Probleme der Zuggurtungsosteosynthese von Patellafrakturen und deren Konsequenzen für weitere Implantatentwicklungen Der XS-Nagel

Gehr, J.; Friedl, W.

doi:10.1007/s001040170037

Cited by 24 publications

(6 citation statements)

References 5 publications

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“…Only 2.7 % of patients had surface hematomas and seromas, which did not result in revision procedures. In the case of plate osteosynthesis, the extramedullary position can make existing soft-tissue trauma The high stability of the XS nail osteosynthesis was confirmed in an experimental study [5,6]. The nail has also been proved to be effective for the treatment of patella fractures and fractures of the upper ankle joint, even under clinical conditions.…”

Section: Resultsmentioning

confidence: 92%

Simple or Compound Olecranon Fractures. Improved Stability and Functional Therapy Using a New Operative Technique

Gehr¹,

Hilsenbeck²,

Friedl³

2005

Osteosynthesis and Trauma Care

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IntroductionOlecranon fractures are common fractures, most of them associated with damage to the soft-tissue as a result of direct trauma. Associated injuries, such as coronoid process or radial-head fractures, are present in approximately 20 % of the patients [26]. The reconstruction of the joint surfaces involves an open anatomic reduction. Subsequent treatment requires an osteosynthesis that is stable enough for early active motion [3,8,9,20]. Various forms of osteosynthesis, such as tension-band wire, intramedullary screw fixation, and plate osteosynthesis, are available for this type of reconstruction, the choice depending on the position and type of fracture. In the case of a small proximal fragment, even exstirpation of the fragment, with trans-osseous refixation of the triceps tendon, has been described [9, 10, 21]. The usual forms of osteosynthesis frequently show problems related to secure fixation. Particularly in the case of classical tensionband wiring in simple fractures, there often is proximal wire migration, resulting in pain across the tip of the olecranon and the occasional formation of fistulae, which necessitates prema- AbstractIntroduction: The open reduction and internal fixation of olecranon fractures places high demands on the fixation device regarding the osseous anchorage and soft-tissue damage. In tension-band wiring, implant loosening and failure of osteosynthesis are frequent complications following mobilization. One of the biomechanical reasons given for this is the eccentric position of the tension band. Plate osteosynthesis -reserved for the more complex types of fracture -does not always provide sufficient stability, particularly in the case of fractures associated with osteoporosis and additional medial, lateral, frontal and extremely small proximal fragments. Another problem is the subcutaneous position of the implant, which can increase soft-tissue complications. Materials and Methods: The IP-X(X)S(L) nail described here is a locking nail with the option of interfragmentary compression. It is locked by threaded K-wires and has been used for all olecranon fractures treated in our clinic since May 1999. From May 1999 until December 2002, 80 olecranon fractures were treated with the XS nail. After an average period of 15 months, 73 of these 80 (follow-up 91.3 %) patients were investigated. Included in this group were 49 (67.1 %) patients with comminuted fractures and 24 (32.9 %) patients with two-fragment fractures. Olecranon osteotomies were excluded. Results: There were six (8.2 %) cases of dislocation of the transverse locking wires, two requiring re-osteosynthesis which were without complications. Two (2.7 %) cases had to be revised because of irritation of nerve structures. No cases of acute or chronic osteitis, implant failure or non-union after primary XS-nail osteosynthesis were found. Using the Murphy score, 47 (64.4 %) excellent, 21 (28.8 %) good, 3 (4.1 %) satisfactory and 2 (2.7 %) poor re-

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Section: Resultsmentioning

confidence: 92%

Simple or Compound Olecranon Fractures. Improved Stability and Functional Therapy Using a New Operative Technique

Gehr¹,

Hilsenbeck²,

Friedl³

2005

Osteosynthesis and Trauma Care

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“…[12]. In der Literatur liegen zu sämtlichen Osteosyntheseverfahren klinische Studien vor [1,2,[7][8][9][10][11][12], jedoch fanden wir bei unserer Literaturrecherche keine prospektiv-randomisierte klinische Studie, die verschiedene rekonstruktive Verfahren vergleicht. Zudem ist ein Vergleich der unten zitierten Studien nicht ohne Weiteres möglich, da keine einheitliche Frakturklassifikation vorgenommen wurde.…”

