[Reconstruction of a metadiaphyseal bone defect after open comminuted fracture of the proximal femur using a modified Masquelet technique]. / Rekonstruktion eines metadiaphysären Knochendefekts nach offener, mehrfragmentärer Fraktur des proximalen Femurs in modifizierter Masquelet-Technik.

The reconstruction of segmental bone defects after surgical treatment of infected delayed unions as well as nonunions, places the highest demands on the surgical technical implementation. After treating the fracture-related infection, guaranteeing biomechanical stability is crucial for the success of the treatment. The presented case describes the successful treatment of an infected delayed union after an open metadiaphyseal comminuted fracture of the proximal femur using a modified Masquelet technique. A solid allogeneic bone graft in combination with autologous cancellous bone were inserted into a 7 cm subtrochanteric defect zone and stabilized with a combined plate and nail osteosynthesis.

Open versus minimally invasive fixation of thoracic and lumbar spine fractures in patients with ankylosing spinal diseases.

PURPOSE: Posterior multilevel fixation of traumatic instability in ankylosing spinal disease (ASD) can be performed by open surgery (OS) or minimally invasive surgery (MIS). We investigated whether both methods differ based on the reduction results and perioperative parameters. METHODS: In this retrospective cohort study, OS and MIS groups were investigated. The bisegmental Cobb angles and dislocation angles were measured using pre- and postoperative CT images, and the initial malalignment and achieved reduction were calculated. Cut-seam time, calculated blood loss, transfusion number, fluoroscopy time, pedicle screw placement accuracy, duration of ICU stay, in-patient stay, and complications (bleeding, postoperative thrombosis and embolism, and postoperative mortality) were recorded. RESULTS: Seventy-five ASD patients with spine fractures (Ø 75 ± 11 years, male: 52, female: 23) (MIS: 48; OS: 27) were included in this study. The extent of reduction did not differ in the OS and MIS groups (p = 0.465; MIS:- 1 ± 3°, OS:-2 ± 6°). The residual postoperative malalignment angle was not significantly different (p = 0.283). Seventy-eight of the implanted screws (11%) showed malpositioning. No difference was found between OS and MIS (MIS, 37 [7%]; OS, 41 [16%]; p = 0.095). MIS was associated with less blood loss (OS: 1.28 ± 0.78 l, MIS: 0.71 ± 0.57 l, p = 0.001), cut-seam time (MIS: 98 ± 44 min, OS: 166 ± 69 min, p < 0.001), and hospital stay (MIS: Ø14 ± 16 d, OS: Ø38 ± 49 d, p = 0.02) than OS. CONCLUSION: OS and MIS show equally limited performance in terms of the fracture reduction achieved. The MIS technique was superior to OS based on the perioperative outcome. Therefore, MIS should be preferred over OS for unstable spinal injuries, excluding C-type fractures, in ASD patients without neurological impairment.

[Closed reduction and minimally invasive fixation of a sacral avulsion fracture : Minimal invasiveness with maximum stability]. / Geschlossene Reposition und minimal-invasive Fixation einer sakralen Ausbruchfraktur : Minimale Invasivität bei maximaler Stabilität.

Surgical stabilization of high-energy sacral avulsion fractures with spinopelvic dissociation places high demands on the surgeon. The goal is to achieve maximum stability while minimizing invasiveness. The present case of a dislocated U­type fracture in a 25-year-old motocross rider exemplifies how a reduction with the targeted application of closed reduction techniques through hyperextension of the hip joints and lordosis in the lumbosacral hinge and through a standardized procedure in intraoperative fluoroscopic imaging, a minimally invasive stabilization by means of transsacral screw fixation and spinopelvic fixation of lumbar vertebra 5 to the ilium in the sense of a bilateral triangular stabilization is possible without compromising the achieved stability of the osteosynthesis. The limitations of the described approach are also pointed out.

[Course of operative treatment of a sacral insufficiency fracture : Successful or serious treatment?] / Behandlungsverlauf der operativen Versorgung einer Sakruminsuffizienzfraktur : Erfolgreiches oder folgenreiches Handeln?

A monolateral sacrum fracture was primarily diagnosed with a CT and treated with PMMA augmented SI screw fixation. The following CT showed an unexpected contralateral fracture which led to the need for a lumbopelvic stabilization. In the course of 6 months, successively occurring adjacent fractures required recurrent vertebroplasty. Most of these fractures could only be diagnosed through MRI. It remains unclear, whether initially even the contralateral sacral ala was fractured.