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Colcuc C, Miersbach M, Cienfuegos M, Grüneweller N, Vordemvenne T, Wähnert D. Comparison of virtual reality and computed tomography in the preoperative planning of complex tibial plateau fractures. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05348-9. [PMID: 38703213 DOI: 10.1007/s00402-024-05348-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/16/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Preoperative planning is a critical step in the success of any complex surgery. The pur-pose of this study is to evaluate the advantage of VR glasses in surgical planning of complex tibial plateau fractures compared to CT planning. MATERIALS AND METHODS Five orthopedic surgeons performed preoperative planning for 30 fractures using either conventional CT slices or VR visualization with a VR headset. Planning was performed in a randomized order with a 3-month interval between planning sessions. A standardized questionnaire assessed planned operative time, planning time, fracture classification and understanding, and surgeons' subjective confidence in surgical planning. RESULTS The mean planned operative time of 156 (SD 47) minutes was significantly lower (p < 0.001) in the VR group than in the CT group (172 min; SD 44). The mean planning time in the VR group was 3.48 min (SD 2.4), 17% longer than in the CT group (2.98 min, SD 1.9; p = 0.027). Relevant parameters influencing planning time were surgeon experience (-0.61 min) and estimated complexity of fracture treatment (+ 0.65 min). CONCLUSION The use of virtual reality for surgical planning of complex tibial plateau fractures resulted in significantly shorter planned operative time, while planning time was longer compared to CT planning. After VR planning, more surgeons felt (very) well prepared for surgery.
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Affiliation(s)
- Christian Colcuc
- Bielefeld University, Medical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Department of Trauma and Orthopaedic Surgery, Burgsteig 13, 33617, Bielefeld, Germany
| | - Marco Miersbach
- Bielefeld University, Medical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Department of Trauma and Orthopaedic Surgery, Burgsteig 13, 33617, Bielefeld, Germany
| | - Miguel Cienfuegos
- Bielefeld University, Center for Cognitive Interaction Technology CITEC, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Niklas Grüneweller
- Bielefeld University, Medical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Department of Trauma and Orthopaedic Surgery, Burgsteig 13, 33617, Bielefeld, Germany
| | - Thomas Vordemvenne
- Bielefeld University, Medical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Department of Trauma and Orthopaedic Surgery, Burgsteig 13, 33617, Bielefeld, Germany
| | - Dirk Wähnert
- Bielefeld University, Medical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Department of Trauma and Orthopaedic Surgery, Burgsteig 13, 33617, Bielefeld, Germany.
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Grüneweller N, Leunig J, Zderic I, Gueorguiev B, Wähnert D, Vordemvenne T. Stabilization of Traumatic Iliosacral Instability Using Innovative Implants: A Biomechanical Comparison. J Clin Med 2023; 13:194. [PMID: 38202203 PMCID: PMC10779522 DOI: 10.3390/jcm13010194] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: Demographic changes over the past decade have had a significant impact on pelvic ring fractures. They have increased dramatically in the orthogeriatric population. Surgeons are faced with implant fixation issues in the treatment of these fragility fractures. This study compares two innovative implants for stabilizing the iliosacral joint in a biomechanical setting. (2) Methods: An iliosacral screw with a preassembled plate allowing the placement of an additional short, angular stable screw in the ilium and a triangular fixation system consisting of a fenestrated ilium screw and an iliosacral screw quasi-statically inserted through the "fenestra" were instrumented in osteoporotic artificial bone models with a simulated Denis zone 1 fracture. Biomechanical testing was performed on a servo-hydraulic testing machine using increasing, synchronous axial and torsional sinusoidal cyclic loading to failure. (3) Results: The SI-Plate and TriFix showed comparable stiffness values. The values for fracture gap angle and screw tip cutout were significantly lower for the TriFix compared to the SI-Plate. In addition, the number of cycles to failure was significantly higher for the TriFix. (4) Conclusions: Implant anchorage and primary stability can be improved in iliosacral instability using the triangular stabilization system.
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Affiliation(s)
- Niklas Grüneweller
- Bielefeld University, Medical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Department of Trauma and Orthopedic Surgery, Burgsteig 13, 33617 Bielefeld, Germany (D.W.)
| | - Julia Leunig
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (J.L.); (I.Z.)
| | - Ivan Zderic
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (J.L.); (I.Z.)
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (J.L.); (I.Z.)
| | - Dirk Wähnert
- Bielefeld University, Medical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Department of Trauma and Orthopedic Surgery, Burgsteig 13, 33617 Bielefeld, Germany (D.W.)
| | - Thomas Vordemvenne
- Bielefeld University, Medical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Department of Trauma and Orthopedic Surgery, Burgsteig 13, 33617 Bielefeld, Germany (D.W.)
