Operative Orthopadie Und Traumatologie最新文献

{"title":"Anatomische Grenzen der extraartikulären Kniegelenkresektion bei Sarkomerkrankungen.","authors":"S V Hattem, M Plöger, D Alex, R Placzek, D C Wirtz, S Koob","doi":"10.1007/s00064-026-00950-z","DOIUrl":"10.1007/s00064-026-00950-z","url":null,"abstract":"","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"313-314"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Medial patellofemoral ligament duplication and lateral lengthening plasty ('soft tissue balancing') according to Urs W. Müller : Partial step in patella stabilization surgery or isolated procedure].","authors":"Stephan Bernhart, Constance Raith, Flavio Cagienard, Jan-Christoph Stadelmann, Urs W Müller, Judith Bering","doi":"10.1007/s00064-026-00945-w","DOIUrl":"10.1007/s00064-026-00945-w","url":null,"abstract":"<p><strong>Objective: </strong>Restoration of a functionally intact and stable medial patellofemoral ligament (MPFL).</p><p><strong>Indications: </strong>a) Persistent patellofemoral instability following patellar dislocation with rupture of the MPFL; b) failure of conservative therapy following patellar dislocation; c) partial step: recurrent patellar dislocations with treatment of risk factors leading to dislocation (e.g., trochlear dysplasia, patella alta) by means of, for example, deepening trochleoplasty or tuberosity osteotomy; d) isolated: traumatic patellar dislocations with no or only minor risk factors; e) no age limits.</p><p><strong>Contraindications: </strong>a) Failure to address/treat the risk factors leading to patellar dislocation; b) first time dislocation without the need for immediate surgery (e.g., osteochondral lesion); c) no recurrent dislocation with good progress under conservative therapy; d) malcompliance.</p><p><strong>Surgical technique: </strong>Parapatellar lateral skin incision, two layer incision of the lateral joint capsule and LPFL, sharp dissection of the capsule up to the medial epicondyle, hemostasis. Exposure of the MPFL and incision of the fibrous layer along the fiber direction without opening the synovial layer. Doubling of the MPFL with single sutures and continuous overlock suture, lateral tension-free closure using continuous suture.</p><p><strong>Postoperative management: </strong>Mobilization in knee brace with weight-bearing according to pain immediately after surgery. Immediate start of physiotherapy according to in-house protocol, depending on the patella stabilizing procedure (e.g., isolated MPFL, trochleoplasty with MPFL, tuberosity osteotomy with MPFL). Thromboembolism prophylaxis using low molecular weight heparin. Removal of suture material 14 days postoperatively.</p><p><strong>Results: </strong>Between November 2011 and April 2024, 116 patients aged 13-48 years (mean age 19.8) underwent MPFL doubling surgery. Depending on the individual pathologies, 78 (67.2%) patients underwent deepening trochleoplasty, 16 (13.8%) underwent tuberosity osteotomy, and 15 (12.9%) underwent a combination of the three procedures. Seven (6.0%) patients underwent MPFL duplication surgery. Postoperatively, 104 (89.7%) patients were symptom-free and satisfied. Twelve (10.3%) patients experienced postoperative complications.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"290-302"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medial elbow approach via a medial epicondyle osteotomy.","authors":"John M Ibrahim, Bryan J M van de Wall, Christian Michelitsch, Korbinian Perl, Reto Babst, Frank J P Beeres","doi":"10.1007/s00064-026-00953-w","DOIUrl":"10.1007/s00064-026-00953-w","url":null,"abstract":"<p><strong>Objective: </strong>To describe a medial epicondyle osteotomy technique to approach the coronoid from the medial side and to present the outcome of our patients.</p><p><strong>Indications: </strong>Displaced coronoid fractures (particularly O'Driscoll anteromedial subtypes 1-3 and basal subtypes 1 and 2 fractures).</p><p><strong>Contraindications: </strong>Infected or compromised skin on the medial elbow.