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At least 235 records · Page 13Linked to original sources
PubMed1998

[Resorbable rods and screws for fixation of ankle fractures. A randomized clinical prospective study].

A prospective randomized clinical trial was performed to evaluate the use of self-reinforced absorbable composites (Biofix) in the fixation of ankle fractures. The aim of this study was to demonstrate that fixation with Biofix rods and screws is as good as the standard A.O. fixation. The benefits of Biofix rods and screws are: a reduction in costs since no secondary operation is needed, prevention of stress-shielding and thereby diminishing the risk of bone porosity. Patients aged between 16 and 75 years old with closed, non-comminuted fractures of the lateral and/or medial malleolus and dislocation of the fracture fragments greater than 2 mm were included in the study. 22 patients were treated with Biofix rods and screws and the control group of 19 patients with a standard technique. After 3, 6 and 12 months, rontgenograms were taken. At the same time functional results were evaluated following the criteria of Olerud and Molander. Two patients were withdrawn from the trial for non-medical reasons. 22 patients (12 from the Biofix group, 10 from the AO group) operated two or more years ago were contacted to see if any complications had occurred since they were last seen. In 4 cases a Biofix screw broke down just beneath the head during insertion. This did not result in an insufficient fixation of the fracture. There were no early post-operative complications. The functional and rontgenological results in both groups were equal. In three cases a sterile sinus developed at the site of screw insertion. Biofix rods and screws, made of polylactic acid, are a good alternative for the fixation of fractures of the ankle. The use of resorbable fracture fixation material has the advantage that a second operation to remove osteosynthesis material is not necessary. The long term results are good. There is, however, a possibility of development of tissue reaction to the resorbable material.

Adolescent↗
PubMed2002

[Slipped capital femoral epiphysis and the "healthy" opposite hip].

The gold standard in the therapy of SCFE is the bilateral procedure in Central Europe. Several statistics demonstrate more than 30% of bilateral slippage as an average. Complications such as accidental pin perforation have become rare since the introduction of large cannulated screws. The advantage of screws as an implant is the easier removal of the device after termination of growth. Exceptionally, only the involved site may be operated on when cessation of growth is to be expected immediately. Because the disease takes place in the growing area of the femur, leg length differences up to 2 cm are not unusual and cannot always be avoided.

Adolescent↗
PubMed2004

[Knee para-articular focal dome osteotomy].

Focal dome osteotomy (FDO) is a cylindrically shaped osteotomy, with corresponding bone cuts rotating around the central axis of the deformity. Thus, complete correction can be achieved without secondary translation. FDO provides high adjustability of the bone ends, optimal bone contact, and high primary stability. As with straight cut closing, neutral, and opening-wedge osteotomies, FDO allows closing, neutral, and opening corrections. Opening FDO allows preservation of bone contact, whereas closing FDO does not require removal of bone stock. The osteotomy can be modified to tighten the medial collateral ligament. A FDO below the tuberosity does not compromise patellofemoral function and reduces the risk of intra-articular fractures. Sufficient bone stock of the proximal tibial or distal femoral fragment allows intramedullary stabilization. FDO is of high value in the treatment of sagittal plane and frontal plane corrections of the knee even in severe deformities.

Bone Malalignment↗
PubMed2005

[Partial arthrodesis and total fusion of the rheumatoid wrist].

The hand (wrist and fingers) is one of the regions most frequently affected by rheumatic arthritis (RA). Obviously, the functional handicap affects activities of daily living and imposes an additional psychological burden, because the nature of the alterations means that the clinical picture can be interpreted as RA from external appearances. Thus, treatment of the rheumatoid wrist is a prodigious challenge for hand surgeons. Radiolunate arthrodesis (RLA), as pioneered by Chamay and Della-Santa, has become an established surgical technique for stabilizing and relieving pain in wrists destroyed by RA. RLA has been described by Stanley as the "golden standard" for the treatment of rheumatoid wrists. For patients with a severe wrist deformity and pain, a complete wrist arthrodesis may be the only viable surgical option.

Arthralgia↗
PubMed1999

[Surgical management of posttraumatic mal-alignments and arthroses in the ankle].

