Operative Orthopadie Und Traumatologie最新文献

{"title":"[Cancellous bone harvesting from the distal radius for reconstruction of bone defects in the hand].","authors":"B Hohendorff, B D Sannwaldt, S Spät, L P Müller","doi":"10.1007/s00064-024-00879-1","DOIUrl":"10.1007/s00064-024-00879-1","url":null,"abstract":"<p><strong>Objective: </strong>Extraction of cancellous bone from the distal radius for reconstructive procedures on the hand.</p><p><strong>Indications: </strong>All reconstructive procedures on the hand for which a corticocancellous and/or vascularized bone graft or a large amount of cancellous bone is not required.</p><p><strong>Contraindications: </strong>Acute distal radius fracture, osteosynthesis material embedded in the distal radius, e.g., after palmar plate osteosynthesis of a distal radius fracture, tumor in the distal radius.</p><p><strong>Surgical technique: </strong>Removal of cancellous bone from the distal radius radially from the dorsal radial tuberosity via a small bone window at the base of the second extensor tendon compartment.</p><p><strong>Postoperative management: </strong>Wound dressing on the distal radius, elevation of the arm above heart level until swelling has subsided, first dressing change on postoperative day 1 or 2, depending on the primary procedure on the hand, dressing until wound healing is complete, removal of the skin sutures around postoperative day 14.</p><p><strong>Results: </strong>In 2023, cancellous bone was harvested from the distal radius of 17 patients for reconstructive procedures on the hand (6 mediocarpal partial arthrodeses, 3 acute fractures, 5 delayed bone healings, 1 pseudarthrosis, 2 bone tumors). In all cases, the available amount of radius cancellous bone was sufficient, resulting in satisfactory healing. All patients complained of short-term, slight discomfort at the donor site for the first few days after surgery, which resolved completely. There were no complications at the donor site on the distal radius.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"70-75"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900495","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":"[Minimally invasive stabilization of acetabular fractures with virtual navigation combined with robot-assisted 3D imaging].","authors":"Raffael Cintean, K Schütze, F Gebhard, C Pankratz","doi":"10.1007/s00064-024-00872-8","DOIUrl":"10.1007/s00064-024-00872-8","url":null,"abstract":"<p><strong>Objective: </strong>Minimally invasive stabilization of non- and minimally displaced acetabular fractures using intraoperative, robot-assisted three-dimensional (3D) imaging and a navigation system.</p><p><strong>Indications: </strong>Nondisplaced or only minimally displaced fractures of the acetabulum.</p><p><strong>Contraindications: </strong>Comminuted and highly displaced fractures of the acetabulum, protrusion of the femoral head into the pelvis with the need for open reduction, lack of possibility of intraoperative navigation.</p><p><strong>Surgical technique: </strong>After supine positioning the patient, the patient-side navigation reference is attached to the anterior superior iliac spine using a Schanz screw. The 3D scan and registration of the dataset in the navigation system can then be performed. This allows the 7.3 mm screws to be planned using 3D imaging and then implanted through minimally invasive incisions.</p><p><strong>Postoperative management: </strong>After successfully implanting the screws using the minimally invasive surgical technique, the patient can be mobilized the following day with pain-adapted physiotherapy exercises. Full weight bearing is usually possible.</p><p><strong>Results: </strong>Between 2015 and 2023, 101 patients were treated using minimally invasive and navigation-assisted screw osteosynthesis for acetabular fractures. In 2 patients, a secondary screw dislocation occurred in the hip joint after mobilization, which required revision surgery with repositioning of the screw osteosynthesis and a hip arthroplasty, respectively. Minimally invasive navigated screw osteosynthesis, thus, offers adequate treatment of nondisplaced and minimally displaced acetabular fractures. Attention must be paid to the correct indication and surgical technique.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"14-22"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11790764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632493","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":"[Minimally invasive techniques in pelvic ring and acetabular surgery].","authors":"Reto H Babst, Björn-Christian Link","doi":"10.1007/s00064-024-00884-4","DOIUrl":"https://doi.org/10.1007/s00064-024-00884-4","url":null,"abstract":"","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":"37 1","pages":"1-2"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081624","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":"[Arthroscopically assisted suture osteosynthesis of tibial eminence fractures in children and adolescents].","authors":"Vincent Frimberger, Nina Berger, Stephan Kellnar","doi":"10.1007/s00064-024-00876-4","DOIUrl":"10.1007/s00064-024-00876-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The surgical goal is the arthroscopically assisted, closed reduction, and suture osteosynthesis of fractures of the tibial eminence in children and adolescents.