A. Schäffler

Perkutane navigierte Ballonreposition einer dislozierten Acetabulumfraktur

Kyphoplasty is a well proven surgical procedure for osteoporotic fractures in spine surgery. Anatomic reconstruction of the joint is the primary aim in the treatment of acetabular fractures. To achieve this, extensive approaches with entry related morbidity are usually needed. Percutaneous stabilisations are still limited for non- or minimally displaced fractures.For displaced acetabular fractures, there are percutaneous procedures described with intraoperative CT control or by the use of a 3D C-arm. The case of an anterior column posterior hemitranverse fracture with an articular step in the weight bearing area is presented. In this case, a kyphoplasty balloon was placed by use of 3D C-arm navigation. After 2D C-arm controlled fracture reduction, the supra-acetabular screw was inserted percutaneously using the previous 3D navigation data set.With the combination of kyphoplasty technique, intraoperative 3D C-arm control and 3D C-arm based navigation, this displaced acetabular fracture could be reduced and fixed percutaneously. Anatomic reconstruction of the joint remains the primary aim.ZusammenfassungIm Bereich der Wirbelsäulenchirurgie hat sich die Kyphoplastie als perkutanes Verfahren zur Aufrichtung und Stabilisierung von osteoporotischen Frakturen bewährt. Bei der Stabilisation von Acetabulumfrakturen ist die anatomische Gelenkrekonstruktion oberstes Primat. Dies erfordert häufig ausgedehnte operative Zugänge mit entsprechender zugangsbedingter Morbidität. Perkutane Stabilisierungen sind bisher weitgehend auf nicht oder kaum dislozierte Frakturen beschränkt.Perkutane Repositionen von dislozierten Acetabulumfrakturen unter CT-Kontrolle oder mit Nutzung eines 3D-Bildwandlers wurden bereits beschrieben. Bei dem hier vorgestellten Fall handelt es sich um eine linksseitige vorderer Pfeiler-/posterior hemitranverse Acetabulumfraktur mit deutlicher Stufe im Pfannendachbereich. Bei dieser Fraktur wurde mit der 3D-bildwandlerbasierten Navigation ein Kyphoplastieballon zur Reposition perkutan platziert, die anatomische Reposition unter Bildwandlerkontrolle durchgeführt und nachfolgend mit demselben Datensatz die Schraube zur perkutanen Osteosynthese navigiert eingebracht.Durch die Kombination von Kyphoplastietechnologie, intraoperativer 3D-Kontrolle und 3D-bildwandlerbasierter Navigation konnte auch diese dislozierte Fraktur perkutan reponiert und stabilisiert werden. Die anatomische Gelenkrekonstruktion und Stabilisation bleibt dabei unverändert das Ziel.AbstractKyphoplasty is a well proven surgical procedure for osteoporotic fractures in spine surgery. Anatomic reconstruction of the joint is the primary aim in the treatment of acetabular fractures. To achieve this, extensive approaches with entry related morbidity are usually needed. Percutaneous stabilisations are still limited for non- or minimally displaced fractures.For displaced acetabular fractures, there are percutaneous procedures described with intraoperative CT control or by the use of a 3D C-arm. The case of an anterior column posterior hemitranverse fracture with an articular step in the weight bearing area is presented. In this case, a kyphoplasty balloon was placed by use of 3D C-arm navigation. After 2D C-arm controlled fracture reduction, the supra-acetabular screw was inserted percutaneously using the previous 3D navigation data set.With the combination of kyphoplasty technique, intraoperative 3D C-arm control and 3D C-arm based navigation, this displaced acetabular fracture could be reduced and fixed percutaneously. Anatomic reconstruction of the joint remains the primary aim.

[Percutaneous iliosacral screw fixation for pelvis insufficiency fracture after implantation of a pedestal cup: case report].

Insufficiency fractures of the sacrum are frequently overlooked injuries especially in postmenopausal women with an osteoporotic bone structure and without a history of significant trauma. Plain radiographs are frequently inadequate in showing insufficiency fractures of the sacrum. Regarding this a fracture of a pubic ramus combined with appropriate clinical symptoms should raise the suspicion of a concomitant sacral injury. Therefore, further investigations including a CT scan are necessary.The case of an osteoporotic female patient with bilateral insufficiency fractures of the sacrum and a fracture of the right superior and inferior pubic ramus 5 weeks after primary total hip arthroplasty and implantation of a pedestal cup due to an intraoperative fracture of the right acetabulum is presented. To ensure early mobilization as well as avoidance of further concomitant morbidities a percutaneous iliosacral screw fixation was performed. This approach has been established as an operative treatment for minimally or non-displaced insufficiency fractures of the sacrum.

