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  • 1
    Language: English
    In: Strategies in trauma and limb reconstruction, 2017-08, Vol.12 (2), p.99-106
    Description: Distraction osteogenesis of the humerus with fully implantable lengthening is now possible since the diameter of the available nails was reduced to 10 mm and below. We report on the first intramedullary lengthening cases of the humerus with two different lengthening devices (FITBONE and PRECICE). Two different approaches and implantation techniques were used. We retrospectively reviewed clinical and radiographic data and pointed out results, pitfalls and complications of the procedure. Four adult patients with relevant length discrepancy of the humerus were treated with fully implantable systems in two centers between 2012 and 2015. Three patients were treated with FITBONE by an antegrade approach; one patient had lengthening with a PRECICE and a retrograde approach. Average nail lengthening was 55 mm (40–65 mm), and the average duration of lengthening was 70 days (52–95 days). The average distraction index was 0.72 mm/day (range 0.4–1.0 mm/day) or 12.5 days/cm (range 8.0–16.2 days/cm). The average consolidation index was 33.6 days/cm (range 25–45 days/cm). There was an implant failure (arrest) with the PRECICE. After consolidation and exchange with a technically improved implant, the course of treatment was uneventful. In patients with antegrade lengthening shoulder abduction decreased, and in the patient with the retrograde approach it improved but elbow extension decreased marginally. Reduced motion of the adjacent joints can be a major problem in intramedullary lengthening of the humerus. This first case series in the field of a rare indication suggests that lengthening of the humerus by fully implantable lengthening nails might be a valuable alternative to lengthening with external fixation. Main advantage of the PRECICE technology is the possible shortening in-between of lengthening.
    Subject(s): Humerus lengthening ; PRECICE ; Intramedullary lengthening ; FITBONE ; Surgical Orthopedics ; Medicine & Public Health ; Orthopedics ; Traumatic Surgery ; Distraction osteogenesis ; Lengthening nail ; Implants, Artificial ; Prosthesis ; Surgery, Plastic ; Original
    ISSN: 1828-8936
    ISSN: 1828-8928
    E-ISSN: 1828-8928
    Source: Academic Search Ultimate
    Source: PubMed Central
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  • 2
    Language: English
    In: Orthopaedic journal of sports medicine, 2020-05-28, Vol.8 (5_suppl4), p.2325967120
    Description: Aims and Objectives: The analysis of lower limb anatomy is mandatory in deformity surgery and total knee replacement. Standard values for joint angles and alignment are only available for 2D images using long standing and lateral radiographs. In contrast, 3D bone models realistically represent the anatomy and are independent of position and projection. Using a self-developed, standardised and validated protocol for 3D analysis of lower limb geometry, standard values for specific joint angles and axes can be obtained in a young cohort for the first time. Materials and Methods: After power and sample size analysis, 60 thin-slice CTs of the entire leg were analysed (30 patients, 13 f, 17 m; age = 33.8 [18-50 years]). After segmentation all 24 relevant bony landmarks were set using our standardised analysis method. Results of joint angles and mechanical axis deviation are calculated automatically. Mean values are stated with standard deviations to describe a possible reference range. Results: The mean neck-shaft angle (NSA) was 133±10° and the mean medial proximal femoral angle (MPFA) 85±9°. Around the knee joint, the mean mechanical lateral distal femoral angle (mLDFA) was 87±4° and the medial proximal tibial angle (MPTA) 88±5°. Medial and lateral slope averaged 12±7° and 9±8°. The deviation of the frontal mechanical leg axis from the knee joint center (MAD frontal) was 7±15mm and the mechanical femoro-tibial angle (HKA) 175±6°. Women showed a smaller mLDFA than men (86.4° vs. 87.8°, p〈0.05) and a larger joint line convergence angle (JLCA 2.5° vs. 1.4°, p〈0.01) representing a more valgiform anatomy. Conclusion: The standardised 3D analysis enabled reference ranges for the relevant joint angles and axes to be defined on the 3D bone model for the first time. The results redefine reference ranges for 3D measurements similar to existing 2D measurements on long standing radiographs. The systematic analysis of the complex 3D anatomy results in a multitude of new questions and possibilities in preoperative planning.
