The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Uwe Eckelt - One of the best experts on this subject based on the ideXlab platform.
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an experimental in vivo analysis of the resorption to ultrasound activated pins sonic weld and standard biodegradable screws resorbx in sheep
British Journal of Oral & Maxillofacial Surgery, 2007Co-Authors: Eckart Pilling, Richard Loukota, Ronald Mai, Bernd Stadlinger, F Theissig, Uwe EckeltAbstract:We compared the healing and reaction in the mandibles of 11 sheep of a conventional bioresorbable screw Osteosynthesis with the newly developed ultrasound-activated pin Osteosynthesis. The thermal stress caused by insertion of the ultrasound-aided pins leads to no cellular reaction around the pin. There is neither clinical nor histological evidence of any initial inflammation that could have been induced by the insertion. Adequate attachment of fibrous tissue to the pin head and the absence of any inflammation are important preconditions for the introduction of this new method of Osteosynthesis into clinical practice. Further advantageous characteristics are easy intraoperative handling and a reduction in operating time, because cutting the thread is not required. There must be sufficient interlinkage of the polymer and the trabecular structures to ensure stability.
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Ultrasound aided pin fixation of biodegradable osteosynthetic materials in cranioplasty for infants with craniosynostosis
Journal of Cranio-maxillofacial Surgery, 2007Co-Authors: Uwe Eckelt, Matthias Nitsche, Annett Müller, Eckart Pilling, Thomas Pinzer, Dietmar RoesnerAbstract:Summary Aim Biodegradable Osteosynthesis materials are often used for fixation of bone fragments when repairing craniosynostoses. When compared with titanium plates they have the disadvantage of difficult handling and time-consuming thread cutting. A new method of using resorbable pins inserted with the aid of ultrasound (bone welding) and not requiring thread cutting was applied in patients for the first time. Method In eight patients with craniosynostoses, the biodegradable material Resorb-X ® was fixed with resorbable pins inserted with the aid of ultrasound. The patients were followed up for 12 months. Results Pin fixation was stable in all cases. The time required for applying the Osteosynthesis materials was reduced by about 50% since handling of the material was easier and no thread cutting was required. Conclusions Due to fixation in cortical as well as cancellous bone ultrasound aided fixation using resorbable Osteosynthesis materials is more stable than screw fixation. The time required for application is considerably shortened as no thread cutting is required.
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analysis of complications in fractures of the mandibular angle a study with finite element computation and evaluation of data of 277 patients
Journal of Cranio-maxillofacial Surgery, 2003Co-Authors: Kayuwe Feller, Matthias Schneider, Matthias Hlawitschka, Gunter Pfeifer, Gunter Lauer, Uwe EckeltAbstract:Abstract Aim: The purpose of this study was to compute the load on different Osteosynthesis plates in a simplified model using finite element analysis, and to find out whether miniplates were sufficiently stable for application at the mandibular angle. Patients: Data from 277 patients with 293 fractures of the mandibular angle have been evaluated. Methods: A computation model using finite elements was established in order to compute mechanical stress occurring in Osteosynthesis plates used for fixation of fractures of the mandibular angle. In the second part of this study, the data from all in-patients treated for fracture of the mandibular angle were evaluated retrospectively. Age and sex of the patients, cause of fracture, state of dentition, type of therapy as well as complications were noted. Results: In those tests, both the 1.0 mm miniplate and the 2.3 mm module plate were sufficiently stable. The rate of major complications (requiring revisional surgery with general anaesthesia) amounted to approximately 17% in comminuted fractures, or in non-compliant patients in which primary stability with a single miniplate did not appear sufficient, so that other Osteosynthesis methods were used in addition. This rate was considerably higher than that in simple mandibular fractures. Simple fractures of the mandibular angle were just treated with one miniplate following Champy's guidelines strictly. In these fractures the rate of major complications was only 2.3%. Conclusion: In comminuted fractures and in non-compliant patients, the use of a stronger Osteosynthesis material should be considered while in all other cases application of a single 1.0 mm miniplate was regarded as sufficient for fixation using open reduction.
Harm Hoekstra - One of the best experts on this subject based on the ideXlab platform.
