Advertisement for orthosearch.org.uk
Results 1 - 4 of 4
Results per page:
Applied filters
Content I can access

Include Proceedings
Dates
Year From

Year To
Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 18 - 18
1 Sep 2012
Keel M Benneker L Seidel U Siebenrock K Bastian J
Full Access

Introduction

Significant access morbidity with intercostal neuralgia and post-thoracotomy pain syndrome was reported in case that an anterior approach for spondylodesis of fractures of the thoracolumbar spine was used. We describe our experience with thoracoscopical fusion from anterior as a less invasive approach.

Patients

Between 02/2007 and 09/2008 in a series of 32 patients (18 male; mean age 43, 17–74yrs) with fractures of the thoracolumbar spine (level Th11: n = 2, level Th12: n = 12, level L1: n = 18; fracture types: A3.1.1: n = 15, A3.2.1: n = 11, A3.3.1: n = 3, B2.1: n = 1 and B2.3: n = 2) thoracoscopical fracture stabilization was performed. A less invasive approach with three portals without an assistant was used facilitated by a new retractor system. In 16 patients fracture stabilization from anterior was supported by an additional spondylodesis using an dorsal approach. For reconstruction of the anterior column a VLIFT-system (n = 19), a Synex- (n = 11) or a Harms-Cage (n = 2) in combination with a MACS-TL (n = 16) or a Arcofix-system (n = 2) were used.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 150 - 150
1 May 2011
Büchler L Schaller C Bastian J Keel M Siebenrock K
Full Access

Acetabular retroversion is a well-documented cause of femoro-acetabular impingement (FAI). There are few reports of long-term outcomes following correction of retroversion. We hypothesized that correction of acetabular retroversion with peri-acetabular osteotomy (PAO) in young adults with symptomatic FAI can lead to symptomatic relief, improvement of function and thus potentially delay the progression of osteoarthritis.

Twenty-two patients (29 hips) underwent Bernese PAO for treatment of symptomatic FAI with acetabular retroversion between April 1997 and August 1999. Mean age at surgery was 23 years (14–41). Mean duration of symptoms was 17 months (6–24). All pre-operative radiographs demonstrated Tönnis grade 0 of degenerative changes. Mean follow up was 127 months (109–142). Clinical, functional and radiographic outcomes are presented.

The overall mean Merle d’Aubigné score improved from 14.0 points (12–16) pre-operatively to 16.3 points (14 to 18) at the time of last follow-up. There were three reoperations due to loss of correction, posterior impingement and cam impingement. There were no major vascular or neurologic complications and none related to non- healing of the osteotomies. All patients had symptomatic relief at final follow-up. Range of motion and functional scores improved in all cases (even in those with repeat procedures). The vast majority of patients continued to demonstrate no signs of osteoarthritis (Tönnis greade 0) at final follow-up.

Acetabular retroversion is a mechanical factor that can lead to FAI. In symptomatic cases, PAO is a safe and reliable method for correction of the retroversion and can relief symptoms, improve function and prevent rapid progression of osteoarthritis.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_II | Pages 316 - 317
1 May 2010
Bastian J Zumstein M Tomagra S Bosshard C Schuster A
Full Access

Background: The purpose of the study was to evaluate whether anteroposterior translation (APT) after ACL reconstruction with intraoperative balancing of the transplant tension to that of the contralateral ACL could be obtained at follow up. Additionally, differences of APT’s following ACL reconstruction using either autologous patella bonetendon–bone (BTB) or autologous quadriceps-tendon-bone (QTB) were assessed.

Methods: In a consecutive series of 44 patients (44 knees), ACL deficiency was treated in 30 patients (median age: 33, 16–58, 20 male, 22 right knee) with BTB–and in 14 patients (median age: 31, 17–50, 8 male, 10 right knee) with QTB-reconstruction. APT was evaluated in 20° knee flexion in the affected and healthy contralateral knee using the Rolimeter®. Measurements were performed in both knees preoperative, during, and immediately after ACL-reconstrucion, as well as 3, 6 and 12 months postoperatively in triplates. For statistical analysis the non-parametrical Kruskal-Wallis Test (post test: Dunn’s Test) was used.

Results: Statistically significant decreases of APT were observed between pre–and intraoperative measurements in the BTB–and the QTB-group due to ACL reconstruction (11.1±2.0 to 6.3±0.7mm; p< 0.001 in the BTB and 11.1±2.3 to 6.8±1.2mm; p< 0.001 in QTB group). At the intraoperative measurements, there were no differences in APT between the contralateral healthy knee and the reconstructed knee in both groups. During the follow up, significant loss of APT in the balanced reconstructed knees were only observed in the BTB group after 12 months (6.3±0.7 to 7.5±1.2mm; p< 0.05).

Conclusion: After reconstruction of the ACL, BTB–and QTB-ACL reconstruction groups, yielded the same anteroposterior translation (APT) as contralateral healthy knees. This new intraoperative technique provides ACL reconstruction with balancing of the anteroposterior knee translation of the healthy contralateral knee. An increase in APT could be observed 12 months after ACL reconstruction only in the BTB group. Further research is necessary to assess whether QTB-ACL-reconstruction should be preferred regarding preservation of the initial ligament tension at follow up.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_I | Pages 39 - 39
1 Mar 2009
Bastian J Hertel R
Full Access

Background: The purpose of the presented study was to evaluate the longterm outcome of surgically treated complex fractures of the proximal humerus including fractures with initial humeral head ischemia. The study was focused on the assessment of the functional outcome as well as on the occurence of avascular necrosis.

Methods: 100 shoulders (98 patients/60y/21–88) with intracapsular fractures of the proximal humerus were included in a prospective surgical evaluation protocol (Binary [LEGO] description system: 48/100 4-, 46/100 3-, 6/100 2-fragment fractures). Humeral head perfusion was assessed intraoperatively by means of laser-Doppler flowmetry and borehole judgement. 51/100 fractures were treated with osteosynthesis (group A). 49/100 were treated with hemiarthroplasty (group B). In group A 41/51 heads were perfused at the index procedure (A1) and 10/51 were ischemic (A2). The patients were re-evaluated at a mean follow-up of 5.0 years (3.3–7.3) using the Constant-Murley-Score (CMS), the Subjective Shoulder Value (SSV) and conventional x-ray imaging.

Results: The median total CMS was 76 (37–98) in group A, 70 (39–84) (group B) (p=0.02). The median SSV was 92 (40–100) (group A) and 90 (40–100) in group B (p=0.93). In group A1 6/30 heads were structurally alterated but not collapsed; 4/30 were collapsed. In group A2 6/10 were structurally alterated but not collapsed; 3/10 were collapsed. The median CMS for patients without structural alterations was 80 (37–98), for those with structural alterations 84 (53–93) and for those with collapsed heads 63 (48–74). The median SSV was 95 (50–100), 92 (50–100) and 60 (40–80), respectively.

Conclusions: Revascularization of the humeral head after initial ischemia is possible and occured in 7/10 patients. Their functional results were comparable to those of patients with initially perfused heads. When feasible, osteosynthesis is a viable option even for ischemic heads. The indication for osteosynthesis should be weighed against the fact that Osteosynthesis and Arthroplasty showed comparable long-term results.