Het genereren en evalueren van voorspellingen van omzet en netto winst

Het genereren en evalueren van voorspellingen van omzet en netto wins

Bipolar press-fit radial head arthroplasties: surgical technique and expected outcomes

Several types of radial head prostheses have been designed and introduced in clinical practice over the last decades. Currently, radial head prostheses can be categorized according to the material (silicone, polyethylene, pyrocarbon, and metal), modularity (monoblock or modular), polarity (monopolar or bipolar), and method of stem fixation (cemented, loose-fit, expandable stem, and press-fit). The topic of this chapter is the bipolar press-fit radial head arthroplasties (RHA). Two types of this implant are described in the literature: (1) the press-fit RHS (Tornier, Montbonnot-Saint-Martin, France) and (2) the bipolar SBI (radial head implant, Small Bone Innovation, Morrisville, Pennsylvania, USA). The aims of this chapter are (1) to describe the surgical technique and (2) to report the clinical results yielded by these two types of implant. A bipolar press-fit radial head, i.e., Antea (Adler Ortho, Milano, Italy), has recently been marketed, though no studies have yet been published on this new device

Performance control after arthroscopic arthrolysis with capsulectomy in fresh-frozen elbow joints

Background and objective Posttraumatic or postoperative movement restrictions in elbow joints can often occur (including capsular contracture) and can generate everyday limitations. In persistent elbow stiffness, arthroscopic arthrolysis with removal of the dorsal and ventral capsule portions can be carried out. The purpose of this study was to assess the efficacy of arthroscopic capsulectomy by means of an in vitro anatomical study. Methods A standardized elbow arthroscopy with ventral and dorsal capsulectomy was performed and image-documented in five fresh-frozen elbow specimens. Subsequently, open dissection of the elbow joint was performed to analyze the amount of residual capsule by means of photodocumentation of the specimens. Results Regardless of the surgeon and surgical experience, anterior and posterior remnants of the capsule remained in all specimens. Dorsal capsule strands around the standard arthroscopy portals were noticed particularly more often in the area of the high dorsolateral camera portal. An incomplete capsulectomy was seen on the ulnar side at the level of the posterior medial ligament (PML) in the immediate vicinity of the ulnar nerve. Ventrally, a capsulectomy was performed from the radial side and also the ulnar side until the brachialis muscle and additionally a complete capsulectomy as far as the anterior medial ligament (AML) and radial collateral ligament (RCL) was achieved. The capsule was completely resected in a proximal direction. Distally, irrelevant capsular remnants were found in the region of the annular ligament and distal of the tip of the coronoid process. Conclusion Arthroscopic arthrolysis can be performed with a high degree of radicality. The radicality must be self-critically taken into account in one's own action. The radicality of the portal change may even be higher ventrally than with an isolated column procedure. On the other hand, it must be critically considered that posteriorly, the PML cannot be adequately addressed by means of arthroscopy due to the risk of ulnar nerve injury. Portal changes might help to enable a more complete visualization of the joint capsule and may avoid leaving possibly relevant remnants of the capsule. If a release of the PML is required, this may have to be carried out in combination with an ulnar nerve release in a mini-open technique