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Schwarz AM, Hohenberger GM, Sauerschnig M, Niks M, Lipnik G, Mattiassich G, Zacherl M, Seibert FJ, Plecko M. Effectiveness of reverse total shoulder arthroplasty for primary and secondary fracture care: mid-term outcomes in a single-centre experience. BMC Musculoskelet Disord 2021; 22:48. [PMID: 33419418 PMCID: PMC7792308 DOI: 10.1186/s12891-020-03903-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The introduction of reverse total shoulder arthroplasty (RSA) as a treatment option in complex proximal humeral fractures, has significantly extended the surgical armamentarium. The aim of this study was to investigate the mid-term outcome following fracture RSA in acute or sequelae, as well as salvage procedures. It was hypothesized that revision RSA (SRSA) leads to similar mid-term results as primary fracture treatment by RSA (PRSA). METHODS This retrospective study describes the radiological and clinical mid-term outcomes in a standardized single-centre and Inlay design. Patients who underwent RSA in fracture care between 2008 and 2017 were included (minimum follow-up: 2 years, minimum age: 60 years). The assessment tools used for functional findings were range of motion (ROM), Visual Analogue Scale, absolute (CS) plus normative Constant Score, QuickDASH, and Subjective Shoulder Value. All adverse events as well as the radiological results and their clinical correlations were statistically analysed (using p < .05and 95% confidence intervals). RESULTS Following fracture RSA, 68 patients were included (mean age: 72.5 years, mean follow-up: 46 months). Forty-two underwent primary RSA (PRSA), and 26 underwent revision RSA (SRSA). Adverse advents were observed in 13% (n = 9/68). No statistically significant results were found for the scores of the PRSA and SRSA groups, while the failed osteosynthesis SRSA subgroup obtained statistically significantly negative values for ROM subzones (flexion: p = .020, abduction: p = .020). Decreased instances of tubercle healing were observed for the in PRSA group relative to the SRSA group (p = .006). The absence of bony healing of the tubercles was related to significant negative clinical and subjective outcomes (all scores: p < .05, external rotation: p= .019). Significant postoperative improvements were evaluated in the SRSA group (CS: 23 to 56 at mean, p = .001), the time from index surgery to operative revision revealed no associations in functional findings. CONCLUSIONS RSA is an effective option in severe shoulder fracture management with predictable results for salvage as well as first-line treatment. Promising mid-term functional results, reasonable implant survival rates, and high patient satisfaction can be achieved. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- A M Schwarz
- AUVA - Trauma Hospital (UKH) Styria | Graz, Teaching Hospital of the Medical University of Graz, Göstinger Straße 24, 8020, Graz, Austria.
| | - G M Hohenberger
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - M Sauerschnig
- AUVA - Trauma Hospital (UKH) Styria | Graz, Teaching Hospital of the Medical University of Graz, Göstinger Straße 24, 8020, Graz, Austria
| | - M Niks
- AUVA - Trauma Hospital (UKH) Styria | Graz, Teaching Hospital of the Medical University of Graz, Göstinger Straße 24, 8020, Graz, Austria
| | - G Lipnik
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - G Mattiassich
- AUVA - Trauma Hospital (UKH) Styria | Graz, Teaching Hospital of the Medical University of Graz, Göstinger Straße 24, 8020, Graz, Austria
| | - M Zacherl
- AUVA - Trauma Hospital (UKH) Styria | Graz, Teaching Hospital of the Medical University of Graz, Göstinger Straße 24, 8020, Graz, Austria
| | - F J Seibert
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - M Plecko
- AUVA - Trauma Hospital (UKH) Styria | Graz, Teaching Hospital of the Medical University of Graz, Göstinger Straße 24, 8020, Graz, Austria
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Kerschhagl M, Larcher L, Mattiassich G, Prantl L. Replantation of a circumferentially degloved thumb in an occupational crush injury – A case report and review of the literature. Clin Hemorheol Microcirc 2019; 71:403-414. [DOI: 10.3233/ch-199004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M. Kerschhagl
- Traumacenter Linz, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
| | - L. Larcher
- Plastic, Aesthetic and Reconstructive Surgery Sanitaetsbetrieb South Tyrol (SABES), Bolzano, Italy
| | - G. Mattiassich
- Traumacenter Styria, Teaching Hospital of the Medical University Graz, Graz, Austria
| | - L. Prantl
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
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Mattiassich G, Ortmaier R, Rittenschober F, Hochreiter J. Diagnostic parameters in periprosthetic infections: the current state of the literature. Eur J Orthop Surg Traumatol 2018; 28:1573-1580. [PMID: 29948400 DOI: 10.1007/s00590-018-2238-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/23/2018] [Indexed: 12/30/2022]
Abstract
Despite progress in recent years, a definitive diagnosis of PPI is not yet possible. Due to new diagnostic possibilities and the further development of already existing diagnostic tools, a more accurate diagnostic clarification of uncertain cases should be possible. The following article includes an overview of common existing diagnostic tools and instruments, which will likely gain importance in the future.