Percutaneously navigated balloon fracture reduction in a displaced acetabular fracture

Kyphoplasty is a well proven surgical procedure for osteoporotic fractures in spine surgery. Anatomic reconstruction of the joint is the primary aim in the treatment of acetabular fractures. To achieve this, extensive approaches with entry related morbidity are usually needed. Percutaneous stabilisations are still limited for non- or minimally displaced fractures.For displaced acetabular fractures, there are percutaneous procedures described with intraoperative CT control or by the use of a 3D C-arm. The case of an anterior column posterior hemitranverse fracture with an articular step in the weight bearing area is presented. In this case, a kyphoplasty balloon was placed by use of 3D C-arm navigation. After 2D C-arm controlled fracture reduction, the supra-acetabular screw was inserted percutaneously using the previous 3D navigation data set.With the combination of kyphoplasty technique, intraoperative 3D C-arm control and 3D C-arm based navigation, this displaced acetabular fracture could be reduced and fixed percutaneously. Anatomic reconstruction of the joint remains the primary aim.ZusammenfassungIm Bereich der Wirbelsäulenchirurgie hat sich die Kyphoplastie als perkutanes Verfahren zur Aufrichtung und Stabilisierung von osteoporotischen Frakturen bewährt. Bei der Stabilisation von Acetabulumfrakturen ist die anatomische Gelenkrekonstruktion oberstes Primat. Dies erfordert häufig ausgedehnte operative Zugänge mit entsprechender zugangsbedingter Morbidität. Perkutane Stabilisierungen sind bisher weitgehend auf nicht oder kaum dislozierte Frakturen beschränkt.Perkutane Repositionen von dislozierten Acetabulumfrakturen unter CT-Kontrolle oder mit Nutzung eines 3D-Bildwandlers wurden bereits beschrieben. Bei dem hier vorgestellten Fall handelt es sich um eine linksseitige vorderer Pfeiler-/posterior hemitranverse Acetabulumfraktur mit deutlicher Stufe im Pfannendachbereich. Bei dieser Fraktur wurde mit der 3D-bildwandlerbasierten Navigation ein Kyphoplastieballon zur Reposition perkutan platziert, die anatomische Reposition unter Bildwandlerkontrolle durchgeführt und nachfolgend mit demselben Datensatz die Schraube zur perkutanen Osteosynthese navigiert eingebracht.Durch die Kombination von Kyphoplastietechnologie, intraoperativer 3D-Kontrolle und 3D-bildwandlerbasierter Navigation konnte auch diese dislozierte Fraktur perkutan reponiert und stabilisiert werden. Die anatomische Gelenkrekonstruktion und Stabilisation bleibt dabei unverändert das Ziel.AbstractKyphoplasty is a well proven surgical procedure for osteoporotic fractures in spine surgery. Anatomic reconstruction of the joint is the primary aim in the treatment of acetabular fractures. To achieve this, extensive approaches with entry related morbidity are usually needed. Percutaneous stabilisations are still limited for non- or minimally displaced fractures.For displaced acetabular fractures, there are percutaneous procedures described with intraoperative CT control or by the use of a 3D C-arm. The case of an anterior column posterior hemitranverse fracture with an articular step in the weight bearing area is presented. In this case, a kyphoplasty balloon was placed by use of 3D C-arm navigation. After 2D C-arm controlled fracture reduction, the supra-acetabular screw was inserted percutaneously using the previous 3D navigation data set.With the combination of kyphoplasty technique, intraoperative 3D C-arm control and 3D C-arm based navigation, this displaced acetabular fracture could be reduced and fixed percutaneously. Anatomic reconstruction of the joint remains the primary aim.

