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

Unlabelled: In order to estimate incidence, severity and associated factors in the development of the degenerative arthritis of the knee following a cruciate ligament injury, a multicenter, longterm follow-up study was undertaken. The time interval between injury and follow-up exam was a minimum of 15 years (range 15-52 years). Extensive physical examination and radiographic analyses from four "Knee Centers" (Hospital for Special Surgery, New York; Orthopädische Klinik, Bruderholz; Orthopaedic and Arthritic Hospital, Toronto; Orthopaedic Department Wichita, Kansas) on 328 patients revealed that the best correlation to the degree of osteoarthritis could be found to the time of meniscectomy. All other operations (suture of cruciate ligament, intraarticular or extraarticular reconstruction) showed much less correlation to the severity of the degenerative arthritis found at the follow-up exam.

In conclusion: Preservation of as much meniscus tissue as possible at the time of injury seems to be the best warranty for slowing down degenerative arthritis after cruciate ligament injury.

Early recognition of spine injuries is of outmost importance. In the case of suspected fractures and in all severe skull injuries, a careful approach and careful positioning of the injured patient is mandatory. Immobilization of the spine is the prime concern during transportation of trauma patients to prevent neurologic compromise. We prefer the supine position on a stable support. In the case of cervical spine injury, immobilisation with a cervical collar in extension is necessary. Definitive transportation should be performed on a vacuum mattress supported by a scoop-stretcher. In fractures of the thoraco-lumbar spine, a lordotic support with a soft pillow is recommended.

Snowboarding has become increasingly popular in recent years. A prospective multicenter study was therefore performed during the winter 1992/93. 345 injuries were analysed and compared with 305 healthy snowboarders on the slopes. Preliminary results show predominantly injuries of the upper extremity comparative to those suffered from alpine skiing. Protection of the hand and wrist is recommended as well as an instruction for a special technique for falling as measurements for accident prevention.

During the period from 1.1 to 31.12.90, 86 injuries associated with paragliding were analysed in a prospective study in 12 different Swiss hospitals with reference to causes, patterns, and frequencies. Spine injuries (36%) and lesions of the lower extremities (35%) were diagnosed most frequently. Surprisingly no neurological complications occurred, which is possibly explained by the solitary axial trauma. In 15 cases very severe malleolar fractures required surgical intervention. One accident was fatal due to a lung rupture. 60% of all accidents happened during the landing phase, 26% at launching and 14% at flight. Half of the pilots were affected in their primary training course. Most accidents were due to an in-flight error of judgement, such as incorrect estimation of wind conditions and a choice of unfavourable landing sites. In contrast to early reports of hang-gliding injuries, only one accident was due to an equipment failure, namely a ruptured steering line. In more than a third of all accidents, the used paraglider was not in correct correlation with the pilot's weight and experience. Inspired by the desire for a long flight, gliders of too large surface-areas were often used, leading to a more unstable flight. To reduce the frequency of paragliding injuries, an accurate choice of equipment and increased attention to environmental factors is mandatory. Furthermore education-programs should focus more on intensifying the pilot's mental and practical skills.

The goal of this prospective study was to investigate possible factors which might prevent the recurrence of dislocation after a first time traumatic shoulder dislocation. Of the 504 patients initially recorded, 376 were followed up clinically and radiologically after 1 year, and 324 were followed up after 5 years. 20% (64/324) of the patients examined after 5 years sustained a recurrent dislocation of the shoulder. We can confirm age dependency in the occurrence dislocations (50% of the patients > 30 yrs; 15% > 30 yrs). However, we were unable to find a relationship between the duration of immobilization and the incidence of recurrence redislocation (20% recurrence for 0, 1, 2, 3, > 3 weeks of immobilization). A simultaneous avulsion fracture of the tuberculum majus seems to improve the prognosis for recurrent shoulder dislocation (3/114 = 3%), whereas other bony injuries detected using conventional radiology do not appear to influence the incidence of recurrence. A shoulder stabilisation operation had to be carried out in a total of 10% of the follow-up cases. Based on our experience, we recommend a sufficiently long immobilization period of the freshly injured shoulder. In young patients, extensive and invasive procedures (arthro-MRI, pneumo-arthro-CT, shoulder arthroscopy) should be carried out after the first redislocation.