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Indications: &lt;/strong&gt;Fractures of the tibial eminence type (II)-III according to Meyers & McKeever or type IV according to Zaricznyj.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Contraindications: &lt;/strong&gt;Fracture of the tibial eminence type I, conservatively treatable fracture type II according to Meyers & McKeever and ligamentous rupture of the anterior cruciate ligament.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Surgical technique: &lt;/strong&gt;Supine position. Securing the leg with a lateral support on the thigh and a roll to support the foot in 90° kneeflexion. Unwrap for blood evacuation with cuff on the thigh. Creation of the anterolateral portal and filling of the joint with Ringer's solution. Usually, extensive irrigation of the hemarthrosis is required first to gain visibility. Then the anteromedial portal is created. A diagnostic walk-around is performed to rule out concomitant injuries to the cartilage and menisci. The fracture bed is then debrided with the shaver and the fracture is reduced on a trial basis using the cruciate ligament targeting device. Remove the cruciate ligament targeting device and reinforce the anterior cruciate ligament (ACL) with a suture shuttle forceps with two 1 Polysorb&lt;sup&gt;TM&lt;/sup&gt; sutures (Medtronic, Minneapolis, MN, USA), which are discharged and secured via the anteromedial portal. Now reinsert the cruciate ligament targeting device via the anteromedial portal. This is set to an angle of a good 60°. The image converter is used for control. Skin incision in the area of the 3 mm drill sleeve. Now a 2.4 mm cannulated drill with a core is used to predrill into the joint medial to the tibial eminence, strictly epiphyseal depending on the age. After removing the core of the drill, a wire loop is inserted into the joint, grasped with the forceps and also passed out via the anteromedial portal. Now remove the drill while leaving the wire loop in place. The medial thread legs are now threaded through the lasso loop and passed out distally via the drill channel. The analogous procedure is performed via the anterolateral portal so that the legs of both sutures meet ventrally at the tibial epiphysis/metaphysis. Now complete extension of the knee, reduction of the fracture with the cruciate ligament targeting device, under image converter control hand-tight knotting and, thus, firm reduction of the fracture. Suction of the joint. Layered wound closure. Application of a femoral cast sleeve in full extension. Removal of the osteosynthesis material is unnecessary with this method. Immobilization is in the femoral cast sleeve for 6 weeks.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Postoperative management: &lt;/strong&gt;Removal of the femoral cast sleeve and radiological consolidation control 6 weeks postoperatively. Then start physiotherapy to restore the anatomical range of motion and strengthen thigh muscle","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"76-86"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683651","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":"[Treatment with TOPS for short femoral stump].","authors":"Marko Saß, Horst Heinrich Aschoff, Thomas Mittlmeier","doi":"10.1007/s00064-024-00885-3","DOIUrl":"https://doi.org/10.1007/s00064-024-00885-3","url":null,"abstract":"<p><strong>Objective: </strong>Treatment with transcutaneous osseointegrated prosthesis systems (TOPS) for short femoral amputation stumps aims to restore independent walking ability after proximal femoral amputation by direct bone-guided prosthesis anchorage. This cannot be safely achieved with conventional socket prostheses due to the mechanically inadequate socket contact surface.</p><p><strong>Indications: </strong>Treatment of patients with short transfemoral stumps who cannot be mobilized sufficiently with conventional socket prostheses.</p><p><strong>Contraindications: </strong>Known contraindications as with standard TOPS fittings.</p><p><strong>Surgical technique: </strong>Special features already arise during positioning with correct orthograde adjustment of the short femoral stump under X‑ray fluoroscopy. The prosthesis is anchored using the specified technique, taking into account the central insertion of the femoral neck screw with the aid of the aiming arm under X‑ray fluoroscopy in two planes.</p><p><strong>Postoperative management: </strong>In most cases, step 1 and 2 treatment is primarily possible, i.e., insertion of the double-cone adapter and passing through the skin by the intraoperatively created stoma (skin opening on the amputation stump). This requires patient compliance and hygiene with twice daily showering of the stoma and dressing. After the exoprosthesis components have been fitted by the patient's orthopedic technician, weight-bearing with the new adapted prosthesis is possible.</p><p><strong>Results: </strong>A total of 14 TOPS procedures were performed at Rostock University Medical Center between 2022 and 2024, including 9 patients with short femoral stumps. A prolonged rehabilitation phase compared to patients with \"standard\" TOPS restorations is not recognizable, but a significant gain in quality of life is evident.