E. Liodakis

[Development of compartment syndrome after intravenous administration of an X-ray contrast medium. Recommendations on acute therapy regimens].

The incidence of extravasation of contrast medium is reported in the literature to be between 0.2u2009% and 0.9xa0%. A rare consequence of this could be compartment syndrome of the affected limb which requires immediate treatment.We report the case of a patient who developed acute compartment syndrome of the forearm after intravenous injection of radiographic contrast medium in a radiovolar vein during a computed tomography (CT) scan for multiple trauma. The clinical symptoms with pain, loss of range of motion and sensitivity functions, measurement of compartment pressure and radiological images confirmed the diagnosis. After emergency dermatofasciotomy of the forearm the full range of motion and sensitivity functions could be restored.ZusammenfassungDie Inzidenz von Kontrastmittelparavasaten wird in der Literatur mit 0,2–0,9u2009% angegeben. Eine seltene Folge kann ein Kompartmentsyndrom der betroffenen Extremität sein, welches sofortiger Behandlung bedarf.Wir berichten über einen Patienten, dem im Rahmen eines Polytrauma-CT-Scans Kontrastmittel radiovolar i.xa0v. appliziert wurde. Im Verlauf kam es durch Paravasation von Kontrastmittel zu einem Kompartmentsyndrom. Sowohl das klinische Beschwerdebild mit deutlicher Schmerzsymptomatik, als auch der Verlust von motorischen und sensiblen Funktionen, wie auch die Kompartmentdruckmessung und die radiologische Bildgebung sicherten die Diagnose. Durch die notallmäßig durchgeführte Dermatofasziotomie erhielt der Patient eine völlige Wiederherstellung der zuvor verlorengegangenen motorischen und sensiblen Funktion.AbstractThe incidence of extravasation of contrast medium is reported in the literature to be between 0.2u2009% and 0.9xa0%. A rare consequence of this could be compartment syndrome of the affected limb which requires immediate treatment.We report the case of a patient who developed acute compartment syndrome of the forearm after intravenous injection of radiographic contrast medium in a radiovolar vein during a computed tomography (CT) scan for multiple trauma. The clinical symptoms with pain, loss of range of motion and sensitivity functions, measurement of compartment pressure and radiological images confirmed the diagnosis. After emergency dermatofasciotomy of the forearm the full range of motion and sensitivity functions could be restored.

Kompartmentsyndrom nach paravasaler Applikation von Röntgenkontrastmittel

The incidence of extravasation of contrast medium is reported in the literature to be between 0.2u2009% and 0.9xa0%. A rare consequence of this could be compartment syndrome of the affected limb which requires immediate treatment.We report the case of a patient who developed acute compartment syndrome of the forearm after intravenous injection of radiographic contrast medium in a radiovolar vein during a computed tomography (CT) scan for multiple trauma. The clinical symptoms with pain, loss of range of motion and sensitivity functions, measurement of compartment pressure and radiological images confirmed the diagnosis. After emergency dermatofasciotomy of the forearm the full range of motion and sensitivity functions could be restored.ZusammenfassungDie Inzidenz von Kontrastmittelparavasaten wird in der Literatur mit 0,2–0,9u2009% angegeben. Eine seltene Folge kann ein Kompartmentsyndrom der betroffenen Extremität sein, welches sofortiger Behandlung bedarf.Wir berichten über einen Patienten, dem im Rahmen eines Polytrauma-CT-Scans Kontrastmittel radiovolar i.xa0v. appliziert wurde. Im Verlauf kam es durch Paravasation von Kontrastmittel zu einem Kompartmentsyndrom. Sowohl das klinische Beschwerdebild mit deutlicher Schmerzsymptomatik, als auch der Verlust von motorischen und sensiblen Funktionen, wie auch die Kompartmentdruckmessung und die radiologische Bildgebung sicherten die Diagnose. Durch die notallmäßig durchgeführte Dermatofasziotomie erhielt der Patient eine völlige Wiederherstellung der zuvor verlorengegangenen motorischen und sensiblen Funktion.AbstractThe incidence of extravasation of contrast medium is reported in the literature to be between 0.2u2009% and 0.9xa0%. A rare consequence of this could be compartment syndrome of the affected limb which requires immediate treatment.We report the case of a patient who developed acute compartment syndrome of the forearm after intravenous injection of radiographic contrast medium in a radiovolar vein during a computed tomography (CT) scan for multiple trauma. The clinical symptoms with pain, loss of range of motion and sensitivity functions, measurement of compartment pressure and radiological images confirmed the diagnosis. After emergency dermatofasciotomy of the forearm the full range of motion and sensitivity functions could be restored.

