Unfallchirurgie最新文献

We report a rare case of a 35-year-old man who sustained a severe injury of the tarso-metatarsal joint. An isolated fracture of the medial cuneiform was seen on initial radiographs; final diagnosis was made by CT-scan.

The influence of the residual application of postoperative wound suction drainage devices on wound healing was examined in 150 patients with total hip replacement. The duration of continuous wound-draining as well as their bacterial contamination were analysed and the possible correlation was evaluated. Another aim of the study was to observe if the bacteriologic result is a proper method to obtain evidence about the wound situation. The 150 patients were divided in 3 groups. Two groups (of 50 patients each) had total hip replacement at the same time period. One group had postoperative wound complications or infection that had to be reoperated. The other 50 patients had normal wound healing without any complication. The third group of 50 patients with a shorter draining period was analysed and compared with the others. As a control factor the indication for operation, the sex and the age of the patients were similar in each group. We could show an increasing number of bacteriological contamination in drainage tubes which had a longer suction period than 3 days. In the reoperated group we found a significantly higher number of contaminated tips (37.4%) than in the groups with uncomplicated wound healing (8% and 2.8%). The comparison of the bacteriological examination of the drainages with the smear of reoperated wounds showed the same constellation of germs in 64.3% of the cases. It seems to be a good method to get information about the bacterial wound conditions.

From 1988 through 1995 we operated 48 patients with dislocated humeral fractures using the T-Plate (median age 66 years [20 to 90 years], 32 male, 16 female). After a median 22 months (9 to 60 months) 33 patients were followed up clinically and radiologically. Six patients had suffered a 2-part fracture, 17 a 3-part fracture, and 10 a 4-part fracture. Judged by the Constant score 6 patients reached a very good result, 8 had a good result, 4 a satisfactory and 15 a poor result. Radiologically we saw an arthrosis in 31%, an axial deviation in 50%, and a dislocation of the fragments in 72%. The rate of necrosis of the humeral head was 39%. MRI (17 patients) provided additional relevant information about soft tissue and bone quality and is valuable in the early detection of necrosis of the humeral head. Functionally poor results correlated rather to dislocated fragments and persisting axial deviation than to the type of fracture or the necrosis of the humeral head. The T-plate osteosynthesis is one way to treat dislocated fractures of the proximal humerus, if early operation, correct reposition, and biological principles are respected.

In this retrospective study 72 patients were followed up clinically and radiologically after surgical treatment for dislocation of the patella. The period of observation varied between 13 and 76 months, with an average of 32 months. Acute traumatic dislocation of the patella was only rarely encountered (n = 6 [8%]). Primary dislocation occurred most frequently during the second and third decades of life. Chondral and osteochondral fractures were fairly frequent (n = 24 [33%]). Additional injuries involved the anterior cruciate ligament, the medial collateral ligament and the menisci. At clinical examination 32 patients (44%) could be assessed as "very good" and "good" (classification of Larsen and Lauridsen). Redislocation occurred in 12 patients (16.7%). The radiological condition of the patella and that of the trochlea femoris were assessed in terms of the classification of Wiberg and Baumgartl and of Hepp, respectively. The condylar-joint angle (Brattström) and the condylar depth index (Ficat and Bizou) were also evaluated.

In 30 patients (12 male and 18 female) with extensive lesions of the cartilage of the upper and lower ankle joint, controlled partial-loading of the lower extremity was established by means of the load-relieving orthosis by Allgöwer and Wenzl. In these orthoses a hidden step-counter could be integrated. Average patient age was 46 (range 20 to 74) years. The load-relieving orthosis was used on average for 68 (range 22 to 98) days with a mean of 10,756 steps (range: 261 to 30,538); respectively 158 steps per day. Neither age, sex, diagnosis nor the duration of complete postoperative immobilisation correlated with the number-of-steps-per-diem compliance (r > +0.22).

The long-term results with an average of 4.3 years of 87 patients with an AC-dislocation grade III according to Tossy, treated operatively with a Bosworth screw or a Wolter plate are described and submitted to critical evaluation. Of the patients 16% had implant failures. Redislocation was seen in 25% of the patients, calcifications in 39% and arthritis in 41%. The end-result was good or excellent in 60% of the patients and fair or bad in 40%. The only factor, influencing the end result was the redislocation rate (p < 0.05). These moderate results surprised and disappointed us. They made us conclude that the grade III acromioclavicular dislocation is no absolute indication for surgical treatment, as is often suggested in literature. No significant differences could be revealed between both surgical techniques.

We report about 48 patients who sustained a deceleration trauma after jumping out of a window. The average free fall height was 11.6 m. 45.8% of the patients suffered from psychic disorders. 12.5% were addicted to opiates or hallucinogenics. The lethality of the analysed group was 12.5%. Within the group of spinal injuries (66.7%) compression- and bursting vertebra fractures of the thoracolumbar spine dominate. Injuries of the osseus pelvic ring (62.5%) and the thorax (64.6%) were equally often in all free falls. Abdominal- (25%) and head trauma (35.4%) occurred less at the patients in our clinic. At the extremities a predeliction of injuries of joint near and joint building osseus structures was noticeable. Out of the 103 injuries of the lower extremities 57.3% concerned foot, ankle and the distal lower leg. With increasing height of the falls the rate of multi-injuries and chain fractures raised. Out of the 37 injuries of the upper extremities 40.5% concerned hand and distal forearm and 29.7% the elbow.

Accident proceedings and injuries were investigated in a consecutive series of 70 patients (65.2% male, 34.8% female, age: 18 +/- 9 years) presented to the emergency department after in-line skate falls. 52.7% wore no protective equipment. 41.8% used knee pads, 27.3% wrist guards, 12.7% elbow pads, and 5.5% each helmets and gloves. The most common cause of fall were obstacles/irregularities (32.7%) on a dry and plain surface. The upper extremity (67.9%) and the head (12.8%) were the most commonly injured body parts. 47.8% in-line skaters sustained fractures. The distal radius (51.5%) was most commonly injured body parts. 47.8% in-line skaters sustained fractures. The distal radius (51.5%) was most commonly fractured. Injuries to novice skaters were more often severe. Advanced freestyle and jumping in-line skaters sustained even injuries of the trunk. Life-threatening injuries of the abdomen and the head may occur. The use of a complete personal protection equipment is recommended.

The most serious complication of accident surgery is postoperative osteitis. At the same time, perioperative antibiotic prophylaxis is generally recommended in order to reduce the rate of infection in joint surgery. The criteria for the suitability of a substance as prophylaxis include inter alia the activity spectrum with respect to the expected microorganisms, its retention time in the body and its ability to penetrate the endangered tissue. In the present study, the systemic and local activity levels after a single i.v. dose of 1500 mg cefuroxime was investigated in relation to the time of administration in 30 patients who had to undergo total hip replacement owing to a medial fracture of the neck of the femur. The tissue and serum samples were analyzed by high pressure liquid chromatography (HPLC). The results show that the tissue levels of the intermediary cephalosporin after an i.v. single shot dose are on average still several times higher than the minimum inhibitory concentration (MIC) of the most frequent bacterium. Staphylococcus aureus, as late as 4 hours after application. The optimal time for the administration form selected was immediately prior to the operation and the concentrations measured suggest that several repeat doses of cefuroxime for short-term prophylaxis are not necessary.