Franz Rachbauer

Motion in Lumbar Functional Spine Units During Side Bending and Axial Rotation Moments Depending on the Degree of Degeneration

Study Design. Human lumbar spine specimens were tested in axial rotation and side bending. Motion was related to the grade of degeneration. Objectives. To determine the degree to which degeneration with fissure formation in the disc affects axial rotation of the lumbar functional spine unit. Summary of Background Data. There is controversy in the literature regarding the influence of severe degeneration and fissures of the disc on the range of axial rotation. Methods. Thirty-six lumbar spine specimens were tested in axial rotation and side bending, by applying pure moments in an unconstrained setting. The motion in 6 df was recorded by dial gauges. The grade of degeneration was established by the grading schemes of Nachemson, Thompson, Adams, and Mimura. Results. A significant increase of axial rotation and lateral translation under torque was found. This increase mainly took place between Grade 3 according to the schemes of Nachemson, Thompson, and Adams (no fissure formation) and the higher grades of degeneration (defined by fissure formation). Reduced disc height was always associated with fissures. Conclusions. A reduced lumbar disc height in radiographs seems to be associated with fissure formation in the disc. In this case, the range axial rotation after torque is increased in comparison with cases with less degeneration.

Radiographic Abnormalities in the Thoracolumbar Spine of Young Elite Skiers

An increased frequency of radiologic abnormalities in the thoracolumbar spine has been reported among young athletes in various sports, but there are no data concerning ski sports. To evaluate the incidence of these abnormalities in young elite skiers, we compared 120 skiers younger than 17 years old (alpine skiers, ski jumpers, and Nordic cross-country skiers) with a random sample of 39 control subjects of the same age who had no history of high-performance sports participation. Standardized anteroposterior and lateral radiographs of the entire lumbar spine, the lower thoracic spine, and the upper part of the sacrum were obtained from each athlete and each control subject. Radiographs were evaluated by two independent observers for the presence and size of anterior and posterior endplate lesions and Schmorls nodes. The elite alpine skiers and ski jumpers demonstrated a significantly higher rate of anterior endplate lesions than did the control subjects. This finding might be attributable to excessive loading and repetitive trauma of the immature spine under high velocity, especially in the forward bent posture.

Reproducible assessment of radiolucent lines in total knee arthroplasty.

The Knee Society Total Knee Arthroplasty Radiographic Evaluation and Scoring System was introduced to encourage uniform reporting of radiographic outcome. However, the method for evaluation of radiolucent lines has been shown to be unreliable. Because it has been shown that reducing the complexity of classification systems increases reliability and reproducibility, we questioned whether a simplification of the Radiographic Evaluation and Scoring System would improve reliability and reproducibility. A new system for assessment of radiolucent lines was introduced, and the interobserver reliability and intraobserver reproducibility were studied in 100 patients with 120 total knee replacements. For the new system the mean kappa intraobserver reproducibility coefficient was 0.71 (range, 0.62–0.85) for the femoral component, 0.86 (range, 0.80–0.96) for the tibial component, and 0.58 (range, 0.46–0.75) for the patella prosthesis. The mean interobserver reliability coefficient among three observers was 0.61 (range, 0.45–0.72) for the femoral component, 0.82 (range, 0.73–0.88) for the tibial component, and 0.58 (range, 0.43–0.72) for the patella prosthesis. The new system for assessment of radiolucent lines increased reliability and reproducibility and should supplement the Knee Society’s Radiographic Evaluation and Scoring System. Level of Evidence: Diagnostic study, Level II-1 (development of diagnostic criteria on basis of consecutive patients—with universally applied reference gold standard). See the Guidelines for Authors for a complete description of levels of evidence.

High-Dose-Rate Intraoperative Brachytherapy (IOHDR) Using Flab Technique in the Treatment of Soft Tissue Sarcomas