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Berk T, Zderic I, Varga P, Schwarzenberg P, Berk K, Grüneweller N, Pastor T, Halvachizadeh S, Richards G, Gueorguiev B, Pape HC. Substitutional semi-rigid osteosynthesis technique for treatment of unstable pubic symphysis injuries: a biomechanical study. Eur J Trauma Emerg Surg 2023; 49:2569-2578. [PMID: 37555991 PMCID: PMC10728235 DOI: 10.1007/s00068-023-02333-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/15/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND/PURPOSE The surgical fixation of a symphyseal diastasis in partially or fully unstable pelvic ring injuries is an important element when stabilizing the anterior pelvic ring. Currently, open reduction and internal fixation (ORIF) by means of plating represents the gold standard treatment. Advances in percutaneous fixation techniques have shown improvements in blood loss, surgery time, and scar length. Therefore, this approach should also be adopted for treatment of symphyseal injuries. The technique could be important since failure rates, following ORIF at the symphysis, remain unacceptably high. The aim of this biomechanical study was to assess a semi-rigid fixation technique for treatment of such anterior pelvic ring injuries versus current gold standards of plate osteosynthesis. METHODS An anterior pelvic ring injury type III APC according to the Young and Burgess classification was simulated in eighteen composite pelvises, assigned to three groups (n = 6) for fixation with either a single plate, two orthogonally positioned plates, or the semi-rigid technique using an endobutton suture implant. Biomechanical testing was performed in a simulated upright standing position under progressively increasing cyclic loading at 2 Hz until failure or over 150,000 cycles. Relative movements between the bone segments were captured by motion tracking. RESULTS Initial quasi-static and dynamic stiffness, as well as dynamic stiffness after 100,000 cycles, was not significantly different among the fixation techniques (p ≥ 0.054).). The outcome measures for total displacement after 20,000, 40,000, 60,000, 80,000, and 100,000 cycles were associated with significantly higher values for the suture technique versus double plating (p = 0.025), without further significant differences among the techniques (p ≥ 0.349). Number of cycles to failure and load at failure were highest for double plating (150,000 ± 0/100.0 ± 0.0 N), followed by single plating (132,282 ± 20,465/91.1 ± 10.2 N), and the suture technique (116,088 ± 12,169/83.0 ± 6.1 N), with significantly lower values in the latter compared to the former (p = 0.002) and no further significant differences among the techniques (p ≥ 0.329). CONCLUSION From a biomechanical perspective, the semi-rigid technique for fixation of unstable pubic symphysis injuries demonstrated promising results with moderate to inferior behaviour compared to standard plating techniques regarding stiffness, cycles to failure and load at failure. This knowledge could lay the foundation for realization of further studies with larger sample sizes, focusing on the stabilization of the anterior pelvic ring.
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Affiliation(s)
- Till Berk
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland.
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - Ivan Zderic
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Peter Varga
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | | | - Karlyn Berk
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland
| | - Niklas Grüneweller
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
- Department of Trauma Surgery and Orthopedics, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld‑Bethel, Burgsteig 13, 33617, Bielefeld, Germany
| | - Tatjana Pastor
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
- Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, Freiburgstrasse 15, 3010, Bern, Switzerland
| | - Sascha Halvachizadeh
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland
| | - Geoff Richards
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland
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Colcuc C, Fischer S, Leimkühler P, Miersbach M, Lefering R, DGU T, Wähnert D, Vordemvenne T, Grüneweller N. Impact of the First and Second Wave of the SARS-CoV-2 Pandemic on Severe Trauma and the Care Structures in the German TraumaNetzwerk DGU ®. J Clin Med 2022; 11:jcm11237036. [PMID: 36498614 PMCID: PMC9737013 DOI: 10.3390/jcm11237036] [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] [Received: 10/21/2022] [Revised: 11/24/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
(1) Background: The aim of this study was to investigate the effects of the pandemic on transfer rates of severely injured patients within the German TraumaNetzwerk of the DGU. Furthermore, cause of accident, rescue times, and trauma cases are compared to pre-pandemic times. (2) Methods: For this investigation patients documented in the TraumaRegister DGU® from 2018 to 2020 were analyzed. The years 2018 and 2019 served as a comparison to 2020, the first COVID-19 pandemic year. All primary admissions and transfers were included if treated on an intensive care unit. (3) Results: Demographics (age, sex) and injury severity in 2020 were comparable with 2018/2019. In 2020, a significant decrease (3.7%) in car accidents was found. In contrast, a significant increase (3.2%) in bicycle accidents was seen. During the second wave, there was a significant burden of COVID-19 patients on hospitals. In this time, we found a significant increase in early transfers of trauma patients primarily from small level 3 to large level 1 centers. There was also a small but significant increase in rescue time, especially during the 2nd wave. (4) Conclusions: Our data confirm the importance of the network structures established in the TraumaNetzwerk DGU®, especially during the pandemic. The established structures allow smaller hospitals to spread their resources and prevent internal collapse. Therefore, the structures of the TraumaNetzwerk DGU® play a prominent role in stabilizing the healthcare system by helping to maintain both surgical and critical care capacity and providing adequate emergency care.
