Werner Kolb

Fixation of Distal Femoral Fractures With the Less Invasive Stabilization System: A Minimally Invasive Treatment With Locked Fixed-angle Screws

BACKGROUND The Less Invasive Stabilization System (LISS) is an internal fixator, which combines closed reduction of the diaphysis or metaphysis of distal femur fractures with locked unicortical screw fixation. METHODS In a retrospective consecutive study, 50 patients with Association for the Study of the Problems of Internal Fixation/Orthopaedic Trauma Association (AO/OTA) type 33-A1 to 33-C3 fractures were treated with the LISS between January 1999 and December 2003. Final results were assessed using the functional score of Neer after a median follow-up of 29 months (15-48 months). RESULTS Fifteen male and 16 female patients were followed up. The mean age was 49 years (17-90 years). Deep wound infection was seen in one patient (3%) and malpositioning with cutting-out of the proximal screws was in two patients (6%). All other fractures healed uneventfully without bone graft requirements after a mean of 12 weeks (7-20 weeks). A revised osteosynthesis was performed for correction of a valgus deformity of 20 degrees after 4 months. There was no difference in leg length exceeding 2 cm. One patient had a valgus deformity of 10 degrees combined with a rotational deformity of 10 degrees. Range of motion of the knee joint was >120 degrees in 15 patients (48%); 12 (39%) had a range of motion between 90 degrees and 120 degrees and 4 (13%) between 70 degrees and 90 degrees. The function according to the Neer score was excellent in 15 (48%), good in 10 patients (32%), and fair in 6 patients (20%). The mean Neer score was 80 (60-100). CONCLUSIONS The LISS promotes early mobilization and rapid rates of bony and clinical healing without bone grafting with low rates of infection.

Fixation of periprosthetic femur fractures above total knee arthroplasty with the less invasive stabilization system: a midterm follow-up study.

BACKGROUND The complication rate of periprosthetic femoral fractures above well-fixed total knee arthroplasties is high. The Less Invasive Stabilization System (LISS) was introduced to reduce surgical dissections at the fracture site. The purpose of this retrospective study was to evaluate the midterm functional outcome of a group of patients with periprosthetic fractures above well-fixed total knee arthroplasties treated with the LISS. METHODS Between January 1999 and June 2004, 23 consecutive patients (all women) with periprosthetic fractures above well-fixed total knee arthroplasties were treated with the LISS. The mean age was 77 years (range, 61-90 years). RESULTS Nineteen of the patients (83%) were seen after a midterm follow-up of 46 months (range, 26-67 months). Three patients (13%) died, and one patient (4%) was lost to follow-up. A proximal screw pull-out of the internal fixator occurred in one patient (4%). All fractures healed within a mean of 14 weeks (range, 9-21 weeks). No bone graft was required. There were two delayed unions, no nonunions or infections. One patient (4%) had a malalignment with 7° varus. The mean range of motion was 102° (range, 65-120°). The mean knee score of the Knee Society was 81 points (range, 65-90 points), and the mean function score of the Knee Society was 56 points (range, 35-90 points). CONCLUSIONS We found that a minimally invasive, locked plating system permitted stable fixation, early knee motion with good midterm results, and minimal complications. These techniques should be used in place of less stable and more invasive methods.

Operative treatment of distal femoral fractures above total knee arthroplasty with the indirect reduction technique: a long-term follow-up study.

