[Periarticular knee osteotomies for pre-arthritic deformities in the frontal plane : Indications and surgical techniques].

Background: Currently, periarticular knee joint osteotomies are an integral part of the treatment of early arthritic deformities in the knee joint.

Diagnostics: Analysis of the deformity is performed with a standardized full-leg standing x‑ray of both legs, as well as a lateral x‑ray of the knee joint that includes 2/3 of the proximal tibial shaft. An MRI examination of the knee joint is obtained to assess the articular cartilage, the ligaments and menisci.

[Treatment of rotational malalignment of the lower leg].

Background: Rotational malalignment after intramedullary nailing of tibial shaft fractures is not uncommon. In-toeing and out-toeing conditions in children are often the reason for orthopedic and traumatological medical consultation.

Objective: Evaluation of diagnostic modalities and therapeutic options for rotational malalignment in relationship to the patient's age.

Noninvasive ultrasonic measuring system for bone geometry examination.

Background: Bone deformities are typically identified through standard radiograms. Since X-ray examinations are easily applied and offer high quality imaging, noninvasive techniques are not commonly used in bone diagnostics. Nevertheless, nonradiological techniques are considered necessary because of the harmful effects of X-ray radiation.

[Non-union of pediatric lateral humeral condyle following post-traumatic cubitus valgus].

Non-union of the pediatric lateral humeral condyle following post-traumatic cubitus valgus is a severe complication after inadequate treatment. We report on a then 14-year-old male patient who developed an increasingly defective position in terms of cubitus valgus after conservative treatment of a lateral humeral condyle fracture. After performing screw osteosynthesis and achieving consolidation, a successful supracondylar dome osteotomy was performed which led to relief from pain and free range of motion of the elbow joint.

Reliability of computer-assisted surgery as an intraoperative ruler in navigated high tibial osteotomy.

Background: Computer-assisted surgery (CAS) can act as an intraoperative ruler in high tibial osteotomy (HTO) to visualize continuously the leg during surgery.

Questions: The aim of the study is to evaluate the accuracy of CAS with respect to preoperative planning and postoperative deviation from the planned leg axis in HTO. In addition, the influence of surgeon experience as well as operation time and perioperative complications are analyzed.

Can computer-assisted surgery reduce the effective dose for spinal fusion and sacroiliac screw insertion?

Background: The increasing use of fluoroscopy-based surgical procedures and the associated exposure to radiation raise questions regarding potential risks for patients and operating room personnel. Computer-assisted technologies can help to reduce the emission of radiation; the effect on the patient's dose for the three-dimensional (3-D)-based technologies has not yet been evaluated.

Questions/purposes: We determined the effective and organ dose in dorsal spinal fusion and percutaneous transsacral screw stabilization during conventional fluoroscopy-assisted and computer-navigated procedures.

Limb geometry after elastic stable nailing for pediatric femoral fractures.

Background: Elastic stable intramedullary nailing has become a popular treatment for pediatric long-bone fractures. However, early limb malalignment and length differences may occur in children with femoral fractures who are managed with this procedure.

Methods: We prospectively followed sixty-eight children (mean age, 5.

Improving surgical precision--application of navigation system in orthopedic surgery.

Navigation systems track objects with precision expressed as root mean square equalling even up to 0.15 mm. Application of navigation system combined with imaging technique makes surgical operations less invasive, which results in the reduced risk of infection, smaller scar and a shorter time of rehabilitation.

[Clinical accuracy of fluoroscopic navigation at the thoracic and lumbar spine].

The aim of the present study was the verification of the accuracy of 2D fluoroscopy-based navigated pedicle screw placements at the thoracic and lumbar spine in a case series of traumatised patients. Within 36 months 111 pedicle screws were instrumented using C-arm based navigation in 29 patients, 60 at the thoracic and 51 at the lumbar spine. All screw positions were evaluated postoperatively by a routine thin-slice CT scan using multiplanar reconstruction.

[Clinical accuracy of fluoroscopic navigation at the thoracic and lumbar spine].

The aim of the present study was the verification of the accuracy of 2-D fluoroscopy-based navigated pedicle screws at the thoracic and lumbar spine in a case series of traumatised patients. Within 36 months 111 pedicle screws in 29 patients were instrumented using C-arm based navigation, 60 at the thoracic and 51 at the lumbar spine. All screw positions were evaluated postoperatively by a routine thin slice CT scan using multiplanar reconstruction.