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Affiliation(s)
- Christian Colcuc
- Department of Trauma Surgery and Orthopedics, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld-Bethel, 33617 Bielefeld, Germany
| | - Sebastian Fischer
- Department of Foot and Ankle Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, 60389 Frankfurt, Germany
| | - Philipp Leimkühler
- Department of Trauma Surgery and Orthopedics, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld-Bethel, 33617 Bielefeld, Germany
| | - Marco Miersbach
- Department of Trauma Surgery and Orthopedics, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld-Bethel, 33617 Bielefeld, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, 51109 Cologne, Germany
| | - TraumaRegister DGU
- Committee on Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU), 10623 Berlin, Germany
| | - Dirk Wähnert
- Department of Trauma Surgery and Orthopedics, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld-Bethel, 33617 Bielefeld, Germany
| | - Thomas Vordemvenne
- Department of Trauma Surgery and Orthopedics, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld-Bethel, 33617 Bielefeld, Germany
- Correspondence:
| | - Niklas Grüneweller
- Department of Trauma Surgery and Orthopedics, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld-Bethel, 33617 Bielefeld, Germany
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Grüneweller N, Wähnert D, Schillians N, Komadinic A, Vordemvenne T. [Medicine for people with disabilities : Special features of trauma surgical care of extremity injuries in people with severe mental and physical disabilities]. Unfallchirurg 2021; 125:165-172. [PMID: 34755211 PMCID: PMC8813810 DOI: 10.1007/s00113-021-01105-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/29/2022]
Abstract
Die von Bodelschwinghschen Stiftungen Bethel blicken auf eine über 150-jährige Tradition in der Behandlung von Menschen mit Behinderungen. Das traumatologische Patient*innenkollektiv ist dabei regelmäßig durch schwerste geistige und körperliche Entwicklungsstörungen und (Mehrfach‑)Behinderungen, mit und ohne Verhaltensstörungen, und internistische Begleiterkrankungen charakterisiert. Diese besondere Kombination erfordert ärztlich wie pflegerisch eine Therapie und Indikationsstellung, welche in allen Behandlungsschritten spezifisch abgewogen und angepasst werden muss. Behandlungsrichtlinien oder Empfehlungen zu diesem Patientenkollektiv existieren in der Literatur nicht. Des Weiteren kann die Behandlung von Frakturen bei Menschen mit Behinderungen nicht immer nach etablierten Konzepten erfolgen. Aufgrund einer hohen postoperativen Komplikationsrate kommt der konservativen Therapie eine entscheidende Rolle zu. Die Entscheidung zur operativen Therapie muss interdisziplinär und individuell unter Berücksichtigung sämtlicher Faktoren getroffen werden. Spezielles Augenmerk muss dabei auf das zu wählende Verfahren (Stabilität, funktionelle Bedürfnisse) gerichtet werden.
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Affiliation(s)
- Niklas Grüneweller
- Evangelisches Klinikum Bethel, Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum OWL der Universität Bielefeld, Campus Bielefeld-Bethel, Burgsteig 13, 33617, Bielefeld, Deutschland
| | - Dirk Wähnert
- Evangelisches Klinikum Bethel, Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum OWL der Universität Bielefeld, Campus Bielefeld-Bethel, Burgsteig 13, 33617, Bielefeld, Deutschland
| | - Nathalie Schillians
- Krankenhaus Mara Bethel, Klinik für Chirurgie des Zentrums für Behindertenmedizin, Universitätsklinikum OWL der Universität Bielefeld, Campus Bielefeld-Bethel, Maraweg 21, 33617, Bielefeld, Deutschland
| | - Adrian Komadinic
- Evangelisches Klinikum Bethel, Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum OWL der Universität Bielefeld, Campus Bielefeld-Bethel, Burgsteig 13, 33617, Bielefeld, Deutschland
| | - Thomas Vordemvenne
- Evangelisches Klinikum Bethel, Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum OWL der Universität Bielefeld, Campus Bielefeld-Bethel, Burgsteig 13, 33617, Bielefeld, Deutschland. .,Krankenhaus Mara Bethel, Klinik für Chirurgie des Zentrums für Behindertenmedizin, Universitätsklinikum OWL der Universität Bielefeld, Campus Bielefeld-Bethel, Maraweg 21, 33617, Bielefeld, Deutschland.
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Abstract
BACKGROUND Increasing numbers of posterior pelvic ring fractures, especially in elderly patients, demonstrate the need for soft tissue protecting surgical techniques. Standard of care is iliosacral screw osteosynthesis. This type of osteosynthesis has its limitations especially in patients with reduced bone properties. Therefore, the development of new and straightforward surgical techniques and implant designs is favorable. METHODS Introducing this modular system for the posterior pelvic ring, known complications of iliosacral screw osteosynthesis, such as implant loosening and malpositioning may be reduced, due to innovative mechanical characteristics. RESULTS The shown cases demonstrate the potential benefits of the system with a wide range of treatment options due to its modularity. CONCLUSION The modular implant system presented here can significantly facilitate and improve the stabilization of posterior pelvic ring instabilities.
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Affiliation(s)
- Niklas Grüneweller
- Department of Trauma Surgery and Orthopedics, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld-Bethel, Burgsteig 13, 33617, Bielefeld, Germany
| | - Dirk Wähnert
- Department of Trauma Surgery and Orthopedics, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld-Bethel, Burgsteig 13, 33617, Bielefeld, Germany
| | - Thomas Vordemvenne
- Department of Trauma Surgery and Orthopedics, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld-Bethel, Burgsteig 13, 33617, Bielefeld, Germany.