[Implant-free tibial fixations of the posterior cruciate ligament. Development and biomechanical testing].

BACKGROUNDnA secure tibial press fit technique in posterior cruciate ligament reconstructions may be a relevant alternative to common techniques because no hardware is necessary. Up to the present point in time no biomechanical data exist for a tibial press fit posterior cruciate ligament (PCL) reconstruction. This study compares the biomechanical properties of hamstring and quadriceps tendon grafts using a press fit technique with those of an interference screw fixation.nnnMETHODSnQuadriceps and hamstring tendons of 20 human cadavers (age 49.2±18.5 years) were used. A press fit fixation with a knot in the semitendinosus tendon (K) and a quadriceps tendon bone block graft (Q) were compared to an interference screw fixation (I) in 27 porcine tibiae. In each group, nine constructs were cyclically stretched and then loaded until failure. Maximum load to failure, stiffness and elongation during failure testing and cyclical loading were investigated.nnnRESULTSnThe maximum load to failure was 518±157xa0N (387-650xa0N) for the K group, 558±119xa0N (466-650xa0N) for the I group and 620±102xa0N (541-699xa0N) for the Q group. The stiffness was 55±27xa0N/mm (18-89xa0N/mm) for the K group, 117±62xa0N/mm (69-165xa0N/mm) for the I group and 65±21xa0N/mm (49-82xa0N/mm) for the Q group. The stiffness of the I group was significantly larger (ANOVA on ranks, P=0.01). The elongation during cyclical loading was significantly larger for all groups from the 1st to the 5th cycle compared to the elongation in between the 5th and the 20th cycle (P<0.03).nnnCONCLUSIONnAll techniques exhibited larger elongation during initial loading. Load to failure and stiffness were significantly different between the fixations. The Q fixation showed equal biomechanical properties compared to a pure tendon fixation (I) with an interference screw. The results of group K were inferior. All three investigated fixation techniques exhibit comparable biomechanical properties. Preconditioning of the constructs is critical. Future randomized, clinical trials have to investigate the biological effectiveness of these fixation techniques.ZusammenfassungEinleitungEine stabile Press-fit-Fixierung des hinteren Kreuzbandes (HKB) ist aufgrund der Implantatfreiheit eine in Betracht zu ziehende Technik zur ligamentären Kniegelenkrekonstruktion. Bis zum jetzigen Zeitpunkt existieren keine biomechanischen Daten bezüglich einer Press-fit-Fixierung zur Rekonstruktion des HKB. Zweck dieser Studie war es, die biomechanischen Eigenschaften von Hamstring- und Quadrizepssehnentransplantaten in Press-fit-Technik mit denen einer Interferenzschraubenfixierung zu vergleichen.Material und MethodenInsgesamt wurden Hamstring- und Quadrizepssehnentransplantate von 20 Leichenkniegelenken verwendet, deren Alter 49,2±18,5xa0Jahre betrug. Eine Press-fit-Fixierung der Semitendinosussehne (K) und eine Quadrizeps-Knochenblock-Fixierung (Q) wurden mit der Fixierung mittels Interferenzschraube (I) verglichen. Es wurden 3xa0Gruppen á 9xa0Präparate gebildet, die an insgesamt 27 porcinen tibiaezyklischen Dehnungen ausgesetzt und anschließend bis zum Versagen belastet wurden. Die maximale Versagenslast, das Dehnungsverhalten und die Elongation während der Belastung wurden untersucht.ErgebnisseDie maximale Versagenslast betrug 518±157 (387–650) N für die K-Gruppe, 620±102 (541–699) N für die Q-Gruppe und 558±119 (466–650) N für die I-Gruppe. Die Steifigkeit betrug 55±27 (18–89) N/mm für die K-Gruppe, 65±21 (49–82) N/mm für die Q-Gruppe und 117±62 (69–165) N/mm für die I-Gruppe. Die Elongation zeigte für alle Gruppen einen signifikanten Größenunterschied zwischen dem 1. und 5. Zyklus im Vergleich zur Elongation zwischen dem 5. und 20. Zyklus (p<0,03).SchlussfolgerungAlle Techniken wiesen die größte Längenänderung während der initialen zyklischen Belastung auf. Die maximale Versagenslast und das Dehnungsverhalten zeigten signifikante Differenzen zwischen den unterschiedlichen Fixierungstechniken. Die Q-Fixierung wies vergleichbare biomechanische Eigenschaften auf wie eine reine Sehnenfixierung mit einer Interferenzschraube (I). Die biomechanischen Eigenschaften der K-Gruppe waren schlechter.AbstractBackgroundA secure tibial press fit technique in posterior cruciate ligament reconstructions may be a relevant alternative to common techniques because no hardware is necessary. Up to the present point in time no biomechanical data exist for a tibial press fit posterior cruciate ligament (PCL) reconstruction. This study compares the biomechanical properties of hamstring and quadriceps tendon grafts using a press fit technique with those of an interference screw fixation.MethodsQuadriceps and hamstring tendons of 20 human cadavers (age 49.2±18.5 years) were used. A press fit fixation with a knot in the semitendinosus tendon (K) and a quadriceps tendon bone block graft (Q) were compared to an interference screw fixation (I) in 27 porcine tibiae. In each group, nine constructs were cyclically stretched and then loaded until failure. Maximum load to failure, stiffness and elongation during failure testing and cyclical loading were investigated.ResultsThe maximum load to failure was 518±157xa0N (387–650xa0N) for the K group, 558±119xa0N (466–650xa0N) for the I group and 620±102xa0N (541–699xa0N) for the Q group. The stiffness was 55±27xa0N/mm (18–89xa0N/mm) for the K group, 117±62xa0N/mm (69–165xa0N/mm) for the I group and 65±21xa0N/mm (49–82xa0N/mm) for the Q group. The stiffness of the I group was significantly larger (ANOVA on ranks, P=0.01). The elongation during cyclical loading was significantly larger for all groups from the 1st to the 5th cycle compared to the elongation in between the 5th and the 20th cycle (P<0.03).ConclusionAll techniques exhibited larger elongation during initial loading. Load to failure and stiffness were significantly different between the fixations. The Q fixation showed equal biomechanical properties compared to a pure tendon fixation (I) with an interference screw. The results of group K were inferior. All three investigated fixation techniques exhibit comparable biomechanical properties. Preconditioning of the constructs is critical. Future randomized, clinical trials have to investigate the biological effectiveness of these fixation techniques.

