Operative Orthopadie Und Traumatologie最新文献

{"title":"[Surgical treatment of forefoot and midfoot fractures : Minimally invasive fixation of metatarsal fractures].","authors":"Patrick Gahr, Lennart Schleese, Thomas Mittlmeier","doi":"10.1007/s00064-024-00853-x","DOIUrl":"10.1007/s00064-024-00853-x","url":null,"abstract":"<p><strong>Objective: </strong>Minimally invasive stabilization of metatarsal fractures to enable adequate fracture healing in a correct position to restore anatomy and biomechanics of the foot.</p><p><strong>Indications: </strong>A. Dislocated diaphyseal and subcapital fractures of the second to fifth metatarsal (> 3 mm, > 10° dislocation). B. Fifth metatarsal fracture at the metadiaphyseal junction (Lawrence and Botte type III).</p><p><strong>Contraindications: </strong>High grade soft tissue damage or infection at the implant insertion site.</p><p><strong>Surgical technique: </strong>A. Fluoroscopically assisted closed reduction and antegrade intramedullary fixation of diaphyseal and subcapital fractures of the second to fifth metatarsal. B. Fluoroscopically assisted wire-guided intramedullary screw fixation of fifth metatarsal fractures at the metadiaphyseal junction.</p><p><strong>Postoperative management: </strong>A. Mobilization with partial weight bearing (20 kg) for 6 weeks wearing a stiff sole; implant removal under local anesthesia after 6-8 weeks, followed by a free range of movement and weight-bearing as tolerated (WBAT). B. Early mobilization with weight-bearing as tolerated (WBAT); removal of the orthosis after 6 weeks, implant removal optional.</p><p><strong>Results: </strong>A. Antegrade nailing of subcapital and shaft fractures of metatarsals II-V achieves good clinical results with low complication rates both when using prepared Kirschner wires or elastically stable intramedullary nails (ESIN). B. According to current literature, intramedullary screw osteosynthesis of proximal metatarsal V fractures of zone II and III according to Lawrence and Botte leads to faster bony healing with a lower nonunion rate compared with conservative treatment. It is recommended especially, but not only, for active athletes.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"211-222"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789895","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":"[Single-cut derotational osteotomy of the distal femur for correction of torsion and frontal axis].","authors":"Florian B Imhoff, Mathieu Trierweiler","doi":"10.1007/s00064-024-00844-y","DOIUrl":"10.1007/s00064-024-00844-y","url":null,"abstract":"<p><strong>Objective: </strong>A rotational osteotomy requires a complete cut of the bone in order to correct maltorsion. An additional correction of the frontal axis can be achieved via an oblique cut of the bone. The osteotomy with bone to bone contact is fixed with an angle stable plate.</p><p><strong>Indications: </strong>Symptoms such as anterior knee pain, inwardly pointing knee syndrome, lateral patellar subluxation or dislocation, lateral patellar hypercompression syndrome are a common indication for derivational osteotomy if clinically increased femoral internal rotation and radiologically increased femoral antetorsion is detected.</p><p><strong>Contraindications: </strong>Increased hip external rotation versus internal rotation, increased femoral torsion but no increased internal hip rotation, malcompliance, inability for partial weight bearing, risk of delayed union (nicotine abuse and obesity) as well as patellofemoral arthritis and systematic glucocorticoids, immunosuppressants are (relative) contra-indications.</p><p><strong>Surgical technique: </strong>A lateral or optionally medial approach to the distal femur and exposure of the bone with Eva hooks for the osteotomy is done. The use of patient-specific cutting blocks accurately specify the planned extent of derotation and level of incision. A defined oblique cutting plane of the single-cut osteotomy and derotation will additionally correct/change frontal axis. An additional biplanar osteotomy with an anterior wedge increases intraoperative stability and generates a larger bone contact area for consolidation.</p><p><strong>Postoperative management: </strong>With the use of an extra medullary fixation device partial weight bearing with 15-20 kg with crutches up to 6 weeks is required, but no restriction on knee movement is given.</p><p><strong>Results: </strong>The literature shows significantly improved patient satisfaction regarding patellofemoral stability and knee function. With the use of patient-specific cutting guides, high accuracy of the osteotomy and 3‑dimensional correction can be achieved, while delayed union rate is up to 10%.