The complication rate of conventional plate osteosynthesis (CPO) of periprosthetic femoral fractures above total knee arthroplasties (TKA) is high. Indirect reduction techniques were introduced to reduce surgical dissection at the fracture site. Twenty-one patients (4 men and 17 women) with femoral fractures above well-fixed total knee arthroplasties were consecutively treated with the indirect reduction technique. AO/ASIF (Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of the Problems of Internal Fixation) Type 33A fractures were included. The mean age was 78 years (range, 67-94 years). Four fractures were stabilised with bone grafts, three in combination with bone cement. Nineteen of the patients were seen at a 1-year follow-up, 15 were seen after a long-term follow-up of 9 years (range, 7-12 years). There was only one implant failure in a comminuted fracture with severe osteoporosis, no infection, and no non-union. At the 1-year follow-up malalignment of 5 degrees varus occurred in one patient. The mean range of motion of the eighteen patients was 98 degrees (range, 65-110 degrees). The mean knee society score was 74 (range, 62-84), the mean function score was 52 (range, 39-72). At the long-term follow-up, the mean range of motion of the patients was 101 degrees (range, 65-115 degrees). The mean knee society score was 77 (range, 65-88), the mean function score was 55 (range, 40-75). Our results suggest the 95 degrees condylar blade plate in the indirect reduction technique is still a good implant with good long-term results. It works best in proximal fractures when there is minimal comminution of the distal fragment in the hands of an experienced trauma surgeon. Knee function and range of motion increased less over time.

The condylar plate for treatment of distal femoral fractures: A long-term follow-up study

The aim of this retrospective study was to present the long-term functional and radiological outcomes of indirect reduction techniques and fixation with a condylar plate for treatment of distal femoral supracondylar or intracondylar femoral fractures. The series included 24 men and 17 women, mean age 51 years, between March 1994 and April 1999. All fractures were AO type 33, and eight were open fractures. Primary iliac bone graft was used in five cases. In one case of severe osteoporosis, screw fixation was augmented with cement. There were three delayed unions, one non-union and two infections; four participants required reoperation with bone grafts. Two (5%) participants developed a second varus deformity and three a second valgus deformity; correction osteotomy with bone grafts was necessary in these cases. After a mean follow-up of 9.5 years, the mean Neer score was 82 points and indicated that function was excellent in 16, satisfactory in 9, unsatisfactory in 4 and poor in 2 cases. The mean Neer score in cases of isolated fracture was 89 points and in cases with additional injuries was 72 points. Thus the long-term results of indirect reduction techniques of distal femoral fractures treated with the condylar plate were good to excellent in 82% of cases.

Die offene Arthrolyse der posttraumatischen Ellenbogensteife

BACKGROUND The incidence of relevant posttraumatic functional deficits in the sense of elbow stiffness with less than 30 degrees in extension or flexion less than 120 degrees , is unknown. A differentiation can be made between intraarticular, extraarticular and combined causes. An open procedure is indicated in elbow stiffness after correct analysis of the situation and failure of conservative treatment. MATERIALS AND METHODS An open procedure was carried out on 35 patients between March 1995 and November 2001, 10 (3-24) months after the trauma. The mean age of the 24 men and 11 women was 45 (range 17-75) years. Of the patients 15 had distal humerus fractures, 10 radius head or neck fractures and 12 proximal ulnar fractures. RESULTS Of the patients 11 (31%) had an excellent result in the Cauchoix and Deburge score, 15 (42%) a good, 4 (11%) a fair, 4 (11%) a bad and 1 (3%) a very bad result after a mean follow-up of 21.5 (range 9-60) months. Of the patients 11 (31%) had an excellent result in the Mayo elbow performance score, 14 (40%) a good, 5 (14%) a fair and 5 (14%) a poor result. CONCLUSION Open arthrolysis for severe posttraumatic elbow stiffness carried out 10 months (range 3-24 months) after the accident led to good results in most cases with a clear improvement in functional mobility.

