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Mückley T, Lerch C, Gonschorek O, Marintschev I, Bühren V, Hofmann GO. Compression nailing for posttraumatic rotational femoral deformities: open versus minimally invasive technique. INTERNATIONAL ORTHOPAEDICS 2005; 29:168-73. [PMID: 15815905 PMCID: PMC3456891 DOI: 10.1007/s00264-005-0647-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2004] [Revised: 01/22/2005] [Accepted: 02/01/2005] [Indexed: 11/27/2022]
Abstract
Between January 1996 and December 1999, we performed 30 derotational osteotomies with compression nailing in 29 patients. In 18 cases (group 1), we used an intramedullary saw (minimally invasive technique), and in 12 cases (group 2), we used a conventional open technique. Follow-up included clinical, conventional radiological, and computer tomographical assessment. The mean angle of derotation was 28.6+/-12.3 degrees in group 1 and 27.6+/-10.7 degrees in group 2. The postoperative mean rotational deviation between left and right side was 7.9+/-6.7 degrees in group 1 and 6.6+/-4.4 degrees in group 2. There were five postoperative complications: two delayed unions, two insufficient corrections, and one infection. There was no significant difference between the groups. When using the minimally invasive technique, we recommend the derotation angle to be marked with Schanz screws instead of Kirschner wires, as soft-tissue resistance may lead to bending of these.
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102
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Beisse R, Mückley T, Schmidt MH, Hauschild M, Bühren V. Surgical technique and results of endoscopic anterior spinal canal decompression. J Neurosurg Spine 2005; 2:128-36. [PMID: 15739523 DOI: 10.3171/spi.2005.2.2.0128] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Decompression of the spinal canal in the management of thoracolumbar trauma is controversial, but many authors have advocated decompression in patients with severe canal compromise and neurological deficits. Anterior decompression, corpectomy, and fusion have been shown to be more reliable for spinal canal reconstruction than posterior procedures; however, traditional anterior-access procedures, thoracotomy, and thoracoabdominal approaches are associated with significant complications. Endoscopy-guided spinal access avoids causing these morbidities, but it has not been shown to yield equivalent results in spinal canal clearance. This study was conducted to demonstrate the effectiveness of endoscopic spinal canal decompression and reconstruction quantitatively by using pre- and postoperative computerized tomography (CT) scanning. METHODS Thirty patients with thoracolumbar canal compromise underwent endoscopic anterior spinal canal decompression, interbody reconstruction, and stabilization for fractures (27 cases), and tumor, infection, and severe degenerative disc disease (one case each). The mean follow-up period was 42 months (range 24 months-6 years). Neurological examinations, Frankel grades, radiological studies, and intraoperative findings were prospectively collected. Spinal canal clearance quantified on pre- and postoperative CT scans improved from 55 to 110%. A total of 25% of patients with complete paraplegia and 65% of those with incomplete neurological deficit improved neurologically. The complication rate was 16.7% and included one reintubation, two pleural effusions, one intercostal neuralgia, and one persistent lesion of the sympathetic chain. CONCLUSIONS The authors describe the endoscopic technique of anterior spinal canal decompression in the thoracolumbar spine. The morbidities associated with an open procedure were avoided, and excellent spinal canal clearance was accomplished as was associated neurological improvement.
