RESUMO
Operating rooms are the central unit in the hospital network in trauma centers. In this area, high costs but also high revenues are generated. Modern operating theater concepts as an integrated model have been offered by different companies since the early 2000s. Our hypothesis is that integrative concepts for operating rooms, in addition to improved operating room ergonomics, have the potential for measurable time and cost savings. In our clinic, an integrated operating room concept (I-Suite, Stryker, Duisburg) was implemented after analysis of the problems. In addition to the ceiling-mounted arrangement, the system includes an endoscopy unit, a navigation system, and a voice control system. In the first 6 months (9/2005 to 2/2006), 112 procedures were performed in the integrated operating room: 34 total knee arthroplasties, 12 endoscopic spine surgeries, and 66 inpatient arthroscopic procedures (28 shoulder and 38 knee reconstructions). The analysis showed a daily saving of 22-45 min, corresponding to 15-30% of the daily changeover times, calculated to account for potential savings in the internal cost allocation of 225-450 EUR. A commercial operating room concept was evaluated in a pilot phase in terms of hard data, including time and cost factors. Besides the described effects further savings might be achieved through the effective use of voice control and the benefit of the sterile handle on the navigation camera, since waiting times for an additional nurse are minimized. The time of the procedure of intraoperative imaging is also reduced due to the ceiling-mounted concept, as the C-arm can be moved freely in the operating theater without hindering cables. By these measures and ensuing improved efficiency, the initial high costs for the implementation of the system may be cushioned over time.
Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Salas Cirúrgicas/economia , Procedimentos Ortopédicos/economia , Cirurgia Assistida por Computador/economia , Carga de Trabalho/economia , Alemanha , Procedimentos Ortopédicos/estatística & dados numéricos , Cirurgia Assistida por Computador/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricosRESUMO
In addition to conventional C-arms which can be used for intraoperative imaging, C-arm image amplifiers with an option for three-dimensional imaging (ISO-C3D) are available to visualize reduction of fragments and positions of implants. In ten cadaver wrists intra-articular steps and intra-articular screw positions were simulated. Images obtained by conventional two-dimensional C-arm image amplifier, computed tomography and ISO-C3D were evaluated by four investigators using a questionnaire. For 2D image amplifier scans the investigators rated the quantity of the articular steps correctly in 45%, incorrectly in 51% and were uncertain in 4%. Concerning CT scans these values were 57, 40 and 3%, respectively. With a slow 190° ISO-C3D mode the investigators rated the steps correctly in 47%, incorrectly in 44% and were uncertain in 9%. The positions of the tip of the screw were rated correctly for 2D scans in 56%, incorrectly in 40% and were uncertain in 4%. For CT screw positions were assessed correctly in 40%, incorrectly in 43% and were uncertain in 17%. For ISO-C3D in fast 190° mode the rating was correct in 59%, wrong in 30% and uncertain in 11%. In the slow Iso-C3D mode the results were inferior with correct assessment in 51%, wrong results in 36% and uncertain evaluation in 13%. In our cadaveric study, ISO-C3D scans have been found valuable for intraoperative controls of implant positions and assessment of intra-articular steps.
Assuntos
Parafusos Ósseos , Fixação Interna de Fraturas/instrumentação , Imageamento Tridimensional/instrumentação , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/cirurgia , Cirurgia Assistida por Computador/instrumentação , Tomografia Computadorizada por Raios X/instrumentação , Cadáver , Desenho de Equipamento , Fixação Interna de Fraturas/métodos , Humanos , Imageamento Tridimensional/métodos , Rádio (Anatomia)/lesões , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodosRESUMO
The conservative functional treatment of Achilles tendon ruptures has developed further over the last 20 years and is basically possible for 60-80% of patients. The treatment leads to success if the indications obtained by dynamic sonography are correctly interpreted (adaptation of the tendon ends up to 20 degrees plantar flexion), if the patient presents sufficient compliance and the physiotherapy is increasingly intensified depending on tendon healing. Modern ortheses allow an increased equinus position and therefore improved protection of the healing tendon. If these factors are present a relatively low re-rupture rate of only 7% can be achieved. The decisive advantage of conservative functional therapy is the avoidance of specific operative risks, such as infection and injury to the sural nerve. After removal of the orthesis the tendon should continue to be modeled using shoe insoles and raised heels.
