Long-term results of olecranon fractures treated using the XS nail® system.

PURPOSE: Olecranon fractures are particularly vulnerable to distraction and subsequent fracture dislocation due to the high tensile forces. Surgical treatment aims at reducing the fracture and restoring the anatomical joint surface condition, as well as neutralizing the strain inhibiting fracture healing. The XS nail® (Intercus GmbH, Bad Blankenberg, Germany), an intramedullary implant exerting compression across the entire fracture surface, unlike plates, leaves a minimal extra-cortical profile, and can be secured with threaded locking wires, thereby retaining the anatomical reduction without displacement or steps within the articular surface, which was often found in tension band wiring. After encouraging initial results, the long-term outcome was assessed. METHODS: This retrospective study evaluated the long-term outcome of patients surgically treated at our trauma center between January 2002 and December 2005 using the XS nail®. Patients over the age of 18 years eligible for the study must have undergone surgery for isolated, recent (less than 14 days) traumatic olecranon fractures, without concomitant injuries to the ipsilateral elbow and forearm. Further exclusion criteria were pseudarthrosis, re-fractures and osteotomy for distal humerus surgery, as well as polytraumatized patients unable to aid in their own recovery. Data were retrospectively gathered by standardised questionnaire and patient records, as well as surgery and anesthesiology reports. Data analysis was performed using Microsoft Office Excel® 2016. RESULTS: There were 32 patients, 13 males (mean age 49.0 years) and 19 females (mean age 68.9 years) with 11 Schatzkers type D, 7 each type A and C, 5 type B and 2 type E at an average of 55.2 months, all showing complete consolidation. Of them, 6 patients had a loss of range of motion with more than 10° in the sagittal plane, and only 1 patient exceeded 10° reduction of supination. Twenty-five patients reported being pain-free under all circumstances, and all but 2 patients (93.75%) had returned to their previous activity level. The average disabilities of the arm, shoulder and hand score was 21.15 (range 0-88.3), and the overall Mayo elbow performance index was 91.87, without complications, such as wound infection, neurovascular impairment or premature hardware removal. CONCLUSION: Using the XS nail® system, all fracture types can be successfully treated and the rate of complications was lower than that treated by standard methods published in current literature. An excellent functional outcome, high range of motion as well as good retention of reduction without soft tissue irritation makes this a very suitable implant for fractures subject to tension.

[3D image enhancer-adjusted percutaneous triangular stabilization of geriatric pelvic ring fractures : Operation technique and indications]. / 3D-BV-adjustierte perkutane trianguläre Stabilisierung der geriatrischen Beckenringfraktur : Operationstechnik und Indikation.

The 3D image enhancer-adjusted percutaneous triangular stabilization of geriatric pelvic ring fractures avoids implant-associated perioperative complications. Displaced fractures of the posterior pelvic ring require stable instrumentation to enable solid bony fusion in a balanced alignment and to control the risk of neurological and vascular damage. This is mandatory in high-energy injuries in young patients and especially in low-energy injuries of geriatric patients. Various surgical techniques have been established. The triangular stabilization technique shows the best biomechanical results. The percutaneous instrumentation reduces access-related morbidity and provides all the benefits of minimally invasive surgery. In order to avoid implant-associated complications, such as vascular and nerve injuries, anatomical and radiological principles are indispensable. The use of 3D image enhancement ensures a safe instrumentation. Nevertheless, pitfalls have to be considered. This article presents the technique of percutaneous triangular stabilization using the 3D scan. After percutaneous insertion of the guide wires into the L4 vertebral body, the iliac bone and transiliosacrally under 2D X­ray control, the correct wire position is verified by the 3D scan. Then, screws are inserted and the instrumentation is completed in a standard fashion. Using this technique implant-associated perioperative complications, such as nerve and vascular damage due to screw misplacement can be reduced.

High failure rate of a new pressfit cup in mid-term follow-up.

BACKGROUND: Unacceptably high rates of loosening of a novel cementless cup system (Mathys, SeleXys TH+) have been reported. In this study, our mid-term-results with the SeleXys TH+ cup are compared with an established pressfit cup (Ceraver, Cerafit-R). METHODS: Between 2008 and 2011, a total of 407 implantations, 19 of them bilaterally, were conducted on 388 patients with the implants in question. A total of 280 cups were available for follow-up. Of these, 160 SeleXys TH+ cups and 120 Cerafit-R cups had been used. RESULTS: The mean follow-up period was 48.6 months (min. 28, max. 75). A total of 18 cases of loosening were found in the SeleXys TH+ group. Of these, one was of a traumatic nature and one was of septic origin. This left 16 cases of aseptic, atraumatic loosening (10% loosening rate). In the Cerafit-R group, only two cases (1.7%) of loosening were seen over the same period. Both were of traumatic origin. No cases of aseptic, atraumatic loosening were seen in the follow-up period. Further, significantly more cases of loosening were observed in women than in men with the SeleXys cup. CONCLUSIONS: The SeleXys TH+ cup shows an unacceptably high failure rate after six years. The time of revision is not limited to the first months after implantation, which means that close clinical and radiological controls will continue to be necessary in future in patients treated with SeleXys TH+ cups. Level of Evidenve: III (retrospective cohort study).

