Operative Orthopadie Und Traumatologie最新文献

{"title":"[Peripheral nerve grafting].","authors":"Ali Ayache, Frank Unglaub, Adrian Cavalcanti Kußmaul, Christian K Spies, Martin F Langer","doi":"10.1007/s00064-024-00862-w","DOIUrl":"10.1007/s00064-024-00862-w","url":null,"abstract":"<p><strong>Objective: </strong>Peripheral nerve lesions often lead to significant and permanent loss of motor and sensory function. The aim of peripheral nerve grafting is to bridge nerve defects.</p><p><strong>Indications: </strong>When tension-free nerve repair is not possible, peripheral nerve grafting is indicated.</p><p><strong>Contraindications: </strong>Local infection, insufficient soft tissue coverage, significant muscle atrophy or joint contraction in case of \"motor\" nerve grafting, lack of microsurgical instruments or experience, life-threatening injuries.</p><p><strong>Surgical technique: </strong>Exposure and preparation of the nerve stumps. Choosing and preparation of the donor nerve. Approximation. Nerve repair. Nerve reconstruction must always be tension-free as nerve repair with tension frequently leads to disruption of nerve healing and poor functional outcome. Autologous nerve grafting from various donor sites leads to excellent functional results with little sensory deficits at the donor regions.</p><p><strong>Postoperative management: </strong>Limited immobilization, physiotherapy, ergotherapy, regular clinical and neurological assessments.</p><p><strong>Results: </strong>Outcome of peripheral nerve grafting may, for example, depend on defect length, caliber and quality of the injured nerve, quality of the donor nerve, microsurgical expertise of the surgeon, time of reconstruction, and age of the patient.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"332-342"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382444","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":"[Microsurgery].","authors":"Andreas Arkudas, F Unglaub, R E Horch","doi":"10.1007/s00064-024-00870-w","DOIUrl":"https://doi.org/10.1007/s00064-024-00870-w","url":null,"abstract":"","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":"36 6","pages":"305-306"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741403","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":"[Microsurgical nerve repair].","authors":"A Ayache, M F Langer, A Cavalcanti Kußmaul, F Unglaub","doi":"10.1007/s00064-024-00867-5","DOIUrl":"10.1007/s00064-024-00867-5","url":null,"abstract":"<p><p>Substantial nerve lesions almost always lead to persistent functional deficits, even with ideal treatment. Nerve lesions commonly occur in young patients, are often part of complex injuries, and are repeatedly diagnosed and treated with delay. Functional outcome crucially depends on early and adequate treatment. The aim of surgical treatment is a precise and tension-free microsurgical restoration of nerve continuity in a vital and healthy tissue environment. Adequate microsurgical treatment with differentiated postoperative treatment can result in an excellent clinical outcome, even after a delayed diagnosis.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"343-353"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648768","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":"[Refixation of osteochondral flake fractures after patellar dislocation-The parachute technique].","authors":"Romed P Vieider, Sebastian Siebenlist, Lorenz Fritsch, Ahmed Ellafi, Yannick Ehmann, Julian Mehl","doi":"10.1007/s00064-024-00873-7","DOIUrl":"10.1007/s00064-024-00873-7","url":null,"abstract":"<p><strong>Objective: </strong>Patellar dislocations are a common occurrence in orthopedic practice, often accompanied by osteochondral fractures of the retropatellar cartilage surface, known as flake fractures, in up to 58% of cases. The parachute technique represents a simple and cost-effective surgical option aimed at restoring osteochondral integration and preserving native cartilage.</p><p><strong>Indications: </strong>Flake fracture of the patella with osteochondral fragments.</p><p><strong>Contraindications: </strong>Patella fracture.</p><p><strong>Surgical technique: </strong>By utilizing transpatellar, absorbable sutures, a stable osteochondral interface is achieved without penetrating the fragment itself.</p><p><strong>Postoperative management: </strong>Postoperative treatment involves partial weight-bearing with a maximum of 20 kg for 6 weeks in full knee extension. In addition, the range of motion of knee flexion is limited to 30° and is increased by 30° every 2 weeks.</p><p><strong>Results: </strong>To examine the short- to medium-term clinical outcomes, all patients with acute patellar dislocation treated using the parachute technique between 01/2012 and 11/2022 were included. Clinical outcomes were assessed using the visual analog scale (VAS), Tegner Activity Scale (TAS), Kujala Score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC). Out of 20 patients, 19 (10 men, 11 right-sided, 95% follow-up rate) could be recruited for postoperative evaluation. The average follow-up period was 62.5 ± 20.5 months. The clinical outcome scores yielded the following results: VAS 0.5 ± 1.6, TAS 5.8 ± 2.2, Kujala 89.4 ± 12.5, KOOS 87.8 ± 14.1, and IKDC 86.7 ± 14.3. Overall, 18 patients (90.0%) expressed willingness to undergo the procedure again. At the time of follow-up, 19 patients (95.0%) were satisfied with the surgical outcome. One patient (23-year-old man) required revision. None of the included patients suffered from the recurrence of patellar dislocation. In summary, the parachute technique demonstrated excellent clinical function in the short- to medium-term follow-up for acute patellar dislocation.