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"96-104"},"PeriodicalIF":0.7,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11014875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140307904","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":"[Corrective osteotomies around the knee joint using hexapods].","authors":"Jörg Dickschas","doi":"10.1007/s00064-023-00836-4","DOIUrl":"10.1007/s00064-023-00836-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Correction of deformities around the knee joint in the frontal and sagittal axis, torsion, length and translation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Indications: &lt;/strong&gt;Complex deformities of the proximal tibia, and to a lesser extent of the distal femur, which cannot be treated with acute correction using plate or nail osteosynthesis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Contraindications: &lt;/strong&gt;Nicotine abuse, soft tissue problems, lack of patient compliance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Surgical technique: &lt;/strong&gt;First, mounting of the proximal ring of the ring fixator strictly parallel to the joint line in 2 planes, fixation with 3 or 4 pins or wires. Then mounting of the distal ring, fixation also with 3 or 4 wires, connection of both rings with 6 struts (movement units with which the length can be adjusted). Then the fibula osteotomy is performed in the transition from the distal to the middle third, and finally the tibial osteoclasia is performed via a mini-incision as a drill hole chisel osteotomy in the CORA (center of rotation and angulation) of the malposition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Postoperative management: &lt;/strong&gt;Immediately postoperatively, the deformity is defined usimg computer software, the exact position and size of the ring and struts are entered, and a knee image is taken in 2 planes with X‑ray signal adapter (beacon) on the ring fixator to plan the continuous correction. Thereupon continuous correction of the deformity via daily rotation on the 6 struts, which is done by the patients themselves at home after the hospital stay. At the time of correction, pain-adapted partial weight-bearing with 20 kg up to half body weight. After completion of the correction, repeat X‑ray diagnosis and check whether the correction goal has been achieved. If necessary, reprogram a program for renewed continuous correction if residual deformity remains. When the correction goal is reached, X‑ray check. After 6 weeks, with bony consolidation, gradual loading. The treatment of the correction can either be carried out in the ring fixator (wearing time of 0.5-1 year not unusual) or secondarily via a change of procedure to plate osteosynthesis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We report on 25 knee joint corrections in 23 patients (12 women and 11 men) using hexapods (Taylor spatial frame) during the period 2016-2023. One patient had a femoral and a tibial fixator at the same time; another patient had a triple fixator at the tibia. The mean age was 32 (6-73) years. 15 left and 10 right corrections were performed. 19 fixators had been applied tibial, 5 fixators femoral, and 1 fixator cross-jointly (for contracture). The indications were 6 congenital complex deformities, 10 posttraumatic complex deformities, 3 pseudarthroses after correction osteotomies, 2 patients with osteomyelitis, 1 knee contracture and 1 infection after fracture osteosynthesis with nails. The forms of correction performed were varizations and valgizations in frontal axis, extension and flexion in sagittal pl","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"83-95"},"PeriodicalIF":0.7,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72016186","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":"Open lift-drill-fill-fix for medial osteochondral lesions of the talus: surgical technique.","authors":"Quinten G H Rikken, Barbara J C Favier, Jari Dahmen, Sjoerd A S Stufkens, Gino M M J Kerkhoffs","doi":"10.1007/s00064-023-00833-7","DOIUrl":"10.1007/s00064-023-00833-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Osteochondral lesions of the talus (OLT) with a fragment on the talar dome that fail conservative treatment and need surgical treatment can benefit from in situ fixation of the OLT. Advantages of fixation include the preservation of native cartilage, a high quality subchondral bone repair, and the restoration of the joint congruency by immediate fragment stabilization. To improve the chance of successful stabilization, adequate lesion exposure is critical, especially in difficult to reach lesions located on the posteromedial talar dome. In this study we describe the open Lift, Drill, Fill, Fix (LDFF) technique for medial osteochondral lesions of the talus with an osteochondral fragment. As