Operative Orthopadie Und Traumatologie最新文献

{"title":"[Lateral open wedge tibial osteotomy for posttraumatic deformity].","authors":"Katrin Karpinski, Philipp-Johannes Braun, Theresa Diermeier","doi":"10.1007/s00064-024-00864-8","DOIUrl":"10.1007/s00064-024-00864-8","url":null,"abstract":"<p><strong>Objective: </strong>Correction of pseudoinstability and tibial malalignment by re-establishment of the pretraumatic tibial axis.</p><p><strong>Indications: </strong>Posttraumatic valgus malalignment accompanied by pseudoinstability.</p><p><strong>Contraindications: </strong>Infections, significant inhibition of movement and multidirectional ligament instability.</p><p><strong>Surgical technique: </strong>Standard anterolateral approach to the proximal tibial head. Lateral open wedge high tibial osteotomy above (supra) the tibiofibular joint and opening until the pseudoinstability of the lateral collateral ligament is levelled.</p><p><strong>Postoperative management: </strong>Partial weight bearing for 4 weeks, after radiological control full body weight loading is allowed. Implant removal after full bony consolidation.</p><p><strong>Results: </strong>There is limited evidence in the current literature but the available results show good results in 70% of the cases in long-term follow-up.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"238-245"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Medial closing wedge osteotomy for correction of valgus deformity].","authors":"Wolf Petersen, Hasan Al Mustafa, Matin Häner, Johannes Buitenhuis, Karl Braun","doi":"10.1007/s00064-024-00855-9","DOIUrl":"10.1007/s00064-024-00855-9","url":null,"abstract":"<p><strong>Objective: </strong>Correction of a proximal tibial valgus deformity.</p><p><strong>Indications: </strong>Lateral osteoarthritis of the knee or cartilage damage in a valgus deformity > 5° with a medial proximal tibial angle (MPTA) > 90°.</p><p><strong>Contraindications: </strong>Medial proximal tibial angle < 90°, medial cartilage damage, medial meniscus loss.</p><p><strong>Surgical technique: </strong>Skin incision medial of the tibial tuberosity approximately 8-10 cm. Insertion of two converging guidewires directly above the pes anserinus, ascending obliquely, and ending at the tip of the fibula. Control of the wire position with the image intensifier. Osteotomy with an oscillating saw. Removal of the wedge and closure of the osteotomy. Osteosynthesis with a medial angle-stable plate.</p><p><strong>Postoperative management: </strong>Partial load bearing with 10-20 kg for 2 weeks, then step-wise increase in load. Mobility: free.</p><p><strong>Results: </strong>We performed this surgery in the manner described in 21 patients with lateral osteoarthritis or cartilage damage (17 men, 4 women, average age: 51 years). The valgus deformity was reduced from an average of 5.6 to -0.5°. The KOOS-PS (Knee Injury and Osteoarthritis Outcome Score-Physical Function Short-form) score decreased significantly from 39.1 ± 14 to 25.8 ± 20 points.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"246-256"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996934","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 pendulum osteotomy to correct severe tibial varus deformity].","authors":"Wolf Petersen, Hasan Al Mustafa, Martin Häner, Karl Braun","doi":"10.1007/s00064-024-00854-w","DOIUrl":"10.1007/s00064-024-00854-w","url":null,"abstract":"<p><strong>Objective: </strong>Correction of a severe tibial varus deformity near the knee joint with only a slight influence on leg length and patella height.</p><p><strong>Indications: </strong>Medial osteoarthritis and/or cartilage damage with a severe varus deformity > 10° with a medial proximal tibial angle (MPTA) < 80°.</p><p><strong>Contraindications: </strong>Femoral varus deformity with lateral distal femoral angle > 91°, severe lateral cartilage damage, lateral osteoarthritis, lateral meniscus loss.</p><p><strong>Surgical technique: </strong>Skin incision of approx. 8-10 cm between the tibial tuberosity and the head of the fibula. Exploration of the peroneal nerve. Detachment of the extensors. Insertion of an obliquely ascending guidewire ending approximately 10 mm below the medial articular surface. Insertion of a second guidewire. This aims at the middle of the first wire (hemi wedge). Check the wire position under fluoroscopy. Osteotomy with an oscillating saw under cooling. Removal of the wedge and closure of the osteotomy. Percutaneous needling of the medial collateral ligament with a cannula to carefully lengthen the ligament. Check the correction result with a metal rod. Osteosynthesis with lateral angle-stable plate.</p><p><strong>Postoperative management: </strong>Partial weight-bearing with 10 kg for 6 weeks postoperatively, free range of motion.</p><p><strong>Results: </strong>Reports from the literature show that good clinical results can be achieved with this procedure for severe tibial varus deformities. Postoperative leg length discrepancies are less common with this procedure than with laterally closing osteotomy.