Cyrus Klostermann - Academia.edu (original) (raw)
Papers by Cyrus Klostermann
Der Unfallchirurg, 2021
This case report describes the successful fixation of a periprosthetic patellar fracture in an 89... more This case report describes the successful fixation of a periprosthetic patellar fracture in an 89-year-old female patient after total knee arthroplasty (TKA) and cemented retropatellar component. Fixation was performed by use of a fixed-angle plate combined with cerclage, under preservation of the firmly fixed retropatellar prosthetic component. No complications were observed postoperatively. Radiologic controls confirmed bone healing. A range of movement of the knee joint of 0/5/110° was achieved by the last clinical examination 5 years postoperatively. The patient was free of pain and had an age-appropriate mobility. The use of fixed-angle plates in the treatment of type II periprosthetic patellar fractures according to Ortiguera and Berry can provide stable fixation while preserving the retropatellar prosthetic component. Additional augmentation by cerclage, tapes or traction screws is recommended in cases of poor bone stock or severe osteoporosis.
Archives of Orthopaedic and Trauma Surgery
Introduction Data from clinical trials suggest that CT-confirmed nondisplaced scaphoid waist frac... more Introduction Data from clinical trials suggest that CT-confirmed nondisplaced scaphoid waist fractures heal with less than the conventional 8–12 weeks of immobilization. Barriers to adopting shorter immobilization times in clinical practice may include a strong influence of fracture tenderness and radiographic appearance on decision-making. This study aimed to investigate (1) the degree to which surgeons use fracture tenderness and radiographic appearance of union, among other factors, to decide whether or not to recommend additional cast immobilization after 8 or 12 weeks of immobilization; (2) identify surgeon factors associated with the decision to continue cast immobilization after 8 or 12 weeks. Materials and methods In a survey-based study, 218 surgeons reviewed 16 patient scenarios of CT-confirmed nondisplaced waist fractures treated with cast immobilization for 8 or 12 weeks and recommended for or against additional cast immobilization. Clinical variables included patient se...
Injury, 2018
Radiographic fracture classification helps with research on prognosis and treatment. AO/OTA class... more Radiographic fracture classification helps with research on prognosis and treatment. AO/OTA classification into fracture type has shown to be reliable, but further classification of fractures into subgroups reduces the interobserver agreement and takes a considerable amount of practice and experience in order to master. We assessed: (1) differences between more and less experienced trauma surgeons based on hip fractures treated per year, years of experience, and the percentage of their time dedicated to trauma, (2) differences in the interobserver agreement between classification into fracture type, group, and subgroup, and (3) differences in the interobserver agreement when assessing fracture stability compared to classifying fractures into type, group and subgroup. This study used the Science of Variation Group to measure factors associated with variation in interobserver agreement on classification of proximal femur fractures according to the AO/OTA classification on radiographs....
Zeitschrift für Orthopädie und ihre Grenzgebiete
European Journal of Trauma
The case of a 68-year-old patient with septic nonunion of a segmental humerus fracture and associ... more The case of a 68-year-old patient with septic nonunion of a segmental humerus fracture and associated septic shoulder joint following failed intramedullary fracture treatment is presented. After surgical debridement and 17 weeks of external ring fixation, the infection was successfully treated and osseous union achieved, allowing removal of the fixator. The presented case illustrates how certain difficult fractures complicated by sepsis, osteoporosis, or poor soft tissue coverage can be effectively and reliably treated with Ilizarov ring fixation as a salvage alternative to possible amputation.