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Wähnert D, Grüneweller N, Gueorguiev B, Vordemvenne T, Gehweiler D. Removal of cement-augmented screws in distal femoral fractures and the effect of retained screws and cement on total knee arthroplasty: a biomechanical investigation. J Orthop Traumatol 2021; 22:5. [PMID: 33638741 PMCID: PMC7914321 DOI: 10.1186/s10195-021-00568-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/08/2021] [Indexed: 11/15/2022] Open
Abstract
Background Given the increasing number of osteoporotic fractures of the distal femur, screw augmentation with bone cement is an option to enhance implant anchorage. However, in implant removal or revision surgeries, the cement cannot be removed from the distal femur without an extended surgical procedure. Therefore, the aims of this study were to investigate (1) whether cement augmentation has any influence on screw removal and removal torque, and (2) whether the implantation of a femoral component of a knee arthroplasty and its initial interface stability are affected by the remaining screws/cement. Material and methods Eight pairs of fresh-frozen human female cadaveric distal femurs (mean age, 86 years) with a simulated AO/OTA 33 A3 fracture were randomized in paired fashion to two groups and fixed with a distal femoral locking plate using cannulated perforated locking screws. Screw augmentation with bone cement was performed in one of the groups, while the other group received no screw augmentation. Following biomechanical testing until failure (results published separately), the screws were removed and the removal torque was measured. A femoral component of a knee arthroplasty was then implanted, and pull-out tests were performed after cement curing. Interference from broken screws/cement was assessed, and the maximum pull-out force was measured. Results The mean screw removal torque was not significantly different between the augmented (4.9 Nm, SD 0.9) and nonaugmented (4.6 Nm, SD 1.3, p = 0.65) screw groups. However, there were significantly more broken screws in in the augmented screw group (17 versus 9; p < 0.001). There was no significant difference in the pull-out force of the femoral component between the augmented (2625 N, SD 603) and nonaugmented (2653 N, SD 542, p = 0.94) screw groups. Conclusion The screw removal torque during implant removal surgery does not significantly differ between augmented and nonaugmented screws. In the augmented screw group, significantly more screws failed. To overcome this, the use of solid screws in holes B, C, and G can be considered. Additionally, it is possible to implant a femoral component for knee arthroplasty that retains the initial anchorage and does not suffer from interference with broken screws and/or residual cement. Level of Evidence 5
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Affiliation(s)
- Dirk Wähnert
- Department of Trauma and Orthopedic Surgery, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld-Bethel, Burgsteig 13, 33617, Bielefeld, Germany. .,AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland.
| | - Niklas Grüneweller
- Department of Trauma and Orthopedic Surgery, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld-Bethel, Burgsteig 13, 33617, Bielefeld, Germany
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Thomas Vordemvenne
- Department of Trauma and Orthopedic Surgery, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld-Bethel, Burgsteig 13, 33617, Bielefeld, Germany
| | - Dominic Gehweiler
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
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Hartensuer R, Grüneweller N, Lodde MF, Evers J, Riesenbeck O, Raschke M. The S2-Alar-Iliac Screw for Pelvic Trauma. Z Orthop Unfall 2020; 159:522-532. [PMID: 32659833 DOI: 10.1055/a-1190-5987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Percutaneous sacro-iliac screw osteosynthesis is considered to be standard of care for most posterior pelvic ring fractures. However, special situations require alternative strategies for sufficient stabilization. In these cases, stabilization can often be achieved using posterior instrumentation e.g. using SIPS-screws (spina-iliaca-posterior-superior screws). However, this often leads to implant-related aggravation of the sometimes already critical soft tissue conditions after pelvic trauma. S2-Ala-Ilium screws (S2AI screws) are a suitable alternative. The starting point lies medial of the posterior superior iliac spine below the iliac level. It is almost in line with a potential spinal instrumentation and therefore usually causes fewer soft tissue problems. Although this technique has been widely used in spinal surgery in recent years, its use in orthopaedic traumatology is largely unknown. The possibilities but also the limitations of this technique for the treatment of injuries to the pelvis are illustrated by this retrospective case series.
