Angular stable locking in a novel intramedullary nail improves construct stability in a distal tibia fracture model.

Introduction: Intramedullary nails are frequently used for treatment of unstable distal tibia fractures. However, insufficient fixation of the distal fragment could result in delayed healing, malunion or nonunion. Recently, a novel concept for angular stable nailing was developed that maintains the principle of relative stability and introduces improvements expected to reduce nail toggling, screw migration and secondary loss of reduction.

[Antegrade and retrograde nailing of humeral shaft fractures].

Objective: Restoring humeral shaft alignment using direct or indirect reduction techniques with subsequent intramedullary stabilisation with an antegrade or retrograde inserted humeral nail. Achieving osseous union and restoration of painfree upper arm function.

Indications: Antegrade: Humerus shaft fractures located in the proximal 2/3 of the humerus.

Evaluation of the reduction, tightening and gripping performance of an innovative set screw technology for instrumented posterior lumbar fusion: A biomechanical study.

Background: Instrumented posterior lumbar fusion with top-loading pedicle screw systems (PSS) requires fully tightened set screws to achieve a secure fixation and symmetric load condition. This assumes a complete reduction of the rod by 90°, which is not always attainable in situ, especially under constraint. The objective of this work is to compare the mechanical performance of different innovative set screw technologies, which should improve the tightening process.

Safety and efficacy of 2D-fluoroscopy-based iliosacral screw osteosynthesis: results of a retrospective monocentric study.

Introduction: Iliosacral screw osteosynthesis is a well-accepted procedure for stabilization of sacral fractures and iliosacral (fracture) dislocations.

Materials And Methods: In this monocentric study, safety and efficacy of conventional 2D-fluoroscopic-guided iliosacral screw insertion were evaluated.

Results: During a 10-year period (2005-2014), 98 patients between the age of 18 and 65 years received 207 iliosacral screws in 101 procedures.

Suprapatellar nailing of fractures of the tibia.

Objective: Intramedullary nailing of tibia fractures via a suprapatellar, transarticular approach with the knee joint in 20-30° of flexion and the use of specific protection tubes to preserve intra-articular structures.

Indications: Extra-articular fractures of the proximal tibia; simple and comminuted fractures of the tibia diaphysis; segmental diaphyseal fractures of the tibia; extra-articular fractures of the distal tibia and fractures with simple intra-articular distal extension; floating knee injuries.

Contraindications: Gustilo grade 3C open fractures of the tibia; severe soft tissue laceration, contamination or infection in the suprapatellar area; ipsilateral knee joint prosthesis; knee arthrodesis; implants blocking the nail entry point.

Radiation exposure in whole-body computed tomography of multiple trauma patients: bearing devices and patient positioning.

Background: Whole-body computed tomography (WBCT) plays an important role in the management of severely injured patients. We evaluated the radiation exposure of WBCT scans using different positioning boards and arm positions.

Methods: In this retrospective study, the radiation exposure of WBCT using a 16-slice multislice computed tomography scanner was evaluated.

Stabilization of fatigue fractures of the dorsal pelvis with a trans-sacral bar. Operative technique and outcome.

Introduction: Due to ageing of our population the number of fatigue fractures of the pelvic ring is steadily growing. These fractures are often treated with bed rest but may result in a disabling immobility with severe pain. An operative treatment is an option in these cases.

Radiological analysis, operative management and functional outcome of open book pelvic lesions: a 13-year cohort study.

Unlabelled: We present the clinical and radiological outcome of a 13-year cohort study of 38 open book pelvic lesions. All patients were treated in one Level I Trauma centre. In the posterior pelvis, sacro-iliac diastasis was seen in 31 patients, sacral fracture in 7.

Mid- to long-term results after bipolar radial head arthroplasty.

Background: Radial head arthroplasty is considered the treatment of choice for unreconstructable radial head fractures in the acute fracture situation. Although short-term results in the current literature are promising, replacement of the radial head remains controversial as long-term results are still missing. We report our 8.

Outcome in Pelvic Ring Fractures.

Pelvic ring fractures represent a negative prognostic factor for what concerns morbidity and mortality of a polytraumatized patient. The subjective and functional prognosis of a pelvic ring fracture is dependent upon its degree of instability. Associated severe peripelvic soft tissue injuries and neurovascular lesions (complex pelvic trauma) affect outcome negatively.

Management of Acute Hemorrhage in Pelvic Trauma: An Overview.

Pelvic disruption is a combination of fractures or dislocations of the pelvic ring with trauma of the soft tissues on the inside and outside of this ring. Hemodynamic instability is the result of blood loss out of the fracture fragments, the posterior venous plexus, ruptured pelvic organs, or arterial lesions. In the resuscitation phase, different measures are possible to reduce the volume of the disrupted pelvis and to restore mechanical stability.