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103
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Schmeiser G, Kunze C, Militz M, Bühren V, Putz R. Anatomic basis for a minimally invasive approach to the subtalar joint. Arch Orthop Trauma Surg 2004; 124:621-5. [PMID: 14767780 DOI: 10.1007/s00402-003-0627-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2003] [Indexed: 02/09/2023]
Abstract
INTRODUCTION An isolated arthrodesis of the talocalcaneonavicular joint is a common indication in cases of pain and post-traumatic arthroses. MATERIALS AND METHODS Because of the high infection rate after surgery with the lateral incision, the authors decided to evaluate an alternative, minimally invasive procedure. Joint destruction was carried out via a posterolateral access after the insertion of two guidewires. For an evaluation of the risk for vessel and nerve structures, 102 ankle joint specimens preserved in formalin/alcohol were examined. Additionally, the minimally invasive access was evaluated in ten ankle joint specimens. RESULTS Neither in the specimen nor during evaluation of the minimally invasive access could injuries of vessels or nerve structures larger than 1 mm in diameter be found. The authors did not encounter any problems when drilling open the articular surface with a destruction of 65% of the overall surface and when performing the following arthrodesis using a plug technique. Using a posterolateral, minimally invasive access between the Achilles tendon and lateral malleolus, it is possible to resect about 65% of the subtalar articular surface for arthrodesis without impact on major vessels and nerves. Postoperative complications such as sensitive and sensory failure as well as wound healing impairment at the lateral side of the foot are not to be expected when choosing the minimally invasive access. CONCLUSION It has to be said, however, that this technique does not offer the opportunity of performing a corrective arthrodesis as the hindfoot cannot be displayed during surgery. As the result of this study was positive, clinical evaluation was started.
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104
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Woltmann A, Bühren V. Schockraummanagement bei Verletzungen der Wirbels�ule im Rahmen eines Polytraumas. Unfallchirurg 2004; 107:911-8. [PMID: 15459806 DOI: 10.1007/s00113-004-0829-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Injuries to the spine are often part of life-threatening multiple trauma. In this review diagnostics and emergency room management were investigated in order to formulate effective recommendations for the emergency strategy. Clinical trials were systematically collected (MEDLINE, Cochrane, and hand searches) and classified into evidence levels (1 to 5 according to the Oxford system). The patient's history and clinical symptoms have low rates for specificity and positive predictive value, whereas their negative predictive value and sensitivity are high between 90 and 100%, respectively. CT imaging reaches higher rates for sensitivity, specificity, and positive and negative predictive values in comparison to conventional radiographic series. The patient's history should be asked and clinical investigation should be done in any case. Imaging diagnostics preferably as multislice spiral CT should be performed after stabilization of the patient's general condition and before admission to the intensive care unit.
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105
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Mückley T, Kruis C, Schütz T, Brucker P, Bühren V. [Fractures of the lower leg in professional skiers]. SPORTVERLETZUNG-SPORTSCHADEN 2004; 18:22-7. [PMID: 15022119 DOI: 10.1055/s-2004-812899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Fractures of the lower leg due to skiing accidents remain an important concern. Few studies have focussed on the special demands of professional athletes who sustain these injuries. We present our experience with three cases of lower leg fractures in competitive professional downhill skiers and discuss management and treatment concepts. We performed limited reamed compression nailing in all the patients presented because it offers the advantages of high mechanical stability and optimized fragment apposition. Plate osteosynthesis of the fibula is not required in most typical fractures. All patients resumed ski training. Two of them returned to World Cup. Only one achieved her pre-injury World Cup level of performance and success. In conclusion, a successful return for professional skiers with lower leg fractures is feasible using an optimized treatment strategy.
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106
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Mückley T, Schütz T, Schmidt MH, Potulski M, Bühren V, Beisse R. The role of thoracoscopic spinal surgery in the management of pyogenic vertebral osteomyelitis. Spine (Phila Pa 1976) 2004; 29:E227-33. [PMID: 15167673 DOI: 10.1097/00007632-200406010-00023] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report, operative technique. OBJECTIVES Vertebral osteomyelitis is frequently associated with elderly and debilitated patients who have significant medical comorbidities. If surgical debridement is contemplated, an open anterior approach like a thoracotomy can be associated with significant complications in this patient population. Thus, patients with vertebral osteomyelitis who need surgery may benefit from minimal invasive techniques that avoid the complications of more extensive open approaches. We performed thoracoscopic spinal surgery in patients with pyogenic vertebral osteomyelitis, attempting to reduce the morbidity attributable to standard open thoracotomy surgery. METHODS The technique and results of minimally invasive thoracoscopic spinal surgery for pyogenic vertebral osteomyelitis in three patients, including radical debridement and anterior spinal reconstruction, are presented. RESULTS Radical debridement and anterior spinal reconstruction are feasible via endoscopic approach. Standard thoracotomy or thoracoabdominal approaches associated with high morbidity can be avoided, even for fusion across multiple levels. Conversion to open technique was not necessary in this study. There was no recurrence of infection or loss of reduction during the follow-up period. Operative time and blood loss of endoscopic technique were comparable to open technique. CONCLUSIONS The cases clearly demonstrate the feasibility and efficacy of thoracoscopic spinal surgery in the management of pyogenic vertebral osteomyelitis. Debridement, decompression of the spinal canal, interbody fusion, and anterior spinal fixation can be performed via endoscopic approach.