such, the lesion can be seen as an intra-articular non-union that requires debridement, bone-grafting, stabilization, and compression. The LDFF procedure combines these needs with access through a medial distal tibial osteotomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Indications: &lt;/strong&gt;Symptomatic osteochondral lesion of the talus with a fragment (≥ 10 mm diameter and ≥ 3 mm thick as per computed tomography [CT] scan) situated on the medial talar dome which failed 3-6 months conservative treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Contraindications: &lt;/strong&gt;Systemic disease, including active bacterial arthritis, hemophilic or other diffuse arthropathies, rheumatoid arthritis of the ankle joint, and malignancies. Neuropathic disease. End-stage ankle osteoarthritis or Kellgren and Lawrence score 3 or 4 [3]. Ipsilateral medial malleolus fracture less than 6 months prior. Relative contra-indication: posttraumatic stiffness with range of motion (ROM) &lt; 5°. Children with open physis: do not perform an osteotomy as stabilization of the osteotomy may lead to early closure of the physis, potentially resulting in symptomatic varus angulation of the distal tibia. In these cases only arthrotomy can be considered.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Surgical technique: &lt;/strong&gt;The OLT is approached through a medial distal tibial osteotomy, for which the screws are predrilled and the osteotomy is made with an oscillating saw and finished with a chisel in order to avoid thermal damage. Hereafter, the joint is inspected and the osteochondral fragment is identified. The cartilage is partially incised at the borders and the fragment is then lifted as a hood of a motor vehicle (lift). The subchondral bone is debrided and thereafter drilled to allow thorough bone marrow stimulation (drill) and filled with autologous cancellous bone graft from either the iliac crest or the distal tibia (fill). The fragment is then fixated (fix) in anatomical position, preferably with two screws to allow additional rotational stability. Finally, the osteotomy is reduced and fixated with two screws.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Postoperative management: &lt;/strong&gt;Casting includes 5 weeks of short leg cast non-weightbearing and 5 weeks of short leg cast with weightbearing as tolerated. At 10-week follow-up, a CT scan is made to confirm fragment a","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"132-144"},"PeriodicalIF":0.7,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11014820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41220307","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":"[Acetabular metastatic defect reconstruction using the modular revision support cup MRS-C].","authors":"S Koob, H Kohlhof, T M Randau, D C Wirtz","doi":"10.1007/s00064-023-00834-6","DOIUrl":"10.1007/s00064-023-00834-6","url":null,"abstract":"<p><strong>Objective: </strong>Stabilization of metastatic acetabular defects with a bone cement-augmented revision support cup for remobilization of oncological patients in advanced cancer stages.</p><p><strong>Indications: </strong>Metastatic acetabular defects (Metastatic Acetabular Classification, MAC 2-4) in patients with a prognostic medium or long-term survival.</p><p><strong>Contraindications: </strong>Highly limited survival due to metastatic disease (< 6 weeks). Local bone or soft tissue infection. Primary bone tumor with curative treatment option. Advanced pelvic discontinuity. Recent wound compromising systemic therapy.</p><p><strong>Surgical technique: </strong>Standard hip approach. Curettage of the metastatic defect and careful reaming of the acetabulum before insertion of the cup. Predrilling of the dome und flange screws before application of the bone cement through the center hole of the implant and filling of the acetabular defect. Complete insertion of the screws for compound osteosynthesis. Implant of a modular inlay or dual mobility system.</p><p><strong>Postoperative management: </strong>Full weight bearing or mobilization with two crutches according to the level of pain. Adjuvant local radiation therapy after wound consolidation. Continuation of systemic therapy according to tumor board decision.</p><p><strong>Results: </strong>Between 2012 and 2019, we treated 14 patients with metastatic acetabular defects using the modular revision support cup \"MRS-TITAN® Comfort\", MRS-C, Peter Brehm GmbH, Weisendorf, Germany) at our institution. Mean Harris Hip Score improvement was 23.2 with a mean patient's survival of 9.7 months due to the reduced cancer-related prognosis; 13 of the 14 implants endured the patient's prognosis. One implant had to be removed due soft tissue defect-related periprosthetic joint infection.