[Tibial press-fit fixation of flexor tendons for reconstruction of the anterior cruciate ligament].

BACKGROUNDnPress-fit fixation of hamstring tendon autografts for anterior cruciate ligament reconstruction is an interesting technique because no hardware is necessary. This study compares the biomechanical properties of press-fit fixations to an interference screw fixation.nnnMETHODSnTwenty-eight human cadaveric knees were used for hamstring tendon explantation. An additional bone block was harvested from the tibia. We used 28 porcine femora for graft fixation. Constructs were cyclically stretched and then loaded until failure. Maximum load to failure, stiffness and elongation during failure testing and cyclic loading were investigated.nnnRESULTSnThe maximum load to failure was 970±83xa0N for the press-fit tape fixation (T), 572±151xa0N for the bone bridge fixation (TS), 544±109xa0N for the interference screw fixation (I), 402±77xa0N for the press-fit suture fixation (S) and 290±74xa0N for the bone block fixation technique (F). The T fixation had a significantly better maximum load to failure compared to all other techniques (p<0.001).nnnCONCLUSIONnThis study demonstrates that a tibial press-fit technique which uses an additional bone block has better maximum load to failure results compared to a simple interference screw fixation.ZusammenfassungHintergrundDie Verankerung von Hamstringtransplantaten zur Rekonstruktion des vorderen Kreuzbandes (VKB) mittels einer Press-fit-Fixation ist eine interessante Technik, da keine Implantate nötig sind. Ziel dieser Studie war es, die biomechanischen Eigenschaften von Press-fit-Fixationen zu charakterisieren und sie mit einer Interferenzschraubenfixation zu vergleichen.MethodenFür die Explantation der Semitendinosus- und Grazilissehnen (SG) wurden 28 Leichenknie verwendet. Ein zusätzlicher Knochenblock wurde medial der Tuberositas tibiae aus einem Bereich, in dem der tibiale Bohrkanal bei der VKB-Rekonstruktion angelegt wird, entnommen. Für die Verankerung im Bohrkanal wurden porcine Femora benutzt.ErgebnisseDie maximale Ausreißkraft der Press-fit-tape-Fixation lag bei 970±83xa0N, die Knochenbrückenfixation lag bei 572±151xa0N, die Interferenzschraubenfixation lag bei 544±109xa0N, die Press-fit-suture-Fixation lag bei 402±77xa0N und die Knochenblockfixation erreichte einen Wert von 290±74xa0N. Die maximale Ausreißkraft der T-Gruppe ist allen anderen Gruppen signifikant überlegen (p<0,001).SchlussfolgerungDiese Studie zeigt, dass eine tibiale Press-fit-Technik, die autologe Knochenblöcke verwendet, einer einfachen Interferenzschraubenfixation hinsichtlich ihrer maximalen Versagenslast überlegen ist.AbstractBackgroundPress-fit fixation of hamstring tendon autografts for anterior cruciate ligament reconstruction is an interesting technique because no hardware is necessary. This study compares the biomechanical properties of press-fit fixations to an interference screw fixation.MethodsTwenty-eight human cadaveric knees were used for hamstring tendon explantation. An additional bone block was harvested from the tibia. We used 28 porcine femora for graft fixation. Constructs were cyclically stretched and then loaded until failure. Maximum load to failure, stiffness and elongation during failure testing and cyclic loading were investigated.ResultsThe maximum load to failure was 970±83xa0N for the press-fit tape fixation (T), 572±151xa0N for the bone bridge fixation (TS), 544±109xa0N for the interference screw fixation (I), 402±77xa0N for the press-fit suture fixation (S) and 290±74xa0N for the bone block fixation technique (F). The T fixation had a significantly better maximum load to failure compared to all other techniques (p<0.001).ConclusionThis study demonstrates that a tibial press-fit technique which uses an additional bone block has better maximum load to failure results compared to a simple interference screw fixation.

