Operative Orthopadie Und Traumatologie最新文献

{"title":"[Surgical suture material-fundamentals].","authors":"Klaus Dresing,&nbsp;Theddy Slongo","doi":"10.1007/s00064-023-00812-y","DOIUrl":"10.1007/s00064-023-00812-y","url":null,"abstract":"<p><p>At the end of surgical therapy, the access is closed with sutures. Surgical sutures are thus used to adapt wound edges and tissues. The task of the suture material is to hold the tissues together until healing. For patients, a cosmetically good suture is often the sign of good surgery. Different tissues and layers have different requirements regarding the suture material. The different types from monofil to polyfil, braided, from absorbable to nonabsorbable are presented. The classification of suture strengths is compared. The areas of application of different strengths and the duration until removal of the sutures for the different body regions are presented. The one-hand and two-hand techniques of surgical knots are explained in detail. The technique of suture removal is presented. In the online material, the suture materials of different composition and manufacturers can be compared.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"298-316"},"PeriodicalIF":0.7,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10520208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10568471","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":"Commercially manufactured spacers for the treatment of periprosthetic joint infection of the hip.","authors":"Max Jaenisch,&nbsp;Soufian Ben Amar,&nbsp;Mari Babasiz,&nbsp;Charlotte Rommelspacher,&nbsp;Matthias Dominik Wimmer,&nbsp;Dieter Christian Wirtz,&nbsp;Thomas Martin Randau","doi":"10.1007/s00064-023-00802-0","DOIUrl":"https://doi.org/10.1007/s00064-023-00802-0","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infection remains a common and serious complication after hip arthroplasty. To improve function and patient comfort after joint removal in two-stage revision, commercially manufactured spacers for the hip joint allow retention of the anatomical joint geometry thereby limiting soft tissue contraction and allow mobilization.</p><p><strong>Indications: </strong>Periprosthetic joint infection of the hip, septic arthritis with severe destruction of the hip cartilage and/or bone requiring arthroplasty.</p><p><strong>Contraindications: </strong>Allergies to polymethylmethacrylate (PMMA) or antibiotics, severe hip dysplasia with insufficient cranial support, incompliant patient, large osseous defect of the acetabulum, insufficient metaphyseal/diaphyseal support of the femoral bone, resistance of the microbiological pathogen to spacer-inert antibiotic medication, inability to perform primary wound closure requiring temporary open-wound therapy.</p><p><strong>Surgical technique: </strong>Preoperative templating on radiograph; removal of joint prosthesis and thorough debridement with removal of all foreign material; trial spacer selection and insertion and trial reduction of the joint, fixing the spacer with PMMA to the proximal femur, final reduction, radiograph and stability test.</p><p><strong>Results: </strong>Data were analyzed from patients treated between 2016 and 2021. In all, 20 patients were treated with preformed spacers and 16 with custom-made spacers. Pathogens were detected in 23 of the 36 cases (64%). Polymicrobial infections were present in 8 of 36 cases (22%). In patients who received preformed spacers, there were 6 cases of spacer-related complications (30%). Of the 36 patients (83%), 30 were reimplanted with a new implant; 3 patients died due to septic or other complications before reimplantation (8%). Average follow-up was 20.2 months after reimplantation. There were no major differences between the two groups of spacers. Patient comfort was not measured.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":"35 3-4","pages":"179-187"},"PeriodicalIF":0.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9591543","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":"Spacers for periprosthetic infections.","authors":"Maximilian Rudert,&nbsp;Dieter C Wirtz","doi":"10.1007/s00064-023-00813-x","DOIUrl":"https://doi.org/10.1007/s00064-023-00813-x","url":null,"abstract":"","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":"35 3-4","pages":"133-134"},"PeriodicalIF":0.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9793361","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":"Handmade spacers for two-stage exchange at the hip.","authors":"Sebastian von Hertzberg-Bölch,&nbsp;Martin Luedemann,&nbsp;Jan Oberfeld,&nbsp;Axel Jakuscheit,&nbsp;Maximilian Rudert","doi":"10.1007/s00064-023-00811-z","DOIUrl":"https://doi.org/10.1007/s00064-023-00811-z","url":null,"abstract":"<p><strong>Objective: </strong>Two-stage exchange with implantation of a temporary spacer is the gold standard treatment for chronic periprosthetic joint infection of the hip. This article describes a simple and safe technique for handmade spacers at the hip.