0000000000041274
AUTHOR
Jochen Blum
Clinical performance of a new medullary humeral nail: antegrade versus retrograde insertion.
Objective A new intramedullary nail system for humeral shaft fractures is evaluated to determine whether retrograde nailing is as reliable as antegrade nailing. Study design Prospective multicenter nonrandomized clinical study. Patients Eighty-four patients with acute humeral shaft fractures were nailed with the new unreamed humeral nail (UHN) system. Fifty-seven nails were introduced retrogradely, and twenty-seven antegradely. Bone healing and functional outcome were the follow-up parameters. Results The ratio of perioperative complications was equivalent for both groups, but one shaft fracture and three fractures or fissures at the entry point occurred in the group with retrograde nail in…
Verfahrenswechsel in der operativen Knochenbruchbehandlung der oberen Extremität, geplant und erzwungen
Prinzipiell werden in der operativen Knochenbruchbehandlung der oberen Extremitat definitive Verfahren angestrebt. Als ¶geplant ist der Verfahrenswechsel bei zweit- und drittgradig offenen Frakturen, insbesondere am Unterarm, akzeptiert, um nach Beherrschung der Weichteilsituation zum definitiven Verfahren, meist Plattenosteosynthese oder Marknagelung, zu wechseln. Am Oberarm kann die Indikation zum definitiven Verfahren insbesondere durch Titanmarknagel auch bei offenen Frakturen weiter gestellt werden, der Fixateur externe tritt mehr in den Hintergrund. Infekte nach Osteosynthesen, aber auch Knochenheilungsstorungen, erzwingen in der Regel den Verfahrenswechsel auch an der oberen Extremit…
Bilaterale Acetabulumfrakturen der vorderen Pfeiler und Wirbelkörperfraktur nach alkoholinduziertem Krampfanfall
The case of a 54-year-old male with a compression fracture of the T 12 vertebral body and a bilateral anterior column fracture of the acetabulum is presented. The origin of this rare combination of fractures is explained by the action of the patient's own muscle force on bone of very poor quality. The treatment of these lesions is comparable to the treatment of similar fractures in bone of normal quality.
Komprimierte Marknagelung bei Oberarmschaftfrakturen
Aufgrund geringer Fragmentverzahnung neigen Quer- und kurze Schragfrakturen des Humerus zur Entwicklung einer Pseudarthrose. Da der menschliche Humerus durch das Korpergewicht kaum axial druckbelastet ist und bei den taglichen Verrichtungen eher Zug- und Rotationskraften ausgesetzt ist, erfordern Humerusfrakturen eine hohe Stabilisierungspotenz. Diese lasst sich durch die Verriegelungsmarknagelung u. U. mit zusatzlicher interfragmentarer Kompression erreichen. Eine spezielle Kompressionsvorrichtung verlagert den dynamischen Bolzen an der Nagelbasis zusammen mit dem Knochenfragment in Richtung Bruchspalt und bewirkt nach Fragmentadaption eine Fragmentpressung und die Bolzenverklemmung. Das E…
Influence of formalin fixation on the biomechanical properties of human diaphyseal bone.
Owing to the lack of fresh human bones, formalin-fixed specimens are frequently used in biomechanical testing. However, formalin fixation is assumed to affect the biomechanical properties of bone. The aim of this study was to compare axial and torsional stiffness and bone mineral density in fresh and embalmed human bones. The subtrochanteric regions of 12 pairs of fresh human femora were randomised into two groups for paired comparison. After bone mineral density measurement, one group was preserved in 4% formalin. After 6 weeks, bone mineral density was remeasured and each specimen underwent axial and torsional loading. The formalin group showed significant higher stiffness values for tors…
Internal Fixation of Proximal Humeral Fractures: Current Concepts
Fractures of the proximal humerus are an increasingly common type of injury. Mainly elderly patients with osteoporotic bone are affected. Whereas non-displaced and stable fractures are managed successfully with conservative treatment, there is no general agreement on the surgical strategy for displaced and unstable two- to four-part fractures. The clinical outcome is influenced by the fracture type and concomitant injury to the rotator cuff. Extensive surgical manipulation of the soft tissues, non-anatomic and/or unstable fixation as well as technical errors are important contributing factors to poor clinical results. Goals of surgical treatment are to restore anatomy, to achieve fixation t…
Die retrograde Verriegelungsmarknagelung von Humerusschaftfrakturen mit dem unaufgebohrten Humerusnagel
Operationsziel Ubungsstabile Osteosynthese des Humerus mit solidem, intramedullaren Verriegelungsmarknagel in nichtaufgebohrter Technik. Rasche Wiederherstellung von Form und Funktion der betroffenen Gliedmase.
Antibiotic single-dose prophylaxis of shunt infections.
Shunt infections after implantation or revision of a shunt for CSF drainage in hydrocephalic patients are serious complications. In view of their frequency, this study investigated the efficacy of prophylactic administration of a single dose of the antibiotic cefazedone in reducing in the post-operative infection rate. Fifty children of up to 14 years of age suffering from hydrocephalus of various etiologies were treated prophylactically and compared with a similar untreated group. The diagnosis of infection was based mainly on microbiological and clinical observations and investigations. Classical infection parameters were also recorded and evaluated, but played only a secondary role in es…
Retrograde locked nailing of humeral shaft fractures using the unreamed humeral nail (UHN)
Objectives Bony consolidation of humeral fractures in anatomical reduction. Rapid rehabilitation. Restoration of normal function.
Humeral nailing revisited.
Unreamed interlocked humeral nailing for stabilisation of acute humeral fractures was introduced a decade ago. Antegrade and retrograde nail insertion are equally popular. The role of nailing as opposed to plating of humeral fractures is the subject of continuous debate. Between 1997 and 2005, 99 acute fractures of the humeral shaft were treated operatively with the unreamed humeral nail (UHN, Synthes) in our Level I Trauma Centre. The mean age of the patients was 63 years. Only eight patients (8.1%) were polytraumatised, nine patients had an open fracture (9.1%), five had a primary radial nerve palsy (5.1%). There were 54 antegrade and 45 retrograde nailings. The procedures were performed …
Ergebnisse nach primärer ungebohrter Tibianagelung von Unterschenkelfrakturen mit schwerem offenem oder geschlossenem Weichteilschaden
Primary stabilization was performed in 72 tibial fractures with sever open (n = 37) or closed (n = 35) soft tissue injury using unreamed interlocking nails. In 60 (83%) cases the fractures healed without additional procedures. There were 2 cases of osteitis, but both these fractures healed after removal of the nail or after reamed nailing. In 9 patients with delayed union reamed nailing (n = 8) or bone grafting (n = 1) led to healing. In 1 patient with hypertrophic pseudarthrosis, union was achieved after substitution of a reamed nail for the anreamed nail. The infection rate was similar to that observed with external fixation. More secondary procedures, such as bone grafting or a change of…
Retrograde Nailing of Humeral Shaft Fractures
The use of intramedullary nailing in the upper extremity is still controversial. Those who have experience with antegrade nailing have either great enthusiasm or strong criticism for the procedure. Criticism of the procedure is because of the trauma that can occur to the rotator cuff and possible impingement syndrome, which can occur after antegrade nail insertion. The technique of retrograde nail insertion with the unreamed humeral nail is described in detail. In a series of 190 retrograde nailings performed in a prospective multicenter study, the most frequent intraoperative problems were fissure or avulsion at the entry portal (n = 8; 4.2%) and secondary radial nerve palsy (n = 8; 4.2%).…