The AO-Classification of patellar fractures, introduced 1979 is based on difficult radiomorphologic criteria. It has never been widely accepted. The suggested classification should allow a clear therapeutic concept. The prognostic value will be analysed in a further study.
Unlabelled: During an insurance claim case, the question arose as to whether it is possible for the lower leg and foot to completely freeze and subsequently suffer necrosis if liquid nitrogen is accidentally spilled on them on one single occasion. Thermometric and thermographic experiments on corpses revealed that if liquid nitrogen is simply poured over a limb, "hoar frost" is formed on the skin but the temperature within the limb does not drop. Immersing a limb in liquid nitrogen for 40 seconds resulted in the skin becoming frozen, while the temperature within the limb only dropped a few degrees. After the limb was removed from the liquid nitrogen, it thawed out within 5-8 minutes.
Conclusion: In this particular case we must assume self-affliction by means of direct contact with liquid nitrogen over a long period of time. Based on this case the manifestation of acts of self-infliction and the possibility of proving them is dealt with in more detail.
During the period from the beginning of 1988 until July 1991 all LC-DCP plate osteosynthesis at the hospital of Davos have been documented in a prospective multicenter study and were followed up after a meantime of 17.6 months. The clinical results of the 57 implantations at the hospital of Davos were excellent as the results of the overall study. 98% of all reexaminated patients (follow up rate 81%) had an uneventful clinical course. The results demonstrate the good biological tolerance of the new plate and underline, that in combination with a careful soft tissue handling excellent clinical outcomes can be reached with this plate osteosynthesis.
Incidence and severity of shoulder lesions are increasing especially in alpine skiing accidents. In case of a shoulder dislocation there is always the question of a safe and atraumatic reduction technique if possible without analgetics or even general anesthesia. We present a new reduction technique with the help of the patient's own body weight under muscular relaxation. Even in the presence of displaced fractures of the greater tuberosity or a depression fracture of the humeral head successful reductions were obtained. After the reduction, the arm is immobilized in a Gilet. The patient is able to leave immediately after a radiographic control. We have been using this method for some years with a primary success rate of about 60 per cent.
Although reduced gonadal steroid hormone concentration appear to play a major role in lower trabecular bone density (BMD) in female marathon runners, dietary deficiencies and eating behaviors may also affect BMD. To investigate that possibility, dietary patterns and BMD were examined in 27 female regular marathon runners classified as eumenorrheic (8), amenorrheic (10) and under oral contraception (9). The results show a significant lower BMD in amenorrheic athletes but no dietary deficiencies. These results suggest that the eating behavior don't play any role in the lower BMD of our athletes.
In Switzerland the incidence of sport injuries is twice as high as traffic injuries. Soccer and alpine skiing are the major reasons for such injuries. Nowadays one out of four skiing injuries is an injury of the knee ligaments. Especially in skiing areas favored by beginners, we observed an incidence of knee ligament injuries three times as high compared to other areas. Since 1986 we evaluated 206 patients which were operated for knee ligament injuries. In 44% the direction of instability was unidirectional, most of them in the anterior direction. 115 patients had combined instabilities, 86% of those were anteromedial. 179 patients (87%) were followed up for at least 20 months. The knee was evaluated with the scoring system of the OAK (Orthopädische Arbeitsgruppe Knie der Schweizerischen Gesellschaft für Orthopädie) and judged by four criterias (pain/swelling; movement/force; stability and function). As expected, unidirectional instabilities show better results than multidirectional. The mean value of the total score for isolated medial collateral injuries was 95.3 of 100, for isolated anterior instabilities 90.4 and for combined antero-medial instabilities 86.7 Altogether 2/3 of the patients showed very good results in stability but, 4/5 showed good results in function, so 4/5 of the patients and their physicians considered the final result as good to very good and 2/3 of those patients are back to sports, only two percent do no more sports at all.
A prospective study was performed on 16 patients with lateral tibial plateau fractures. All injuries were associated with alpine or cross country skiing. Included in the study were those patients with a 2 mm or greater articular surface depression with radiographic findings consistent with the AO/ASIF classification of tibial plateau fractures, 41 B2.2./B3.1. A combined procedure was performed with arthroscopic visualization of the knee joint and utilization of a cannulated plateau elevator. All fractures were reduced with this device with subsequent autogenous bonegraft and when indicated, transverse cancellous lag screw fixation. Followup was from 1 to 6.5 years for the 15 patients with all but two reporting resumption of activity to pre-injury levels.
The main aim of this analysis was to study from different point of views the registered accidents in whom people were involved caused by avalanches during the winter-periods 1972/73 to 1987/88. As a result of this study a Swiss register for all accidents caused by avalanches was produced. The final goal of the register is to compile centralized a most complete database on all the details of either the avalanche victims or of the accidents themselves. This database is to be used for further analysis of the accidents in order to provide more background information to discuss and to improve the primary care of these patients.
The region Davos/Klosters is a big wintersport area in Switzerland, where more than 5 million kilometers of vertical drop are skied per year. Over the last 20 years 28,777 patients with wintersport accidents have been treated in the 100-bed hospital of Davos, 85% of these patients have sustained their accident while skiing. An analysis of these datas show an increase of ski accidents as well as an increase of the distance skied. Especially an increase in snowboard accidents is noted over the last few years with a preponderance of lesions of the upper extremity. Injuries of the head, the trunk and simple skin lacerations remain stable over that period. Injuries of the upper extremity are increasing, whereas lower extremity lesions are slightly decreasing. There is a significant decrease of fractures of the leg, while at the same time an important increase of knee injuries is noted. Young patients below 20 years and those between 31 and 40 years of age sustained less accidents over the last 20 years, while the rest of the alpine skiers remain more or less stable in their accident incidence.
By 250 million years ago, the five-finger digit is established. In developmental terms, the human hand is both specialized and primitive. Man's hand is not a unique structure, it is only the way in which it is used that sets it apart from the other animals. Its value seems therefore to be correlated with the development of brain. The fact that skin and nervous system share the same ectoblastic origin may strengthen the symbiotic effect related to brain development. Since the wrist sustains and enables most of the capabilities of the hand, a deterioration of its function may give rise to challenging diagnostic problems. Therefore a classification of wrist disabilities in five main groups may be helpful in daily practice. An ulnar translocation, a SL-dissociation, a LT-disruption or a carpal collapse may be clearly diagnosed. When no clear pathology can be demonstrated, the physician is faced with the so-called normal group. In those cases a ganglion or an osteonecrosis on onset may explain the pain. In any case however, the physician has to recall the central and physiological aspect of the hand, an organ which has become the symbol of man and power.
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