Evaluation of the ankle function after Achilles tendon resection: a retrospective clinical study.

Introduction: The Achilles tendon is the strongest tendon in the human body and has the function of plantar ankle flexion. When the tendon is exposed, the peritendineum has been breached and the thick avascular tendon colonized with bacteria, a complete resection of the tendon may be indicated to achieve infection control and facilitate wound closure. The Achilles tendon reconstruction is not mandatory, as the plantar flexion of the ankle joint is assumed by the remaining flexor hallucis longus, flexor digitorum longus and tibialis posterior muscles.

[Surgical treatment of calcifying insertional Achilles tendinopathy via a lateral approach].

Objective: Reduction of pain and swelling over the Achilles tendon insertion while maintaining function.

Indications: Strong, intolerable pain over the Achilles tendon insertion with chronic, calcifying insertional tendinopathy that does not respond to non-operative treatment over a minimum of 6 months.

Contraindications: Chronic wounds or severe circulatory deficits at the foot or ankle, irradiating or projected pain, complex regional pain syndrome (CRPS).

[Less invasive turn-down flap tendinoplasty in chronic Achilles tendon rupture].

Objective: Bridging the defect in chronic ruptures of the Achilles tendon via a turn-down flap of the aponeurosis sparing the skin of the rupture zone.

Indications: Chronic Achilles tendon rupture with a defect distance ≤ 6 cm.

Contraindications: Extended Achilles tendon defect interval ≥ 7 cm, chronic wounds or infections near the surgical approach, higher degrees of arterial or venous malperfusion, complex regional pain syndrome.

Prolonged Application of Continuous Passive Movement Improves the Postoperative Recovery of Tibial Head Fractures: A Prospective Randomized Controlled Study.

Methods: 60 patients with THFs were randomly and equally divided into the CPM group and non-CPM group. Both groups immediately received CPM and conventional physical therapies during hospitalization. After discharge, the non-CPM group was treated with conventional physical therapy alone, while the CPM group received conventional physical training in combination with CPM treatment.

Percutaneous Achilles tendon repair with the Dresden instrument. Clinical and MRI evaluation of 90 patients.

Background: This study aims at evaluating a substantial number of patients treated with a percutaneous, paratenon preserving technique for Achilles tendon repair using three different incisions with clinical follow-up and magnetic resonance imaging (MRI).

Methods: Ninety patients with percutaneous Achilles tendon repair using the Dresden technique for acute rupture were evaluated. Fifteen patients were treated using a central approach, 15 patients using a posterolateral approach and the original posteromedial approach was used in 60 patients.

Interlocking Nail Fixation for the Treatment of Displaced Intra-Articular Calcaneal Fractures.

Introduction: Less invasive restoration of joint congruity and calcaneal shape in displaced intra-articular calcaneal fractures via a sinus tarsi approach followed by percutaneous internal fixation with an interlocking nail results in a low rate of soft-tissue complications and good short-term outcomes (Video 1).

Step 1 Patient Placement: Place the patient in the lateral decubitus position, supporting the involved extremity with a soft radiolucent pillow, flex the contralateral knee, check with fluoroscopy before draping, and obtain lateral radiographs.

Step 2 Incision: Use a sinus tarsi approach for control of the articular reduction.

[Treatment of calcaneal fractures with a locking nail (C-Nail)].

Objective: Anatomic reconstruction of the posterior facet by primary stabilization of the calcaneal fracture with a locking nail.

Indications: All intraarticular calcaneal fractures and unstable two-part fractures independent of the degree of closed/open soft tissue trauma.

Contraindications: High perioperative risk, soft tissue infection, beak fracture (type II fracture) and still open apophysis.

[New techniques in the operative treatment of calcaneal fractures].

The ideal treatment of displaced intra-articular calcaneal fractures is still controversially discussed. Because of the variable fracture patterns and the vulnerable soft tissue coverage an individual treatment concept is advisable. In order to minimize wound edge necrosis associated with extended lateral approaches, selected fractures may be treated percutaneously or in a less invasive manner while controlling joint reduction via a sinus tarsi approach.

Introduction of a New Locking Nail for Treatment of Intraarticular Calcaneal Fractures.

Objectives: To reduce the complication rate associated with open reduction and internal fixation of displaced intraarticular calcaneal fractures through extensile approaches, a locking nail system (C-Nail) was developed for internal fixation.

Design: Prospective case-control study.

Setting: Two level I trauma centers (university hospital) and 1 large regional hospital in the Czech Republic and Germany.

[Treatment of fractures of the ankle in the elderly].

Background: Osteoporotic fractures of the ankle were observed three times more often in the year 2000 than in the year 1970 and it is predicted that this will increase another three times by the year 2030. The most important predictive values for ankle fractures in the elderly are smoking, multipharmacy and poor mobility.

Injury Patterns: Conservative treatment only seems to be successful in stable ankle fractures with good surrounding soft tissue.

[Operative treatment of displaced intra-articular calcaneal fractures].

Objective: Anatomic reduction of displaced intra-articular calcaneal fractures with restoration of height, length, and axial alignment and reconstruction of the subtalar and calcaneocuboid joints.

Indications: Displaced intra-articular calcaneal fractures with incongruity of the posterior facet of the subtalar joint, loss of height, and axial malalignment.