Background: Adjuvant radiotherapy has been shown to improve local control in patients with soft tissue sarcoma. Additional brachytherapy represents a means of enhancing the therapeutic ratio, as biological and dosimetric advantage over single external-beam irradiation (EBRT) can be expected. High-dose-rate intraoperative brachytherapy (IOHDR) as a boost therapy should therefore be able to further diminish the rate of local recurrence even when performing marginal resection. There are sparse data on IOHDR using flab applicators as adjuvant boost to EBRT in combination with marginal resection of soft tissue sarcomas. Patients and Methods: Within a period of 8 years, we prospectively studied 39 adult patients treated by marginal resection, IOHDR using the flab technique and EBRT for soft tissue sarcomas. There were 32 high-grade and seven low-grade tumors, 35 were > 5 cm. Mean follow-up was 26 months (range 3–59 months). Results: We could not detect any local recurrences. No treatment-related loss of limb or life occurred. There were no neurologic or vascular complications, all patients maintained functioning extremities as evidenced by a mean Musculoskeletal Tumor Society (MSTS) functional score of 88.5 (70–100). Treatment-related wound morbidity occurred in eleven patients necessitating revision surgery in eight. Metastatic disease developed in seven patients, six of them had died. The 2-year actuarial disease-free survival was 84%. Conclusions: IOHDR using the flab technique in combination with EBRT and marginal resection is an efficient treatment technique leading to optimal local control rates and limited functional impairment.Hintergrund: Die adjuvante perkutane Strahlentherapie hat unter Beweis gestellt, dass sie die lokale Kontrolle von Weichteilsarkomen verbessern kann. Eine zusätzliche Brachytherapie könnte die therapeutische Wirksamkeit weiter erhöhen, da mit einem biologischen und dosimetrischen Vorteil gegenüber der alleinigen perkutanen Strahlentherapie zu rechnen ist. Die intraoperative Hochdosisbrachytherapie (IOHDR) als Boost-Therapie sollte daher in der Lage sein, die Lokalrezidivrate weiter zu senken, selbst wenn der Tumor nur marginal reseziert wird. Bis jetzt gibt es nur sehr wenige Daten über die IOHDR unter Verwendung von Flab-Applikatoren und marginaler Resektion von Weichteilsarkomen. Patienten und Methodik: Innerhalb einer Zeitspanne von 8 Jahren haben wir prospektiv den Verlauf von 39 erwachsenen Patienten verfolgt, die wegen eines Weichteilsarkoms mit marginaler Tumorresektion, IOHDR unter Verwendung von Flab-Applikatoren und perkutaner Strahlentherapie behandelt wurden. Es lagen 32 hochmaligne und sieben niedrigmaligne Tumoren vor, 35 Tumoren waren > 5 cm. Die mittlere Nachuntersuchungszeit betrug 26 Monate (3–59 Monate). Ergebnisse: Es ließen sich keine Lokalrezidive feststellen. Auch kam es zu keinem Extremitätenverlust oder therapiebedingten Todesfällen. Es traten keine Nerven- oder Gefäßkomplikationen auf, bei allen Patienten konnten funktionstüchtige Extremitäten erhalten werden, was sich in einem mittleren Musculoskeletal-Tumor-Society-(MSTS-)Funktionswert von 88,5 (70–100) zeigte. Wundheilungsstörungen stellten sich bei elf Patienten ein, die aber nur in acht Fällen chirurgisch versorgt werden mussten. Fernmetastasen traten bei sieben Patienten auf, von denen in der Zwischenzeit sechs verstorben sind. Die aktuarische krankheitsfreie 2-Jahres-Überlebensrate betrug 84%. Schlussfolgerungen: Die IOHDR in Verbindung mit perkutaner Strahlentherapie und marginaler Tumorresektion stellt eine effektive Behandlungstechnik dar, die den Tumor lokal optimal kontrolliert und die Extremitätenfunktion nur geringfügig einschränkt.

Suprascapular nerve entrapment at the spinoglenoid notch caused by a ganglion cyst

A 34-year-old man had right infraspinatus muscle palsy and posterior aching of the shoulder caused by electromyographically confirmed suprascapular nerve entrapment. Sonography and magnetic resonance imaging revealed a cystic lesion at the spinoglenoid notch; this lesion was diagnosed as a ganglion. Operative removal led to immediate pain relief and incomplete recovery of the compressed branches of the suprascapular nerve.

Glenohumeral osteoarthrosis after the Eden-Hybbinette procedure.

Thirty-six patients (36 shoulders) who underwent the Eden-Hybbinette procedure for recurrent anterior dislocation of the shoulder with an average followup of 15 years were evaluated. Evaluation consisted of radiographic assessment in a true anteroposterior view and an axillary lateral view of both shoulders, physical examination, and a questionnaire. Mild glenohumeral osteoarthrosis was present in 1/3 of the patients, and moderate and severe osteoarthrosis was evident in 1/2. There were no signs of osteoarthrosis in four shoulders. Function, as assessed by the Rowe score as modified by Young and Rockwood, was excellent or good in 27 shoulders and fair or poor in nine shoulders. The extent of osteoarthrosis was related to restriction of external rotation, length of followup, and function.