</p><p><strong>Surgical technique: </strong>A curvilinear incision centered over the anterior aspect of the medial epicondyle is performed. The ulnar nerve is released. The medial epicondyle is osteotomized in a trajectory that parallels both the medial trochlea and the fibers of the flexor-pronator mass, from posterior to anterior. This is performed with a sagittal saw and completed with an osteotome. The flexor pronator mass and medial ulnar collateral ligament (MUCL) are reflected distally and the anterior capsule is elevated to expose the articular surface of the ulnohumeral joint. The coronoid fracture is anatomically reduced and fixed with either (headless) compression screws or a (anatomic) buttress plate, depending on the fracture configuration. The medial epicondyle is reduced and fixed in place with two diverging cortical screws (2.7 or 3.5 mm). A stable construct should be achieved to allow for early mobilization.</p><p><strong>Postoperative management: </strong>Free range of motion exercises can be initiated immediately. At 6 weeks, strength exercises can be initiated. At 12 weeks, the patient may return to activities as tolerated.</p><p><strong>Results: </strong>In all, 13 patients (7 men and 6 women; ages 20-62 years old) underwent fixation of their complex coronoid fractures through a medial epicondyle osteotomy. Average elbow flexion-extension arc of motion was 118° and average pronation-supination arc of motion was 154°. One complication was reported in a patient who required revision fixation of the medial epicondyle osteotomy.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"274-289"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovative Osteotomietechniken zur Optimierung des Zugangs und Reduktion der Zugangsmorbidität.","authors":"Reto H Babst, Frank J P Beeres","doi":"10.1007/s00064-026-00956-7","DOIUrl":"https://doi.org/10.1007/s00064-026-00956-7","url":null,"abstract":"","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":"38 5","pages":"241-243"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149032076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extraartikuläre Kniegelenkresektion : Kritischer Blick auf die Operationstechnik und deren Umsetzung in die Praxis.","authors":"Werner Plötz","doi":"10.1007/s00064-026-00949-6","DOIUrl":"10.1007/s00064-026-00949-6","url":null,"abstract":"","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"310-312"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Olecranon flip osteotomy for distal humerus fractures.","authors":"Nicole Maria van Veelen, Klaas Victor, Simon Lambert, Frank J P Beeres, Reto Babst","doi":"10.1007/s00064-026-00957-6","DOIUrl":"10.1007/s00064-026-00957-6","url":null,"abstract":"<p><strong>Objective: </strong>Present the olecranon flip osteotomy approach for the treatment of distal humerus fractures as an alternative to the chevron osteotomy or previously described triceps-sparing approaches.</p><p><strong>Indications: </strong>Distal humerus fractures requiring direct visualization of the articular surface.</p><p><strong>Contraindications: </strong>Patient unfit for surgery.</p><p><strong>Surgical technique: </strong>A longitudinal skin incision starting 10 cm proximal to the olecranon tip is performed. The incision curves radially around the tip of the olecranon and continues distally, parallel to the ulnar crest. Identify and protect the ulnar nerve. Proximally a plane along the ulnar edge of the triceps muscle and tendon is developed, releasing the long head of the triceps from the medial intermuscular septum to gain access to the distal humerus. Distally the facia is dissected off the ulna. A thin chip of bone is elevated from the tip of the olecranon together with the triceps tendon and fascia allowing it to be flipped to the radial side. After dissecting the capsule and triceps off the humerus, the distal humerus can be visualized.</p><p><strong>Postoperative management: </strong>Immediate functional nonweight-bearing rehabilitation with no limitations regarding range of motion. Sling or splint for comfort during the first few days. Graduated weight-bearing after 6 weeks.</p><p><strong>Results: </strong>The authors have successfully applied the flip osteotomy in 12 cases, one of which was treated with a hemi-arthroplasty. All osteosyntheses achieved fracture healing and all patients acquired good elbow function after 3-6 months.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"260-273"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Practical guidelines for difficult and complex hardware removal in orthopedic surgery].","authors":"Martin C Jordan, Justus Bremer, Abdul Al Refai, Felix Wolff, Georgi I Wassilew, Janosch Schoon, Stefan Zwingenberger, Philipp Heilig","doi":"10.1007/s00064-026-00955-8","DOIUrl":"10.1007/s00064-026-00955-8","url":null,"abstract":"<p><strong>Objective: </strong>Safe and complete removal of osteosynthesis materials while preserving the surrounding soft tissues.