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Affiliation(s)
- Rene Hartensuer
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital of Muenster
| | - Niklas Grüneweller
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital of Muenster
| | | | - Julia Evers
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital of Muenster
| | - Oliver Riesenbeck
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital of Muenster
| | - Michael Raschke
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital of Muenster
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Everding J, Raschke MJ, Polgart P, Grüneweller N, Wähnert D, Schliemann B. Ex situ reconstruction of comminuted radial head fractures: is it truly worth a try? Arch Orthop Trauma Surg 2019; 139:1723-1729. [PMID: 31385021 DOI: 10.1007/s00402-019-03250-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Received: 01/28/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Complex radial head fractures are difficult to treat. In cases where stable fixation cannot be achieved, radial head resection or primary arthroplasty are frequently performed. Ex situ reconstruction of comminuted fractures may also be an option. This technique has widely been neglected in the literature, and only two small case series report satisfactory results. The aim of the present case series was to determine the functional and radiological outcomes of ex situ reconstructed Mason III and Mason IV fractures. We expect that the on-table reconstruction of comminuted radial head fractures will lead to bony union with no avascular necrosis in the postoperative course, which will demonstrate that this operative procedure is a reasonable option. PATIENTS AND METHODS Two Mason type III and seven Mason type IV fractures (including four Monteggia-like lesions) were reconstructed ex situ. The mean age of the patients was 47 years (range 22-64). The clinical examination included RoM tests, elbow stability tests, and a neurological examination. The functional outcome was assessed with the MEPS and DASH score. The radiographic examination included a.p. and lateral views of the elbow to detect non-unions, inadequacy or loss of reduction, radial head necrosis, heterotopic ossifications and signs of posttraumatic arthritis. RESULTS The mean follow-up time was 39 months (range 11-64). The mean MEPS was 82 points (range 15-100), and the mean DASH score was 20 points (range 0-85). All ex situ-reconstructed radial heads survived, and no signs of avascular necrosis were observed. Bony union was achieved in all but one patient who presented with an asymptomatic non-union. Signs of posttraumatic arthritis were found in all patients. With regard to the radial head, neither secondary resection nor arthroplasty had to be performed. All patients returned to their pre-injury occupations. CONCLUSION Ex situ radial head reconstruction can be a reliable option in the surgical treatment of complex radial head fractures associated with severe elbow trauma. Even in the midterm follow-up, no signs of avascular necrosis were observed. Modern implants may even extend the indications for reconstruction in such cases. LEVEL OF EVIDENCE Level IV-retrospective cohort study.
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Affiliation(s)
- Jens Everding
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Munster, Germany.
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Munster, Germany
| | - Patrick Polgart
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Munster, Germany
| | - Niklas Grüneweller
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Munster, Germany
| | - Dirk Wähnert
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Munster, Germany
| | - Benedikt Schliemann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Munster, Germany
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Evers J, Oberste M, Wähnert D, Grüneweller N, Wieskötter B, Milstrey A, Raschke MJ, Ochman S. [Outcome after surgical treatment of calcaneal fractures]. Unfallchirurg 2019; 122:778-783. [PMID: 30402689 DOI: 10.1007/s00113-018-0578-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/30/2022]
Abstract
BACKGROUND After controversial discussions in the literature about therapy regimens for calcaneal fractures, a retrospective study of patients operatively treated in a maximum care trauma center was conducted. OBJECTIVE Investigation of the influencing factors on the treatment quality of operatively treated patients with calcaneal fractures. MATERIAL AND METHODS Between 2005 and 2013 a total of 90 patients with calcaneal fractures were surgically treated in this hospital with locking plate osteosynthesis. A total of 48 patients with 55 fractures were retrospectively investigated. The assessment with respect to posttraumatic arthrosis was made radiologically and Böhler's and Gissane's angles were also determined. Clinically AOFAS and SF-36 scores were documented. The results were statistically tested with respect to possible risk factors. RESULTS A total of 9 patients (18.8%) were found with complications necessitating operative revision, with 8 patients requiring subtalar arthrodesis and 1 patient with a deep wound infection. Nicotine abuse and a long interval between trauma and reconstructive surgery were identified as factors that influenced the development of wound healing problems. The average AOFAS score was 68 points and the SF-36 was 58.86 points. A poor result in the scores was caused by the development of symptomatic arthritis and the type of insurance. In this cohort factors, such as age and complexity of fractures were not correlated with a poor result. CONCLUSION In this patient collective nicotine abuse and a long interval between trauma and surgery were risk factors for development of wound infections. Other factors with an influence on the outcome were the postoperative development of arthritis and the type of health insurance; however, patient age had no impact on the outcome.
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Affiliation(s)
- J Evers
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland.
