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

Today intramedullary nailing is considered the treatment method of choice in fractures of the femoral diaphysis. In this retrospective quality control study 57 femoral fractures treated with the AO-Universal Femoral Nail have been reviewed. The average follow up time was 2.9 years. Intramedullary nailing was done as a primary procedure in 40 cases and in 17 cases as a secondary procedure following various initial operations. The results were evaluated according to the Stromsoe score. 27 of the 40 primary procedures went on to an uneventful healing and showed good to excellent final result. Technical errors (7), non-unions (4) and 1 deep infection required various secondary procedures. Thereafter the final number of good to excellent results amounted to 35 out of 40 patients. In the group with secondary i.m. nailing 9 out of 17 patients showed a good to excellent final result. 2 non unions persisted. In conclusion the AO-Universal Femoral Nail proved to be suited for the treatment of femoral shaft fractures for both primary and secondary procedures. In this series, however, technical imperfections led to a high rate of secondary procedures. Strict observation of the recommended operative technique is therefore mandatory.

Health is a social term. The insurance company physician is interconnected between medicine and law. His task is not only the patient's treatment but also responsibility to the general public. Reasons for increasing health expenses are discussed.

Penetrating trauma is an uncommon injury in downhill skiing. We have observed only two cases at our clinic. 15 years ago a skier collided with a trail marker. The post entered the patient's right inguinal region and left the pelvis at buttock. The patient removed the foreign body on the slope without assistance. Remarkably, the only vital structure involved was a small puncture of the duodenum. The patient had an uncomplicated postoperative course with a transient impotence lasting six months. At a follow up 15 years later the patient complained of sequelae. This season 1992/93 an English woman collided while skiing with a tree. She sustained a penetrating injury of her left thigh. We performed a careful extraction of the foreign body with a debridement and drainage of the wound. The patient had an uncomplicated postoperative course.

Even the concept of carpal stability is not clear. The complex anatomy of the multiple ligaments is difficult to understand. Arthroscopy is the golden standard in diagnosis of ligamentary tears. But the arthroscopical findings are in contrast to the today's classification of carpal instability.

The phenomenon of pain has four dimensions: somatic, psyche, social, cultural. This explains the potential difficulties of the therapeutical approach, which remains challenging especially with long standing patients. A global multidisciplinary therapy seems mandatory to enable any healing or, at least, a significant improvement of the quality of life. The analysis of four case histories shows the bio-psycho-socio-cultural components of pains. This gives the opportunity to consider the myth of Asklepios in relation to our present culture and to point out some practical advice.

A documentation system for patients in ICU is presented. The programming is based on Filemaker Pro from Claris. Two files have been created: the first "1 Eintritt" contains all the patients data like name, address, the patients history, diagnosis, therapies as the planned procedures. All these data can be imported into the second file "2 KG Unfallchirurgie" with a personal identification number. Complications, new results or further procedures can be added. Different layouts allow the user to print summaries or duty reports. The experience with 300 patients showed, that this system is easy to learn and to use, that it has a good compliance with the medical staff and that is gains a lot of time writing summaries or reports used for transferring patients to other units.

Out of the total number of patients of three Centers for Orthopaedic and Trauma Surgery, 93 comminuted humeral head fractures were clinically and radiologically controlled by means of a retrospective analysis. The classification of the fractures was made according to C.S. Neer, the clinical evaluation according to the Constant-Score. The analysis of the results in relation to the respective therapeutic methods revealed fundamental differences between the various types of fractures depending on the number of fragments. The prognosis of the three-part fractures appears essentially determined by the biomechanical conditions. This means that the therapeutic method has to be applied according to the restitution of the respective position of the fragments. Open reduction and internal fixation (mean Constant-Score 83 resp 91 points) or conservative treatment (78 points) seem to be primarily indicated in these cases. The prognosis of the four-part fractures, on the contrary, is largely determined by the problems of vascular supply of the head fragment, with a high risk of a humeral head necrosis. For this reason a primary prosthetic replacement (mean Constant-Score in case of primary implantation 75 points, compared with 54 points in case of conservative treatment and 52 points for open reduction and internal fixation), should be recommended for this type of fracture. For therapeutic and prognostic reasons, fractures at the proximal end of the humerus require an exact classification on the radiological basis of at least a so-called "trauma series". However, for a more accurate visualisation especially of the region of the lesser tuberosity (which is difficult to assess by means of conventional radiology), and consequently for the precise determination of the number of fracture-parts and their respective positions, we consider a CT Scan to be compulsory.

Injuries to the ulnar collateral ligament of the thumb are common in down hill-skiing, and are thus called "skier's thumb". In complete disruption of the ligament, surgical treatment is mandatory to restore stability. The management gets more difficult if a bony lesion is present: does a non-displaced fragment represent a non-displaced bony avulsion of the ulnar collateral ligament, thus allowing conservative treatment? We reviewed sixty-three consecutive patients with an acute skier's thumb injury in order to determine the anatomical nature of injuries in thumbs that were treated surgically either for fracture or for instability. Of all 63 thumbs, twenty-five (40%) had a fracture. Surgical exploration showed two types of fractures: a fragment attached to the ulnar collateral ligament, and a fragment not attached to the ulnar collateral ligament. The first type, corresponding to a true avulsion fracture of the ulnar collateral ligament, was found in eight cases. The same fracture type was seen in other seven cases with an additional isolated fragment not attached to the ligament. Such an isolated fragment was observed in ten other cases where the ulnar collateral ligament was completely disrupted. This type of bone fragmentation cannot be differentiated from a bony avulsion of the ulnar collateral ligament on routine films. Therefore, it is mandatory to stress test the injured thumb even when a bony avulsion fracture with no or minimal displacement is suspected on X-ray. The fracture may not represent a bony avulsion, but a fragmentation of the ulnar volar aspect of the proximal phalanx associated with a complete disruption of the ulnar collateral ligament.

We report on a 14-year old girl with an ankle mortice insufficiency after ankle strain. The age dependent pattern and therapy of the distal tibial epiphyseal fracture as avulsion of the anterior syndesmosis at the tubercule de Tillaux-Chaput are discussed.

The range of payments by health insurance companies in case of accident and illness is presented and possible deficits of reimbursement are explained. The discussion of benefits and possible negative effects of physical activity leads--with a side-glance to professional sport--to the claim for a more reasonable use of our physical structure. Finally, abuses of our social network and financial consequences from our behavior are quoted as examples.