[Reconstruction of an iatrogenic acromial pseudarthrosis: a case report].

ZusammenfassungDie Fraktur des Akromions ist eine seltene, aber schwerwiegende Komplikation, die im Rahmen einer subakromialen Dekompression auftreten kann. Wir berichten über einen Patienten mit Pseudarthrose des Akromions, der bei Schmerzpersistenz mehrfach operiert wurde, bis es schließlich zur Diagnose „Pseudarthrose“ kam. Die Pseudarthrose wurde erfolgreich durch Osteosynthese mit einer distalen Radiusplatte und einem monokortikalen Beckenkammspan therapiert. Zwei Jahre nach der Operation sind die Fraktur verheilt und die Beschwerden des Patienten erheblich gebessert. Im Constant Score erreicht der Patient 58xa0Punkte (präoperativ 25xa0Punkte) und im Subjective Shoulder Rating System (SSRS) 65 Punkte (präoperativ 25xa0Punkte). Die Beweglichkeit ist postoperativ deutlich verbessert und beträgt für aktive Abduktion/Adduktion 50/0/25º (30/0/20° präoperativ), für Außenrotation/Innenrotation 35/0/45º (30/0/30° präoperativ) und für Anteversion/Retroversion 60/0/35° (35/0/20° präoperativ).AbstractAcromial fractures are rare but severe complications which can occur during subacromial decompression. We report a case of acromial pseudarthrosis which was discovered belatedly due to persistent pain after several operations. The pseudarthrosis was successfully treated by osteosynthesis with a distal radius plate and implantation of a monocortical bone graft from the iliac crest. Two years after surgery, the fracture has healed and the patient’s pain improved significantly. In the constant score the patient achieved postoperatively 58xa0points compared to 25xa0points before surgery and 65xa0points compared to 25xa0points preoperatively in the subjective shoulder rating system (SSRS). Postoperatively, the patient had a better range of motion with active abduction/adduction of 50/0/25º (30/0/20° preoperatively), outward rotation/inward rotation of 35/0/45º (30/0/30° preoperatively) and anteversion/retroversion of 60/0/35° (35/0/20° preoperatively).Acromial fractures are rare but severe complications which can occur during subacromial decompression. We report a case of acromial pseudarthrosis which was discovered belatedly due to persistent pain after several operations. The pseudarthrosis was successfully treated by osteosynthesis with a distal radius plate and implantation of a monocortical bone graft from the iliac crest. Two years after surgery, the fracture has healed and the patients pain improved significantly. In the constant score the patient achieved postoperatively 58xa0points compared to 25xa0points before surgery and 65xa0points compared to 25xa0points preoperatively in the subjective shoulder rating system (SSRS). Postoperatively, the patient had a better range of motion with active abduction/adduction of 50/0/25º (30/0/20° preoperatively), outward rotation/inward rotation of 35/0/45º (30/0/30° preoperatively) and anteversion/retroversion of 60/0/35° (35/0/20° preoperatively).

