Archiv fur orthopadische und Unfall-Chirurgie最新文献

In all specimens the cross-sections of bone taken at 4 marked points showed atrophy of the cortical bone which had occured in a typical manner. In the 1-week specimens no qualitative changes could be observed by normal light microscopy. In the 2nd week, however, a vivacious bone remodelling with wide Haversian canals and vessels starts from the medial cortex as could be seen identically in every series of our experiments. In the 4th week and especially in the 6th week it becomes also apparent on the lateral, dorsal and ventral wall. In the 12th week bone remodelling is still active but obvious diminishing of the osteons can be observed between internal and external lamellae. In the 24th week only solitary enlarged sinus and few osteons are found medially and laterally. Alltogether the cortical bone has become very thin. The bone remodelling has stopped and this state is characterized by loss of osteons and abundance of intermediate lamellae. Already in the 1st week polarisation microscopy shows a certain demascating of the collagenous fibres opposite to the plate. The control specimens do not show changes of the collagenous structure in this area. In addition to these results histomorphometric investigations of 1-week specimens revealed a quantitative increase of Haversian canals which are located closer to the medullary space as well as to the side opposite the plate. This result is due to the fact that the bone remodelling starts from the cortex opposite to the metal implant.

The fixation of a fracture in a plaster cast, or in traction is not absolutely rigid. Experiments were carried out on adaver tibial fractures placed in long leg plaster casts. It was observed that the possible deformity ranged between 4-8 degrees in a well-padded cast and 2-5 degrees in a nonpadded cast. Further observation were conducted while hip osteotomies were compressed by external fixator. These osteotomies are further protected by hip spicas. It was demonstrated that increasing the length of the cast did not increase the degree of fixation. It is suggested that fracture healing in conservatively treated cases is optimal if movement of the fragments remains within the physiological elastic limits of the not fractured bone. Fracture healing can be disturbed not only by extensively denudation and soft tissue disturbance, but also by under-or overstressing the bone and by unphysiological immobilisation.

30 fracture-dislocations of the hip were operated in the years 1967-1973. Indication, operative approach, X-ray diagnostic and complications are discussed. Postoperatively continuous traction is applied for some weeks, 26 patients were followed up with 11 very good, 10 good, 3 fair and 2 poor results. It is pointed out, that open reduction with interfragmentar compression - osteosynthesis is a real progress in the treatment of irreducable fracture-dislocations of the hip.

Electromyographic examinations of the paravertebral muscles were performed on patients after operation of the spine. It was demonstrated that injuries of the paravertebral muscles ocurred in relation to the different grade of intra-operative damage of the dorsal spinal nerves.

A new technique of arthrodesis of the ankle joint by internal fixation with self-compression blade-plates is presented. The both possible techniques of inserting the plate lateraly or medialy are described. We prefer the lateral approach. After resection of the ankle joint we also resect the tibiofibular syndesmosis putting than in a transfixion screw. We than compare under biomechanical aspects the new techniques with Charnley's external fixation with compression clamps. The osteosynthesis with blade-plates gives a higher stability in which external splintage with plaster becomes unnecessary. Following our experiences consolidation occurs after 8 tp 12 weeks.

Report on szintigraphical examinations using 87-mSr in young rabbits treated by direct current of different intensity varying from 2.5 to 40 micro-Ampère. The current was applicated to one tibia using the other as comparison. Corresponding to the realised growth-increase by electric stimulation there was found an increased uptake of 87m-Sr in the electro-stimulated tibia in all 16 rabbits.

With the aid of radiological and clinical functional criteria, the results of 33 hip joints, operated after the method of Salter, are analysed. As in most cases a femoral detorsion occurs as a result of the pelvic osteotomy, basic coupling of the pelvic osteotomy with a femoral osteotomy dose not appear to be necessary. The importance of necessity of exact adherence to the principles of surgical technique, as described by Salter, as well as pre and post operative care, is stressed.