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Goost H.,Universtitatsklinikum Bonn | Kabir K.,Universtitatsklinikum Bonn | Burger C.,Universtitatsklinikum Bonn | Pennekamp P.,Universtitatsklinikum Bonn | And 4 more authors.
Operative Orthopadie und Traumatologie | Year: 2015

Background: Instability of the sternoclavicular joint is a very uncommon disorder of the shoulder girdle. Acute traumatic dislocations are commonly treated nonoperatively. But severe displacement or chronic instability with recurrent symptomatic subluxation may require surgical intervention. We present our results with open reduction and internal fixation through an autologous gracilis tendon transplant or fiber tape in 8 patients treated surgically. The operative stabilisation of the sternoclavicular joint reduces pain level and improves function of the shoulder. This technique provides an effective surgical procedure for treatment of symptomatic sternoclavicular joint instability. Objective: Restoration of the function and aspect of the sternoclavicular joint. Indications: Chronic and painful instabilities. Contraindications: Local infection, tumor. Surgical technique: The gracilis tendon graft is harvested as previously described by Petersen. Direct incision over the sternoclavicular joint. Sharp dissection of the periostal sleeve and partial release of sternocleidomastoideus and pextoralis muscle. Resection of osteophytes. Careful placement of a raspatorium under the proximal clavicle and sternum to protect the mediastinal structures. Application of 2.5 or 3.2 mm drill holes to the sternum and the proximal clavicle. The gracilis tendon or the fiber tape is pulled through the drill holes in a figure of eight and then sutured. Recontruction of the joint capsule, closure of the wound. Postoperative management: Gilchrist brace for 3–5 days, functional physiotherapy with a maximum abduction of 90° for 6 weeks. No carrying or lifting of weights greater than 5 kg for 3 months. Results: During the period from January 2006 to December 2010, 8 patients with sternoclavicular instability were treated. Four patients were treated with fiber tape and four were treated with a gracilis tendon autograft. Postoperative all patients described a reduction of pain and improved shoulder function. The Constant score was 72 points, the DASH 58 points. © 2015, Springer-Verlag Berlin Heidelberg.


Goost H.,Universtitatsklinikum Bonn | Deborre C.,Universtitatsklinikum Bonn | Kabir K.,Universtitatsklinikum Bonn | Weber O.,Universtitatsklinikum Bonn | And 3 more authors.
Journal fur Mineralstoffwechsel | Year: 2011

The risk of cut-out of a pedicle screw is high in the presence of osteoporotic bone. In cadaver studies it was found that cement augmentation of pedicle screws markedly increases pullout forces. However, the use of conventional low viscosity vertebroplasty or kyphoplasty cement is associated with the risk of cement extravasation. The risk might be reduced by using high viscosity, radiofrequency-activated bone cement. After performing DEXA scans, six fresh-frozen vertebral bodies of different bone densities were obtained from cadavers. Two pedicle screws (WSI Expertise-Inject, Peter Brehm, Germany) were placed in the pedicles. About 3 ml of radiofrequency-activated, ultra-high viscosity cement (ER2 Bone Cement, DFine Europe GmbH, Germany) was injected through the right pedicle. The left pedicle screw was left uncemented and served as control. Axial pullout tests were performed using a material testing device (Zwick/Roell Zmartpro, Ulm, Germany). The tests revealed that cement-augmented pedicle screws were able to withstand markedly higher pullout forces. Extravasation of cement did not occur. The value of the study is limited by the fact that only six samples were investigated. Further cadaver studies and clinical evaluation will be needed in the future. However, this pilot study showed that combining cannulated pedicle screws with ultra-high viscosity bone cement is a successful approach. Revision due to cut-out and complications secondary to cement extravasation can be reduced by this method.


Goost H.,Universtitatsklinikum Bonn | Deborre C.,Universtitatsklinikum Bonn | Kabir K.,Universtitatsklinikum Bonn | Weber O.,Universtitatsklinikum Bonn | And 3 more authors.
Journal fur Mineralstoffwechsel | Year: 2010

Pedicle screw cut-out is increased in osteoporotic bone. With cement augmentation of pedicle screws the pullout forces are significantly elevated. With the application of low viscosity vertebroplasty or kyphoplasty cement the risk of cement extravasation is associated. This risk can be reduced by using high viscosity, radio-frequency-activated cement. By Dexa-Scan 6 fresh-frozen vertebral bodies from different cadavers were collected. Two pedicle screws (WSI Expertise-Injekt, Peter Brehm, Germany) were placed in the pedicles, through the right screw 3 ml of radiofrequency-activated cement (StabiliT® Vertebral Augmentation System, DFine Europe GmbH, Germany) were injected. As a control the left pedicle screw was left uncemented. Axial pullout test was performed by a material testing device (Zwick/ Roell Zmartpro, Germany). The tests showed an increased pullout force by cement augmentation. Extravasation of cement was not observed. Certainly the value of this study is limited due only 6 samples. Further cadaver studies and also clinical evaluation is needed. However, this pilot study demonstrated the successful combination of cannulated pedicle screw and ultra high-viscosity bone cement. Revision rate due to cut-out and complications by cement extravasation will decrease.


PubMed | Universtitatsklinikum Bonn
Type: Journal Article | Journal: Operative Orthopadie und Traumatologie | Year: 2015

Instability of the sternoclavicular joint is a very uncommon disorder of the shoulder girdle. Acute traumatic dislocations are commonly treated nonoperatively. But severe displacement or chronic instability with recurrent symptomatic subluxation may require surgical intervention. We present our results with open reduction and internal fixation through an autologous gracilis tendon transplant or fiber tape in 8patients treated surgically. The operative stabilisation of the sternoclavicular joint reduces pain level and improves function of the shoulder. This technique provides an effective surgical procedure for treatment of symptomatic sternoclavicular joint instability.Restoration of the function and aspect of the sternoclavicular joint.Chronic and painful instabilities.Local infection, tumor.The gracilis tendon graft is harvested as previously described by Petersen. Direct incision over the sternoclavicular joint. Sharp dissection of the periostal sleeve and partial release of sternocleidomastoideus and pextoralis muscle. Resection of osteophytes. Careful placement of a raspatorium under the proximal clavicle and sternum to protect the mediastinal structures. Application of 2.5 or 3.2mm drill holes to the sternum and the proximal clavicle. The gracilis tendon or the fiber tape is pulled through the drill holes in a figure of eight and then sutured. Recontruction of the joint capsule, closure of the wound.Gilchrist brace for 3-5days, functional physiotherapy with a maximum abduction of 90 for 6weeks. No carrying or lifting of weights greater than 5kg for 3months.During the period from January 2006 to December 2010, 8 patients with sternoclavicular instability were treated. Four patients were treated with fiber tape and four were treated with a gracilis tendon autograft. Postoperative all patients described a reduction of pain and improved shoulder function. The Constant score was 72points, the DASH 58 points.

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