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author:("penning, D.")
1.  Biomechanics of the anterior cruciate ligament and implications for surgical reconstruction 
Abstract
Injury to the anterior cruciate ligament (ACL) is regarded as critical to the physiological kinematics of the femoral-tibial joint, its disruption eventually causing long-term functional impairment. Both the initial trauma and the pathologic motion pattern of the injured knee may result in primary degenerative lesions of the secondary stabilisers of the knee, each of which are associated with the early onset of osteoarthritis. Consequently, there is a wide consensus that young and active patients may profit from reconstructing the ACL. Several factors have been identified as significantly influencing the biomechanical characteristics and the functional outcome of an ACL reconstructed knee joint. These factors are: (1) individual choice of autologous graft material using either patellar tendon-bone grafts or quadrupled hamstring tendon grafts, (2) anatomical bone tunnel placement within the footprints of the native ACL, (3) adequate substitute tension after cyclic graft preconditioning, and (4) graft fixation close to the joint line using biodegradable graft fixation materials that provide an initial fixation strength exceeding those loads commonly expected during rehabilitation. Under observance of these factors, the literature encourages mid-to long-term clinical and functional outcomes after ACL reconstruction.
doi:10.1007/s11751-007-0016-6
PMCID: PMC2321720  PMID: 18427909
Anterior cruciate ligament; ACL reconstruction; Biomechanics; Graft fixation; Graft tension
2.  Minimally invasive ankle arthrodesis with a retrograde locking nail after failed fusion 
Abstract
A retrograde nail with posterior-to-anterior (PA) locking into os calcis, talus and tibia was used to correct deformity and achieve fusion after failed fusion. A variety of methods have been published to achieve union of the ankle and subtalar joint in a failed fusion situation. We have studied a retrograde locking nail technique through a 2.5-cm incision in the non-weightbearing part of the sole of the foot. Remaining cartilage in the ankle joint, where necessary, was percutaneously removed through an anterior approach and the locking nail was inserted after reaming of os calcis, talus and tibia. Locking screw insertion was in the sagittal plane (p.a. direction), in talus os calcis and tibial diaphysis using a nail mounted jig. Ten patients were entered in the study (age 27-60 years). The initial aetiology for attempted fusion was post-traumatic in nine cases and rheumatic in one case. There were 25 previous operations in the cohort not leading to fusion. An additional temporary external fixator was used in four cases to reach and maintain the optimum position for the procedure. The intervention time was 30-75 min. Dynamisation of the nail was performed after four months under local anaesthesia. The mean duration of follow-up was 4 years (3-5.5 years). Radiologically and clinically, fusion was achieved in 16 weeks (range, 12-20 weeks). There was no loosening of the implant or implant failure. A leg length discrepancy was avoided using this technique. There was one complication with varus malunion in a heavy smoker which united after corrective osteotomy, revision nailing and bone grafting. Patient satisfaction was measured on a scale (not visual analogue) of 0 (not satisfied) to 10 (completely satisfied); overall satisfaction averaged 9.5 points (range, 6-10 points). The postoperative ankle-hindfoot score of the American Orthopedic Foot and Ankle Society averaged 73.5 points (range, 61-81 points). Retrograde locked nailing with locking in the sagittal plane is a reliable minimally invasive procedure to achieve fusion of the ankle and the subtalar joint after failed fusion.
doi:10.1007/s11751-007-0018-4
PMCID: PMC2321722  PMID: 18427914
Ankle arthrodesis; Failed fusion; Retrograde nail; Calcaneotalotibial arthrodesis
3.  The treatment of severely comminuted intra-articular fractures of the distal radius 
Comminuted fractures of the distal end of the radius are caused by high-energy trauma and present as shear and impacted fractures of the articular surface of the distal radius with displacement of the fragments. The force of the impact and the position of the hand and carpal bone determine the pattern of articular fragmentation and their displacement and the amount and the extent of frequent concommitant ligament and carpal bone injury. The result of the osseous lesion in comminuted fractures was termed "pilon radiale", which emphasizes the amount of damage to the distal radius and the difficulties to be expected in restoring the articular congruity. Besides this the additional injury, either strain of disruption of the ligaments and the displacement of the carpus and/ or the triangular fibrocartilage complex will equally influence the functional outcome. This review will expand on the relevant anatomy, correct classification and diagnosis of the fracture, diagnostic tools and operative treatment options. Current treatment concepts are analysed with regard to actual literature using the tools of evidence based medicine criteria. A new classification of severely comminuted distal radius fractures is proposed using CT data of 250 complex intraarticular radius fractures. Finally a standardized treatment protocol using external fixation in combination with minimal invasive internal osteosynthesis is described.
