Operative Orthopadie Und Traumatologie最新文献

{"title":"[Implantation of a stem- and cement-free inverted shoulder prosthesis].","authors":"H Wille, M Szakacs, J Zeichen","doi":"10.1007/s00064-025-00891-z","DOIUrl":"10.1007/s00064-025-00891-z","url":null,"abstract":"<p><strong>Objective: </strong>Safe and bone-sparing implantation of a stem- and cement-free reversed shoulder prosthesis.</p><p><strong>Indications: </strong>Shoulder arthritis with rotator cuff degeneration, symptomatic rotator cuff arthropathy with no further therapy, posttraumatic arthritis, rheumatoid arthritis, humeral head necrosis, revision surgery after implantation of a surface prosthesis.</p><p><strong>Contraindications: </strong>Infection, axillary nerve lesion, deltoid muscle insufficiency, insufficient central glenoid bone substance for glenoid screw fixation.</p><p><strong>Surgical technique: </strong>Implantation of the shoulder prosthesis via a standard deltopectoral approach. Dissection and resection of the humeral head. Glenoid preparation, soft tissue release, baseplate and glenosphere placement. Implantation of the humeral shell and inlay.</p><p><strong>Postoperative management: </strong>Short-term immobilization in a Gilchrist bandage. Followed by early functional rehabilitation.</p><p><strong>Results: </strong>The surgical technique has so far been used in 42 cases in the author's clinic. Both objectively and subjectively, good postoperative results and a significant reduction in pain were observed in the patients.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"171-180"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617863","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 prosthesis systems (TOPS)-specific indications and revision techniques].","authors":"Thomas Mittlmeier, Horst-H Aschoff","doi":"10.1007/s00064-025-00898-6","DOIUrl":"https://doi.org/10.1007/s00064-025-00898-6","url":null,"abstract":"","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":"37 2","pages":"87-88"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756057","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":"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":"133-141"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","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":"Surgical technique of a transcutaneous osseointegration prosthesis system (TOPS) for transtibial amputees.","authors":"Jan Paul Frölke, Ruud Leijendekkers, Robin Atallah","doi":"10.1007/s00064-025-00888-8","DOIUrl":"10.1007/s00064-025-00888-8","url":null,"abstract":"<p><p>Transcutaneous osseointegration prosthetic systems (TOPS) are intended to provide stable skeletal attachment for artificial limbs after extremity amputation and is an alternative for socket attachment. TOPS for individuals with limb amputation using osseointegration implants (OI) has proven to consistently and significantly improve quality of life and mobility for the vast majority of amputees, previously using a socket prosthesis also experiencing socket-related problems. As with any implant, complications such as infection, aseptic loosening, or implant fracture can occur, which may necessitate hardware removal. Approximately half of patients who undergo a below-knee amputation are able to utilize an artificial leg acceptably well with a socket-suspended prosthesis. However, the other half of patients experience limitations resulting in reduced prosthesis use, mobility, and quality of life. Limb-to-prosthesis energy transfer is poor because of the so-called \"pseudojoint\" (i.e., the soft tissue interface), and gross mechanical malalignment is common. Furthermore, transtibial amputees may experience irritation from pistoning and suction at the residual limb-socket interface. These issues result in skin problems and difficulties with socket fit because of fluctuation in the size of the residual limb size, resulting in a decrease in overall satisfaction and confidence in mobility. A bone-anchored implant creates a direct skeletal connection between the residual limb and artificial leg, in which energy transfer is optimal and mechanical alignment is significantly improved.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"89-100"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11958483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450802","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":"[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":"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":"142-149"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","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":"[Resection of the second ray applying the palmar approach].","authors":"Johannes Rau, Urs Hug, Steffen Löw, Frank Unglaub, Lars P Müller, Christian K Spies","doi":"10.1007/s00064-025-00893-x","DOIUrl":"https://doi.org/10.1007/s00064-025-00893-x","url":null,"abstract":"<p><strong>Objective: </strong>Improving the overall function of the hand by resection of the second ray applying the palmar approach in order to achieve an aesthetically pleasing postoperative result.