</p><p><strong>Indications: </strong>Indications include implant-related pain, soft-tissue irritation, infection, implant failure, pseudarthrosis, and risk to adjacent tendons, nerves, or vessels as well as implants in children.</p><p><strong>Contraindications: </strong>Disproportionate procedural risk in patients with poor bone quality, extensive scarring, or high surgical morbidity.</p><p><strong>Surgical technique: </strong>Thorough preoperative planning, precise identification of the implant type and manufacturer, and the availability of the manufacturer's original extraction tools as well as alternative extraction instruments-such as special extractors, carbide drills, and hollow reamers-are essential. In this article, stepwise removal techniques are detailed for screws, plates, intramedullary nails, and spinal or pelvic implants, including strategies for managing stripped, cold-welded, or fractured implants.</p><p><strong>Postoperative management: </strong>Early functional rehabilitation is encouraged. Following removal of load-bearing implants, temporary activity restrictions and postoperative X‑rays to detect iatrogenic fractures are recommended.</p><p><strong>Clinical relevance: </strong>Implant removal is a frequent yet technically demanding procedure. Careful preparation, appropriate instrumentation, and meticulous technique reduce complications and enhance patient safety.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"315-330"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Revision anterior cruciate ligament reconstruction with fluoroscopically controlled positioning of the femoral and tibial bone tunnel].","authors":"Christopher Gries, Markus Fink, Maurice Balke, Jürgen Höher","doi":"10.1007/s00064-025-00915-8","DOIUrl":"10.1007/s00064-025-00915-8","url":null,"abstract":"<p><strong>Objective: </strong>The goal of the fluoroscopically controlled tunnel positioning in anterior cruciate ligament (ACL) revision surgery is the prevention of malpositioning of femoral and tibial tunnel resulting in a reduced risk of rerupture of the ACL graft.</p><p><strong>Indications: </strong>Remaining instability of the ACL after performed surgery, either after tunnel filling or as a single-stage surgery.</p><p><strong>Contraindications: </strong>Relative: minor instability, contraindications against performing intraoperative x‑rays, advanced osteoarthrosis. Absolute: general contraindications against surgery.</p><p><strong>Surgical technique: </strong>Supine position with tourniquet in place and lateral thigh support. Creation of the portals analogous to ACL surgery. Positioning of the drill wires using a targeting device, first femoral, then tibial. Now use of the C‑arm to fluoroscopically check the wire position using the ACL X‑app; correct it if necessary. If the position is adequate, use the quadrant method according to Bernard and Hertel (femoral) or according to Stäubli (tibial) to drill over to the target size of the drill channel. Subsequently, the transplant is drawn in and fixed. If necessary, add additional peripheral stabilization.</p><p><strong>Postoperative management: </strong>Knee brace for 6 weeks postoperatively, limited flexion at 90° for 2-3 weeks, partial weight bearing (20 kg) for 2-3 weeks.</p><p><strong>Results: </strong>In the 51 performed ACL revisions performed, there was a postoperative difference of 1 mm in Rolimeter measurement after 6 months.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"303-309"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Olecranon medial flip osteotomy for total elbow arthroplasty : Triceps-preserving approach to the elbow.","authors":"Klaas Victor, Nicole M van Veelen, Roland Camenzind, Frank J P Beeres, Reto Babst, Simon Lambert","doi":"10.1007/s00064-026-00954-9","DOIUrl":"10.1007/s00064-026-00954-9","url":null,"abstract":"<p><strong>Objective: </strong>The olecranon medial flip osteotomy offers adequate exposure to the posterior elbow, while preserving the continuity of the triceps extensor complex and sparing the innervation of the anconeus muscle. It avoids soft-tissue injury due to strain and aids in protecting the ulnar nerve by medially reflecting the long head of triceps.