Tibiale Press-fit-Fixierungen von Beugesehnen zur Rekonstruktion des vorderen Kreuzbandes

BACKGROUNDnPress-fit fixation of hamstring tendon autografts for anterior cruciate ligament reconstruction is an interesting technique because no hardware is necessary. This study compares the biomechanical properties of press-fit fixations to an interference screw fixation.nnnMETHODSnTwenty-eight human cadaveric knees were used for hamstring tendon explantation. An additional bone block was harvested from the tibia. We used 28 porcine femora for graft fixation. Constructs were cyclically stretched and then loaded until failure. Maximum load to failure, stiffness and elongation during failure testing and cyclic loading were investigated.nnnRESULTSnThe maximum load to failure was 970±83xa0N for the press-fit tape fixation (T), 572±151xa0N for the bone bridge fixation (TS), 544±109xa0N for the interference screw fixation (I), 402±77xa0N for the press-fit suture fixation (S) and 290±74xa0N for the bone block fixation technique (F). The T fixation had a significantly better maximum load to failure compared to all other techniques (p<0.001).nnnCONCLUSIONnThis study demonstrates that a tibial press-fit technique which uses an additional bone block has better maximum load to failure results compared to a simple interference screw fixation.ZusammenfassungHintergrundDie Verankerung von Hamstringtransplantaten zur Rekonstruktion des vorderen Kreuzbandes (VKB) mittels einer Press-fit-Fixation ist eine interessante Technik, da keine Implantate nötig sind. Ziel dieser Studie war es, die biomechanischen Eigenschaften von Press-fit-Fixationen zu charakterisieren und sie mit einer Interferenzschraubenfixation zu vergleichen.MethodenFür die Explantation der Semitendinosus- und Grazilissehnen (SG) wurden 28 Leichenknie verwendet. Ein zusätzlicher Knochenblock wurde medial der Tuberositas tibiae aus einem Bereich, in dem der tibiale Bohrkanal bei der VKB-Rekonstruktion angelegt wird, entnommen. Für die Verankerung im Bohrkanal wurden porcine Femora benutzt.ErgebnisseDie maximale Ausreißkraft der Press-fit-tape-Fixation lag bei 970±83xa0N, die Knochenbrückenfixation lag bei 572±151xa0N, die Interferenzschraubenfixation lag bei 544±109xa0N, die Press-fit-suture-Fixation lag bei 402±77xa0N und die Knochenblockfixation erreichte einen Wert von 290±74xa0N. Die maximale Ausreißkraft der T-Gruppe ist allen anderen Gruppen signifikant überlegen (p<0,001).SchlussfolgerungDiese Studie zeigt, dass eine tibiale Press-fit-Technik, die autologe Knochenblöcke verwendet, einer einfachen Interferenzschraubenfixation hinsichtlich ihrer maximalen Versagenslast überlegen ist.AbstractBackgroundPress-fit fixation of hamstring tendon autografts for anterior cruciate ligament reconstruction is an interesting technique because no hardware is necessary. This study compares the biomechanical properties of press-fit fixations to an interference screw fixation.MethodsTwenty-eight human cadaveric knees were used for hamstring tendon explantation. An additional bone block was harvested from the tibia. We used 28 porcine femora for graft fixation. Constructs were cyclically stretched and then loaded until failure. Maximum load to failure, stiffness and elongation during failure testing and cyclic loading were investigated.ResultsThe maximum load to failure was 970±83xa0N for the press-fit tape fixation (T), 572±151xa0N for the bone bridge fixation (TS), 544±109xa0N for the interference screw fixation (I), 402±77xa0N for the press-fit suture fixation (S) and 290±74xa0N for the bone block fixation technique (F). The T fixation had a significantly better maximum load to failure compared to all other techniques (p<0.001).ConclusionThis study demonstrates that a tibial press-fit technique which uses an additional bone block has better maximum load to failure results compared to a simple interference screw fixation.

