In a monocenter randomized controlled trial, 45 patients with isolated malleolar fracture type OTA/AO 44 A1-B2 undergoing ORIF were allocated randomly to a postoperative treatment either with a vacuum-stabilized orthesis with prescribed full weight bearing after the second week (23 patients) (orthesis group -- OG) or with functional aftertreatment with partial weight bearing of 15 kg for 6 weeks (22 patients) (control group -- CG). Outcomes were compared at 6- and 10-week follow-up examinations. The Olerud and Molander ankle (OMA) score, ankle swelling, usage of crutches, range of motion, Short Form 12, patient-reported visual analogue scales (VAS) (pain, comfort, walking confidence) and time to return to work were evaluated. All patients of OG showed reduced swelling at discharge. The median OMA scores after 6 weeks were 42 and 42.5 (p = 0.46) and after 10 weeks 69 and 72 (p = 0.55) in the OG and CG, respectively. The time to achieve secure walking capacity was reduced by 1 day (p = 0.03) in the OG. After ORIF of simple malleolar fractures, patients with a vacuum-stabilized orthesis can bear full weight 2 weeks postoperatively. This group experienced no adverse events. Postoperative swelling was significantly reduced and of the ability to walk on stairs confidently was shorter as compared to a functional aftertreatment without any external stabilization of the ankle.
Objective: Outcome of complex distal radius fractures. Design: Retrospective clinical observation. Setting: Outcome assessment of a clinical series of patients with complex distal radius fractures treated according to a structured, stepwise treatment algorithm. Patients: 17 patients (average age 47 years) with mostly high-energy injuries, 16/17 articular fractures including concomitant carpal injuries, fracture dislocations, extension of the fracture into the diaphysis, and large defects.Intervention: Initial external fixation, followed by soft tissue treatment and further diagnostics and, finally, definitive adapted surgical therapy including combination of external fixation, plates, screws, K-wires, bone graft, and ligament repair. Main Outcome Measurements: DASH, range of motion, radiologic outcome. Results: Average subjective overall performance score (DASH) 16.4 (0-36.7, standard deviation [SD] 11.82, 95% confidence interval [CI] 8.0-23.6), 73% of the patients back to premorbid work and activities. Conclusions: Using a clearly structured, stepwise approach, complex distal radius fractures can be treated with good clinical outcome preserving hand function.
Between May 1998 and September 2001, a total of 42 patients had their distal femoral fractures stabilized by LISS. The AO distractor was used from the 18th case onward. A time saving of approximately 13% was estimated, taking the learning curve of the LISS system into consideration. Three of 42 fractures showed relevant postoperative varus or valgus malalignment. No rotational malalignment was found. An effect of the LISS tractor on the incidence of malalignment could not be found with the limited number of cases examined; however, malalignment was correlated well with the rates found in literature for distal femoral fractures.
Between January 2009 and November 2011, minimally invasive plate osteosynthesis using the minimally invasive cerclage passer or the collinear reduction clamp was performed in 21 patients with 23 distal femoral fractures. None of the patients suffered from postoperative malalignment or malrotation. Mean time to adequate fracture consolidation was 128 days (range 53-470 days).
Ziel der hier vorgestellten Pilotstudie ist eine Standortbestimmung bezüglich Erfahrungen und Vorgehensweisen der kindernephrologischen Behandlungszentren Deutschlands bei der Nierenersatztherapie bei Kindern und Jugendlichen mit schwerer geistiger Behinderung [5].Aktuelle Richtlinien zur Behandlung geistig behinderter Kinder mit chronischer Niereninsuffizienz sind in Deutschland derzeit nicht formuliert. Eine generelle Öffnung des Nierenersatztherapie-Angebotes für diese Patientengruppe ist jedoch seit Jahren gegeben.
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