Minimalinvasive Hüftendoprothetik über den anterioren Zugang

ZusammenfassungOperationszielDurch die minimalinvasive Hüftendoprothetik über einen vorderen Zugang sollen der Gewebeschaden vermindert, der Blutverlust und die postoperativen Schmerzen verringert, der Aufenthalt im Spital verkürzt, die postoperative Wiederherstellung beschleunigt und die Narbe klein gehalten werden.IndikationenDie Technik eignet sich für primäre und sekundäre Koxarthrosen sowie Schenkelhalsbrüche mit Ausnahme komplexer Fehlstellungen des proximalen Femurs.KontraindikationenKomplexe Fehlstellung des proximalen Femurs.OperationstechnikIm Intervall zwischen den Musculi tensor fasciae latae, glutei medius et minimus lateral und den Musculi sartorius und rectus femoris medial wird der Schenkelhals dargestellt und osteotomiert, und der Kopf wird extrahiert. Das Azetabulum wird eingestellt und für die Aufnahme der Pfanne aufgefräst. Nach einer peritrochantären Kapsulotomie wird das außenrotierte, adduzierte und elevierte proximale Femur aufgeweitet. Es werden zementfreie oder zementierte Implantate eingesetzt.WeiterbehandlungDie Patienten werden ab dem 1. postoperativen Tag voll belastend mobilisiert und entlassen, sobald sie Transfers sicher beherrschen sowie Treppen bewältigen.ErgebnisseDie Methode ist ein sicheres Verfahren, das eine korrekte Platzierung der Pfannen- und Schaftkomponenten erlaubt. Es lässt sich in angemessener Zeit durchführen, der Blutverlust ist gering. Das Verfahren schont die Muskulatur und führt zu kleinen, kosmetisch ansprechenden Narben. Die Patienten leiden üblicherweise nicht an ausgeprägten postoperativen Schmerzen, ihre Wiederherstellung verläuft beschleunigt. Sie stimmen daher einem kurzen postoperativen Krankenhausaufenthalt zu.AbstractObjectiveMinimally invasive total hip arthroplasty via direct anterior approach aims at reducing soft-tissue damage, diminishing blood loss and postoperative pain, shortening stay in hospital, accelerating rehabilitation, and keeping scars small.IndicationsThe technique is suitable for primary and secondary osteoarthritis as well as fractures of the femoral neck. Complex distortions of the proximal femur should be exempted.ContraindicationsComplex malalignment of the proximal femur.Surgical TechniqueThe femoral neck is exposed in the interval between tensor fasciae latae, glutei medius and minimus muscles laterally, and sartorius and rectus femoris muscles medially. After osteotomy of the neck and extraction of the head the acetabulum is reamed to prepare for cup prosthesis. Following peritrochanteric capsulotomy the externally rotated, adducted and elevated femor is broached. Cemented and cementless implants may be used.Postoperative ManagementThe patients are allowed to walk full weight bearing beginning on the 1st postoperative day. As soon as they are able to safely master the transfers and stairs, they are discharged.ResultsThe method is a safe procedure that allows correct placement of acetabular and femoral components. It may be performed in a reasonable time, the blood loss is little. The procedure preserves the muscles and leads to small, cosmetically pleasing scars. Patients usually do not suffer from pronounced pain, rehabilitation is accelerated. They therefore agree in an short postoperative stay in hospital.OBJECTIVE Minimally invasive total hip arthroplasty via direct anterior approach aims at reducing soft-tissue damage, diminishing blood loss and postoperative pain, shortening stay in hospital, accelerating rehabilitation, and keeping scars small. INDICATIONS The technique is suitable for primary and secondary osteoarthritis as well as fractures of the femoral neck. Complex distortions of the proximal femur should be exempted. CONTRAINDICATIONS Complex malalignment of the proximal femur. SURGICAL TECHNIQUE The femoral neck is exposed in the interval between tensor fasciae latae, glutei medius and minimus muscles laterally, and sartorius and rectus femoris muscles medially. After osteotomy of the neck and extraction of the head the acetabulum is reamed to prepare for cup prosthesis. Following peritrochanteric capsulotomy the externally rotated, adducted and elevated femor is broached. Cemented and cementless implants may be used. POSTOPERATIVE MANAGEMENT The patients are allowed to walk full weight bearing beginning on the 1st postoperative day. As soon as they are able to safely master the transfers and stairs, they are discharged. RESULTS The method is a safe procedure that allows correct placement of acetabular and femoral components. It may be performed in a reasonable time, the blood loss is little. The procedure preserves the muscles and leads to small, cosmetically pleasing scars. Patients usually do not suffer from pronounced pain, rehabilitation is accelerated. They therefore agree in an short postoperative stay in hospital.

