Unfallchirurgie最新文献

In a retrospective study the operative results of 200 patients with chronic subdural hematoma were investigated. In the majority of patients a burr hole and a closed drainage was performed. The operative result was very good (resumption of normal life) in 67.5% of the patients. Operative mortality was 4.5%, in these patients an obvious connection was appearant between the result and the poor preoperative condition. The recurrence of hematomas required a second operation in 8% and a third in 1%.

The object of this study are transport vehicle accidents (ICD-E Code 800 to 829) in children and adolescents. During the years 1980 through 1989 there were 3660 such casualties in persons under 20 years of age in Austria. The investigation is based on data available on death certificates. The mortality rate (per 10,000 child years) for pedestrians was 0.20, for pedal cyclists 0.06, for motor cyclists 0.35, and for others (mostly car occupants) 1.19. For older teenagers (15 to 19 years old) these rates were 0.23, 0.06, 1.12, and 3.25, respectively. The male to female ratio was 3.26:1. Subgroup-analysis of pedestrians revealed a difference in injury pattern due to different body proportions: the ratio of head injury deaths to spine injury deaths was 3.7:1 in children less than 10 years old, but 11.6:1 in teenagers. In this latter age group head trauma was more common an injury leading to death in pedal cyclists than in motorcyclists (79%:66%). It is worthwhile to recommend and promote the use of bicycle helmets. However, the problem with bicyclists is rather small compared with that of the motor-vehicle related mortality of adolescents.

In a first experimental study we investigated the visualisation of metal implants in reference to dimension, shape, material (titanium, steel, biodegradable screws) and surface structures and an eventual change of the echo pattern in correlation to the surrounding structures, the vicinity to bone and the change of the sound angle. For this purpose ultrasound investigation was performed in artificial and cadaver bones and in cadaver limbs after implantation of screws, plates, K-wires and cerclage wires. We found that metal implants of a certain dimension can be localised by typical artefacts (resonance artefact, comet tile artefact). In the following clinical study we investigated the value of ultrasound in finding and localisation of implants after osteosynthesis. In patients with 25 locking femur nailing, 30 locking tibia nailing, 30 osteosynthesis done by screws and plating, metal was easily localised by typical artefacts. Ultrasound examination gave the possibility to define the number of screws, the localisation to surrounding tissue, loosening of screws and eventual as sociated inflammatory tissue swelling (bursitis, tendovaginitis).

From 87 patients who underwent anterior cruciate ligament (ACL) surgery with an alloplastic ligament (Trevira hochfest) the radiographs of 77 patients were examined by 2 physicians, who were not involved in the operation. They evaluated the increase of degenerative osteoarthritis according to the classification by Holz [12] finding a significant increase of degenerative osteoarthritis after surgery with a mean follow-up of 41.2 months. The ligament reconstruction was performed in 50 fresh ACL tears by reinsertion plus synthetic ligament protection and in 27 chronic instabilities with several failed previous operations by using the alloplastic ligament as an ACL prosthesis by means of a salvage procedure. Both investigators found a significant increase of degenerative osteoarthritis in both groups, but the chronically instable knees had a higher initial value. Patients with concomitant meniscus and/or posterior cruciate ligament (PCL) ruptures showed the highest increase of osteoarthritic changes; isolated ACL tears were found with very low degeneration. Considering the special profile of our collective, the factors that were found to as a risk of osteoarthritis and the comparison with the literature we could not find any indication for a relevantly increased risk of osteoarthritic progression using the Trevira hochfest ligament.

Fractures of the femoral neck and the intertrochanteric region account for 7.2% of our surgically treated trauma-patients. Thanks to gentle anaesthetic methods, pre- and postoperative intensive care, and using dynamic hip screws for stabilizing intertrochanteric fractures or total hip replacement in hybrid technique for fractures of the femoral neck, hospital mortality has decreased to 4.8%. A rate of 8.5% local complications, 5% of them needing revisional surgery, did not influence the final outcome. However, success of rehabilitation of the elderly patients is limited by pre-existing multimorbidity. Despite of achieved weight bearing strength of reconstruction, the number of people confined to bed increases from preoperative 4.9% to postoperative 11.5% at the end of 4 weeks hospitalization and up to 22.6% after 1 year. The need for permanent help in daily life activities, provided by the family or nursing homes increases from 50% to 80% after hospital discharge, usually with an increasing need for care. In the future--besides more and better organized out-patient physiotherapy--only more possibilities to look after the patients in their own families or the supply with an increasing number of places in nursing homes will give a chance, to provide a maximum of rehabilitation for these patients.

Recurrent haemarthros is described as consequence of cruciate ligament repair. The main cause of haemarthros is described after unisometric fixation of the ligaments which leads to the rupture of the synovia membrane. This is a case report of a young man, who suffered from recurrent haemarthros for several years although he has intensively examined by radiological and arthroscopical means. It was falsely presumed to be a muscular arthrophy. The cause, however, was found in a wire suture, which was used to fix the anterior cruciate ligament in the femoral bone. This suture was laying under the synovia within the ligament and there fore could be seen and taken away arthroscopically only after total synovialectomy.

The human posterior cruciate ligament (7 unselected specimens) consists of 2 different bundles with a common tibial attachment: 1. a thin, flat and slightly twisted posterior bundle running to the posterior medial condyle taut in extension and lax in flexion of the knee, 2. a thick oval anterior bundle with parallel fibers running to the roof of the notch lax in extension and taut in flexion. This contra-tensile function explains the different posterior instability in extension or flexion of the knee in case of an isolated rupture of only 1 of these bundles.

Fat embolism is since many decades a known and feared complication of fracture of long bones, polytrauma and also in endoprosthetic surgery. During this literature study old and actual experiences about fat embolism, in reference to pathophysiology and diagnosis, were summarized, the actual state of knowledge defined and also different possibilities of reducing fat embolism risks presented and evaluated. In order to estimate the clinical importance of fat embolism, 106 cases of fat embolism (51 clinical and 55 death cases) after hip and knee endoprosthesis were obtained from the literature and retrospectively compared with the results obtained by our own patients. Within a period of 10 years there were in Kantonsspital Liestal 834 primary hip prosthesis and 235 revisions, with 3 deaths. In none of the cases, fat embolism could be shown. Seven patients had respiratory complications after operation, but in only 2 cases the suspicion of fat embolism could not be excluded with certainty. Only 1 case out of 6 patients who had to stay in the intensive care unit after the operation could possibly be connected with intraoperative liberation of fat. At the end of this study simple and clinical proven methods are suggested, which can be helpful to reduce the risks of fat embolism.

We implanted in case of hip-near fractures of the femur after DHS the anti-rotation screw with help of a special parallel drill guide. It was possible to position the anti-rotation screw in a parallel fashion in all patients so that the dynamic effect of the DHS was not impaired and a faulty penetration of the screw into the hip by a badly positioned anti-rotation screw could be avoided. The radiological follow up shows us no sign of impaired healing.