Joint incongruency, malalignement as well as degenerative changes of the ankle joint may result in disabling pain with a significant decrease in function and mobility. The clinical symptoms may affect all aspects of life. Primary osteoarthritis of the ankle joint is uncommon, and posttraumatic conditions with significant changes in joint mechanics are usually the primary source of joint degeneration with the resultant clinical symptoms. Apart from pain relief and restoration of joint mobility, prevention of joint degeneration or progression of arthrosis should be the main goal in treating such conditions. Arthrodesis of the ankle still is the method of choice for severe osteoarthritis of the ankle, however several surgical treatment options are available to deal with mild to moderate joint degeneration. Restoration of the anatomy and joint alignement in posttraumatic deformities as well as ligament reconstruction in chronic instability are measurements to prevent development or progression of osteoarthritis. Joint debridement is useful in primary anterior joint pathology, in advanced osteoarthritis at least temporary pain relief can be achieved. In severe osteoarthritis arthrodesis of the ankle is the method of choice for long-term pain relief and restoration of mobility.

Ankle Injuries↗
PubMed1999

[Arthroscopic ankle surgery. Indications, methods, results, complications].

Based on the one experience and the information that is available in the literature indications for ankle arthroscopy are given, surgical equipment, patient placement and surgical technique of different procedures are described. Finally the results and possible complications are presented. Removal of loose bodies as well as synovectomies in case of an acute infection or rheumatoid arthritis are good indication. Arthroscopic treatment of anterior pathology in the athletic ankle need a thorough diagnostic work-up; the results of the treatment do not always meet the expectations of this especially demanding population. Cartilage treatment is technically possible, however, long term results are still missing. This is also true for the treatment on osteochondritis dissecans. In patients with degenerative joint disease arthroscopic debridement can only lead to a temporary benefit. Arthroscopic assisted arthrodeses (AAA) is technically demanding, but can serve as an excellent alternative to conventional open techniques. The complication rate in ankle arthroscopy is high compared to other joints, which is especially true for neurologic complications and postoperative infections. This should be addressed when performing the informed consent.

Ankle Injuries↗
PubMed1999

[Biomechanical and clinical aspects of spondylodesis of the lower cervical spine. Methods and implants].

The break with the demand for maximum rigidity of implant fixation of a traumatized unstable lower cervical spine is based on analysis and implementation of scientific and clinical data on the biomechanics of the native, the unstable and the implant-fixed spinal column. In view of these facts, recommendations for stabilization of the lower cervical spine can presently be formulated as follows: The surgical procedure is to bring about decompression, restoration of form and stability. The anterior approach should be the primary and preferred one. With regard to surgical and positioning technique, this access clearly involves less problems than the posterior approach; if required, unrestricted additional cord decompression can take place; implant fixation is technically simple: and the awareness of instability and type of implant permits functional therapy, also and above all for the paraplegic patient. For traumatic conditions, posterior methods are reserved for exceptional indications, and being single procedures, they require the anterior column to be intact and a multisegmental procedure. They are therefore less recommendable for traumata but rather suitable for degenerative, rheumatoid or tumorous instabilities. The cerclage wire technique depends on intact, osseous posterior elements, while after laminectomy only screwed implants can secure safe stability. This disadvantage of the posterior access for the proprioception of the cervical muscles and the subjective well-being of the patient are known and to be taken into account. Combined techniques are indicated for highly unstable or particularly complex injuries. On the cervicothoracic junction or in cases of Bechterew's disease, the decision is justifiably made in favor of the technique, which ca be performed as one-stage or two-stage operation. Whenever possible, selection of the implant should take into account the foreseeable developments in diagnostic procedures; and therefore, with a view to follow-up examinations required later and to modern imaging techniques, the implant chosen should be made of titanium.

Biomechanical Phenomena↗
PubMed1999

[Correction of leg deformities. Definition, estimation and realignment of axis deviation and misalignment].

The operative realignment of mechanical axis deviations (MAD) is necessary to prevent early joint degeneration and to reach normal load-bearing. Modern types of external fixation systems allow an alignment of the mechanical axis to exact degrees. Predominantly this are corrections of angular deformities. In some cases the analysis of the MAD does not show any angular deformity, but a parallel staggering of the mechanical axis lines of a bone. Such parallel staggering of the mechanical axis lines is defined as a translation deformity of the bone. In combined deformities with angulation and translation the centre of deformity can be established proximal or distal out of the limit of the bone. In translation deformities the realignment of the mechanical axis requires a parallel re-staggering made by a translation-osteotomy or by a counter-angulated double osteotomy. In complex deformities with angulation and translation, the translation requires a separate corrective planning. By using external fixator systems to perform acute or progressive corrective osteotomies the position of the Axis of Correction of Angulation (ACA) in relation to the n-CORA of the deformity has to be considered. If ACA position is not conform with the n-CORA position relevant geometric effects in relation of length and translation occur. These geometric effects to corrective osteotomies can be calculated by using simple trigonometric formulas or graphical methods. Possibilities to compensate translation and length effects are shown by using unilateral external fixator systems.

