Archiv fur orthopadische und Unfall-Chirurgie最新文献

The postoperative clinical course and late x-ray results after plastic reconstruction of the cruciate ligament with a meniscus. Presented here are the postoperative results after plastic reconstruction of the anterior cruciate ligament with the medial meniscus. The periods of observation cover up to 29 years. 14 patients were personally re-examined, 3 were accounted for after answering a questionnaire. Only 2 cases showed severe instability and 13 cases gonarthrosis of varying degree. 13 cases were satisfied with the results of the operation. 16 patients were able to maintain their occupations, 5 changed their professions. The majority of patients is involved in athletic activity of wide variety, 6 participate in competitive sports.

The authors assert the usefulness of the scintigraphy in the early diagnosis and/or for the confirmation of the main complications connected with the artroprosthesis of the hip. Such investigation is effective only if it is carried out at a distance of at least six months from the operation and must be completed by clinical, bio-humoral and radiographic tests. This study is based on the observation of 40 cases, of which 20 represent the control group. The isotope used is the Tc99m-pyrophosphate.

The forefoot reconstruction as a routine treatment, is increasing in significance, not only in treating polyarthritic patients, but also after numerous surgical failures in treating halux valgus or hammer toes. Far from being a simple operation, the reconstruction requires an exact knowledge of the physiopathology of the foot. Special attention should be given to the digital and metatarsal formula. Based on an analysis of 200 forefoot reconstructions, the advantages and the disadvantages of the various methods are discussed. For the first time in the German speaking countries, the frequency of occurrences of the different digitial and metatarsal formulas has been compiled in tables from an examination of 500 forefeet.

From experience with 58 own cases the authors found that Morton's metatarsalgia due to a sclerosing neuroma of the plantar digital nerve is very often not recognised for many years. As this painfull affection easily can be cured, the clinical symptoms and histological findings, the diagnostic steps and treatment are described and the etiology discussed. For the excision of the plantar digital neuroma, situated generally between 3rd and 4th metatarsal head, the dorsal web-splitting approach is preferred because of better scars and immediate weigt-bearing. The operation is performed on outdoor patients. There were no complications. The results of 35 operations two or more years back show immediate and complete relief of pain in 31 cases and significant but incomplete relief in 4 cases.

The increase of knee lesions within the last years has provoked a generally more intensive discussion about the functional anatomy, the biomechanics and the pathophysiology of the capsule and ligaments of the knee joint. Several authors have stressed the importance of the active and passive factors, stabilizing the knee joint. The injury to a single element leads to different instabilities, as proven by meticulous clinical and radiological diagnostic procedures. The progress in the treatment of fresh and old injuries of knee ligaments is connected with the names of O'Domoghue, Slocum, Larson, Hughston, Nicholas and Trillat. For a fresh completely ruptured ligament surgery is recommended. Torn menisci are reattached whenever possible. An initial graft can be necessary for ruptures of the anterior cruciate ligament. Complex injuries, which are found most frequently, have to be dealt with completely. Old injuries of capsule and ligaments may require a plastic reconstruction. For the reconstruction of the anterior cruciate ligament it has been proven useful to take distally attached tendons of the pes anserinus group as well as the free graft from the central 1/3 of the patellar ligament. Rotational instabilities have to be dealt with according to the type of instability. The techniques of Slocum and Larson and the "five in one" reconstruction by Nicholas have to be emphasized as treatment of the anteromedial rotational instabilities. McIntosh has shown a procedure which seems to be successful for anterolateral rotational instabilities. Several techniques have been compared with our own experiences and late results studied. The point is stressed that further progress has to be made for the treatment of injuries to ligaments of the knee.

This is a report about the histopathological findings after excision of the inflammably overhead paratenon at top sportsmen, which were operated of cause of a paratenonitis. The good clinical results are written and the histological findings are described and discussed. The development of the paratenonitis is decleared. Pathological alterations of the paratenon at the tendon itself are difficulty to merk off. At the sportsmen the etiology of the disease is often a mechanical overloading of the tissue.

In 60 cases typical compression fractures of the calcaneus were achieved by means of static compression of the test preparation. Afterwards the load bearing capacity of the fractured calcaneus was studied. In case of pure vertical compression the calcaneus does not loose much stability. The load bearing capacity of the studied bones after fracture achieved on an average still 63% of the initial value. In adequate cases of compression fractures, not only the early mobilization but the early weight bearing has to be discussed.