Perkutane SI-Verschraubung bei Beckenringinsuffizienzfraktur nach Implantation einer Sockelpfanne@@@Percutaneous iliosacral screw fixation for pelvis insufficiency fracture after implantation of a pedestal cup: Ein Fallbericht@@@Case report

Insufficiency fractures of the sacrum are frequently overlooked injuries especially in postmenopausal women with an osteoporotic bone structure and without a history of significant trauma. Plain radiographs are frequently inadequate in showing insufficiency fractures of the sacrum. Regarding this a fracture of a pubic ramus combined with appropriate clinical symptoms should raise the suspicion of a concomitant sacral injury. Therefore, further investigations including a CT scan are necessary.The case of an osteoporotic female patient with bilateral insufficiency fractures of the sacrum and a fracture of the right superior and inferior pubic ramus 5 weeks after primary total hip arthroplasty and implantation of a pedestal cup due to an intraoperative fracture of the right acetabulum is presented. To ensure early mobilization as well as avoidance of further concomitant morbidities a percutaneous iliosacral screw fixation was performed. This approach has been established as an operative treatment for minimally or non-displaced insufficiency fractures of the sacrum.

Perkutane navigierte Ballonreposition einer dislozierten Acetabulumfraktur@@@Percutaneously navigated balloon fracture reduction in a displaced acetabular fracture

Kyphoplasty is a well proven surgical procedure for osteoporotic fractures in spine surgery. Anatomic reconstruction of the joint is the primary aim in the treatment of acetabular fractures. To achieve this, extensive approaches with entry related morbidity are usually needed. Percutaneous stabilisations are still limited for non- or minimally displaced fractures.For displaced acetabular fractures, there are percutaneous procedures described with intraoperative CT control or by the use of a 3D C-arm. The case of an anterior column posterior hemitranverse fracture with an articular step in the weight bearing area is presented. In this case, a kyphoplasty balloon was placed by use of 3D C-arm navigation. After 2D C-arm controlled fracture reduction, the supra-acetabular screw was inserted percutaneously using the previous 3D navigation data set.With the combination of kyphoplasty technique, intraoperative 3D C-arm control and 3D C-arm based navigation, this displaced acetabular fracture could be reduced and fixed percutaneously. Anatomic reconstruction of the joint remains the primary aim.ZusammenfassungIm Bereich der Wirbelsäulenchirurgie hat sich die Kyphoplastie als perkutanes Verfahren zur Aufrichtung und Stabilisierung von osteoporotischen Frakturen bewährt. Bei der Stabilisation von Acetabulumfrakturen ist die anatomische Gelenkrekonstruktion oberstes Primat. Dies erfordert häufig ausgedehnte operative Zugänge mit entsprechender zugangsbedingter Morbidität. Perkutane Stabilisierungen sind bisher weitgehend auf nicht oder kaum dislozierte Frakturen beschränkt.Perkutane Repositionen von dislozierten Acetabulumfrakturen unter CT-Kontrolle oder mit Nutzung eines 3D-Bildwandlers wurden bereits beschrieben. Bei dem hier vorgestellten Fall handelt es sich um eine linksseitige vorderer Pfeiler-/posterior hemitranverse Acetabulumfraktur mit deutlicher Stufe im Pfannendachbereich. Bei dieser Fraktur wurde mit der 3D-bildwandlerbasierten Navigation ein Kyphoplastieballon zur Reposition perkutan platziert, die anatomische Reposition unter Bildwandlerkontrolle durchgeführt und nachfolgend mit demselben Datensatz die Schraube zur perkutanen Osteosynthese navigiert eingebracht.Durch die Kombination von Kyphoplastietechnologie, intraoperativer 3D-Kontrolle und 3D-bildwandlerbasierter Navigation konnte auch diese dislozierte Fraktur perkutan reponiert und stabilisiert werden. Die anatomische Gelenkrekonstruktion und Stabilisation bleibt dabei unverändert das Ziel.AbstractKyphoplasty is a well proven surgical procedure for osteoporotic fractures in spine surgery. Anatomic reconstruction of the joint is the primary aim in the treatment of acetabular fractures. To achieve this, extensive approaches with entry related morbidity are usually needed. Percutaneous stabilisations are still limited for non- or minimally displaced fractures.For displaced acetabular fractures, there are percutaneous procedures described with intraoperative CT control or by the use of a 3D C-arm. The case of an anterior column posterior hemitranverse fracture with an articular step in the weight bearing area is presented. In this case, a kyphoplasty balloon was placed by use of 3D C-arm navigation. After 2D C-arm controlled fracture reduction, the supra-acetabular screw was inserted percutaneously using the previous 3D navigation data set.With the combination of kyphoplasty technique, intraoperative 3D C-arm control and 3D C-arm based navigation, this displaced acetabular fracture could be reduced and fixed percutaneously. Anatomic reconstruction of the joint remains the primary aim.