Thromboseprophylaxe in der muskuloskelettalen Chirurgie

ZusammenfassungMuskuloskelettale Eingriffe sind mit einem hohen Risiko für venöse Thrombosen und Pulmonalembolien assoziiert. Die Einführung direkter oraler Antikoagulanzien (DOAK) hat die Möglichkeiten in der Prophylaxe venöser Thromboembolien bei orthopädischen und unfallchirurgischen Eingriffen erweitert. Die Fachgesellschaften für Orthopädie und Orthopädische Chirurgie (ÖGO), Unfallchirurgie (ÖGU), Hämatologie und Onkologie (OeGHO) und für Anaesthesiologie, Reanimation und Intensivmedizin (ÖGARI) tragen dieser Entwicklung Rechnung und haben die Initiative zur Erstellung österreichischer Empfehlungen für die Thromboembolieprophylaxe nach totalem Gelenksersatz von Hüfte und Knie, nach chirurgischer Versorgung von Hüftfrakturen, nach Eingriffen an der Wirbelsäule und nach kleineren orthopädischen und traumatologischen Eingriffen ergriffen. Zudem werden die Pharmakologie der DOAK und die wesentlichen Studiendaten zu jeder einzelnen der derzeit auf dem Markt befindlichen Substanzen – Apixaban, Dabigatran und Rivaroxaban – kurz dargestellt. Den Themen „Antikoagulation und neuroaxiale Blockaden“ und „Bridging“ wurden eigene Abschnitte gewidmet.SummaryMusculoskeletal surgery is associated with a high risk of venous thrombosis and pulmonary embolism. The introduction of direct oral anticoagulants (DOAK) has broadened the possibilities for prevention of venous thromboembolism in the course of orthopedic and trauma surgery. Addressing this recent development, the Austrian Societies of Orthopedics and Orthopedic Surgery (ÖGO), Trauma Surgery (ÖGU), Hematology and Oncology (OeGHO) and of Anaesthesiology, Reanimation und Intensive Care Medicine (ÖGARI) have taken the initiative to create Austrian guidelines for the prevention of thromboembolism after total hip and knee replacement, hip fracture surgery, interventions at the spine and cases of minor orthopedic and traumatic surgery. Furthermore, the pharmacology of the DOAK and the pivotal trial data for each of the three currently available substances – apixaban, dabigatran, and rivaroxaban – are briefly presented. Separate chapters are dedicated to “anticoagulation and neuroaxial anesthesia” and “bridging”.

Konsensus Diagnose und Therapie von Weichteilsarkomen

SummarySoft tissue sarcomas are heterogeneous tumours and relatively uncommon. There have been advances over the past years concerning pathology, clinical behaviour, diagnosis strategies and the treatment. To summarize these advances as well as making it public is one of the goals of the following consensus guidelines. But why do we need special guidelines for Austria? There are international guidelines published by the European Society of Medical Oncology (ESMO) and the National Comprehensive Cancer Network (NCCN). The cause is that we need an explanation of the matrix the ESMO and the NCCN gave according to our clinical practice, the local requirements and facilities in Austria. The following recommendations were drawn up following a consensus meeting of sarcoma specialists from the three high volume centres located at the medical universities in Austria. All fields of involved physicians from diagnosis to therapy worked together to know that soft tissue sarcomas are an interdisciplinary challenge and multimodal treatment is essential. For this reason, these guidelines not only explain but also give the state of the art and clear recommendations. One of the most important guidelines is that any patient with a suspected soft tissue sarcoma should be referred to one of the three university centres and managed by a specialist sarcoma multidisciplinary team. We hope that the consensus is helpful for the clinical practice and improves the quality of care for patients with soft tissue sarcomas in Austria.ZusammenfassungDie Behandlung von Weichteilsarkomen stellt eine interdisziplinäre Herausforderung dar, die eines spezialisierten Zentrums bedarf. Nur bei entsprechender Kooperation von Chirurgen, Strahlentherapeuten und Onkologen mit den diagnostischen Disziplinen Pathologie und Radiologie, ist die Chance auf das beste erreichbare Behandlungsergebnis für einen individuellen Patienten gewährleistet. Voraussetzung einer effizienten Kommunikation ist die Grundkenntnis der Besonderheiten und Klassifikation von Weichteiltumoren, deren Basis eine Unterteilung in drei Dignitätsgruppen (benigne – intermediär – maligne) darstellt. Der Therapieansatz ist in der Regel multimodal und erfordert entsprechende Infrastrukturen und Erfahrung in der Durchführung von komplexen Therapien.Soft tissue sarcomas are heterogeneous tumours and relatively uncommon. There have been advances over the past years concerning pathology, clinical behaviour, diagnosis strategies and the treatment. To summarize these advances as well as making it public is one of the goals of the following consensus guidelines. But why do we need special guidelines for Austria? There are international guidelines published by the European Society of Medical Oncology (ESMO) and the National Comprehensive Cancer Network (NCCN). The cause is that we need an explanation of the matrix the ESMO and the NCCN gave according to our clinical practice, the local requirements and facilities in Austria. The following recommendations were drawn up following a consensus meeting of sarcoma specialists from the three high volume centres located at the medical universities in Austria. All fields of involved physicians from diagnosis to therapy worked together to know that soft tissue sarcomas are an interdisciplinary challenge and multimodal treatment is essential. For this reason, these guidelines not only explain but also give the state of the art and clear recommendations. One of the most important guidelines is that any patient with a suspected soft tissue sarcoma should be referred to one of the three university centres and managed by a specialist sarcoma multidisciplinary team. We hope that the consensus is helpful for the clinical practice and improves the quality of care for patients with soft tissue sarcomas in Austria.