Assuntos
Tendão do Calcâneo/lesões , Aparelhos Ortopédicos , Modalidades de Fisioterapia , Traumatismos dos Tendões/reabilitação , Tendão do Calcâneo/diagnóstico por imagem , Humanos , Recidiva , Ruptura/terapia , Traumatismos dos Tendões/diagnóstico por imagem , Resultado do Tratamento , UltrassonografiaRESUMO
Hind foot tendinopathies mainly involve the Achilles tendon. Color and Power-Doppler ultrasound visualizes pathological neovessels in painful tendons, which are associated with pain mediating nerve fibres. These neovessels are characterized by an increased capillary blood flow at the point of pain. Painful eccentric training can significantly reduce pain and improve function in Achilles tendinopathy (evidence level Ib). Shock wave therapy in combination with eccentric training is superior to eccentric training alone (evidence level Ib). Long-term results suggest a collagen induction and reduced pain following topical application of glyceryl trinitrate (NO) (evidence level Ib). Color and Power-Doppler-guided sclerosing therapy using polidocanol reduces pain, improves function and may lead to tendon remodeling (evidence level Ib). Pain-restricted sport up to a visual analogue scale (VAS) score 5/10 during therapy is recommended (evidence level Ib). Cryotherapy sessions of 3-times 10 min of reduce pain and capillary blood flow (evidence level Ib). The role of proprioceptive training in tendinopathy has to be determined in future trials (evidence level II). Anecdotical treatment of hindfoot tendinopathies has been replaced by evidence-based recommendations.
Assuntos
Tendão do Calcâneo/lesões , Artralgia/prevenção & controle , Tendinopatia/terapia , Traumatismos dos Tendões/terapia , Terapia por Ultrassom , Tendão do Calcâneo/diagnóstico por imagem , Administração Tópica , Crioterapia , Medicina Baseada em Evidências , Humanos , Nitroglicerina/administração & dosagem , Modalidades de Fisioterapia , Traumatismos dos Tendões/diagnóstico por imagem , UltrassonografiaRESUMO
The open tendon suture is the most commonly used method of treatment for Achilles tendon rupture in Germany. Over the last decade the therapeutic spectrum of operative methods has been further enlarged by the development of new minimally invasive surgical techniques. Important criteria for planning treatment are the location and age of the rupture and comorbidities. For recent Achilles tendon ruptures minimally invasive suturing is indicated but for older ruptures a reconstruction often has to be carried out. The decisive disadvantage of an open tendon suture is the relatively high risk of infection. Using minimally invasive surgical techniques the frequency of postoperative infection could be significantly reduced. The suture methods without opening the ruptured region can be collectively grouped under the term percutaneous suture techniques and the minimally invasive methods with opening of the rupture region as combined open percutaneous techniques. Documented problems with the Ma-Griffith technique, such as injury of the sural nerve, low stability of the suture and insufficient adaption of the tendon stumps have been minimized by new minimally invasive operation techniques. Achilles tendon ruptures which nearly always arise without any external influence or accidents can have substantial psychological consequences regarding the integrity of one's own body especially for people actively engaged in sport. This aspect should be considered and accepted in particular during postoperative treatment.
Assuntos
Tendão do Calcâneo/lesões , Tendão do Calcâneo/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Técnicas de Sutura , Traumatismos dos Tendões/cirurgia , Humanos , Ruptura/cirurgiaRESUMO
Pain syndromes of the Achilles tendon (AT) include both insertional and non-insertional tendinopathy, two distinct disorders with different underlying pathophysiologies and management options, characterized by pain, impaired performance and swelling in and around the tendon. This article gives an overview of the operative treatment of pain syndromes of the Achilles tendon, including both insertional tendinopathy of the AT and tendinopathy of the main body of the AT. New minimally invasive techniques for the management of this condition, including endoscopy are also reported.
