylmethacrylate was injected into the pre-drilled hole prior to screw placement. Interfragmentary compression was determined using a cannulated ring compression sensor. Maximum torque was recorded with a torque wrench. Compressive relaxation after 24 h, relaxation after loosening and re-tightening the screw as well as maximum compression and torque at failure were measured. FINDINGS: Mean relaxation was significantly lower for the augmented group (p < 0.01). After 24 h, a remaining fragmental compression of 62 % for the augmented and 52 % for the non-augmented specimens was found. Loosening and re-tightening of the screw did not affect the compressive relaxation when augmentation was applied (p = 0.529), compared to an increased relaxation after re-tightening in the non-augmented group (p = 0.04). The mean maximum compression and torque until failure were significantly higher for the augmented group (p < 0.001). INTERPRETATION: Cement augmentation of lag screws can improve fixation stability in terms of installing and maintaining interfragmentary compression. Effects of relaxation can be reduced and re-tightening of screws is possible without compromising the fixation. Particularly in reduced bone mass, augmentation of lag screws can markedly increase the security of the technique.
Archives of Orthopaedic and Trauma Surgery 12/2012; · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Aim of the current study was to evaluate the structural properties of an arthroscopic refixation technique for meniscal root tears. HYPOTHESIS: Arthroscopic two suture root tear refixation technique using a transtibial approach restores the structural properties of the intact meniscus attachment more closely than a one suture technique. METHODS: Lateral root tear refixation was performed in a porcine knee model. Using a material testing machine, structural properties were determined after a cyclic loading protocol comparing transtibial tunnel reconstruction using one or a double suture technique. Intact posterior horn served as control group. RESULTS: Elongation after cyclic testing was significantly lower for intact and two suture technique when compared to single suture technique. Stiffness was significantly higher for intact constructs with a mean of 53.7 (±6.5) N/m and two suture technique with 44.8 (±9.9) N/m when compared to one suture technique with a mean of 37.1 (±5.4) N/m. In elongation and stiffness, no differences were found between intact and two suture technique. Ultimate failure loads were 325.6 (±77) N for the intact, 273.6 (±45.6) N for two suture technique and 149.8 (±24.3) N for the one suture technique. Both reconstruction techniques showed significantly lower ultimate failure load when compared to the intact control. CONCLUSION: Structural properties of root tear fixation using a transtibial single suture technique showed significantly higher elongation and lower stiffness and failure load after cyclic loading compared to the intact, whereas a two suture technique showed no difference in elongation and stiffness; however, lower failure load.
Archives of Orthopaedic and Trauma Surgery 10/2012; · 1.36 Impact Factor