doi:10.1007/s11751-006-0001-5
PMCID: PMC2780584
Distal radius fractures; External fixation; Plate osteosynthesis; Meta-analysis
4.  Efficacy of the A-V Impulse System versus cryotherapy in the reduction of postoperative oedema of the hand: a prospective randomised trial 
In a prospective randomised trial, the effects of an intermittent compression hand pump vs. cryotherapy were compared on reduction of postoperative hand swelling and gain in finger movement after distal radius fractures. Although intermittent compression as a physical method for thromboprophylaxis and swelling reduction in orthopaedic and trauma patients of the lower leg are established, a prospective randomised trial for an objective evaluation of the effects of intermittent compression in the upper extremity has not been previously performed. Forty-three subjects (63±33 years, 32 women, 11 men) with a unilateral distal radius fracture treated with transarticular external fixation were randomised into two treatment groups. In group A 21 patients were treated with cryotherapy. In group B 22 patients were treated with an intermittent compression hand pump. Reduction in swelling of the treated hand and MP and PIP joint movement were recorded with computerised assessment software (EVAL Hand Evaluation System) in comparison to the uninjured contralateral side. Reduction of swelling in group A was not statistically significant (28.5% of total swelling or 0.61 cm, SD 0.39, p=0.42), but in group B it was significant (92% of total swelling, 3.62 cm, SD 1.48, p<0.001). Comparison of increases in MP and PIP joint movement (p<0.0016) showed statistically significant differences in favour of the intermittent compression pump. This study demonstrates that intermittent compression is more effective in the reduction of postoperative oedema and gain of finger movement of the hand than cryotherapy.
doi:10.1007/s11751-006-0004-2
PMCID: PMC2780588
Postoperative swelling; Intermittent compression pump; Cryotherapy; Hand; Distal radius fracture
5.  Minimally invasive ankle arthrodesis with a retrograde locking nail after failed fusion 
Abstract
A retrograde nail with posterior-to-anterior (PA) locking into os calcis, talus and tibia was used to correct deformity and achieve fusion after failed fusion. A variety of methods have been published to achieve union of the ankle and subtalar joint in a failed fusion situation. We have studied a retrograde locking nail technique through a 2.5-cm incision in the non-weightbearing part of the sole of the foot. Remaining cartilage in the ankle joint, where necessary, was percutaneously removed through an anterior approach and the locking nail was inserted after reaming of os calcis, talus and tibia. Locking screw insertion was in the sagittal plane (p.a. direction), in talus os calcis and tibial diaphysis using a nail mounted jig. Ten patients were entered in the study (age 27-60 years). The initial aetiology for attempted fusion was post-traumatic in nine cases and rheumatic in one case. There were 25 previous operations in the cohort not leading to fusion. An additional temporary external fixator was used in four cases to reach and maintain the optimum position for the procedure. The intervention time was 30-75 min. Dynamisation of the nail was performed after four months under local anaesthesia. The mean duration of follow-up was 4 years (3-5.5 years). Radiologically and clinically, fusion was achieved in 16 weeks (range, 12-20 weeks). There was no loosening of the implant or implant failure. A leg length discrepancy was avoided using this technique. There was one complication with varus malunion in a heavy smoker which united after corrective osteotomy, revision nailing and bone grafting. Patient satisfaction was measured on a scale (not visual analogue) of 0 (not satisfied) to 10 (completely satisfied); overall satisfaction averaged 9.5 points (range, 6-10 points). The postoperative ankle-hindfoot score of the American Orthopedic Foot and Ankle Society averaged 73.5 points (range, 61-81 points). Retrograde locked nailing with locking in the sagittal plane is a reliable minimally invasive procedure to achieve fusion of the ankle and the subtalar joint after failed fusion.
doi:10.1007/s11751-007-0018-4
PMCID: PMC2321722  PMID: 18427914
Ankle arthrodesis; Failed fusion; Retrograde nail; Calcaneotalotibial arthrodesis
6.  The “floating forearm” injury in a child: a case report 
Abstract:
The case of a eleven-year-old girl who had a fracture dislocation of the left elbow with entrapment of the ulnar nerve into the dislocated ulnar epicondyle anlage and unstable forearm fracture of the ipslateral upper extremity is described. This severe injury to the elbow and the ipsilateral forearm is termed “floating forearm” injury. The forearm was stabilized percutaneously and the elbow fracture dislocation, remaining unstable after internal fixation was treated with a pediatric elbow fixator with motion capacity.
