M.J. Friedrich

Interkalare Rekonstruktion diaphysärer Knochendefekte mit einem modularen Diapyhsenersatzsystem

OBJECTIVE Reconstruction and long-term stabilization of segmental diaphyseal bone defects of the humerus, femur, and tibia. INDICATIONS Segmental bone defects due to aggressive benign or primary malignant bone tumors, trauma, pathological fractures, osteomyelitis, or failed osteosynthesis. CONTRAINDICATIONS Acute or chronic local infections, large metadiaphyseal bone defects preventing adequate anchorage of the prosthesis, very short life expectancy (<3 months). SURGICAL TECHNIQUE Exposure and resection of the bony defect according to the preoperative planning. Reaming of the intramedullary canals proximally and distally followed by implantation of the stems (cemented or noncemented). Reducing sleeves can be used to bridge the difference in diameter between the nail and the spacer. Mounting of the spacer half shell with the threaded holes from underneath after adjusting for alignment and rotation. Assembling of the other half shell by guided pins to ensure proper alignment. Tightening of the clamping screws using a torque screwdriver. Connection of two spacers is possible. POSTOPERATIVE MANAGEMENT Active physiotherapy and full weight bearing; antibiotic prophylaxis. RESULTS The results of 14 consecutive patients treated with 15 modular intercalary endoprostheses (Osteobridge™, Merete, Berlin, Germany) between January 2007 and January 2012 with a mean follow up of 24 ± 12 months (range 12-51 months) were evaluated retrospectively. One patient had a primary malignant bone tumor, while all the other patients underwent resection for metastatic disease. The mean age at surgery was 65.9 ± 15.7 years (range 25-83 years). The mean diaphyseal reconstruction length was 110 ± 50 mm (range 50-190 mm). Three patients (20%) required revision of the distal stem due to aseptic loosening. Evaluation of the functional outcome using the MSTS score by Enneking revealed 3 very good (22%), 7 good (50%), 4 fair (28%), and no poor results.

[Intercalary reconstruction for diaphyseal bone defects with a modular replacement system: Clinical results].

OBJECTIVE Reconstruction and long-term stabilization of segmental diaphyseal bone defects of the humerus, femur, and tibia. INDICATIONS Segmental bone defects due to aggressive benign or primary malignant bone tumors, trauma, pathological fractures, osteomyelitis, or failed osteosynthesis. CONTRAINDICATIONS Acute or chronic local infections, large metadiaphyseal bone defects preventing adequate anchorage of the prosthesis, very short life expectancy (<3 months). SURGICAL TECHNIQUE Exposure and resection of the bony defect according to the preoperative planning. Reaming of the intramedullary canals proximally and distally followed by implantation of the stems (cemented or noncemented). Reducing sleeves can be used to bridge the difference in diameter between the nail and the spacer. Mounting of the spacer half shell with the threaded holes from underneath after adjusting for alignment and rotation. Assembling of the other half shell by guided pins to ensure proper alignment. Tightening of the clamping screws using a torque screwdriver. Connection of two spacers is possible. POSTOPERATIVE MANAGEMENT Active physiotherapy and full weight bearing; antibiotic prophylaxis. RESULTS The results of 14 consecutive patients treated with 15 modular intercalary endoprostheses (Osteobridge™, Merete, Berlin, Germany) between January 2007 and January 2012 with a mean follow up of 24 ± 12 months (range 12-51 months) were evaluated retrospectively. One patient had a primary malignant bone tumor, while all the other patients underwent resection for metastatic disease. The mean age at surgery was 65.9 ± 15.7 years (range 25-83 years). The mean diaphyseal reconstruction length was 110 ± 50 mm (range 50-190 mm). Three patients (20%) required revision of the distal stem due to aseptic loosening. Evaluation of the functional outcome using the MSTS score by Enneking revealed 3 very good (22%), 7 good (50%), 4 fair (28%), and no poor results.

Interkalare Rekonstruktion diaphysärer Knochendefekte mit einem modularen Diapyhsenersatzsystem@@@Intercalary reconstruction for diaphyseal bone defects with a modular replacement system: Klinische Ergebnisse@@@Clinical results

OBJECTIVE Reconstruction and long-term stabilization of segmental diaphyseal bone defects of the humerus, femur, and tibia. INDICATIONS Segmental bone defects due to aggressive benign or primary malignant bone tumors, trauma, pathological fractures, osteomyelitis, or failed osteosynthesis. CONTRAINDICATIONS Acute or chronic local infections, large metadiaphyseal bone defects preventing adequate anchorage of the prosthesis, very short life expectancy (<3 months). SURGICAL TECHNIQUE Exposure and resection of the bony defect according to the preoperative planning. Reaming of the intramedullary canals proximally and distally followed by implantation of the stems (cemented or noncemented). Reducing sleeves can be used to bridge the difference in diameter between the nail and the spacer. Mounting of the spacer half shell with the threaded holes from underneath after adjusting for alignment and rotation. Assembling of the other half shell by guided pins to ensure proper alignment. Tightening of the clamping screws using a torque screwdriver. Connection of two spacers is possible. POSTOPERATIVE MANAGEMENT Active physiotherapy and full weight bearing; antibiotic prophylaxis. RESULTS The results of 14 consecutive patients treated with 15 modular intercalary endoprostheses (Osteobridge™, Merete, Berlin, Germany) between January 2007 and January 2012 with a mean follow up of 24 ± 12 months (range 12-51 months) were evaluated retrospectively. One patient had a primary malignant bone tumor, while all the other patients underwent resection for metastatic disease. The mean age at surgery was 65.9 ± 15.7 years (range 25-83 years). The mean diaphyseal reconstruction length was 110 ± 50 mm (range 50-190 mm). Three patients (20%) required revision of the distal stem due to aseptic loosening. Evaluation of the functional outcome using the MSTS score by Enneking revealed 3 very good (22%), 7 good (50%), 4 fair (28%), and no poor results.

Niedrigintensiver gepulster Ultraschall zur Behandlung von Frakturen und Pseudarthrosen – Evidenz und Erkenntnisse aus Forschung und Klinik

In Germany, 800,000 fractures are treated per year, and up to 10 % of these patients may suffer subsequently from a delayed union or a nonunion at the fracture site. Surgical treatment of these complications is tedious and associated with high costs. Therefore non-operative treatment is recently receiving more scientific and clinical attention. The adjuvant treatment with ultrasound has been propagated for the past years to enhance fracture healing and bony union, and has been discussed controversially. This review article demonstrates the significance of the low intensity pulsed ultrasound application in fracture treatment, on the basis of basic science results, animal experiments and the results of clinical trials.

Weichgewebstumor in der Nähe von Gelenken: Hibernom

Gelenknahe Tumoren mussen histologisch abgeklart werden, da neben entzundlichen Veranderungen auch benigne und maligne Tumoren auftreten. Wir berichten uber einen glatt begrenzten Tumor, der in der Ellenbeuge lokalisiert war und sich histologisch als Hibernom erwies. Die Therapie erfolgt chirurgisch durch komplette Resektion, Rezidive treten sehr selten auf. Es lag keine MDM-2-Genamplifikation vor, somit war ein Liposarkom mit hibernomahnlichen Arealen auszuschliesen. Hibernome sind Tumoren des braunen Fettgewebes, die selten auch in der Nachbarschaft von Gelenken auftreten konnen.