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Abstract
The wrist and hand form a highly complex organ that is of great importance in almost all daily activities. The hand serves as a tool and an organ of sense. Injuries of the hand and wrist as well as mechanical, neurological or systemic inflammatory changes are common. Taking a detailed history can already lead to a diagnosis. Almost all structures of the hand are easily accessible for clinical examination, i. e. inspection, palpation and clinical tests, including dynamic testing. Diagnostic imaging completes the examination procedure.
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Affiliation(s)
- H R Springorum
- Orthopädisches Fachzentrum, Seehauser Straße 2, 82418, Murnau, Deutschland.
| | - C Baier
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - J Götz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - T Schwarz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - A Benditz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - J Grifka
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - G Heers
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
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2
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Abstract
The wrist and hand form a highly complex organ that is of great importance in almost all daily activities. The hand serves as a tool and an organ of sense. Injuries of the hand and wrist as well as mechanical, neurological or systemic inflammatory changes are common. Taking a detailed history can already lead to a diagnosis. Almost all structures of the hand are easily accessible for clinical examination, i. e. inspection, palpation and clinical tests, including dynamic testing. Diagnostic imaging completes the examination procedure.
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Affiliation(s)
- H R Springorum
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland.
| | - C Baier
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - J Götz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - T Schwarz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - A Benditz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - J Grifka
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - G Heers
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
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Craiovan B, Weber M, Worlicek M, Schneider M, Springorum HR, Zeman F, Grifka J, Renkawitz T. Measuring Acetabular Cup Orientation on Antero-Posterior Radiographs of the Hip after Total Hip Arthroplasty with a Vector Arithmetic Radiological Method. Is It Valid and Verified for Daily Clinical Practice? ROFO-FORTSCHR RONTG 2016; 188:574-81. [PMID: 27093395 DOI: 10.1055/s-0042-104205] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this prospective study is to validate a vector arithmetic method for measuring acetabular cup orientation after total hip arthroplasty (THA) and to verify the clinical practice. MATERIALS AND METHODS We measured cup anteversion and inclination of 123 patients after cementless primary THA twice by two examiners on AP pelvic radiographs with a vector arithmetic method and compared with a 3D-CT based reconstruction model within the same radiographic coronal plane. RESULTS The mean difference between the radiographic and the 3D-CT measurements was - 1.4° ± 3.9° for inclination and 0.8°± 7.9° for anteversion with excellent correlation for inclination (r = 0.81, p < 0.001) and moderate correlation for anteversion (r = 0.65, p < 0.001). The intraclass correlation coefficient for measurements on radiographs ranged from 0.98 (95 %-CI: 0.98; 0.99) for the first observer to 0.94 (95 %-CI: 0.92; 0.96) for the second observer. The interrater reliability was 0.96 (95 %-CI: 0.93; 0.98) for inclination and 0.93 (95 %-CI: 0.85; 0.96) for anteversion. CONCLUSION The largest errors in measurements were associated with an extraordinary pelvic tilt. In order to get a valuable measurement for measuring cup position after THA on pelvic radiographs by this vector arithmetic method, there is a need for a correct postoperative ap view, with special regards to the pelvic tilt for the future. KEY POINTS • Measuring acetabular cup orientation on anteroposterior radiographs of the hip after THA is a helpful procedure in everyday clinical practice as a first-line imaging modality• CT remains the golden standard to accurately determine acetabular cup position.• Future measuring on radiographs for cup orientation after THA should account for integration of the pelvic tilt in order to maximize the measurement accuracy. Citation Format: • Craiovan B, Weber M, Worlicek M et al. Measuring Acetabular Cup Orientation on Antero-Posterior Radiographs of the Hip after Total Hip Arthroplasty with a Vector Arithmetic Radiological Method. Is It Valid and Verified for Daily Clinical Practice?. Fortschr Röntgenstr 2016; 188: 574 - 581.