Der Bewegungsfixateur des Ellenbogens

ZusammenfassungOperationszielStabilisierung des humeroulnaren Gelenks gegen Rotations- und Scherkräfte bei erhaltener Flexions- und Extensionsbewegung, um die Kollateralbänder während der Heilung zu schützen.IndikationenAnhaltende Instabilität des Ellenbogengelenks in 90° Beugung nach Ellenbogenluxationen, vor allem in anteroposteriorer Richtung, Luxationsfrakturen, Arthrolysen und Interpositionsarthroplastiken sowie geschlossener Distraktionsarthrolyse.KontraindikationenLokale Infektion im Bereich der vorgesehenen Schanz- Schrauben, unklare Lage der neurovaskulären Strukturen, fehlende Erfahrung mit dem Fixateur externe.OperationstechnikBestimmung der Gelenkachse durch das Capitulum humeri und die Trochlea. Einbringen eines 3-mm-Kirschner-Drahts (Referenzpin) im Rotationszentrum. Besetzen der humeralen und ulnaren Schanz-Schrauben unter Sicht von lateral oder medial. Die lateralen humeralen Schanz-Schrauben werden in den distalen Humerus dorsal des Nervus radialis eingebracht. Entfernung des Referenzpins. Symmetrische Distraktion der Ulna 2–3 mm von der Gelenkfläche des Humerus mit Hilfe des Distraktors.WeiterbehandlungKeine Ruhigstellung; sofortiger Beginn mit aktiver und passiver Physiotherapie unter Plexusanästhesie abhängig von der Weichteilsituation, den individuellen Schmerzen und der Größe des operativen Eingriffs.ErgebnisseIm Rahmen einer retrospektiven Studie wurden zwischen April 2001 und März 2003 zehn Patienten mit anhaltender Instabilität in 90° Beugung oder veralteter Luxation des Ellenbogens behandelt. Das Durchschnittsalter betrug 51 Jahre (40–62 Jahre). Bei sieben Patienten musste eine Osteosynthese im Bereich des Ellenbogens durchgeführt werden, sechs wurden zunächst mit einem AO-Fixateur behandelt. Nach durchschnittlich 8 Tagen Verfahrenswechsel auf einen Bewegungsfixateur. Der mittlere Mayo-Ellenbogenfunktionsscore betrug 78 Punkte, mit zwei sehr guten, drei guten und fünf befriedigenden Ergebnissen. Die subjektive Zufriedenheit nach dem DASH-Score (Disabilities of the Arm, Shoulder and Hand) ergab eine geringe Beeinträchtigung von durchschnittlich 18 Punkten.AbstractObjectiveStabilization of the ulnohumeral joint against rotation and shear forces, preserving flexion and extension movements, in order to safeguard the healing of the collateral ligaments.IndicationsPersistent instability of the elbow joint in 90° flexion following elbow dislocation, particularly in the anteroposterior direction; dislocation fractures; arthrolysis and graft arthroplasties; closed distraction arthrolysis.ContraindicationsLocal infection in the area of the planned Schanz pins, uncertain position of the neurovascular structures, and lack of experience with the external fixator.Surgical TechniqueDetermination of the joint axis through the capitulum of the humerus and the trochlea. Insertion of a 3-mm Kirschner wire (reference pin) in the center of rotation. Insertion of the humeral and ulnar Schanz pins under direct vision from the lateral or medial aspect. The lateral humeral Schanz pins are inserted in the distal humerus dorsal to the radial nerve. Removal of the reference pin. Symmetrical distraction of the ulna 2–3 mm from the joint surface of the humerus with the aid of the distractor.Postoperative ManagementNo immobilization, immediate start on active and passive physiotherapy under plexus anesthesia, depending on the soft-tissue situation, individual pain, and the extent of the surgical procedure.ResultsThe case histories of ten patients treated for persistent instability of the elbow at 90° flexion or for an old dislocation of the elbow between April 2001 and March 2003 were studied retrospectively. The average age was 51 years (40–62 years). In seven patients internal fixation of the elbow had to be performed, six of which were treated initially with an AO fixator. After an average of 8 days the management was changed to hinged fixation. The median Mayo Elbow Function Score was 78 points with two very good, three good, and five satisfactory results. Subjective satisfaction on the DASH Score (Disabilities of Arm, Shoulder and Hand) revealed a slight reduction by an average of 18 points.

A hinged external fixator for the elbow.