Comparative biomechanical analysis of two techniques of radiolunate plate-fusion: Oblique screw vs. parallel screws

The purpose of this prospective randomized comparative biomechanical study on four pairs of human cadaveric forearms was to discern whether primary stability following plate arthrodesis differs from the position of the screws. Four wrists were randomly assigned to either group such that one wrist of each pair was fixed via parallel screws and the other via an oblique screw crossing the radius and the lunate. Under fluoroscopic guidance, passive extension and flexion of each wrist was performed using a spring balance. Traction force increased by 5 N at each step, ranging from 0 N to a maximum of 100 N. Fixation using a plate and oblique screw demonstrated lower recoverable deformation of the implant and a higher primary stability at the fusion site than parallel screws. The current investigators conclude that an oblique screw crossing radius and lunate increase primary stability which is consistent with the radiological results of comparable clinical trails.

Rekonstruktion einer iatrogenen Akromionpseudarthrose

ZusammenfassungDie Fraktur des Akromions ist eine seltene, aber schwerwiegende Komplikation, die im Rahmen einer subakromialen Dekompression auftreten kann. Wir berichten über einen Patienten mit Pseudarthrose des Akromions, der bei Schmerzpersistenz mehrfach operiert wurde, bis es schließlich zur Diagnose „Pseudarthrose“ kam. Die Pseudarthrose wurde erfolgreich durch Osteosynthese mit einer distalen Radiusplatte und einem monokortikalen Beckenkammspan therapiert. Zwei Jahre nach der Operation sind die Fraktur verheilt und die Beschwerden des Patienten erheblich gebessert. Im Constant Score erreicht der Patient 58xa0Punkte (präoperativ 25xa0Punkte) und im Subjective Shoulder Rating System (SSRS) 65 Punkte (präoperativ 25xa0Punkte). Die Beweglichkeit ist postoperativ deutlich verbessert und beträgt für aktive Abduktion/Adduktion 50/0/25º (30/0/20° präoperativ), für Außenrotation/Innenrotation 35/0/45º (30/0/30° präoperativ) und für Anteversion/Retroversion 60/0/35° (35/0/20° präoperativ).AbstractAcromial fractures are rare but severe complications which can occur during subacromial decompression. We report a case of acromial pseudarthrosis which was discovered belatedly due to persistent pain after several operations. The pseudarthrosis was successfully treated by osteosynthesis with a distal radius plate and implantation of a monocortical bone graft from the iliac crest. Two years after surgery, the fracture has healed and the patient’s pain improved significantly. In the constant score the patient achieved postoperatively 58xa0points compared to 25xa0points before surgery and 65xa0points compared to 25xa0points preoperatively in the subjective shoulder rating system (SSRS). Postoperatively, the patient had a better range of motion with active abduction/adduction of 50/0/25º (30/0/20° preoperatively), outward rotation/inward rotation of 35/0/45º (30/0/30° preoperatively) and anteversion/retroversion of 60/0/35° (35/0/20° preoperatively).Acromial fractures are rare but severe complications which can occur during subacromial decompression. We report a case of acromial pseudarthrosis which was discovered belatedly due to persistent pain after several operations. The pseudarthrosis was successfully treated by osteosynthesis with a distal radius plate and implantation of a monocortical bone graft from the iliac crest. Two years after surgery, the fracture has healed and the patients pain improved significantly. In the constant score the patient achieved postoperatively 58xa0points compared to 25xa0points before surgery and 65xa0points compared to 25xa0points preoperatively in the subjective shoulder rating system (SSRS). Postoperatively, the patient had a better range of motion with active abduction/adduction of 50/0/25º (30/0/20° preoperatively), outward rotation/inward rotation of 35/0/45º (30/0/30° preoperatively) and anteversion/retroversion of 60/0/35° (35/0/20° preoperatively).