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Affiliation(s)
- G Mattiassich
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Seilerstätte 4, 4020, Linz, Austria. .,Trauma Center Linz, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria.
| | - R Ortmaier
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Seilerstätte 4, 4020, Linz, Austria
| | - F Rittenschober
- Trauma Center Linz, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
| | - J Hochreiter
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Seilerstätte 4, 4020, Linz, Austria
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Ortmaier R, Hitzl W, Matis N, Mattiassich G, Hochreiter J, Resch H. Reverse shoulder arthroplasty combined with latissimus dorsi transfer: A systemic review. Orthop Traumatol Surg Res 2017; 103:853-859. [PMID: 28433759 DOI: 10.1016/j.otsr.2017.03.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 03/24/2017] [Accepted: 03/31/2017] [Indexed: 02/02/2023]
Abstract
Reverse shoulder arthroplasty (RSA) combined with latissimus dorsi transfer (LDT) is described for patients with cuff arthropathy and a combined loss of abduction and external rotation. The purpose of this systemic review was to present clinical and radiological outcomes following RSA combined with LDT. A comprehensive literature review was performed to identify studies reporting clinical and radiological results of RSA combined with LDT. Seven articles that describe the treatment of 116 patients were selected. Functional scores, range of motion, radiological outcome, complications, rehabilitation regime, surgical technique, patient demographics and indication were analyzed and discussed. All studies reported significant improvement in functional scores and abduction and external rotation. Complications occurred in 26% of patients. Although high-level studies are lacking, this systemic review shows that RSA combined with LDT is a reliable surgical method with which to treat patients with loss of active abduction and loss of external rotation. The available data are insufficient to draw conclusions regarding the long-term outcomes of this procedure. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- R Ortmaier
- Department of Orthopaedics and Traumatology, Paracelsus Medical University, 48, Müllner Hauptstraße, 5020 Salzburg, Austria.
| | - W Hitzl
- Department of Biostatistics Paracelsus Medical University, 48, Müllner Hauptstraße, 5020 Salzburg, Austria.
| | - N Matis
- Department of Orthopaedics and Traumatology, Paracelsus Medical University, 48, Müllner Hauptstraße, 5020 Salzburg, Austria
| | - G Mattiassich
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 4, Seilerstätte, 4020 Linz, Austria
| | - J Hochreiter
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 4, Seilerstätte, 4020 Linz, Austria
| | - H Resch
- Department of Orthopaedics and Traumatology, Paracelsus Medical University, 48, Müllner Hauptstraße, 5020 Salzburg, Austria
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Mattiassich G, Rittenschober F, Dorninger L, Rois J, Mittermayr R, Ortmaier R, Ponschab M, Katzensteiner K, Larcher L. Long-term outcome following upper extremity replantation after major traumatic amputation. BMC Musculoskelet Disord 2017; 18:77. [PMID: 28187720 PMCID: PMC5303287 DOI: 10.1186/s12891-017-1442-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 02/03/2017] [Indexed: 11/30/2022] Open
Abstract
Background Amputations in general and amputations of upper extremities, in particular, have a major impact on patients’ lives. There are only a few long-term follow-up reports of patients after macro-replantation. We present our findings in contrast with the existing literature. Methods Sixteen patients with traumatic macro-amputation of an upper extremity were eligible for inclusion in this study. Altogether, the patients underwent replantation in 3 institutions between 1983 and 2011. Results Twelve male and four female patients with an average age at injury of 40.6 years (range, 14–61 years) were included in this study. The mean follow-up period was 13.5 years (range, 4.4–32.6 years; SD, 5.7 years). The mean disabilities of the arm, shoulder and hand (DASH) outcome measure was 41 (range, 5.2–94.8; SD, 18.2), functional independence measurement (FIM) was 125 (range, 120–126; SD, 1.8). Chen I representing very good function was accounted in six, Chen II representing good function in eight, Chen III (fair) in one and Chen IV (bad function) in one patient. Conclusions We found that while the majority of the included patients exhibited good or very good function of the extremity, none of the replanted appendages regained normal levels of functionality. In addition, all participants were very satisfied with their outcomes. Positive long-term results with high rates of subjective satisfaction are possible after replantation of upper extremities.