Trauma und Berufskrankheit
Der Chirurg
Seit kurzem stehen expandierbare Cages als Wirbelkörperersatz an der thorakolumbalen Wirbelsäule ... more Seit kurzem stehen expandierbare Cages als Wirbelkörperersatz an der thorakolumbalen Wirbelsäule zur Verfügung , es existieren jedoch nur wenige Informationen über ihre biomechanischen Eigenschaften. Ziel dieser Untersuchung war es daher, die biomechanischen Eigenschaften 3 verschiedener expandierbarer Cages mit einem nicht expandierbaren Cage zu vergleichen.32 humane thorakolumbale Wirbelsäulen wurden in Flexion, Extension, axialer Rotation und Seitneigung mit einem nicht destruktiven Testaufbau getestet. Die räumliche Bewegung der Präparate wurde mittels eines optischen Messsystems ermittelt. Als erstes wurden alle Bewegungssegmente im intakten Zustand getestet. Anschließend wurde eine komplette Korporektomie von LWK 1 durchgeführt und die Cages eingebracht. Zusätzlich wurden die Cages mit einer dorsalen sowie einer dorsoventralen Stabilisation mit USS (Synthes) in Kombination mit einer ventralen Platte (LCDCP, Synthes) getestet. Beim Vergleich der biomechanischen Eigenschaften vo...
Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
The purpose of the study was the examination of the osseous integration of hydroxyapatite grafts ... more The purpose of the study was the examination of the osseous integration of hydroxyapatite grafts used for the filling of metaphyseal bone defects in tibia head fractures. Four patients with lateral tibia plateau fractures AO-type B3 (12) were included in the study. Patients were treated by arthroscopically assisted reduction and percutaneous screw fixation. The metaphyseal bone defects were filled with prepared solid hydroxyapatite graft blocks (Endobon Fa. Merk Darmstadt, Germany). In all of the patients a CT study for the osseous integration of hydroxyapatite grafts used for the filling of metaphyseal bone defects in tibial head fractures was performed. Measurements of density were performed of the implant region, the periimplant region, the distant periimplant region and the fibula bone. Follow-up CT examinations of these specific regions were performed 6 and 12 months postoperative. In all cases an increase of density of the hydroxyapatite graft after 6 months and 12 months foll...
Der Unfallchirurg, 2004
Autografts and allogeneous bone grafts as well as cages are used for the reconstruction of the an... more Autografts and allogeneous bone grafts as well as cages are used for the reconstruction of the anterior column after corpectomy. Recently, expandable cages for vertebral body replacement have been developed. Based on our own experience, the purpose of this study was to summarize the available biomechanical and clinical data of expandable corpectomy cages and to compare it with established fixation techniques. If used correctly, expandable cages offer several surgical advantages in comparison to non-expandable cages. However there were no significant differences between the biomechanical properties of expandable and non-expandable cages. Additionally, design variations of expandable corpectomy cages did not show any significant impact on the biomechanical stability. Currently available mid-term clinical and radiological data on the treatment of fractures, metastasis and infection of the cervical, thoracic and lumbar spine demonstrated no significant difference between expandable and ...
Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen, 2001
A case of a 22-year-old patient with a malunited dens fracture and secondary atlanto-axial instab... more A case of a 22-year-old patient with a malunited dens fracture and secondary atlanto-axial instability is presented. The significant narrowing of the spinal canal due to the atlanto-axial instability was associated with anterior myelon compression and neurological deficit. A transoral approach with odontoid resection and anterior atlanto-axial plate fixation was performed. With this technique the atlanto-axial subluxation was reduced and the myelon was decompressed. The postoperative course was uneventful. The follow-up showed a complete remission of the neurological deficit and a bony fusion of the atlanto-axial joints. The presented case illustrates the importance of an accurate initial diagnosis of the degree of instability and the need for short-term follow-up examinations. If atlanto-axial pseudarthrosis or malunion with anterior spinal cord compression occurs, a transoral procedure with odontoid resection and atlanto-axial plate fixation seems to be an excellent salvage proced...
Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen, 2001
Osteosynthese International, 2001
Trauma und Berufskrankheit, 2005
da dy an-Klos ter mann Sek ti on Wir bel säu len chir ur gie, Zent rum für mus ku loske let ta le... more da dy an-Klos ter mann Sek ti on Wir bel säu len chir ur gie, Zent rum für mus ku loske let ta le Chi rur gie, Cha ri te, Cam pus Virchow Kli ni kum, Ber lin 19 8 Al ter (Durch schnitt) [Jah re] 48,5 (19-72) 43,3 (22-79) An zahl der Wir bel kör per 80 38 An zahl der Pe di kel schrau ben 160 76 Ta bel le 2 Schrau ben fehl la ge na vi giert vs. kon ven tio nell im Rah men der Stu die Po si ti on Na vi ga ti on Kon ven tio nell Op ti mal 134 (83,75%) 46 (60,5%) 0-2 mm 22 (13,75%) 16 (21%) 2-4 mm 3 (1,9%) 11 (14,5%) 4-6 mm 1 (0,6%) 3 (4%) Per fo ra ti on >2 mm 4 (2,5%) 14 (18,5%), p<0,001
Langenbeck's Archives of Surgery, 2002
The treatment of three- or 4-part proximal humerus fractures is still a matter of scientific disc... more The treatment of three- or 4-part proximal humerus fractures is still a matter of scientific discussion. The following study presents the results of a combined procedure using limited invasive fixation techniques for reconstruction of the humerus head and retrograde intramedullary wiring with elastic nails for the treatment of displaced three- or 4-part fractures. A prospective study of 24 patients with 3-part and 4-part fractures was performed from September 1995 to December 1998. Combined biologic fixation for reconstruction of the humerus head, including intramedullary wiring, was utilized. Fracture reduction was performed in an open soft-tissue-preserving technique through a limited lateral approach. Fixation of the head fragments was performed using screw and/or cerclage wire fixation. The reconstructed humerus head was stabilized to the shaft with intramedullary wires, with retrograde insertion 2 cm above the olecranon fossa. Supportive fixation of the head fragments was achieved using fully threaded cancellous screws. At the 1-year postoperative follow-up, 40% of the 18 patients had excellent results using the Neer and Constant score. Forty-five percent had satisfactory and 15% unsatisfactory results. The initial results of this study reveal that a combination of limited internal fixation of the humerus head and retrograde elastic intramedullary wiring provide stable fixation with limited soft-tissue destruction. This approach has been shown to be especially useful for the combined treatment of three- or four-part fractures of the humeral head.
Journal of Orthopaedic Trauma, 2009
Clinical and radiologic follow-up of patients with osteoporosis with painful, traumatic A3-type v... more Clinical and radiologic follow-up of patients with osteoporosis with painful, traumatic A3-type vertebral compression fractures in the thoracic and lumbar spine. Prospective study over the period of 1 year. Level I Trauma Center. Twenty-five patients with osteoporosis (14 women and 11 men) and painful, traumatic A3-type fractures were treated with Balloon Kyphoplasty in combination with a short-segment posterior fixation (using the Universal Spine System). Twenty-one patients returned for their 1-year follow-up visit. X-rays were taken preoperatively, postoperatively, and at 3, 6, and 12 months&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; follow-up to evaluate vertebral height and local Cobb angle. Pain was measured using the self-reporting Visual Analogue pain Scale (VAS). Disability was measured using the Oswestry Disability questionnaire (ODI). The mean pain score (VAS) improved significantly from pretreatment to posttreatment from 7.8 +/- 2.2 (5.6-10) to 4.9 +/- 2.1 (2.8-8.0) (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). It improved further to 2.9 +/- 1.4 (2.1-4.3) at 3 months and increased slightly after 1 year (3.8 +/- 1.9) (1.9-4.7). Limitation of daily activities (ODI) improved significantly from 88% (78-100) to 35% (15-48) at 3 months (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Improvement was maintained at 1 year at 36.5% (10-42). At 1-year follow-up, maintenance of the height restoration and kyphotic deformity correction was found. Balloon Kyphoplasty in combination with short-segment posterior instrumentation in traumatic A3 vertebral fractures led to a significant reduction in pain and disability. The combination of both surgical techniques was able to restore and maintain vertebral body height and correction of angular deformity. This technique might offer important safety advantages over an invasive anterior-posterior approach.