Electronic supplementary material
The online version of this article10.1007/s11751-007-0017-5contains supplementary material, which is available on SpringerLink
doi:10.1007/s11751-007-0017-5
PMCID: PMC2321724  PMID: 18427915
Forearm injury; Elbow fracture dislocation; Hinged external fixation; Floating elbow injury
7.  Biomechanics of the anterior cruciate ligament and implications for surgical reconstruction 
Abstract
Injury to the anterior cruciate ligament (ACL) is regarded as critical to the physiological kinematics of the femoral-tibial joint, its disruption eventually causing long-term functional impairment. Both the initial trauma and the pathologic motion pattern of the injured knee may result in primary degenerative lesions of the secondary stabilisers of the knee, each of which are associated with the early onset of osteoarthritis. Consequently, there is a wide consensus that young and active patients may profit from reconstructing the ACL. Several factors have been identified as significantly influencing the biomechanical characteristics and the functional outcome of an ACL reconstructed knee joint. These factors are: (1) individual choice of autologous graft material using either patellar tendon-bone grafts or quadrupled hamstring tendon grafts, (2) anatomical bone tunnel placement within the footprints of the native ACL, (3) adequate substitute tension after cyclic graft preconditioning, and (4) graft fixation close to the joint line using biodegradable graft fixation materials that provide an initial fixation strength exceeding those loads commonly expected during rehabilitation. Under observance of these factors, the literature encourages mid-to long-term clinical and functional outcomes after ACL reconstruction.
doi:10.1007/s11751-007-0016-6
PMCID: PMC2321720  PMID: 18427909
Anterior cruciate ligament; ACL reconstruction; Biomechanics; Graft fixation; Graft tension
8.  Efficacy of the A-V Impulse System versus cryotherapy in the reduction of postoperative oedema of the hand: a prospective randomised trial 
In a prospective randomised trial, the effects of an intermittent compression hand pump vs. cryotherapy were compared on reduction of postoperative hand swelling and gain in finger movement after distal radius fractures. Although intermittent compression as a physical method for thromboprophylaxis and swelling reduction in orthopaedic and trauma patients of the lower leg are established, a prospective randomised trial for an objective evaluation of the effects of intermittent compression in the upper extremity has not been previously performed. Forty-three subjects (63±33 years, 32 women, 11 men) with a unilateral distal radius fracture treated with transarticular external fixation were randomised into two treatment groups. In group A 21 patients were treated with cryotherapy. In group B 22 patients were treated with an intermittent compression hand pump. Reduction in swelling of the treated hand and MP and PIP joint movement were recorded with computerised assessment software (EVAL Hand Evaluation System) in comparison to the uninjured contralateral side. Reduction of swelling in group A was not statistically significant (28.5% of total swelling or 0.61 cm, SD 0.39, p=0.42), but in group B it was significant (92% of total swelling, 3.62 cm, SD 1.48, p<0.001). Comparison of increases in MP and PIP joint movement (p<0.0016) showed statistically significant differences in favour of the intermittent compression pump. This study demonstrates that intermittent compression is more effective in the reduction of postoperative oedema and gain of finger movement of the hand than cryotherapy.
doi:10.1007/s11751-006-0004-2
PMCID: PMC2780588
Postoperative swelling; Intermittent compression pump; Cryotherapy; Hand; Distal radius fracture
9.  The treatment of severely comminuted intra-articular fractures of the distal radius 
Comminuted fractures of the distal end of the radius are caused by high-energy trauma and present as shear and impacted fractures of the articular surface of the distal radius with displacement of the fragments. The force of the impact and the position of the hand and carpal bone determine the pattern of articular fragmentation and their displacement and the amount and the extent of frequent concommitant ligament and carpal bone injury. The result of the osseous lesion in comminuted fractures was termed "pilon radiale", which emphasizes the amount of damage to the distal radius and the difficulties to be expected in restoring the articular congruity. Besides this the additional injury, either strain of disruption of the ligaments and the displacement of the carpus and/ or the triangular fibrocartilage complex will equally influence the functional outcome. This review will expand on the relevant anatomy, correct classification and diagnosis of the fracture, diagnostic tools and operative treatment options. Current treatment concepts are analysed with regard to actual literature using the tools of evidence based medicine criteria. A new classification of severely comminuted distal radius fractures is proposed using CT data of 250 complex intraarticular radius fractures. Finally a standardized treatment protocol using external fixation in combination with minimal invasive internal osteosynthesis is described.
doi:10.1007/s11751-006-0001-5
PMCID: PMC2780584
Distal radius fractures; External fixation; Plate osteosynthesis; Meta-analysis
10.  The “floating forearm” injury in a child: a case report 
Abstract:
The case of a eleven-year-old girl who had a fracture dislocation of the left elbow with entrapment of the ulnar nerve into the dislocated ulnar epicondyle anlage and unstable forearm fracture of the ipslateral upper extremity is described. This severe injury to the elbow and the ipsilateral forearm is termed “floating forearm” injury. The forearm was stabilized percutaneously and the elbow fracture dislocation, remaining unstable after internal fixation was treated with a pediatric elbow fixator with motion capacity.
Electronic supplementary material
The online version of this article10.1007/s11751-007-0017-5contains supplementary material, which is available on SpringerLink
doi:10.1007/s11751-007-0017-5
PMCID: PMC2321724  PMID: 18427915
Forearm injury; Elbow fracture dislocation; Hinged external fixation; Floating elbow injury

Results 1-10 (10)