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107
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Mückley T, Hierholzer C, Diefenbeck M, Hofmann GO, Bühren V. Behandlung der MRSA-Infektion in der septischen Extremit�tenchirurgie. Chirurg 2004; 75:269-75. [PMID: 15021948 DOI: 10.1007/s00104-003-0753-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Infection with methicillin-resistant Staphylococcus aureus (MRSA) remains a major challenge both therapeutically and hygienically. METHODS Between January 2000 and January 2002, 27 patients with MRSA infections were treated and evaluated in a prospective clinical study. For effective wound management, operative revisions were performed every 3rd day. Following debridement, the wounds were vacuum sealed and specific i.v. antibiotics were administered. Wound closure was performed if three consecutive wound samples submitted for bacterial culture remained negative. RESULTS All patients with MRSA infections were treated successfully until signs of infection disappeared and bacterial cultures were negative. An average of 7.3 operations per patient was required to eradicate MRSA infection. Follow-up of patients revealed recurrence of infection in four patients. CONCLUSION Prevention of further spreading and successful treatment of MRSA infections in reconstructive orthopedic surgery is possible with appropriate surgical and hygienic concepts. In almost every second patient complex revision procedures were required.
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108
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Hungerer S, Nolte D, Bühren V, Messmer K. EFFECTS OF DIASPIRIN CROSSLINKED HEMOGLOBIN (DCLHB) ON THE MICROCIRCULATION AFTER RESUSCITATION FROM HEMORRHAGIC SHOCK. Shock 2004. [DOI: 10.1097/00024382-200403001-00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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109
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Thannheimer A, Woltmann A, Vastmans J, Bühren V. Die hämodynamisch wirksame Beckeninstabilität. Zentralbl Chir 2004; 129:37-42. [PMID: 15011110 DOI: 10.1055/s-2004-44882] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
For the hemodynamically unstable patient with pelvic fracture a target focussed and rapid diagnostic and therapy is mandatory. After hemorrhage control at crash site the direct transport in a trauma center follows. Primary therapy in the emergency room sometimes includes stabilization by a pelvic clamp or an external fixator. If the patient is still hemodynamically unstable the life threatening bleeding is packed. After that simple internal osteosynthesis is allowed. The presented article shows the possible options of the therapy. The main message is: hemorrhage control is not possible without stabilization of the pelvic ring.