Journal of Orthopaedic Trauma, 2014
Journal of Neurosurgery: Spine, 2003
OMMON causes for the destruction of the cervical spine are fractures, tumors, and infections. 9,1... more OMMON causes for the destruction of the cervical spine are fractures, tumors, and infections. 9,14,15,18,29 When cervical spine surgery is necessary because of spine instability, neurological deterioration, intractable pain, and failure of conservative treatment, allogenous or autogenous bone grafts such as rib, 41 fibula, 9,26,32 tibia, 1,37 and iliac crest 4,9 have been used to reconstruct the anterior column. These commonly performed bone grafting techniques may produce a number of well-known problems related to donor-site morbidity, 9,30 nonunion, 9,28,38 or fatigue failure. 41 Biomechanical problems, such as the low compression stiffness of the grafts 41 or the insufficient anchorage of the grafts to the vertebral endplates, sometimes have resulted in graft collapse and dislocation. 2,28,33 In attempts to solve these problems, cervical spine cages for VB replacement have been developed.
Journal of Neurosurgery: Spine, 2002
✓ Dyggve-Melchior-Clausen (DMC) syndrome is a very rare disease. Only 58 cases have been reported... more ✓ Dyggve-Melchior-Clausen (DMC) syndrome is a very rare disease. Only 58 cases have been reported in the literature. The syndrome is probably an autosomal recessive inherited disorder, one that is characterized by mental retardation, the short-spine type of dwarfism, and skeletal abnormalities, especially of the spine, hands, and pelvis. Atlantoaxial instability— induced spinal cord compression is a serious and preventable complication. The purpose of this report is to describe the first case of DMC syndrome in which anterior transarticular atlantoaxial screw fixation was used to treat atlantoaxial instability. The authors report on a 17-year-old man with DMC syndrome and concomitant severe atlantoaxial instability. Computerized tomography scanning and magnetic resonance angiography demonstrated an irregular course of the vertebral artery (VA) at C-2, which made a posterior fixation procedure impossible. Additionally, transoral fusion was impossible because the patient was unable to...
Journal of Neurosurgery: Spine, 2001
Object. The placement of an anterior atlantoaxial plate after transoral odontoid resection has be... more Object. The placement of an anterior atlantoaxial plate after transoral odontoid resection has been described by Harms. Recently, the authors of biomechanical and clinical studies have shown that this procedure, especially in combination with posterior wiring, is a good alternative to established, isolated posterior atlantoaxial fixation techniques. Reports on the anatomy of the atlas and axis primarily focus on the posterior surgical approach. Scarce research regarding the quantitative anatomy of the anterior aspect of C-1 and C-2 has been reported. This study was undertaken to measure relevant dimensions of C-1 and C-2 and their relation to the anterior transoral approach. The aim of the study was to determine “safe zones” for screw placement in anterior atlantoaxial plate fixation. Method. Fifty human dry C-1 and C-2 vertebrae were obtained for direct anatomical, radiographic, and computerized tomography (CT) measurements. Thirty-two linear and four angular parameters were evalua...
Injury, 2005
The use of instrumentation for stabilization following cervical trauma has evolved rapidly in the... more The use of instrumentation for stabilization following cervical trauma has evolved rapidly in the past few decades. Nonoperative maneuvers, including traction, extended bed rest, and cast immobilization, have given way to wiring or screw rod constructs that allow immediate fixation and early mobilization of the patient. These procedures can be performed soon after trauma and with a minimum of surgical risk. They offer immediate stability of the injured spine, and can prevent the sequelae of acute cervical spinal cord injury that may accompany prolonged bed rest, thus allowing early rehabilitation and the potential for improved recovery. Current techniques for posterior cervical spine stabilization following trauma include spinous process or facet wiring [1-9], lateral mass plating [10-18], and cervical pedicle screws [19-27]. Several radiological tools, including MRI [28] and reformatted CT, yield precise details of the injured spine and allow the treating physician to determine which, if any, fixation technique offers the best chance of recovery with the least amount of risk. The goals of surgery following acute cervical spine injury include decompressing the injured spinal cord or nerve root, maintaining alignment, providing stability to the spine, promoting healing and fusion, and allowing early mobilization. This article will review indications for posterior cervical spine surgery, as well as the techniques that are currently available to help achieve the above-noted goals. We also report a recent retrospective review of 5-year data in treating posterior cervical trauma with lateral mass and pedicle screw fixation.
