In a still ongoing open, randomized prospective trial the preliminary data of 50 intensive care patients on artificial ventilation were analysed. The evaluation included clinical and bacteriological efficacy and tolerance of ceftazidime alone or in combination with tobramycin versus azlocillin plus tobramycin. Artificially ventilated patients who had been treated in an intensive care unit for at least five days were selected to enter the study because of a high probability of colonisation with gram-negative bacteria. 16 patients were treated for bronchopulmonary infection with ceftazidime alone, and 17 each were treated with ceftazidime plus tobramycin or with azlocillin plus tobramycin. In the ceftazidime group nine patients were cured and three were improved (75% clinical success). Of the patients treated with ceftazidime plus tobramycin, 11 were cured and one was improved (75% clinical success); one patient died from very severe multiple trauma. In the azlocillin-tobramycin group, six patients were cured and two were improved (57% clinical success). Two patients from this group died from their underlying disease and another died from multiple organ failure due to septicemia.
21 patients underwent replacement arthroplasty of the metatarsophalangeal joint of the great toe. The indication for surgery was hallux rigidus in 16 patients and failed resection arthroplasty in 5 patients. The minimum follow-up period was 24 months. Clinical review showed an increased range of passive dorsiflexion from 10°to 50°postoperatively. 17 patients reported less pain or no pain and activity levels that were increased or maintained. Functional complications such as lack of toe purchase (n=5) or metatarsalgia (n=4) were successfully treated with orthotics.Résumé. Cette étude rétrospective évalue les résultats cliniques et radiographiques obtenus par l'arthroplastie appliquée au traitement des stades avancés d'hallux rigidus et des reprises chirurgicales. Vingt et un implants placés chez 21 patients présentant un suivi de 24 mois sont inclus dans cette étude. Les plaintes provoquées par un stade terminal d'hallux rigidus représentent l'indication dans 16 cas et 5 cas étaient des échecs d'arthroplastie de résection. La revue clinique montre une augmentation de la mobilité post-opératoire en dorsi-flexion passive de 10°à 50°. Un questionnaire auquel ont répondu tous les patients révèle des résultats satisfaisants. Parmi les 21 patients, 17 n'ont plus ou ont moins de douleurs après l'intervention. Des complications fonctionnelles comme la perte àppui du gros orteil (n=5) ou des métatarsalgies (n=4) peuvent être améliorées par des orthèses. L'activité est augmentée ou maintenue chez 17 patients.
Follow-up study of 162 patients. Follow-up period at least 2 years (24-38 months). Increase in dorsiflexion by 27 degrees. 80% of the patients temporarily showed pain at the sesamoids. Twelve patients with progression of the osteoarthritis underwent implant arthroplasty of the first metatarsophalangeal joint (n = 10) or a fusion of the joint (n = 2) as salvage surgery. Fusion or implant arthroplasty of the first metatarsophalangeal joint could be avoided primarily. In comparison to the relevant literature the results are superior to a cheilectomy.
Reconstructive osteotomies for the treatment of Hallux valgus are among the most prevalent procedures in foot and ankle surgery. The combination of biodegradable materials with an innovative method for fixation by application of ultrasonic energy facilitates a new bonding method for fractures or osteotomies. As clinical experience is still limited, the aim of this study was to assess the safety and performance of the SonicPin system for fixation of Austin/Chevron osteotomies. Chevron osteotomy was performed on 30 patients for the treatment of Hallux valgus. The used SonicPins were made from polylactide and are selectively melted into the cancellous bone structure during insertion by ultrasonic energy. Patients were followed for one year, which included X-ray and MRI examinations as well as evaluation of life quality by EQ-5D (EuroQol). The MRI after three months showed adequate bone healing in all cases and no signs of foreign body reactions, which was again confirmed by MRI 12 months postoperatively. The bony healing after 12 months was uneventful without any signs of foreign body reactions. In summary, based on the low complication rate and the significant improvement in health related quality of life (EQ-5D) reported in this study, fixation of an Austin/Chevron osteotomy with a SonicPin for treatment of Hallux valgus can be considered to be safe and efficient over the short term. Level of Clinical Evidence: Therapeutic Level III.
Arthrodesen K. Olms • Bad Schwartau Arthrodesen im Fußbereich Di e Versteifung eines Gelenks am Fuß ist ein sehr wirkungsvoller Eingriff mit vorhersehbarem und dauerhaftem Ergebnis. Die Adaptation des Fußes an die Arthrodese ist nur eingeschränkt möglich und fordert vom Operateur insbesondere die ex-akte Positionierung der Arthrodese und die Vermeidung von Transferarthrosen. In-situ-Fusionierungen werden von Achsen korrigierenden Arthrodesen unterschieden und erfordern einen sehr unterschiedlichen operativen Aufwand. Die Osteosynthese bietet die üblichen Variationen von Drähten, Schrauben, Platten und Fixateur externe. Die Stabilität der Konstruktion ist für die Konsolidierung entscheidend.
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