Unfallchirurgie最新文献

After severe head injury intracranial pressure (ICP) must be measured continuously for management to assess and maintain the cerebral perfusion. Therefore in our hospital epidural transducers are used. To prove the efficiency of this method in a 12-month period the clinical courses of 23 patients with intracranial pressure transducers were analysed retrospectively. Eighteen patients survived, 5 of them without residuals, 13 with residuals and 2 remained in coma. In 14 patients secondary rises of intracranial pressure were observed between days 3 and 6 post injury. The mean ICP value of the survivors revealed 25 mm Hg. whereas the expired showed 60 mm Hg. In 17 patients the measurements were considered as reliable, 6 measurements were not reliable, which included 1 of the 5 patients who died. One transduce was displaced, another one showed a hemorrhage at the drill hole. There was no infection.

Intercalary replacement is a valuable option in the treatment of diaphysary long bone metastases. In certain cases methylmethacrylate bone cement may be used as a cheap and readily available alternative to modular or custom-made prostheses. Stabilization is best performed by locked intramedullary nailing. By cutting open the cylindric part of a large syringe and placing it around the bone ends after resection a mould is created where liquid bone cement can be filled in. Thus spilling of liquid methacrylate into the adjacent soft tissues is prevented. After curing this results in a smooth round intercalary segment with perfect contact to the bone ends allowing early postoperative mobilization.

This is a report of a rare case of an avulsion of the apophysis of anterior inferior iliac spine by a 14-year-old football player. Origin, diagnosis, differential diagnosis, and treatment are evaluated and described.

The objective of our investigation was to study the patency rates of anastomoses in arteries, damaged by a balloon dilatation, in a training model of microvascular surgery. In general anaesthesia, a balloon dilatation was repeated 5 times in 31 left common carotid arteries of female Wistar rats (body weight: 250 to 350 g). A common carotid artery autograft of 4 mm was harvested 1 minute after reflow, turned 180 degrees, and reinserted into the artery. The reflow of the vessels was investigated by micro-Doppler ultrasound equipment. Autografts without balloon dilatation or any other intended damage were performed in further 26 common carotid arteries. In addition, in further 14 common carotid arteries the balloon dilatation was the sole damage. The vessels were harvested and investigated postoperatively after perfusion with 3% glutaraldehyde at 1 day, 7 days, and 1 month. The balloon dilatation in no instance caused an occlusion of the vessel as judged by the micro-Doppler ultrasound. One vessel was found to be occluded after reflow was allowed following insertion of the autograft in the group without balloon dilatation. However, this vessel proved to be patent after explantation (patency rate: 100%). In the group with balloon dilatation preceding the autograft insertion, by micro-Doppler ultrasound, 16 vessels were occluded and 14 were patent. At different times of follow-up, in this group the summarized patency rates were 50%. The patency differences in both groups with autografts proved to be significant, both after micro-Doppler imaging and by histological evaluation (p < 0.001). For clinical use the balloon dilatation is recommended to remove a thrombus or to dilate a spastic vessel segment in anastomized vessels threatening the success of microvascular flaps. In this training model of microvascular surgery we demonstrated the thrombogenic effect of balloon dilatation.

The etiology of the osteoarthrosis is a multifactorial causality. Some factors, the preosteoarthrotic deformities, which concur with the recovery, are well known. The factors of the primary osteoarthrosis are still in the dark and require research. It is presented, that by the miner, the co-operation of several preosteoarthrotic deformities, especially the preosteoarthrotic deformity "repeated knee microtrauma" with unknown factors, leads to the high rate of knee wear and tear which makes the osteoarthrosis after occupational knee strain by mineworkers into an occupational disease.

Pathological fracture in histologically proven post-Paget osteosarcoma of the humerus is a rare complication. Due to individual requests as well as age and comorbidity, a course of primary palliative treatment was chosen in the present case. Survival time after diagnosis was 9 months and the patient died of a tumor-independent disease. Even in combined treatment, consisting of surgery and (neo-)adjuvant radio-/chemotherapy, prognosis of osteosarcomas secondary to Paget's disease remains very disappointing. Therefore, in treatment of this highly lethal tumor the patient's individual requests and personal situation often require more consideration than in many other malignancies.

We report 3 individually different cases of primary chronic osteomyelitis. Neither the plasmacellular nor the sclerosing forms caused diagnostic or therapeutic difficulties whereas the case of a 40-year old male patient with a Brodie abscess in the tibial head could not be diagnosed unless the untreated abscess had perforated into the knee itself and empyema of the knee leaded to operative treatment and finally diagnosis of the Brodie abscess. Follow-up X-rays in weekly periods or MRT could have been helpful to avoid delayed diagnosis.

Over a long period of time the dislocated and unstable fracture of the femoral neck has been called "the unsolved fracture". Regardless of all technical improvement developed the head- and joint preserving treatment of this fracture seemed to remain an "unsolvable" problem. Fundamental reason for this discrediting judgement was the continuously high rate of complications like segmental collapse of the femoral head and pseudarthrosis of the femoral neck. The invention and speedy acceptance of hip joint replacement made many surgeons hope that the "unsolved" problems of treating femoral neck fractures could be guided to a definite conclusion. This revising discussion is done to bring home being familiar with the experience gained by practising the head- and joint preserving surgery of femoral fractures.