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Affiliation(s)
- B Craiovan
- Orthopedic Surgery, University Medical Center Regensburg, Bad Abbach/Regensburg, Germany
| | - M Weber
- Orthopedic Surgery, University Medical Center Regensburg, Bad Abbach/Regensburg, Germany
| | - M Worlicek
- Orthopedic Surgery, University Medical Center Regensburg, Bad Abbach/Regensburg, Germany
| | - M Schneider
- Orthopedic Surgery, University Medical Center Regensburg, Bad Abbach/Regensburg, Germany
| | - H R Springorum
- Orthopedic Surgery, University Medical Center Regensburg, Bad Abbach/Regensburg, Germany
| | - F Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Germany
| | - J Grifka
- Orthopedic Surgery, University Medical Center Regensburg, Bad Abbach/Regensburg, Germany
| | - T Renkawitz
- Orthopedic Surgery, University Medical Center Regensburg, Bad Abbach/Regensburg, Germany
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Heers G, Grifka J, Springorum HR, Craiovan B, Anders S. [Operative treatment of the rheumatic shoulder]. Z Rheumatol 2015; 74:801-11. [PMID: 26555660 DOI: 10.1007/s00393-015-1614-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The duration and severity of rheumatic diseases of the shoulder correlate with symptom frequency, structural changes and associated functional limitations. The multifactorial character of the underlying rheumatic disease requires a multimodal therapeutic concept including interaction of surgical and non-surgical disciplines. In addition to basic systemic anti-inflammatory medication, injections targeting the synovial tissue by corticoid instillation and glenohumeral radiosynoviorthesis (with an intact rotator cuff) are further options. Operative interventions on rheumatic shoulders can be characterized as disease-modifying, protective, reconstructive or palliative, depending on the stage. Combining minimally invasive arthroscopic surgical techniques with modern basic therapy has the potential to shift the indications for operative interventions towards an earlier stage of disease without favoring or propagating structural alterations which have already occurred. In cases of severe joint destruction with loss of the rotator cuff, reverse shoulder arthroplasty can be an appropriate option.
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Affiliation(s)
- G Heers
- Orthopädische Klinik, Asklepios Klinikum Bad Abbach, Universität Regensburg, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - J Grifka
- Orthopädische Klinik, Asklepios Klinikum Bad Abbach, Universität Regensburg, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - H R Springorum
- Orthopädische Klinik, Asklepios Klinikum Bad Abbach, Universität Regensburg, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - B Craiovan
- Orthopädische Klinik, Asklepios Klinikum Bad Abbach, Universität Regensburg, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - S Anders
- Orthopädische Klinik, Asklepios Klinikum Bad Abbach, Universität Regensburg, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
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Springorum HR, Winkler S, Maderbacher G, Götz J, Heers G, Grifka J, Preissler P. [Wrist arthroscopy : challenging procedure of modern hand surgery]. Orthopade 2014; 44:89-102. [PMID: 25527300 DOI: 10.1007/s00132-014-3059-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Arthroscopy of the wrist has developed in the shadow of arthroscopy of the large joints. Nowadays, wrist arthroscopy has a relevant importance in the diagnostics and therapy in hand surgery and is indispensable for serious surgery of the wrist. Special equipment and extensive knowledge of the surgeon are necessary for carrying out the procedure.
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Affiliation(s)
- H-Robert Springorum
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland,
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Baier C, Springorum HR, Maderbacher G, Pickl C, Grifka J, Götz J. [Arthrodesis for patients with rheumatic arthritis of the ankle and hindfoot. A reasonable option?]. Z Rheumatol 2014; 73:796-805. [PMID: 25373549 DOI: 10.1007/s00393-014-1405-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Ankle and hindfoot deformities as well as degenerative changes are often found in patients with rheumatological diseases. They often suffer from severe pain and complain of increasing immobility. Corrective procedures with ankle or hindfoot arthrodesis are promising options. OBJECTIVES This article presents epidemiological data and describes the clinical aspects, diagnostics and treatment options for patients with ankle and hindfoot osteoarthritis. MATERIALS AND METHODS The retrospective results of 56 patients after ankle or hindfoot arthrodesis are presented. RESULTS After an average follow-up of 52 months the majority of results were good or excellent with relief of pain and reconstruction of the function of the foot. CONCLUSION Ankle or hindfoot arthrodesis represents a promising option for patients with severe osteoarthritis and can safeguard patients from increasing immobility.
