Beitrage zur Orthopadie und Traumatologie最新文献

The intraosseous wiring, using two wires twisted on both sides, is an essential enlargement of the operative techniques of osteosynthesis and arthrodesis at the hand skeleton. Its efficiency results from the bio-mechanical principles of tension-band stabilization and inter-fragmentary compression. Indications are transverse fractures, pseudarthroses and corrective osteotomies of the metacarpals and phalanges, interpositions of bone grafts, replantations and finger transpositions as well as arthrodesis of interphalangal joints.

From 1983 to 1989 we performed about 4,000 arthroscopies of the knee in our hospital. Iatrogen lesions of the cartilage were the most frequent complication. Other complications were edemas of the subcutaneous tissue, the necessary of arthrotomy, long operating time, subcutaneous hematomas, postoperative effusion or hemarthrosis and thrombosis. The rate of severe complications was 0.5% as described by other authors. Arthroscopy has a low rate of complications, but it isn't a method without risks.

On the basis of 4 patients from our own records we describe the rare syndrome of "Hyperostosis sternocostoclavicularis". The etiology of this disorder is still unclarified. In addition to a swelling that is generally only slightly tender to pressure, the most important symptom is usually a long-standing, intermittent, dull pain in the upper sternum, the claviculae and the adjacent uppermost ribs. Laboratory diagnosis usually shows an accelerated blood sedimentation rate, but other laboratory findings are unremarkable and rheumatological serology gives a negative result. The changes detected by radiography are described, as are the histological findings. Primary or secondary malignant osteomas are also to be taken into account in differential diagnosis. For therapy most authors recommend medicinal treatment with non-steroidal antiphlogistic agents.

We report on arthroscopic procedures of 279 shoulder joints which were done in two hospitals of East-Berlin. We stress out the intention to arthroscopic diagnostic and simultaneous surgery. Arthroscopic surgery was mainly performed as resections and exstirpations. In cases of luxation and severe rotator cuff tears the open revision was necessary to perform.

Differentiating from the indications to an acute or early arthroscopic procedure in cases of injuries of athlete's knee joints the consequence of an early arthroscopy in this patient group is demonstrated in cases without haemarthrosis. If conservative treatment is unsuccessful an early arthroscopy is particularly indicated in these cases due to the shortening of the required time of treatment.

This study aims to localize the ligamentous lesions in distinct knee joint instabilities. For that reason 41 human cadaver knee joint specimens were tested in a three-dimensional determined apparatus. Ligaments were successively dissected and forces and torques were introduced. Both cruciates are the dominant structures in preventing straight anterior und posterior movement of the tibia. As a supporting element the postero-medial capsule prevents anterior dislocation in ACL-deficient knees. Therefore extraarticular procedures in cruciate instabilities will not be successful. In contrast varus- and valgus instabilities resulted after transsection of a couple of ligaments. Valgus stability decreased after cutting the medial collateral, posterior oblique and both cruciate ligaments. The most important element in preventing straight varus instability was the lateral collateral followed by the posterior cruciate ligament, while the popliteus tendon had only little influence. Therefore in medial and lateral instabilities all supporting structures should be exposed and reconstructed.

As a glenohumeral instability is defined each case of transient recurrent and permanent decentration of the joint. We propose to differentiate primary and secondary glenohumeral instabilities. Arthroscopical diagnostic is helpful to classify the luxation and subluxation and for verify transient instabilities. In cases clinically snapping phenomena were noticed, arthroscopic findings were documented. A relation between those phenomena and arthroscopic findings is discussed.

We reviewed experiences and results of six shoulder and nine elbow joint synovectomies, performed in a time period between 1989 and 1990 by arthroscopic technique. The operation technique is pretentious an requires some expenditure. The postoperative course distinguishes itself by little pain and early increase of range of motion.

In the area of the hand the carpo-metacarpal joint of the thumb together with the metacarpo-phalangeal joints is the most important joint according to the function of the hand. Its reduction of movement leads to misfunction of the thumb and the whole hand. Osteoarthritis of that very special joint commonly occurs in females after the menopause. The increasing severeness of the arthrosis is often complicated through pathological positions as well as through contractures (so called Z-deformities). In these patients operative treatment for improvement of function is very often not avoidable. Especially in the elderly patient with reduced manual work the implantation of a cemented carpo-metacarpal prosthesis (created by de la Caffinière) seems to be a useful treatment. As in all cemented implants the disadvantage is the danger of aseptic loosening of the prosthesis.

The mechanical stabilizing effect of artificially applied muscular strength to the peroneal tendons was examined in an experimental study using cadaveric lower legs with unstable ankle joints. Therefore the anterior fibulo-talar and the fibulo-calcanear ligament was dissected and the resulting instability with examination of the anterior drawer sign and the talar tilt was measured under standardized conditions. After initial measurement under standardized conditions a muscular strength of 75 N and 150 N was applied and the resulting stability was measured again. In a second experiment an additional orthotic device was applied and the stability was measured again under applied muscular strength. The results demonstrated that stable conditions at the lateral unstable ankle joint are only achievable when a muscular strength of 75 N (ant. drawer sign) or 150 N (talar tilt) is combined with the application of an orthotic device. For clinical treatment this means that functional treatment for ankle sprains with application of an orthotic device needs additional training for improvement of the muscular strength of the peroneal muscles.