</p><p><strong>Indications: </strong>This surgical approach allows the exposure required for total elbow arthroplasty and concomitant radial head excision.</p><p><strong>Contraindications: </strong>Patients who underwent previous surgical procedures to the triceps tendon insertion.</p><p><strong>Surgical technique: </strong>A posterior midline incision is used, extending radial to the olecranon and parallel to the crista ulnaris. Incising the triceps aponeurosis, the long head of the triceps is separated from the lateral head to expose the medial tricipital head deeply. Dissection is performed between the long head and medial head of the triceps. A thin extra-articular medallion of the olecranon tip is elevated, in continuity with the long tricipital head proximally and in continuity with the ulnar head of the flexor carpi ulnaris distally. The integral functional complex, including the long head of triceps, the osseous medallion, and the flexor carpi ulnaris, is flipped to the ulnar side to gain access to the elbow joint. On the radial side, the anconeus muscle is kept in continuity with the medial tricipital head.</p><p><strong>Postoperative management: </strong>A sling or splint can be provided for comfort and to allow soft tissue healing in the early postoperative period. Immediate active-assisted range of motion exercises are allowed within the limits of discomfort.</p><p><strong>Results: </strong>The olecranon medial flip osteotomy was safely performed in 11 consecutive patients who underwent total elbow arthroplasty. No triceps-related complications were encountered at a mean follow-up of 20 months. All patients regained an elbow extension strength of at least grade 4 on the Medical Research Council (MRC) scale. A mean flexion angle of 126° (range 90-150) and a mean extension lag of 38° (range 30-70) were found. In conclusion, the olecranon medial flip osteotomy is a safe and effective approach for total elbow arthroplasty.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"244-259"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closed reduction of acute femoral neck fractures-a simple and reproducible technique.","authors":"Andrin Baer, Samuel Haupt, Philipp F Stillhard, Yves P Acklin, Christoph Sommer, Christian Michelitsch","doi":"10.1007/s00064-026-00958-5","DOIUrl":"https://doi.org/10.1007/s00064-026-00958-5","url":null,"abstract":"<p><strong>Objective: </strong>Surgical technique of closed reduction followed by percutaneous fixation of acute femoral neck fractures.</p><p><strong>Indications: </strong>Displaced femoral neck fractures.</p><p><strong>Contraindications: </strong>Open femoral neck fractures and concomitant neurovascular injuries.</p><p><strong>Surgical technique: </strong>The patient is positioned supine on a traction table, ensuring optimal fluoroscopic visualization. Closed reduction is attempted before draping to assess reducibility. Gentle axial traction restores length and valgus alignment, followed by internal rotation to correct anterior angulation and restore alignment, guided by the disappearance of the lesser trochanter. Minor adjustments in abduction or adduction optimize reduction, and traction is released to maintain cortical contact. Final reduction is verified fluoroscopically in two planes according to the surgeon's assessment the Garden classification, and Lowell's criteria.</p><p><strong>Results: </strong>Between 2012 and 2021, the data of 55 patients under 65 years of age with a femoral neck fracture were collected for a retrospective cohort study. Of these 55 patients, 51 were treated with closed reduction followed by percutaneous fixation. The median (interquartile range [IQR]) age was 58 years (48-60), and the operation was accomplished in 54 min (38-90). During the median (IQR) follow-up time of 12 months (6-14), a total of 10 complications were reported. Eight patients required conversion to a total prosthesis; five due to avascular necrosis, three due to nonunion. One patient needed reoperation because of an inappropriately long 7.5-mm cannulated screw, and one patient required antibiotic therapy due to a superficial wound infection. The quality of reduction was radiographically intra- and/or postoperatively rated by three experienced trauma surgeons based on the overall impression. The statistical analyses revealed a satisfactory reduction result in approximately 90% of the cases.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}