Operative Orthopädie und Traumatologie

At the end of surgical therapy, the access is closed with sutures. Surgical sutures are thus used to adapt wound edges and tissues. The task of the suture material is to hold the tissues together until healing. For patients, a cosmetically good suture is often the sign of good surgery. Different tissues and layers have different requirements regarding the suture material. The different types from monofil to polyfil, braided, from absorbable to nonabsorbable are presented. The classification of suture strengths is compared...

The planning and implantation of a customized partial pelvis replacement places high demands on both the surgeon and the entire team (engineer, assistants, surgical team). Thanks to careful preoperative planning and meticulous perioperative execution, customized partial pelvic replacement represents a complex but reliable procedure for defect reconstruction even with highly complex acetabular bone defects or after multiple previous surgeries.

OBJECTIVE: Early correction of congenital scoliosis including short fusion, while minimizing both mobility restrictions and growth impairment. INDICATIONS: Congenital scoliosis with marked deformity, proven progression, significant compensatory curves, and/or impairment of trunk balance. Furthermore, in case of compression of neural structures or pain due to secondary degeneration. CONTRAINDICATIONS: No absolute contraindication. SURGICAL TECHNIQUE: Posterior approach to the apex of the deformity...

OBJECTIVE: Correction of a pathological kyphosis to restore a balanced, low-pain or pain-free and load-bearing spine. INDICATIONS: Pronounced sagittal imbalance, progressive kyphosis despite conservative therapy, and neurological deficits are indications for surgery. Further surgical indications are severe therapy-resistant complaints and/or psychologically burdening cosmetic impairment. The guidelines for surgical indications are kyphosis angles of 75-80° thoracic and 30-50° lumbar...

OBJECTIVE: Three-dimensional (3D) analysis and implementation with patient-specific cutting and repositioning blocks enables correction of complex tibial malunions. Correction can be planned using the contralateral side or a statistical model. Patient-specific 3D-printed cutting guide blocks enable a precise osteotomy and reduction guide blocks help to achieve anatomical reduction. Depending on the type and extent of correction, fibula osteotomy may need to be considered to achieve the desired reduction...

OBJECTIVE: Presentation of a minimally invasive surgical approach for the treatment of scapular fractures and the clinical outcome using this technique. INDICATIONS: Displaced extra-articular fractures of the scapula body and glenoid neck (AO 14B and 14F) and simple intra-articular fractures of the glenoid. CONTRAINDICATIONS: Complex intra-articular fractures and isolated fractures of the coracoid base. SURGICAL TECHNIQUE: Make a straight or slightly curved incision along the lateral margin of the scapula leaving the deltoid fascia intact...

OBJECTIVE: Balanced frontal curve correction with horizontal shoulder levels, restoration of sagittal plane and vertebral derotation with a fusion length as short as possible. INDICATIONS: Curves larger than 40-50° Cobb angle; furthermore age, location, degree of rotation, and sagittal plane deviation have to be considered. SURGICAL TECHNIQUE: Posteriorly, segmental pedicle screw instrumentation with a high screw density (80%) and both titanium alloy and cobalt chrome rods...

OBJECTIVE: To describe the indications, operative technique, and long-term outcomes of patients treated with the Scheker (Aptis) distal radio-ulnar joint (DRUJ) prosthesis. INDICATIONS: The Scheker prosthesis is intended to replace the DRUJ in patients with rheumatoid, degenerative, or posttraumatic arthritis of the sigmoid notch and/or ulnar head, or in cases of gross instability of the DRUJ. Moreover, a Scheker prosthesis can be used to treat failed salvage procedures, such as the Sauvé-Kapandji procedure, ulnar head resection, and ulnar head arthroplasty...

OBJECTIVE: For patients with soft tissue sarcoma, surgical resection is a key element of curative therapy. Surgery is performed as a wide resection with microscopically negative margins (R0 resection) and as limb-sparing procedure whenever possible to preserve maximum function. INDICATIONS: Soft tissue sarcoma, metastases. CONTRAINDICATIONS: Extensive disease with major neurovascular involvement, placement of biopsy tract necessitates extensive resection, palliative care...

OBJECTIVE: Distal fracture of the radius is common in all age groups. Under careful consideration of individual indications and contraindications, conservative treatment with reduction and immobilization can have significant advantages over the frequently applied surgical approach, particularly in older patients. THERAPEUTIC GOAL: Immobilization after closed reduction enables satisfactory wrist function to be achieved according to individual patient expectations...

