[Post-traumatic growth impairment following pediatric distal radius fractures resulting in an ulnar variance : A case report]. / Posttraumatische Wachstumsstörung nach kindlichen distalen Radiusfrakturen mit Entwicklung einer Ulnalängenvarianz : Ein Fallbeispiel.

BACKGROUND: Fractures of the distal forearm are common in children. While we treat adults by trying to anatomically reconstruct the wrist joint, in children, fracture treatment is predominantly conservative due to the high correction potential of the distal growth plate. However, the presentation of young adults with post-traumatic wrist pain is not unusual. OBJECTIVES: Do pediatric distal forearm fractures really heal without consequences despite a large tolerance of axial deviation? MATERIALS AND METHODS: Review of the literature, discussion of results and case report. RESULTS: Positive ulnar variance is the most common sequelae of pediatric distal forearm fractures. A positive variance of as little as >2 mm frequently causes ulnar-sided wrist pain and loss of motion, as is also shown in our case. CONCLUSIONS: Careful follow-up is advisable beyond fracture union following pediatric distal forearm fractures, especially after transphyseal osteosynthesis or growth plate involvement. Reconstructively corrective osteotomy of the ulna should be considered in patients with corresponding clinical symptoms, radiological findings and a positive ulnar variance of >2 mm.

[Clinical findings and treatment of perilunar dislocations and dislocation fractures]. / Diagnostik und Therapie von perilunären Luxationen und Luxationsfrakturen.

Perilunate dislocations, dislocation fractures and lunate dislocations are rare injuries predominantly resulting from hyperextension of the wrist during high-energy trauma. Early recognition and treatment of these injuries usually results in good functional outcome despite degenerative changes on radiographs. Immediate reduction and adequate restoration of normal alignment are the key to successful healing. Surgical intervention with open reduction and ligament repair aims at stable reconstruction of the carpus. It requires broad surgical experience and a profound knowledge of normal anatomy.

CT volumetry of intravertebral cement after kyphoplasty. Comparison of polymethylmethacrylate and calcium phosphate in a 12-month follow-up.

This study was intended to measure the volume of intravertebral cement after balloon kyphoplasty with high resolution computed tomography (CT) and dedicated software. Volume changes of biocompatible calcium phosphate cement (CPC) were detected during a follow-up of 12 months. Measurements were compared with a control group of patients treated with polymethylmethacrylate (PMMA). Twenty-three vertebrae (14 CPC, 9 PMMA) of 12 patients were examined with CT using an identical imaging protocol. Dedicated software was used to quantify intravertebral cement volume in subvoxel resolution by analyzing each cement implant with a density-weighted algorithm. The mean volume reduction of CPC was 0.08 ml after 12 months, which corresponds to an absorption rate of 2 vol%. However, the difference did not reach significance level (P>0.05). The mean error estimate was 0.005 ml, indicating excellent precision of the method. CT volumetry appears a precise tool for measurement of intravertebral cement volume. CT volumetry offers the possibility of in vivo measurement of CPC resorption.

[The evaluation of balloonkyphoplasty for osteoporotic vertebral fractures. An interdisciplinary concept]. / Die Wertigkeit der Ballonkyphoplastie bei der osteoporotischen Wirbelkörperfraktur. Ein interdisziplinäres Konzept.

BACKGROUND DATA: Patients with osteoporotic vertebral compression fractures frequently complain of pain and a loss of function and mobility. Such fractures are associated with an increased mortality. The common treatment with bed rest, bracing or osteosynthesis does not lead to satisfying results. With two new surgical techniques, vertebroplasty and kyphoplasty, an internal stabilisation of osteoporotic vertebral fractures is possible. METHODS: All patients were treated by kyphoplasty. With a minimal invasive dorsal approach, an inflatable bone tamp is placed in the fractured vertebral body. This tamp can restore the vertebral body height and create a cavity, which is filled with bone cement under low pressure. The advantage of kyphoplasty compared to vertebroplasty is the restoration of the vertebral height and a decreased cement leakage rate. We performed a prospective, interdisciplinary study with a follow-up of 12 months. We treated 192 vertebral fractures in 102 patients. Augmentation was performed with polymethylmethacrylate in 138 cases and with a new injectable calcium phosphate-cement in 54 vertebral bodies. Outcome data were obtained with two different spine-scores and by the radiomorphometric evaluation of x-rays before and after treatment. RESULTS: We noticed a significant improvement in pain and function in 89% of the patients. All patients showed a regain of vertebral height of on average 17%. In 7% of all treated vertebral bodies, we noticed cement leakage, which was, however, far below the rates published for vertebroplasty (20-70%). There were two complications, bleeding due to an unknown coagulopathy and a violation of the myelon by malpunction. CONCLUSION: Kyphoplasty is a reliable and minimally invasive method for stabilizing fractured osteoporotic vertebral bodies. Improvement of pain and function and a regain in height of the treated vertebral body can be accomplished.

[Balloon kyphoplasty of vertebral compression fractures with a new calcium phosphate cement]. / Augmentation von Wirbelkörperfrakturen mit einem neuen Calciumphosphat-Zement nach Ballon-Kyphoplastie.

QUESTION: Can the same levels of pain reduction and increase in function be achieved in kyphoplasty procedures with Calcibon as with polymethylmethacrylate (PMMA) cement? PATIENTS AND METHODS: In a prospective, interdisciplinary single-center study, 99 patients (173 vertebral fractures) were treated with kyphoplasty. Augmentation was performed with PMMA in 66 cases (127 vertebral bodies) and with Calcibon in 33 patients (46 vertebral bodies). Outcome data were obtained with a VAS spine score and by radiomorphometric evaluation of X-rays before and after treatment. RESULTS: Pain and function improved in 87% of the patients; an average of 16% of the lost vertebral height was regained. A 9% cement leakage rate was observed with PMMA and 10% with Calcibon. There was no significant difference in pain reduction and radiomorphometric evaluation between the two techniques. CONCLUSION: Kyphoplasty is a reliable, minimally invasive method to stabilize fractured vertebral bodies. Augmentation with Calcibon improves pain and function and enables the treated vertebral body to regain of height.