Zeitschrift fur Orthopadie und Unfallchirurgie最新文献

Around a third of all cervical spine injuries occur in the upper cervical spine in the area between the occiput and the second cervical vertebra. The latter being the most common location of the injury with around 70%. But also atlas fractures, occipital condyle fractures, traumatic spondylolisthesis of C2, atypical fractures in the corpus area as well as atlantooccipital and atlantoaxial ligamentous lesions should be mentioned in connection with injuries in this area. In many cases, conservative therapy regimen is possible. In unstable or displaced injuries, however, surgical intervention is required, with various surgical procedures being used. The frequency, diagnostics, classification, and standard therapy of the individual entities are presented in detail in this continuing medical education article.

A 51-year-old patient presented with a painful swelling palmar to the metacarpophalangeal joint of the ring finger. A round tumor was detected using X-rays and MRI. After excision, tumoral calcinosis could be verified histologically.

Since 2019, a surgery supporting system (SPM, surgical process manager; Johnson & Johnson, New Brunswick, New Jersey, Vereinigte Staaten) has been used in a Level I trauma center for common trauma surgery procedures (distal radius fractures, proximal femur fractures, ankle fractures, proximal humerus fractures, and spine fractures). The hypothesis of this study was that implementing standardized procedures (by using SPM) may reduce radiation exposure, especially for unexperienced surgeons.Workflows were developed for different surgical procedures (distal radius fractures, proximal femur fractures, ankle fractures, proximal humerus fractures, and spine fractures) and added into the SPM. Between October 2019 and June 2022, 90 surgeries using the SPM were included in the study. A control group was included with 107 surgeries using the same surgical technique. The values measured were the radiation exposure during the surgical procedure, the experience of the head surgeon, and whether or not the SPM was used. A statistical analysis was performed by using the chi square and Fischer exact tests, with significance set at a p value < 0.05.SPM was applicated in 51 cases for the distal radius (control group 54 patients), 20 cases for distal fibula fractures (control group 21 patients), 9 cases for the proximal femur (control group 19 patients), 5 cases for vertebral fractures (control group 7 patients), and 5 cases for the proximal humerus (control group 6 patients). No difference concerning the median radiation exposure was observed by plating distal radius fractures with 5.7 Gy/cm² in the SPM group and a median radiation exposure of 6.4 Gy/cm² in the control group (p = 0.96). The distal fibula fractures showed no significant difference in the intraoperative radiation (17.4 Gy/cm² vs. 6.4 Gy/cm², p value 0.53). Radiation exposure was lower when a consultant performed surgery without showing any significance, independent if SPM was used or not.In this study, no significant difference in the intraoperative radiation dose was observed when using a surgery supporting computer system. The experience of the surgeon showed no influence as well, regardless if SPM was used or not. Additional data should be collected questioning these findings.

The aim of this study was to prospectively evaluate the clinical and radiological results of dorsal metatarsal closed wedge osteotomy and headless screw fixation in the surgical treatment of Freiberg's disease.Thirty-four patients who were treated with dorsal metatarsal closed wedge osteotomy (DMCWO) for Freiberg's disease between February 2018 and March 2022 were included in the study. Patients were staged according to the classification system described by Smillie. Clinical outcomes were evaluated using the American Orthopedic Foot and Ankle Society's (AOFAS) lesser metatarsophalangeal-interphalangeal scale, the visual analog scale (VAS), the range of motion (ROM) of the metatarsophalangeal (MTP) joint, and a subjective patient satisfaction questionnaire. For radiological evaluation, the amount of preoperative shortening of the involved metatarsal, the amount of metatarsal shortening developed after osteotomy, and radiological recovery times were recorded.Thirty-two (94.1%) of the patients were female, and two (5.9%) were male. The average postoperative follow-up period for patients was 33.7 months (range: 24 months to 41 months). The mean AOFAS scores increased from 53.24 to 86.26 (p < 0.01). The mean VAS scores decreased from 8.59 to 1.79, and it was observed that the patients' pain improved significantly (p < 0.01). The mean ROM of the MTP joint increased from 48.76 degrees to 70.76 degrees (p < 0.01). An average of 2.5 mm (range 1 mm to 4.1 mm) of shortening of the metatarsal length developed postoperatively (p < 0.01). Arthrosis developed in 1 case (2.9%), and transfer metatarsalgia developed in 2 cases (5.8%).DMCWO is an effective treatment for both the early and advanced stages of symptomatic Freiberg's disease, leading to high patient satisfaction.

Compared to the anterior cruciate ligament injury, the rupture of the posterior cruciate Ligament (PCL) is the rarer condition. A high healing potential is attributed to the PCL in the literature, which is why conservative therapy is also considered important in addition to surgical treatment 1. Posterior cruciate ligament rupture is often associated with concomitant injuries. Among other things, up to 70% of cases are associated with accompanying injuries to the posterolateral corner 2. The detection of concomitant injuries has a significant influence on the outcome, as isolated surgical PCL stabilization does not lead to satisfactory results in these cases.