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MESH Headings
- Adolescent
- Adult
- Aged
- Angiography
- Child
- Emergencies
- Emergency Medical Services
- Female
- Fracture Fixation/methods
- Fractures, Bone/classification
- Fractures, Bone/diagnostic imaging
- Fractures, Bone/mortality
- Fractures, Bone/surgery
- Hemostatic Techniques
- Hospital Mortality
- Humans
- Image Processing, Computer-Assisted
- Imaging, Three-Dimensional
- Joint Instability/classification
- Joint Instability/diagnostic imaging
- Joint Instability/mortality
- Joint Instability/surgery
- Male
- Middle Aged
- Multiple Trauma/classification
- Multiple Trauma/diagnostic imaging
- Multiple Trauma/mortality
- Multiple Trauma/surgery
- Pelvic Bones/blood supply
- Pelvic Bones/diagnostic imaging
- Pelvic Bones/injuries
- Pelvic Bones/surgery
- Prognosis
- Reoperation/mortality
- Resuscitation
- Sacrum/blood supply
- Sacrum/diagnostic imaging
- Sacrum/injuries
- Sacrum/surgery
- Shock, Hemorrhagic/diagnostic imaging
- Shock, Hemorrhagic/mortality
- Shock, Hemorrhagic/surgery
- Spinal Fractures/classification
- Spinal Fractures/diagnostic imaging
- Spinal Fractures/mortality
- Spinal Fractures/surgery
- Survival Rate
- Tomography, Spiral Computed
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Pickel H, Hungerer S, Bühren V. [Treatment and problem analysis in acute and chronic instabilities of the elbow]. Zentralbl Chir 2003; 128:W134-43; quiz W144-7. [PMID: 14964196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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111
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Mückley T, Schütz T, Srivastava S, Goebel M, Gonschorek O, Bühren V. Die Technik der tibiotalaren Arthrodese mit Kompressionsmarknagel. Unfallchirurg 2003; 106:732-40. [PMID: 14631528 DOI: 10.1007/s00113-003-0638-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Tibiotalar arthrodesis still remains the primary choice of treatment for disabling ankle arthropathy since the results of ankle arthroplasty are not yet convincing. Numerous operative techniques have been described, with an increasing trend towards the use of internal fixation and compression. Using an intramedullary compression nailing technique, 137 tibiotalar fusions were performed at our hospital. The special design of the nail allows distal interlocking in the talus and dynamic axial compression with high primary stability. With correct joint axis, only the cartilage joint surfaces were removed. For axis correction the corresponding bony joint surfaces were also resected. We also performed a dowel technique with bone grafting from the lateral malleolus. We examined 110 of the 137 patients during follow-up. A primary union could be achieved in 99 cases (90.0%). A further six cases (5.5%) healed after recompression and bone grafting. Nonunion remained in five cases (4.5%). Operative complications included one tibial shaft fracture and one hematoma. Septic complications were three superficial and eight deep infections. Sufficient pain relief after arthrodesis was reported by 70 (63.6%) patients; in 37 (33.6%) patients the symptoms remained unchanged and 3 (2.7%) patients found their pain to be worse than before the procedure. Intramedullary compression nailing is shown to be an effective technique for tibiotalar arthrodesis in severe ankle arthropathy. The main advantages of the technique are limited soft tissue damage in the ankle area and high primary stability allowing early weight bearing.
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112
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Goebel M, Mückley T, Gerdesmeyer L, Militz M, Bühren V. [Intramedullary nailing in tibiotalocalcaneal arthrodesis]. Unfallchirurg 2003; 106:633-41. [PMID: 12955234 DOI: 10.1007/s00113-003-0626-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tibiotalcalcaneal arthrodesis is still the treatment of choice for disabling arthrosis of the upper and lower ankle joint, although replacement of the upper ankle joint is widely accepted. Numerous techniques have been described, with increasing use of internal fixation and compression. In 20 patients tibiotalocalcaneal arthrodesis was performed using a retrograde femur nail inserted through the heel, whereas in 20 patients combined arthrodesis of the upper and lower ankle joint was performed using a distal tibia nail through an anterograde approach. Patients were evaluated in a standardized examination using criteria of SF 36 focussing on approach, osseous consolidation, and quality of life.Both techniques demonstrated good results: bony consolidation was achieved after follow-up time of 19 months in 85% of the anterograde group and 95% of the retrograde group. In 78% pain was reduced effectively using the intramedullary nail arthrodesis and quality of life improved drastically. In four cases pseudarthrosis occurred, two implant failures were reported, and there were two infections. Using the anterograde as well as the plantar approach, tibiotalocalcaneal intramedullary nail arthrodesis is an appropriate technique. In this study both groups demonstrated good results regarding bony consolidation, reduction of pain, and improved quality of life. Advantage of the retrograde technique is the noninvasiveness of the proximal tibia. Heel pain or plantar infections were not observed. We see limits of the presented technique in severe malalignment and septic history of the patient.