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"269-279"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989579","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":"[Standardized reduction and palmar plating of dorsally displaced distal radius fractures for safe and atraumatic reconstruction of the anatomy of the radius].","authors":"Steffen Löw, Sebastian Kiesel","doi":"10.1007/s00064-023-00838-2","DOIUrl":"10.1007/s00064-023-00838-2","url":null,"abstract":"<p><strong>Objective: </strong>Standardization of palmar plate osteosynthesis in order to consequently achieve physiologic anatomy of the distal radius end.</p><p><strong>Indications: </strong>Unstable dorsally displaced distal radius fractures or fractures that should be treated functionally.</p><p><strong>Contraindications: </strong>Severe intraarticular joint depression that cannot be reduced with either a palmar or arthroscopic assisted approach.</p><p><strong>Surgical technique: </strong>Patient in supine position with the forearm supinated on arm table. Radiopalmar incision along the radial border of the flexor carpi radialis tendon. Detachment of the pronator quadratus muscle from radial to ulnar. Gross reduction with eventual correction of a dorsal or radial shift. Placement of the angular stable plate and preliminary fixation with a nonangular stable cortical screw in the long hole at the radius shaft. Fluoroscopic control of axial alignment in the anteroposterior view and of correct distal position of the plate in the lateral view under reduction condition. Placement of one or two angular stable screws at the shaft. Under subtle reduction with flexion, ulnar deviation and axial traction placement of two K‑wires via the holes at the distal edge of the plate. These wires mostly keep reduction maintained while reduction maneuver can be paused. Fluoroscopic control in two planes. Replacement of the wires by distal angular stable screws with the help of the wires as an orientation. In case of insufficient reduction, reduction maneuver can be repeated while the first angular stable screw is locked. Final fluoroscopic control in two planes and ulnar deviation, eventually also in tangential view and clinical testing for stability of the distal radioulnar joint. Wound closure only by skin suture. Application of a sterile dressing and a palmar cast.</p><p><strong>Postoperative management: </strong>Arm consequently in upright position and active and complete movement of fingers. Palmar below-elbow cast for 2 weeks, then movement of wrist without exertion. After regular radiographic control 4-5 weeks postoperatively, increase of axial load to normal and, if needed, physiotherapy. Clinical control for irritation of tendons by plate or screws after 1 year and eventual plate removal.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"223-234"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138489057","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":"[Central band reconstruction in Essex-Lopresti lesions].","authors":"Niklas Theisen, Nadine Ott, Tim Leschinger, Lars Peter Müller, Michael Hackl","doi":"10.1007/s00064-024-00850-0","DOIUrl":"10.1007/s00064-024-00850-0","url":null,"abstract":"<p><strong>Objective: </strong>Restoration of longitudinal forearm stability by reconstruction of the central band (CB) of the interosseous membrane (IOM) of the forearm.</p><p><strong>Indications: </strong>Acute and chronic Essex-Lopresti lesions (EL) with longitudinal forearm instability.</p><p><strong>Contraindications: </strong>Absolute: acute/subacute infection. Relative: severe complex regional pain syndrome (CRPS), bony deformity/bone loss, pronounced osteoarthritis of the elbow and wrist.</p><p><strong>Surgical technique: </strong>Ulnar approach with exposure of the ulna approximately 6 cm proximal to the ulnar styloid. Creation of a 3.5 mm drill hole from ulnar-distal to radial-proximal. A Fiberloop (Fa. Arthrex, Naples, FL, USA) is fixed to one end of the LARS (Ligament Advanced Reconstruction System, Fa. Corin Group, Cirencester, UK) in a whipstitch technique, is shuttled through the drill hole from radial to ulnar and fixed over a BicepsButton (Fa. Arthrex, Naples, FL, USA). Exposure of the radius through a modified Henry approach. A 3.5 mm drill hole is made from radial-proximal to ulnar-distal approximately 12 cm proximal to the radial styloid. The graft is shuttled from the ulnar to the radial incision directly on the palmar surface of the IOM and shortened to the required length. Another Fiberloop is used to perform a whipstitch on the free end of the LARS. The final fixation of the CB reconstruction is achieved by shuttling the Fiberloop sutures through the radial drill hole with fixation over a BicepsButton.</p><p><strong>Postoperative management: </strong>Short-term immobilization in a long arm cast with subsequent early functional treatment.</p><p><strong>Results: </strong>Mediocre to poor clinical results are reported in the literature for the treatment of chronic EL. Future research will tell whether the advanced surgical techniques with CB reconstruction will lead to better clinical outcomes.