Archiv fur orthopadische und Unfall-Chirurgie最新文献

The causes for revalgisation after varus osteotomies are examined in 153 follow ups. Varus osteotomies which slow an insuffizient fixation due to faulty technic or use of Kirschner wires demonstrate only a slight degree of revalgisation. In contrast, stable fixation leads to post-operative revalgisation directly proportional to the time of rigid fixation, we therefore recommend the removal of the fixation device after osseous consolidation, i.e. after 6 months.

Whiplash injuries of the cervical spine are due to the rapid sequence of movements in opposite direction. They are mainly following rear-end collisions where the trunk is pushed rapidly forward. Very important forces act therefore on the different segments of the cervical spine and lead to lesions of the perispinal soft tissues, of the ligaments, of the disks and the bony structures. In 24 tables, the signs and symptoms in 104 personal cases observed for a period which lasted more than 4 years are described. Amongst the clinical signs there are cervical strain, cervico brachial pain, headaches, radicular signs as well as symptoms of concussion and cercial medullar lesion. Radiological findings are discrete; functional X-rays sometimes show local diminution of motility in a single segment. The treatments, amongst these immobilisation and local heat, are discussed. The unusually long duration of local disturbance is stressed. Signs of neurasthenia are part of the typical findings and do not at all mean a secondary neurotic development.

At least 16 cases of posttraumatic chondromalacia of the patella out of a total of 79 patients operated between 1968 and 1971 were diagnosed on the basis of a questionnaire and follow-up examination. The clinical findings and delineation of this complaint from femoro-patellar osteoarthritis are discussed. The diagnosis was confirmed by arthroscopy in 2 patients. The significance of cartilagenous damage due to direct contusion is pointed out. The mechanisms which result in a degradation of the cartilagenous layer in the weeks following the accident are mentioned. The therapeutic consequences for the treatment of fractures of the patella are as follows: One must aim at exact bony reduction. Macroscopically damaged parts of the cartilage should be removed. Indication to partial patellectomy should be on a broad basis. A long term treatment with salicylic acid or Chloroquin-both of which are said to prevent enzymatic degradation of cartilage-should be considered.

A method of joint surface replacement for the operative correction of severe osteoarthrosis of the hip joint is described. This type of surface replacement has obvious advantages especially in the younger age group. From experience with homogenous carilage transplants in which only the joint cartilage surfaces are transplanted, the method described offers hope of good results. The important advantage of surface replacement is the fact that the substance of the neck and head of femur are not removed. Therefore all alternative future procedures remain available if necessary. Accurate assessment of this method will require more prolonged follow up.

Intraosseous injection of physiological saline or local anaesthetic (prilocain) results in a marked relief of rest pain in rheumatoid shoulder. 28 shoulders were treated in tis way and the intraosseous pressure of the proximal end of the humerus was measured with simple central venous pressure equipment. The intraosseous pressure tends to decrease after injections.

Due to mass participation in certain sports combination injuries of the knee joint have greatly increased in number. To a certain extend injuries of the cruciate ligaments are typical. According to our own follow-up studies the immidiate suture of the ligaments leads to better results than late reconstructions which emphasises the early diagnosis of an injury to the cruciate ligaments. Old and new injuries to these ligaments present diagnostic problems. Therefore the mechanism of injury, the symptomatology, and both clinical and radiological possibilities for the diagnosis of damage to the cruciate ligaments are demonstrated.

Results of follow-up investigations on 45 patients with hip operated between 1968 and 1973 after the method of Chiari are reported by the authors. The post-operative development of the C.E. angle (Wiberg) and of the acetabular inclination angle (v. Lanz) are discussed. Attention is drawn to the necessity of X-ray films taken in a second projection (Fauxprofil view). With the aid of arthrography of the hip joint it is demonstrated that the most important demands of acetabulum formation surgery, namely the antomical congruence of the joint components, can be achieved by means of pelvic osteotomy after the method of Chiari.

A critical analysis of X-ray signs induced by the interaction of a bone tumor with bone itself is presented. These enables the physician to recognise a pattern of characteristic findings for each particular tumor. Clinical examples are demonstrated illustrating at the same time a schematic classification of those signs on a roentgenogramm which in many cases facilitate the prediction of the specific diagnosis and in consequence the prognosis of the lesion. The need for an effective cooperation between the involved specialties is stressed.

20 samples of human cortical bone removed from the subtrochanteric region after introchanteric femoral osteotomies with subsequent fixation by a blade plate were examined for studies of the phenomenon of cancellous transformation. Previous experiments with animals can be confirmed. A dilatation of Haver's canals in the direction from endosteum peripherally becomes apparent. This quantitative loss of cortical density is associated with a loss of mineral density. Under polarisation and scanning microscopy a derangement of collagen fibrils usually arranged in an oriented fashion can be shown. The loss of mechanical properties is discussed in connection with the derangement of orientation of collagen fibrils.

The period of applicability during polymerisation of four well introduced bone cements (Sulfix-6, CMW, Simplex, Palacos) was measured by a subjective method in function of room respectively conditioning temperature. Simultaneously temperature in the cement and mechanical admittance (transfer of oscillation of 750 Hz) were registered. The duration of working-up period and plymerisation period depends considerably from the room temperature. An increase of 10 degree C accelerates polymerisation by a factor of 1.5 to 2.0. The working time of the products differs widely. Increased room temperature means also increasing maximum polymerisation temperature. Mechanical admittance is an interesting measure for the objectivation of the working period. Discussing new ISO standards a proposal is made for more accurate determination of the end of the working-up period (set time).