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"354-362"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11604685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583540","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":"[Microsurgical vascular suture].","authors":"Lilly Maxine Mengen, Raymund E Horch, Andreas Arkudas","doi":"10.1007/s00064-024-00869-3","DOIUrl":"10.1007/s00064-024-00869-3","url":null,"abstract":"<p><strong>Objective: </strong>Anastomosis of two vessels by end-to-end or end-to-side suturing to create an uninterrupted blood flow between the two vessels.</p><p><strong>Indications: </strong>Transplantations; replantations; vascular trauma.</p><p><strong>Contraindications: </strong>Active infections in the area to be vascularized or surgical site; large differences in caliber between the vessels; hypercoagulability; extensive tissue damage.</p><p><strong>Surgical technique: </strong>First, clamping, cleaning and flushing of the vessel ends; adaptation of the vessel ends using end-to-end or end-to-side anastomosis, using an end-to-side anastomosis if an existing vessel axis should not be interrupted; creation of the anastomosis using a single button suture or continuous suture technique; careful avoidance of puncturing the posterior wall and exact adaptation of the vessel ends without leaks; release of the blood flow and examination of the anastomosis.</p><p><strong>Postoperative management: </strong>Postoperative avoidance of traction, tension, pressure and shear forces on the anastomosis; regular blood flow checks of the revascularized tissue or flap; sufficient anticoagulation.</p><p><strong>Results: </strong>An atraumatic and gentle suturing technique is a basic requirement for a successful anastomosis. Special suturing techniques can improve the anastomosis of fragile vessels.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"307-319"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632487","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":"[Reconstruction of the medial collateral ligament complex with a flat semitendinosus auto- or allograft].","authors":"Wolf Petersen, Hassan Al Mustafa, Johannes Buitenhuis, Karl Braun, Martin Häner","doi":"10.1007/s00064-024-00856-8","DOIUrl":"10.1007/s00064-024-00856-8","url":null,"abstract":"<p><strong>Objective: </strong>Replacement of superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL) with an allograft.</p><p><strong>Indications: </strong>Chronic 3° isolated medial instability and combined anteromedial or posteromedial instability.</p><p><strong>Contraindications: </strong>Infection, open growth plates, restricted range of motion (less than E/F 0-0-90°).</p><p><strong>Surgical technique: </strong>Longitudinal incision from medial epicondyle to superficial pes anserinus and exposure of the medial collateral ligament complex. Thawing of the allogeneic semitendinosus tendon graft at room temperature, reinforcement of the tendon ends with sutures and preparation of a two-stranded graft. Placement of guidewires in the sMCL and POL insertions and control with image intensifier. Tunnel drilling. Pulling the graft loop into the femoral bone tunnel and fixation with a flip button. Pulling the two graft ends into the tibial tunnels. Tibial fixation by knotting the suture ends in a 20° flexion on the lateral cortex. Suture the tendon bundles to the remaining remnants of the medial collateral ligament complex to adopt the flat structure of the natural medial collateral ligament complex.</p><p><strong>Postoperative management: </strong>Six weeks partial weight-bearing, immediately postoperatively splint in the extended position, after 2 weeks movable knee brace for another 4-6 weeks. Mobility: 4 weeks 0-0-60, 5th and 6th weeks 0-0-90.</p><p><strong>Results: </strong>From 2015-2021, this surgical procedure was performed in 19 patients (5 women, 14 men, age 34 years). Mean Lysholm score at follow-up after at least 2 years was 89 (76-99) points. In 6 patients, there was restricted range of motion 3 months postoperatively, which resulted in further therapy (3 × systemic cortisone therapy, 3 × arthroscopically supported manipulations under anesthesia).