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Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_28 | Pages 97 - 97
1 Aug 2013
Richter P Rahmanzadeh T Gebhard F Krischak G Arand M Weckbach S Kraus M
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INTRODUCTION

Isolated injuries of the sacral bone are rare. The pathomechanism of these injuries are usually high velocity accidents or falls from large heights. The computer-assisted implantation of iliosacral screws (SI-screw) becomes more important in the treatment of dorsal pelvic ring fractures. The advantage of the minimal-invasive screw placement is the reduction of the non-union and deep wound infection rate. Another advantage of computer-navigated SI-screw placement is the reduction of intraoperative radiation for the patient and the surgical staff. The purpose of this study was to analyse the position of navigated iliosacral screws.

METHODS

In the study group 74 screws (49 patients) were included and radiologically analysed. All screws were implanted using 3D-navigation (BrainLAB Vector Vision, Brainlab, Germany). Navigation was always executed with the same 3D c-arm (ARCADIS Orbic 3D, Siemens, Germany) and navigation system. We determined the grade of perforation and angular deviation in the postoperative CT-scans in all screws. The classification was performed according to Smith et al in 4 grades. Grade 0 implies no perforation and grade 1 a perforation less than 2 mm. Grade 2 correlates a perforation of 2–4 mm and grade 3 a perforation of more than 4 mm. Furthermore the intra- and postoperative complications as well as the body-mass-index, the co-morbidities and the duration of radiation were documented. The statistical analysis was executed using Microsoft Excel 2003.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 454 - 454
1 Jul 2010
Schultheiss M von Baer A Arand M Gebhard F Barth T Mayer-Steinacker R
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Objective: To evaluate outcome parameters after custommade diaphyseal replacement of femur and humerus in long term allograft failures.

Methods: A subset of osteo allograft reconstructions after tumour resection ultimately will fail in patients achieving long-term survival. The reasons for original allograft failure were fractures, osteonecrosis or delayed bony ingrowths and implant loosening (plates, nails).In this study patients had a failed massive allograft after tumor resection of humerus or femur. Alternative surgical approach to revising these reconstructions are endoprosthetic revisions to preserve limb function with minimal complications due to custom made modular diaphyseal replacement systems of femur or humerus, especially with short proximal or distal intramedullary anchoring.

Results: A series of custom made diaphyseal replacement systems of femur or humerus was done in our department demonstrating the feasibility of this technique. Most patients initially were treated because of malignant bone tumors like Ewing sarcoma or soft tissue tumours. Allograft fractures occured up to 49 month after initial tumour resection. The follow up included radiographic and clinical parameters. In all cases limb salvage, good function and pain relief was achieved.

Conclusion: Reconstruction of the diaphyseal aspect of the femur or humerus after failure of osteoarticular allograft with custom made diaphyseal replacement of femur and humerus is a good option to achieve limb salvage, good function and pain relief.