</p><p><strong>Indication: </strong>Periprosthetic joint infection of the hip. Septic arthritis of the native joint.</p><p><strong>Contraindications: </strong>Known allergy against components of polymethylmethacrylate bone cements. Inadequate compliance for two-stage exchange. Patient unfit to undergo two-stage exchange. Bony defect situation at the acetabulum impeding stable reduction of the spacer. Bone loss at the femur jeopardizing stable fixation of the stem. Soft tissue damage with need for plastic temporary vacuum-assisted wound closure (VAC) therapy.</p><p><strong>Surgical technique: </strong>Tailoring bone cement with antibiotics. Preparation of a metal endoskeleton. Molding of spacer stem and head by hand. Customizing spacer off-sets to bony anatomy and soft tissue tension. Implantation assuring rotational stability at the femur with a bone cement collar. Confirmation of correct position by intraoperative radiography.</p><p><strong>Postoperative management: </strong>Restricted weight-bearing. Range of motion as possible. Reimplantation after successful treatment of infection.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":"35 3-4","pages":"146-153"},"PeriodicalIF":0.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9597867","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":"Temporary arthrodesis through static spacer implantation in two-stage treatment of periprosthetic joint infections of the knee.","authors":"Max Jaenisch,&nbsp;Soufian Ben Amar,&nbsp;Mari Babasiz,&nbsp;Alexander Seuser,&nbsp;Hendrik Kohlhof,&nbsp;Dieter Christian Wirtz,&nbsp;Thomas Martin Randau","doi":"10.1007/s00064-023-00809-7","DOIUrl":"https://doi.org/10.1007/s00064-023-00809-7","url":null,"abstract":"<p><strong>Objective: </strong>Treatment of chronic periprosthetic joint infection of the knee requires the removal of the implant and thorough debridement, with reimplantation in a second stage surgery. Intramedullary spacers can be helpful during the interval between explantation and reimplantation and provide a temporary arthrodesis which fixes the knee in extension preserving leg length and administers local antibiotic therapy.</p><p><strong>Indications: </strong>Periprosthetic joint infection of the knee with large bony defects and severe infection of the native joint with advanced destruction/infiltration of the cartilage and bone and/or ligament insufficiency.</p><p><strong>Contraindications: </strong>Suspected antibiotic resistance of the microbiological pathogen to local antibiotic drugs, incompliant patient, and known allergy to bone cement or antibiotic.</p><p><strong>Surgical technique: </strong>After implant removal, suitable metal rods are coated with antibiotic-loaded bone cement and inserted into the cleaned intramedullary canals of femur and tibia. Rods are joined at the joint line with a connector and joint space is filled with more bone cement to achieve temporary and very stable arthrodesis.</p><p><strong>Postoperative management: </strong>Partial weight-bearing and no flexion/extension while spacer is in place; second stage reimplantation as soon as infection is controlled.</p><p><strong>Results: </strong>Complications related to the spacer were rare (5.3%). Reimplantation of an implant was possible in 95 of 113 patients (84%), of those, 23 (20%) received an arthrodesis. Of the 95 patients that were reimplanted, 14 showed signs of recurrent infection. Mean time to last follow-up was 15.6 months post reimplantation. Mean knee pain was 2.9/10; overall function was good; 6 patients had an extension lag; mean total range of motion was 88°.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":"35 3-4","pages":"170-178"},"PeriodicalIF":0.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9594013","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 muscular torticollis].","authors":"Milena M Ploeger,&nbsp;Christoph Trillhaase,&nbsp;Charlotte Rommelspacher,&nbsp;Rahel Bornemann,&nbsp;Robert Ossendorf,&nbsp;Richard Placzek","doi":"10.1007/s00064-023-00805-x","DOIUrl":"https://doi.org/10.1007/s00064-023-00805-x","url":null,"abstract":"<p><strong>Objective: </strong>Surgical treatment of congenital muscular torticollis with tripolar release of the sternocleidomastoid muscle, followed by modified postoperative treatment with a special orthosis.</p><p><strong>Indications: </strong>Muscular torticollis due to contracture of the sternocleidomastoid muscle; failure of conservative therapy.</p><p><strong>Contraindications: </strong>Torticollis due to bony anomaly or other muscular contractures.</p><p><strong>Surgical technique: </strong>Tenotomy of the sternocleidomastoid muscle occipitally and resection of at least 1 cm of the tendon at the sternal and clavicular origin.