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functional outcome and general health status after plate Osteosynthesis of posterior malleolus fractures the quest for eligibility
Injury-international Journal of The Care of The Injured, 2020Co-Authors: Maarten Mertens, Julia Wouters, Johannes Kloos, Stefaan Nijs, Harm HoekstraAbstract:Abstract Introduction The necessity for reduction and fixation of posterior malleolus fractures remains under debate. Therefore, we assessed the functional outcome and quality after plate Osteosynthesis of the posterior malleolus, identified the main drivers of outcome and aimed to determine which patient and fracture type are eligible for plate Osteosynthesis of the posterior malleolus. Materials and methods A prospective patient cohort of 50 patients with an ankle fracture including the posterior malleolus underwent plate Osteosynthesis via a posterior approach, and was compared to a retrospective patient cohort of 85 consecutive patients who did not. Twenty-five demographic, operative and postoperative characteristics were assessed. Outcome was recorded using questionnaires: AOFAS, EQ-5D, EQ-5D-VAS, EQ-5D-TTO, sensory nerve‐associated complications, and flexion deficit of the hallux. Results Direct reduction and plate Osteosynthesis of posterior malleolus fractures was inferior to non-operative treatment. Subanalysis of trimalleolar fractures revealed that the outcome of plate Osteosynthesis was equal. Both fracture type and plate Osteosynthesis were independent drivers of the outcome; Haraguchi type 3 posterior malleolus fractures were associated with the best functional outcome and quality of life scores. Comorbidity, age, postoperative complications and reintervention largely determined the outcome. Up to 30% of the patients reported (temporarily) flexion deficit of the hallux and 38% numbness at the lateral side of the foot. Conclusions There is no indication for routine plate Osteosynthesis of all posterior malleolus fractures. Careful patient selection, less invasive surgery and modified postoperative rehabilitation seem mandatory to improve the outcome and prevent adverse effects.
Berend Linke - One of the best experts on this subject based on the ideXlab platform.
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the lcp concept in the operative treatment of distal humerus fractures biological biomechanical and surgical aspects
Injury-international Journal of The Care of The Injured, 2003Co-Authors: J Korner, H Lill, L P Muller, P M Rommens, E Schneider, Berend LinkeAbstract:Distal humerus fractures in adults are treated by open reduction and internal fixation, which produces good results in the majority of patients. However, in elderly patients or in cases with metaphyseal comminution, stable fracture fixation still remains problematic. Anatomical joint reconstruction and primary stable Osteosynthesis are often particularly difficult to achieve in this group of patients since poor bone mineral quality is frequently encountered. Consequently, longer immobilization is necessary, which is known to negatively influence functional outcome. Over the past few years, double-plate Osteosynthesis techniques using different configurations have become the treatment of choice. Nevertheless, complications due to inappropriate primary stability and/or implant failure have been described. Investigations on whether the recently introduced Locking Compression Plates (LCPs) could enhance primary stability are rare. On the basis of clinical and biomechanical experiences, the authors consider LCPs a helpful tool for increasing primary stability in Osteosynthesis of distal humerus fractures. LCPs might be of substantial advantage in patients with diminished bone mineral quality or in the presence of metaphyseal comminution.
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the lcp concept in the operative treatment of distal humerus fractures biological biomechanical and surgical aspects
Injury-international Journal of The Care of The Injured, 2003Co-Authors: J Korner, H Lill, L P Muller, P M Rommens, E Schneider, Berend LinkeAbstract:Injury, Int. J. Care Injured 34 (2003) S-B20–S-B30 Summary1 Distal humerus fractures in adults are treated by open reduction and internal fixation, which produces good results in the majority of patients. However, in elderly patients or in cases with metaphyseal comminution, stable fracture fixation still remains problematic. Anatomical joint reconstruction and primary stable Osteosynthesis are often particularly difficult to achieve in this group of patients since poor bone mineral quality is frequently encountered. Consequently, longer immobilization is necessary, which is known to negatively influence functional outcome. Over the past few years, double-plate Osteosynthesis techniques using different configurations have become the treatment of choice. Nevertheless, complications due to inappropriate primary stability and/or implant failure have been described. Investigations on whether the recently introduced Locking Compression Plates (LCPs) could enhance primary stability are rare. On the basis of clinical and biomechanical experiences, the authors consider LCPs a helpful tool for increasing primary stability in Osteosynthesis of distal humerus fractures. LCPs might be of substantial advantage in patients with diminished bone mineral quality or in the presence of metaphyseal comminution.
Chin Youb Chung - One of the best experts on this subject based on the ideXlab platform.