| | - M Oberste
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland
| | - D Wähnert
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland
| | - N Grüneweller
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland
| | - B Wieskötter
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland
| | - A Milstrey
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland
| | - M J Raschke
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland
| | - S Ochman
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland
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Grüneweller N, Raschke MJ, Zderic I, Widmer D, Wähnert D, Gueorguiev B, Richards RG, Fuchs T, Windolf M. Biomechanical comparison of augmented versus non-augmented sacroiliac screws in a novel hemi-pelvis test model. J Orthop Res 2017; 35:1485-1493. [PMID: 27564231 DOI: 10.1002/jor.23401] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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] [Received: 03/01/2016] [Accepted: 08/19/2016] [Indexed: 02/04/2023]
Abstract
Operative treatment of sacral insufficiency fractures is frequently being complicated by osteopenic bone properties. Cement augmentation of implanted sacroiliac screws may lead to superior construct stability and prevent mechanical complications. A novel hemi-pelvis test model with dissected symphysis was developed. Five fresh-frozen cadaveric pelvises were vertically osteotomized at the sacrum on both sides and fixed with sacroiliac screws in both corridors of the first sacral vertebral body. One side was randomly augmented with bone cement. Cyclic testing consisting of torsional loading (±2.5 Nm) combined with progressively increasing axial loading (+50 N compression, -10 N traction, ±0,01 N/cycle) was performed until failure; simulated physiological loads derived from inverse dynamic calculations. The fixation was analyzed fluoroscopically quantifying screw migrations and assessing failure mechanisms. Failure modes were cut-out, pull-out, screw-out, and washer penetration. Motion at fracture site was analyzed via optical motion tracking. Unscrewing was provoked four times with non-augmented and twice with augmented screws. When focusing on the sacral region only, cement augmentation significantly improved screw fixation in terms of increased number of cycles to failure (p = 0.043). However, when considering overall construct stability, there was no significant difference between augmented and non-augmented state due to washer penetration at the iliac bone. The generated hemi-pelvis model was found to be valid due to the reproduction of the clinically observed failure mode (unscrewing). Unscrewing was not fully prevented by cement augmentation. Augmentation effects stability at the screw tip, but particularly in porotic bone, failure may shift to the next weak point. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1485-1493, 2017.
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Affiliation(s)
- Niklas Grüneweller
- AO Research Institute Davos, Clavadelerstraße 8, 7270 Davos, Switzerland.,Department for Trauma-, Hand- and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Münster, 48149, Germany
| | - Michael J Raschke
- Department for Trauma-, Hand- and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Münster, 48149, Germany
| | - Ivan Zderic
- AO Research Institute Davos, Clavadelerstraße 8, 7270 Davos, Switzerland
| | - Daniel Widmer
- AO Research Institute Davos, Clavadelerstraße 8, 7270 Davos, Switzerland
| | - Dirk Wähnert
- Department for Trauma-, Hand- and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Münster, 48149, Germany
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstraße 8, 7270 Davos, Switzerland
| | | | - Thomas Fuchs
- Department for Trauma and Reconstructive Surgery, Vivantes Hospital Friedrichshain, Landsberger Allee 49, Berlin, 10249, Germany
| | - Markus Windolf
- AO Research Institute Davos, Clavadelerstraße 8, 7270 Davos, Switzerland
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Abstract
ZusammenfassungDie demografische Entwicklung hat in den letzten Jahren zu einer Zunahme an älteren multimorbiden Patienten mit Beckenringfraktur geführt. Dabei stellen Diagnose, Therapie sowie peri- und postoperatives Patientenmanagement eine große Herausforderung dar. Für eine optimale Patientenversorgung ist ein interdisziplinärer Behandlungsansatz notwendig. In der Altersgruppe der > 65-jähringen Patienten sind Beckenringverletzung häufig durch Niedrigenergietraumen verursacht und mit einer reduzierten Knochenqualität vergesellschaftet. Die therapeutischen Optionen reichen von konservativen bis hin zu verschiedenen operativen Maßnahmen. Allerdings wird auch die operative Therapie durch altersbedingte Komorbiditäten beeinflusst. Daher werden hierfür minimalinvasive und schonende OP-Methoden favorisiert. Die mit zunehmendem Alter reduzierte Knochenqualität erschwert jedoch die knöcherne Verankerung von unfallchirurgischen Implantaten erheblich. Im Folgenden stellen wir ein minimalinvasiv durchführbares Verfahren, die Zementaugmentation von iliosakralen Schrauben, vor. Dieses kann bei therapierefraktären Beschwerden und immobilisierenden Schmerzen zur Behandlung der hinteren Beckenringfraktur bei reduzierter Knochenqualität durchgeführt werden. Die Schraubenaugmentation trägt hier zu einer deutlichen Verbesserung der Implantatverankerung bei. Das Augmentationsverfahren kann ohne wesentliche Erweiterung des Zugangswegs und der chirurgischen Morbidität durchgeführt werden. Kanülierte und spitzenperforierte Schraubensysteme werden nach der gewohnten perkutanen Implantation bei reduziertem Eindrehmoment mittels Knochenzement im Bereich der Schraubenspitze augmentiert. Ziel dieser Therapie ist eine suffiziente Schmerzreduktion und die sofortige Mobilisation unter Vollbelastung, um Komplikationen und Folgeschäden durch Immobilisation für den geriatrischen Patienten zu vermeiden.