Section: K-drahtunclassified

“…Trotz der überwiegend guten klinischen Ergebnisse wird in sämtlichen Publikationen auf die häufigste negative Spätfolge nach Zuggurtungsosteosynthese, das Beugedefizit, und subjektive Beschwerden ohne fassbares morphologisches Korrelat hingewiesen [1][2][3][4][5][6][7][8][9][10][11][12]. Aus diesem Grund untersuchten Gehr & Friedl in einer Studie den XS-Nagel für die Patellaosteosynthese.…”

Section: K-drahtunclassified

“…Bis auf zwei Ausnahmen konnten die Patienten nach abgeschlossener Wundheilung ohne Tutorschutz voll belasten, lediglich zum Treppensteigen wurde das Tragen eines Tutors empfohlen. Die sehr guten klinischen Resultate werden in der Studie durch biomechanische Ergebnisse unterstützt [7]. Trotz der sehr guten Ergebnisse mit diesem Implantat ist ein flächendeckender Einsatz wegen des hohen Preises im Vergleich zu den oben beschriebenen Systemen nicht wahrscheinlich.…”

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Patellafraktur

Dietz

Hessmann²,

Gercek³

et al. 2009

Orthop Traumatol

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“…Transverse patella fractures are commonly fixed via tension band wiring (TBW) in all its modifications [ 9 , 10 ], most frequently using two parallel longitudinal Kirschner (K-) wires or cannulated screws inserted perpendicularly to the fracture plane together with a cerclage wire placed anteriorly in a figure-of-eight pattern around their extrusion [ 11 – 13 ]. Alternative fixation methods, such as using staples or intraosseous nailing, have been reported but are rather less common [ 8 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Anterior variable-angle locked plating versus tension band wiring of simple and complex patella fractures – a biomechanical investigation

Stoffel

Pastor

Woodburn³

et al. 2023

BMC Musculoskelet Disord

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Background The aim of this study was to investigate the biomechanical performance of novel anterior variable-angle locking plates versus tension band wiring used for fixation of simple and complex patella fractures. Methods Sixteen pairs of human cadaveric knees were used to simulate two-part simple transverse AO/OTA 34-C1 and five-part complex AO/OTA 34-C3 patella fractures. The complex fracture pattern was characterized with a medial and a lateral proximal fragment, together with an inferomedial, an inferolateral and an inferior fragment mimicking comminution around the distal patella pole. Eight pairs with simple fractures were split for fixation via either tension band wiring (TBW) through two parallel cannulated screws or anterior variable-angle locked plating, whereas other eight pairs with complex fractures were split for either TBW through two parallel cannulated screws plus circumferential cerclage wiring, or anterior variable-angle locked plating using a cortical caudo-cranial polar screw. Each specimen was tested over 5000 cycles with a range of motion from 90° flexion to full extension by pulling on the quadriceps tendon. Interfragmentary movements were captured by motion tracking. Results For both fracture types, the longitudinal and shear articular displacements, measured between the proximal and distal fragments at the central patella aspect between 1000 and 5000 cycles, together with the relative rotations of these fragments around the mediolateral axis were all significantly smaller following anterior variable-angle locked plating versus TBW, p ≤ 0.01. Conclusions From a biomechanical perspective, anterior locked plating of both simple and complex patella fractures resulted in less interfragmentary displacement under extended cyclic loading.

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Probleme der Zuggurtungsosteosynthese von Patellafrakturen und deren Konsequenzen für weitere Implantatentwicklungen Der XS-Nagel

Cited by 24 publications

References 5 publications

Simple or Compound Olecranon Fractures. Improved Stability and Functional Therapy Using a New Operative Technique

Simple or Compound Olecranon Fractures. Improved Stability and Functional Therapy Using a New Operative Technique

Patellafraktur

Anterior variable-angle locked plating versus tension band wiring of simple and complex patella fractures – a biomechanical investigation

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