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4 in 1 Osteosynthesis for atrophic type congenital pseudarthrosis of the tibia
Journal of Pediatric Orthopaedics, 2011Co-Authors: In Ho Choi, Hyuk Ju Moon, Chin Youb Chung, Moon Seok ParkAbstract:BACKGROUND: According to the authors' multi-targeted, fibular status-based algorithmic approach using the Ilizarov technique, ankle stabilization by end-to-end Osteosynthesis of the fibula is advocated for mild (type B1), "4-in-1 Osteosynthesis" in which all 4 proximal and distal segments of the tibia and fibula are placed in 1 healing mass for moderate (type B2), and distal tibiofibular (TF) fusion for severe (type B3) fibular pseudarthrosis in association with atrophic-type congenital pseudarthrosis of the tibia (CPT). This report describes the indications, operative technique, and outcomes of "4-in-1 Osteosynthesis" for atrophic-type CPT associated with type B2 fibular pseudarthrosis. METHODS: Thirteen patients presented with atrophic-type CPT associated with type B2 fibular pseudarthrosis underwent Ilizarov Osteosynthesis between 1989 and 2007 for atrophic-type CPT. To validate the efficacy of "4-in-1 Osteosynthesis" in these patients, fracture risk and ankle function were compared between 2 groups of type B2 patients, namely, 8 patients (mean age, 6.3 y) who underwent "4-in-1 Osteosynthesis" according to our current protocol (Group I), and 5 patients (mean age, 3.2 y) treated by other techniques (3 distal TF fusion, 2 failed end-to-end Osteosynthesis) during the learning period (Group II). RESULTS: No refracture occurred in Group I, whereas refracture occurred in all except 1 in Group II. Ankles were eventually stabilized by distal TF fusion in all patients in Group II. The Kaplan-Meier method revealed a refracture-free cumulative survival rate of 100% in Group I, whereas in Group II, it dropped progressively and reached 60% at 1.8 years and 20% at 2.7 years. No significant difference in ankle function was evident between the 2 groups (american orthopaedic foot and ankle society (AOFAS) score, 89.25 ± 7.25 after 7.4 y of follow-up in Group I, and 84.6 ± 9.53 after 13 y of follow-up in Group II). CONCLUSIONS: It is imperative that fibular status be evaluated carefully to enable the planning of the most effective, safe, practical treatment. "4-in-1 Osteosynthesis," which is primarily considered for bony union with a large cross-sectional area and ankle stabilization, seems to be a better choice for atrophic-type CPT associated with type B2 fibular pseudarthrosis, in which end-to-end Osteosynthesis of the fibula often fails. LEVEL OF EVIDENCE: Level III, Retrospective comparative study.
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refracture after ilizarov Osteosynthesis in atrophic type congenital pseudarthrosis of the tibia
Journal of Bone and Joint Surgery-british Volume, 2008Co-Authors: In Ho Choi, Chin Youb ChungAbstract:We investigated patterns of refracture and their risk factors in patients with congenital pseudarthrosis of the tibia after Ilizarov Osteosynthesis. We studied 43 cases in 23 patients. Temporal and spatial patterns of refracture and refracture-free survival were analysed in each case. The refracture-free rate of cumulative survival was 47% at five years and did not change thereafter. Refracture occurred at the previous pseudarthrosis in 16 of 19 cases of refracture. The risk of refracture was significantly higher when Osteosynthesis was performed below the age of four years, when the tibial cross-sectional area was narrow, and when associated with persistent fibular pseudarthrosis. Refracture occurs frequently after successful Osteosynthesis in these patients. Delaying Osteosynthesis, maximising the tibial cross-sectional area and stabilising the fibula may reduce the risk of refracture.
Maarten Mertens - One of the best experts on this subject based on the ideXlab platform.
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functional outcome and general health status after plate Osteosynthesis of posterior malleolus fractures the quest for eligibility
Injury-international Journal of The Care of The Injured, 2020Co-Authors: Maarten Mertens, Julia Wouters, Johannes Kloos, Stefaan Nijs, Harm HoekstraAbstract:Abstract Introduction The necessity for reduction and fixation of posterior malleolus fractures remains under debate. Therefore, we assessed the functional outcome and quality after plate Osteosynthesis of the posterior malleolus, identified the main drivers of outcome and aimed to determine which patient and fracture type are eligible for plate Osteosynthesis of the posterior malleolus. Materials and methods A prospective patient cohort of 50 patients with an ankle fracture including the posterior malleolus underwent plate Osteosynthesis via a posterior approach, and was compared to a retrospective patient cohort of 85 consecutive patients who did not. Twenty-five demographic, operative and postoperative characteristics were assessed. Outcome was recorded using questionnaires: AOFAS, EQ-5D, EQ-5D-VAS, EQ-5D-TTO, sensory nerve‐associated complications, and flexion deficit of the hallux. Results Direct reduction and plate Osteosynthesis of posterior malleolus fractures was inferior to non-operative treatment. Subanalysis of trimalleolar fractures revealed that the outcome of plate Osteosynthesis was equal. Both fracture type and plate Osteosynthesis were independent drivers of the outcome; Haraguchi type 3 posterior malleolus fractures were associated with the best functional outcome and quality of life scores. Comorbidity, age, postoperative complications and reintervention largely determined the outcome. Up to 30% of the patients reported (temporarily) flexion deficit of the hallux and 38% numbness at the lateral side of the foot. Conclusions There is no indication for routine plate Osteosynthesis of all posterior malleolus fractures. Careful patient selection, less invasive surgery and modified postoperative rehabilitation seem mandatory to improve the outcome and prevent adverse effects.
