Unfallchirurgie最新文献

Improvements in techniques for the management of open tibial fractures with the external fixator have made a great impact on the final results in recent years. More recently this system has been discussed controversially. The longer treatment takes, the more likely it is that complications will occur when relying solely on the conventional external fixator. The new pinless fixator for the tibia was designed to overcome these problems. Early conversion to a more stable implant is one of the primary goals of this system. In this article the pros and cons are presented in detail and the limitation of this device explained. Moreover first clinical experiences are summarized and possible additional indications highlighted.

Using a functional brace, we treated 67 patients who had a fracture of the humeral shaft over a 5-year period from 1987 to 1992. We analysed several parameters of the fractures to discover those which influence healing. Desault, plaster cast or traction were used before applying a brace in an average time of 15 days. The osseous consolidation was 10 weeks in the average. The functional results were very good and good in 78.3%, acceptable in 18.3% and poor in 3.4% of the cases. Twelve humeral-shaft fractures were associated with a radial nerve palsy. Every patient recovered a full radial nerve function under the treatment with a functional brace. The retentive management of an operative treatment of humeral-shaft fractures associated with a nerve injury can be supported because of our experience.

In a retrospective analysis the clinical history of 202 geriatric patients with vast morbidity who had received hip prosthesis were reviewed. The age of the patients at the time of operation was calculated to a mean of 82.9 years. Hundred and three cases who had underwent cefazolin application as an antibiotic prophylactic therapy were compared to 99 patients who had not received any antibiotics (control group). In comparison wound infections after surgery were less common among the cefazolin group (13.6%) than in the control group (26.3%). Additionally the incidences of reoperations, decubital ulcers and urinary tract infections were statistically significant lower in the cefazolin group as well.

Treatment of polytrauma patients requires a large number of well trained staff and expensive medical equipment. The high medical standard in polytrauma care resulted in a reduction of a 40% lethality in the 70's to 10 to 15% today. The changes in german health systems (GSG) cut down the financial resources and call for careful evaluation of costs in trauma centers. Our analysis of the costs of 1 multiple injured patient in 1996 showed, that the reimbursements of hospital charges ended in a deficit of DM 30,000,-. Our department treats approximately 100 polytraumas a year which implies a budget deficit of 3 million DM per year. Today the aim of trauma centers is the maintenance of a high surgical standard in trauma care together with adequate reimbursement of hospital expenses. Trauma care and life saving interventions must not be shortened by financial restrictions. The trauma surgeon has to take care for his multiple injured patients and balanced financial reimbursements as well.

Total hip replacement is considered one of the most effective treatments in modern medicine. Thus in recent years loosening of total hip prosthesis in elderly patients has become increasingly frequent. An analysis and follow-up study of 63 operations with replacement of hip prostheses evaluating the intra- and postoperative complications shows good results in 50 to 85% concerning pain, function and mobility after a 3-year period. The extended operation matches with a significant win of life quality.

The in-vivo effectiveness of continuous cold pressure therapy was evaluated in 24 patients following elective knee or hip replacement surgery. A cooling of the skin surface down to 8 degrees C resulted in a reduction of the epifascial tissue temperature to 22 degrees C. A significant reduction of subfascial pressure in combination with decreased protein leakage via redovac output were notable. Observing a constant decreased pH-level increased oxygen saturation and reduced drop of base excess were interpreted as signs of reduced enzyme-linked metabolism activity. Clinically these findings were found in correlation to a 50% decrease of postoperative analgetic demands as well as a 20% increased range of motion level.

This is a report of a rare case of an isolated fracture of the trapezium. Origin, diagnosis, differential diagnosis, treatment and complications are evaluated and described.

A new pneumatic compression pump--the AV-impulse system--causes increased return of venous blood from the lower limbs to the heart and increases total blood flow in the lower limbs by emptying the plantar venous plexus. Up to date there exist no experiences with using this system in plaster cast. We studied the maximum venous blood flow, the venous blood flow per minute and the venous diameters above the popliteal and femoral vein by duplexsonography in 12 lower limbs of 6 healthy persons before and after applying below-the-knee plaster casts. After applying the plaster cast we observed a slight increase in venous diameter (p = 0.02). By using the AV-impulse-system we observed a significant increase in maximum venous blood flow and venous blood flow per minute (p < 0.05). We demonstrated a significant increase of venous blood return in the deep veins of the lower limbs after applying a lower limb plaster cast by using the AV-impulse-system. These results indicate the possible benefit of using the AV-impulse-system as a physical method of thromboprophylaxis in orthopaedic and trauma patients with plaster cast immobilisation of the leg.

Infections of the soft tissue and joint are the serious complication in traumatology. We are presenting our new surgical planned revision concept based on the clinical findings and the microbial sensitivity test. This concept shows that a number of radical debridements influencing by the local findings and the sterile results of 2 following cytologic smears led us to a higher certainty in healing surgical soft tissue and joint infection.

The present paper reports the results of 112 extraarticular ligamento-plasties performed on the knee with the procedure proposed by Lemaire. The series includes isolated tears of the anterior cruciate and medical collateral ligament as well as combined tears of both ligaments. The clinical and radiological results with a mean follow-up time of 11.5 years are compared with the results obtained in a first assessment 8 years ago. Good clinical results are in contrast with increasing osteoarthrosis in 1/3 of the knees radiologically assessed. The operation for a torn anterior cruciate ligament should be performed as soon as possible to avoid secondary meniscal lesions with subsequent severe osteoarthrosis. Presence or absence of arthrotic signs in the X-rays mainly determine the long-term result after ligamento-plasties of the knee. The Lemaire plasties are well tolerated even by elderly still active people and need little postoperative care.