Percutaneous triangular stabilization of type 3 and type 4 fragility fractures of the pelvis usually leads to fracture healing despite high revision rates.

This is a monocentric, retrospective study to analyze radiological findings as well as perioperative and postoperative complications in patients who underwent percutaneous triangular stabilization of type 3 and type 4 fragility fractures of the pelvis. From August 2017 to December 2018, 20 patients were treated surgically. Thirteen patients (65%) were followed-up and received a CT scan of the pelvis after an average time of 14.8 months. A total of 5 patients (38%) had to undergo revision surgery, 2 patients (15%) immediately, 3 patients (23%) in the interval. In 84.6% no fracture line was visible in the sacrum. Fracture healing of the anterior pelvic ring was observed in all cases. Our results show that percutaneous triangular stabilization of type 3 and type 4 fragility fractures of the pelvis usually leads to fracture healing. Radiological signs of loosening were observed in 62%, an implant removal due to symptomatic loosening was necessary in 23%.

Pleomorphic rhabdomyosarcoma infiltrating thoracic spine in a 59-year-old female patient: Case report.

Rhabdomyosarcoma (RMS) represents a malignant tumor of skeletal muscle cells arising from rhabdomyoblasts. RMS represents the most common soft tissue sarcoma in children. In adults it is uncommon and accounts for less than 1% of all malignant solid tumors. While treatment protocols are well known for children, there is no standardized regimen in adults. This is one reason, why the outcome in adults is worse than in children. We present the case of a 59-year-old female patient with pleomorphic rhabdomyosarcoma (PRMS) infiltrating the thoracic spine. Multimodality treatment was performed including en-bloc resection, adjuvant multidrug chemotherapy and radiation beam therapy. The patient was tumor free and had no relapse within 6 month follow-up.

Organ-specific distribution of ACE2 mRNA and correlating peptidase activity in rodents.

Biochemical analysis revealed that angiotensin-converting enzyme related carboxy-peptidase (ACE2) cleaves angiotensin (Ang) II to Ang-(1-7), a heptapeptide identified as an endogenous ligand for the G protein-coupled receptor Mas. No data are currently available that systematically describe ACE2 distribution and activity in rodents. Therefore, we analyzed the ACE2 expression in different tissues of mice and rats on mRNA (RNase protection assay) and protein levels (immunohistochemistry, ACE2 activity, western blot). Although ACE2 mRNA in both investigated species showed the highest expression in the ileum, the mouse organ exceeded rat ACE2, as also demonstrated in the kidney and colon. Corresponding to mRNA, ACE2 activity was highest in the ileum and mouse kidney but weak in the rat kidney, which was also confirmed by immunohistochemistry. Contrary to mRNA, we found weak activity in the lung of both species. Our data demonstrate a tissue- and species-specific pattern for ACE2 under physiological conditions.

Prone position in balloon kyphoplasty leads to no secondary vertebral compression fractures in osteoporotic spine - a MRI study.

PURPOSE: Vertebral compression fractures are the most common fractures in the elderly. Long lasting pain and deformity is responsible for consecutive impairment with markedly reduced life quality, increased morbidity and mortality. The beneficial effects of balloon kyphoplasty are verified in many studies. Subsequent fracture risk is not finally clarified, cement related risks and deformity related risks are discussed. There is less knowledge about the risk of bone marrow edema and new fractures during balloon kyphoplasty procedure. The goal of this study is to examine, if prone position during kyphoplasty is an independent risk factor for new fractures in the osteoporotic spine. METHODS: Consecutive MRI study of 20 patients with fresh, non-traumatic thoracolumbar vertebral compression fractures and balloon kyphoplasty treatment. MRI Scans of the thoracolumbar spine were obtained after surgery, before patients have been mobilized. Specific MRI changes like new bone marrow edema, signal intensity changes in adjacent and remote segments and new fractures were assessed by specialized neuro-radiologist. RESULTS: 20 MR images were examined within 48 hours after balloon kyphoplasty procedure. 85% did not show bone marrow edema extent changes after kyphoplasty. We found minor increase of bone marrow edema within the augmented vertebral body in 3 cases. We did not find any new bone marrow edema and no new fractures in adjacent and remote segments after balloon kyphoplasty treatment. CONCLUSION: Prone position leads to no new bone marrow edema and no new fractures in the osteoporotic spine. Accordingly, prone position has no risk for adjacent level fractures in osteoporotic spines.

External transpedicular spine fixation in severe spondylodiscitis - salvage procedure.

Specific and non-specific infections of the spine are rare. Due to their potential for severe instabilities, deformities and the impairment of neurological structures, the treatment is often prolonged and needs an interdisciplinary management. The clinical presentation is uncharacteristic, therefore diagnosis is often delayed. There are no prospective randomized studies for therapy recommendation. The surgical concept includes eradication of the infection and the reliable stabilization of involved segments. This concept is successful in most cases of endogenous vertebral osteomyelitis. The therapy of the exogenous spine infections after macro and micro surgery is more difficult, due to the critical wound situation and the involvement of the posterior parts of the spine. In these cases, infection-associated instability of the anterior part is complicated by critical posterior wound conditions. We present three cases of severe exogenous vertebral infections, where temporary external transpedicular spine fixation was used for salvage procedure, till soft tissue conditions have permitted a definitive internal stabilization.