Mid-term results of a cementless hip stem in femoral revision: how much diaphyseal press-fit do we need?

Introduction: The aim of this retrospective study was to analyze the clinical and functional outcome of a modular tapered revision hip stem after mid-term follow-up with a special focus on the length of the distal bicortical fixation of the cementless hip stem.

Materials And Methods: Follow-up examination was carried out for all patients with implantation of the Prevision hip stem between 2014 and 2019 to collect demographic, functional, and radiographic data.

Results: 44 patients with stem in situ were examined, and 61 patients could be included in the Kaplan-Meier survival analysis.

The Requirement for Closed Reduction of Dorsally Displaced Unstable Distal Radius Fractures Before Operative Treatment.

Background: Dorsally displaced distal radius fractures are generally treated with closed reduction followed by casting. Current evidence suggests that fracture reduction is of no benefit before either conservative or surgical treatment. It has not been studied to date whether the degree of pain suffered by the patient during preoperative casting is any different if the fracture is reduced beforehand.

Pain Perception following Initial Closed Reduction in the Preoperative Care of Unstable, Dorsally Displaced Distal Radius Fractures.

Closed reduction and cast immobilization is a common practice as initial treatment for distal radius fractures. This study examines the pain perception that accompanies this approach. Thirty dorsally displaced distal radius fractures were reduced and casted under finger-trap traction with intravenous analgesics.

The required minimum length of video sequences for obtaining a reliable interobserver diagnosis in wrist arthroscopies.

Purpose: To examine the relationship between video length for wrist arthroscopy and interobserver reliability.

Materials And Methods: 100 consecutive wrist arthroscopies were documented by long and short videos of the radiocarpal and the midcarpal joints. The long videos were about twice as long as the short videos.

[Standard wrist arthroscopy: technique and documentation].

Objective: Minimally invasive approach to the wrist in order to diagnose and treat different wrist pathologies.

Indications: Diagnosis of unclear chronic pain syndromes, cartilage status, intra-articular ligament structures as well as post-traumatic and inflammatory conditions of the wrist. Treatment of ulnar impaction syndrome, dorsal ganglia and also in fracture treatment and various different wrist interventions.

[The "wide-awake approach" - efficiency and patient safety in carpal tunnel releases].

In order to improve operating room efficiency in our institution, we introduced the wide-wake approach for carpal tunnel releases in 2012. This study examines the effect of this new anaesthetic technique on the work-flow and the duration of operation compared to the previously used axillary plexus anaesthesia.In this retrospective study, we reviewed the surgical case data of all patients in whom carpal tunnel releases had been performed as single procedures.

[Pediculated deltoid muscle flap: an alternative for coverage of chronic radionecrotic lesions in the shoulder region].

Soft tissue lesions in the clavicular region may be the result of trauma, infections or oncological resection and necessitate plastic surgery coverage. A case of an 85-year-old woman is presented with non-union of the mid-portion of the left clavicle with an overlying skin defect and a brachial plexus lesion after radiation therapy for breast cancer. The left arm was functionless so after partial resection of the medial part of the clavicle coverage of the defect was conducted by a proximally pediculated anterior part of the deltoid muscle with a split thickness skin graft.

Standardized palmar plating of dorsally displaced distal radius fractures.

With the inauguration of fixed-angle plates, palmar plating has become a widely accepted way to treat dorsally displaced distal radius fractures. The technique by which the plate is applied to the radius varies. Such plates are primarily fixed either distally or at the proximal limbs.

The complexity of proximal humeral fractures is age and gender specific.

Background: Studies that investigated possible associations between the complexity of proximal humeral fractures and patient characteristics are rare. We hypothesized that the grade of fracture complexity may correlate with age and gender of hospitalized, adult patients.

Methods: Based on the Neer classification, we defined four radiological grades of fracture complexity.

Clinical and radiological evaluation of minimally displaced proximal humeral fractures.

