De resultaten van intramedullaire Prevotpenosteosynthese versus plaatosteosynthese

Nonoperative treatment of the dislocated midshaft clavicle fracture often results into a painfull nonunion and unsatisfactory functional results. Two of the most common surgical approaches include fixation using plate and screws, and intramedullary fixation using nails. The functional results following these treatments are equal, but the rate and consequenses of the complications seem to be variate. In this study we compare the rate of complications following plating versus intramedullary nailing in the operative management of displaced midshaft clavicular fractures. We performed a retrospective analysis of 73 patiënts treated with either intramedullary nailing (n=38) or plate fixation (n=35) in the period between Januari 2000 and May 2010 at the Deventer Hospital or the Medisch Spectrum Twente. There was no significant difference in the number of complications between the two groups. Implant failure occurred significantly more often in the plating group compared with the nailing group (5 patients versus 0 patients, p=0.02). There was no significant difference in demographic data, time to consolidation, hospital stay and Disability of the Arm, Shoulder and Hand score (DASH) between both groups. The patients treated with intramedullary nailing were significantly more satisfied with respect to the functional result (p=0.000) and cosmetic aspect (p=0.000) of the shoulder. There is no significant difference in the number of complications following intramedullairy nailing or plate fixation in the management of displaced midshaft clavicle fractures. The patients treated with intramedullary nailing were afterwards more satisfied with the final result.

Treatment of Aortoiliac Aneurysms: Compatibility of the E-liac Stent Graft (Artivion((R)), Iliac Branch Device) with Endurant II or IIs (Medtronic((R)), EVAR)

Purpose Iliac branch devices (IBD) are widely used to treat aortoiliac aneurysms with an unfit distal landing zone for standard endovascular aneurysm repair (EVAR). The aim of this retrospective study was to examine the treatment of aortoiliac aneurysms with the combination of the Endurant II(s) stent graft system (Medtronic((R))) and the E-liac stent graft (Artivion((R))).Materials and Methods Data of all patients who underwent an EVAR combined with unilateral or bilateral IBD between January 2015 and January 2020 were analyzed. Primary outcomes were technical success at implantation (successful EVAR with IBD extension placement and patency of the grafts without type 1 or type 3 endoleak), and type 1b/3 endoleak, hypogastric artery patency and IBD-related reinterventions during follow-up. Secondary outcomes were all type 1 endoleak, all reinterventions, rupture, and mortality during follow-up.Results A total of 38 patients were treated with a combination of EVAR with IBD. Technical success was 94.7% (n = 36/38). The 30-day survival was 100%. Median follow-up time was 31 months (range 8-56). During follow-up, no patients developed type 1b or type 3 endoleak and all hypogastric arteries at the side of IBD remained patent. The overall reintervention rate at 12 months follow-up was 5.3% (n = 2/38) and the IBD-related reintervention rate was 2.6% (n = 1/38).Conclusion The combination of the Endurant II(s) and the E-liac stent graft system is an effective and safe procedure for patients with an aortoiliac aneurysm. We confirm the high hypogastric artery patency rate using IBD. Furthermore, these devices have a high technical success rate even when it is combined with an Endurant II(s) EVAR main body