Consensus diagnosis and therapy of soft tissue sarcoma

SummarySoft tissue sarcomas are heterogeneous tumours and relatively uncommon. There have been advances over the past years concerning pathology, clinical behaviour, diagnosis strategies and the treatment. To summarize these advances as well as making it public is one of the goals of the following consensus guidelines. But why do we need special guidelines for Austria? There are international guidelines published by the European Society of Medical Oncology (ESMO) and the National Comprehensive Cancer Network (NCCN). The cause is that we need an explanation of the matrix the ESMO and the NCCN gave according to our clinical practice, the local requirements and facilities in Austria. The following recommendations were drawn up following a consensus meeting of sarcoma specialists from the three high volume centres located at the medical universities in Austria. All fields of involved physicians from diagnosis to therapy worked together to know that soft tissue sarcomas are an interdisciplinary challenge and multimodal treatment is essential. For this reason, these guidelines not only explain but also give the state of the art and clear recommendations. One of the most important guidelines is that any patient with a suspected soft tissue sarcoma should be referred to one of the three university centres and managed by a specialist sarcoma multidisciplinary team. We hope that the consensus is helpful for the clinical practice and improves the quality of care for patients with soft tissue sarcomas in Austria.ZusammenfassungDie Behandlung von Weichteilsarkomen stellt eine interdisziplinäre Herausforderung dar, die eines spezialisierten Zentrums bedarf. Nur bei entsprechender Kooperation von Chirurgen, Strahlentherapeuten und Onkologen mit den diagnostischen Disziplinen Pathologie und Radiologie, ist die Chance auf das beste erreichbare Behandlungsergebnis für einen individuellen Patienten gewährleistet. Voraussetzung einer effizienten Kommunikation ist die Grundkenntnis der Besonderheiten und Klassifikation von Weichteiltumoren, deren Basis eine Unterteilung in drei Dignitätsgruppen (benigne – intermediär – maligne) darstellt. Der Therapieansatz ist in der Regel multimodal und erfordert entsprechende Infrastrukturen und Erfahrung in der Durchführung von komplexen Therapien.Soft tissue sarcomas are heterogeneous tumours and relatively uncommon. There have been advances over the past years concerning pathology, clinical behaviour, diagnosis strategies and the treatment. To summarize these advances as well as making it public is one of the goals of the following consensus guidelines. But why do we need special guidelines for Austria? There are international guidelines published by the European Society of Medical Oncology (ESMO) and the National Comprehensive Cancer Network (NCCN). The cause is that we need an explanation of the matrix the ESMO and the NCCN gave according to our clinical practice, the local requirements and facilities in Austria. The following recommendations were drawn up following a consensus meeting of sarcoma specialists from the three high volume centres located at the medical universities in Austria. All fields of involved physicians from diagnosis to therapy worked together to know that soft tissue sarcomas are an interdisciplinary challenge and multimodal treatment is essential. For this reason, these guidelines not only explain but also give the state of the art and clear recommendations. One of the most important guidelines is that any patient with a suspected soft tissue sarcoma should be referred to one of the three university centres and managed by a specialist sarcoma multidisciplinary team. We hope that the consensus is helpful for the clinical practice and improves the quality of care for patients with soft tissue sarcomas in Austria.