Der Unfallchirurg, 2021
This case report describes the successful fixation of a periprosthetic patellar fracture in an 89... more This case report describes the successful fixation of a periprosthetic patellar fracture in an 89-year-old female patient after total knee arthroplasty (TKA) and cemented retropatellar component. Fixation was performed by use of a fixed-angle plate combined with cerclage, under preservation of the firmly fixed retropatellar prosthetic component. No complications were observed postoperatively. Radiologic controls confirmed bone healing. A range of movement of the knee joint of 0/5/110° was achieved by the last clinical examination 5 years postoperatively. The patient was free of pain and had an age-appropriate mobility. The use of fixed-angle plates in the treatment of type II periprosthetic patellar fractures according to Ortiguera and Berry can provide stable fixation while preserving the retropatellar prosthetic component. Additional augmentation by cerclage, tapes or traction screws is recommended in cases of poor bone stock or severe osteoporosis.
Archives of Orthopaedic and Trauma Surgery
Introduction Data from clinical trials suggest that CT-confirmed nondisplaced scaphoid waist frac... more Introduction Data from clinical trials suggest that CT-confirmed nondisplaced scaphoid waist fractures heal with less than the conventional 8–12 weeks of immobilization. Barriers to adopting shorter immobilization times in clinical practice may include a strong influence of fracture tenderness and radiographic appearance on decision-making. This study aimed to investigate (1) the degree to which surgeons use fracture tenderness and radiographic appearance of union, among other factors, to decide whether or not to recommend additional cast immobilization after 8 or 12 weeks of immobilization; (2) identify surgeon factors associated with the decision to continue cast immobilization after 8 or 12 weeks. Materials and methods In a survey-based study, 218 surgeons reviewed 16 patient scenarios of CT-confirmed nondisplaced waist fractures treated with cast immobilization for 8 or 12 weeks and recommended for or against additional cast immobilization. Clinical variables included patient se...
Injury, 2018
Radiographic fracture classification helps with research on prognosis and treatment. AO/OTA class... more Radiographic fracture classification helps with research on prognosis and treatment. AO/OTA classification into fracture type has shown to be reliable, but further classification of fractures into subgroups reduces the interobserver agreement and takes a considerable amount of practice and experience in order to master. We assessed: (1) differences between more and less experienced trauma surgeons based on hip fractures treated per year, years of experience, and the percentage of their time dedicated to trauma, (2) differences in the interobserver agreement between classification into fracture type, group, and subgroup, and (3) differences in the interobserver agreement when assessing fracture stability compared to classifying fractures into type, group and subgroup. This study used the Science of Variation Group to measure factors associated with variation in interobserver agreement on classification of proximal femur fractures according to the AO/OTA classification on radiographs....
Zeitschrift für Orthopädie und ihre Grenzgebiete
European Journal of Trauma
The case of a 68-year-old patient with septic nonunion of a segmental humerus fracture and associ... more The case of a 68-year-old patient with septic nonunion of a segmental humerus fracture and associated septic shoulder joint following failed intramedullary fracture treatment is presented. After surgical debridement and 17 weeks of external ring fixation, the infection was successfully treated and osseous union achieved, allowing removal of the fixator. The presented case illustrates how certain difficult fractures complicated by sepsis, osteoporosis, or poor soft tissue coverage can be effectively and reliably treated with Ilizarov ring fixation as a salvage alternative to possible amputation.