Bone Lengthening↗
PubMed1999

[Cogenital femoral defect. Indication, therapy and complication management].

Congenital femoral deficiencies remain a surgical challenge. There is no common classification: both radiological and clinical methods are recommended. Depending on the severity of the deformity, reconstructive and lengthening techniques are performed, while accompanying deformations are taken into consideration. In addition, amputation or fusion techniques together with orthotic devices are used. A total of 35 patients (37 extremities) with congenital femoral deficiencies have been treated at the Orthopaedic Hospital Vienna-Speising, from 1982 to 1998. 24 extremities were treated with reconstructive and/or lengthening techniques. Results and complications are reported.

Amputation, Surgical↗
PubMed1999

[External transpedicular fixation in the treatment of injuries of the spinal column and spinal cord].

Injuries to the spine and the spinal cord are an important problem. In the present paper the application of external transpedicular fixation of the spinal column for surgical treatment of patients in the acute phase of spinal cord injuries is described. The results of treatment obtained in 54 patients in the acute phase are presented. Decompression of the spinal cord can be accomplished by way of a dorsal approach. In this way it is possible to remove the compressing factor in stages. Positive results were achieved in the late phase in 84.22% of patients with acute spinal and spinal cord injuries.

Acute Disease↗
PubMed2001

Biomechanical properties of quadruple tendon and patellar tendon femoral fixation techniques.

Two femoral fixation techniques for quadruple hamstring tendon grafts were compared under cyclic loading with the patellar tendon: the rectangular inserted pin (TransFix) and biodegradable interference screw fixation of the quadruple tendon and titanium interference screw fixation of the middle third of the patellar tendon. Porcine specimens were mounted onto a tension load machine, and the tendon-fixation-femur-complex was tested for stiffness, displacement during 800 cycles of loading between 50 and 250 N and ultimate tension load. TransFix fixation showed the greatest stiffness at 183.6 N/mm ( P<0.05). The least displacement under cyclic loading was observed for the titanium interference screw followed by the TransFix and biodegradable interference screw ( P<0.01). The ultimate tension load was greatest for the TransFix fixation at 1303+/-282 N, followed by patellar tendon fixation with 763+/-103 N and the biodegradable interference screw fixation with 480+/-133 N ( P<0.001). To reduce initial elongation of the graft and displacement at the fixation site, preconditioning of both the tendon and tendon-fixation complex is especially important when using quadruple tendons. TransFix fixation provides better stability and greater stiffness and pull-out strength than the other techniques. This finding is of clinical relevance to surgeons of the anterior cruciate ligament.

Absorbable Implants↗
PubMed2004

Fixation principles in metaphyseal bone--a patent based review.

Osteoporotic changes start in cancellous bone due to the underlying pathophysiology. Consequently, the metaphyses are at a higher risk of "osteoporotic" fracture than the diaphysis. Furthermore, implant purchase to fix these fractures is also affected by the poor bone quality. In general, researchers and developers have worked on three different approaches to address the problem of fractures to osteoporotic bone: adapted anchoring techniques, improved load distribution as well as transfer with angular stable screws, and augmentation techniques using bone substitutes. A patent-based review was performed to evaluate which ideas were utilized to improve fixation in osteoporotic, metaphyseal bone, especially in the proximal femur, and to analyze whether the concept had entered clinical use. Anchoring devices that are either extramedullary or intramedullary have a long clinical history. However, demanding surgical techniques and complications, especially in poor quality bone, are justification that such implants and their corresponding surgical techniques need to be improved upon. Expanding elements have been evaluated in the laboratory. The results are promising and the potential of this approach has yet to be fully exploited in the clinics. Internal fixators with angular stable screws open the door for many new anchorage ideas and have great potential for further optimization of load distribution and transfer. Augmentation techniques may improve anchorage in osteoporotic bone. However, the properties of bone substitute materials will need to be modified and improved upon in order to meet the demanding requirements. If we summarise the development process and the clinical use of implants to date, we have to clearly state that more factors than simply biomechanical advantage will determine the clinical success of a new fixation principle or a new implant. Instead, fracture treatment of patients with osteoporosis really needs an interdisciplinary approach!

