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

Hyperextension of the wrist may induce underestimated intrinsic and extrinsic ligamentous tears. Undetected scaphoid fractures show the importance of accurate primary diagnostic. Evaluation of the anatomic and functional integrity of the ligaments of the wrist remains challenging. It requires great experience, but in any case, radiology remains the basic diagnostic tool used by both the general practitioner and the specialist. Only the use of reproducible imaging techniques will allow for comparison between healthy and pathological side as well as for follow-up. Every one should master and use standardized techniques as described in this paper. The costs bound to appropriate imaging techniques are certainly lower than the consequences of misdiagnosed ligamentous damage or carpal bone fractures. Furthermore, standardized techniques will avoid repeating radiological sessions.

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.

A complete statistical evaluation of epidemiologic data and costs of burn injuries in 1984 with a follow-up for 5 years is presented, considering a collective of 1.77 million workers in Switzerland. The majority of burns are minor injuries; only about 5% of the burn victimes are admitted to a hospital, 0.2% die. Only one fifth of the costs caused by burns are due to medical treatment and rehabilitation. All other expenses result from continuation of payments of salaries and annuities. The few treatments of severely burnt patients in the burn units cause effective costs higher than the tariff paid by the insurance. Even so, the predominant portion of the enormous costs is taken up by wages while off work and annuities. As our conclusion we stress the importance of primary care for all severe burns including all burns of the hands in a specialized centre. Any economic effort for primary burn treatment, however high it may be, is justified if the duration of rehabilitation and invalidity can thus be reduced.

The compartment syndrome of the foot is a rare and unrecognized entity. The most common etiology is post traumatic. Some years ago the diagnostic was suspected when the after-effects appear. Since fifteen years many authors have precised the anatomy, the diagnostic and the treatment of the compartment syndrome of the foot. Consequently the morbidity of this Pathology has diminished. In fact, because of the severity of associated injuries of the foot, after-effects are not rare and responsible for late disability.

Controversies exists about the value of sosgraphy in diagnosis of meniscal injuries. We therefore examined 179 knee joints. In a prospective study of 177 patients with knee problems, ultrasound was utilized to assess its values as a screening tool for meniscal tears. Prior to the arthroscopy the menisci were scanned from an independent team by using 7.5 and 10.0 MHz ultra-sound waves. 113 meniscal tears were seen at arthroscopy; 22% of these tears could not be detected by scanning (false negative results) while 10% of intact menisci showed positive echogenic structures analysed as meniscal tears. The results showed a sensitivity of 30.0% and a specificity of 85.3%. We cannot share the opinion of some autors that ultrasound is a reliable means of accurately diagnosing meniscal tears. It seems that ultrasound scanning of the menisci is still a experimental method without any clinical importance.

Acute rupture of the ulnar collateral ligament (UCL) of the metacarpophalangeal joint of the thumb (skier's thumb) is a common skiing injury in adults. Do we find this injury in children? Of the 302 skier's thumbs during the last 4 years we found 24 (8%) injuries in children (mean age 13.4 years) with open growth plates: 5 partial ruptures of the UCL, 3 Salter I and 6 Salter II fractures with a radial fragment of the proximal phalanx I; all these had conservative treatment. In addition one had a Salter II fracture with open reduction and fixation, 6 avulsion fractures which were treated twice operatively and 4 times conservatively and 3 ruptures of the ligament which needed reconstruction. In contrast to adults, we see a different, age dependent injury pattern in children. The younger had Salter-I- and II-lesions of the proximal phalanx, whereas the adolescents showed avulsion fractures and ruptures of the UCL as seen in adults. The follow-up of 17 patients one year after the accident showed in 12 a full recovery, in 4 cases full function with minor complaints and in one case an ancylosis of the MCP-joint following a postoperative infection.

The anatomy of the palmar scapho-triquetral ligament was studied: on 15 hand specimens by means of gross anatomical dissections and MR imaging; and on a further 10 foetal wrist specimens, microanatomically. This ligament allows us to present the proximal carpal row as a socket, consisting of an upper part (the triquetrum, distal part of the scaphoid, and the dorsal and palmar scapho-triquetral ligament), and a base (the concave parts of the lunatum and scaphoid, connected by the scapho-lunate ligament). With a hyperextension wrist injury the upper part follows the distal part of the carpus, while the base remains fixed at the radius. The upper part slips away from the base, consequently, injuring the ligamentous structure, or causing a scaphoid fracture. The luno-triquetral and the palmar scapho-triquetral ligaments are also frequently torn. The overall prognosis depends on the grade of ligament damage. The arthroscopy allows us to estimate the state of the ligament structures, therefore, it is indicated before any reconstructive operation.

The treatment of recurrent anterior shoulder dislocation with the rotational humeral osteotomie by Weber showed best results in the follow-up of 53 operations when combined with a shortening of the capsule and the musculus subscapularis. Rotational humeral osteotomie alone showed in 20% redislocations. The rate of redislocation could significantly be reduced by additional shortening of the soft tissue.

Hand injuries have occurred due to inflation of an air bag security system during a high velocity car accident. A driver and a passenger retained by three-point lap-shoulder belts crashed on the central railing of a motorway during their vehicle lost of control due to aquaplaning. The air bags inflated during the collision. The driver presented a superficial second degree burn with a 12 cm long blister on the radial side of the hand and distal forearm. The passenger suffered an intra-articular palmar avulsion fracture of the middle phalanx (PIP joint) and a mallet finger of the left fifth digit. The driver was treated conservatively and healed without sequelae. The passenger had K-wire fixation, after fracture repositioning, under local anaesthesia. Physiotherapy was started early. K-wires were removed at three weeks and active therapy continued. 6 months later the digit presented PIP joint stiffness and a 20 degrees flexion deformity. To the best of our knowledge this is the first description of upper extremity lesions due to inflation of an air bag device.

In 1991, 762,800 leisure time accidents were recorded in Switzerland. 33% of the accidents occurred in the course of a sporting activity with the majority happening while playing football. Skiing accidents came second. Although the recession reduced the number of accidents, skiing accidents were on the increase. The number of all other leisure time accidents including football accidents (the largest group) declined, as did occupational accidents. In terms of medicine, insurance and the economy, the significance of more than 54,000 skiing accidents each year is enormous. SUVA, the Swiss National Accident Insurance Organization is launching a comprehensive campaign to prevent skiing accidents. Among the many methods of prevention possible, such as physical preparation prior to the skiing season, safe equipment, correct skiing technique, consideration for other slope users and adaptation to the snow conditions, etc., this campaign focuses on the avoidance of a cold start. The campaign, which is planned to last several years and will cover the whole of Switzerland, aims to propagate the warm up before setting off downhill. The concept and development of this large-scale, professionally-run SUVA preventive campaign are described.