Unfallchirurgie最新文献

From 1992 to 1995 126 patients were treated with percutaneous wire pinning. Sixty-one patients were treated by Kapandji's technique and 65 patients were treated conventionally. Forty-nine patients were examined by 3 different scores (Cooney, Castaing, Stewart). The analysis of the scores showed no differences between the Kapandji technique and the conventional method. Functional and radiological results showed no correlation. Furthermore we found out that the results depend on the score. We conclude that the Kapandji technique shows no benefit in comparison to the conventional method. Functional and radiological results are not divisible: a conclusion from X-ray to function and vice versa is not allowed. A comparison of results is senseless if someone does not use the same score.

Isolated dislocations of the radial head in children without fracture of the ulna are an extremely rare injury. The diagnosis is easily missed. This leads to permanent deformity of the elbow; on the other hand prompt treatment restores a normal anatomical and functional elbow. Fourteen patients and their long-term outcome are presented.

In the past, biomechanical investigations on the dorsal pelvic ring have generally been performed on a small number of cadaveric pelves in various non-standardized procedures. Significant differences in stability between different internal fixation methods of unstable pelvic ring fractures were not found. The experimental design presented here was based as closely as possible on the physiological loading of the pelvis in one-leg stance. This method made it possible to carry out standardized, reproducible tests on different osteosytheses of the sacroiliac joint. Furthermore, the suitability of artificial bones for such investigations can be assessed on the basis of a larger number of similar experiments on artificial and human pelves and the number of human pelves required for such studies could be reduced.

Based on the results of clinical and animal studies as reported in the literature, the subimplant cortex becomes porous underneath conventional osteosynthesis plates with a flat surface. To solve this problem, we developed an implantable plate which creates multiple contact points between plate and bone, called the multi-point contact or MPC plate. In an experimental animal study conducted on 16 Göttingen minipigs we investigated the bone reaction beneath 2 different types of osteosynthesis plates: the conventional type with a flat interface versus the multi-point contact type. Both epiperiostal and subperiostal plating was performed on pig's intact tibiae. After an implantation period of 16 weeks, the results were documented and compared. It was shown that the osteal remodeling activity of the cortical bone adjacent to the plate increased under both plates up to the twelfth week, but declined towards the end of the study period. Compared to the MPC plate, a conspicuous remodeling front accompanied by porosis of the cortical bone adjacent to the plate was found underneath the conventional osteosynthesis plates with a flat surface-to-bone interface. The different subimplant reactions between the 2 plates can be best explained by the fact that intracortical implant-induced viscoelastic osteocyte diffusion is better under the MPC plate, whereas it is impaired under the conventional flat plate.

Plate osteosynthesis is a method of choice in the treatment of forearm fractures with senso-motorical impairment, poorly or non-reduceable, retained, fragmented and open fractures. Dislocated fractures of the forearm frequently cause problems because of their poor reduction and retention. In such cases, exclusively conservative treatment requires reduction and change of therapeutical approach to avoid functional limitations resulting from axial malpositioning. The sincere contact of bone fragments, accompanied by sufficient anatomical axial and conservative reduction techniques that maintain parossal perfusion as well as a limited osteosynthesis plate contact should be the aim of the operative strategy. The use of a new titanium osteosynthesis plate system with multi-point contact between bone and plate promotes the incorporation of vessels and callus formation at the bone-plate interface and leads to the realization of the aforementioned aim, which was revealed in animal studies before. In order to examine the results, 18 patients with forearm fractures were studied, which underwent reduction and internal fixation using this new titanium osteosynthesis plate, the multi-point contact plate (MPC) system. In these patients, functional and radiological results after plate removal were studied. Our initial clinical experiences with the MPC-plate for internal fixation confirm the animal study results. The in-growth of parossal vessels into the multiple inter-point spaces enhances the subimplant (bio-logical) formation of callus, which can be visualized radiographically and intraoperatively after plate removal. These results indicate that the MPC plate has marked advantages over conventional plates.