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"145-156"},"PeriodicalIF":0.7,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11014813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71434887","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":"[Treatment of symptomatic end-stage osteoarthritis of the ankle with anterolateral approach and an anatomical plate].","authors":"Klaus Edgar Roth, Paul Simons, Markus Egermann, Matthias Knobe, Robert Ossendorff, Philipp Drees, Kajetan Klos","doi":"10.1007/s00064-023-00831-9","DOIUrl":"10.1007/s00064-023-00831-9","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this paper is to describe the anterolateral approach using an anatomical plate for ankle arthrodesis and to present the first mid-term results with this technique in a high-risk population.</p><p><strong>Indications: </strong>The indication for arthrodesis of the ankle joint with this described technique is moderate to severe osteoarthritis of the ankle.</p><p><strong>Contraindications: </strong>In addition to the general contraindications typical of any operation, there is a specific contraindication in cases of active infection of the soft tissues and accompanying osteomyelitis at the ankle.</p><p><strong>Surgical technique: </strong>The incision is made along the course of the peroneus tertius muscle. After that, the mobilization of the peroneus superficialis nerve is carried out, followed by the mobilization of the long extensor tendons, especially the extensor digitorum muscle in a medial direction opening the capsule and removal of the residual cartilage on the distal tibia and talus. Subsequently, the subchondral sclerosis is opened, and the implantation of a suitable osteosynthesis material, e.g., an anatomical angle-stable plate, is carried out. Finally, wound closure is performed involving the muscle belly of the extensor digitorum muscle covering the plate.</p><p><strong>Postoperative management: </strong>Immobilization of the ankle for 5-7 days in a dorsal knee-high splint. Retention in a walker after decongestion for another 5 weeks. Increased loading can be done after X‑ray/computed tomography (CT) control from the 6th week.</p><p><strong>Results: </strong>In all, 11 patients were observed retrospectively for an average of 14 months. There were no complications. The European Foot and Ankle Society (EFAS) score improved significantly from 3.3 to 17.8 points. All patients were subjectively satisfied with the result and would have the operation again.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"73-79"},"PeriodicalIF":0.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41240997","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":"Dank an die Gutachterinnen und Gutachter 2023.","authors":"","doi":"10.1007/s00064-024-00841-1","DOIUrl":"https://doi.org/10.1007/s00064-024-00841-1","url":null,"abstract":"","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139652195","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 treatment of congenital scoliosis].","authors":"Michael Ruf","doi":"10.1007/s00064-023-00827-5","DOIUrl":"10.1007/s00064-023-00827-5","url":null,"abstract":"<p><strong>Objective: </strong>Early correction of congenital scoliosis including short fusion, while minimizing both mobility restrictions and growth impairment.</p><p><strong>Indications: </strong>Congenital scoliosis with marked deformity, proven progression, significant compensatory curves, and/or impairment of trunk balance. Furthermore, in case of compression of neural structures or pain due to secondary degeneration.</p><p><strong>Contraindications: </strong>No absolute contraindication.</p><p><strong>Surgical technique: </strong>Posterior approach to the apex of the deformity. In the growing spine the periosteum should only be touched at the levels where fusion is planned. Insertion of pedicle screws adjacent to the hemivertebra. The posterior elements of the hemivertebra are removed: lamina, joint facets, pedicle, transverse process. Resection of the accessory proximal rib in the thoracic spine. Following blunt dissection at the lateral and anterior surface of the hemivertebra, the body of the hemivertebra and the adjacent discs are resected. The resulting gap is closed by compression via transpedicular instrumentation thus correcting the scoliotic deformity. In case of synostosis or contralateral bar formation, the concave side of the spine is dissected and the synostosis osteomized.</p><p><strong>Postoperative management: </strong>Early mobilization on postoperative day 1. Bracing for 12 weeks depending on stability of the instrumentation. Periodic clinical and radiographic controls until the end of growth.