ZusammenfassungOperationszielStabilisierung des humeroulnaren Gelenks gegen Rotations- und Scherkräfte bei erhaltener Flexions- und Extensionsbewegung, um die Kollateralbänder während der Heilung zu schützen.IndikationenAnhaltende Instabilität des Ellenbogengelenks in 90° Beugung nach Ellenbogenluxationen, vor allem in anteroposteriorer Richtung, Luxationsfrakturen, Arthrolysen und Interpositionsarthroplastiken sowie geschlossener Distraktionsarthrolyse.KontraindikationenLokale Infektion im Bereich der vorgesehenen Schanz- Schrauben, unklare Lage der neurovaskulären Strukturen, fehlende Erfahrung mit dem Fixateur externe.OperationstechnikBestimmung der Gelenkachse durch das Capitulum humeri und die Trochlea. Einbringen eines 3-mm-Kirschner-Drahts (Referenzpin) im Rotationszentrum. Besetzen der humeralen und ulnaren Schanz-Schrauben unter Sicht von lateral oder medial. Die lateralen humeralen Schanz-Schrauben werden in den distalen Humerus dorsal des Nervus radialis eingebracht. Entfernung des Referenzpins. Symmetrische Distraktion der Ulna 2–3 mm von der Gelenkfläche des Humerus mit Hilfe des Distraktors.WeiterbehandlungKeine Ruhigstellung; sofortiger Beginn mit aktiver und passiver Physiotherapie unter Plexusanästhesie abhängig von der Weichteilsituation, den individuellen Schmerzen und der Größe des operativen Eingriffs.ErgebnisseIm Rahmen einer retrospektiven Studie wurden zwischen April 2001 und März 2003 zehn Patienten mit anhaltender Instabilität in 90° Beugung oder veralteter Luxation des Ellenbogens behandelt. Das Durchschnittsalter betrug 51 Jahre (40–62 Jahre). Bei sieben Patienten musste eine Osteosynthese im Bereich des Ellenbogens durchgeführt werden, sechs wurden zunächst mit einem AO-Fixateur behandelt. Nach durchschnittlich 8 Tagen Verfahrenswechsel auf einen Bewegungsfixateur. Der mittlere Mayo-Ellenbogenfunktionsscore betrug 78 Punkte, mit zwei sehr guten, drei guten und fünf befriedigenden Ergebnissen. Die subjektive Zufriedenheit nach dem DASH-Score (Disabilities of the Arm, Shoulder and Hand) ergab eine geringe Beeinträchtigung von durchschnittlich 18 Punkten.AbstractObjectiveStabilization of the ulnohumeral joint against rotation and shear forces, preserving flexion and extension movements, in order to safeguard the healing of the collateral ligaments.IndicationsPersistent instability of the elbow joint in 90° flexion following elbow dislocation, particularly in the anteroposterior direction; dislocation fractures; arthrolysis and graft arthroplasties; closed distraction arthrolysis.ContraindicationsLocal infection in the area of the planned Schanz pins, uncertain position of the neurovascular structures, and lack of experience with the external fixator.Surgical TechniqueDetermination of the joint axis through the capitulum of the humerus and the trochlea. Insertion of a 3-mm Kirschner wire (reference pin) in the center of rotation. Insertion of the humeral and ulnar Schanz pins under direct vision from the lateral or medial aspect. The lateral humeral Schanz pins are inserted in the distal humerus dorsal to the radial nerve. Removal of the reference pin. Symmetrical distraction of the ulna 2–3 mm from the joint surface of the humerus with the aid of the distractor.Postoperative ManagementNo immobilization, immediate start on active and passive physiotherapy under plexus anesthesia, depending on the soft-tissue situation, individual pain, and the extent of the surgical procedure.ResultsThe case histories of ten patients treated for persistent instability of the elbow at 90° flexion or for an old dislocation of the elbow between April 2001 and March 2003 were studied retrospectively. The average age was 51 years (40–62 years). In seven patients internal fixation of the elbow had to be performed, six of which were treated initially with an AO fixator. After an average of 8 days the management was changed to hinged fixation. The median Mayo Elbow Function Score was 78 points with two very good, three good, and five satisfactory results. Subjective satisfaction on the DASH Score (Disabilities of Arm, Shoulder and Hand) revealed a slight reduction by an average of 18 points.