56 cases of proximal intraarticular tibia fractures over a 4-year period are reviewed. In every case the patients described a preceding valgus-compression trauma of their knee. Clinically we always found a hemarthrosis combined with a tenderness on pressure at the fractured condyle. Roentgenograms should be performed in 4 projections, eventually followed by conventional tomograms or computed tomography. Frequency of the several fracture types is demonstrated following the classification of the AO working group for osteosynthesis. The Eminentia intercondylaris was concerned in 13 cases as avulsion fracture of the anterior cruciate ligament (ACL) with a double peak distribution in the under 20-years- and over 40-years-age group. In the remaining cases we observed split- and/or compression fractures of the lateral tibial plateau of the 40 to 60 year old skier, in 20% communitive fractures. In 85% of the ACL-avulsion fractures we applied a cast brace as a conservative measure, whereas 75% of the tibia plateau fractures were treated operatively by mean of open reconstruction of the articular surface and internal fixation based on the AO-principles as well as bone graft buttressing in two third of the cases.

In a prospective, randomized study in patients with hip fracture we discuss whether a single dose of low-molecular-heparin (Sandoparin) has the same effect as a tripple dose of standard-heparin (Liquemin: 3 x 5000 I.E.) The first dose of low-molecular-heparin respectively standard-heparin is given in the emergency room before the operation. Between 4th and 6th day following operation the patients were screened for deep vein thrombosis: Clinical examination, Liquid Crystal Contact Thermography (LCCT), colour coded ultrasound examination and with phlebography. 33 patients have been treated with standard-heparin and 35 with low-molecular-heparin. In the group of standard-heparin 30% of all the patients showed a deep vein thrombosis, whereas only 17% deep vein thrombosis were found in the group treated with low-molecular-heparin. But to reach statistical significance in both groups 60 patients are needed. Postoperative haemorrhagic complications were seen in 6.1% in the group of standard-heparin and in 8% in the group of low-molecular-heparin. The LCCT and the ultrasound examination were compared with the phlebography. The LCCT had a sensitivity of 92% and a specificity of 85%. The ultrasound examination had a sensitivity of only 15%! Therefore the ultrasound examination is an unsuitable screening method to detect deep vein thrombosis in patients with fractures of the proximal end of the femur.

This is a retrospective study analyzing the operation records of 637 patients cured for carpal tunnel syndrome. No statistical difference could be demonstrated between the mean age of female compared to male. However a highly significant statistical difference between age distribution in between sex could be demonstrated (p = 0.0015). 61.3% of the female (male: 47.6%) are affected by the disease between 40 and 65 years and only 16.4% (male 27.6%) later on. Under 40 years of age both sex are affected in the same proportion. This confirms that hormonal factors related to sex play a major role in the etiology of this disease affecting mainly women (71%). On the contrary, combined pathology as tendovaginitis, ulnaris neuropathy at the elbow, synovitis bound to rheumatoid arthritis and epicondylitis were equally distributed between sex.

Calcaneus traction is a common temporary procedure in fractures of the lower leg, when an internal fixation is not permitted for soft tissue reasons. Usually a Steinmann-pin or a K-wire is driven across the calcaneus, which is a simple manoeuvre performed in local anaesthesia. Infection due to this perforation of the calcaneus are rare, but signify for the patient a catastrophic complication. With the introduction of the pinless external fixateur in 1991 in clinical trials a very handy pinless-clamp exists, which can safely be anchored in the heel and thus permits safe calcaneus traction without any transosseous fixation. We have used this pinless clamp in 39 patients for various reasons and haven't stated any major complications. The clamp has proved to be very useful for temporary traction as well as for the fixation of the leg during closed intramedullary nailing using the fracture table.