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"180-187"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794112","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":"[Technical modifications to elbow interposition arthroplasty].","authors":"Christoph-Johannes Pucher, Tim Leschinger, Nadine Ott, Lars Peter Müller, Michael Hackl","doi":"10.1007/s00064-024-00847-9","DOIUrl":"10.1007/s00064-024-00847-9","url":null,"abstract":"<p><strong>Objective: </strong>Interposition arthroplasty of the elbow involves the interposition of a fascia lata or dermis autograft or allograft between the distal humerus and the ulna or radius, while preserving the original form of articulation.</p><p><strong>Indications: </strong>Interposition arthroplasty is indicated for young patients with high functional demands who suffer from end-stage elbow arthritis and associated pain or joint stiffness.</p><p><strong>Contraindications: </strong>Contraindications include acute or subacute infection, skeletal immaturity, bone loss, deformity, or gross instability.</p><p><strong>Surgical technique: </strong>Once the ulnar nerve has been secured, joint access is established via a posterior approach. The radial collateral ligament (RCL) and the common extensor tendon origin (CEO) are detached, while preserving the anconeus muscle and the lateral ulnar collateral ligament (LUCL). Subsequently, a capsular release is required to maintain adequate joint exposure and address the accompanying stiffness. Three to four transosseous drill holes are placed at the level of the distal humerus to secure the graft. After the graft has been positioned successfully within the joint space using two guide sutures, it can be secured to the distal humerus using a horizontal mattress stitch. Finally, the detached tendon and ligament structures are reconstructed.</p><p><strong>Postoperative management: </strong>After initial immobilization, early functional exercise of the elbow is performed in the motion orthosis, avoiding valgus or varus stress.</p><p><strong>Results: </strong>The efficacy of elbow interposition arthroplasty has been demonstrated, particularly for young and active patients with severe inflammatory or post-traumatic osteoarthritis. Despite the results in terms of postoperative function and pain reduction are satisfactory, the current literature reports high complication, subsequent treatment, and revision rates. In the event of interposition arthroplasty failure, revision with another interposition procedure or conversion to endoprosthesis may be considered.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"167-179"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861651","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":"[Elbow hemiarthroplasty for coronal shear fractures of the distal humerus].","authors":"Marc Maximilian Weber, Valentin Rausch, Tim Leschinger, Lars Peter Müller, Michael Hackl","doi":"10.1007/s00064-024-00852-y","DOIUrl":"10.1007/s00064-024-00852-y","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the operation is to replace the articular surface of the distal humerus in cases of nonreconstructible fractures of the distal humerus.</p><p><strong>Indications: </strong>Active patients with high functional requirements, in whom weight limitation of total elbow arthroplasty should be avoided.</p><p><strong>Contraindications: </strong>Contraindications include fractures with irreconstructible epicondyles and/or irreconstructible collateral ligaments, as well as ulnohumeral, or radiohumeral osteoarthritis.</p><p><strong>Surgical technique: </strong>Following subcutaneous anterior transposition of the ulnar nerve, surgical dislocation of the elbow joint is achieved through a paratricipital approach with release of the soft tissue structures from the humerus. After resection of the trochlea, the intramedullary canal of the humerus is prepared using rasps in order to implant the hemiprosthesis with retrograde cementing. Finally, the medial and lateral collateral ligaments as well as the flexors and extensors are repaired.</p><p><strong>Postoperative management: </strong>Early functional rehabilitation in a hinged elbow orthosis while avoiding varus/valgus stress after wound healing is completed.</p><p><strong>Results: </strong>Between 2018 and 2022, 18 patients with coronal shear fractures were treated with elbow hemiarthroplasty. The mean Mayo Elbow Performance Score (MEPS) was 79 (70-95) after a mean follow-up of 12 months. The mean range of motion was 99° (70-130°) in extension-flexion and 162° (90-180°) in pronation-supination.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"159-166"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735715","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":"[Autologous minced cartilage implantation for focal cartilage lesions of the humeral capitellum].","authors":"Nadine Ott, Michael Hackl, Lars Peter Müller, Tim Leschinger","doi":"10.1007/s00064-024-00849-7","DOIUrl":"10.1007/s00064-024-00849-7","url":null,"abstract":"<p><strong>Objective: </strong>The goal of minced cartilage implantation (MCI) is to restore an intact cartilage surface in focal osteochondral lesions of the humeral capitellum.