Trauma und Berufskrankheit
Der Chirurg
Seit kurzem stehen expandierbare Cages als Wirbelkörperersatz an der thorakolumbalen Wirbelsäule ... more Seit kurzem stehen expandierbare Cages als Wirbelkörperersatz an der thorakolumbalen Wirbelsäule zur Verfügung , es existieren jedoch nur wenige Informationen über ihre biomechanischen Eigenschaften. Ziel dieser Untersuchung war es daher, die biomechanischen Eigenschaften 3 verschiedener expandierbarer Cages mit einem nicht expandierbaren Cage zu vergleichen.32 humane thorakolumbale Wirbelsäulen wurden in Flexion, Extension, axialer Rotation und Seitneigung mit einem nicht destruktiven Testaufbau getestet. Die räumliche Bewegung der Präparate wurde mittels eines optischen Messsystems ermittelt. Als erstes wurden alle Bewegungssegmente im intakten Zustand getestet. Anschließend wurde eine komplette Korporektomie von LWK 1 durchgeführt und die Cages eingebracht. Zusätzlich wurden die Cages mit einer dorsalen sowie einer dorsoventralen Stabilisation mit USS (Synthes) in Kombination mit einer ventralen Platte (LCDCP, Synthes) getestet. Beim Vergleich der biomechanischen Eigenschaften vo...
Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
The purpose of the study was the examination of the osseous integration of hydroxyapatite grafts ... more The purpose of the study was the examination of the osseous integration of hydroxyapatite grafts used for the filling of metaphyseal bone defects in tibia head fractures. Four patients with lateral tibia plateau fractures AO-type B3 (12) were included in the study. Patients were treated by arthroscopically assisted reduction and percutaneous screw fixation. The metaphyseal bone defects were filled with prepared solid hydroxyapatite graft blocks (Endobon Fa. Merk Darmstadt, Germany). In all of the patients a CT study for the osseous integration of hydroxyapatite grafts used for the filling of metaphyseal bone defects in tibial head fractures was performed. Measurements of density were performed of the implant region, the periimplant region, the distant periimplant region and the fibula bone. Follow-up CT examinations of these specific regions were performed 6 and 12 months postoperative. In all cases an increase of density of the hydroxyapatite graft after 6 months and 12 months foll...
Der Unfallchirurg, 2004
Autografts and allogeneous bone grafts as well as cages are used for the reconstruction of the an... more Autografts and allogeneous bone grafts as well as cages are used for the reconstruction of the anterior column after corpectomy. Recently, expandable cages for vertebral body replacement have been developed. Based on our own experience, the purpose of this study was to summarize the available biomechanical and clinical data of expandable corpectomy cages and to compare it with established fixation techniques. If used correctly, expandable cages offer several surgical advantages in comparison to non-expandable cages. However there were no significant differences between the biomechanical properties of expandable and non-expandable cages. Additionally, design variations of expandable corpectomy cages did not show any significant impact on the biomechanical stability. Currently available mid-term clinical and radiological data on the treatment of fractures, metastasis and infection of the cervical, thoracic and lumbar spine demonstrated no significant difference between expandable and ...
Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen, 2001
A case of a 22-year-old patient with a malunited dens fracture and secondary atlanto-axial instab... more A case of a 22-year-old patient with a malunited dens fracture and secondary atlanto-axial instability is presented. The significant narrowing of the spinal canal due to the atlanto-axial instability was associated with anterior myelon compression and neurological deficit. A transoral approach with odontoid resection and anterior atlanto-axial plate fixation was performed. With this technique the atlanto-axial subluxation was reduced and the myelon was decompressed. The postoperative course was uneventful. The follow-up showed a complete remission of the neurological deficit and a bony fusion of the atlanto-axial joints. The presented case illustrates the importance of an accurate initial diagnosis of the degree of instability and the need for short-term follow-up examinations. If atlanto-axial pseudarthrosis or malunion with anterior spinal cord compression occurs, a transoral procedure with odontoid resection and atlanto-axial plate fixation seems to be an excellent salvage proced...
Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen, 2001
Osteosynthese International, 2001
Trauma und Berufskrankheit, 2005
da dy an-Klos ter mann Sek ti on Wir bel säu len chir ur gie, Zent rum für mus ku loske let ta le... more da dy an-Klos ter mann Sek ti on Wir bel säu len chir ur gie, Zent rum für mus ku loske let ta le Chi rur gie, Cha ri te, Cam pus Virchow Kli ni kum, Ber lin 19 8 Al ter (Durch schnitt) [Jah re] 48,5 (19-72) 43,3 (22-79) An zahl der Wir bel kör per 80 38 An zahl der Pe di kel schrau ben 160 76 Ta bel le 2 Schrau ben fehl la ge na vi giert vs. kon ven tio nell im Rah men der Stu die Po si ti on Na vi ga ti on Kon ven tio nell Op ti mal 134 (83,75%) 46 (60,5%) 0-2 mm 22 (13,75%) 16 (21%) 2-4 mm 3 (1,9%) 11 (14,5%) 4-6 mm 1 (0,6%) 3 (4%) Per fo ra ti on >2 mm 4 (2,5%) 14 (18,5%), p<0,001
Langenbeck's Archives of Surgery, 2002
The treatment of three- or 4-part proximal humerus fractures is still a matter of scientific disc... more The treatment of three- or 4-part proximal humerus fractures is still a matter of scientific discussion. The following study presents the results of a combined procedure using limited invasive fixation techniques for reconstruction of the humerus head and retrograde intramedullary wiring with elastic nails for the treatment of displaced three- or 4-part fractures. A prospective study of 24 patients with 3-part and 4-part fractures was performed from September 1995 to December 1998. Combined biologic fixation for reconstruction of the humerus head, including intramedullary wiring, was utilized. Fracture reduction was performed in an open soft-tissue-preserving technique through a limited lateral approach. Fixation of the head fragments was performed using screw and/or cerclage wire fixation. The reconstructed humerus head was stabilized to the shaft with intramedullary wires, with retrograde insertion 2 cm above the olecranon fossa. Supportive fixation of the head fragments was achieved using fully threaded cancellous screws. At the 1-year postoperative follow-up, 40% of the 18 patients had excellent results using the Neer and Constant score. Forty-five percent had satisfactory and 15% unsatisfactory results. The initial results of this study reveal that a combination of limited internal fixation of the humerus head and retrograde elastic intramedullary wiring provide stable fixation with limited soft-tissue destruction. This approach has been shown to be especially useful for the combined treatment of three- or four-part fractures of the humeral head.
Journal of Orthopaedic Trauma, 2009
Clinical and radiologic follow-up of patients with osteoporosis with painful, traumatic A3-type v... more Clinical and radiologic follow-up of patients with osteoporosis with painful, traumatic A3-type vertebral compression fractures in the thoracic and lumbar spine. Prospective study over the period of 1 year. Level I Trauma Center. Twenty-five patients with osteoporosis (14 women and 11 men) and painful, traumatic A3-type fractures were treated with Balloon Kyphoplasty in combination with a short-segment posterior fixation (using the Universal Spine System). Twenty-one patients returned for their 1-year follow-up visit. X-rays were taken preoperatively, postoperatively, and at 3, 6, and 12 months&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; follow-up to evaluate vertebral height and local Cobb angle. Pain was measured using the self-reporting Visual Analogue pain Scale (VAS). Disability was measured using the Oswestry Disability questionnaire (ODI). The mean pain score (VAS) improved significantly from pretreatment to posttreatment from 7.8 +/- 2.2 (5.6-10) to 4.9 +/- 2.1 (2.8-8.0) (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). It improved further to 2.9 +/- 1.4 (2.1-4.3) at 3 months and increased slightly after 1 year (3.8 +/- 1.9) (1.9-4.7). Limitation of daily activities (ODI) improved significantly from 88% (78-100) to 35% (15-48) at 3 months (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Improvement was maintained at 1 year at 36.5% (10-42). At 1-year follow-up, maintenance of the height restoration and kyphotic deformity correction was found. Balloon Kyphoplasty in combination with short-segment posterior instrumentation in traumatic A3 vertebral fractures led to a significant reduction in pain and disability. The combination of both surgical techniques was able to restore and maintain vertebral body height and correction of angular deformity. This technique might offer important safety advantages over an invasive anterior-posterior approach.