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054282","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":"[Modified Z-plasty of the patellar tendon for patella baja and flexion deficits].","authors":"Wolf Petersen, Hasan Al Mustafa, Johanna Schulze Borges, Martin Häner","doi":"10.1007/s00064-024-00886-2","DOIUrl":"https://doi.org/10.1007/s00064-024-00886-2","url":null,"abstract":"<p><strong>Objective: </strong>Lengthening of the patellar tendon to normalize patellar height and improve knee flexion deficits.</p><p><strong>Indications: </strong>Flexion deficits in combination with patella baja (Caton index < 0.6).</p><p><strong>Contraindications: </strong>Infection.</p><p><strong>Surgical technique: </strong>Arthroscopy of the knee and resection of adhesions in suprapatellar pouch and additional intraarticular adhesions. Approximately 15 cm long incision from tibial tuberosity up to the patella. Exposition of the patellar tendon. Longitudinal incision in the middle from the tibial tuberosity towards the proximal patella. Division of the tendon into two strands. Detachment of the lateral tendon strand with periosteum from the bone of the patella and detachment of the medial strand with periosteum from the bone of the tibial tuberosity. Resection of fibrotic adhesions within Hoffa's fad pad and detachment of the longitudinal retinacula. Lengthening of the patella tendon of maximal 2.5 cm. Refixation of the medial strand to the upper part of the tibial tuberosity and the lateral strand to the distal patella pole with a soft anchor. Drilling of small transverse bone tunnels in the patella and tibial tuberosity for application of a McLaughlin cerclage for augmentation of the z‑plasty with a thick braided suture cord.</p><p><strong>Postoperative management: </strong>Six weeks partial weight bearing with 10 kg within a straight leg brace. Free passive range of motion.</p><p><strong>Results: </strong>Previously published results show that the Z‑plasty technique presented here on the patellar tendon can normalize the Caton index and improve mobility and clinical scores.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029883","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":"[Transcutaneous osseointegrated prostheses systems (TOPS) for rehabilitation following limb loss : Surgical approach for necessary removal of the implant].","authors":"Horst-Heinrich Aschoff, Marko Sass, Thomas Mittlmeier","doi":"10.1007/s00064-024-00883-5","DOIUrl":"https://doi.org/10.1007/s00064-024-00883-5","url":null,"abstract":"<p><strong>Objective: </strong>Removal of a transcutaneous osseintegrated endo-fix stem (ESKA Orthopaedic, Lübeck, Germany) following a fatigue fracture of the implant, whilst protecting the residual femur bone to allow transcutaneous osseointegrated prosthesis system (TOPS) reimplantation.</p><p><strong>Indications: </strong>A patient's request for a further TOPS implantation following a fatigue fracture of a circular osseointegrated implant stem.</p><p><strong>Contraindications: </strong>Impending destruction of the bone tube through mobilisation of the femoral implant stem with insufficient thickness of the cortical wall (< 2-3 mm). This fact has to be considered before providing the indication for implant replacement.</p><p><strong>Surgical technique: </strong>A fatigue fracture of a circular osseointegrated implant stem is generally associated with difficult removal of the implant. The longitudinal osteotomy of the tubular femur would lead to massive destruction of the bone due to the osseointegration of the corticalis into the three-dimensional structured surface of the implant and must be excluded as an option for removal. Therefore, the implant must be mobilized from the distal end of the bone. For this approach, tubular cutters and shock wave chisels are available. The procedure itself is time-consuming and is accompanied by a weakening of the corticalis of the femur bone. Intraoperative smear tests to prove a bacteria-free intramedullary space are obligatory.</p><p><strong>Postoperative management: </strong>After successful removal of an endo-fix stem, reassembling of a new TOPS implant should be considered 4-6 weeks later after ensuring the absence of bacterial colonization of the intramedullary space. If bacteria are detected, surgical revision is necessary.</p><p><strong>Results: </strong>The authors experience with the described removal of the implant with 4 patients over a period of 17 years must be regarded as anecdotal. All 4 patients could be successfully re-implanted, which emphasizes the value of the described method.