Komplexe osteoligamentäre Verletzungen des Ellenbogens

BACKGROUND Hinged external fixation is a recognized method to treat instabilities after complex dislocations and fracture-dislocations of the elbow. The hinged external fixator allows stabilization of the elbow while preserving flexion and extension. METHODS Eighteen patients with an average age of 47 years (range 35-67) were treated with a hinged external fixator between April 2001 and March 2006 for 6 weeks. In 11 patients an internal fixation had to be done; six were treated initially with an AO fixator. After 8 days (3-14), we changed to a hinged external fixator. RESULTS At 39 months (12-71) of follow-up, all 18 elbows were stable. One stress-fracture of the ulna after pin removal occurred. The mean Mayo Elbow Performance Index (MEPI) was 78 points. Five (28%) patients had an excellent result, six (33%) a good result and seven (39%) a fair result. The average DASH score (disabilities of the arm, shoulder and hand) was 18 points, which indicates a discrete impairment. CONCLUSION The treatment outcome of complex instabilities treated with a hinged external fixator using our technique is comparable to outcomes from other studies.

Open arthrolysis of posttraumatic elbow stiffness

BACKGROUND The incidence of relevant posttraumatic functional deficits in the sense of elbow stiffness with less than 30 degrees in extension or flexion less than 120 degrees , is unknown. A differentiation can be made between intraarticular, extraarticular and combined causes. An open procedure is indicated in elbow stiffness after correct analysis of the situation and failure of conservative treatment. MATERIALS AND METHODS An open procedure was carried out on 35 patients between March 1995 and November 2001, 10 (3-24) months after the trauma. The mean age of the 24 men and 11 women was 45 (range 17-75) years. Of the patients 15 had distal humerus fractures, 10 radius head or neck fractures and 12 proximal ulnar fractures. RESULTS Of the patients 11 (31%) had an excellent result in the Cauchoix and Deburge score, 15 (42%) a good, 4 (11%) a fair, 4 (11%) a bad and 1 (3%) a very bad result after a mean follow-up of 21.5 (range 9-60) months. Of the patients 11 (31%) had an excellent result in the Mayo elbow performance score, 14 (40%) a good, 5 (14%) a fair and 5 (14%) a poor result. CONCLUSION Open arthrolysis for severe posttraumatic elbow stiffness carried out 10 months (range 3-24 months) after the accident led to good results in most cases with a clear improvement in functional mobility.

Complex osteoligamentary injuries of the elbow. Treatment with a hinged external fixator

BACKGROUND Hinged external fixation is a recognized method to treat instabilities after complex dislocations and fracture-dislocations of the elbow. The hinged external fixator allows stabilization of the elbow while preserving flexion and extension. METHODS Eighteen patients with an average age of 47 years (range 35-67) were treated with a hinged external fixator between April 2001 and March 2006 for 6 weeks. In 11 patients an internal fixation had to be done; six were treated initially with an AO fixator. After 8 days (3-14), we changed to a hinged external fixator. RESULTS At 39 months (12-71) of follow-up, all 18 elbows were stable. One stress-fracture of the ulna after pin removal occurred. The mean Mayo Elbow Performance Index (MEPI) was 78 points. Five (28%) patients had an excellent result, six (33%) a good result and seven (39%) a fair result. The average DASH score (disabilities of the arm, shoulder and hand) was 18 points, which indicates a discrete impairment. CONCLUSION The treatment outcome of complex instabilities treated with a hinged external fixator using our technique is comparable to outcomes from other studies.