RESUMO
Internal fixation using angle stable plates is the treatment standard in periprosthetic fractures around stable implants. To provide instant postoperative full weight-bearing, bicortical screw fixation is advisable but often surgically demanding. This work presents the first clinical results of the LOQTEQ® VA Periprosthetic Plate (aap Implantate AG, Berlin, Germany), a new plate system to simplify screw placement around implants. This plate system uses insertable hinges that allow for variable angle screw anchorage. Data of 26 patients with a mean age of 80 years and a mean follow-up of 13.9 months were retrospectively collected. Patients were clinically and radiologically examined. Bony union was achieved in 14 out of 15 patients with no signs of non-union or implant loosening. One patient, however, presented with implant failure. Clinical scores demonstrated acceptable results. Since the hinge plates are easy to apply, the first results are promising.
RESUMO
Treatment of peri- and interprosthetic fractures represents a challenge in orthopedic trauma surgery. Multiple factors such as osteoporosis, polymedication and comorbidities impede therapy and the rehabilitation of this difficult fracture entity. This article summarizes current concepts and highlights new developments for the internal fixation of periprosthetic fractures. Since the elderly are unable to follow partial weight bearing, stable solutions are required. Therefore, a high primary stability is necessary. Numerous options, such as new angular stable plate systems with additional options for variable angle screw positioning, already exist and are in the process of being further improved. Lately, individually produced custom-made implants are offering interesting alternatives to treat periprosthetic fractures.
RESUMO
A 24-year-old male patient who suffered a periprosthetic fracture of the left distal femur due to an escooter accident was referred to the outpatient department of tumor orthopedics. The patient had been diagnosed with Ewing's sarcoma of the left proximal tibia 11 years previously that was treated with a tumor endoprosthetic reconstruction. The current periprosthetic fracture required a further bony resection of the distal femur as well as a reconstruction with a knee revision implant. The aim of this case report is to raise awareness for a new potential source of danger in the presented risk group.
Assuntos
Prótese do Joelho , Sarcoma de Ewing , Fêmur , Humanos , Masculino , Tíbia , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Severe pulmonary hemorrhage is a life-threatening complication in critically ill patients. Due to tracheobronchial obstruction, ventilation is often impaired. Traditionally, rigid bronchoscopy is an option for recanalization. However, in comparison to flexible bronchoscopy, the application of rigid bronchoscopy is more complex. Against this background we evaluated the use of flexible cryo-probes for blood clot removal in critically ill patients. METHODS: Retrospectively, we identified 16 patients (median age: 60 years, 69% male patients), who suffered from severe airway obstruction due to blood clots. All patients required invasive ventilation and 11 patients depended on extracorporeal membrane oxygenation (ECMO). To remove blood clots, flexible bronchoscopic cryoextraction was performed in n=27 cases, whereas rigid bronchoscopy was only needed in two cases. RESULTS: Whereas in 9 cases single flexible cryoextraction was successful immediately, the procedure had to be repeated again in 7 patients. In all cases, tracheobronchial obstruction was treated with success and conditions of invasive ventilation were improved. In no case severe complications were observed. CONCLUSIONS: In consideration of the underlying evaluation, we highly recommend flexible cryoextraction as both a safe and less complex technique for blood clot removal in critically ill patients.