    Subject(s): Knee ; Three dimensional imaging ; Joint replacement surgery ; Orthopedics
    ISSN: 2325-9671
    E-ISSN: 2325-9671
    Source: PubMed Central
    Source: ProQuest Central
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  • 3
    Language: English
    In: International journal for computer assisted radiology and surgery, 2016-11, Vol.11 (11), p.2111-2117
    Description: Determination of lower limb alignment is a prerequisite for successful orthopedic surgical treatment. Traditional methods include the electrocautery cord, alignment rod, or axis board which rely solely on C-arm fluoroscopy navigation and are radiation intensive.To assess a new augmented reality technology in determining lower limb alignment.A camera-augmented mobile C-arm (CamC) technology was used to create a panorama image consisting of hip, knee, and ankle X-rays. Twenty-five human cadaver legs were used for validation with random varus or valgus deformations. Five clinicians performed experiments that consisted in achieving acceptable mechanical axis deviation. The applicability of the CamC technology was assessed with direct comparison to ground-truth CT. A t test, Pearson’s correlation, and ANOVA were used to determine statistical significance.The value of Pearson’s correlation coefficient R was 0.979 which demonstrates a strong positive correlation between the CamC and ground-truth CT data. The analysis of variance produced a p value equal to 0.911 signifying that clinician expertise differences were not significant with regard to the type of system used to assess mechanical axis deviation.All described measurements demonstrated valid measurement of lower limb alignment. With minimal effort, clinicians required only 3 X-ray image acquisitions using the augmented reality technology to achieve reliable mechanical axis deviation.
    Subject(s): Tibial osteotomy ; Medicine & Public Health ; Surgery ; Computer Imaging, Vision, Pattern Recognition and Graphics ; Health Informatics ; C-arm fluoroscopy ; Lower limb alignment ; Imaging / Radiology ; Computer Science, general ; Intraoperative navigation ; Augmented reality ; Mechanical axis deviation ; Humans ; Knee Joint - diagnostic imaging ; Tibia - diagnostic imaging ; Male ; Tomography, X-Ray Computed ; Tibia - surgery ; Knee Joint - surgery ; Orthopedic Procedures ; Aged, 80 and over ; Female ; Aged ; Imaging, Three-Dimensional ; Monitoring, Intraoperative ; Cadaver ; Analysis ; Radiation ; Index Medicus
    ISSN: 1861-6410
    E-ISSN: 1861-6429
    Source: Alma/SFX Local Collection
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  • 4
    Language: English
    In: Orthopedic Reviews, 2016-03-21, Vol.8 (1), p.6384-6384
    Description: A common treatment of tibial defects especially after infections is bone transport via external fixation. We compare complications and outcomes of 25 patients treated with a typical Ilizarov frame or a hybrid system for bone reconstruction of the tibia. Average follow up was 5.1 years. Particular interest was paid to the following criteria: injury type, comorbidities, development of osteitis and outcome of the different therapies. The reason for segmental resection was a second or third grade open tibia fractures in 24 cases and in one case an infection after plate osteosynthesis. Average age of the patients was 41 years (range 19 to 65 years) and average defect size 6.6 cm (range 3.0 to 13.4 cm). After a mean time of 113 days 23 tibial defects were reconstructed, so we calculated an average healing index of 44.2 days/cm. Two patients with major comorbidities needed a below knee amputation. The presence of osteitis led to a more complicated course of therapy. In the follow up patients with an Ilizarov frame had better results than patients with hybrid systems. Bone transport using external fixation is suitable for larger defect reconstruction. With significant comorbidities, however, a primary amputation or other methods must be considered.