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113
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Mückley T, Schütz T, Kirschner M, Potulski M, Hofmann G, Bühren V. Psoas abscess: the spine as a primary source of infection. Spine (Phila Pa 1976) 2003; 28:E106-13. [PMID: 12642773 DOI: 10.1097/01.brs.0000050402.11769.09] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report, literature review, discussion. OBJECTIVES To emphasize the role of the spine as primary source of infection for psoas abscess. SUMMARY OF BACKGROUND DATA Spine-associated psoas abscesses increase with more frequent invasive procedures of the spine and recurring tuberculosis in industrialized countries. Diagnosis is often delayed by misinterpretation as arthritis, joint infection, or urologic or abdominal disorders. METHODS We present six cases of psoas abscesses associated with spinal infections that were treated in our hospital from January to December 2001. Diagnostic and treatment concepts are discussed. RESULTS Our data emphasize the importance of the spine as primary source of infection and suggest an increase in the incidence of secondary psoas abscess. Treatment includes open surgical drainage and antibiotic therapy. In patients with high operative risk and uniloculated abscess, a CT-guided percutaneous abscess drainage can be sufficient. It is essential to combine abscess drainage with causative treatment of the primary infectious focus. Related to the spine, this includes treatment of spondylodiscitis or implant infection after spinal surgery. Usually, several operations are necessary to eradicate bone and soft-tissue infection and restore spinal stability. Continuous antibiotic therapy over a period of 2-3 weeks after normalization of infectious parameters is recommended. CONCLUSION The spine as primary source of infection for secondary psoas abscess should always be included in differential diagnosis. Because the prognosis of psoas abscess can be improved by early diagnosis and prompt onset of therapy, it needs to be considered in patients with infection and back or hip pain or history of spinal surgery.
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Mückley T, Schütz T, Hierholzer C, Potulski M, Beisse R, Bühren V. [Psoas abscess after anterior spinal fusion]. Unfallchirurg 2003; 106:252-8. [PMID: 12658345 DOI: 10.1007/s00113-002-0560-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We present 3 cases of secondary psoas abscess after anterior spinal fusion. Psoas abscess is still a rare clinical entity. It is often associated with unspecific symptomatology and may present as late infection. A high index of suspicion is required for early diagnosis and treatment. Computed tomography is the imaging technology of choice. Treatment includes open abscess drainage and antibiotic therapy. In secondary psoas abscess causative treatment of the primary infection focus is essential. For psoas abscess after anterior spondylodesis this includes treatment of a deep wound infection. Predisposing factors for postoperative infection are large implants, bone grafting, long operating times, previous spinal surgery, immunodeficiency and metabolic disorders. Usually several operations are necessary to eradicate infection. As long as stability is guaranteed, implant materials should be removed. Continuing antibiotic therapy for 2-3 weeks after normalization of infectious parameters is suggested. Delayed therapy results in an increase of the morbidity and mortality of psoas abscess.
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116
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117
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Bühren V. Hygienemaßnahmen in der Chirurgie. Chirurg 2002. [DOI: 10.1007/s00104-002-0526-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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118
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Schmeiser G, Vastmans J, Potulski M, Hofmann GO, Bühren V. [Retrograde intramedullary nailing of knee para-articular fractures in paraplegic patients]. Unfallchirurg 2002; 105:612-8. [PMID: 12219647 DOI: 10.1007/s00113-001-0400-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Patients with spinal cord lesions suffer injury even by marginal trauma, especially in the area of the knee joint. Because of lost sensitivity and proprioception, the treatment of the fracture has to be minimally invasive but stable enough for physiotherapy. METHODS There were 18 patients with 20 fractures near the knee: 15 fractures of the supracondylar femur were treated with a retrograde intramedullary GSH nail and 5 fractures of the proximal tibia with a new retrograde nailing technique. RESULTS At review all patients had a good motion range of the knee joint (> 100 degrees), and ankle joint motion was free. CONCLUSION We saw in this study that the GSH nail is an excellent method for stabilizing supracondylar fractures of the femur in paraplegic patients because the treatment is minimally invasive and the fracture is stable enough for physiotherapy. The retrograde nailing of proximal fractures of the tibia is a good alternative method for treatment of patients with spinal cord lesions.
