M. Runkel

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 8.8-year results after treatment with a bipolar radial head prosthesis by Judet. MATERIALS AND METHODS In our department, 19 patients were treated with bipolar radial head arthroplasty between 1997 and 2001. Seventeen of these patients-14 men and 3 women-were examined retrospectively after 106 months (range, 78-139). Of these, 9 patients were treated primarily, 7 patients secondarily, and 1 because of a tumor. RESULTS On the Mayo Elbow Performance Score, 6 patients achieved excellent results, 10 good, and one fair. The mean DASH score was 9.8 (range, 0-34). No differences were seen between primary and secondary implantation. Flexion averaged 124° (range, 110-150°), the extension deficit was 21° (range, 0-40°), pronation 64° (range, 30-90°), and supination 64° (range, 30-90°). The following complications were seen: 2 dislocations and 8 cases of degenerative changes of the capitellum, 1 with severe erosion. Signs of ulnohumeral arthrosis were found in 12 patients. No evidence of loosening, radiolucencies, or proximal bone resorption was detected. CONCLUSION Despite major primary complications and high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judets bipolar prosthesis.

Minimally invasive plate fixation in femoral shaft fractures

Bridge-plating with its advantages in terms of vascularity and bone healing is a well established procedure today in the treatment of comminuted femoral fractures. Bridge-plating means that the fracture site is not interfered with during the operative procedure. This paper introduces a surgical technique in which the plate is inserted through isolated proximal and distal incisions only, behind the vastus lateralis. Alignment is secured by the plates, the fracture site remains untouched, fixation and screw insertion is restricted to the proximal and distal main fragments. Longitudinal femoral fractures extending right into the trochanteric and or condylar areas are the main indication for minimally invasive plate fixations with angled blade plates or condylar screws since fractures which are restricted to the diaphyseal area are mostly treated by nailing today. The surgical trauma resulting from plating by proximal and distal incisions only is less than that associated with conventional techniques. Indirect reduction of femoral fragments is much easier since the integrity of the surrounding muscles and soft tissue is preserved, the fragments often being reduced simply by traction. Adjustment of rotation is an essential aspect requiring careful attention. For special indications, namely comminuted fractures affecting a large part of the femur and extending into the trochanteric or condylar areas, insertion of the plate via proximal and distal incisions only is a further development in bridge-plating which minimizes surgical trauma and operation time.

Behandlung und Ergebnisse nach Rupturen des Ligamentum patellae

ZusammenfassungDie vergleichsweise seltenen Rupturen des Ligamentum patellae werden im jungen Erwachsenenalter durch ein direktes Trauma ausgelöst; beim älteren Menschen führt ein inadäquates Ereignis zur Spontanruptur. Im eigenen Krankengut der Jahre 1980 bis 1990 stehen acht traumatische Rupturen (Durchschnittsalter: 26,5 Jahre) elf Spontanzerreißungen (Durchschnittsalter: 57,5 Jahre) gegenüber. Zur operativen Wiederherstellung der zerrissenen oder ausgerissenen Patellarsehne gibt es keine Alternative; Sehnennaht und entlastende Drahtschlaufe ermöglichen unter frührunktioneller Nachbehandlung ein gutes funktionelles Resultat mit leichteren bleibenden Muskelverschmächtigugen und geringen Bewegungseinschränkungen des Kniegelenkes.AbstractRuptures of the patellar ligament are rather uncommon. In younger individuals they are due to adequate trauma, in older individuals spontaneous ruptures occur after inadequate trauma. We observed eight traumatic (

Ergebnisse nach primärer ungebohrter Tibianagelung von Unterschenkelfrakturen mit schwerem offenem oder geschlossenem Weichteilschaden

\bar x = 26.5

Die versorgung von femurfrakturen bei hüftendoprothese

years) and eleven spontaneous ruptures (

Die Effizienz der sonographisch kontrollierten direkten Reposition von Fragmenten der Wirbelkörperhinterkante

\bar x = 57.5