    Subject(s): Fractures ; Bone transport ; Ilizarov ; tibia ; fracture ; distraction osteogenesis
    ISSN: 2035-8237
    E-ISSN: 2035-8164
    Source: Academic Search Ultimate
    Source: PubMed Central
    Source: ProQuest Central
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  • 5
    Language: English
    In: Deutsches Ärzteblatt international, 2020-10-23, Vol.117 (43), p.733-733
    Subject(s): Lower Extremity ; Patellar Dislocation - diagnostic imaging ; Patellar Dislocation - epidemiology ; Tibia ; Humans ; Risk Factors ; Index Medicus
    ISSN: 1866-0452
    E-ISSN: 1866-0452
    Source: PubMed Central
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  • 6
    Language: English
    In: BMC musculoskeletal disorders, 2020-03-31, Vol.21 (1), p.201-201
    Description: Varus deformities of the knee are frequently corrected by osteotomies, which should be performed at the level of origin. But in contrast to high tibial osteotomies (HTO), little data exists for distal femoral osteotomies (DFO). This study evaluates radiological and clinical outcomes after valgisation osteotomies in the proximal tibia and distal femur. We used an observational cohort study design and prospectively performed preoperative long standing radiographs (LSR), lateral x-rays and clinical questionnaires (SF-36, Lysholm score, VAS). Postoperative LSR and lateral x-rays were obtained on average 18 months postoperative and postoperative clinical questionnaires at final visit (mean follow up 46 months). A subgroup analysis of the different surgical techniques (oHTO vs. cDFO) was performed, with regards to radiological and clinical outcomes. Finally 28 osteotomies with medial tibial opening (oHTO) or lateral femoral closing (cDFO) wedge osteotomies in 25 consecutive patients (mean age 40 years) were identified. There were 17 tibal and 11 femoral procedures. All osteotomies were performed at the origin of deformity, which was of different etiology. The average deviation of the final HKA compared to the preoperative planning was 2.4° ± 0.4°. Overall, there was a significant improvement in all clinical scores (SF-36: 61.8 to 79.4, p 〈 0.001; Lysholm-score: 72.7 to 90.4, p 〈 0.001; VAS: 3 to 1, p 〈 0.001). There was no significant correlation between surgical accuracy and outcome scores. Valgisation osteotomies lead to a significant improvement in all clinical scores with the demonstrated treatment protocol. An appreciable proportion of varus deformities are of femoral origin. Since cDFO provides comparable radiological and clinical results as oHTO, this is an important treatment option for varus deformities of femoral origin.
    Subject(s): Humans ; Middle Aged ; Postoperative Period ; Tibia - diagnostic imaging ; Male ; Treatment Outcome ; Femur - diagnostic imaging ; Musculoskeletal Abnormalities - surgery ; Tibia - surgery ; Radiography ; Young Adult ; Adolescent ; Knee - surgery ; Adult ; Female ; Femur - surgery ; Knee - diagnostic imaging ; Cohort Studies ; Osteotomy - methods ; Index Medicus ; Osteotomies ; High Tibial osteotomy ; HTO ; DFO ; Valgisation ; Distal femoral osteotomy
    ISSN: 1471-2474
    E-ISSN: 1471-2474
    Source: BioMedCentral Open Access
    Source: Academic Search Ultimate
    Source: PubMed Central
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  • 7
    Language: English
    In: Acta orthopaedica et traumatologica turcica, 2017-12, Vol.51 (6), p.488-491
    Description: One third of the people aged 65 years and over fall every year, and 1–5% of these falls result in a fracture. For these people, history of fracture and surgery become a risk factor for recurrent falls. In osteoporotic patients, repeated fractures often require several osteosynthetic procedures within a short time frame. Despite the lack of biomechanical studies, clinical experience suggests that additional fractures adjacent to implants occur because of the difference in stiffness between the metallic implant and the osteoporotic bone. This requires customized fixation techniques to ensure stability. The technique was first performed in an 81-year old female patient presenting with a dislocated proximal femoral fracture at the tip of a previously implanted distal femoral nail (DFN), and non-union of the old fracture. For this technique, the DFN was advanced until it passed the proximal fracture, thereby reducing both fractures, while a lateral femoral nail (LFN), extra-long and 3 mm thicker than the DFN, was introduced and advanced distally. The LFN was implanted in a “kissing nail technique,” meaning the tips of the two nails were touching each other, and all fracture fragments were held in functional reduction. The DFN was slowly pulled backwards and fragment stability was maintained, while both nails passed the distal non-union. The Kissing Nail Technique allows simple, safe and fast reduction of all instable fragments, precise and easy positioning of the proximal entry point by the retrograde guide wire, a minimally invasive procedure, and stable fixation of a periprosthetic fracture. We found this new customized procedure accommodating to the unique anatomical features of a single patient, that can be applied as a strategy especially for osteoporotic patients with periprosthetic fractures.
