ABSTRACT
Destruction of the sacrum due to metastatic tumors may lead to a significant instability of the posterior pelvic ring. This often causes pain, immobility, and subsequently a loss of quality of life. The surgical treatment options are limited. A new technique is presented using a cement augmented expandable cage placed percutaneously using 3D fluoroscopy-based navigation with or without an additional osteosynthesis.
Subject(s)
Bone Neoplasms/secondary , Bone Neoplasms/surgery , Bone Plates , Fluoroscopy/methods , Imaging, Three-Dimensional/methods , Pelvic Bones/diagnostic imaging , Pelvic Bones/surgery , Bone Neoplasms/diagnostic imaging , Female , Humans , Middle Aged , Plastic Surgery Procedures/instrumentation , Plastic Surgery Procedures/methods , Treatment OutcomeABSTRACT
BACKGROUND: It is hypothesized that misplacement of sustentacular screws during osteosynthesis of intraarticular calcaneal fractures can be reduced with the help of navigation. A method for three-dimensional (3D) navigated placement of sustentacular screws for treating intraarticular calcaneal fractures is presented and evaluated. MATERIAL AND METHODS: 11 consecutive patients with 15 intraarticular calcaneal fractures were treated using 3D navigation. In 12 cases osteosynthesis was done through an extended lateral approach; in three cases, it was achieved through a minimally invasive percutaneous approach. For verification and documentation of the placed screws, a second 3D scan was performed. RESULTS: A total of 20 screws were placed using 3D navigation. None of the navigated screws was misplaced. Extra operating time due to navigation averaged 11.9 minutes (+/-2.2 min). CONCLUSION: Through a combination of intraoperative 3D imaging and navigation, placement of sustentacular screws is possible and can yield precise and reliable results. Especially in minimally invasive treatment, a high quality of osteosynthesis can be achieved.
Subject(s)
Calcaneus/injuries , Calcaneus/surgery , Foot Injuries/surgery , Fracture Fixation, Internal/instrumentation , Fractures, Bone/surgery , Minimally Invasive Surgical Procedures/instrumentation , Surgery, Computer-Assisted/instrumentation , Adult , Aged , Calcaneus/pathology , Equipment Design , Female , Foot Injuries/pathology , Fracture Fixation, Internal/methods , Fractures, Bone/diagnosis , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures/methods , Surgery, Computer-Assisted/methods , Young AdultABSTRACT
In distal intraarticular humerus fractures primary stable osteosynthesis is essential for early mobilization of the elbow joint. Double-plate osteosynthesis techniques using different configurations are the gold standard. In the literature plate position is sometimes discussed controversially. In cases of distal humerus fractures (type AO 13C3) with metaphyseal comminution, as well as in elderly patients with poor bone quality, utilizing locking plates with angular stability was found to have increased structural properties with regard to primary fixation stability. The dorsal approach with osteotomy of the olecranon seems to be very effective in open reduction and internal fixation of this type of fracture. One new development is the anatomically preformed plate-fixation systems such as the LCP-System for distal humerus (Synthes). This study presents our first experience with this system in 11 cases of open reduction and internal fixation of type AO 13C3 distal humerus fractures. The system-specific features and intraoperative options were analyzed.
Subject(s)
Bone Plates , Elbow Injuries , Fracture Fixation, Internal/instrumentation , Humeral Fractures/surgery , Adult , Bone Screws , Elbow Joint/diagnostic imaging , Elbow Joint/surgery , Equipment Design , Female , Fracture Healing/physiology , Humans , Humeral Fractures/diagnostic imaging , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Male , Middle Aged , Osteotomy/methods , Postoperative Complications/diagnostic imaging , Postoperative Complications/surgery , Prospective Studies , Reoperation , Tomography, X-Ray Computed , Ulna Fractures/diagnostic imaging , Ulna Fractures/surgeryABSTRACT
We compared in a prospective study including 82 patients treated with ORIF of an intraarticular calcaneus fracture the quality of fluoroscopy, intraoperatively Iso-C(3D) and postoperative CT-scans. Therefore the posterior facet of the calcaneus (PFOC) was divided into three sectors. Joint steps and fracture gaps were detected by two independent investigators and statistically analysed. Another focus was to evaluate if the findings due to intraoperatively Iso-C(3D) assessment performed by the surgeon were correct and subsequently influenced the surgical procedure. There were no statistically differences between the Iso-C(3D)- and CT findings concerning joint steps or fracture gaps in PFOC sectors I-III. With fluoroscopy an assessment of the PFOC sectors I and II was not possible. In six cases (7.3%), intraoperative reduction was redone after performing an Iso-C(3D) scan. In ten cases, 12 malpositioned screws were replaced (12.2%/14.6%). These results suggest that intraoperative 3D Iso-C(3D) imaging provides a high diagnostic reliability. By careful assessment of the images the surgeons receive information which could lead to a change of the operative strategy.
Subject(s)
Ankle Injuries/diagnostic imaging , Ankle Injuries/surgery , Calcaneus/injuries , Fluoroscopy/instrumentation , Fractures, Bone/diagnostic imaging , Fractures, Bone/surgery , Image Processing, Computer-Assisted/instrumentation , Imaging, Three-Dimensional/instrumentation , Intraoperative Complications/diagnostic imaging , Intraoperative Complications/surgery , Point-of-Care Systems , Radiographic Image Enhancement/instrumentation , Tomography Scanners, X-Ray Computed , Algorithms , Ankle Injuries/classification , Bone Screws , Calcaneus/diagnostic imaging , Calcaneus/surgery , Fracture Fixation, Internal , Fractures, Bone/classification , Humans , Observer Variation , Prospective Studies , Sensitivity and Specificity , Technology Assessment, BiomedicalABSTRACT
Based on the case report of a 35-year-old patient presenting a Castleman tumor of the neck, we describe the diagnostic challenge of identifying this tumor entity. It is important to consider this type of tumor. Diagnostic imaging methods such as ultrasound and CT/MRI cannot identify the Castleman tumor due to the lack of tumor-specific signs but yield important information concerning exact tumor localization. Only surgical resection and conventional histology give a correct characterization of this tumor and possibly allow further additive treatment modalities.
Subject(s)
Castleman Disease/diagnosis , Magnetic Resonance Imaging , Neck , Adult , Castleman Disease/pathology , Castleman Disease/surgery , Diagnosis, Differential , Humans , Lymph Node Excision , Lymph Nodes/pathology , Male , Neck/pathology , Neck/surgery , Tomography, X-Ray ComputedABSTRACT
The influence of an unreamed femur nail on axial and torque stiffness of nine different external fixator devices was investigated in a biomechanical study. With a newly developed femur bone model simulating segmental transport, 582 biomechanical tests were performed. The additional use of an unreamed femur nail (UFN) increased axial stiffness of the external fixator devices up to 8108% (average 1673.8-2631.8%) and increased torque stiffness up to 86% (average 47%). The best results could be achieved when combining a small-diameter UFN (9 x 360 mm, Synthes Co.) and external fixator devices with high torque and comparatively little axial stiffness. The use of stainless steel half-pins instead of titanium half-pins improved torque stiffness significantly. Concerning the biomechanical demands made on external fixator devices used for femoral segmental transport, the Hexfix fixator with steel bar and steel half-pins combined with an UFN achieved the best results.