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Wähnert D, Grüneweller N, Gehweiler D, Brunn B, Raschke MJ, Stange R. Double plating in Vancouver type B1 periprosthetic proximal femur fractures: A biomechanical study. J Orthop Res 2017; 35:234-239. [PMID: 27061941 DOI: 10.1002/jor.23259] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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] [Received: 01/28/2016] [Accepted: 04/04/2016] [Indexed: 02/04/2023]
Abstract
Periprosthetic hip fractures are an increasing problem in modern orthopedic and trauma surgery. Many options for the operative treatment are available to the surgeon ranging from modern variable angular systems to standard plates, screws, and cerclages. However, there is no gold standard and therefore, the aim of this study, was to investigate the biomechanical characteristics of double plating versus a lateral standard plate in a Vancouver B1 fracture model. Ten 4th generation composite femora were used to implant cementless total hip prosthesis and create Vancouver B1 periprosthetic fractures. Afterwards, the osteotomies were fixed using the locking compression plate in combination with the locking attachment plate (LCP, LAP, DePuy Synthes, Solothurn, Switzerland)-group I. Group II additionally achieved a 5-hole 4.5/5.0 mm LCP anteriorly. Each construct was cyclically loaded to failure in axial compression. Axial construct stiffness was 50.87 N/mm (SD 1.61) for group I compared to 738.68 N/mm (SD 94.8) for group II, this difference was statistically significant (p = 0.016). The number of cycles to failure was also significant higher for group II (2,375 vs. 13,000 cycles; p = 0.016). Double plating can significantly increase construct stiffness and stability, and thus, is an option in the treatment of complex periprosthetic fractures, in revision surgery and for patients with the inability to partial weight bear. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:234-239, 2017.
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Affiliation(s)
- Dirk Wähnert
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Niklas Grüneweller
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Dominic Gehweiler
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Benjamin Brunn
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Richard Stange
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
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Evers J, Wähnert D, Grüneweller N, Raschke MJ, Ochman S. Delayed Surgical Reconstruction of a Peroneal Tendon Rupture in an Accessory Os Peroneum A Rare Differential Diagnosis in Chronic Ankle Pain. J Am Podiatr Med Assoc 2016; 106:439-444. [PMID: 28033048 DOI: 10.7547/15-092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 02/03/2023]
Abstract
A fracture of the os peroneum is a rare cause of ankle and foot pain and is often overlooked and not assumed. Only a few case reports have discussed the different etiologies, options for diagnosis, and therapeutic interventions for acute cases. We present a case of delayed diagnosis of an os peroneum fracture due to a distortion of the ankle that occurred during air sports. Initial diagnostic testing with magnetic resonance imaging demonstrated a rupture of the peroneus longus tendon with no pathologic abnormalities at the peroneus brevis tendon. During surgery, a combination of an os peroneum fracture and a peroneus brevis tendon split was found and was successfully treated with bone and tendon repair using a lasso stich technique.
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Affiliation(s)
- Julia Evers
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Dirk Wähnert
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Niklas Grüneweller
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Michael J. Raschke
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Sabine Ochman
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
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Schliemann B, Grüneweller N, Yao D, Kösters C, Lenschow S, Roßlenbroich SB, Raschke MJ, Weimann A. Biomechanical evaluation of different surgical techniques for treating patellar tendon ruptures. Int Orthop 2015; 40:1717-1723. [PMID: 26432575 DOI: 10.1007/s00264-015-3003-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/15/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study was to biomechanically assess patellar tendon repair techniques with additional cable wire or polydioxanone suture (PDS) cord augmentation in comparison with a suture-anchor repair technique. METHODS Patellar tendon repair was performed in 60 specimens using a porcine bone model. Yield load, maximum load, stiffness and elongation of patellar tendon reconstructions with (1) cable wire augmentation, (2) PDS cord augmentation or (3) suture anchor repair were evaluated using a cyclic loading and load-to-failure test setup. RESULTS In comparison with suture anchor repair, augmentation of the reconstruction with either cable wires or PDS cords provides significantly higher maximum loads (527 and 460 N vs. 301 N; p < 0.01 and p = 0,012, respectively) under load-to-failure testing and less elongation (8.81 mm ± 1.55 mm and 10.56 mm ± 3.1 mm vs. 18.38 mm ± 7.51 mm; p = 0.037 and p = 0.033, respectively) under cyclic loading conditions. CONCLUSION Augmentation of a patellar tendon repair with either a cable wire or a PDS cord provides higher primary stability than suture anchor repair in patellar tendon ruptures. The study supports the use of additional augmentation of a tendon repair in the clinical setting in order to prevent loss of reduction and allow for early post-operative mobilisation.
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Affiliation(s)
- Benedikt Schliemann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany.