</p><p><strong>Postoperative management: </strong>Orthosis must be worn for 6 weeks 24 h/day, then for another 6 weeks 12 h/day.</p><p><strong>Results: </strong>A total of 13 patients were treated with tripolar release of the sternocleidomastoid muscle and modified postoperative management. Average follow-up time was 25.7 months. One patient presented with recurrence after 3 years. No intra- or postoperative complications were observed.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":"35 3-4","pages":"188-194"},"PeriodicalIF":0.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10247838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9595700","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":"[The conjoined latissimus dorsi and parascapular free flap for reconstruction of extensive soft tissue defects].","authors":"Benjamin Thomas,&nbsp;Florian Falkner,&nbsp;Emre Gazyakan,&nbsp;Leila Harhaus,&nbsp;Ulrich Kneser,&nbsp;Amir Khosrow Bigdeli","doi":"10.1007/s00064-023-00806-w","DOIUrl":"https://doi.org/10.1007/s00064-023-00806-w","url":null,"abstract":"<p><strong>Objective: </strong>Durable and resilient soft tissue reconstruction of vast defects of the extremities or the torso.</p><p><strong>Indications: </strong>Reconstruction of disproportionately large defects, particularly in cases of simultaneous bone and joint reconstruction.</p><p><strong>Contraindications: </strong>History of surgery or irradiation of upper back and axilla, impossibility of surgery under lateral positioning; relative contraindications in wheelchair users, hemiplegics, or amputees.</p><p><strong>Surgical technique: </strong>General anesthesia and lateral positioning. First, the parascapular flap is harvested, with the initial skin incision made medially in order to identify the medial triangular space and the circumflex scapular artery. Flap raising then proceeds from caudal to cranial. Second, the latissimus dorsi is harvested, with the lateral border being dissected free first, before the thoracodorsal vessels are visualized on its undersurface. Flap raising then proceeds from caudal to cranial. Third, the parascapular flap is advanced through the medial triangular space. If the circumflex scapular and thoracodorsal vessels originate separately from the subscapular axis, an in-flap anastomosis is warranted. Subsequent microvascular anastomoses should be performed outside the zone of injury, typically in an end-to-end fashion of the vein and end-to-side fashion of the artery.</p><p><strong>Postoperative management: </strong>Postoperative anticoagulation with low-molecular-weight heparin under anti-Xa monitoring (semitherapeutic in normal-risk and therapeutic in high-risk cases). Hourly clinical assessment of flap perfusion for 5 consecutive days, followed by stepwise relaxation of immobilization and commencement of dangling procedures in cases of lower extremity reconstruction.</p><p><strong>Results: </strong>Between 2013 and 2018, 74 conjoined latissimus dorsi and parascapular flaps were transplanted to cover vast defects of the lower (n = 66) and upper extremity (n = 8). The mean defect size was 723 ± 482 cm² and the mean flap size was 635 ± 203 cm². Eight flaps required in-flap anastomoses for separate vascular origins. There was no case of total flap loss.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":"35 3-4","pages":"205-222"},"PeriodicalIF":0.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9585777","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 and preliminary results of a moulded, mobile spacer for the treatment of periprosthetic joint infection of the knee.","authors":"Max Jaenisch,&nbsp;Mari Babasiz,&nbsp;Soufian Ben Amar,&nbsp;Eva Lück,&nbsp;Martin Gathen,&nbsp;Dieter Christian Wirtz,&nbsp;Thomas Martin Randau","doi":"10.1007/s00064-023-00803-z","DOIUrl":"10.1007/s00064-023-00803-z","url":null,"abstract":"<p><strong>Objective: </strong>Mobile knee spacers can be utilized in the first stage of a two-stage exchange in periprosthetic joint infection or septic arthritis of the knee to prevent soft tissue contraction, enable local antibiotic elution, and improve patient mobility. Commercially made moulds enable the surgeon to prepare a reproducible spacer design and match the preparation of the arthroplasty, which will be carried out in a second step.</p><p><strong>Indications: </strong>Periprosthetic joint infection of the knee and severe cases of septic arthritis of the knee with advanced destruction/infiltration of the cartilage.</p><p><strong>Contraindications: </strong>Antibiotic resistance of the microbiological pathogen to available antibiotic agents, incompliant patient, large osseous defect preventing proper fixation, known allergy to polymethylmethacrylate (PMMA) or antibiotic, severe soft tissue damage with high ligament instability, especially deterioration of extensor mechanism and insufficient patella/quadricep tendon.