[Reconstruction of fractures of the anterior wall and the anterior column of the acetabulum using an ilioinguinal approach].

Objective: Restoration of the congruence of the hip joint. Correction of gaps or steps in the articular surface, especially in the main weight-bearing area of the acetabular dome. Correction of femoral head subluxation.

Double or triple interlocking when nailing proximal tibial fractures? A biomechanical investigation.

Objectives: To determine whether there are differences in stability between double and triple interlocked intramedullary nails used for the fixation of extraarticular proximal tibial fractures.

Design: Randomized in vitro biomechanical-experimental laboratory investigation.

Setting: Biomechanics laboratory of the Clinic for Trauma Surgery at the Johannes Gutenberg-University Mainz.

[The distally based sural neurocutaneous island flap for coverage of soft-tissue defects on the distal lower leg, ankle and heel].

Objective: Stable coverage of soft-tissue defects in the critical regions of the distal lower leg, ankle and heel by avoidance of a microsurgically transplanted free flap.

Indications: Soft-tissue defects < or = 10 cm in diameter--either by trauma or complications (skin necrosis, infection)--on the distal lower leg, ankle or heel with exposed osseous, tendinous or articular structures including high-risk patients (diabetes mellitus type 1/2 and/or arterial vascular disease including stage IIb, not capable of improvement).

Contraindications: Relative: diameter of defect > 10 cm.

Extracorporeal shock wave-mediated changes in proliferation, differentiation, and gene expression of human osteoblasts.

Background: The goal of this study was to determine whether cell proliferation, differentiation, and gene expression of primary human osteoblasts (hOB) are influenced by shock wave application (SWA).

Methods: Osteoblast cultures were isolated from cancellous bone fragments and treated with 500 impulses of energy flux densities of 0.06 mJ/mm, 0.

[Angle-fixed plate fixation or double-plate osteosynthesis in fractures of the proximal humerus: a biomechanical study].

Internal fixation of fractures of the proximal humerus needs a high stability of fixation to avoid secondary loss of fixation. This is especially important in osteoporotic bone. In an experimental study, the biomechanical properties of the angle-fixed Philos plate (internal fixator) and a double-plate osteosynthesis using two one-third tubular plates were assessed.

[V-y flap for restoration of the fingertip].

Objective: Restoration of the fingertip with a neurovascular V-Y flap.

Indications: Transverse or oblique defects of the fingertip, also with exposed bone of the distal phalanx.

Contraindications: Larger defects of the phalanx over the proximal interphalangeal joint.

[Transosseous repair of patellar tendon ruptures].

Objective: Restoration of active knee extension. Restoration of active knee stabilization. Avoiding secondary patella alta.

Osteosynthesis of Proximal Humeral Fractures with the Fixed Angle PHILOS-plate.

In a retrospective study we analyzed the functional and radiological outcome of 30 proximal humeral fractures, treated by PHILOS-plate, a fixed-angle device. Two of them were characterized as type Neer III, 14 as type Neer IV, 5 as type Neer V and 9 as type Neer VI. There were 2 2-part, 16 3-part and 12 4-part fractures.

Compartment Syndrome of the Lower Extremity.

Acute compartment syndrome of the lower extremity is a limb-threatening emergency that requires prompt surgical treatment. Early detection and decompression are necessary in order to avoid irreversible damage. In the lower extremity, compartment syndrome may occur around the pelvis, in the thigh, the lower leg or the foot.

Intramedullary stabilization of extraarticular proximal tibial fractures: a biomechanical comparison of intramedullary and extramedullary implants including a new proximal tibia nail (PTN).

Objectives: To determine in the laboratory whether there are or are not differences between individual geometrical designs of intramedullary and extramedullary devices used for the fixation of extraarticular proximal tibial fractures.

Methods: Five devices were tested: a newly developed Proximal Tibia Nail (PTN), conventional double-plate osteosynthesis (DPO), the Less Invasive Stabilization System (LISS), an augmented Unreamed Tibial Nail with a T-stabilization-plate (UTN + TSP), and an external fixator (ExFix). A 10-mm defect osteotomy was performed on paired human tibiae, and the proximal and distal ends were potted in polymethylmethacrylate cement (PMMA).

Locked plate fixation and intramedullary nailing for proximal humerus fractures: a biomechanical evaluation.

Background: Internal fixation of proximal humeral fractures is associated with a considerable secondary malalignment rate. Fixed-angle implants have been suggested to increase the stability of fixation.

Methods: The biomechanical properties of four different implants were tested.

Distal humerus fractures in elderly patients: results after open reduction and internal fixation.

Problem: Fractures of the distal humerus are difficult to treat. In elderly patients, diminished bone mineral quality and increased trauma-associated joint destruction may make stable joint reconstruction even more problematic. Furthermore, comorbidities and poor tolerance of joint immobilization might be additional factors which influence elbow function negatively.