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Introduction: We present a detailed procedure for the robotic-assisted plate osteosynthesis of an anterior acetabular fracture. The purpose of this work was to describe a robotic-assisted minimally invasive technique as a possible method for reducing complications, pain, and hospitalization. Another goal was to present technical recommendations and to assess potential pitfalls and problems of the new surgical approach. Methods: Surgery was performed in an interdisciplinary setting by an experienced orthopedic surgeon and a urologist. The DaVinci System with standard instruments was used. Reduction was achieved through indirect traction of a pin that was introduced into the femoral neck and direct manipulation via the plate. The plate position and fixation were achieved through 7 additional minimally invasive incisions. Results: The technique has multiple advantages, such as no detachment of the rectus abdominal muscle, a small skin incision, and minimal blood loss. Furthermore, this approach might lower the incidence of hernia formation, infection, and postoperative pain. Discussion: We see the presented technique as a demanding yet progressive and innovative surgical method for treating acetabular fractures with indications for anterior plate fixation. Trial registration: The study was approved by the local institutional review board (Nr. 248/18). [ABSTRACT FROM AUTHOR]

Background: Surgery for humeral shaft fractures is associated with a high risk of iatrogenic radial nerve palsy (RNP). Plausible causes are difficult anatomical conditions and variants.Methods: We performed a cadaveric study with 23 specimens (13 female and 10 male Caucasian donors) to assess the course and anatomy of the radial nerve (RN) with its branches alongside the humeral shaft. The accuracy of identification of the RN in the surgical field was analyzed by measuring the location, course, diameter, and form of each nerve and vessel of interest.Results: The RN is not a single structure running alongside the humeral shaft; at least 4 parallel structures crossed the dorsal humerus in all subjects. The RN was accompanied by 2 vessels and at least 1 other nerve, which we named the musculocutaneous branch (MCB). With an oval profile and an average diameter of 3.1 mm (range, 2.6 to 3.8 mm), the MCB was thinner but, in some cases, close to the average diameter of 4.7 mm (range, 4.0 to 5.2 mm) of the RN, which had a round profile. Both accompanying vessels had similar diameters: 3.5 mm (range, 2.6 to 4.2 mm) for the radial collateral artery and 4.0 mm (range, 2.9 to 4.4 mm) for the medial collateral artery. In 20 (87%) of the cases, the RN ran proximal to and in 3 (13%) of the cases, distal to the MCB. Furthermore, a distal safe zone of at least 110 mm (range, 110 to 160 mm) was found, measured from the radial (lateral) epicondyle proximally.Conclusions: The RN does not cross the dorsal humerus alone, as often stated in anatomical textbooks, but runs parallel to vessels and at least 1 nerve branch with a similar appearance. Thus, for reliable preservation of the RN, we recommend identification and protection of all crossing structures in posterior humeral surgeries 110 mm proximal to the radial epicondyle. [ABSTRACT FROM AUTHOR]

Objective: Olecranon fractures are common injuries in patients of any age. The vast majority are treated with two operation techniques: a plate fixation (PF) or tension band wiring (TBW). The objective of this study is to compare the outcomes of surgically treated olecranon fractures with plate fixation or tension band wiring. We hypothesise that PF patients would show significantly inferior outcomes due to more complex injuries. Patients and methods: Between 2010 and 2017, a total of 108 patients were treated with plate fixation and or tension band wiring. Clinical data of 40 surgically treated olecranon fractures were collected and analysed. Clinical and functional evaluations were performed using Mayo-Score, DASH-Score, Weseley -Score and subject elbow value (SEV). Furthermore, complication rates, time to return to work and operation duration were documented. Results: The mean follow-up was 70.5 ± 45.6 months. Time of return to work was 6.5 ± 2.2 weeks in the TBW group and 10.9 ± 6,6 in the PF group (p = 0.372). The mean duration of surgery was 95.2 ± 47.0 min in the TBW group and 192.5 ± 113.0 min in the PF group (p = 0.001). In the TBW group, the mean hospitalisation period was 7.9 ± 10.1 days and 11.2 ± 9.8 days in the PF group. Revisions were required in 0.3 ± 0.6 of cases (0.2 ± 0.5 in TBE and 0.4 ± 0.7 in PF). The median DASH Score was 7.0 (3.6-13.7) in the TBW group and 12.1 (5.5-24.8) in the PF group (p = 0.948) Conclusion: Tension band wiring and plate fixation are both practical treatment options with mostly positive outcomes, even though high complication rates can occur. There were no significant differences in either group concerning functional outcome or time back to work. The duration of surgery was significantly higher in the PF group, whereas the incidence of metalwork-associated complications was higher in the TBW group. [ABSTRACT FROM AUTHOR]

This study presents a detailed documentation of a total endoscopic anterior pelvic approach (TAPA) for plate fixation of a symphyseal disruption. The purpose of this work is to describe a minimally invasive technique as a possible method for reducing complications and hospitalization. Other goals included giving technical recommendations and assessing potential pitfalls and problems of this new surgical approach. Surgery was performed in an interdisciplinary setting by an experienced orthopaedic and general surgeon. The first endoscopic approach used to visualize the injury was the same as is used for endoscopic hernia surgery. The repositioning of the symphysial rupture was achieved either through external fixation or indirectly with traction and a pelvic binder. Plate positioning and fixation were achieved through two additional, minimally invasive incisions. The endoscopic approach shows multiple advantages, such as no detachment of the rectus abdominis muscle and smaller skin incisions. Furthermore, this approach could lessen the incidence of hernia and postoperative pain. We see the presented technique as a simple and innovative surgical method for treating symphyseal disruption. [ABSTRACT FROM AUTHOR]