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

Only insufficient statistical data for epidemiologic analysis and calculations of socioeconomic costs are available in Switzerland. The total number of fractures of the proximal femur per year has nearly doubled in the 10 years from 1980 to 1990, climbing from 5500 to 9800 cases. A number of 15,000 cases is foreseen for the year 2020. In 85% of the cases the patients are older than 65 years. The global annual incidence is estimated to be 145/100,000, the partial incidence for the population of more than 65 years being 825/100,000. The mean hospitalization is 30 days. The total number of hospital days per year climbed from 200,000 to 300,000 in ten years, thus increasing the number of required beds by 50%. The mean costs for primary hospitalization is estimated to 15,000.-Swiss francs per case in 1990 and 146 Million francs globally per annum, i.e. the double of the amount in 1980. In the statistics of the National Accident Insurance Company the mean global economic costs for a fracture of the proximal femur in the active population is 57,000.-Swiss francs approximately and 72,000.-francs for patients of more than 45 years of age. Only roughly 20% of the costs are caused by medical treatment, whereas pensions, per diems and other compensations produce 80% of the costs. The mortality for patients over 65 varies from 2-7% during the primary hospitalization and rises up to 30% after 1 to 2 years after the accident. The relationship between the duration of acute hospitalization and rehabilitation is essential for planning. The evaluation of the chances for a successful rehabilitation is very important, the general medical conditions of the patients before the accident being the main determinant factor. A mean hospitalization of 3 weeks in a surgical unit and 6 to 7 weeks in a rehabilitation hospital seems to be realistic. Appropriate criteria for the selection of patients amenable to successful rehabilitation are essential. The question of the social outcome of these patients should be analyzed on a large scale nationwide study.

22 patients after head fracture were treated with replacement of the radial head by a silastic prosthesis. 11 patients were followed up after 91 +/- 48.8 months. The results are good to excellent. Twice a fracture of the prosthesis was detected at control. No prosthetic synovitis occurred in our patients.

With reference to a prospective study 197 preoperative arthroscopies were carried out on 194 patients with fresh severe knee injuries. The injuries are analysed, in particular for diagnosis and treatment of additional meniscus lesions. Advantages and disadvantages of the procedure are discussed.

We are reporting on the preclinical care of our patients taking the conditions of Davos into account. We present the manifold and exact work of the different rescue services, which goes on according the "rescue chain" and international standards. Measures of the prevention of accidents as well as the legal basis are presented. Finally we refer to the development during of rescue activities the past years.

Patient compliance with postoperative partial weight bearing can be a difficult management problem. The problem may be intentional or unintentional. There is no objective way to assess the amount of weight placed on the lower extremity by the patient. It is our clinical suspicion that patients place more weight than is desirable on the effected limb. There are few reports in the literature on this topic. One study has confirmed our suspicion of poor patient compliance with postoperative weight bearing. Our goal is to develop a system to accurately assess weight bearing and to improve this aspect of postoperative fracture care. Through an active feedback device we hope to improve patient education and understanding. We plan to study the clinical applications of using a pressure sensitive shoe insert device. Our ultimate goal is to improve upon the present device and to study the clinical application of there use.

A non-selected sample of 117 common whiplash patients was examined shortly after experiencing trauma (mean = 7.4 days, SD = 4.2) and six months later with regard to neuropsychological performance and psychosocial stress. Neuropsychological examination comprised an assessment of various levels of complexity of attentional processes. Further, subjective complaints, subjective headache and neck pain intensity, utilized medication and self-ratings of well-being and cognitive impairment were recorded. In addition, patients were assessed with regard to personal history of psychosocial stress and personality traits (e.g. neuroticism, depression). At six-month examination, 81 patients subjectively were fully recovered, whereas 36 patients reported persisting symptoms. Symptomatic patients were older, showed more symptoms at baseline and a higher intensity of headache and neck pain, and had a higher subjective cognitive impairment. At both, baseline and six-month examination, no significant statistical differences between the asymptomatic and symptomatic patients were found with regard to cognitive performance. However, performance of symptomatic group in a test of divided attention was pathological at baseline. Additionally, symptomatic group showed a delayed recovery of cognitive functioning, which could be explained--at least in part--by utilized medication and the higher age. This change of cognitive equilibrium could account for these patients' cognitive problems in daily life.

Fractures of the scapula are rare and mainly result from a severe direct trauma. Most fractures may be treated non-operatively, only severely displaced and unstable fractures of the neck and/or the clavicula, unstable intraarticular fractures of the glenoid or open fractures (especially in combination with neurovascular lesions) should be fixed operatively. A dislocated fracture of the clavicula or glenoid should be approached first ventrally. Displaced fractures of the neck and body may also require an open reduction and fixation through a dorsal approach. Careful preoperative planning and anatomical studies are required to prevent intraoperative damage of innervation and vascularization. Cannulated single screws, 1/3 tubular plates or 3.5 LC-DC plates are recommended for the stable fixation of the scapula, whereas a Bosworth screw or a hook plate are helpful to stabilize the lateral clavicula and the acromioclavicular joint. Postoperative treatment: Temporary immobilization in a Gilchrist or Desault bandage for about 3 to 4 days thereafter careful passive and active mobilization.

Medial epicondylitis is rather uncommon, less frequent than external epicondylitis. For this reason, the diagnosis is thought of rather late. While taking the history, one should try to find out the possible causative effects. Symptoms of irritation of the cubital nerve, which are present in one out of five cases should be looked for. Several sports such as baseball, javelin or weight throwing, volleyball, climbing, tennis, golf, which need a strong flexion of the hand and fingers can induce this condition. However, in more than half of our patients, sports or professional activities were not in cause. The majority were housewives and do-it-yourself enthusiasts. Among our 55 operated cases, out of which few had professional or sports activities, we did not encounter during the operation the macroscopic tendinous lesions that are sometimes described by some authors. The treatment should be conservative in all cases. This includes rest, anti-inflammatory drugs, physiotherapy, muscular stretching, immobilisation in a cast, steroid infiltrations. One patient out of ten will have to be operated on. The operative techniques differ on some details, but they all include the desinsertion of the flexor muscles on the medial epicondyle. When there are clinical signs of irritation of the cubital nerve, it should be transposed anteriorly. The result of these operations is good in more than 90 per cent of the cases. However, a come back to professional sport can take as long as 8 months.

The analysis of the etiology of the painful wrist demonstrates quite clearly an increasing number of "carpal collapse" as a sequence of trauma (perilunar dislocation), of congenital disorders and rheumatoid arthritis. The deterioration of the wrist joint may start locally but may end up with generalised deforming osteo-arthritis. In addition to traditional salvage operations (partial/total fusion, carpectomy) the total wrist prosthesis by Meuli (ball and socket joint) has its definite place in the treatment of the painful destruction and instability of the wrist.

Mental disorders after closed-head injury are reviewed. Post-concussive syndrome and post-contusional disability are described with particular emphasis on consciousness disorders, amnesia, frontal disturbance and long-term outcome.