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

We reviewed fourteen patients suffering from thoracic outlet syndrome (TOS). This allowed a critical analysis of the diagnostic tools, especially the Adson and Allen tests, currently used. The value of arthrography and phlebography are discussed in relation to the supposed pathophysiology of the disease. The decision to operate on those patients has to be considered in relation to the possible mishaps related to the surgical procedure. Particular attention has to be paid to post-operative perineural fibrosis, a possible cause of definite disability. The psychological components seem to remain mostly underestimated, a fact that has to be stressed and which we were able to demonstrate in our small sample. However, pre-operative evaluation remains difficult. No definite objective sign enables the surgeon to assert the presence of a thoracic outlet syndrome. Therefore not only the decision making but also the analysis of the results remains debatable. In all cases, even in the presence of clear narrowing of the vessels, indication to operation should be restrictive.

Trauma is the leading cause of death in the under thirties age group in Switzerland and the third leading cause in the 30-64 age group. In addition to efforts in the area of prevention, optimization must also be attained in individual medical care in order to reduce mortality and morbidity. Improvements are only possible, however, when based on precise knowledge of accident epidemiology and possible weak spots in the rescue chain, which begins at the scene of the accident and ends with discharge from hospital. This information should be complied for our region with the aid of a trauma register on the basis of internationally recognized elements. The following comments describe in a shortened form the CDC-Register (Centers for Disease Control, USA). Using our own initial experiences, the practical application and use of the corresponding Register-Software ("Trauma registry", Version 2.0, 1990) for conferences on mortality and morbidity, the basic guarantee of quality, are demonstrated.

Our efforts within trauma-care have to include accident-prevention, the organization of a functioning rescue-chain as well as a pluridisciplinary care of the trauma-patient. This is of special importance within the given Swiss hospital structure. For the treatment of injuries of the locomotor-system general-and orthopaedic surgeons need to cooperate. Additional training and experience in traumatology are therefore important for both specialties.

Technical measures are not sufficient to prevent occupational accidents in patients with specific diseases. Since 1984 the Swiss National Accident Insurance Fund (SUVA) has the possibility to clarify the working conditions and medical aspects of patients presumed to suffer a special risk to occupational accidents. The actual situation and the experiences in the medical prevention of occupational accidents in Switzerland since 1984 are described.

Fractures of the radial head are often combined with ligament ruptures or subluxations creating instability of the elbow joint. Cartilage avulsions of the capitellum trapped between the fragments are a frequent observation. We advocate ORIF for displaced fractures. The posterolateral approach avoiding compression of the radial nerve may be prolonged proximally with an osteotomy of the humeral epicondyle giving full overview of the circumference of the head. It allows the harvesting of cancellous bone used as a graft to fill in articular depressed areas or metaphyseal defects. The stabilisation is achieved with thin screws of 1.5 mm diameter introduced in different planes, their head slightly sunken in the cartilage. Lately miniplates have been used in cases of neck fractures with surprisingly good functional results. The author reports about the results in 42 of 49 operated patients.

During the period from 1.1.90 until 31.12.90, 86 injuries associated with paragliding were analyzed in a prospective study in 12 different Swiss hospitals with reference to causes, patterns, and frequencies. The injuries showed a mean score of over 2 and were classified as severe. Most frequent spine injuries (36%) and lesions of the lower extremity (35%) with a high risk of the ankles were diagnosed. One accident was fatal. 60% of the accidents happened during landing, 26% during launching and 14% during flight. Half of the pilots were affected during their primary training course. Most accidents were caused by inflight error of judgement--especially incorrect estimation of wind conditions--and further the choice of unfavourable landing sites. In contrast to previous injury-reports, only one equipment failure could be noted, but often the equipment was not corresponding with the experience and the weight of the pilot. To reduce the frequency of paragliding-injuries an accurate choice of equipment and an increased attention to environmental factors is mandatory. Furthermore an education-program regarding the attitude and intelligence of the pilot should be included in training courses.

The posterior dislocation of the shoulder is frequently unrecognized for many days, months or even years after the initial accident. After the presentation of its clinical and radiological features, as the different ways of its treatment, some cases will illustrate this entity, too frequently missed or wrongly treated.

The posttraumatic impingement-syndrome caused by displacement and retraction of the entire great tuberosity with the bony insertions of the supraspinatus or infraspinatus muscle is often diagnosed with delay. Two types are distinguished: 1. The fracture of great tuberosity with proximal and dorsal dislocation of the fragment impairs motion by impinging under the acromion and against the posterior glenoid wall. 2. The multi-fragment bony fracture at the rotator cuff insertion, usually finish in rotator cuff deficiency. The analysis of the last 22 operated patients demonstrates the important preoperative complaints, commonly during a long time before reconstruction. The excellent postoperative results show the importance of the early and generous management of proximal humeral fractures.

Iodine is known as a local disinfectant substance for more than 100 years. Its use however was restricted due to strong local irritation. In the last 25 years Polyvinylpyrrolidon-Iodine solutions (Povidone-Iodine, PVP-Iodine, Betadine) has become more and more popular for treating traumatologic, surgical and orthopaedic infections. However several papers have reported changes in the blood chemistry (T3, T4, TSH, PBJ and Iodine excretion in the urine) after utilizing PVP-Iodine, especially in visceral surgery. We report on a patient in whom a massive iodine resorption with clinical signs of hyperthyroidism occurred, with soft tissue necrosis at the site of irrigation.

The fractures of the clavicle are fundamentally minor and usually will heal by simple immobilization. When the trauma is severe, the fracture may cause a lesion of the subclavicular neuro-vascular bundle. However, if the lesion is limited it may appear clinically only a few days after the accident. In other cases, whether the clavicular fracture heals or not, the bone lesion may produce a hypertrophic callus. This phenomenon will cause a narrowing of the costo-clavicular outlet and a compression of the neurovascular bundle which will provoke a real TOS. The authors present 16 cases of clavicular fractures, two of which having had early neurovascular complications and the 14 others a late phenomenon of costo-clavicular syndrome. The pathogenesis of the lesions, the principles of treatment and the results are discussed.