</p><p><strong>Surgical technique: </strong>After thorough debridement and removal of all foreign material, cutting blocks are used to shape femur and tibia to the implant design required. Using a silicone mould, PMMA with suitable antibiotics is moulded into the shape of the future implant. After polymerization, the implants are fixed onto the bone with additional PMMA without pressurize for the sake of easy removal.</p><p><strong>Postoperative management: </strong>Partial weight bearing with no restriction of flexion/extension while spacer is in place; second stage reimplantation as soon as infection is controlled.</p><p><strong>Results: </strong>In all, 22 cases were treated, mostly with a PMMA spacer containing gentamicin and vancomycin. Pathogens were detected in 13 of 22 cases (59%). We observed two complications (9%). Twenty of 22 patients (86%) were reimplanted with a new arthroplasty; 16 of the 20 patients remained revision-free and infection-free at the last follow-up (average time to follow-up 13 months, range 1-46 months). Average range of motion in flexion and extension at follow-up was 98°.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":"35 3-4","pages":"163-169"},"PeriodicalIF":0.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9591529","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":"[Endoscopic release of the carpal tunnel using the Agee technique modified by Neumann].","authors":"A Neumann,&nbsp;T Kponton","doi":"10.1007/s00064-023-00804-y","DOIUrl":"https://doi.org/10.1007/s00064-023-00804-y","url":null,"abstract":"<p><strong>Objective: </strong>Decompression of the median nerve by complete endoscopic release of the transverse carpal ligament (TCL) and the distal antebrachial fascia. Minimization of surgical trauma results in decreased postoperative morbidity and earlier return to work and daily activities.</p><p><strong>Indications: </strong>Symptomatic carpal tunnel syndrome.</p><p><strong>Contraindications: </strong>Revision surgery after open or endoscopic procedure, rheumatic diseases.</p><p><strong>Surgical technique: </strong>Small transverse incision at the ulnar border of the palmaris longus tendon, and proximal to the distal wrist flexion crease. Exposure and incision of the antebrachial fascia, dilatation of the carpal tunnel and dissection of synovial tissue from the undersurface of the TCL. With the wrist in extension, the endoscopic blade assembly with integrated camera is inserted into the canal. Exposure of TCL and short incision in the middle portion. Gradually, dissection of the distal portion of the TCL then completion by retraction of the blade distally to proximally.</p><p><strong>Postoperative management: </strong>Slightly compressive dressing, selfcare on day 1 after procedure.</p><p><strong>Results: </strong>More than 25 years of experience, more than 8000 treated patients, and 3 documented cases with intraoperative lesions of the median nerve requiring revision. High acceptance and patient satisfaction in AQS1 patient-reported surveillance.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":"35 3-4","pages":"195-204"},"PeriodicalIF":0.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9592024","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":"Patient-specific articulating spacer for two-stage shoulder arthroplasty exchange.","authors":"Kilian List,&nbsp;Laura Elisa Streck,&nbsp;Chiara Gaal,&nbsp;Leonard Achenbach,&nbsp;David Dines,&nbsp;Maximilian Rudert","doi":"10.1007/s00064-023-00801-1","DOIUrl":"https://doi.org/10.1007/s00064-023-00801-1","url":null,"abstract":"<p><strong>Objective: </strong>Two-stage exchange with an antibiotic-loaded polymethylmethacrylate (PMMA) spacer is standard treatment for chronic periprosthetic joint infection of the shoulder. We present a safe and simple technique for patient-specific spacer implants.</p><p><strong>Indication: </strong>(Chronic) periprosthetic joint infection of the shoulder.</p><p><strong>Relative contraindications: </strong>Known allergy against components of PMMA bone cements. Inadequate compliance for two-stage exchange. Patient is unfit to undergo two-stage exchange.</p><p><strong>Surgical technique: </strong>Hardware removal, histologic and microbiologic samples, and debridement. Preparation of targeted or calculated antibiotic-loaded PMMA. Tailoring of patient-specific spacer. Spacer implantation.</p><p><strong>Postoperative management: </strong>Rehabilitation protocol. Antibiotic treatment. Reimplantation after successful eradication of infection.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":"35 3-4","pages":"135-145"},"PeriodicalIF":0.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9647840","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}