[Tibiocalcaneal arthrodesis using retrograde insertion of a compression nail]. / Die tibiokalkaneare Arthrodese mit retrograd eingebrachtem Kompressionsnagel.

UNLABELLED: OPERATION GOAL: Arthrodesis of the upper and lower ankle joint because of problematic bone positioning or failed arthrodesis. Osteosynthesis procedure using a retrograde compression nail. To achieve stable, fully weight-bearing osteosynthesis for early, pain-free mobilization. INDICATIONS: Rearthrodesis because of failure of the conventional arthrodesis technique and development of osteoarthritis of the lower ankle joint. Painful osteoarthritis of the upper ankle joint because of inadequate perfusion or a major bone defect because of sclerosis or necrosis. Primary arthrodesis because of facture of the lower leg (pilon tibial) with joint involvement and preexisting osteoarthritis. CONTRAINDICATIONS: Acute osteitis/osteomyelitis, sclerosis in the marrow of the distal tibia, malalignment of the distal tibial shaft and local soft tissue inflammation. SURGICAL TECHNIQUE: Preparation of the articular surface of the upper and lower ankle for arthrodesis using a transfibular approach. If necessary, correction of bone defects with iliac crest spongiosa. Stabile osteosynthesis by retrograde insertion of a compression nail. POSTOPERATIVE MANAGEMENT: A split lower leg cast on the 2nd postoperative day, mobilization of the patient with underarm crutches with floor contact for 2 weeks, then with application of a lower leg walking cast for 8 weeks with partial weight-bearing for 4 weeks and full weight-bearing for the last 4 weeks of cast fixation. X-ray controls immediately postoperatively, then after 6 and 12 weeks. RESULTS: From 2006 to 2008, 12 patients (7 men, 5 women; mean age 59 years) with various indications were treated with retrograde insertion of a compression nail. All patients were routinely controlled radiologically and clinically after 2, 4, 8 and 12 weeks. Follow-up was carried out at 6, 12 and 24 months. All arthrodeses showed osseous consolidation 16 weeks postoperatively. Ten patients were able to use full weight-bearing without pain after 12 weeks. Two patients reported experiencing pain after walking for 2 h. In total three complications occurred: one hindfoot healed with varus malalignment; one patient fell, fracturing the lower leg above the nail; one distal locking screw loosened.

[Elastic stable intramedullary nailing after corrective osteotomy of symptomatic malunited midshaft clavicular fractures]. / Elastisch stabile intramedulläre Nagelung nach Korrekturosteotomie von symptomatisch fehlverheilten Klavikulafrakturen.

OBJECTIVE: To restore alignment and length of the clavicle, to relieve typical symptoms of malunion, and to improve functional outcome and aesthetic results. INDICATIONS: Symptomatic malunion after clavicular fractures, including local pain and tenderness, weakness and rapid fatigability of the shoulder girdle muscles, impairment of overhead mobility, numbness, parasthesia, and pain of the arm and fingers during overhead movements due to brachial plexus irritation (thoracic outlet syndrome), and dissatisfaction with the appearance of the shoulder girdle. CONTRAINDICATIONS: Atrophic nonunions, osteoporosis, asymptomatic malunion. SURGICAL TECHNIQUE: A 5-cm skin incision is made above the deformity of the malunited clavicle. The osteotomy plane is determined under fluoroscopic guidance, within the callus separating the two original main fracture fragments. Under fluoroscopic guidance, the medullary canal is reopened on both sides with a 2.7 mm drill bit. Afterwards a 1.5 cm skin incision is made just above the sternal end of the clavicle. The anterior cortex is drilled and a titanium nail (diameter 2.5 mm) is introduced. Under rotational movement, the nail is advanced to the osteotomy site. The nail is inserted into the lateral fragment. Then the inserted nail is cut back as far as possible on the medial entry point. Wound closure. POSTOPERATIVE MANAGEMENT: No immobilization, movement not restricted. Patients are encouraged to use the arm in daily activities. Heavy weight bearing is not allowed until osseus consolidation. RESULTS: In 5 patients (3 men, 2 women) with a mean age of 34 years (range, 23-44 years) with symptomatic malunion after clavicular fractures, a corrective osteotomy and elastic stable intramedullary nailing (ESIN) was performed. After 6 months (mean 4.4 months), all osteotomies were healed and the nails were removed. There were no complications. At final follow-up (12 months), the DASH and Constant scores were significantly improved compared to preoperative values. Patients were significantly more satisfied with the appearance of the shoulder girdle and overall outcome.

[Sagittal wrist motion following dorsal radiocarpal fracture dislocations]. / Sagittaler Bewegungsumfang nach dorsalen radiokarpalen Luxationsfrakturen.

PURPOSE: Radiocarpal fracture dislocation is a rare, complex injury characterised by dislocation of the radiocarpal joint with avulsion of the dorsal or palmar cortical margin of the distal radius. To evaluate the sagittal motion at the radiocarpal and midcarpal levels following dorsal radiocarpal fracture dislocation (Moneim type I) nine cases were investigated clinically and radiologically. PATIENTS AND METHOD: In a retrospective follow-up examination, eight patients could be included. The average follow-up was 4.1 years. One patient had a bilateral injury. The operative approach was bilateral in all cases. Restoration of the radial articular surface, filling metaphyseal defect zones with cancellous bone graft and internal fixation with a special T-plate were performed from dorsal. For refixation of the radiocarpal ligaments a small palmar approach was used. Standard anteroposterior and lateral radiographs, as well as lateral views in full extension and flexion were taken at follow-up. Clinical investigation included measurement of active range of motion, grip strength and pain evaluation using the VAS. RESULTS: Radiological evaluation of the standard lateral view turned out a mean angle between scaphoid and lunatum of 55.6 degrees, capitatum and lunatum of -11.6 degrees and radius and capitatum of 10.5 degrees. In full flexion the following angles were measured: radius/lunatum 15.3 degrees, capitatum/lunatum 18 degrees and between radius and capitatum 30 degrees. In full extension the angles averaged: radius/lunatum -23.9 degrees, capitatum/lunatum -31 degrees and between radius and capitatum -55 degrees. According to the Knirk and Jupiter classification system, five patients presented arthritis stage 1, three arthritis stage 2 and one a stage 3 arthritis. Clinical evaluation showed a mean wrist motion of 55 degrees for extension, 35 degrees for flexion, 88 degrees for pronation, 70 degrees for supination and 25.5 degrees for the mean radial as well as the mean ulnar motion. The average Mayo Wrist Score was 76.1 points. CONCLUSION: Operative treatment of dorsal radiocarpal fracture dislocation using a bilateral approach led to satisfying results in eight of nine cases with decreased but radiologically evaluated sagittal motion of the proximal row.