Magyar traumatologia, orthopaedia es helyreallito sebeszet最新文献

Authors performed in 1979 through 1991 in the Orthopaedic Department of the Semmelweis University of Medicine 47 osteotomies on the base of the first metatarsal bone in 37 patients. After the operation the intermetatarsal angle was in average under 10 and the metatarsophalangeal angle under 20 degrees. In chosen cases and with careful surgical technique good result can be obtained from the osteotomy of the base of the first metatarsal bone. The technique is not complicated, the osteotomy is healed quickly and well and the internal fixation makes early mobilization possible. It can and should be carried out in cases in which the intermetatarsal angle exceeds 10 degrees. After its performance, if necessary, operation beside the metatarsophalangeal joint may also be carried out.

Authors report on 20 arthrodeses of the talocrural joint performed in infected surrounding. The accident anamnesis was the following: Talar fracture (3 cases), malleolar fracture (10 cases), "pylon tibial" fracture (7 cases). The operative method was a simple transversal resection and fixation with fixateur externe. The average time of bony fusion was 9.9 months. The patients were controlled in average 3.8 years after the operation. 17 patients could be controlled, all of them could walk. 6 have their original jobs, 4 have an easier work, 7 are invalids. 12 patients have no pains, 5 have major or minor complaints. All patients judge their state as being better than before the operation.

The treatment of burned patients is frequently carried out under compulsion in more phases. The prognosis may be favourably influenced by the expert intervention in due time, on the other side deteriorated by transport in critical condition without adequate preparation. The optimal time of the secondary transport corresponds approximately with the end of the critical condition. Authors describe the criteria on the basis of which the condition of the burned patient may be considered as stable during the period of the transport to be expected. The necessary measures during the primary hospital treatment are enumerated.

Authors report on their experiences gained in 69 operations for acetabular fractures. From the diagnostical possibilities the role of the computer tomography is stressed, the value of the not comparable information, rendered by it, underlined. They deal with the operative technique, the complications, the after-treatment and describe the results too.

Bilateral diaphyseal fracture of the femur on different occasions, repeated faulty use of medullary nails and postoperative therapy followed by bilateral fatigue fracture of the femoral neck. Author thought the case because of its lesson worthy of publication.

Authors performed early operative reduction from anterior exposure after unsuccessful conservative treatment on 30 hips of 29 patients in 1981 through 1983. The age of the patients was 6-18 months at the time of the operation. After the excision of the obstacle of the reduction with preservation of the limbus the capsule was closed tight so that it could prevent redislocation. This way it became possible to make functional after treatment without plaster fixation and using Pavlik's harness and abduction splint. It was found that the postoperative development of the acetabulum was accelerated and the development of the acetabular roof reached in average during one year the healthy one and the articular movements were free. The development of the joint was the quicker the younger the age was in which the operation was performed.

Authors describe the operative treatment of a tangential tissue defect with severe crush in the region of the external malleolus. Because of the injury with bone defect and opening of the joint an arthrodesis on the talocrural joint was performed. The opened joints and the free bone surface were covered with primary a. dorsalis pedis island flap plasty. Healing without complication was reached.

Authors report on their experiences with the treatment of thoracic empyema developing from the suppuration of haematoma following thoracic injury. In 30 of 82 patients suppuration of the thoracic cavity has developed. 6 of the 30 patients with empyema were treated first in our Department all 6 healed on drainage whereas in 24 patients, admitted from other departments, the following measures were necessary: 2 pleura lavages under the control of thoracoscope, 3 early decortications, 14 decortications, 5 lung resections and decortications with a decrease of the respiratory surface. Attention is called to the necessity of early and adequate treatment which is a prevention of complication (suppuration). Light is given to the factors which most frequently promote suppuration of the thoracic cavity, developing from traumatic haemothorax. Attention is called to secure the necessary personal and material conditions to the preventive treatment.