| | - Niklas Grüneweller
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany
| | - Daiwei Yao
- Orthopaedic Clinic of the Hanover Medical School, Annastift Hospital, Anna-von-Borries Str. 1-7, 30625, Hannover, Germany
| | - Clemens Kösters
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany
| | - Simon Lenschow
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany
| | - Steffen B Roßlenbroich
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany
| | - Andre Weimann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany
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Evers J, Barz L, Wähnert D, Grüneweller N, Raschke MJ, Ochman S. Size matters: The influence of the posterior fragment on patient outcomes in trimalleolar ankle fractures. Injury 2015; 46 Suppl 4:S109-13. [PMID: 26542855 DOI: 10.1016/s0020-1383(15)30028-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [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: 02/02/2023]
Abstract
INTRODUCTION Ankle fractures are increasing in incidence. The more complicated the lesion is, the higher the risk of developing posttraumatic arthrosis. Severe posttraumatic arthrosis results in a reduced quality of life. Therefore, the treatment of a trimalleolar fractures is crucial. However, the treatment guidelines for posterior malleolar fractures (PMF) are still based on recommendations from 1940. Only a few retrospective studies have been conducted, which analysed patient outcomes based on lateral X-rays of the ankle. The purpose of this retrospective analysis was to survey patient outcomes in relation to the size of the PMF on the basis of CT-scans. METHODS We retrospectively examined 42 patients with trimalleolar fractures with an average follow-up of 2.5 years. Twenty-four patients (57%) received a CT scan of the ankle joint. The radiologic images were analysed for the size of the PMF and the involvement of the joint surface using lateral X-rays and available CT images. We examined all 42 patients clinically and radiologically, and estimated the grade of arthrosis of the ankle in accordance with the Bargon Score and assigned AOFAS Scores for each patient. We divided our patients into different groups according to the size of their PMF and evaluated patient outcomes in accordance with the compiled data first on the basis of X-ray data and then on the basis of CT data. RESULTS Comparing the measurement results by two different radiologic methods revealed that CT results in a more precise determination of PMF size in contrast to lateral X-rays, by which measurements were generally overrated. The statistical evaluation of our data demonstrated that patients with an osteosynthesis of the PMF and a PMF size of >25% showed signs of posttraumatic arthrosis but had better outcomes in accordance to the AOFAS score. All results were not significant. CONCLUSION An exact evaluation of CT images of posterior malleolar fractures in patients with trimalleolar ankle fractures is crucial for the decision to perform an osteosynthesis of the PMF and, therefore, an analysis of patient outcomes. The results of previous studies should be evaluated cautiously due to missing CT data. To date, this is the largest retrospective patient series of patient outcomes based on CT data.
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Affiliation(s)
- Julia Evers
- Trauma-, Hand- and Reconstructive Surgery, University Hospital Münster, Germany
| | - Linda Barz
- Trauma-, Hand- and Reconstructive Surgery, University Hospital Münster, Germany
| | - Dirk Wähnert
- Trauma-, Hand- and Reconstructive Surgery, University Hospital Münster, Germany
| | - Niklas Grüneweller
- Trauma-, Hand- and Reconstructive Surgery, University Hospital Münster, Germany
| | - Michael J Raschke
- Trauma-, Hand- and Reconstructive Surgery, University Hospital Münster, Germany.
| | - Sabine Ochman
- Trauma-, Hand- and Reconstructive Surgery, University Hospital Münster, Germany
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Abstract
BACKGROUND Osteoporotic fractures of the pelvis are an increasing problem in trauma surgery. Sufficient implant anchorage is reduced due to the poor bone stock; however, early mobilization is especially necessary for geriatric patients in order to prevent additional complications. MATERIAL AND METHODS Implant augmentation may be one technique to increase implant anchorage and stability in osteoporotic bone. This procedure is currently used in the treatment of osteoporotic fractures of the dorsal pelvic ring. Beside the augmentation of iliosacral screws in the treatment of sacral insufficiency fractures, cement augmentation with lumbar or sacral pedicle screws is used for increased stability. INDICATIONS AND RISKS Implant augmentation in pelvic surgery should be indicated crucially due to the specific risks of the procedure. Cement leakage and heat generation during cement curing (when PMMA--polymethylmetacrylate--cement is used) can compromise neurovascular structures. Potential complications like cement embolism are possible. CONCLUSION The use of special implants (cannulated and perforated screws) as well as intraoperative navigation and 3D imaging increase patient safety and help to make implant augmentation a low risk procedure.
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Affiliation(s)
- N Grüneweller
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude W1, 48149, Münster, Deutschland
| | - D Wähnert
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude W1, 48149, Münster, Deutschland
| | - M J Raschke
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude W1, 48149, Münster, Deutschland.
| | - T Fuchs
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude W1, 48149, Münster, Deutschland
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Wähnert D, Grüneweller N, Evers J, Sellmeier AC, Raschke MJ, Ochman S. An unusual cause of ankle pain: fracture of a talocalcaneal coalition as a differential diagnosis in an acute ankle sprain: a case report and literature review. BMC Musculoskelet Disord 2013; 14:111. [PMID: 23530869 PMCID: PMC3621797 DOI: 10.1186/1471-2474-14-111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 03/21/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The acute ankle sprain is one of the most common injuries seen in trauma departments. Ankle sprains have an incidence of about one injury per 10 000 people a day. In contrast tarsal coalition is a rare condition occurring in not more than one percent of the population. CASE PRESENTATION We present the case of a 23 year old male patient with pain and local swelling after an acute ankle sprain. Initial clinical and radiological examination showed no pathologies. Due to prolonged pain, swelling and the inability of the patient to weight bear one week after trauma further diagnostics was performed. Imaging studies (MRI and CT) revealed a fracture of a talocalcaneal coalition. To the knowledge of the authors no fracture of a coalition was reported so far. CONCLUSION This report highlights the presentation of symptomatic coalitions following trauma and furthermore, it points out the difficulties in the diagnosis and treatment of a rare entity after a common injury. A diagnostic algorithm has been developed to ensure not to miss a severe injury.
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Affiliation(s)
- Dirk Wähnert
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, 48149 Münster, Germany.
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