OBJECTIVE: Patient-specific osteosynthesis for pseudarthrosis of the acromion. INDICATIONS: Symptomatic pseudarthrosis of the acromion at the level of a meta/mesacromion. CONTRAINDICATIONS: Infection; patient noncompliance regarding postoperative treatment protocol. SURGICAL TECHNIQUE: Preoperatively, a patient-specific three-dimensional model of the scapula is printed. A locking compression plate (LCP) is individually adapted to this model...

OBJECTIVE: The goal of osteotomy is either to restore pretraumatic anatomic conditions or to shift the load to less affected compartments. INDICATIONS: Indications for computer-assisted 3D analysis and the use of patient-specific osteotomy and reduction guides include "simple" deformities and, in particular, multidimensional complex (especially posttraumatic) deformities. CONTRAINDICATIONS: General contraindications for performing a computed tomography (CT) scan or for an open approach for performing the surgery...

OBJECTIVE: Surgical treatment of intra-articular calcaneus fractures via a minimally invasive approach. INDICATIONS: Intra-articular dislocated calcaneus fractures. CONTRAINDICATIONS: Fracture older than 14 days; poor soft tissue quality in the surgical area. SURGICAL TECHNIQUE: Patient in lateral position. Identifying the anatomic landmarks. Incision (3-5 cm) from the tip of the fibula to metatarsal IV...

OBJECTIVE: Three-dimensional correction of the bony alignment in the frontal and sagittal plane of the proximal tibia; surgery is performed via an open- or closing-wedge osteotomy to improve ligament stability and reduce joint degeneration. INDICATIONS: Chronic anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) instability and ligament revision surgeries; subjective knee instability in patients who are ambitious athletes and people who do physical labor; moderate joint degeneration with meniscus and cartilage damage, post-traumatic deformities...

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OBJECTIVE: Surgical treatment of congenital muscular torticollis with tripolar release of the sternocleidomastoid muscle, followed by modified postoperative treatment with a special orthosis. INDICATIONS: Muscular torticollis due to contracture of the sternocleidomastoid muscle; failure of conservative therapy. CONTRAINDICATIONS: Torticollis due to bony anomaly or other muscular contractures. SURGICAL TECHNIQUE: Tenotomy of the sternocleidomastoid muscle occipitally and resection of at least 1 cm of the tendon at the sternal and clavicular origin...

OBJECTIVE: Two-stage exchange with implantation of a temporary spacer is the gold standard treatment for chronic periprosthetic joint infection of the hip. This article describes a simple and safe technique for handmade spacers at the hip. INDICATION: Periprosthetic joint infection of the hip. Septic arthritis of the native joint. CONTRAINDICATIONS: Known allergy against components of polymethylmethacrylate bone cements. Inadequate compliance for two-stage exchange...

OBJECTIVE: Two-stage exchange with implantation of a temporary spacer is considered gold standard treatment for chronic periprosthetic joint infection of the knee. This article describes a simple and safe technique for handmade articulating spacers at the knee. INDICATION: Chronic or relapsing periprosthetic joint infection of the knee. RELATIVE CONTRAINDICATIONS: Known allergy against components of polymethylmethacrylate (PMMA) bone cements or admixed antibiotics...

OBJECTIVE: Treatment of chronic periprosthetic joint infection of the knee requires the removal of the implant and thorough debridement, with reimplantation in a second stage surgery. Intramedullary spacers can be helpful during the interval between explantation and reimplantation and provide a temporary arthrodesis which fixes the knee in extension preserving leg length and administers local antibiotic therapy. INDICATIONS: Periprosthetic joint infection of the knee with large bony defects and severe infection of the native joint with advanced destruction/infiltration of the cartilage and bone and/or ligament insufficiency...

OBJECTIVE: Durable and resilient soft tissue reconstruction of vast defects of the extremities or the torso. INDICATIONS: Reconstruction of disproportionately large defects, particularly in cases of simultaneous bone and joint reconstruction. CONTRAINDICATIONS: History of surgery or irradiation of upper back and axilla, impossibility of surgery under lateral positioning; relative contraindications in wheelchair users, hemiplegics, or amputees...