Zeitschrift fur Unfallchirurgie, Versicherungsmedizin und Berufskrankheiten : offizielles Organ der Schweizerischen Gesellschaft fur Unfallmedizin und Berufskrankheiten = Revue de traumatologie, d'assicurologie et des maladies professio...最新文献

The basic arterial supply of the shoulder is well known, some details for example the supply of the m. supraspinatus are not studied yet. Preparation of shoulder-specimens after injection of silicone-caoutchouc are done to examine the vascular system. The arterial supply of the shoulder is described as a system of four rings. The results are discussed in combination with the literature.

56 distal radius fractures were followed for a median period of 54 months (31-88 months) following the accident. Conservative treatment (immobilisation in a plaster alone) was compared to percutaneous K-wire fixation. The two groups of patients were matched in regard to type of fracture, age (+/- 5 years) and sex. The functional end result was assessed according to the scoring system of Gartland/Werley, which was modified by Solgaard. The operative treatment modality showed better functional end results, especially for intraarticular fractures, when compared to the conservatively treated fractures.

In tibia and fibula fractures the classification of Weber for malleolar fractures is not valuable. Very rare are fractures of the lower leg (tibia and fibula) together with a ruptured syndesmosis. But it exists, the surgeon has to know it, if the patient complains in addition of pain in the region of the lateral malleolus. One typical case is reported. In 4760 documented tibia fractures we had 39 cases with ruptures of ligaments. Lesions of the syndesmosis were seen in 11 cases and fractures of the Volkmann triangle in 4 cases.

Childhood accidents of any kind do not present any particular problems to Swiss third party liability insurers. However, such claims call for an active handling by the claims adjusters as well as intense contacts between claims adjuster, responsible physician, and parents in order to prevent any long term complications.

To sum up we can say that only 10-20% of the distal radius fractures are treated by an external fixator. The combination with the percutaneous Kirschner wire-osteosynthesis is a must for us. About 80 to 90% of the cases are provided according to the category A, that means closed. For 10 to 20% the opened reposition and spongiosa bone graft is needed whereby here the fixator will be put primary for distraction and ligamental replacement. The results of 85% can be judged as good or very good. 15% only are satisfactory or insufficient. These experiences are corresponding to the results of Cooney (1980) and Vidal (1977). Contrary to the original opinion that the older patient is not suited for this treatment it was showed that the incidence of the dystrophy is not higher in an advanced age. The assumption for a successful use of the external fixator is the choice of a suitable fracture, the readiness of the patient for cooperation and the possibility of a regular after-care and control. In that sense the technic completes the normal therapeutical method in the treatment of the distal radius-fracture.

Early full weight bearing in femoral trochanteric fractures is an important problem. It seems to us to be imperative because the very old aged population (about 80 year old average) concerned by that type of fractures. That attitude reduces hospitalisation and rehabilitation time. The authors propose an original 95 degrees angular-plate rendered by a stay. A complete experimental study proved that material able to support the immediate weight bearing. A clinical application on 207 cases confirmed the experimental hypothesis.

This paper presents a special reaction of long tubular bone to a singular compression or bending stress. The characteristics of this special type of reaction to injury are exposed on the basis of bibliographical data and experiences in 12 own patients. Traumatic bowing in the forearm and shank leads to loss of function respectively to delayed union. Up to the age for ten years spontaneous correction by further growth is possible. Beyond this age treatment consists in sensitive correction in general anesthesia and plaster fixation.

The extensor retinaculum is divided between the 3rd and 4th extensor tendon compartment without opening the proper tendon sheaths. For partial wrist joint denervation the posterior interosseus nerve is resected routinely. The special anatomy of the joint capsule is emphasized. Careful preparation allows full protection of healthy structures, keeps their function intact and minimizes additional surgical damage.

Normally, the distal forearm fracture is treated conservatively. The classic conservative therapy mostly obtains good results. Certain fracture-types cannot expect a good result for a long time by the treatment of conservative measures. So, they should be recommended to an operative therapy. In addition to the classical osteosynthesis the external fixator is currently used. The principle of the joint-reconciling fixator can be realized in many ways. Of common use is the small fixator of the AO and also the tube fixator is described in the literature. A real alternative to both treatments is the small extension machine of Wagner. This method has nearly been forgotten in the clinical training. We are talking in a few pages about our experiences and the advantages of that measures.