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Affiliation(s)
- G Mattiassich
- Trauma Center, Unfallkrankenhaus Linz-Teaching Hospital of the Paracelsus Medical University Salzburg, Garnisonstrasse 7, 4010, Linz, Austria. .,Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria. .,Department of Orthopaedic Surgery, Ordensklinikum Linz Barmherzige Schwestern - Teaching hospital of the Paracelcus Medical University Salzburg, Linz, Austria.
| | - F Rittenschober
- Trauma Center, Unfallkrankenhaus Linz-Teaching Hospital of the Paracelsus Medical University Salzburg, Garnisonstrasse 7, 4010, Linz, Austria
| | - L Dorninger
- Trauma Center, Unfallkrankenhaus Linz-Teaching Hospital of the Paracelsus Medical University Salzburg, Garnisonstrasse 7, 4010, Linz, Austria
| | - J Rois
- Trauma Center Vienna Meidling, Vienna, Austria
| | - R Mittermayr
- Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Trauma Center Vienna Meidling, Vienna, Austria
| | - R Ortmaier
- Department of Trauma Surgery, Paracelsus Medical University and Salzburger Landeskliniken, Salzburg, Austria
| | - M Ponschab
- Trauma Center, Unfallkrankenhaus Linz-Teaching Hospital of the Paracelsus Medical University Salzburg, Garnisonstrasse 7, 4010, Linz, Austria.,Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - K Katzensteiner
- Trauma Center, Unfallkrankenhaus Linz-Teaching Hospital of the Paracelsus Medical University Salzburg, Garnisonstrasse 7, 4010, Linz, Austria
| | - L Larcher
- Trauma Center Salzburg, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria.,Plastic, Aesthetic and Reconstructive Surgery Sanitaetsbetrieb South Tyrol (SABES), Bolzano, Italy
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Mattiassich G, Litzlbauer W, Ortmaier R. Voraussetzungen, Erfahrungen und Nutzen des Traumaregisters der DGU in Österreich. Unfallchirurg 2016; 119:613-6. [DOI: 10.1007/s00113-016-0194-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Larcher L, Eisendle K, Schwaiger K, Kaplan R, Riml S, Mattiassich G, Ensat F, Wechselberger G. Lipomatosis of the mons pubis secondary to localized scleroderma (Morphea): first report of surgical management. J Eur Acad Dermatol Venereol 2014; 30:377-8. [PMID: 25370577 DOI: 10.1111/jdv.12810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- L Larcher
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital of St. John of God (Barmherzige Brüder) Salzburg (A), University Teaching Hospital - Paracelsus Medical University Salzburg, Salzburg, Austria
| | - K Eisendle
- Department of Dermatology and Venerology, Central Teaching Hospital of Bozen, Bozen, Italy
| | - K Schwaiger
- Paracelsus Medical University Salzburg, Salzburg, Austria
| | - R Kaplan
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital of St. John of God (Barmherzige Brüder) Salzburg (A), University Teaching Hospital - Paracelsus Medical University Salzburg, Salzburg, Austria
| | - S Riml
- Department of Plastic, Reconstructive and Hand Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - G Mattiassich
- Trauma Center Unfallkrankenhaus Linz, University Teaching Hospital - Paracelsus Medical University Salzburg, Salzburg, Austria
| | - F Ensat
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital of St. John of God (Barmherzige Brüder) Salzburg (A), University Teaching Hospital - Paracelsus Medical University Salzburg, Salzburg, Austria
| | - G Wechselberger
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital of St. John of God (Barmherzige Brüder) Salzburg (A), University Teaching Hospital - Paracelsus Medical University Salzburg, Salzburg, Austria