Introduction: The purpose of this prospective study was to assess the Constant score and radiographic outcome in 66 patients (mean age 58.7 years/mean follow-up 51 months) with a minimally displaced and/or impacted fracture of the proximal humerus treated with early mobilization.

Method: Special attention was paid to analyze the specific intrinsic parameters (age, gender, ASA grade and length of physiotherapy), injury-related parameters (classification, osteoporosis) and therapy-related parameters (initial fracture displacement, residual bony-deformity after healing, secondary fracture displacement during healing period, non-union, humeral head necrosis and omarthrosis) that may influence the final score.

Long-term results after non-plate head-preserving fixation of proximal humeral fractures.

A retrospective study was conducted to evaluate displaced proximal humeral fractures treated with a non-plate head-preserving fixation and to detect factors predicting functional outcome. After a median follow-up period of 79.7 months, 105 patients with nine A-fractures, 36 B-fractures and 60 C-fractures (nine two-part-fractures, 41 three-part fractures and 55 four-part fractures) were assessed.

Indications for computed tomography (CT-) diagnostics in proximal humeral fractures: a comparative study of plain radiography and computed tomography.

Background: Precise indications for computed tomography (CT) in proximal humeral fractures are not established. The purpose of this study was a comparison of conventional radiographic views with different CT reconstructions with 2 D and 3 D imaging to establish indications for additional CT diagnostics depending on the fractured parts.

Methods: In a prospective diagnostic study in two level 1 trauma centers, 44 patients with proximal humeral fractures were diagnosed with conventional X-rays (22 AP + axillary views, 22 AP + scapular Y-views) and CT (multi-planar reconstruction (MPR) and maximum intensity projection (MIP)) with 2 D and 3 D imaging.

Proximal humeral fractures in children and adolescents.

Background: The purpose of the study was to investigate possible reasons for the failure of closed reduction of proximal humerus fractures in children and adolescents. We assessed the rate of soft tissue entrapment, and we also investigated the long-term clinical and radiological results after an age- and deformity-focused treatment regimen according to national guidelines.

Methods: Forty-three patients were included in the study.

Does fixed-angle plate osteosynthesis solve the problems of a fractured proximal humerus? A prospective series of 87 patients.

Background And Purpose: There is considerable controversy about the treatment of complex, displaced proximal humeral fractures. Various types of head-preserving osteosynthesis have been suggested. This prospective case series was designed to evaluate the perioperative and early postoperative complications associated with fixed-angle implants and to record outcome after bone healing.

[Evaluation of a strategy for the management of accompanying osteoporosis after inpatient treatment of fragility fractures].

Aim: The aim of the present study was to evaluate a strategy for the management of accompanying osteoporosis after inpatient treatment of fragility fractures.

Method: A prospective group of patients that was treated for acute fragility fractures between 9/05 and 2/06 was informed about a concomitant osteoporosis according to the national guidelines. Standardised letters with instructions for diagnostics and therapy for osteoporosis were given to patients, members of the family and outpatient care, rehab-clinic and GPs.

Treatment of large femoral bone defects--15-year experiences with the cementless Bicontact revision stem with distal interlocking.

Aim: With the steady growth in the number of hip arthroplasty revision operations, the concept and long-term results of the Bicontact revision stem with distal interlocking for the treatment of extensive femoral bone defects were investigated in this prospective study.

Method: The first 156 stem revision operations performed between January 1992 and December 2002 were evaluated. The indication for operation was aseptic loosening in 133, stem fracture in 14, recurrent dislocation in 2 and reimplantation following Girdlestone removal of a septic prosthesis in 7.

Prospective long-term follow-up of the cementless bicontact hip stem with plasmapore coating.

Aim: A prospective long-term study of the first 250 cementless Bicontact stems implanted in the BG Trauma Centre, Tuebingen, Germany.