Closed traumatic lesions of the extensor tendon hood of a longfinger at the metacarpophalangeal joint are rare. Surgical treatment was done in 6 cases during the last 10 years in our department; in 5 cases the dorsoradial part, in one case the dorsoulnar part of the hood was injured. The tear extended longitudinal or diagonal through the transverse fibers of the hood. Respecting the accident mechanism there have been reported tangential forces at the extensor tendon hood and forced ulnar deviation in the bended metacarpophalangeal joint. A jerky dislocation of the extensor tendon to the ulnar side of the metacarpophalangeal head during increased bending of the metacarpophalangeal joint, sometimes with ulnar abduction of the longfinger, leads usually to the diagnosis. Misdiagnoses of cases sent to our department were: "trigger finger" and "recurrent dislocation of the metacarpophalangeal joint". Once the presurgical diagnosis was "rupture of the extensor tendon" because of a permanent extension deficit in 30 degree position of the metacarpophalangeal joint. Treatment is always surgical with suture of the hood and immobilization of the metacarpophalangeal joint in extension position for 4 weeks. Conservative treatment can not heal up a tear of the extensor tendon hood.

Skeletal scintigraphy is the most frequently utilized nuclear medicine imaging procedure in traumatology. Concerning any skeletal abnormality associated with changes in local perfusion, exudation and metabolism, it is a sensitive functional imaging procedure to detect bony disease. However, because of the varying causes of bony disease, it is characterized by a low specificity. Further, specificity may be enhanced, when patient history, clinical and lab results as well as results obtained from other diagnostic imaging procedures are combined with the result of skeletal scintigraphy. On the other hand, it is known that metabolic abnormalities of the skeleton depicted by radionuclide imaging occur much earlier than structural changes visible on X-ray imaging. Beside skeletal scintigraphy, antigranulocyte antibody or labelled leucocyte imaging may greatly assist in the detection of inflammation or infection following joint replacement surgery, respectively. Ultimatively, a combination of clinical, lab and imaging results including radionuclide imaging may represent the best approach to answer some questions asked by surgical traumatologists.

The occupational radiation exposure of trauma surgeons has increased over the last few years as a result of biologic orthopaedic procedures like intramedullary nailing as closed reduction and insertion of distal interlocking screws need fluoroscopic control. In order to assess the surface doses of the primary surgeon with and without lead shield of the thyroid we performed in vitro measurements during operative procedures of the lower extremities simulating different intraoperative situations under fluoroscopic control. The average registered ionizing dosage without thyroid shield was 70 times higher compared to the measurements with thyroid protection. In a previous study we found average fluoroscopy times during intramedullary nailing of tibia and femur of 4.6 min per procedure. Extrapolation of this value leads to the result, that even when 1000 intramedullary nailings were carried out without wearing lead protection, 13% of the dose limit recommended by the International Commission on Radiological Protection for the thyroid of 300 mSv per year would not be exceeded, whereas by wearing the lead protection only 0.2% of the recommended dose would be reached.

In daily practice, the well-proved Salter-Harris-Rang epiphyseal injuries classification is used worldwide and in Hungary as well. Occasionally there are to be seen epiphyseal injuries which cannot be typed by this classification. The Ogden classification of epiphyseal injuries which enlarges the Salter-Harris-Rang classification with 6 subdivisions and 3 more subdivisions is very useful for the classification of such rare epiphyseal injuries. The authors focus one's attention on Ogden IIB type and Ogden VI type injuries on the basis of their own experience. Ogden IIB is often unstable and susceptible to shortening. In Ogden VI type ligamentous instability beside growing disturbance, caused by meta-epiphyseal bone bridge formation, can be seen. The comminuted growing plate injury caused by high energy direct trauma and healed without growing disturbance in their case, is missed in the Ogden classification. The proper classification is a necessary condition of adequate treatment. We recommend the Ogden classification of rare epiphyseal injuries.