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029884","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":"Surgical technique of minor revision of a transcutaneous osseointegration prosthetic system (TOPS) with implant retention.","authors":"Jan Paul Frölke, Robin Atallah","doi":"10.1007/s00064-024-00882-6","DOIUrl":"https://doi.org/10.1007/s00064-024-00882-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Transcutaneous osseointegration prosthetic systems (TOPS) offer a stable skeletal attachment for artificial limbs post-extremity amputation, serving as an alternative to socket attachment. Press-fit osseointegration implants (OI) utilized in TOPS consistently enhance quality of life and mobility for amputees, particularly those experiencing socket-related issues. Despite notable benefits, late complications such as infection and implant loosening pose challenges unique to TOPS due to their percutaneous nature. Recent studies indicate a low risk of implant failure but highlight the prevalence of minor soft tissue complications. Successful TOPS implementation is hypothesized to rely on early osseointegration and effective drainage of fluid discharge from the stoma. Factors influencing implant survival encompass implant characteristics, bone quality, and host factors. Longitudinal follow-up data reveal changes in periprosthetic bone and soft tissue conditions over time, necessitating ongoing clinical management. Distal bone resorption, evidenced by X‑ray, may result from stress shielding or local osteitis, leading to stoma-related complaints and jeopardizing implant survival. Understanding these dynamics is crucial for optimizing TOPS outcomes and addressing evolving patient needs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Indications: &lt;/strong&gt;Purulent and bloody discharge from the stoma with pain and radiographic evidence of distal cortical resorption.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Contraindications: &lt;/strong&gt;Complaints attributed to other pathologies, signs of progressive bone resorption or implant loosening.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Surgical technique: &lt;/strong&gt;We propose a unique innovative surgical approach to address symptomatic distal bone resorption in individuals undergoing treatment with press-fit transcutaneous osseointegration prosthetic systems (TOPS) following limb amputation. Distal bone resorption can lead to painful symptoms and compromise the effectiveness of TOPS, necessitating a stepwise intervention strategy. The protocol involves assessing cortical involvement through radiographs, followed by surgical debridement with assessment of potential implant loosening. The next step involves application of a two-part mirror-polished sleeve to mitigate local soft-tissue irritation and promote physiological drainage. Patient education is paramount, emphasizing the potential for limited pain relief and the risk of postoperative infectious complications. This protocol offers a structured approach to managing distal bone resorption in TOPS recipients, aiming to optimize treatment outcomes while ensuring informed patient consent.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Postoperative management: &lt;/strong&gt;Following surgery, the cement used to fixate the sleeve must harden and after 24 h the leg prosthesis can be clicked on again. With regard to the surgical wound, no special measures are necessary other than standard orthopedic postoperative wound care. In view of this revision surgical proce","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959093","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":"[Mechanical vascular anastomoses].","authors":"P Pour Farid, A Arkudas, Raymund E Horch","doi":"10.1007/s00064-024-00868-4","DOIUrl":"10.1007/s00064-024-00868-4","url":null,"abstract":"<p><strong>Background: </strong>Mechanical anastomoses of blood vessels represent a major advance in modern surgery. Highly specialized instruments ensure the precise connection of blood vessels, enabling the immediate restoration of blood flow. Ring coupler systems for venous anastomoses, in particular, have proven themselves in clinical practice due to their convenience and reliability and are now an indispensable part of surgical routines.</p><p><strong>Objectives: </strong>Precise and functionally proper anastomosis of blood vessels; shortening of the anastomosis time; minimization of perfusion disorders in the affected tissue; reduction of intraoperative and postoperative complications.</p><p><strong>Indications: </strong>Replantation of extremities after amputations and injuries; defect reconstruction using free flaps; microsurgical vascular bypass procedures.</p><p><strong>Contraindications: </strong>Severe vascular pathologies such as vascular aneurysms, arteriosclerosis or severe inflammation in the area of the anastomosis; large differences between the vessel lumina; too small or too large vessels.</p><p><strong>Surgical technique: </strong>Clamping of both vessel ends; selection of the appropriate ring coupler size based on the vessel diameter; mobilization of at least 1 cm at each vessel end; functional testing of the coupler device; threading the vessels, securely joining the rings and removing the holding device; removing clamps, inspection of the anastomosis.</p><p><strong>Postoperative management: </strong>Regular blood circulation checks; avoiding pressure on the anastomosis; adequate anticoagulation.</p><p><strong>Results: </strong>Precise anastomoses; reduction in operating time.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"320-331"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592238","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":"[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":1.0,"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}