</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"363-374"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019516","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":"Erratum zu: Freie Medial-Sural-Artery-Perforator(MSAP)-Lappenplastik zur Rekonstruktion von Weichteildefekten an der Hand.","authors":"Florian Falkner, Benjamin Thomas, Felix H Vollbach, Oliver Didzun, Leila Harhaus, Emre Gazyakan, Ulrich Kneser, Amir K Bigdeli","doi":"10.1007/s00064-024-00878-2","DOIUrl":"https://doi.org/10.1007/s00064-024-00878-2","url":null,"abstract":"","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607502","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":"[Osteotomies around the knee-part 2].","authors":"Wolf Petersen","doi":"10.1007/s00064-024-00865-7","DOIUrl":"10.1007/s00064-024-00865-7","url":null,"abstract":"","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":"36 5","pages":"235-237"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142309065","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":"[Anterior open wedge osteotomy of the distal femur].","authors":"Theresa Sendner, Frank Pries, Jörg Dickschas","doi":"10.1007/s00064-024-00861-x","DOIUrl":"10.1007/s00064-024-00861-x","url":null,"abstract":"<p><strong>Objective: </strong>To treat instability caused by a genu recurvatum using ventral open wedge osteotomy of the distal femur.</p><p><strong>Indications: </strong>Knee instability caused by Genu recurvatum with femoral extension deformity.</p><p><strong>Contraindications: </strong>Inadequate blood flow to the lower extremity, soft tissue issues, obesity, osteoporosis.</p><p><strong>Surgical technique: </strong>Through a primary medial approach to the distal femur, a ventral open wedge osteotomy is performed using chisel bunch formation and arthrodesis spreader. For symmetrical expansion, another lateral approach at the distal femur and insertion of another arthrodesis spreader is performed. Osteosynthesis was performed with an angle stable plate from the medial side and with additional stabilization using a 4-hole angle stable plate from the lateral side. The osteotomy gap was filled with a bone graft wedge.</p><p><strong>Postoperative management: </strong>Partial weight-bearing of 20 kg was allowed for 6 weeks with passive exercise and lymphatic drainage. A hard frame orthosis for immobilization at 0-10-90° was fitted for 6 weeks. Radiographic controls were performed at 6 weeks, 3 months, and 1 year. After the last radiographic control, hardware was removed.</p><p><strong>Results: </strong>There are no reports in the current literature regarding the effect of a change in the sagittal plane at the distal femur on alignment, stability, and biomechanics of the knee. This case report shows that genu recurvatum with physiological posterior tibial slope can be successfully treated with anterior femoral flexion osteotomy. Hyperextension was completely eliminated at the follow-up examination after hardware removal after 12 months.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"257-268"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005949","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":"[Free medial sural artery perforator flap for reconstruction of hand defects].","authors":"Florian Falkner, Benjamin Thomas, Felix H Vollbach, Oliver Didzun, Leila Harhaus, Emre Gazyakan, Ulrich Kneser, Amir K Bigdeli","doi":"10.1007/s00064-024-00863-9","DOIUrl":"10.1007/s00064-024-00863-9","url":null,"abstract":"<p><strong>Objective: </strong>Defect reconstruction of the hand by means of the free medial sural artery perforator (MSAP) flap.</p><p><strong>Indications: </strong>Reconstruction of full-thickness defects on the hand with a thin non-bulky flap in cases of exposure of functional structures or in combination with simultaneous osteosynthetic procedures.</p><p><strong>Contraindications: </strong>Prior surgery at the donor site or progressive peripheral artery occlusive disease. Defect size that exceeds the maximum width of the free MSAP flap for primary closure of the donor site. Lack of patient consent or compliance.</p><p><strong>Surgical technique: </strong>Suitable perforators are identified through a medial incision on the calf. The vascular pedicle is then completely followed subfascially along the gastrocnemius muscle until its source vessel the medial sural artery is reached. Subsequently, the flap design is adapted to the perforator anatomy and the flap is completely elevated. Indocyanine green fluorescence angiography can be used to identify the size of the reliable angiosome.</p><p><strong>Postoperative management: </strong>Close monitoring of the flap is required for the first 48 hours after surgery. Anticoagulation with low-molecular weight heparin should be administered for thrombosis prophylaxis. The hand can be mobilized on the first day after surgery.</p><p><strong>Results: </strong>Between May 2017 and March 2022 a total of 16 free MSAP flaps were carried out for hand defect reconstruction. All donor sites were primarily closed. The reconstruction was successful in all cases. In one patient venous thrombosis occurred postoperatively, which was successfully revised. In two flaps, surgical hematoma evacuation was necessary within 24 hours after surgery. Complications or wound healing disorders at the donor site were not observed.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"292-304"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141833","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}