    Subject(s): Osteoporosis ; Exchange nailing ; Adjacent fracture ; Management ; Elderly ; Periprosthetic Fractures - diagnosis ; Periprosthetic Fractures - prevention & control ; Bone Nails ; Femoral Fractures - diagnosis ; Humans ; Osteoporotic Fractures - diagnosis ; Risk Factors ; Accidental Falls - statistics & numerical data ; Periprosthetic Fractures - surgery ; Treatment Outcome ; Prosthesis Design ; Accidental Falls - prevention & control ; Periprosthetic Fractures - etiology ; Radiography - methods ; Osteoporotic Fractures - surgery ; Femoral Fractures - surgery ; Aged, 80 and over ; Female ; Fracture Fixation, Intramedullary - instrumentation ; Prosthesis Fitting - methods ; Fracture Fixation, Intramedullary - adverse effects ; Technical Note
    ISSN: 1017-995X
    E-ISSN: 2589-1294
    Source: PubMed Central
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  • 8
    Language: English
    In: Deutsches Ärzteblatt international, 2020-10, Vol.117 (43), p.733-733
    Subject(s): Letters to the Editor
    E-ISSN: 1866-0452
    Source: PubMed Central
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  • 9
    Article
    Article
    2018
    ISSN: 1866-0452 
    Language: English
    In: Deutsches Ärzteblatt international, 2018-10-12
    ISSN: 1866-0452
    E-ISSN: 1866-0452
    Source: PubMed Central
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  • 10
    Language: English
    In: Knee surgery & related research, 2014-06, Vol.26 (2), p.88-96
    Description: The purpose of this study was to document results of a less invasive technique of open wedge proximal tibial osteotomy (PTO) for the varus knee in young adults using an intramedullary tibial nail. We prospectively studied 24 knees in 16 young patients with varus knee deformity. The mean follow-up was 54 months (range, 36 to 107 months) and the mean age of patients at the time of operation was 25.8 years (range, 18 to 40 years). The open wedge PTO was performed below tibial tuberosity using a percutaneous multiple drill-hole technique. Conventional intramedullary tibial nail was used for fixation without bone graft. Radiographic evaluations were made using mechanical alignment (MA), posterior tibial slope angle, and Insall-Salvati ratio. Union time, loss of correction, implant failure, and associated complications were also investigated. The mean MA was significantly changed from -9.7° preoperatively to 1.1° at the final follow-up (p〈0.001). There was no significant change in the proximal tibial anatomy and patellar height. All patients achieved radiographic bony union at an average of 3.1 months without loss of correction. The only complication was knee pain due to nail prominence in 3 patients. Radiographic evaluation indicated that PTO using an intramedullary tibial nail leads to significant improvement in radiographic parameters without changes in posterior tibial slope or patellar height. We found that this technique could be a less invasive and effective alternative for correction of the varus knee in young adults.
    Subject(s): Knee ; Tibia ; Young adult ; Intramedullary nailing ; Corrective osteotomy ; Varus ; Original
    ISSN: 2234-0726
    E-ISSN: 2234-2451
    Source: Academic Search Ultimate
    Source: PubMed Central
    Source: Alma/SFX Local Collection
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