Bone Nails↗
PubMed2002

Hardware complications in scoliosis surgery.

BACKGROUND: Scoliosis surgery has undergone a dramatic evolution over the past 20 years with the advent of new surgical techniques and sophisticated instrumentation. Surgeons have realized scoliosis is a complex multiplanar deformity that requires thorough knowledge of spinal anatomy and pathophysiology in order to manage patients afflicted by it. Nonoperative modalities such as bracing and casting still play roles in the treatment of scoliosis; however, it is the operative treatment that has revolutionized the treatment of this deformity that affects millions worldwide. As part of the evolution of scoliosis surgery, newer implants have resulted in improved outcomes with respect to deformity correction, reliability of fixation, and paucity of complications. Each technique and implant has its own set of unique complications, and the surgeon must appreciate these when planning surgery. MATERIALS AND METHODS: Various surgical techniques and types of instrumentation typically used in scoliosis surgery are briefly discussed. Though scoliosis surgery is associated with a wide variety of complications, only those that directly involve the hardware are discussed. The current literature is reviewed and several illustrative cases of patients treated for scoliosis at the Connecticut Children's Medical Center and the Newington Children's Hospital in Connecticut are briefly presented. CONCLUSION: Spine surgeons and radiologists should be familiar with the different types of instrumentation in the treatment of scoliosis. Furthermore, they should recognize the clinical and roentgenographic signs of hardware failure as part of prompt and effective treatment of such complications.

Adolescent↗
PubMed2006

Lower limb salvage surgery: modular endoprosthesis in bone tumour treatment.

We retrospectively analysed 90 patients who underwent "en bloc" resection and modular endoprosthesis reconstruction in the lower limbs between 1987-2003. After proximal femur resection, reconstruction was performed with a modular endoprosthesis by Howmedica (KFTR, designed by Kotz) and modular revision endoprosthesis by W. Link or Lima-Lto (Revision system, designed by Wagner). The knee joint was reconstructed with a modular endoprosthesis (Howmedica, KFTR designed by Kotz) after distal femur or proximal tibia resection. Malignant bone tumours were present in 58 patients (64.5%), benign tumours in 16 (17.8%), metastases in 8 (8.9%), tumour-like lesions in 4 (4.4 %) and non-tumour-related destruction of the femur in 4 patients (4.4%). High-grade tumours were found in the majority of malignant bone tumours (70.7%). Treatment complications, which occurred in 26 patients, were: local recurrence of the tumour, deep infection, acetabular destruction following hemiarthroplasty, recurrent dislocations of endoprosthesis, periprosthetic fracture and hardware problems. In total, 23 patients (25.6%) died due to tumours. Endoprostheses should be considered as a treatment of choice for bone tumours in the hip and knee joint region. Advances in limb salvage surgery are, and will long continue to be, a great challenge for orthopaedic oncologists of the 21st century.

Adolescent↗
PubMed2006

Megaprostheses for the treatment of malignant bone tumours of the lower limbs.

Lower limb salvage surgery remains a challenge in orthopaedic oncology. Both cemented and cementless, modular, endoprosthetic systems are widely used to treat defects of different sizes. The systems have changed over the years, and each major orthopaedic company offers a modular tumour and revision system for the lower extremities. All systems have worse long-term results compared to conventional total hip or total knee systems. This is due to the large defects that need to be bridged with a more difficult fixation in the diapyhsis of the femur and tibia and a more complex restoration of joint biomechanics. This article summarises the results of several clinical studies with different systems. Newer systems without clinical follow-up are described. We previously reported a prospective study of 50 consecutive patients treated with the MUTARS endoprostheses. The follow-up was 2-7 years. Clinical evaluation showed good results compared to other systems. The review of the literature and our own results do not validate the support or favouring of one specific system. The surgeon should choose a system with which he/she is familiar and that provides the modularity needed intraoperatively to bridge any defect in the lower limbs.

Adult↗