Posttraumatische Torsionsfehler am Unterarm

ZusammenfassungUnterarmfrakturen betreffen alle Altersschichten. Auch wenn die angrenzenden Gelenke nicht direkt beteiligt sind, haben diese Verletzungen den Charakter einer intraartikulären Fraktur. Eine ihrer häufigsten Komplikationen ist eine schmerzhafte Bewegungseinschränkung, die oft auf eine unterdiagnostizierte Torsionsfehlstellung zurückzuführen ist. In den letzten Jahren wurden jedoch durch Verwendung von schnittbildgebenden Verfahren neue Untersuchungsmethoden entwickelt, um diese Torsionsfehlstellung sicht- und quantifizierbar zu machen. Das Prinzip der Messung entspricht dem der Torsionsmessung der unteren Extremität. Auf definierten Höhen werden Computertomographie(CT)- oder Magnetresonanztomographie(MRT)-Scans erstellt. Durch Aufsuchen bestimmter Landmarken werden Torsionswinkel im Verhältnis zu einer definierten Nulllinie gemessen. Eine neue Alternative bilden 3D-Reformationsmodelle. Eine Torsionsfehlstellung v.u202fa. des Radius führt zu einer Bewegungseinschränkung der Pro- und Supination. Bei Vorliegen einer Torsionsfehlstellung können die radiologischen Messungen als Entscheidungskriterium dafür dienen, ob eine Operation durchgeführt werden soll. Anders als bei der unteren Extremität gibt es bisher keine einheitliche Definition, ab wann eine Korrektur indiziert ist. Die Entscheidung muss in Zusammenschau der klinischen und radiologischen Ergebnisse, gemeinsam mit dem Patienten, getroffen werden.AbstractForearm fractures are common in all age groups. Even if the adjacent joints are not directly involved, these fractures have an intra-articular character. One of the most common complications of these injuries is axa0painful limitation of the range of motion and especially of pronation and supination. This is often due to an underdiagnosed torsional deformity; however, in recent years new methods have been developed to make these torsional differences visible and quantifiable through the use of sectional imaging. The principle of measurement corresponds to that of the torsion measurement of the lower limbs. Computed tomography (CT) or magnetic resonance imaging (MRI) scans are created at defined heights. By searching for certain landmarks, torsional angles are measured in relation to axa0defined reference line. Axa0new alternative is the use of 3D reformation models. The presence of axa0torsional deformity, especial of the radius, leads to an impairment of the pronation and supination of the forearm. In the presence of torsional deformities, radiological measurements can help to decide if an operation is needed or not. Unlike the lower limbs, there are still no uniform cut-off values as to when axa0correction is indicated. Decisions must be made together with the patient by taking the clinical and radiological results into account.Forearm fractures are common in all age groups. Even if the adjacent joints are not directly involved, these fractures have an intra-articular character. One of the most common complications of these injuries is axa0painful limitation of the range of motion and especially of pronation and supination. This is often due to an underdiagnosed torsional deformity; however, in recent years new methods have been developed to make these torsional differences visible and quantifiable through the use of sectional imaging. The principle of measurement corresponds to that of the torsion measurement of the lower limbs. Computed tomography (CT) or magnetic resonance imaging (MRI) scans are created at defined heights. By searching for certain landmarks, torsional angles are measured in relation to axa0defined reference line. Axa0new alternative is the use of 3D reformation models. The presence of axa0torsional deformity, especial of the radius, leads to an impairment of the pronation and supination of the forearm. In the presence of torsional deformities, radiological measurements can help to decide if an operation is needed or not. Unlike the lower limbs, there are still no uniform cut-off values as to when axa0correction is indicated. Decisions must be made together with the patient by taking the clinical and radiological results into account.

