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The Bone & Joint Journal
Vol. 100-B, Issue 2 | Pages 212 - 218
1 Feb 2018
Jungbluth P Tanner S Schneppendahl J Grassmann J Wild M Hakimi M Windolf J Laun R

Aims

The aim of this retrospective multicentre study was to evaluate mid-term results of the operative treatment of Monteggia-like lesions and to determine the prognostic factors that influence the clinical and radiological outcome.

Patients and Methods

A total of 46 patients (27 women and 19 men), with a mean age of 57.7 years (18 to 84) who had sustained a Monteggia-like lesion were followed up clinically and radiologically after surgical treatment. The Mayo Modified Wrist Score (MMWS), Mayo Elbow Performance Score (MEPS), Broberg and Morrey Score, and Disabilities of the Arm, Shoulder and Hand (DASH) score were used for evaluation at a mean of 65 months (27 to 111) postoperatively. All ulnar fractures were stabilized using a proximally contoured or precontoured locking compression plate. Mason type I fractures of the radial head were treated conservatively, type II fractures were treated with reconstruction, and type III fractures with arthroplasty. All Morrey type II and III fractures of the coronoid process was stabilized using lag screws.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_I | Pages 21 - 22
1 Mar 2009
Lob G Heppert V Laun R Lob T Rabenseifner L
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Introduction: Improved treatment of primary tumors leads to an increased life expectancy and thus to an increasing number of patients with bone metastases. Techniques like auto- or allogenic bone grafts, vascularised bone transfer and distraction osteogenesis often require multistage surgical procedures and inhibit full early limb function. Diaphyseal replacement using nails, plates and bone cement do not guarantee long term bone stability. Due to this experiences a new diaphyseal replacement device for humerus, femur and tibia has been developed.

Materials and Methods: The diaphyseal replacement implant OSTEOBRIDGE consists of two semi-circular cylindrical shells. The spacer is clamped around two nails via eight screws. Different sizes of spacers and nails can be used to bridge the bone loss correctly.

The outer diameter of the spacer ranges from 20–25–30 mm and the length from 40 to 70 mm. Two or three spacers can be combined via a special connector. Nails in the length 60 to 200 mm and the Ø 7 to 18 mm with the possibility of static or dynamic interlocking complete the modular system entirely made from Ti-6Al-4V.

Biomechanical Testing: Static compression tests to determine the maximum longitudinal forces of the clamp connection spacer/nail were performed, 4-point bending tests with the complete system to investigate the fatigue resistance were undertaken and torsional test to evaluate the rotational stability.

Prospectiv clinical evaluation: In between 2004 and 2006 35 patients were treated with the OSTEO-BRIDGE system.

The indication: Tumor: Humerus 8, Femur 16, Tibia 2, Postinfectious: Tibia 4, Posttramatic Femur 4, Tibia 2.

Results:

Biomechanical testing: the clamp connection spacer/ nail can neutralize axial loads which can not be expected in human beings. The clamp connection spacer/nail Ø 10 mm resisted an average axial load of 8,5 kN. This can be compared to a force of 850 kN (equivalent to 10 multiples of 85 kg body weight). The bending test with a nail Ø 10 mm shows that the spacer can resist long term loads from an occurring stress of 400 N/mm2 in the nail.

Clinical evaluation: All spacers are still in place and all are full functioning, except 2; one spacer in the femur had to be replaced by a second spacer due to bone cement incorporated during first operation.

One spacer was removed during amputation for recurrency of osteosarcoma. No infection, no loosing were reported.

Discussion: The OSTEOBRIDGE spacer system allows to replace lost daiphyseal bone over long distances with proved biomechanical stability. An advantage seems to be the early bony bridging over the spacer within the first 9 months. There might be another advantage in using the spacer as a container for antitumor, bactericidal or bone growth stimulating drugs.