Assuntos
Tendão do Calcâneo/lesões , Tendão do Calcâneo/cirurgia , Artralgia/etiologia , Artralgia/prevenção & controle , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Traumatismos dos Tendões/complicações , Traumatismos dos Tendões/cirurgia , Humanos , Ruptura/cirurgia , Técnicas de Sutura , SíndromeRESUMO
Vertebral compression fractures are among the most common forms of manifestations of osteoporosis. Conservative treatment comprises adequate analgesia, osteoporosis medication and individualized physiotherapy or braces. Nevertheless, vertebral compression fractures frequently lead to persisting pain and decrease daily activity and quality of life. In these cases, kyphoplasty and vertebroplasty can be efficient treatment options. Vertebroplasty is a minimally invasive procedure, in which bone cement is filled into the vertebral body under fluoroscopic control. In most cases, this internal stabilization leads to a rapid reduction in pain. Kyphoplasty additionally aims to correct the kyphotic deformation of the broken vertebra via introducing and inflating a balloon catheter. There is broad clinical experience with both procedures. For kyphoplasty, randomized controlled trials showed significant improvements in pain and quality of life in patients undergoing kyphoplasty. However, cement leakages lead to rare but severe complications such as pulmonary embolism and nerve palsies.
Assuntos
Fraturas por Compressão/cirurgia , Fraturas Espontâneas/cirurgia , Osteoporose/cirurgia , Doenças da Coluna Vertebral/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/instrumentação , Vertebroplastia/métodos , Idoso de 80 Anos ou mais , Cimentos Ósseos/efeitos adversos , Braquetes , Desenho de Equipamento , Medicina Baseada em Evidências , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Feminino , Fraturas por Compressão/diagnóstico por imagem , Fraturas Espontâneas/diagnóstico por imagem , Humanos , Cifose/diagnóstico por imagem , Cifose/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Osteoporose/diagnóstico por imagem , Medição da Dor , Modalidades de Fisioterapia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Embolia Pulmonar/etiologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Reoperação , Doenças da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
UNLABELLED: Recurrent dislocation of the peroneal tendons following operative treatment is relatively uncommon, but can be difficult to treat. We asked whether subligamental transposition of the peroneus brevis tendon, fibular grooving, and reattachment of the superior peroneal retinaculum for failed peroneal tendon dislocation surgery would achieve a stable fixation of the peroneal tendons and whether there would be restrictions of ROM or instability of the hindfoot. We reviewed six female patients (mean age, 24.5 years) with general laxity of joints preoperatively and at 6 weeks and 3, 6, and 12 months postoperatively. Within 1 year postoperatively no recurrence was found. In two ankles the extension was restricted 5 degrees to 10 degrees . In another pronation and supination was restricted 5 degrees each. Stability of the ankle increased in four patients and stayed unchanged in two. AOFAS score increased from a mean value of 36 +/- 20.6 preoperatively to 90 +/- 7 postoperatively at 1 year. We conclude transposition of the peroneus brevis tendon is a reasonable treatment for failed peroneal tendon dislocation surgery. LEVEL OF EVIDENCE: Level IV, therapeutic study (prospective case series). See Guidelines for Authors for a complete description of levels of evidence.
Assuntos
Traumatismos do Tornozelo/cirurgia , Luxações Articulares/cirurgia , Traumatismos dos Tendões/cirurgia , Transferência Tendinosa/métodos , Tenodese/métodos , Adolescente , Adulto , Feminino , Humanos , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Pronação/fisiologia , Estudos Prospectivos , Amplitude de Movimento Articular , Reoperação , Traumatismos dos Tendões/fisiopatologia , Falha de Tratamento , Adulto JovemRESUMO
We performed a retrospective clinical and radiological case control study on 22 rheumatoid wrists following radiolunate fusion via Shapiro staples with a mean follow-up of 5 years. Radiographs showed one early loosening through dorsal staple migration and four nonunions. Six wrists fused in mild ulnopalmar dislocation of the lunate. Primary intra-articular positioning of a staple was found in nine wrists, secondary intra-articular staple dislocation was found in two wrists. Dorsal staple dislocation was found in four fused arthrodeses. Osteolysis around the staples was found in all but two wrists. In contrast to unsatisfactory radiological results the clinical results were good or excellent in 18 patients. Good and excellent clinical results in the majority of the patients following radiolunate fusion does not depend on the fixation device. Nevertheless staple fixation of the radiolunate joint in the rheumatoid wrist is associated with a high rate of radiological complications.