Method: All of the patients in this series (treatment period June 1987 to April 1990) who were still contactable were invited for clinical and radiological follow-up. The radiographs were analysed for signs of loosening in the form of Gruen lysis zones, stress shielding, subsidence behaviour, heterotopic ossification and spot welds.

Treatment of periprosthetic femoral fractures with the Bicontact revision stem.

Purpose: Periprosthetic fractures in cases without prior loosening of the stem can be treated with open reduction and internal fixation, but cases with preexisting loosening and/or bone defects present specific challenges to the surgeon. The keys to the success of intramedullary stabilization of femoral fractures--reconstruction of length, axis and rotation rather than meticulous reduction of the fragments and minimal impact on fragment vascularization by the surgical approach--can be transferred to the treatment of periprosthetic fractures.

Method: The Bicontact revision stem can be regarded as a combination of an interlocking nail in its distal part and a proximally coated femoral stem in its proximal part.

Intramedullary Stabilization of Periprosthetic Fractures of the Femur Taking Special Account of Bone Defects.

Objective: Healing of the periprosthetic fracture and area of defective bone by the bone healing mechanisms of intramedullary stabilization. Reconstruction of the correct length, axial alignment, and rotation of the fractured femoral shaft by anchoring a revision stem in the intact femoral diaphysis.

Indications: Periprosthetic femoral shaft fracture in the region of the prosthetic stem combined with preexistent loosening and/or defect in the periprosthetic bone bed (Vancouver classification type B2 and B3).

Total hip arthroplasty by a minimally invasive, direct anterior approach.

Objective: Implantation of a total hip replacement device through a direct anterior approach to the hip joint with minimal trauma to adjacent tissue.

Indications: All conventional total hip replacements, irrespective of age and bone quality.

Contraindications: Destruction of the proximal femur (tumor, fracture).

Femoral subsidence assessment after hip replacement: an experimental study.

Background: In an experimental set up information is to be gained on the error of measurement for subsidence assessment of the stem after hip replacement.

Methods: Subsidence was measured with a pencil and ruler for four different reference lines and with the computerized EBRA-FCA method. Hip flexion, rotation and abduction were simulated in a standardized way.

[Bone tunnel fixation versus suture anchor: mid- and long-term results after distal biceps tendon rupture].

Aim: The aim of this study was to assess the range of movement, isometric and isokinetic postoperative outcome, Morrey score and heterotropic ossifications after refixation of distal biceps tendon rupture with either suture anchor or bone tunnel fixation.

Methods: 48 patients were surgically treated between 1990 and 2005. Elbow function was investigated isometrically and isokinetically with the CYBEX-NORM.

Current trends in total hip arthroplasty.

After 20 years of application, with excellent short-term and long-term results, uncemented total hip arthroplasty (THA) is now generally regarded as the standard procedure for younger patients undergoing THA. However, expectations regarding hip replacement are continuously rising, along with the increasing number of young and active patients undergoing hip arthroplasty: a complication rate, including postoperative dislocation, close to zero, faster postoperative rehabilitation, low wear even in active patients, high durability and long term survival, etc. Demographic changes in aging societies are also leading to an increased need for cost-effective THA for the low-demand trauma patient.

[T-plate osteosynthesis--an obsolete osteosynthesis procedure for proximal humeral fractures? Middle-term clinical and radiological results].

Aim: The present clinical trial was performed to assess the clinical and radiological outcome after operative treatment of proximal humeral fractures using the T-plate.

Methods: All patients who were treated with the T-plate were included into the study. Patient satisfaction,complications and radiological findings were assessed.

[Bone tunnel fixation versus suture anchor: mid- and long-term results after distal biceps tendon rupture].

Aim: The aim of this study was to assess the range of movement, isometric and is okinetic postoperative outcome, Morrey score and heterotropic ossifications after refixation of distal biceps tendon rupture with either suture anchor or bone tunnel fixation.

Methods: 48 patients were surgically treated between 1990 and 2005. Elbow function was investigated isometrically and isokinetically with the CYBEX-NORM.