Contraindications: High perioperative risk, soft tissue infection, advanced peripheral arterial disease (stage III), neurogenic osteoarthropathy, poor patient compliance (e.

Direct plantar approach to Henry's knot for flexor hallucis longus transfer.

Background: Transfer of the flexor hallucis longus (FHL) tendon is an established method to replace a dysfunctional Achilles tendon. When using a single incision, the FHL tendon has to be transferred as a single stranded graft into the calcaneus and the distal FHL stump cannot be directly attached to the flexor digitorum longus tendon (FDL). Another concern with tendon retrieval is neurovascular damage.

[Tendinosis and ruptures of the Achilles tendon].

Tendinosis of the Achilles tendon is a degenerative-reparative structural change of the tendon with microdefects, increases in cross-section due to cicatricial tendon regeneration, neoangiogenesis and reduction of elasticity. The previously used term tendinitis is only rarely used for the chronic form since signs of inflammation such as redness and hyperthermia or elevated levels of inflammatory parameters on laboratory testing are generally absent. Duplex sonography with visualization of the neovascularization has become a valuable supplement not only for diagnostics but also for therapy planning.

Ultrasonographic classification of achilles tendon ruptures as a rationale for individual treatment selection.

Purpose. This work introduces a distinct sonographic classification of Achilles tendon ruptures which has proven itself to be a reliable instrument for an individualized and differentiated therapy selection for patients who have suffered an Achilles tendon rupture. Materials and Methods.

[Surgical treatment of Achilles tendon rupture].

The open tendon suture is the most commonly used method of treatment for Achilles tendon rupture in Germany. Over the last decade the therapeutic spectrum of operative methods has been further enlarged by the development of new minimally invasive surgical techniques. Important criteria for planning treatment are the location and age of the rupture and comorbidities.

Percutaneous treatment of less severe intraarticular calcaneal fractures.

Unlabelled: Percutaneous treatment of calcaneal fractures is intended to reduce soft tissue complications and postoperative stiffness of the subtalar joint. We assessed the complications, clinical hindfoot alignment, motion, functional outcome scores, and radiographic correction of percutaneous arthroscopically assisted reduction and screw fixation of selected, less severe fractures. We performed percutaneous reduction and screw fixation in 61 patients with Type II (Sanders et al.

[Surgical management of talipes equinovarus as sequelae of a compartment and/or postischemic syndrome of the deep flexor compartment of the lower leg].

Cases of posttraumatic pes equinovarus after compartment syndrome have become more frequent in the last 3 decades because limb-saving procedures like compartment splitting, vascular repair, and microvascular free flaps have become well established in trauma surgery, thus reducing early below knee amputations. But if the deep flexor compartment is not split completely or if the muscles are crushed by direct trauma severe necrosis and subsequent muscle contractures result in a very severe clubfoot deformity. Metatarsalgia of fifth, fourth, and third metatarsal head even in well-fitted orthopaedic shoes occurs as well as painful bunions and fatigue fractures of the fifth metatarsal.

[Transfer of the flexor hallucis longus to replace the Achilles tendon: indications, technique and results].

Background: Transfer of the flexor hallucis longus (FHL) tendon is a therapeutic option to replace a dysfunctional Achilles tendon in cases of rerupture with large defects, loss of the Achilles tendon after postoperative infection or severe tendinosis.

Materials And Methods: Between January 1994 and December 2005, 35 patients (5 female and 30 male, average age 47 years) were treated with 36 FHL transfers and 25 patients with 26 FHL transfers could be re-evaluated at a mean follow-up time of 79 months (range 20-133 months) after surgery.

Results: Of the 25 patients, 18 (72%) subjectively rated the result as excellent, 5 (20%) as good, and 1 patient (4%) each as fair and poor.

Transsection of the rectus abdominis muscle in the treatment of acetabular fractures: operative technique and outcome in 21 patients.

Background: A standard ilioinguinal approach is often insufficient for reduction and stabilization of the medial acetabular wall and the dorsal column in acetabular fractures. To avoid extended approaches, we have used a medial extension of the approach by transverse splitting of the rectus abdominis muscle. We have thus been able to reduce and stabilize transverse and oblique fractures of the dorsal column and the medial acetabular wall and to fix plates in a mechanically better position below the pelvic brim.

Results of dorsal or volar plate fixation of AO type C3 distal radius fractures: a retrospective study.

Purpose: The aim of this study was to define the outcome after dorsal or volar plating of Association for Osteosynthesis (AO) type C3 distal radius fractures based on the fracture morphology.

Methods: Twenty-nine patients with AO type C3 distal radius fractures were surgically managed between 1996 and 2005. Group 1 (n = 15) had volar plating.

[Relative value of internal fixation with K-wires in the treatment of fractures of the distal radius. Study in patients affected by multiple morbidities or dementia].

The age distribution of patients with distal radius fractures shows a clear predominance of patients over 60. In such patients fractures must be treated with due consideration for the general condition, accompanying illnesses, such as osteoporosis, and the often lesser ambitions concerning the function of the wrist joint. Three cases of patients over 70 years of age are presented: two of these patients were suffering from dementia and one, from multiple morbidities and poor general condition: In all three, severe osteitis of the distal radius developed after K-wire pinning to treat distal radius fractures.