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Mattiassich G, Mayrhofer-Stelzhammer M, Huber W, Dorninger L, Kröpfl A. [Early functional treatment of intra-articular fractures of the proximal interphalangeal joint of the finger using a modified traction device]. HANDCHIR MIKROCHIR P 2013; 45:167-74. [PMID: 23860703 DOI: 10.1055/s-0033-1349073] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Treatment of intra-articular fractures of the middle phalanx is both difficult and controversial. We report our experience of using a modified dynamic traction device (mTD) utilizing only one pin in the head of the middle phalanx and thus facilitating further open reconstructive surgery at the proximal interphalangeal joint (PIP). The pin does not necessarily have to be inserted in the movement axis of the joint. AIM OF THE STUDY The aim of the study was to a) determine the effectiveness of the mTD, particularly in comparison with other distraction systems used in the treatment of middle phalanx fractures as described in the literature, and b) compare the results of patients treated using an mTD only with the results of those treated with an mTD in combination with additional open reconstructive surgery. PATIENTS AND METHODS 26 patients with a mean age of 37 years were treated for intra-articular fractures of the base of the middle phalanx using an mTD in the period between 2007 and 2011. 13 of these patients also underwent additional open reconstructive surgery. 18 of the 26 patients (69%) were reevaluated after 33 months (range 9-44 months); 10 of these had undergone additional open reconstructive surgery. Follow-up of 14 of the patients included their completion of a structured questionnaire and calculation of their DASH scores as well as radiological and clinical examinations. 4 patients completed the questionnaire and had their DASH score calculated. Measurement of range of motion was performed by the treating general practitioner. Patient records were analysed with a particular focus on complications and duration of therapy. RESULTS The mTD was used for an average of 34 days (range 8-53 days) and overall treatment took an average of 74 days (range 66-154 days). 4 pin tract infections were reported. The mean DASH score was 6.4. The mean range of motion in the PIP joint was 70° (range 30-110°). The range of motion of the PIP and DIP joints (61º) was significantly poorer in patients with additional surgery than that (82º) in patients with sole mTD treatment. Treatment with the mTD gave results similar to those obtained with other distraction devices with good subjective evaluation by the patients. CONCLUSION Dynamic traction with the help of the modified traction devices is suitable for treating intra-articular fractures of the proximal interphalangeal joint, as demonstrated by a comparison with the literature. Patients who underwent additional open surgery showed less favorable results. The present method has the advantage that only one wire needs to be inserted subcapitaly at a distance from the fracture in the middle finger and this facilitates further surgical interventions.
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Abstract
We present a case of posterior interosseous nerve palsy after bowel surgery associated with intramuscular myxoma of the supinator muscle. The initial symptoms of swelling of the forearm made it difficult to distinguish the condition from extravasations after intravenous cannulation. The diagnosis was finally established with nerve conduction studies and MRI 3 months after symptom onset. The patient underwent surgery for removal of the tumour and decompression of the posterior interosseous nerve. The histological examination identified the tumour as intramuscular myxoma and the patient made a full recovery with no recurrence of the lesion until present. Every swelling on the forearm causing neurological disorders is tumour suspected and should be examined clinically as well as electrophysically and radiographically. Early surgery and nerve decompression should follow immediately after the diagnosis. In case of intramuscular myxoma, good recovery of function after surgery with low recurrence risk may be expected.
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Affiliation(s)
- A Kursumovic
- Department of Neurosurgery and Interventional Neuroradiology, Klinikum Deggendorf, Deggendorf, Germany
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