Unfallchirurgie最新文献

Conservative treatment of acetabular fractures mean a long period with immobilisation followed by quite a few of complications that are life-threatening to old patients. Besides that these fractures often cause painful posttraumatic osteoarthritis of the hip joint. Open reduction and osteosynthesis is favored more and more, but the complications described cannot be avoided absolutely by surgical treatment. The sequelae are risky reoperations and the necessity for implantation of total joint prosthesis. As shown in the enclosed case reports, total hip replacement can be emphasized as first step and as definitive surgery. Implantation of an artificial joint allows postoperative remobilisation with full weight bearing and long lasting immobilisation can be avoided. Therefore this kind of therapy is justified for treatment of old and polymorbid patients as an out of rule therapy.

In 19 years 21 children were operated upon anterior or posterior ligament ruptures. Follow-up based on policlinical data and 12 out of 21 patients were tested on follow-up (average follow-up time: 5.5 years). We made notes of the clinical data of an examination with the knee-arthrometer KT-1000 as well as of radiologic and sonographic methods. The subsequent scoring revealed mostly good to very good results. Still, in the long run it would be desirable to perform a prospective multicenter study to obtain statistically relevant data to give advice for ideal surgical treatment of ligamentous knee injuries in children.

Plate-osteosynthesis proves to be an established procedure in our department for treatment of fractures of the femur in patients older than 70 years with total hip replacement even when loosened. It offers the advantages of comparably low aggressive standard operation techniques and acceptable success rates. This treatment allows for short preoperative period of the patients with their typical multimorbidity in many traumatological departments. In younger patients with symptomatical loosening, simultaneous exchange of the hip prosthesis should always be considered. Thus, individual therapy concept including the specific fracture type, general condition and age must be followed for each patient.

In our retrospective study we reviewed 283 patients who were operated on between 1984 and 1993 after an ACL-rupture. We used a free patellar tendon bone graft in all patients. The aim was to assess the complications such as infections, thrombosis, limitation of movement and graft failures. We also looked on the timing of operation and the technique. We saw an overall complication rate of 21.6%. The most common complication was a restricted range of motion in 10.9% which required surgery. In patients treated immediately after injury (within 7 days) we found an arthrofibrosis rate of 17.6%. In delayed surgery (more than 4 weeks after injury) this complication was only seen in 6.1%. The rate of infection was 4.6%, the rate of thrombosis 1.8% and in 4,2% we had to accept an ongoing instability. With these findings we now evaluate the needs and the social environment even more closely to find the best treatment protocol for each individual. In conclusion we favour secondary ACL-reconstruction.

Drillholes of 8 mm diameter were made through the epiphyseal cartilage of the distal femora in 20 6-week-old Göttingen minipigs. The defects were filled with autologous or with homologous cartilage. This was intended to prevent epi-metaphyseal osseous bridge formation. If of appropriate size and location, the latter would lead to subsequent misgrowth. In group A (autologous costal cartilage), at all drillholes the transplanted costal cartilage can prevent ossification of the defect. An epiphyseal boundary lamella was formed over the transplant which precluded penetration of vessels into the defect. In group B (homologous costal cartilage), the transplanted costal cartilage showed a tendency to mineralization in all preparations at the 20 drillholes available. The cartilage was integrated into the primary cancellous bone developing within the defect. An epiphyseal boundary lamella had not formed in the period of the experiment (in contrast to autogenous transplantation). These investigations show that autologous costal cartilage is superior to homologous costal cartilage in the potential clinical application of costal cartilage transplants in the treatment of Brodie abscesses or post-traumatic epiphyseodeses.

In all of our reported cases a seat belt injury was the reason for the sternal fracture. Only 4 of 27 patients of this prospective study suffered from a heart contusion. None of our patients showed complications. An isolated sternal fracture with or without heart contusion seems to be of minor clinical significance. Referring to our patients a screening of a heart contusion with CKMB/CK activity and ECG seems to be sufficient when the trauma is not older than 12 hours. The longer persisting plasma concentrations of cardiac troponin T (cTnT) enables a diagnosis of a heart contusion even after a few days.

Since 1984 the typical headless double threaded Herbert/Whipple screw is known in managing scaphoid fractures and scaphoid non-unions. We resume technical, biomechanical and histological aspects to point out advantages and disadvantages of this osteosynthesis. Our case review of 39 patients illustrate the same good results as achieved in treating scaphoid injuries, when using the Herbert/Whipple screw of a larger diameter for expanded indications other than scaphoid fractures, such as humeral- or radial-head fractures, Jones fractures and others.

A significant atrophy of the biceps brachii muscle without decreasing maximal force during flexion in the elbow joint was shown at least 1.5 years after surgical refixation in 6 patients with a tendon-rupture of the long head of the right biceps. A decreased myoelectrical activity was found in the caput longum region of the muscle. The decrease correlates with an increase of spectral myoelectrical power in the region of caput breve or brachioradialis muscle. In addition compensatory recruitment processes can be supposed because of changed spectral myoelectrical power in the low-frequency bands. Changes of the morphological structure of the muscle were only found in 1 patient by sonography.

In the trauma emergency room 212 patients were asked--according to German law--for a blood sample for HIV-testing. Nine (4.2%) victims rejected the test, another 3 (1,4%) did not meet the study criteria since they were previously known to be HIV-positive or suffering from AIDS disease. None of the finally tested 200 patients was HIV-positive. On an anonymous questionnaire that was handed out additionally, 64% of the patients said they would accept HIV-testing without consent prior to operative treatment. 49% would reject HIV-testing without consent in non-operative treatment.