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Affiliation(s)
- C Baier
- Orthopädische Klinik, Universität Regensburg im Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland,
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Baier C, Maderbacher G, Springorum HR, Zeman F, Fitz W, Schaumburger J, Grifka J, Beckmann J. No difference in accuracy between pinless and conventional computer-assisted surgery in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2014; 22:1819-26. [PMID: 23370990 DOI: 10.1007/s00167-013-2430-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 01/21/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Many studies have demonstrated higher precision and better radiological results in Total knee arthroplasty (TKA) with computer-assisted surgery (CAS). On the other hand, studies revealed a lengthening of operation time up to 20 min for this technique and demonstrated rare additional complications as fractures and neurovascular injuries caused by the array pins and any intraoperative array dislocation leads to abortion of CAS. To combine the advantages and eliminate the disadvantages of standard CAS, we evaluated the accuracy of a so-called pinless CT-free version of knee navigation (pinless CAS) abandoning the reference pins and reducing the necessary workflow to a minimum. METHOD The present study compares the accuracy of the reference methods of two different CT-free knee navigation software versions (Brainlab Knee 2.1 and Brainlab Knee Express 2.5). Thirty patients received TKA assisted by standard CAS. Intraoperatively, the proposed bony resections of standard CAS were matched with the new pinless CAS. Postoperatively, the results were checked by evaluating the radiographs concerning leg axis, femoral flexion and tibial slope. RESULTS All results concerning precise cuts (femoral as well as tibial coronal/varus-valgus alignment, femoral flexion alignment and tibial slope, resection height) were comparable between both groups (n.s.). In femoral, we found a mean deviation of coronal alignment of 0.3° (SD 0.7) and flexion of 0.2° (SD 0.8). In tibial, we found a mean deviation of coronal alignment of 0.2° (SD 0.5) and slope of 0.2° (SD 0.6). The mean additional operation time for the pinless CAS was below 2 min. The postoperative mechanical leg axis was within the threshold of 3° in all patients, tibial slope and femoral flexion matched with CAS values. CONCLUSION In clinical routine, pinless CAS can comprise the advantages of CAS leaving the disadvantages aside. It reduces surgical time and avoids complications associated with the tracking pins of conventional CAS.
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Affiliation(s)
- C Baier
- Orthopaedic Department, University of Regensburg, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany,
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Heers G, Springorum HR, Baier C, Götz J, Grifka J, Renkawitz T. Proximal interphalangeal joint replacement with an unconstrained pyrocarbon prosthesis (Ascension(R)): a long-term follow-up. J Hand Surg Eur Vol 2013; 38:680-5. [PMID: 23234765 DOI: 10.1177/1753193412469898] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
There have been limited publications that report long-term outcomes of pyrocarbon implants. This report describes both clinical and radiographic long-term results for patients who have been treated with pyrocarbon proximal interphalangeal implants. Thirteen implants in ten patients are reported for an average follow-up of 8.3 years (range 6.2-9.3). All patients were suffering from degenerative joint disease. Five of the 13 digits were free of pain, the remaining eight digits had mild to moderate pain (visual analogue scale 2-5). The average active range of motion was 58° (SD 19°) at latest examination. X-ray results were unremarkable in six digits with an acceptable position of the prosthesis. However, in seven patients significant radiolucent lines (≥ 1 mm) were observed. Three prostheses demonstrated a migration of the proximal component, and one a subsidence of the distal component. Our study does not support the use of this implant for treatment of osteoarthritis of the finger joint owing to high complication rates and limited range of motion.
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Affiliation(s)
- G Heers
- Division of Orthopedics, University of Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany.
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Abstract
To address recurrent patellar instability in children and young adolescents a variety of therapeutic options exist either as non-operative or operative treatment. Recent options, such as reconstruction of the medial patellofemoral ligament have evoked a new focus of attention on this topic. The intention of this article is to present diverse therapeutic options and to evaluate them by reference to the current literature.
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Affiliation(s)
- C Baier
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland.
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Springorum HR, Luring C, Beckmann J, Schaumburger J, Grifka J, Tingart M. Fatigue fracture of the hinge pin in a semi-constrained total knee arthroplasty: a case report. Knee Surg Sports Traumatol Arthrosc 2010; 18:1366-8. [PMID: 20563555 DOI: 10.1007/s00167-010-1195-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Accepted: 06/01/2010] [Indexed: 11/26/2022]
Abstract
Material failure is a rare complication in total knee arthroplasty (TKA). This case report shows a fatigue fracture of the hinge pin as a consequence of a postoperative persisting valgus deviation in a semi-constrained TKA.
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Affiliation(s)
- H R Springorum
- Department of Orthopaedic Surgery, University of Regensburg, Kaiser-Karl-V. Allee 3, 93077 Bad Abbach, Germany.
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