</p><p><strong>Indications: </strong>Mechanically disturbing proximal limb stump, high degree of instability of the index finger, chronic infection/osteomyelitis of the index finger, dystrophic index finger with impaired circulation, degloving injury, malformations, malignant tumours of the index finger, aesthetic improvement after index finger amputation.</p><p><strong>Contraindications: </strong>Loss of grip strength that cannot be tolerated.</p><p><strong>Surgical technique: </strong>Dissection of the index finger with resection of the second metacarpal at the proximal diametaphyseal region, mobilisation of the neurovascular bundles, and transposition of the first dorsal interosseus muscle onto the second dorsal interosseus muscle, reconstruction of the thumb-middle finger commissur.</p><p><strong>Postoperative management: </strong>Sufficient dressing of the thumb-middle finger commissur with immobilisation for 2-5 days, then mobilisation for 8 weeks without forceful pinch grip between thumb tip und middle finger tip, mobilisation without limits after 3 months.</p><p><strong>Results: </strong>After resection of the second ray, studies showed very pleasing aesthetic results with high patient satisfaction despite a decrease in grip strength.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517454","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":"[VY-plasty for chronic quadriceps tendon rupture].","authors":"Wolf Petersen, Hassan Al Mustafa, Johannes Buitenhuis, Karl Braun, Martin Häner","doi":"10.1007/s00064-024-00857-7","DOIUrl":"10.1007/s00064-024-00857-7","url":null,"abstract":"<p><strong>Objective: </strong>Lengthening of the quadriceps tendon for dehiscence in chronic rupture.</p><p><strong>Indications: </strong>Chronic rupture of the quadriceps tendon with delayed diagnosis or failure of primary refixation with a dehiscence between 1 and 5 cm.</p><p><strong>Contraindications: </strong>Dehiscence of more than 5 cm.</p><p><strong>Surgical technique: </strong>Reopen the old incision and lengthen it to about 20-25 cm if necessary. Visualize the rupture. Debridement of the tendon and the insertion. Measurement of the dehiscence. Creation of a V-flap and reinforcement with a holding seam. Gradual mobilization of the V‑flap distally and reinforcement with two strong suture cords (braided suture size 5). Drilling of three obliquely ascending drill holes through the patella. Transosseous threading of the two reinforcement cords through the three drill holes. Knotting the reinforcement cords on the patella. Closure of the gap between the patella and the superficial tendon leaflet with a #2 braided suture. Closure of the gap between the V‑flap and the quadriceps tendon.</p><p><strong>Postoperative management: </strong>Six weeks of partial weight-bearing with 20 kg in a straight orthosis. Mobility: weeks 1-4 E/F 0-0-60, weeks 5 and 6 E/F 0-0-90.</p><p><strong>Results: </strong>We were able to follow-up 8 patients (mean age: 63.1 ± 4.5 years), who underwent this surgery in the manner described. All patients were able to perform an active extension postoperatively. The Lysholm score increased from 46.4 (± 5.4) points preoperatively to 81.6 (± 6.5) points postoperatively. No further rupture was detectable in the ultrasound examination at latest follow-up after an average of 27 (18-36) months.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"62-69"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082622","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 screw fixation of the anterior pelvic ring and the distal ilium : Tips and tricks to be successful.","authors":"Jocelyn Corbaz, Michiel Herteleer, Sylvan Steinmetz, Charlotte Arand, Tobias Nowak, Daniel Wagner","doi":"10.1007/s00064-024-00887-1","DOIUrl":"10.1007/s00064-024-00887-1","url":null,"abstract":"<p><strong>Objective: </strong>Minimally invasive percutaneous techniques are used to stabilize fractures of the anterior pelvic ring. Stabilization of the fracture facilitates early mobilization and rehabilitation, while percutaneous techniques reduce complications such as infection and bleeding.</p><p><strong>Indications: </strong>Indicated for patients with non- or minimally displaced fractures of the anterior pelvic ring, or if fracture displacement can be reduced using minimally invasive techniques.</p><p><strong>Contraindications: </strong>Contraindications include infection at the surgical site, anatomical inability to place screws, or patients unfit for surgery due to health risks.</p><p><strong>Surgical technique: </strong>The technique involves the insertion of ante- and retrograde transpubic screws and lateral compression (LC) II screws in supine position. Precise reduction of fractures is achieved using minimally invasive techniques.</p><p><strong>Postoperative management: </strong>In younger patients, partial weight bearing for 6 weeks is recommended, with full weight bearing in older patients.