Zeitschrift fur Unfallchirurgie und Versicherungsmedizin : offizielles Organ der Schweizerischen Gesellschaft fur Unfallmedizin und Berufskrankheiten = Revue de traumatologie et d'assicurologie : organe officiel de la Societe suisse de ...最新文献

The combination of an ipsilateral clavicule and scapula fracture causes a double instability of the shoulder. In opposite to an isolated clavicule or scapula fracture this injury should be treated operatively. Diagnosis of the scapula fracture in polytrauma can be difficult. If there is a clinical or radiologic suspicion, the indication for a CT scan is given. Osteosynthesis with plates from separated approaches, first the scapula from dorsal then the calvicule from ventral has proven good. The nervus suprascapularis must be treated carefully and, if necessary, liberated from the fracture. The optimal treatment of this injury is not always possible in polytraumatised patient.

An untraumatic method for the reposition of dislocated shoulders without any analgesia is presented. That the way of this method must be right, is proved by a short historical view and by case reports; On one side by the inventor of this method and on the other side by a retrospective study from the orthopedic department of the Kantonsspital of St. Gallen. How to do this reposition is clearly described by words and pictures.

A well proved method for the conservative treatment of fractures of the humeral shaft is clearly shown by words and pictures. A study of 36 own cases during the years 1985 up to 90 informs on the problems of conservative treatment of these fractures. Even if there is a perfect primary reposition, impossibility of proper retention in the plaster cast may lead to post-primary osteosyntheses (2 cases in 36). Despite correct conservative treatment there are always delayed unions in a certain percentage (6 cases in 34), which you can't recognize before 3 months after injury, but then should bring them to operative treatment. There is quite a high number of pseudarthroses (4 cases in 32). It is still unclear, which type of fracture and which type of patient is going to build up a pseudarthrosis. In conservative treatment, the most important thing is--compared to operative treatment--a very closed and carefully observing aftercare.

Normally a bursectomy is the choice of therapy when a bursa of a joint is opened through trauma. A primary closure was performed on 10 patients, selected according to certain specific criteria. Nine out of ten cases showed no complications with good short and long-term results.

With both treatments good results are achieved. In cases treated with the hook-plate mobilisation and load putting are earlier possible. These patients are sooner back to work. The costs for the hook-plate are higher. To take out the hook-plate a second hospitalisation is necessary.

In a retrospective study we analysed 29 operative treated fractures of the Talus. The classification of Marti and Weber has been used in this study. The incidence of necrosis was 17% of the group III and IV and that one of arthritis 27%. There was no infection in our series. We doubt that a longterm non weight-bearing with a caliper brace has an effect on the outcome of a necrosis of the Talus. The evidence of the Hawkins' sign on the ap-radiograph at 6-8 weeks is a good and simple parameter of the vitality of the Talus.

The follow-up of 8 patients with scapular fractures showed a high rate of complications with 3 infections and problems with the osteosynthetic material. This did not effect the results in any case, most results were good. The indication for the operation should be proved restrictively, the following operative treatment should be minimal invasive. CPM-devices were used after operation and had a positive effect.

We report on 17 posterior shoulder dislocations which were investigated by SUVA's medical service during the past three years. We can confirm the information in the literature, that the diagnosis is initially often missed (4 out of 17) and that the injury is often sustained in epileptic fits (4 out of 17). Among our patients, however, the time at which the diagnosis was made did not obviously influence the results of the treatment. After treatment, over half of our patients have an impairment which, in three cases, resulted in integrity compensation, in one case in a recommendation for vocational retraining, in one case in a change of profession and in one case in a pension.

Displaced subcapital fractures of the humerus are difficult to manage due to the specific anatomical and biological conditions in the proximal humerus. With respect to the fracture type and extent of displacement of the humeral head and the tuberosities the concepts for treatment remain controversial. A large spectrum of recommendations for the treatment of unstable subcapital fractures are known ranging from conservative treatment, open reduction and internal fixation using different implants to the primary prosthetic replacement of the humeral head. Recent results from basic research emphasize the importance of sound tissue viability for undisturbed fracture healing and influence today's strategies in fracture management. Minimal exposure of the fracture area, indirect reduction techniques and a minimal but optimal biomechanical use of implants can help to avoid some of the possible (and partially iatrogenic) complications. Fixation of subcapital humeral fractures by intramedullary pinning seems to provide sufficient stability without damaging the vascularity of the fracture fragments leaving intact in addition the soft tissues around the shoulder. The treatment of proximal humeral fractures by the use of Prévotnails is presented in this paper and some possible problems of the method are discussed.