</p><p><strong>Indications: </strong>The indications for MCI are limited osteochondral lesions at the humeral capitellum, also at the head of the radius, with intact cartilage border as well as in situ or a completely detached fragment, and free joint bodies (grade II-grade V according to Hefti).</p><p><strong>Contraindications: </strong>Contraindications for MCI are already concomitant or associated cartilage damage as well as bilateral osteochondral lesions and insufficient available cartilage material.</p><p><strong>Surgical technique: </strong>After diagnostic arthroscopy to detect possible concomitant pathologies and to exclude already corresponding cartilage lesions, the arthroscope is flipped posterolaterally over the high posterolateral portal and a second portal is created under visualization via the soft spot. Initially, debridement of the focal cartilage defect, assessment of the marginal zone, and/or salvage of free joint bodies. Using a smooth shaver and the filter provided, the partially or even completely detached cartilage fragment is unidirectionally fragmented under continuous suction. The remaining defect with a stable marginal zone is cleanly curetted, and the joint is completely dried. The fragmented cartilage collected in the filter is bonded to a membrane using autologous conditioned plasma (ACP) and then arthroscopically applied to the defect via a cannula, sealed using thrombin and fibrin.</p><p><strong>Postoperative management: </strong>Postoperative immobilization in a cast for at least 24 h is required. Afterwards, free exercise of the joint is possible, but no loading should be maintained for 6 weeks. Return to sport after 3 months.</p><p><strong>Results: </strong>Good to very good clinical and MRI morphologic results are already evident in the short-term course. Prospective and retrospective multicenter studies are needed to evaluate future long-term results.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"188-197"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794110","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":"[Bone-cartilage transfer for osteochondritis dissecans of the humeral capitellum].","authors":"Alexander Klug, Matthias Sauter, Reinhard Hoffmann","doi":"10.1007/s00064-024-00848-8","DOIUrl":"10.1007/s00064-024-00848-8","url":null,"abstract":"<p><strong>Objective: </strong>Treatment of focal cartilage defects of the humeral capitellum with autologous bone-cartilage cylinders to prevent development of arthritis of the elbow joint.</p><p><strong>Indications: </strong>High-grade, unstable lesions (> 50% of the capitellum, grade III-IV according to Dipaola), including those involving the lateral edge of the capitellum and with a depth of up to 15 mm.</p><p><strong>Contraindications: </strong>Stable lesions and generalized osteochondritis of the capitellum (including Panner's disease), as well as a relative contraindication for lesions > 10 mm, as the largest punch has a maximum diameter of 10 mm.</p><p><strong>Surgical technique: </strong>Arthroscopy of the elbow joint, transition to open surgery. First, the size of the cartilage defect in the capitellum is determined. Then, one (or several) osteochondral cylinders (OATS Arthex) are removed, which as far as possible completely encompass the defect zone. Corresponding intact bone-cartilage cylinders are obtained from the ipsilateral proximal lateral femoral condyle, each with a 0.3 mm larger diameter via an additive miniarthrotomy. The \"healthy\" cylinders are then inserted into the defect zone in a \"press fit\" technique.</p><p><strong>Postoperative management: </strong>An upper arm cast in neutral position of the hand for 10-14 days, simultaneously beginning physiotherapy (active-assisted movements) and lymphatic drainage. As soon as painless range of motion (ROM) is restored (goal: by week 6), isometric training can be started. Resistance training starts from week 12. Competitive sports are only recommended after 6(-8) months.</p><p><strong>Results: </strong>The current state of research on the surgical treatment of OCD of the humeral capitellum using autologous osteochondral grafts shows mostly promising results. A recent meta-analysis of 24 studies reports a significantly higher (p < 0.01) rate of return to sports (94%) compared to fragment fixation (64%) or microfracture and debridement (71%) [41]. However, the increased donor-site morbidity must be taken into account (ca. 7.8%).</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"198-210"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794111","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":"[Elbow surgery-novel techniques].","authors":"Michael Hackl, Lars Peter Müller","doi":"10.1007/s00064-024-00851-z","DOIUrl":"https://doi.org/10.1007/s00064-024-00851-z","url":null,"abstract":"","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":"36 3-4","pages":"157-158"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894897","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}