</p><p><strong>Results: </strong>Posterior hemivertebra resection with transpedicular instrumentation is considered as the standard treatment of congenital scoliosis. Correction rates of 60-80% are achieved. Cervical and lumbosacral hemivertebrae may require an additional anterior approach. In case of synostosis, bar formation, or rib synostosis, further corrective surgeries may be necessary during growth.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"4-11"},"PeriodicalIF":0.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41158535","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":"[Posterior instrumented correction and fusion of adolescent idiopathic scoliosis].","authors":"Ulf Liljenqvist, Viola Bullmann","doi":"10.1007/s00064-023-00825-7","DOIUrl":"10.1007/s00064-023-00825-7","url":null,"abstract":"<p><strong>Objective: </strong>Balanced frontal curve correction with horizontal shoulder levels, restoration of sagittal plane and vertebral derotation with a fusion length as short as possible.</p><p><strong>Indications: </strong>Curves larger than 40-50° Cobb angle; furthermore age, location, degree of rotation, and sagittal plane deviation have to be considered.</p><p><strong>Surgical technique: </strong>Posteriorly, segmental pedicle screw instrumentation with a high screw density (80%) and both titanium alloy and cobalt chrome rods. Freehand screw placement under consideration of both natural and deformity-induced pedicle morphology. Correction via reduction screws or instruments. Combined correction technique with rod rotation, segmental screw approximation to the generally concave rod and segmental correction of vertebral translation. Moderate concave distraction and convex compression. If needed, final in situ bending of the rods. Schwab type I osteotomies; in rigid curves type II osteotomies. Fusion with local bone, allogenic bone and/or bone substitutes (i.e., tricalcium phosphate). Intraoperative placement of a thoracic epidural catheter for postoperative pain control. Neurological monitoring throughout the procedure.</p><p><strong>Postoperative management: </strong>Mobilization on postoperative day 1 with focus on pain management and nutrition. Return to school after 4 weeks. Physiotherapy after 3 months, cycling after 3-6 months, and full sport activities after 1 year.</p><p><strong>Results: </strong>Frontal curve correction of 60-80%, sufficient sagittal plane correction. Correction of rib hump 40%. Patient satisfaction is high at 95% and long-term revision rates of < 10%.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"21-32"},"PeriodicalIF":0.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10284687","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 treatment of kyphosis in children and adolescents].","authors":"C E Heyde, N von der Höh, A Völker","doi":"10.1007/s00064-023-00828-4","DOIUrl":"10.1007/s00064-023-00828-4","url":null,"abstract":"<p><strong>Objective: </strong>Correction of a pathological kyphosis to restore a balanced, low-pain or pain-free and load-bearing spine.</p><p><strong>Indications: </strong>Pronounced sagittal imbalance, progressive kyphosis despite conservative therapy, and neurological deficits are indications for surgery. Further surgical indications are severe therapy-resistant complaints and/or psychologically burdening cosmetic impairment. The guidelines for surgical indications are kyphosis angles of 75-80° thoracic and 30-50° lumbar.</p><p><strong>Contraindications: </strong>No specific, but general contraindications for surgical treatment.</p><p><strong>Surgical technique: </strong>Depending on the characteristics of the kyphosis, different surgical techniques are used. Rod-screw systems are mainly used, and surgery is primarily performed by shortening the spinal column from posterior using a wide variety of techniques. In individual cases, this can be combined with ventrally mobilizing, resecting, or straightening techniques.</p><p><strong>Postoperative management: </strong>The aim of surgical treatment is to achieve a primarily stable and weight-bearing spine. Regular wound control as well as stabilizing physiotherapy during follow-up are essential. Postoperatively, initially abstaining from sports; later physical activity is encouraged under professional guidance.</p><p><strong>Results: </strong>The literature shows very good corrective results in children and adolescents. The technical procedures are associated with a low and acceptable complication rate. Over the course of time, these patients must be monitored in order to detect possible long-term complications such as junctional kyphosis or pseudarthrosis.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"33-42"},"PeriodicalIF":0.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10286193","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}