A new experimental measurement and planning tool for sonographic-assisted navigation.

In this study, we present a new 2.5-dimensional ultrasonic navigation system for measuring axes, lengths, and torsions preoperatively, intraoperatively, and postoperatively. The system comprises an ultrasound unit with a 5-MHz linear probe (TELEMED Echoblaster 128; Telemed, Vilnius, Lithuania) and a navigation system (OrthoPilot; B.

Limb malalignment and functional outcome after antegrade versus retrograde intramedullary nailing in distal femoral fractures.

Background: Torsional malalignment and mechanical axis deviation (MAD) are worrisome complications after nailing of distal femoral fractures. Variable, sometimes contradictory, reports about these problems have been published.

Methods: In a retrospective nonrandomized study, 41 patients (mean age, 44.

Flexible intramedullary nailing in pediatric lower limb fractures.

Seventy-three children (48 boys and 25 girls; mean age, 5.7 years) with unilateral femoral or tibial shaft fractures were treated using elastic intramedullary nails at the authors' institution. There were 61 simple type A fractures (84%) and 12 wedge type B fractures (16%).

Hybrid external fixation for arthrodesis in knee sepsis.

Several techniques for knee fusion have been described with success rates ranging from 29% to 100%, with worse results occurring in patients with joint sepsis. We treated 21 patients with persistent infections using knee arthrodesis with a hybrid Ilizarov frame at our institution. There were 13 men and eight women ranging from 21 to 75 years (mean, 49.

Implementation, accuracy evaluation, and preliminary clinical trial of a CT-free navigation system for high tibial opening wedge osteotomy.

Objective: The objectives of this study are to design and evaluate a CT-free intra-operative planning and navigation system for high tibial opening wedge osteotomy. This is a widely accepted treatment for medial compartment osteoarthritis and other lower extremity deformities, particularly in young and active patients for whom total knee replacement is not advised. However, it is a technically demanding procedure.

[Computer-assisted knee surgery, what can we expect?].

Navigation systems for operative assistance in knee joint surgery have been established in the last 5 years. Among the large number of variable systems, the image-free kinematic systems have won widespread acceptance. The C-arm based systems are not superior to the image-free systems.

The effectiveness of physiotherapy after operative treatment of supracondylar humeral fractures in children.

The indications for physiotherapy after supracondylar humeral fractures in children are not clear in the literature, even in the presence of an active or passive limitation of elbow joint motion. The authors therefore performed a prospective randomized study to assess the effectiveness of physiotherapy in improving the elbow range of motion after such fractures. The authors studied two groups of 21 and 22 children with supracondylar humeral fractures Felsenreich types II and III, all without associated neurovascular deficits.

[Clinical results with A new retrograde femoral nail with a radiographical-free proximal locking device. A prospective study with 50 fractures].

Introduction: Conventional retrograde nailing of the femur causes two important disadvantages: the proximal locking of the nail is difficult because of the anatomic conditions and a chondral defect was left into the knee.

Material And Methods: After the retrograde implantation the new nail was lead through the greater trochanter. An additional proximal aiming device for proximal interlocking can be fixed.

[Post-traumatic torsional differences and functional tests following antegrade or retrograde intramedullary nailing of the distal femoral diaphysis].

Previous studies have compared the functional outcome and torsional differences following closed intramedullary nailing of femoral fractures. Rotational deformity following intramedullary nailing may cause symptoms and require surgical correction by osteotomy. Until now studies were designed to evaluate the correct torsional differences by examining every patient following antegrade or retrograde femoral nailing.

[Total knee arthroplasty--navigation as the standard].

Today the most common application in the field of computer-assisted surgery is navigated total knee arthroplasty. During the last 5 years the imageless kinematic navigation systems have gained wide acceptance. As several prospective randomized studies could show, the standard deviation of the mechanical axis is reduced significantly by these techniques.

Computer aided high tibial open wedge osteotomy.

High tibial osteotomy is a widely accepted treatment of medial compartment osteoarthritis as well as other lower extremity deformities. However, it is a technically demanding procedure. The lack of exact intraoperative real time control of the mechanical axis often results in postoperative malalignments, which is one reason for poor long term results.