Assuntos
Artrite Reumatoide/cirurgia , Artrodese/instrumentação , Fixadores Internos/efeitos adversos , Grampeamento Cirúrgico/instrumentação , Suturas/efeitos adversos , Articulação do Punho , Adulto , Idoso , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/fisiopatologia , Artrodese/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Radiografia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do TratamentoRESUMO
MATERIALS AND METHODS: The effect of fluoroscopy-based navigation for femoral fracture reduction on the prevention of malrotation was examined in an experimental setting followed by a first case series. Eleven cadaver femurs were used. All femurs were reduced by closed methods. An optoelectronic navigation system was utilized to check for fragment reduction and alignment. Fluoroscopic control without navigation was used as the control group. The Six Sigma Analysis [offset capability index (C (pk)) = 1.3] was used to compare the probability of outliers of more than 15 degrees . In the clinical case series the same navigation tool was used in ten non-consecutive patients with femoral fractures. Torsional differences between both legs were measured postoperatively by CT scan. RESULTS: The highest malrotation in the navigated group was 7.0 degrees for the cadaver testings, while two femurs in the control group showed a difference of more than 10 degrees (10.3 degrees , 17.4 degrees). Only the navigated group showed a sufficient offset capability index (C (pk-navigated) = 1.83; C (pk-conventional) = 0.59). In the clinical series nine femurs were successfully reduced by navigation control. The average malrotation was 6.6 degrees . No patient had a torsional difference of more than 10 degrees. CONCLUSION: Navigated femoral nailing reduces the risk for outliers of postoperative torsional differences and might avoid revision surgery for malrotation. LEVEL OF EVIDENCE: IV.
Assuntos
Pinos Ortopédicos , Fraturas do Fêmur/cirurgia , Cirurgia Assistida por Computador/métodos , Adolescente , Adulto , Idoso , Cadáver , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia Intervencionista , Rotação , Cirurgia Assistida por Computador/instrumentação , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Interface Usuário-ComputadorRESUMO
This study aimed to analyse whether the precision of a three-dimensional mobile image intensifier (ISO-C 3D) differs from conventional two-dimensional fluoroscopy and high resolution CT scan in a fracture model of the proximal tibia. A depression fracture of the medial plateau (AO/OTA 41-B2.3) was created in 12 formalin-fixed, human cadaver knees. The cartilage of the depression could be positioned above (+1mm, +2mm), below (-1mm, -2mm), or in line with the joint surface. Fluoroscopy, computed tomography (CT) scans, and ISO-C 3D scans (four different protocols: 100 images, 66 images, 50 images, and 33 images) were done for each fracture level. Three independent observers assessed each imaging set. The difference between the estimated reduction and the real reduction was used for statistical analysis. Our hypothesis was that no differences in the precision exist between the imaging techniques (p<0.05). The conventional image intensifier group (0.7 mm+/-0.67) showed significantly higher deviations than the CT group (0.3 mm+/-0.43; p<0.001) and significantly higher deviations than all ISO-C 3D groups (0.4-0.5 mm; p<0.001). Of the ISO-C 3D groups, only the scan protocol with the lowest number of images (0.5 mm+/-0.51) showed significantly lower precision than the CT group (p<0.001). It was concluded that the three-dimensional mobile image intensifier showed higher precision in reduction assessment in a fracture model of the tibial plateau compared to fluoroscopy. High resolution CT scans should remain the standard for post-operative assessment of reduction outside the operating theatre.
Assuntos
Interpretação de Imagem Assistida por Computador/instrumentação , Radiografia Intervencionista/instrumentação , Radiografia Intervencionista/métodos , Fraturas da Tíbia/cirurgia , Cadáver , Fluoroscopia , Humanos , Variações Dependentes do Observador , Tomografia Computadorizada por Raios XRESUMO
AIM: Novice drivers are at high risk for crash involvement. We performed an analysis of causations, injury patterns and distributions of novice drivers in cars and on motorcycles in road traffic as a basis for proper measurements. METHOD: Data of accident and hospital records of novice drivers (licence < 2 years) were analysed focusing on the following parameters: injury type, localisation and mechanism, abbreviated injury scale (AIS), maximum AIS (MAIS), delta-v, collision speed and other technical parameters and compared with those of experienced drivers. RESULTS: In 18 352 accidents in the area of Hannover (years 1985-2004), 2602 novice drivers and 18 214 experienced drivers were recorded as having an accident. Novice car drivers were more often and more severely injured whereas on motorcycles the experienced drivers were at higher risk. Novice drivers of both groups sustained more often extremity injuries. 4.5 % of the novice car drivers were not restrained by seatbelts as compared to 3.7 % of the experienced drivers and 6.1 % of the novice motorcycle drivers did not wear a proper helmet (versus 6.5 %). Severe injuries were sustained in 20 % at collision speeds below 30 km/h and in 80 % at collision speeds above 50 km/h. Novice car drivers drove significantly older cars. The risk profile of novice drivers is similar to that of drivers older than 65. CONCLUSION: Structural protection and special lectures like skidding courses could be proper measurements next to harder punishment of violations.
Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Condução de Veículo/educação , Automóveis/estatística & dados numéricos , Motocicletas/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Escala Resumida de Ferimentos , Adolescente , Adulto , Fatores Etários , Condução de Veículo/estatística & dados numéricos , Causalidade , Estudos Transversais , Feminino , Alemanha , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Humanos , Incidência , Masculino , Estudos Prospectivos , Cintos de Segurança/estatística & dados numéricos , Fatores Sexuais , Revisão da Utilização de Recursos de Saúde/estatística & dados numéricos , Adulto JovemRESUMO
Spinal trauma poses considerable threats to survival and quality of life. Especially cervical spine injuries are often associated with neurologic deficits. A thorough diagnostic pathway, often including computed tomography with sagittal reconstruction, is mandatory to evaluate the extent and consequences of spinal trauma. Every treatment must aim to restore stability and prevent secondary neurologic deterioration. Compression fractures usually can be treated successfully with conservative treatment, while burst fractures usually, and flexion/distraction injuries, and fracture-dislocation generally require internal stabilization. Injuries of the upper cervical spine can be treated conservatively or operatively, depending on the degree of instability. In the lower cervical spine, most injuries require internal fixation.
Assuntos
Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral , Vértebras Cervicais/lesões , Vértebras Cervicais/cirurgia , Feminino , Humanos , Luxações Articulares/diagnóstico , Luxações Articulares/cirurgia , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Pessoa de Meia-Idade , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/cirurgia , Osteoporose Pós-Menopausa/complicações , Osteoporose Pós-Menopausa/diagnóstico , Osteoporose Pós-Menopausa/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Implantação de Prótese , Reoperação , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/etiologia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: During computer navigated hip arthroplasty, impingement of soft tissues on reference markers (RMs) may cause errors in the navigation process. The aim of this study was to investigate the effect of such soft tissue impingement during limb movement on the stability of different RMs. MATERIALS AND METHODS: The stability of one- and two-screw RM systems inserted using three different levels of soft tissue dissection was analyzed in fresh cadaver lower limbs. All tests were done with RMs inserted in both the distal-anterior femur and the distal-lateral femur. RESULTS: Rotations of less than 0.15 degrees and translations of less than 0.4 mm occurred in most test combinations. The combination that showed the greatest instability was when a stab incision was used to insert a screw in the distal-lateral femur (translation: 0.73 +/- 0.05 mm; rotation: 0.25 +/- 0.05 degrees ) (p < 0.001). This instability occurred in both single- and double-screw RMs (p = 0.21). CONCLUSIONS: Reference markers can be placed in the anterior distal femur through stab incisions without resulting in significant impingement during limb movement. When RMs are placed in the lateral distal femur, impingement may occur from the fascia lata. Release of the fascia lata 1 cm either side of the screw prevents significant impingement. Wide skin incision is unnecessary in any location.
Assuntos
Artroplastia de Quadril , Articulação do Quadril/cirurgia , Cirurgia Assistida por Computador/instrumentação , Parafusos Ósseos , Cadáver , Humanos , Amplitude de Movimento Articular , RotaçãoRESUMO
Registration is a crucial step in navigation assisted surgery. When performing anatomical pair-point registration, there are several potential sources of error, including inadequate data acquisition, improper segmentation, and distortion resulting from metal artifacts. The aim of this study was to evaluate the influence of metal artifacts on the precision of Iso-C(3D) and fluoroscopy-based navigation, and to assess any changes in precision from the use of a newly developed Schanz screw composed of polyether-ether-ketone (PEEK OPTIMA). A T-shaped test specimen was manufactured from synthetic bone material. It was then scanned with a Siremobil Iso-C(3D) while different types of implant were present in the specimen. Five Iso-C(3D) scans were acquired: one with a steel Schanz screw in the specimen, one with a titanium screw, one with a PEEK screw, one with a 5-hole plate, and one with no screw or plate present. The registration was analyzed by "reverse verification" with a pointer in a purpose-built, manipulable 3D holder. All experiments were then repeated using fluoroscopy-based navigation. Increasing presence of metal in the scan area resulted in an increase in mean error (0.55 mm with the steel Schanz screw, 0.7 mm with the 5-hole plate). Artifacts resulting from the titanium Schanz screw were less than those caused by the stainless steel Schanz screw. While this study demonstrates that metallic artifacts do have an influence on the precision of Iso-C(3D) navigation, such artifacts were not found to be a factor when performing fluoroscopy-based navigation.