Eignung der computerassistierten Femurmarknagelung zur Kontrolle von Torsion und Länge

ZusammenfassungHintergrundDie computerassistierte Femurmarknagelung zeigte in experimentellen Studien sehr aussichtsvolle Ergebnisse. Ziel der vorliegenden Studie war es, die computerassistierte Femurmarknagelung auf der Basis vorhandener klinischer Studien zu evaluieren und zu bewerten.Material und MethodenEs erfolgte die systematische Analyse sämtlicher vorhandener Literatur mit klinischer Anwendung der computerassistierten Femurmarknagelung (PubMed, Cochrane Library und Embase). Publizierte Studien bis zum Mai 2017 wurden eingeschlossen.ErgebnisseEs konnten insgesamt 3 klinische Studien analysiert werden. Unter Verwendung der computerassistierten Femurmarknagelung war in allen Studien ein relevanter Anstieg der Operations- und intraoperativen Strahlungszeit zu verzeichnen. Das klinische Ergebnis in Bezug auf Femurtorsion und -länge war tendenziell besser zugunsten der computerassistierten Versorgung, jedoch waren die Ergebnisse sehr heterogen.SchlussfolgerungDie vorliegende Analyse konnte zeigen, dass der erfolgreiche klinische Einsatz der computerassistierten Femurmarknagelung möglich ist. Jedoch kommt es zu einer relevanten Verlängerung der Operationszeit und zu einer höheren Strahlenbelastung. In Bezug auf das postoperative Ergebnis hinsichtlich Femurtorsion und -länge fanden sich sehr heterogene Ergebnisse. Weitere vergleichende Studien werden in Zukunft benötigt.AbstractBackgroundDespite promising results in experimental studies, computer-assisted femoral intramedullary nailing has not become established in the clinical practice for most orthopedic surgeons. The purpose of this study was to evaluate the advantages and disadvantages of computer-assisted reduction and nailing of femoral fractures as reported in clinical studies.Material and methodsA systematic analysis of the available literature on the clinical application of computer-assisted femoral intramedullary nailing (Pubmed, Cochrane library and Embase) was carried out. Studies published up to May 2017 were included.ResultsAxa0total of three articles were included in this meta-analysis. All studies showed axa0relevant increase in total operating time and radiation exposure time with the use of computer-assisted femoral intramedullary nailing. The clinical results for computer-assisted nailing with respect to femoral torsion and length tended to be slightly better but the results were very heterogeneous.ConclusionOur analysis could show that computer-assisted femoral intramedullary nailing is clinically feasible but the operative and fluoroscopy time needed are high and the reported postoperative results for femoral length and torsion were very heterogeneous. Further comparative studies are needed in the future.BACKGROUNDnDespite promising results in experimental studies, computer-assisted femoral intramedullary nailing has not become established in the clinical practice for most orthopedic surgeons. The purpose of this study was to evaluate the advantages and disadvantages of computer-assisted reduction and nailing of femoral fractures as reported in clinical studies.nnnMATERIAL AND METHODSnA systematic analysis of the available literature on the clinical application of computer-assisted femoral intramedullary nailing (Pubmed, Cochrane library and Embase) was carried out. Studies published up to May 2017 were included.nnnRESULTSnAxa0total of three articles were included in this meta-analysis. All studies showed axa0relevant increase in total operating time and radiation exposure time with the use of computer-assisted femoral intramedullary nailing. The clinical results for computer-assisted nailing with respect to femoral torsion and length tended to be slightly better but the results were very heterogeneous.nnnCONCLUSIONnOur analysis could show that computer-assisted femoral intramedullary nailing is clinically feasible but the operative and fluoroscopy time needed are high and the reported postoperative results for femoral length and torsion were very heterogeneous. Further comparative studies are needed in the future.