</p><p><strong>Results: </strong>Literature reports a high union rate of up to 95% for these procedures, with low rates of nonunion and infection (around 2%). Screw loosening or loss of reduction occurs in 8-18% of cases, with better outcomes using bicortical screws.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"23-33"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878564","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 of acetabular fractures with the two-incision minimally invasive (TIMI) approach].","authors":"S Ruchholtz","doi":"10.1007/s00064-024-00880-8","DOIUrl":"10.1007/s00064-024-00880-8","url":null,"abstract":"<p><strong>Objective: </strong>We present the two-incision minimally invasive (TIMI) approach for the treatment of anterior acetabular fractures.</p><p><strong>Indications: </strong>Displaced fractures of the anterior column of the acetabulum; complex fractures of the acetabulum in combination with the posterior approach (Kocher-Langenbeck); periprosthetic fractures of the acetabulum with or without additional revision of the cup.</p><p><strong>Contraindications: </strong>Possibly previous extended surgery in the anatomical region of the approach.</p><p><strong>Surgical technique: </strong>The first TIMI incision is performed by an alternate cut through at the level of the proximal third of the pelvic brim. After transection of the abdominal wall, the iliac vessels are mobilized medially and the neuromuscular bundle laterally. The second approach lies above the medial pubic bone. The soft tissue is held using a retraction system. After fracture reduction and fixation by isolated screws, a reconstruction plate is inserted for fracture neutralization.</p><p><strong>Postoperative management: </strong>Depending on the fracture type and the severity of the damage to the acetabular dome, the involved extremity is allowed partial weight bearing for 6 weeks to 3 months.</p><p><strong>Results: </strong>In our experience, a relatively short operation time of approximately 1.5-2 h for acetabular osteosynthesis. Wound infections and revisions are very rare. Radiological follow-up shows an anatomical result in over 75% of cases. The 24-month follow-up examination shows a Harris Hip Score of over 85 points. The quality of life measured by the EQ 5D is comparable to the quality of life of a normal collective of the same age.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"47-61"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848362","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":"Percutaneous sacroiliac screw fixation with a 3D robot-assisted image-guided navigation system : Technical solutions.","authors":"Björn-Christian Link, R A Haveman, B J M Van de Wall, R Baumgärtner, R Babst, F J P Beeres, P C Haefeli","doi":"10.1007/s00064-024-00871-9","DOIUrl":"10.1007/s00064-024-00871-9","url":null,"abstract":"<p><strong>Objective: </strong>Presentation and description of percutaneous sacroiliac (SI) screw fixation with the use of a 3D robot-assisted image-guided navigation system and the clinical outcome of this technique.</p><p><strong>Indications: </strong>Pelvic fractures involving the posterior pelvis.</p><p><strong>Contraindications: </strong>Patients not suited for surgery.</p><p><strong>Surgical technique: </strong>Planning the screws on the diagnostic computer tomogram (CT). Matching with a low-dose CT in the operating room. Lateral incision. Verify the guidewire position with the personalized inlet and outlet views. After correct positioning, place a cannulated screw over the guidewire. For fragility fractures, augmentation is recommended. Finish the surgery with a final 3D scan to confirm correct placement of the screws and cement.</p><p><strong>Postoperative management: </strong>Direct postoperative mobilization with pain-adapted full weight-bearing.</p><p><strong>Results: </strong>Data of 141 patients between January 2018 and August 2022 were analyzed (average age 82 ± 10 years, 89% female). Most of the fractures were type II fragility fractures of the pelvis (FFP; 75%). The median hospital stay was 12 ± 7 days and the median surgery duration for a unilateral SI screw was 26 min. In total 221 S1 screws and 17 S2 screws were applied. No screws showed signs of loosening or migration. Of the five suboptimally placed screws, one screw was removed due to sensory impairment. All patients with cement leakage remained without symptoms.</p><p><strong>Conclusion: </strong>The surgical technique with the use of a 3D robot-assisted image-guided navigation system is a technique for safe fixation of dorsal fragility fractures of the pelvis and is associated with fewer complications.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"3-13"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11790701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648863","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}