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119
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Beisse R, Potulski M, Beger J, Bühren V. [Development and clinical application of a thoracoscopy implantable plate frame for treatment of thoracolumbar fractures and instabilities]. DER ORTHOPADE 2002; 31:413-22. [PMID: 12056285 DOI: 10.1007/s00132-001-0285-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The evolution of endoscopic spinal approaches and the associated possibilities for stabilization of the anterior column demands a new generation of spinal implants. Of particular interest is the possibility to implant using an endoscopic approach and the ability to achieve real angular stability so that for a suitable injury pattern an exclusively anterior procedure can be carried out. Since November 1999, a new type of anterior plate, MACS TL, developed to meet minimally invasive clinical requirements, has been used in the Berufsgenossenschaftliche Unfallklinik in Murnau, Germany for treating the mid and lower thoracic and lumbar region. The following reports on the results of the first 100 procedures carried out over a period of 15 months, of which 93% were performed endoscopically. The results convey a trend toward anterior endoscopic treatment of injuries of the anterior column using an implant with angular stability. The results now available on healing after fusion indicate the favorable influence of the stability provided by the implants on the bone-healing rate.
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120
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Goebel M, Militz M, Beickert R, Bühren V. Intramedullary Nailing in Ankle Arthrodesis: Antegrade vs Retrograde. ACTA ACUST UNITED AC 2002. [DOI: 10.1055/s-2002-33846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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121
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Beisse R, Potulski M, Bühren V. Endoscopic Techniques for the Management of Spinal Trauma. ACTA ACUST UNITED AC 2001. [DOI: 10.1007/s00068-001-1178-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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122
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Schmeiser G, Hempfling H, Bühren V, Putz R. The popliteal region: an anatomical study and a new approach to the tibial attachment of the posterior cruciate ligament. Surg Radiol Anat 2001; 23:9-14. [PMID: 11370148 DOI: 10.1007/s00276-001-0009-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Surgical treatment of posterior cruciate ligament injuries is gaining more and more importance. The central posterior approach according to Abbott (1945) has been considered a standard, with various complications involved owing to the local anatomic conditions. This study is intended to present a modified dorsomedial approach to the posterior capsule of the knee joint that is better adapted to the anatomic conditions. As a basis, the popliteal region was dissected in 150 knee joints, and the course of the popliteal artery with its branches as well as the bifurcation of the sciatic nerve were identified. The medial joint line served as a reference point. It has been shown that the knee joint arteries and the two sural arteries arose at relatively constant levels. At least one of the meniscofemoral ligaments was found in all of the knee joints examined; the anterior ligament was present in a slightly higher percentage than the posterior ligament. The modified dorsomedial approach to the posterior joint capsule was evaluated in 50 knee joints. Dissection was achieved by blunt division of the medial head of the gastrocnemius muscle, with careful preservation of the proximal vascular supply of that muscle. It was necessary to expose neither the popliteal artery and vein nor the tibial nerve. The tibial attachment of the posterior cruciate ligament could be exposed in every knee. The advantage of the new approach to the posterior cruciate ligament described in this study consists in the preservation of the central neurovascular bundle and the excellent exposure of the tibial attachment.
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Pickel H, Hofmann GO, Gonschorek O, Bühren V. Umstellung posttraumatischer Fehlstellungen langer Röhrenknochen unter Verwendung von Kompressionsmarknägeln. ACTA ACUST UNITED AC 2001. [DOI: 10.1007/pl00010949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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124
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Bühren V. [Comments on the DRG system from the viewpoint of the trauma surgeon]. Chirurg 2001; 72:suppl 238-40. [PMID: 11594286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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125
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