A simple technique for creating hybrid fixators using a modified AO single adjustable clamp.

Hybrid external fixators with limited internal fixation have become popular in the treatment of complex intraarticular fractures of the tibia. A wide variety of hybrid external fixation systems are commercially available, but these frames are expensive and not always readily available. The authors present a simple hybrid frame constructed from the AO tubular and Ilizarov type external fixator sets using a modified AO single adjustable clamp. This hybrid frame is easy to apply, versatile, and significantly less expensive than other commercially available adaptors and frames.

Posterior stabilization in L5-S1 isthmic spondylolisthesis with paralaminar screw fixation: anatomical and clinical results.

Combined anterior and posterior fusion with posterior instrumentation may be indicated in the treatment of select cases of L5-S1 spondylolisthesis. The instrumentation, however, is expensive and usually bulky, occasionally requiring removal. In an effort to avoid these problems, an L5-S1 paralaminar screw technique was developed for posterior stabilization after an L5-S1 anterior interbody fusion. The technique involves the placement of cortical screws from the base of the articular process of S1 to the pedicle of L5. This study evaluates the anatomic applications and clinical results of this technique. The relationship between the screw and L5 nerve root was examined using five cadaveric specimens with olisthesis of 0, 25, 50, and 75%. This work demonstrates that the screws can only be inserted safely if an L5-S1 olisthesis of at least 25% is present. If < 25%, the screws will either impinge on or directly injure the L5 nerve root. In the clinical study, the outcomes of 20 patients who had an isthmic spondylolisthesis of 25-81% and were treated with partial reduction, L5-S1 anterior interbody fusion, and L5-S1 posterior paralaminar screw fixation were reviewed. Nineteen patients had adequate posterior stabilization to completely heal an L5-S1 anterior interbody fusion without loss of the correction. In one patient, a pseudarthrosis occurred secondary to poor surgical technique of both anterior and posterior fusions. This patient required an additional L4-S1 posterior fusion 9 months later and had a good clinical outcome. No other complications due to screw placement occurred. We conclude that this procedure can be used safely and reliably for the posterior stabilization of L5-S1 after stable anterior L5-S1 interbody fusion in residual slips of at least 25%. Prerequisites are proper patient compliance and low weight. Compared with other posterior instrumentation systems, this screw fixation is inexpensive and does not require implant removal. The disadvantages of the method are the degree of difficulty of the procedure and the limited clinical application to cases of L5-S1 spondylolisthesis with corrected residual slips of 25 to 50-60%. The procedure is technically demanding and should be limited to those surgeons who are comfortable with the method.

[The anterior cruciate ligament, an important structure of the knee joint]. / Das vordere Kreuzband, eine wichtige Struktur des Kniegelenks.

The anterior cruciate ligament (ACL) is a crucial structure for a normal kinematic of the knee joint. Its rupture has been thought to present the initiation of a sequel leading to secondary damage of the meniscus and finally to osteoarthritis. Diagnosis of an ACL rupture is based on the history as well as on the physical examination. A positive Lachman-sign is diagnostic for an ACL lesion. The question whether an ACL rupture should be operated or not must be decided individually and is based on the demands of the patient. Conservative treatment includes rigorous physical therapy emphasizing strengthening exercises of the hamstrings and the gastrocnemius muscles as well as prorioceptive training. The indication for reconstruction is given, should instability persist. The timing of the operation is important for the outcome. This paper presents an overview of the literature including the rehabilitation program and a diagnostic concept used by the authors.