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

For correction of leg length discrepancies and for the treatment of segmental bony defects we used a modular AO-fixator knowing that the principle of the distraction osteogenesis is not dependent of a special fixation device. In our small series the AO-fixator proved to be a good alternative to the ring fixator of Ilizarov for the use on the tibia but not on the femur where we noticed a relatively high incidence of complications, especially deformities of the axis. The distraction osteogenesis has proved to be an efficient technique for limb lengthening and segmental bone transport but is high demanding for the patient and the surgeon.

The results of medical investigations following acceleration mechanism to the cervical spine (so called "soft tissue neck injury") are to be described in common diagnostic terms. Biomechanical and legal considerations are beyond medical competence. In certain cases, the clinical examination must be completed in cooperation with specialists. Within the entire medical context, the neuropsychological and neuropsychiatric assessment may contribute to a comprehensive understanding of the consequences. In cases of litigation, the full array of facts, like the patients' previous history, and differential diagnoses, have to be drawn to attention. At present, compensation takes place only exceptionally and in a limited range, if an impairment by an accompanying brain injury is excluded.

During the past decade several new techniques for the treatment of children's fractures respecting the specificity of the growing bone have been described. The goal of all these techniques was to mechanically stabilise the fracture however to preserve a certain instability of the fracture gap itself inducing early callus formation and subsequent consolidation. The dynamic external fixation as well as the elastic stable intramedullary pinning have become accepted means in the treatment of long bone fractures in the paediatric age group. We report our experience of the last seven years with the intramedullary pinning of 105 fractures. Eighty-four were fractures of the femur, 9 of the humerus, 8 of the forearm, and a further 4 of the tibial shaft. The intramedullary elastic pinning represents a simple technique which supports or even enhances the natural process of fracture healing of the growing bone. The method is not very invasive, is cost effective, and allows short hospitalisation. Early physical activity is guaranteed due to early consolidation of the fracture. Complications are rare and the final orthopedic and cosmetic outcome is excellent.

In the present study 58 out of 105 patients, who had been operated on for anterior cruciate ligament rupture from 1980-1992 by the same experienced surgeon, were followed up clinically and by X-ray examination. Most of them were sports accidents, above all skiing and soccer. In 11 patients an isolated rupture of the anterior cruciate ligament was found, the remaining 47 had sustained additional injuries (mainly the medial collateral ligament and the medial meniscus). In 52 cases the operation was performed with primary repair of the anterior cruciate ligament. For chronic instability 4 patients (7%) had to be treated with secondary anterior cruciate ligament reconstruction. In the follow-up study 60% of all patients achieved a Lysholm-score of 95-100 points, 19% of 84-94 points. The remaining 21% achieved less than 84 points. In the side to side comparison the Lachman Test was equal or showed a slightly diminished stability of the operated knee in 91% of 54 patients without secondary reconstruction. The anterior stability with 90 degrees flexed knee in neutral position was within a similar scope, the anterior medial stability was a little worse. In 48% of all patients we found radiological signs of osteoarthritis (stage II and III according to the classification of Jäger and Wirth).

From the beginning of 1988 to July 1991, ten Swiss and German clinics undertook to document all cases of internal fixation using the titanium LC-DCP as part of a prospective multicenter study. The follow-up period was 14.2 months on average. The clinical results of 504 fixations were convincing. The follow-up rate was 72%. Of these, 95% healed without complication. The most frequent complication was delayed healing which occurred in 2.5% of cases. The infection rate was low (1.1%). A separate comparison of DCP fixations on the tibial shaft in 1984-1988 demonstrated the obvious biological compatibility of the new plate and shows that excellent results can be obtained using plate fixation.

Clinical experience has often demonstrated the inadequate relationship between degree of injury and rehabilitation outcome. The aim of this study is to investigate the importance of different psychosocial factors in coping behaviour after lower back injury. 194 patients of three nationalities (Swiss, Italian, Yugoslavian) were examined, 70 in an acute and 124 in a chronic phase of injury. A semistructured interview, followed by a physical examination, was used to gather the needed information; a follow-up examination was done one year afterwards. Factors shown to contribute to poor outcome were: reduced sense of wellbeing, pessimistic self-prognosis of outcome, poor job security, migration, social status, insufficient doctor-patient relationship, lack of social support and limitations in certain physical parameters. The most reliable predictor for poor outcome was the patients evaluation of job security. In addition to diagnosis of existing chronification, resumption of work "for therapeutic purposes" after thorough preparation of the patient and conclusion of cases within the shortest possible time with definitive settlement of insurance payments were proposed as concluding steps.

In a retrospective manner we studied the injury pattern of 2053 patients following a skiing accident that required hospital admission in the year 1984-1992. Of these 361 or 18% were categorised as severely injured according to the AIS/ISS scoring system. 31% of these 361 skiers were injured by colliding at considerable speed with either a moving object (other skier, snow cat, ski-lift, etc) or fixed obstacles (trees, rocks, pilons, etc) along the ski slopes. As the most extensive injuries seem to result from collisions with the latter, fixed obstacles, it should be requested that more protective measures are being taken to prevent such severe accidents.

Acute compartment syndrome is a serious complication of trauma to the extremities. Increases in intra-compartmental tissue pressure result from increases in fluid pressure. The indication for a fasciotomy in impending compartment syndrome depends on the tissue pressure. To facilitate the diagnosis of high intramuscular pressure in acute and chronic compartment syndrome, we have developed a pressure monitor that enables us to measure pressure simply and exactly. The pressure monitor has a very low drift, high accuracy and linearity, and is easy to handle. The clinical application of the pressure monitor proved to be a useful tool in the management of an injured limb. This article reviews the pathophysiology and mechanism of acute and chronic compartment syndrome as well as the intracompartmental pressure monitoring.

Like every working person employed in Switzerland, sports professionals are also required to be insured under the Accident Insurance Law--the mandatory social accident insurance in Switzerland. They can also take out supplementary private insurance contracts for cases in which the mandatory accident insurance does not cover the total injury claim. Often the limitations imposed by law on accident insurance do not meet the demanding individual requirements of sports professionals, or more precisely, those of their employers. A survey of private insurance companies showed some difficulties encountered with the regulations regarding the damages of sports professionals. The main differences concern the interpretation of the legal terms of the notions of accident, of lesions assimilated to an accident and of occupational disease, questions of causality, problems of economy of treatment, excesses of rehabilitation, discrepancy between the ability for any working and the ability for sport, certain career constraints, and finally, problems with the termination of the career brought about by an accumulation of a series of chronic injuries.

The International Classification of Impairments, Disabilities and Handicaps touches a field of increasing importance: the consequences of disease. Three levels can be distinguished: Impairments, Disabilities and Handicaps. Having define these three levels, we go on to show their significance and bring to light the relativity of the handicap, often according to non-medical data and having nothing to do with the handicapped person. The ICIDH broadens the medical evaluation by including these data and, in this way, fosters better understanding of handicaps. It should be more widely known in Switzerland.