Journal of Orthopaedic Trauma, 2014
Journal of Neurosurgery: Spine, 2003
OMMON causes for the destruction of the cervical spine are fractures, tumors, and infections. 9,1... more OMMON causes for the destruction of the cervical spine are fractures, tumors, and infections. 9,14,15,18,29 When cervical spine surgery is necessary because of spine instability, neurological deterioration, intractable pain, and failure of conservative treatment, allogenous or autogenous bone grafts such as rib, 41 fibula, 9,26,32 tibia, 1,37 and iliac crest 4,9 have been used to reconstruct the anterior column. These commonly performed bone grafting techniques may produce a number of well-known problems related to donor-site morbidity, 9,30 nonunion, 9,28,38 or fatigue failure. 41 Biomechanical problems, such as the low compression stiffness of the grafts 41 or the insufficient anchorage of the grafts to the vertebral endplates, sometimes have resulted in graft collapse and dislocation. 2,28,33 In attempts to solve these problems, cervical spine cages for VB replacement have been developed.
Journal of Neurosurgery: Spine, 2002
✓ Dyggve-Melchior-Clausen (DMC) syndrome is a very rare disease. Only 58 cases have been reported... more ✓ Dyggve-Melchior-Clausen (DMC) syndrome is a very rare disease. Only 58 cases have been reported in the literature. The syndrome is probably an autosomal recessive inherited disorder, one that is characterized by mental retardation, the short-spine type of dwarfism, and skeletal abnormalities, especially of the spine, hands, and pelvis. Atlantoaxial instability— induced spinal cord compression is a serious and preventable complication. The purpose of this report is to describe the first case of DMC syndrome in which anterior transarticular atlantoaxial screw fixation was used to treat atlantoaxial instability. The authors report on a 17-year-old man with DMC syndrome and concomitant severe atlantoaxial instability. Computerized tomography scanning and magnetic resonance angiography demonstrated an irregular course of the vertebral artery (VA) at C-2, which made a posterior fixation procedure impossible. Additionally, transoral fusion was impossible because the patient was unable to...
Journal of Neurosurgery: Spine, 2001
Object. The placement of an anterior atlantoaxial plate after transoral odontoid resection has be... more Object. The placement of an anterior atlantoaxial plate after transoral odontoid resection has been described by Harms. Recently, the authors of biomechanical and clinical studies have shown that this procedure, especially in combination with posterior wiring, is a good alternative to established, isolated posterior atlantoaxial fixation techniques. Reports on the anatomy of the atlas and axis primarily focus on the posterior surgical approach. Scarce research regarding the quantitative anatomy of the anterior aspect of C-1 and C-2 has been reported. This study was undertaken to measure relevant dimensions of C-1 and C-2 and their relation to the anterior transoral approach. The aim of the study was to determine “safe zones” for screw placement in anterior atlantoaxial plate fixation. Method. Fifty human dry C-1 and C-2 vertebrae were obtained for direct anatomical, radiographic, and computerized tomography (CT) measurements. Thirty-two linear and four angular parameters were evalua...
Injury, 2005
The use of instrumentation for stabilization following cervical trauma has evolved rapidly in the... more The use of instrumentation for stabilization following cervical trauma has evolved rapidly in the past few decades. Nonoperative maneuvers, including traction, extended bed rest, and cast immobilization, have given way to wiring or screw rod constructs that allow immediate fixation and early mobilization of the patient. These procedures can be performed soon after trauma and with a minimum of surgical risk. They offer immediate stability of the injured spine, and can prevent the sequelae of acute cervical spinal cord injury that may accompany prolonged bed rest, thus allowing early rehabilitation and the potential for improved recovery. Current techniques for posterior cervical spine stabilization following trauma include spinous process or facet wiring [1-9], lateral mass plating [10-18], and cervical pedicle screws [19-27]. Several radiological tools, including MRI [28] and reformatted CT, yield precise details of the injured spine and allow the treating physician to determine which, if any, fixation technique offers the best chance of recovery with the least amount of risk. The goals of surgery following acute cervical spine injury include decompressing the injured spinal cord or nerve root, maintaining alignment, providing stability to the spine, promoting healing and fusion, and allowing early mobilization. This article will review indications for posterior cervical spine surgery, as well as the techniques that are currently available to help achieve the above-noted goals. We also report a recent retrospective review of 5-year data in treating posterior cervical trauma with lateral mass and pedicle screw fixation.