Assuntos
Artefatos , Parafusos Ósseos , Cetonas , Polietilenoglicóis , Cirurgia Assistida por Computador , Benzofenonas , Fluoroscopia , Humanos , Imageamento Tridimensional/instrumentação , Polímeros , Aço Inoxidável , TitânioRESUMO
PURPOSE: Solitary enchondroma is the most common bone tumour at the hand. Nevertheless there are only a few studies referring to a recurrence of this lesion after operative treatment. PATIENTS AND METHOD: 21 patients (17 women/4 men) were examined retrospectively 2 to 18 (mean: 9) years after operative treatment. Clinical and radiological examinations were performed. 3 to 4 years later 9 of these patients were re-examined. 1 patient was first seen at the time of the second examination. Recurrence was the endpoint of the study. RESULTS: At the first examination 11 patients had normal cancellous bone structure 4 to 18 (mean: 8) years after operative treatment. 7 patients had remaining bone defects and their follow-up was 2 to 15 (mean: 8) years. Recurrence was found in 3 patients 11 to 17 years postoperatively. Through the re-examination of 9 patients 2 further recurrences were found 4 to 6 or, respectively, 11 to 14 years postoperatively arising from remaining defects. Another remaining defect became normal cancellous bone structure 2 to 5 years postoperatively. Over all 6 recurrences were found in 22 patients. All patients were free of clinical symptoms. CONCLUSION: Recurrence may occur even more than 10 years postoperatively. Therefore we recommend periodical radiological re-examination for recurrence before weakness of bone can lead to a pathological fracture. Re-examination intervals of 2 to 5 years would probably be adequate.
Assuntos
Condroma/cirurgia , Mãos/cirurgia , Condroma/diagnóstico por imagem , Feminino , Seguimentos , Mãos/diagnóstico por imagem , Humanos , Masculino , Radiografia , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
Since 1983, radiolunate arthrodesis has been the gold standard for stabilising the rheumatic wrist. Rearthrodesis of the radiolunate joint has not yet been described. In a prospective study on five radiolunate rearthrodeses with a dorsal mini titanium plate and oblique screw, bone healing was achieved in four. Fatigue fracture of the plate occurred in one case of delayed bone healing. After another rearthrodesis using the same technique, bone healing was achieved. Complete fusion of the wrist can be avoided after failed radiolunate fusion using the described operative technique for rearthrodesis of the radiolunate joint. Preserving some wrist mobility is of high value for these multimorbid patients.
Assuntos
Artrite Reumatoide/cirurgia , Artrodese/instrumentação , Artrodese/métodos , Placas Ósseas , Articulação do Punho/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação/instrumentação , Reoperação/métodos , Resultado do TratamentoRESUMO
BACKGROUND: The role of trauma documentation has grown continuously since the 1970s. Prevention and management of injuries were adapted according to the results of many analyses. Since 1993 there have been two different trauma databases in Germany: the German trauma registry (TR) and the database of the Accident Research Unit (UFO). Modern computer applications improved the data processing. Our study analysed the pros and cons of each system and compared them with those of our European neighbours. METHODS: We compared the TR and the UFO databases with respect to aims and goals, advantages and disadvantages, and current status. Results were reported as means +/- standard errors of the mean. The level of significance was set at P<0.05. RESULTS: There were differences between the two databases concerning number and types of items, aims and goals, and demographics. The TR documents care for severely injured patients and the clinical course of different types of accidents. The UFO describes traffic accidents, accident conditions, and interrelations. The German and British systems are similar, and the French system shows interesting differences. DISCUSSION: The German trauma documentation systems focus on different points. Therefore both can be used for substantiated analyses of different hypotheses. Certain intersections of both databases may help to answer very special questions in the future.